Information on HIV/AIDS

QUESTION 1: Today is World AIDS Day. What are your highest current priorities for confronting AIDS?

PETER PIOT: In the hardest-hit countries, we need to mount the massive effort which will rebuild societies falling apart under the strain of AIDS. That means ensuring that we keep people alive, by extending the availability of antiretroviral therapy, which today gets to fewer than one in twenty of those who need it in the developing world. We need to make young people a priority - they are most at risk, but they have also proved by their efforts that they can be in the forefront of successful efforts to halt transmission. At stake is the next generation—including those millions of orphans AIDS has created, who need special support so they can stay in school and look forward to decent livelihoods.

Alongside these efforts, there needs to be more attention to AIDS in the regions where the epidemic is still in its early stages but growing fast, especially Eastern Europe and Asia.

We need to recognize that the global epidemic increasing wears a female face—by attacking unequal relations between men and women we tackle one of the epidemic's drivers, at the same time as we give women more power and resources to lessen the impact of AIDS.

Finally, we must not let up in an all-out attack on HIV-related stigma, which still continues to hold back responses to AIDS everywhere, and adds exponentially to the burdens facing people living with HIV.

QUESTION 2: You frequently encourage political leaders to "de-stigmatize" AIDS through open discussion of the disease, prevention and treatment. Which leaders have done the best job in this? What programs can be emulated elsewhere?

PETER PIOT: Today, every African leader, whether in political, religious or business spheres, knows about AIDS—and most of them are doing something about it. In the Caribbean, too, public leadership about AIDS is prominent and effective.

The same cannot be said for leaders in most other regions, and especially those where the epidemic is more recent and growing. The fact is that the longer leaders wait before they tackle AIDS, the harder their job becomes—that is a lesson learnt all too tragically in Africa.

We can apply one of the lessons of HIV prevention education to this task—peers are often the best at encouraging successful behaviour change. UNAIDS is supporting leadership efforts in a number of regions, including through political leaders at the highest level with the AIDS Watch Africa group of African heads of State, and the Asia Pacific Leadership Forum. Developing peer pressure on leaders also underpins much of our partnership work in business and religious fields.

QUESTION 3: We now fortunately have more treatment options than ever before. Are you concerned that treatment programs might crowd out prevention programs in terms of priorities or funding? How do we assure that prevention programs receive appropriate attention?

PETER PIOT: Treatment and prevention must go hand in hand.

People living with HIV are entitled to a future. There are six million people across the globe whose lives are in jeopardy because they cannot obtain life-saving medicines - medicines which can now be supplied for as little as fifty cents a day.

The United Nations is in the forefront of the global emergency response which aims to save these lives. UNAIDS, with our Cosponsor the World Health Organization in the lead, is spearheading the campaign to ensure that by 2005, at least three million people with HIV receive life-saving antiretroviral therapy. This target is our first step on the way to overcoming the treatment gap which today divides the rich and resource-poor worlds.

An inseparable part of our efforts must be renewed attention to preventing the spread of HIV. Today's prevention gap is almost as large as the treatment gap—globally, fewer than one in five people have access to any sort of HIV prevention programme.

But where nations and communities have grasped the nettle, progress has been made. Across the world there are more and more examples of resolute action which is halting AIDS in its tracks. The increasing evidence of success needs to give momentum to our collective efforts to deliver HIV prevention programmes at the scale needed.

QUESTION 4: At the Latin America and Caribbean regional conference on HIV/AIDS in April you underlined the fact that a key group in that region, men who have sex with men, receives far too little attention for effective prevention interventions. It was thanks to national-level data on HIV/AIDS spending developed by local specialists (with UNAIDS support) that you had access to spending data that other regions have not collected. What are the prospects for expanding coverage of critically important information on resource flows and resource tracking that supports the efforts of UNAIDS and its partners?

PETER PIOT: The UNAIDS Secretariat is forming a Consortium on Resource Tracking which will bring together a wide group of experts interested in collecting data on financial resource flows for AIDS. This group will identify gaps and duplications in resource tracking, as well as collect data and improve data collection methods. And in 2004, UNAIDS, including our Cosponsor UNFPA, will survey national government spending in developing countries and countries in transition.

A parallel approach we are supporting is the development of National AIDS Accounts. We have worked with the Government of Thailand in establishing National AIDS Accounts in Thailand. In the coming year, we hope to support national AIDS Account establishment in two to three countries in each regions, along with in depth country case studies.

QUESTION 5: Unprecedented sums are now available for AIDS worldwide, but they still fall short of estimated global needs. There is skepticism among some major donors about absorptive capacity. What do developing countries need to do to put this money to quick and effective use?

PETER PIOT: In AIDS as elsewhere, program managers are often little more than data processors for donors, spending obscene amounts of time trying to satisfy dozens of duplicative reporting requirements, and hosting repetitive review missions month after month. Donor-driven agendas are raising transaction costs and reducing program effectiveness. It is a bit rich for donors to complain of absorptive capacity when they are the ones absorbing much of it.

But at the same time, we have to be alert to bottlenecks, and open to new ways of clearing the funding pipeline so that resources flow to the community level where they will most make a difference. We cannot be afraid of investing directly in restoring human resources in badly affected countries. And we must ensure that the evidence base, built up painstakingly over the past twenty years, is applied to spending.

There are hopeful signs that AIDS is providing the impetus to overcome some long-standing faults in development practice—for example under the Multi-Country AIDS Programme of UNAIDS Cosponsor the World Bank, funds are flowing directly to 2000 Kenyan community organisations, and to 5000 Ethiopian villages. Devolved and decentralized mechanisms, which break through traditional barriers between sectors, will be needed.

QUESTION 6: The 3x5 Commitment of UNAIDS, WHO, and GFATM; the US President's Initiative in 14 Countries; the Millennium Development Goals, and other global objectives amount to a proliferation of targets. Does UNAIDS see any need to bring more order and consistency to these so far uncoordinated efforts? What role will UNAIDS play to assure programs work together effectively with national governments?

PETER PIOT: Aid is increasingly in the form of integrated programmes supporting sectoral budgets. However, substantial challenges remain in inadequate human resources, worsening poverty, crime and health, and lack of transparency on both the side of recipient governments and donors.

Best practice in coherent, harmonized long-term AIDS spending is far from the norm in recent AIDS initiatives. Instead, short-term projects are multiplying, and there is insufficient attention to funding bottlenecks.

It is time for donors of all types—multilateral, bilateral, philanthropic—to formally agree to work together under national leadership, guided by the "three ones": one national AIDS strategy; one national AIDS authority to coordinate it, and one nationally-owned monitoring and evaluation system.

QUESTION 7: This interview is being sent to 8,000 AIDS economists and policymakers around the world. Do you have advice for them?

PETER PIOT: Yes, keep up your efforts!

We are at an important moment in the short history to date of the global AIDS epidemic—a moment where there is greater than ever momentum of evidence, of resources, and of leadership. But we are still a long way from ensuring that the epidemic will be turned around. Now, more than ever, we need to sustain the momentum, and translate what are today effective but isolated examples and projects into massive nation-wide programming.

That is a transformation in the whole way we operate and think—the "institutional behaviour change" which for years I have been calling for. Making this great leap forward will require "all hands to the pump". The coming months and years will be crucial: we still have the chance to head off the impact of AIDS for much of the world's population, and we still have the chance to protect a generation even in the worst-affected regions. These are tasks that will require the concerted efforts of all 8,000 of your members—and more!