The author interviewed Dr. Piot regarding the AIDS crisis in Eastern Europe:
 

VVS: Dr. Piot, is the window of opportunity to prevent a wide-scale AIDS epidemic in Eastern Europe still open? 

PP: There is still an enormous opportunity to make a significant impact on the future epidemic in Eastern Europe through massive prevention efforts to reduce young people’s sexual and drug injecting risk behaviour. I have, however, become more wary of using the phrase “window of opportunity”. To some it may give the impression that the HIV/AIDS epidemic in Eastern Europe can be solved with a quick fix. To others it may give room for defeatism and complacency, as they observe the sky-rocketing increase of reported HIV cases in recent years, representing the fastest growing epidemic in the world. We can make a major difference in the course of the epidemic, but only through a determined, long-term sustainable and massive effort involving all sectors of society.

VVS: What is the single most important factor that will determine the AIDS epidemic's size in Eastern Europe? 

PP: Country leadership at all levels to support community and civil society-based efforts in HIV/AIDS prevention and care. I am linking the two – top down and bottom up – because one cannot work without the other. 

VVS: I was very impressed with the “UNAIDS Handbook for Legislators on HIV/AIDS, Law and Human Rights”, which I picked up at a recent Health and Human Rights Conference commemorating Dr. Jonathan Mann. Has this handbook been translated and given to Parliamentarians in Ukraine and Eastern Europe? If so, how has it been received? Does UNAIDS provide assistance beyond the guide to governments regarding the human rights aspects of AIDS?

PP: Yes, the handbook is a very practical and concrete tool. It has been translated into Russian and widely distributed in the region. We have trained a network of lawyers and legal experts in the countries concerned. Generally, human rights is a cross-cutting principle that is mainstreamed into all activities. Successful HIV/AIDS prevention and care can only be achieved if human rights are respected and safeguarded.

VVS: What advice should be given to donors and developing country policy makers in Ukraine and Eastern Europe concerning international assistance for HIV/AIDS in general and ARV therapy[1] in particular?

PP: In the long run a large part of the necessary resources will have to come from the countries themselves. Some of the countries have, however, become deeply impoverished during the process of social and economic transition following the breakdown of the Soviet Union. These countries are in urgent need of international assistance to avoid a further deterioration of the social and economic regression caused by a devastating HIV/AIDS epidemic. Experience has shown that even the countries that are better off will hardly be able and ready to mobilize sufficient resources in the short-term for the massive early intervention efforts that are needed to curb the epidemic and keep the countries on the right track for social and economic development. Moreover, within the countries there are huge segments of the population living under very poor conditions. Therefore, any donor interested in supporting the social and economic development of the region should also consider investing in HIV/AIDS prevention and care.

There is a growing demand for access to care including ARVs arising from governments, people living with HIV/AIDS and civil society organizations in the region, as thousands of people are becoming ill. We support the development of national action plans for access to care. These plans form the basis for negotiations between the countries and pharmaceutical companies on price reductions for ARVs, and, at the same time, serve to strengthen the capacity of the health system in the countries to deliver comprehensive care for people living with HIV/AIDS. Traditionally some donors have shunned away from support to care, and the expensive ARVs, especially in regions with low HIV prevalence rates, thinking that prevention should be the first and only priority. Prevention remains the mainstay of the response, but we have become increasingly aware that prevention and care are intrinsically linked and go hand in hand. This is one of the important principles that came out of the UN General Assembly Special Session on HIV/AIDS in New York last year, and was endorsed by Heads of State in the Declaration of Commitment, which was adopted at the Special Session.

VVS: Is there significant AIDS activism in Ukraine or Eastern Europe? Are AIDS activist organizationsin the U.S. or other Westerncountries doing anything to help those in Eastern Europesince your announcement on the AIDS epidemic in Eastern Europe? What can individuals do to help? Have any Western AIDS service and support organizations, developed partnerships with any AIDS activist groups and NGOs in Ukraine or Eastern Europe? IsUNAIDS working with anyinitiatives oflinking up AIDS activists, or is there too little civil society in Eastern Europe to link up with?

PP: As I stated above, experiences from around the world show that a successful response requires government leadership in partnership with civil society. I firmly believe that this is true for Eastern Europe as well, though several peculiarities of the region have delayed the emergence of a strong civil society response and partnership in the region. During the Communist era there was little room for civil society movements. It is only within the last decade that civil society organizations have emerged and today represent a fragile, yet vibrant and important part of society. The partnership formed between the government of Ukraine, people living with HIV/AIDS and other civil society organizations represents an encouraging example, which I am confident other countries in the region will soon follow. Collaboration with Western activist organizations has been somewhat hampered by language and cultural barriers, but organizations have emerged and today represent a fragile, yet vibrant and important part of society. The partnership formed between the government of Ukraine, people living with HIV/AIDS and other civil society organizations represents an encouraging example, which I am confident other countries in the region will soon follow. Collaboration with Western activist organizations has been somewhat hampered by language and cultural barriers, but organizations like the Open Society Institute, Médecins Sans Frontières, and Médecins du Monde have worked hard to support the establishment of hundreds of projects in collaboration with civil society organizations in the region.

VVS: How would you rate the countries of Eastern Europe’s infrastructure and capacity to provide any HIV/AIDS-related services; whether through prevention programs; voluntary, anonymous counseling and testing; treatment; or care and support programs?

PP: While the health systems and general infrastructure in many Eastern European countries have suffered from the economic hardship and cutback in public spending, the capacity of the region remains in general at a good level. This is particularly true when it comes to human resources. People are in general well educated and the illiteracy rate is very low. There is, however, a huge need for training and capacity building especially in the areas and approaches to prevention and care, which are new to the region. There is also a strong need to move away from the traditional vertical structures and from often rather oppressive approaches, towards multisectoral responses firmly grounded in principles of human rights and empowerment. I am amazed to see how quickly Eastern European countries have picked up lessons learnt from around the world in such a short timeframe. We are currently facing a tremendous resource gap at all levels with regard to the AIDS response, but I feel confident that funding can be scaled up in the not too distant future through five major channels – the budgets of countries themselves, bilateral donors, multilateral organizations, international NGOs and the private sector, and the Global Fund to fight AIDS, TB and Malaria. 

VVS: Thank you Dr. Piot. 

Also of interest:

AIDS SITUATION ANALYSIS IN UKRAINE

Heads of State in the Declaration of Commitment

Testimony to the hearing of the Committee on Foreign Relations of the United States Senate on 'Halting the Global Spread of HIV/AIDS: the Future of U.S. Bilateral and Multilateral Responses

by
Peter Piot, UNAIDS Executive Director 

Washington, 13 February 2002

United Nations General Assembly Special Session on HIV/AIDS