Interview with Peter Piot, director of the London School of Hygiene & Tropical Medicine, previously founding executive director of UNAIDS
LONDON (AlertNet) - A new World Health Organization-led report released on Wednesday ahead of World Aids Day shows that a funding crisis is risking gains made by the international community in fighting HIV/AIDS over the past decade.
Annual funding for HIV/AIDS programmes fell to $15 billion in 2010 from $15.9 billion in 2009, well below the estimated $22-24 billion the U.N. agencies say is needed by 2015 to pay for a comprehensive, effective global response.
In the following interview, Peter Piot, director of the London School of Hygiene & Tropical Medicine (LSHTM) and previously founding executive director of UNAIDS, shares his views on the fight against HIV/AIDS. Under his leadership UNAIDS became the chief advocate for worldwide action against the disease.
What should the direction of the fight be now?
It’s a bit paradoxical because for the first time we have results, the latest reports from UNAIDS came out and showed that less people become infected, less people are dying, so millions of lives are being saved because of the introduction of treatment and prevention campaigns. Now, at this stage when we have this rare success in international development, in international aid, the funding starts going down. It’s a combination of the financial crisis in general, we all have to cut, it’s one thing that’s unavoidable. It’s also a bit of a fatigue about AIDS … The challenges are how to maintain the attention of the public, of world leaders, and how to maintain funding levels.
How big a problem are the funding cutbacks in the fight against HIV/AIDS?
We can do better with the same amount of funding by making sure that every penny we use can go to where it’s making the biggest difference. What does that mean? Concentrating efforts on the populations where the risks are the highest, and also on the countries where there is a big burden of disease – another challenge we have is that thanks to recent scientific breakthroughs we have more tools to defeat this epidemic than ever before, but now the money isn’t there so that is a bit of a bind. Just crying for more money isn’t going to do it, we need to make sure it’s wisely used. It’s a rare, rare instance in international development when you can say thanks to that money so many lives have been saved. It’s a very powerful message. There is a limit to what you can do with efficiency gains, but they have no choice, it will have to be directed towards the countries that are the most in need. The Global Fund is still funding programs in China and middle-income countries that can afford to pay for it. They can now re-orient their money to the poorest African countries where the needs are the highest. There’s no way out of the fact that they will need to keep their funding at the level that it was before. It’s just one dramatic symptom of the state of the world at this moment.
What was it like to be the first UNAIDS director?
In the beginning it was very lonely – in 1995 AIDS was definitely not on the agenda with the international community. There was hardly any money and we didn’t really have any tools for controlling this epidemic except for the condom. Then gradually things changed completely. In 1996, the fact that treatment became possible was a total game changer. For people living with HIV, treatment saved their lives, and also the perception of what this epidemic was – it became a “problem with a solution”. Treatment alone is not a solution, but one can do something, and it provided an impact – that was key.
How did you set out to tackle the disease?
What I did first at UNAIDS was get the facts right: how bad is the problem, what does it cost, what does it mean for certain groups in certain countries? Then second, said this is a problem with a solution, we can do something about it, then create alliances. As long as it was only dealt with in the medical community and by AIDS activists, it didn’t really have any traction.
When did things begin to change?
The turning point came in 2001, when in the U.N. General Assembly there were 45 heads of state, heads of governments, joining together and saying: “Yes, we must do something.” They agreed on a road map and then the Global Fund was created to fight AIDS, TB (tuberculosis) and malaria … We’d worked on bringing down the price of anti-retrovirals. It was many balls in the air at the beginning and very few people engaged, but then the momentum grew as of the turn of the century.
What has changed?
The first thing that has changed is that less people are dying and less people become infected, and that is obviously what we need first. Some of that is due to the change in behaviour, there is an increase in condom use – in many countries, less partners. But, when I think, in the first place what has changed is that AIDS is discussible and it made it to the top political agenda. It depends so much on the country. There is still enormous stigma and that has not changed, I would say. There is a bit of a perception that now that we’ve got treatment maybe we don’t have to practice safe sex. In a sense, it’s a never-ending struggle because it’s about something very, very fundamental – it’s about human sexuality in the first place.
How did the image of HIV/AIDS change?
It was the top of the political agenda, it was debated in the U.N. Security Council where they normally talk about war and peace. There were several summits, and the G8 talked about it, you can say it’s a lot of talk and that is true, but it resulted in an enormous increase in funding for AIDS. When UNAIDS was created, about $200 million was spent on AIDS in lower- and middle-income countries. Today, it’s around $15 billion. That is a mega increase and it gives you an idea of the political commitment because money talks. Speeches can be fine, but if it isn’t followed by budget then of course it’s not very serious in terms of commitment.
An Africa-focused PopART project led by LSHTM offers voluntary testing for HIV, medical circumcision to men who test HIV-negative and immediate antiretroviral therapy (ART) for people who test HIV-positive. How effective can this project be in the fight against HIV/AIDS?
The research is really important because it's trying to figure out if when you introduce treatment on a large scale is that also going to bring down the spread of HIV in that population. It’s very important in highly effective communities because it will provide an argument for increasing our efforts to provide treatment to as many people as possible and as early as possible.
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