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AIDS: Spreading Scourge

International health experts explain the importance of donating more resources to stop the spread of AIDS.

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    Are people hearing the same old messages or surprisingly new bad news? Here to elaborate on the latest findings on the AIDS pandemic, are two experts attending the Barcelona conference. Peter Piot, the executive director of UNAIDS, the joint United Nations program on HIV-AIDS, and Sandra Thurman, president of the International AIDS Trust. Ms. Thurman was also the U.S. AIDS czar during the Clinton administration.

    Dr. Piot, among the findings that you are publicizing this week in Barcelona is that there could be as many as 68 million new AIDS deaths by the year 2020. What's the reason for this explosion?

  • DR. PETER PIOT, Executive Director, UNAIDS:

    Well, the report that we issued just before the beginning of the Barcelona conference showed clearly that we haven't reached yet the peak of the epidemic. HIV continues to expand, certainly in Africa, even in the worst affected regions.

    Think of Botswana, the worst affected country in the world– nearly 40 percent of the adults are now HIV positive, and HIV is spreading very fast in the former Soviet Union, in China, in India, and the reason that that's happening is, I believe, because we've waited so long, we've wasted so much time, and because of a lack of leadership in these countries, and in the West, in response against HIV. And we could have prevented millions and millions of deaths if we would have started acting ten years ago, 15 years ago as many countries are now doing.


    In Botswana it's also a question– and countries like that– it's also a question of life expectancy which has been affected by this pandemic.


    Yeah, and the worst affected countries like Botswana or in South Africa, life expectancy at birth is collapsing. What does that mean? That means that someone today, who is born today, will live on the average for 40 years, as compared to 60 years without AIDS.

    A boy of 16 who lives in one of these countries in Southern Africa is like a 60 percent probability to die from AIDS in his lifetime. And whole economies are on the verge of collapse. And AIDS is really having a major devastating impact. Just think of the fact that last year alone, one million African kids lost their teachers because these teachers died from AIDS. That's another facet of the AIDS epidemic.


    Ms. Thurman, in another facet of the AIDS epidemic, it was described by another UN official is that it seems to be disproportionately affecting people we wouldn't necessarily expect– in this case, women.

  • SANDRA THURMAN, International AIDS Trust:

    Oh, I think that's the story that's not yet been told in the fight against HIV and AIDS. This is an epidemic that is disproportionately affecting women and children. In fact, over 50 percent of all people infected in Africa, which has the most cases of HIV Infection in the world, are women. And in many regions, young girls are six times more likely than boys their same age to become infected by HIV. This is clearly a gender issue, and if we're going to really fight AIDS, we're going to have to address these issues of gender and equity.


    Ms. Thurman, one of the things which is also remarkable that we saw in these first reports from the conference is that among the U.S. numbers– domestic United States numbers– the amount of ignorance among people who didn't realize they had HIV– many of them young, gay, and bisexual men.


    Well, I think that's what's so frightening. The epidemic of the United States has leveled off at about 40,000 new cases a year in the last decade, but we see a dramatic increase in numbers of young people, of women, and of young, bisexual men — particularly young, gay, and bisexual men of color.

    In many urban areas we have as many as one-third of all young gay men of color infected with HIV, which parallels what we see in many African nations. We have a Holocaust happening in our own inner cities and we aren't even recognizing it. So it's reason for us to really focus again not only on the epidemic domestically, but redouble our efforts in the epidemic internationally.


    Do you have any answers to why this epidemic seems to be so… to be galloping at such a pace in the urban communities, why black women are so disproportionately affected, for instance, in the increase?


    Again I think it goes back to the beginning of the epidemic, that in the early days of the epidemic, people all around the world thought this was an epidemic of gay, white men, and prostitutes for the most part, and that stuck in our minds. And that was actually never the case. So that's the perception that people have taken into this part of the epidemic with them, and people don't think they're at risk.

