A Brown University symposium opens with the idea that the pandemic has become a security issue for all nations.

01:00 AM EDT on Saturday, April 24, 2004

BY FELICE J. FREYER
Journal Medical Writer

PROVIDENCE -- AIDS is finally on the political agenda of almost every country, bringing resources and "a momentum of hope" that could turn the tide of the deadly pandemic, Dr. Peter Piot, leader of a global AIDS program, told a Brown University audience yesterday.

"We are living in a time of great opportunity when it comes to AIDS," said Piot, the Belgian physician who heads UNAIDS, the AIDS program run by the United Nations and the World Bank.

Nations have come to see that AIDS is not just a medical problem among marginalized people, but a force that decimates populations, destroys economies and destabilizes nations. That makes it a security issue, he said, and "there are no budget ceilings for security, apparently."

"It's become clear to me," Piot said, "that this is a problem with a solution, that this is something that can be stopped, that it's not hopeless."

Piot spoke at the opening session of "Provoking Hope," a weekend symposium on AIDS at Brown that also features Stephen Lewis, the U.N. envoy for HIV/AIDS in Africa; Ira Magaziner, of the Clinton Foundation HIV/AIDS Program; and Dr. Suniti Solomon, the microbiologist who diagnosed the first case of HIV in India, in 1986.

Piot's message of hope yesterday was interspersed with grim statistics and saddening observations. Despite all that is known about preventing AIDS, every Western nation saw an increase in HIV infections last year, a fact that, he said, "probably reflects the marginalization of whole populations."

"Last year, 5 million people became infected. That's a failure of prevention. . . . Last year 3 million people died of AIDS, more than ever before. That's a failure of providing treatment."

Meanwhile, AIDS is spreading rapidly in Asia. In China, the number of new infections is increasing by 30 percent per year.

"It's sad to say, but we are still in the early phases of the epidemic," Piot said. "We're also in the early stages of the full impact of AIDS on society."

Still, a watershed moment came in 2000, when the U.N. Security Council met to discuss AIDS. Once that happened, many heads of state saw the epidemic as important for the first time, even though some already had millions of infected people in their countries. A second watershed was President Bush's pledge of support for the fight against global AIDS in his State of the Union address last year.

Today, Piot said, "When global leaders meet, AIDS is on the agenda."

As a result, funding for AIDS in developing countries has risen from a mere $200 million seven years ago to $4.7 billion last year -- which is still less than half the $10 billion needed.

"AIDS does to society what HIV does to the human body," Piot said. "It undermines the first line of defense."

In some countries, health-care workers and teachers are dying faster than new ones can be trained. Food production is dropping as farmers die. In Swaziland, in southeast Africa, one in six households is headed by a child.

"You can't have business as usual when in the population there's a whole group that disappears," Piot said. Historically, such sudden losses have happened in wartime, but the people killed were mostly men. Now, women are increasingly the victims of AIDS, transmitting the virus to their children and leaving them without their primary caregiver.

This "feminization of the epidemic," Piot said, results from women's biological vulnerability -- with sex, AIDS is more easily transmitted from men to women than vice versa -- as well as women's lack of power, Piot said. In many societies, women cannot refuse sex, let alone insist that their partners wear condoms.

AIDS is, he said, "the ultimate revealer of the inferior position of women throughout the world."

That is why it is critical to develop an HIV-killing gel that women could put in their vaginas without their partners knowing. Such a gel, Piot said, would be the equivalent of the birth-control pill in its revolutionary impact on women's lives.

Before his speech, Piot met informally at Miriam Hospital with doctors and others in the Brown University AIDS Program. He spoke of the importance of addressing AIDS not just as a health issue, but as one involving education, the media, law enforcement and economic development.

Piot said he recently met with the top executives of the world's major media companies and extracted a promise to incorporate AIDS education into their broadcasts, including entertainment programs. "That's really what reaches people," Piot said. "It's not your public service announcement."

The symposium continues today and tomorrow in the Starr Auditorium, MacMillan Hall, 167 Thayer St. It is free and open to the public.