Dr. Peter Piot Discusses the World's AIDS Epidemic and Ways to Combat It

Dr. Peter Piot is executive director of UNAIDS, the United Nations agency coordinating the fight against AIDS. He is a physician and microbiologist and one of the co-discoverers of the Ebola virus. He grew up in Belgium. Excerpts from his interview follow.

GROSS: "What's the connection between AIDS and political instability?

PIOT: ". . . In January 2000, . . . the UN Security Council held a debate for the first time on AIDS as a security issue. And it was both a breakthrough in the concept of how we looked at AIDS, but also in how we look at security. . . . [Security is] . . . the absence of fear, absence of hunger, absence of fatal epidemics, just as AIDS is. And AIDS is definitely a factor of instability. . .  We have countries where 30 to 40 percent of the adult population is infected; in other words, one out of three people, nearly one out of two adults. And what are the implications of that? First, that these people will die prematurely . . . secondly, AIDS doesn't only affect the poor; it also affects the skilled, the well-educated. For example, in several countries, a country like Zambia in Central Africa, today there are as many teachers who die from AIDS as the country trains every year. So that's a disaster. We see the same . . . in businesses. . . . They're all dying from AIDS. . . . And then we've got the orphans, those who are left behind. . . . We have also, the fact that many of the armies in Africa are very, very heavily infected with HIV, well over 50 percent. . . .

"Wars have been major conduits for the spread of classic sexually transmitted diseases. . . . And that has to do with the fact that war is associated with violence. Violence often includes, also, sexual violence. And this is what we've seen throughout the world, that women get raped, that they often, in addition to being raped, are also being infected with HIV. We've seen it during the genocide in Rwanda a few years ago. . . . There are displaced populations, sometimes millions, on the run; refugee camps; people, particularly women, having only their body to sell in order to survive to feed their kids."

GROSS: "One of the things you're up against is that AIDS awareness means talking openly about sex. . . ."

PIOT: ". . . I was actually, in a sense, happy that during the debates of the special session of the General Assembly at the UN [in June] that homosexuality, women's rights, women's control over their sexuality, sex education -- that all that was discussed in rather non-diplomatic terms. . . . We went to the heart of the discussion. And that's the real problem for us. . . . This is an issue about every single country I have been in and is also a problem in Western countries."

GROSS: "Has the pope and the Catholic Church been an obstacle for you on [condoms]?"

PIOT: "Yeah, the condom issue is one of the more difficult ones in our daily work. And there -- it is still true that the Catholic Church objects to the use of condoms. When we look at what happens in practice, it's a bit different. First, our position in UNAIDS in the following one, and that is that we -- when it comes to preventing sexual transmission of HIV, we have A, B, C. And by that I mean, A for 'abstinence,' B for 'be faithful' and C for 'condom." It's easy to explain. The Catholic Church says A, B and we complete the alphabet to go to A, B, C."

GROSS: "Why have you stayed with the AIDS epidemic for so long?"

PIOT: ". . . My ambition is more of a political nature now in the sense that to make sure that AIDS is at the top of every country's agenda in the world and that the money is there. So it's because probably I've dealt with various aspects from the virus to the people to the politics. And secondly, I think in general, I'm someone who's more of, let's say, a marathon runner than a sprinter, so I guess we get less easily burned out, take it one step at a time."

GROSS: "What's the most devastating example of AIDS you've seen in your travels around the world?"

PIOT: "One is in Rwanda, you know, a country where one million people were killed in genocide several years ago. And I met with a group of women who were survivors of the genocide and who were HIV positive and who had been raped during the genocide and who their rapists had left alive, as even a worse punishment, if you want, than if they would had been killed. And that we absolutely just -- I couldn't imagine how people could behave like that. And they were without treatment. It's the same story in most developing countries. People with HIV have no treatment. They lose everything."

GROSS: "Maybe you can choose a country for us that you think has been doing an effective job in stopping the spread of AIDS and give us a brief description of what they've done that's been so helpful."

PIOT: ". . . Uganda is in eastern Africa, and in the early '90s, over 20 percent of the adult population in the country were HIV positive. Today that's something around 8 percent; still very high by any standard, but a major drop. . . . Well, there's no secret: hard work, leadership. The president, Museveni, took it on as a national cause, and imposed on all his Cabinet, on all leaders in the country, to talk constantly about AIDS, to take this on in their work. . . . And secondly, far more openness about AIDS. Thirdly, people with HIV got themselves organized. . . . Major investment in sex education for young people, in condom promotion, and it has results in a later age of first sexual intercourse, less sex partners in the population and far more condom use. . . ."

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