Health 
Politicising AIDS: Interview with Peter Piot 

At the end of 1999, there were 34.3 million men, women and children worldwide living with HIV or AIDS, while total deaths from the syndrome had reached 18.8 million. More than 5 million new cases were reported in just one year. Appointed in 1994 as Executive Director of the United Nations HIV/AIDS programme, UNAIDS, Doctor Peter Piot believes the pandemic cannot be fought on the medical front alone: it has to involve the whole of society. He sees the support of the trade unions as essential.

For several years now I have been striving to establish links with the trade unions - in the first place, because AIDS has become the single most serious obstacle to economic and social development in the countries worst hit by the epidemic, especially in Sub-Saharan Africa. The problem goes far beyond protecting the health of individuals. 

Secondly, in order to respond to AIDS today, I am convinced a mass movement is needed, not only to promote safer sex practices but also to provide support for the affected communities and families. We should not forget that we are talking about countries where 25-30 per cent of the adult population - or even 35 per cent, as in the case of Botswana - are infected and likely to die of the disease. There are well over 10,000 million orphans. These are highly destabilising factors.

Thirdly, from a trade union point of view, we must struggle to ensure access to social benefits, including financial security and proper health care.

Two years ago, in South Africa, the mining-sector employers responded favourably, for the first time, to the demands put forward by the miners' union to achieve these goals. This reflects a growing awareness that the problem is beginning to seriously affect the life of society as a whole.

One final aspect that should be highlighted is the fact that, as far as prevention is concerned, the workplace is very important. We explain to employers that not only do they have a moral obligation to invest in prevention programmes, but it is also financially in their best interests.

For the past year or so, there has hardly been a world summit (be it the G8, the United Nations or one of the international financial institutions) which did not place HIV/AIDS at the top of the agenda. Is this a decisive development? And, if so, what has led to this general (albeit belated) response?

No doubt, the year 2000 can be described as the year when the problem of AIDS was recognised also as a political problem. Five years ago, when UNAIDS was created, my first objective was to politicise AIDS. I was convinced that, otherwise, we would never be able to reach out to the populations in the poorer countries or mobilise the necessary resources.

The process began last December with a meeting organised by Kofi Anan and myself to launch the Partnership against AIDS in Africa. Leaders of both trade union confederations were present. Subsequently, the issue was debated by the Security Council, the World Bank, and also by the summit of Non-Aligned Countries in Havana, Cuba. I think several factors have contributed to this new departure. To begin with, in the countries affected by AIDS, the mortality rate has increased to appalling levels. Practically every family is confronted by AIDS, either because they have lost a relative or because a member of the family is ill - and politicians are no exception.

Secondly, the social and economic impact of AIDS is now better documented. It is sad but true: the main decision-makers hardly showed any interest until it was brought home to them that productivity and economic growth were being seriously affected.

But a lot of time has been wasted. For years, the forecasts published by certain experts, including the World Bank, were hardly alarming. For example, according to their cold-blooded economic analyses, demographic growth would offset the loss of life, the loss of production, etc.

We have tried to change this. Through UNAIDS, I believe we have definitely helped to shake up the institutions. We have striven to find supporters of our cause within them. We approached finance ministers and heads of government. But I believe that, on the international scene, it was the debate in the Security Council which had the greatest impact. 

Right. But does a real political commitment not involve taking steps to ensure anti-AIDS treatment - and, more generally, all essential medicines - are accessible to the developing countries? Is there any point in the efforts undertaken by many agencies and individuals, including many people who live with HIV, unless there is some hope of effective treatment becoming available?

Clearly, prevention alone is insufficient. Some 35 million people are living with HIV in different parts of the world. We cannot leave them in the lurch. Much more needs to be done in this respect. There are very few prevention programmes working on a national or even on a regional scale. In most cases, what we have are small community-based programmes. These are very positive, but they are not enough. The whole country must be involved, like for example in Uganda or Thailand. 

This requires considerable resources. On the other hand, people are not entitled to proper treatment merely on humanitarian grounds or in recognition of their basic human rights. In fact, where treatment is unavailable, the credibility of the programmes is seriously undermined. There is little motivation or, if you like, no "incentive" to screen people at risk, for example. For years we have been insisting on the need to link prevention to treatment but - in this case, too - it is only in the past twelve months that we have had any positive response. The pharmaceutical industry has accepted something it had systematically refused until now: to grant the poorer countries preferential prices, that is, to allow them to buy patent medicines at a lower price. Once again, this is quite a reasonable arrangement: in exchange for the protection of intellectual property rights, the medicines must be sold at production cost plus a small margin to cover distribution costs. 

In Senegal, an agreement has been signed a few days ago between the government and three pharmaceutical companies. The price of medicines has been reduced massively. For drugs used to combat the virus itself, the price dropped from US$ 10,000 to less than US$ 2,000. Price reductions have also been applied to the medicines used to treat opportunistic diseases. We expect a similar agreement to be concluded in Uganda next week.

