UNAIDS boss: Better act now

UNAIDS boss: Better act now

Tantri Yuliandini, The Jakarta Post, Jakarta

Peter Piot may have studied as a medical doctor at the University
of Ghent (1974) and hold a PhD in microbiology from the
University of Antwerp (1980), but his interest goes beyond the
molecular structure of diseases.

The 54-year-old executive director and initiator of the Joint
United Nations Program on HIV/AIDS (UNAIDS) is far more
interested in the "why" of diseases: why people become ill and
why some are more affected than others.

During his three-day visit here to launch the Indonesian
National Strategy Against HIV/AIDS 2003-2007, Piot managed to fit
in a 10-minute interview with The Jakarta Post amid his tight
schedule.

Here is an excerpt from the interview:

Question: This is not the first National Strategy program that Indonesia
has launched for HIV/AIDS (Human Immunodeficiency Virus/Acquired
Immune Deficiency Syndrome). The first program was launched in
1994, but instead of reducing the number of people infected with
HIV/AIDS, the number has actually increased. What are your views
on this?

Answer: I think the big difference between 1994 and today is that in
1994 there were hardly any people with HIV in the country, and so
I would say it was far more difficult to mobilize society when
the problem is really not there.

Today, HIV is really here in Indonesia. Also, today there is,
I would say, a far bigger engagement at the top level in the
country on AIDS.

We've learned from other countries that it's better to act
now, or very early on, for several reasons.

One, it's easier, and because the epidemic is far more
concentrated in people who are at highest risk. The most
vulnerable are injecting drug users, sex workers and their
clients. We shouldn't blame prostitutes, because there would be
no prostitution without the men going there.

Second, it's much cheaper. If one waits until there are lots
of people who are infected and need treatment, that's very
expensive. The impact on the economy would also be bigger.

Q: How expensive would treatment cost?

A: For treatment I think it's now, in dollar terms, something
like US$650 to $700 per person a year, but that's lifelong
treatment, and second, you have to add to that the cost of
laboratory testing, monitoring, medical fees and so on.

But that price has come down tremendously thanks to the work
of UNAIDS, because it used to cost over $10,000 per person per
year, and that's still the case in quite a few countries. That's
the price that we've negotiated with developing countries.

Q: What do you think is specifically the Indonesian story of the
spread and prevalence of HIV/AIDS?

A: On the one hand, I think the story is a bit the same as in
other countries, but it has taken much longer in Indonesia to
start off.

Indonesia's been very fortunate that until basically two or
three years ago there were very very few people infected with
HIV.

I always thought that this was only a matter of time. Because
what has happened elsewhere is that once the virus is introduced,
for example, among people who inject drugs and share needles,
then you see a very rapid increase.

And that is what has happened. It's always the most vulnerable
(group), the most at risk, who are going to be the first
infected. And then it spreads to others who are a bit less at
risk.

What's specifically Indonesian with that I think, and we see a
bit of the same thing in the Philippines, is that it has always
been at a low level for many years. Will it go the same way? I
think that's probably to be expected unless one invests far more
in education, awareness and openness.

I think there is a bit of an illusion that so-called Asian
values will protect any country from a thing like AIDS. The
reality is that there can be a big difference between what the
official values are, or what you are supposed to do, and what is
actually happening.

I think the power of Indonesia will be in the values that hold
a strong community together, the family together, that could be
played out.

The problem that I see is that the country is so vast --
(there are) few cities, and Papua is not Jakarta, it is not
Sumatra, etc. -- so one would have to tailor the activities
against AIDS to the culture and specific region and all that.

Q: Should the National Strategy be broken down to meet the
situation of specific areas then?

A: I think the principle is the same everywhere, a national AIDS
strategy is important as the commitment of the government in the
first place.

Second, to say what are the principles of the response, like
to prevent sexual transmission, transmission through the sharing
of needles. Third, it's a way of generating resources, money.

But then the actual action plan will indeed be adapted to each
region. I also understand that Indonesia's becoming more and more
decentralized in terms of how business is done, even public
business, so that means one will have to adapt it.

Q: Why do you think the epidemic started off so slow in Indonesia
compared to, for example, Thailand and Cambodia?

A: I think it must have had to do with the behavior of people,
the fact that probably in Thailand and Cambodia there is a far
more flourishing sex industry. It's much more a part of their
local culture I think. It is about sexual behavior and about
injecting needles. (At this point the interview is interrupted,
as Coordinating Minister for People's Welfare Jusuf Kalla has
arrived for a dinner in which Piot is the guest of honor.)

Q: As the executive director of UNAIDS, do you ever worry that
members of your own family might get infected with HIV?

A: I have children who are in their twenties, and as a parent you
always must be worried. But that's why it's important that we
talk to our children. That's what I've done.

We have been open about sexuality, and also include how they
can protect themselves. And making sure that we talk about drugs
and so on. Making it discussable.

That doesn't mean you have to sit down (to talk about it) all
the time. I mean, because it's not easy, even for me. I can talk
about this with the media, but when it's your own children its
always more difficult. When it's your own parents it's also more
difficult.

But that's what I've done. I would not be credible
(otherwise).