Learning & Knowledge
Peter Piot: AIDS: The Need for an Exceptional Response to an Unprecedented Crisis
Presidential Fellows Lecture Series
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Since his early professional years as a doctor in Zaire, Dr.
, Executive Director, UNAIDS, has witnessed first hand, the worldwide spread of AIDS. In the interim, he has been closely involved with policy and project developments to address the growing epidemic. He has served as a member of the National AIDS Committee of Belgium and served as the Associate Director of the Global Programme on AIDS at the World Health Organization. He also supported the launch of Projet SIDA, the first international project on AIDS in Africa. As part of the World Bank’s Presidential Fellows Lecture Series, Piot addressed the global impact of HIV/AIDS and new efforts to respond to the crisis.
The event was chaired by World Bank President,
who commented on collaborations between the World Bank and UNAIDS. He noted that AIDS is not just a health issue, but one that gets to the very heart of development and must be integrated into all activities of the World Bank.
Piot began his address by giving a historical account of his experience confronting AIDS over the past 20 years. He noted that since his first diagnosis of AIDS while working in Kinshasa, it was apparent that the world was on the verge of an epidemic. He then reflected on the early challenges of trying to convince the World Bank and other institutions to combat AIDS. He then noted the shift over the past ten years from a reluctance to address the crisis, to AIDS issues being internalized into development agendas. He noted that this is evidence that institutional change is possible.
Piot then provided an overview of the current situation highlighting three key points: the globalization of the epidemic; the growing gender parity in infection rates; and the realization of secondary effects. He noted that the number of infections worldwide is not leveling off. He cited recent studies that predict large increases in AIDS cases in Eastern Europe, Russia, and China and that approximately half of those infected will be women. He noted that the increasing feminization of the disease creates a new set of challenges to address such as gender discrimination and the collapse of households especially those headed by women. In turn, these situations produce a number of secondary effects such as a larger number of orphans and a reduction in healthy workers capable of contributing to national economic output. According to Piot, this loss of human capital will make it even more difficult to deliver services and carry out development initiatives such as the Millennium Development Goals (MDGs).
Even with these daunting challenges, Piot acknowledged that this is also a time of great opportunity and that AIDS is a problem with a solution. He noted that global leaders are working together, many of them for the first time, to take these issues seriously and donors are increasing their financing and advocacy. He also stated that there is evidence that the epidemic can be controlled through the use of prevention efforts and falling drug prices.
Piot then addressed key challenges for the future. He said that more must be done to increase capacity for implementation and to address shortages of human resources, especially teachers and nurses. To do so, will require more treatment through the use of antiretroviral medications. More must also be done to enlist the help of those living with HIV/AIDS to assist with community outreach and prevention efforts. Piot also emphasized the need for greater donor harmonization and accountability. He stated that donors need to agree to coordinated national AIDS strategies, implemented by one national AIDS authority, and nationally-owned monitoring and evaluation systems. He noted that thinking must be changed from short-term projects to generational strategies. According to Piot, the most daunting challenge is overcoming the "exceptionalism" of AIDS. In particular, he noted that the disease is able to spread rapidly while remaining invisible for years at a time. Therefore, new thinking and alternatives to standard approaches will be required.
He concluded by stating that no predictions about the spread of AIDS have been proven to be too pessimistic. He noted that for the situation to improve, changes in both personal and institutional behaviors will be essential. He called on the development community to learn from its past mistakes of ignoring the crisis, and redouble its current efforts on AIDS. Failing to do so now will ensure that problems become larger and more complex in the future, and initiatives such as the MDGs will not be successful.
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