From the Frontlines: UNAIDS Executive Director, Dr. Peter Piot, Discusses the History of His Involvement in Fighting the Epidemic

DR. PETER PIOT: I studied in the late '60s and the early '70s, so I spent -- when I was in medical school, I think I spent as much time in politics, radical politics, as in studying. And I have always been interested in the social aspects, and in the question why, beyond the molecule, in terms of disease. Why are people getting ill, and some are more affected. Why are people poor? How does it affect their behavior, et cetera?

My history, or my relationship with HIV goes back to very, very early days, even before AIDS was discovered, but I wasn't smart enough to see it was a new thing. We had a few patients coming from -- it was then called Zaire, in Central Africa, and who died with something we didn't know what it was. Retrospectively, later in '85, we could prove it was AIDS.

When I started with UNAIDS, I had three objectives. The first was to put AIDS on the political agenda. Politicize it. I was convinced then, and even more today that anything that's not high on the political agenda of a head of state, the president or prime minister, has no chance of succeeding to be under control in a society, and that only a political movement or activism will generate the pressure that will change institutional behavior.

Coming from a background as a scientist, where I looked at it as a scientific or public health issue, today I believe that the solution is a political one. Of course, once the political decisions have been taken, we've got to make sure that it's scientifically sound approaches that are being used, not ideological ones, like sex education works, abstinence is one of the options. And that fundamentally we will only defeat AIDS if we change the norms and values in society about sexuality, homosexuality, the relations between men and women, and that in addition that there is a movement which would put pressure on those in power to tackle AIDS in a serious way to make sure the money is there, the institutions are changed, and that we will make sure that the young generation has all the information and the means to protect themselves.

Secondly, I was also convinced that this epidemic is the biggest epidemic that humankind has ever known, but also that we've got to look for successes. That it's absolutely possible to be successful in this epidemic. I'm not interested in something that -- you know, where every year we can get another report out saying that it's worse than last year, the doom and gloom. I mean that gets to the front pages, but I want success.

I think that when I look into my crystal ball for where we will be with AIDS over the next five years, I strongly believe that there will be more countries like Uganda who will have less infections in 2005, 2010 than they have today.

Already two years ago in January 2000, the U.N. Security Council declared AIDS as a matter of international security. It fundamentally affects stability of whole nations. Now, with all the horror of September 11th, I think one of the positive developments that I'm seeing is that in the United States, and also in other industrialized nations, that we now understand much better that we're not isolated from the world, that it is also in our enlightened interest, self-interest, to support programs to fight AIDS in the poorest nations.

Look, this is about the survival of the nation, about national security, if you don't deal with this, the country is going to go down the drain, you will attract less international investment, and it's going to mean trouble for you politically. We're approaching the time that politicians will be elected or kicked out of office in function of their performance in terms of AIDS.

The third objective was also to expand response. What does that mean? It means that this should not be approached any longer as a problem that can be solved by doctors alone. That medical approach has clearly failed. And it still is a recipe for failure. We need a medical profession and system and science to treat people. But when it comes to prevention, the journalists can save more lives than doctors.

What I'm tired of is that 20 years in this epidemic, I still have to explain sometimes that you can't get HIV from toilet seats, or from mosquitoes, but I'm particularly tired of all the stories of stigma, of discrimination, of exclusion of people with HIV. We should know better 20 years into the epidemic.

There are moments that I'm tired, fatigued, but these moments only last a few seconds because they move nearly always in anger, you know, and in thinking how can I fight back.

Special coverage from the XIV International AIDS Conference provided by kaisernetwork.org, a free service of the Kaiser Family Foundation.