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).