San Francisco Chronicle - Wednesday, May 9, 2007
Sabin Russell, Chronicle Medical Writer, srussell@sfchronicle.com

As executive director of the Joint United Nations Program on HIV/AIDS known as UNAIDS, Piot has, since the organization's founding in 1995, helped forge a global coalition of Western leaders who have vastly increased the international response to the disease. Global spending on AIDS has risen to nearly $10 billion from $250 million a decade ago.

The number of AIDS patients receiving life-sustaining antiviral drugs in low- and moderate-income countries has surpassed 2 million, from about 400,000 only three years ago.

But a changing of the guard is under way.

French President Jacque Chirac leaves office next week. British Prime Minister Tony Blair plans to do the same by September. President Bush will depart the White House in 20 months.

"The issue is long-term leadership," said Piot, during an interview Tuesday in Menlo Park, where he was preparing for a public lecture on the epidemic this evening at Stanford. "How do we keep AIDS on the political agenda? I'm very worried about it."

The UNAIDS executive director said that one lesson of the past is that the cost of dealing with HIV today would have been much less had world leaders done more years ago. "We are paying now for the price of inaction," he said. "The lesson is, that if anything else like this come up, act now."

Piot himself will be stepping down from his post when his term expires in 2009. There is a new leader of the World Health Organization, Dr. Margaret Chan, following the death last year of Dr. Lee Jong-wook, and last month Dr. Michel Kazatchkine succeeded Dr. Richard Feachem as head of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

These leadership changes are taking place as the global battle against AIDS is in a state of transition -- from one of proving that a large-scale treatment with antiviral drugs was possible, to one of sustaining it as the number of people living with HIV grows.

"Treatment is not going to stop this epidemic," Piot said. "In 2005, there were six new infections for every person put into treatment. That is not sustainable. That means we are losing the battle."

Providing AIDS drugs to all who need them by 2010 -- a goal endorsed by the major industrial nations at the 2005 G-8 Summit in Gleneagles, Scotland -- will take at least a doubling of global spending on the epidemic, to $20 billion. Piot knows that it will be difficult to keep AIDS at the center of the world stage, with so many competing concerns -- from regional conflicts and poverty to economic development and climate change.

"Sustaining political intent on any issue is very tough," he said.

Former President Bill Clinton, who has been criticized for not doing enough about the international AIDS crisis while in office, continued his post-presidential push against the epidemic on Tuesday. He announced in New York that his Clinton Foundation has negotiated new prices for AIDS drugs that will be needed in poor countries for patients who begin to fail on the standard regimens.

Clinton said an agreement with Indian generic drugmakers Cipla Ltd. and Matrix Laboratories, Ltd. will cut prices of the second-line pharmaceuticals by 25 percent in poor countries. Today, those medicines can cost 10 times as much as the first-line drugs, which now can be procured for as little as $73 a year.

Piot brings an increasingly rare perspective to today's HIV epidemic -- he is one of the earliest AIDS fighters, and he is still on the job. A Belgian-trained epidemiologist, he was renowned as a co-discoverer in 1976 of the Ebola virus in Zaire, Congo. In the early 1980s, he began to see hospitals in the capital, Kinshasa, filling with patients suffering a mysterious wasting disease -- the first signs of a heterosexual AIDS epidemic in sub-Saharan Africa.

Now Piot is becoming increasingly active in recruiting a new generation of leaders to continue the battle. He is arranging a conference in Mountain View in mid-October with Google.org, the philanthropic arm of the multibillion dollar Internet giant. The event, still in the planning stages, will focus on what young leaders with their mastery of new technologies can do during the next 25 years of AIDS.

Tonight at Stanford, Piot will deliver a lecture in which he will argue that AIDS has been an agent for social change even as it spread its misery throughout the developing world.

AIDS has devastated a generation of gay men, but it also accelerated the progress of the gay rights movement, as the world watched that community battle back and provide leadership in the international struggle against the epidemic, Piot said. The disease has led to a healthy and more open consideration of sexuality and gender roles. "Things became more discussable," he said.

Piot believes that the burden of AIDS that has fallen disproportionately on women in sub-Saharan Africa will have a similar empowering effect for women's rights throughout the world. "AIDS deaths are directly related to the inequality of women. This is a wake-up call," he said. "It is possible to turn around a catastrophe into something positive."

______________

AIDS talk

Who: Dr. Peter Piot

The lecture: AIDS: Pandemic and Agent for Change

When: 5:15 p.m.

Where: Kresge Auditorium at Stanford Law School

Admission: Free

Online: Details are available at links.sfgate.com/ZDT

070509
SC070503

Always watch for outdated information. This article first appeared in 2007. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2007. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .