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U.N. Targets Women, Developing World in AIDS Fight

December 1, 2004 at 12:00 AM EDT
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SUSAN DENTZER: The international face of HIV and AIDS is increasingly a female one. That’s the conclusion of a new report by UNAIDS, the United Nations’ umbrella group on the pandemic.

It says women now make up just under half of the nearly 40 million around the world infected with the HIV virus. Women and girls have also made up a huge share of the three million with HIV who have died this year. The report says the feminization of AIDS is linked to low social and economic status of women in much of the world.

ASUNTA WAGURA: My life has never been the same.

SUSAN DENTZER: Asunta Wagura is a Kenyan woman with HIV. She spoke at a Washington news conference today.

ASUNTA WAGURA: If you are a woman and you’re HIV-infected and you don’t have the resources to keep yourself healthy or to access the treatment, then definitely you die very quickly within three years of knowing your HIV infection.

SUSAN DENTZER: Dr. Piot, welcome. Why are women around the world so affected by HIV/AIDS?

DR. PETER PIOT: There are basically two major reasons why women are more affected by HIV: First is biology. It’s just more efficient to transmit HIV from men to women than from women to men during intercourse. But the main reason has to do with the status of women in society: The fact that half of the world’s women live with less than $2 a day. So in other words they are living in extreme poverty which has a lot of consequences. It means often that selling your body is the only way to feed your kids.

Secondly, women are less educated on the average and so understanding how to protect themselves from diseases is a problem.

Thirdly, the inferior status of women in many societies makes it that they can’t say no to sex. There’s a lot of sexual violence and they even lose all their property and they have no inheritance rights when, for example, their husband dies from AIDS. All that makes that we are faced with a new AIDS epidemic: Half of all people living with HIV are women.

SUSAN DENTZER: The mantra of prevention in AIDS is ABC, Abstinence, Be faithful and use Condoms. You’ve said that’s not applicable for most of the world’s women. Why?

DR. PETER PIOT: We believe ABC has to be expanded everywhere because most people don’t even have access to that. But the reality is also that for many women, what matters is not so much their own sexual behavior, but it’s the behavior, the risk behavior of their partner. For example, in Thailand we know today that half of all women who become infected with HIV become infected from their only sex partner and that’s their husband.

We know that marriage doesn’t protect against HIV Infection because in many societies, girls, young women, are married to older men, older men who are sexually experienced, have already HIV before marriage and that’s how the women got infected. And what about abstinence in societies where there is a lot of sexual violence? And women are raped and become infected that way.

So all this makes that we have got to go beyond ABC, and we’ve got to make sure there is zero tolerance for sexual violence and sexual abuse with or without AIDS but in the era of AIDS, this becomes absolutely deadly. We have to make sure that girls remain in school as long as possible.

We have to make sure there is some money, some micro credit schemes for widows who are left behind so they can feed kids, send them to school instead of having to sell their bodies.

SUSAN DENTZER: One technology that has been mentioned as a way for women to defend themselves against HIV AIDS, is microbicides. What are those and how can they be helpful?

DR. PETER PIOT: Microbicides are Gels and creams that women can put in the vagina that includes a substance that kills HIV, the virus and thereby that would protect women and their male partners from being infected during intercourse.

This is a product that is still in development. A lot of research is done and it will take a few years before that can come on the market. But I don’t know of any other technology that would make such a difference to stop the heterosexual spread of HIV.

SUSAN DENTZER: In a speech here in Washington yesterday, you said we are nearing a tipping point in HIV AIDS in three countries: India, China and Russia. What do you mean?

DR. PETER PIOT: Well, when I look at the history of the epidemic, it is clear that many countries have gone the way that South Africa has. Over ten years ago, South Africa was at 1 percent of the adult population that was infected. It took five or six years to go from .5 percent to 1 percent. And then once it had reached 1 percent, it really shot up to 25 percent, the situation where we are now in. We’ve seen it in every society.

When you go beyond like 1 or 2 or 3 percent of infection in society, suddenly you get a logarithmic growth. You go outside classic groups that are at high risk such as sex workers, truck drivers, injecting drug users and there is more heterosexual transmission.

You reach the general population and that’s what the going to happen in China. That’s what’s going to happen in India if we are not really scaling up the response to AIDS in a way that is unprecedented: Strong leadership and programs everywhere.

SUSAN DENTZER: Four out of five people around the world in highly infected countries lack preventive services. Nine out of ten who need to be on anti-retro viral drugs are not. What needs to happen in the coming year to seriously make inroads into the AIDS pandemic?

DR. PETER PIOT: Well, first of all, there is still a major funding gap. Even if we made major progress in terms of mobilizing money from the rich countries and the developing countries to deal with AIDS, we are now at about $6 billion this year; that’s a major increase over the last two years. But there’s a need for at least a double of that. So that’s the first thing.

But secondly and equally important, we’ve got to make sure the money works for the people on the ground. What does that mean? We need to make sure that the drugs that are needed to save lives are getting to the village level, to the community level, so that there is a good supply management.

It means also that we’ve got to do something on the institutions that people who have to deliver the goods, nurses, the doctors, the teachers, they’re dying from AIDS as well — they also don’t have access to treatment in many countries.

And what you are seeing is a phenomenon that I saw in Malawi, a small country in Central Africa, where in the main hospital that should be the reference for treatment for HIV, that only one out of three slots for nurses are filled because the nurses have emigrated to South Africa or to Great Britain or the U.S. because their salary conditions are so lousy. Some have moved to work in research projects and one-third have died from AIDS.

So we’ve got to work at the same time — making sure that the people are there to deliver the services because that’s what AIDS is also doing to society. Just what AIDS does to the human body, where it undermines our resistance to infections, et cetera, AIDS is also eroding the institutions, the services, the people who are the first line of defense in society against this epidemic. So we’ve got to work at these two fronts.

SUSAN DENTZER: Dr. Piot, thank you.

DR. PETER PIOT: Thanks.