    Young people don't think they're at risk, women don't think they're at risk, women of color don't think they're at risk. And so we really have to focus on our prevention messages targeting all of those separate groups of people, and get the message out there that everyone is at risk for HIV infection. HIV Infection doesn't discriminate and we need to make sure that people understand that.


    Dr. Piot, I think many people, including folks who have followed this pretty closely, have been led to believe over the past several years that, in fact, there was a plateau that which had occurred worldwide, as much as in the U.S. Was that not the case?


    Experts have predicted several times since the '80s that we had reached or that we were close to reaching a plateau of new infections, and unfortunately they've always been wrong. Every year we've got the report at UNAIDS that more people are being infected, and the virus is now spreading in about every single country in the world, and it's simple: This is the worst epidemic in human history and we don't know yet where this will end.


    So, Dr. Piot, if we know– at least we have an idea about what the parameters are of this epidemic, of this pandemic– what is the cost to arrest it in your opinion?


    Well, last year in UNAIDS we estimated that the poor countries need about $10 billion per year to make sure that prevention programs are being organized everywhere, from Africa to Asia to the Caribbean.

    Secondly, that most people who need it and who are infected will get access to treatment, and then also to take care of the millions of orphans, to give them food, a roof, and education. That's where it goes, and where are we today? We're at about one-third of that $10 billion mark.

    There's about $3 billion available to fight AIDS this year, and so we need to make sure that that gap is filled. And how can that gap be filled — by the governments in the affected countries themselves, after all, it's about their survival– it's an issue of national security for all of them– but also by the richer countries who need to invest in AIDS prevention, in AIDS treatment, in these countries.

    Not only as a matter of our helping poor nations out of solidarity, but also because it's in our enlightened self- interest. In today's globalized world, you know, when a whole continent is destabilized, that is going to have implications for the rest of the world and thousands of miles from where the real major epidemic is.


    Ms. Thurman, I wanted to expand on what Dr. Piot was just saying about what happens in poor countries where the cost for the treatment, the cost for the actual drugs, can seem so prohibitive. Today there was talk of a new drug which shows great promise: T-20. Talk a little bit about that and about the whole notion of whether it's possible for poor countries without these mass distribution systems that we have in the United States to actually do something about people who… for people who have actually contracted the disease.


    Well, with T-20 and other drugs, we certainly have some promise on the horizon, but the fact of the matter is that these drugs are very, very expensive for poor countries, and even though the drug companies are trying very hard to reduce prices… to reduce them by 90 percent or even 95 percent in some cases, the fact of the matter is the majority of the people who are infected with HIV are living on less than a dollar a day. And in countries that live… or spend five dollars per capita on health care across the board, there's just no opportunity for them to purchase these drugs.

    If we take Africa, for instance, where we have 26 million people infected with HIV, only 36,000 people have access to the triple combination therapies that people in the United States and in Europe and other wealthy nations have access to all the time. So that's 36,000 out of 26 million people who are infected. That gap is just enormous. So, what I think we have to do is several things. The first is to face, to focus on getting basic drugs to people, drugs that treat opportunistic infections like tuberculosis and other infections that are very inexpensive and fairly easy to treat. I think that's the first thing we need to do.

    We need to look at getting the drug that prevents– the drugs– that prevent mother to child transmission of the virus to pregnant mothers in Africa. That would prevent 600,000 new infections each year in Africa alone. So there's some basics that we know how to do that are very cost-effective, and I think that's the first step we have to take. Then we have to look at building the infrastructure and finding some way to reach some middle ground so we can get these drugs to people, the more complicated drugs, to people who need them.

    I mean, you know, when we look at the fact that we live in a global society, if the promise of science doesn't have application to all people who live in a global society in the same global economy, then there's something wrong with that. And I think after September 11, there's a much greater understanding in the United States and around the world that we are connected in ways that we didn't understand before, and that what happens to poor people in Afghanistan or what happens to poor people in Botswana affects all of us, not just indirectly, but directly. So these are the challenges that I think we have to face in the future.


    Sandra Thurman and Peter Piot, thank you very much for joining us.