Dimensions of Disease

Article excerpt

International cooperation and the AIDS epidemic

Peter Piot, a native Belgian, was appointed executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS) and assistant secretary general of the United Nations in 1994. He was formerly associate director of the Global Program on AIDS of the World Health Organization and president of the International AIDS Society. A doctor by training and a former professor, Dr. Piot has done extensive field research and is the co-discoverer of the Ebola virus.

Dr. Piot leads UNAIDS in its effort to direct the activities of its organizational members (UNICEF, UNDP, UNFPA, UNESCO, WHO, UNDCP, and the World Bank) as they try to reduce the threat and spread of HIV, provide support for those affected by the epidemic, and address the socioeconomic consequences of the disease. Senior Editor Patty Li spoke with Dr. Piot in February about the international impact and understanding of the AIDS epidemic and its implications for both developing and industrialized nations.

HARVARD INTERNATIONAL REVIEW:

Over 16 million people have died from AIDS since the disease was first recognized, and over 33 million people currently have HIV or AIDS. The AIDS epidemic is having a substantial impact on societies and economies around the world. Has the scope and seriousness of the AIDS problem finally been understood by the international community?

If you are referring to the average person on the street, I do not think so. I don't think people in the Western world can imagine how bad the problem is in the most affected countries. I think there is a much better understanding today in international circles (particularly after the issue was raised in a debate in the UN Security Council) among those who are involved in international politics, development, and economics. This issue has been on the agendas of finance ministers' meetings in Africa, and there's talk now of putting it on the agenda of the next ASEAN summit. The issue is also a high priority for the World Bank, at least in the African region. All of this indicates that the problem is getting more global recognition.

But it is hard for most people to imagine or fully comprehend the dimensions of the crisis. It's even difficult for me to grasp, and I have been working in this field for over 15 years. Every time I visit one of the heavily affected countries, I'm shocked just by the number of orphans. It is hard to imagine that one out of four adults in a country (such as Zimbabwe and Botswana) is carrying HIV and is going to die.

Beyond the serious medical concerns raised by AIDS, what are some of the broader consequences for the affected societies?

Beyond the suffering of individuals who lose their friends and family members, AIDS has a clear economic impact on society in general. AIDS is unique, first because it affects people in the prime of their lives, killing them during their most productive years. Second, it affects both the rich and poor. Most health problems primarily affect the poor, but in this case AIDS also kills the managers, the teachers, the doctors, the engineers. This erosion of human and social capital makes the impact of AIDS extend so far beyond any disease we've seen up to now, especially because it is epidemic. AIDS has a tremendous stigma attached to it, which makes the problem difficult to talk about and get political recognition for. People are afraid to come out and admit they have AIDS because they may lose their jobs, their housing, and so on.

I think it's increasingly clear that the economic impact of AIDS is going to be a major factor of destabilization in the heavily affected countries. Not only are more people being driven into poverty, but there are also so many more orphans and households headed by kids; the world now has an entire generation of what I call desocialized youth. This generation includes kids who haven't been to school, who have no future, who haven't grown up in a normal environment. …