Yet the promises made last March are taking a long time to materialise. Most people campaigning for increased access to essential medicines feel, quite simply, that the pharmaceutical multinationals are making astronomical amounts of money and that their arguments about profitability are untenable.

This is very true. But it is highly unlikely that antiretroviral treatment will become available to everyone promptly, and this is so for three reasons: To begin with, the majority of infected people are not aware that they have the virus. Additional efforts are urgently required to screen larger numbers of people at risk.

But do governments have any real power faced with the might of the pharmaceutical lobbies, which are even managing to influence foreign trade policy, as in the case of the agreements between the United States and South Africa last year?

True, the southern countries are very vulnerable. In general terms, the foreign debt is a terrible burden. If I had to choose between the supply of free medicines and the cancellation of the debt, I would choose the latter. Incidentally, how should we interpret Zambia's recent decision to reject a proposal by the World Bank concerning the granting of loans for the struggle against AIDS, on the grounds that servicing the debt is already an insurmountable problem for the country?

We are hoping to achieve the same results in Zambia, within a few weeks, as we have already achieved in Malawi. In the latter country, we managed to devise a strategic five-year plan against AIDS. The plan does not rely solely on the authorities but involves civil society as a whole. A round table was held with potential donors to provide the necessary resources. As a result, we managed to raise 90 per cent of the funds required to combat AIDS in Malawi over the next five years.

More specifically, what activities will these funds cover?

Firstly, prevention programmes on sexually transmitted viruses, including educational activities, promoting the use of condoms, etc. Secondly, prevention programmes against transmission from mother to child, including the provision of medicines. Thirdly, the treatment of opportunistic diseases and palliative care, including access to painkillers.

However, the funds do not provide for antiretroviral treatment. The government was against the idea and, furthermore, one of the priorities was to develop the provision of care centres, relying on the existing associations and hospitals.

Furthermore, AIDS also exists in the northern countries, which in fact explains the existence of solidarity between the north and the south. People are grappling with AIDS all over the world and this gives rise to a sense of a shared struggle. 

Designating AIDS as a disease of the poor entails a risk of marginalisation. It is very true, however, that AIDS is a factor of poverty, particularly where social protection systems are inadequate or non-existent. It can also be said that poverty is a factor determining migration, the break-up of families and prostitution. But the President of South Africa, Mr Mbeki, is mistaken when he says that poverty is the root cause of AIDS.

Concerning South Africa, AIDS hit the country somewhat later than it did other countries in the region. However, the situation there is quite tragic today, in spite of this "period of grace" and in spite of the increasing amount of knowledge about the virus and the means of combating it. It looks as if governments are forever being caught unprepared. How do you explain this incapacity?

We are dealing here with an "announced catastrophe" and, personally, I find this a very frustrating situation. Why do people fail to learn from others? I keep asking myself this question. And who knows what might happen tomorrow in Asia or Eastern Europe? Our task is to shorten the learning curve. This is why it is important to launch concerted actions at a global level, and this is where trade unions can play a key role.

Like other countries before it, South Korea has recently expelled a number of HIV-positive migrants. What do you think about this kind of decision?

Our position is very clear. Such decisions constitute a violation of human rights and they contravene the international agreements. Furthermore, this kind of measure is totally ineffectual. It is a delusion to think that one can protect a country in this way. It is like the Great Wall of China, which never stopped anything. But even the United States has introduced entry restrictions for HIV-positive people. As regards other forms of discrimination, one of our joint projects with the ILO consists in developing, specifically for companies, a code of conduct on HIV/AIDS in order to protect the workforce and encourage employers to invest in prevention programmes.

Last year, when you urged the private sector (particularly pharmaceutical companies) to invest more resources in the southern countries, you were running counter to the widespread belief that developing countries are insolvent markets and therefore unattractive for businesses. Could you explain this point?

During the world congress in Durban last April, there was a great deal of debate on AIDS, and a resolution was voted on this issue. On the other hand, the ICFTU did not manage to agree on another resolution concerning the rights of gay people in relation to employment. In fact, many delegates believed it was preferable to avoid the whole issue. What is your opinion on the subject?

Because of AIDS, it has become clear to anyone who still doubted it that homosexuality exists everywhere, including a number of societies where the establishment used to deny it. The truth of the matter is that homosexuality is still strongly repressed both socially and in legal terms. We are working with gay associations in all parts of the world. This requires specific programmes, as in the case of other social groups (for example, young people) or occupations (transport workers, etc.). For us, it is not a question of principle, but a practical matter. How can we take effective action in a society where homosexuals are hidden - in the sense, for example, that they are often married? In the southern countries, there is no gay identity such as we increasingly have in our part of the world. This makes combating AIDS very difficult.

Peter Piot was interviewed by Jacky Delorme, ICFTU

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