AIDS impact threatens world stability

Peter Piot found his mission in a crowded hospital ward in Zaire more than 25 years ago, yet he talks today as if his work has just begun. As executive director of the United Nations Joint Programme on HIV/AIDS, or UNAIDS, the Belgian-born physician and microbiologist has marshaled the funds and leadership to help combat AIDS, yet his goal of containing the virus that has infected 65 million people is as distant as ever.

'After 25 years, the end of the epidemic is nowhere in sight, and that's a sobering fact,' Piot told a crowd of 200 on May 9 in Kresge Auditorium. 'AIDS has become one of the global make-or-break issues of our time. It should be in the same category as global climate change, mass poverty and the nuclear threat - because if AIDS is not brought under control, there won't be stability in the world.'

Piot, MD, PhD, who serves as the Under Secretary-General of the United Nations, visited Stanford under the auspices of the Freeman Spogli Institute for International Studies. He was introduced to the crowd by Alan Garber, MD, the Henry J. Kaiser Professor of Medicine, who called him 'the kind of person who makes you say, 'Wow.''

Piot was among the first scientists to foresee a crisis of epic proportion when he visited Zaire (now the Democratic Republic of Congo) in the early 1980s and witnessed hundreds of wasted men and women. That was the first indication that the mysterious disease - later identified as AIDS - was transmitted heterosexually as well homosexually. He and colleagues published their findings in the respected journals Lancet and Science, yet no one took heed. Frustrated, Piot became an activist, believing that only through politics could he extract a world response.

He was appointed the first director of UNAIDS in 1995 and saw global funding for the disease increase 40-fold - from $250 million that first year to $10 billion today. He agitated for greater access to treatment, with some success; today, 2 million people in developing countries receive life-saving antiretroviral drugs, compared to 100,000 just five years ago, he noted.

Yet he laments the world's response to the disease has been agonizingly slow.

'It's all come too late,' he told the crowd. 'Sometimes I wonder how would the world look if we had the same political will, the same funding and action on the ground before. We would have saved millions of lives. The price of inaction the world is paying now is extraordinarily high.'

More than 8,000 people still die of AIDS every day. In some countries, such as Swaziland, so many adults have died that one in every five households is headed by a child, he said. And in Botswana, the life expectancy is so short that a 15-year-old has a 50 percent chance of dying by the time he or she reaches age 50.

With so many casualties, particularly among young adults who make up a country's workforce, AIDS has had a destabilizing impact in many countries. South Africa, for instance, has difficulty maintaining an army because 70 percent of its military personnel have been lost to the disease.

'AIDS does to societies what HIV does to the body. It weakens the resilience of society and its ability to face difficult things,' he said.

At the same time, however, Piot said he sees the AIDS pandemic as a positive force for change in some arenas. It has exposed gaping health inequities and given rise to health activism. It has put gay rights on the agenda and could do the same for women, who are disproportionately affected by the disease, he said.

'I hope women will say enough is enough and that there will be stronger leadership in women's issues' as a result of the crisis, he said.

It also has led to dramatic change in policies that protect intellectual property rights. Because of pressure to make anti-AIDS drugs affordable to patients in developing countries, the World Trade Organization in 2001 enacted a new policy that allows countries facing public health emergencies to bypass patent laws and import low-cost generic drugs.

'This is quite a revolution in international trade agreements and intellectual protection,' Piot said. 'So AIDS broke that open.'

As for the future, Piot said he is turning his attention to prevention after years of 'shouting' for better access to treatment. The world simply can't sustain the long-term costs of maintaining the 2 million people on antiretroviral treatment today, much less those who are newly infected every day, he said.

'We can't continue with a situation where, for every person put on antiretroviral treatment today, there are eight new infections. We must get serious about HIV prevention,' he said.

In an interview before his talk, he noted that in the early days of the epidemic in San Francisco's gay population, there were no drugs, no fancy technologies to fight the virus - just effective education. He envisions similar, grassroots education programs across the globe, including AIDS curricula in the schools.

'It's a matter of community mobilization - education, communication, changing what's acceptable,' he said.