Peter Piot sets out the global political agenda in the fight against HIV/AIDS

AIDS has entered a new era as a major issue on the global political stage, according to Peter Piot, executive director of UNAIDS, who set out the immediate political agenda when he spoke to thousands of delegates at the opening ceremony in Barcelona’s huge Palau St Jordi.

He said it was now important to mobilise the political commitment, to scale up the prevention and treatment work, eliminate stigma, develop a vaccine and find $10 billion a year to fight the virus.

Piot told his audience it now had to fight AIDS on the political stage “where struggles over power and resources are fought”. He said: “Governments promised leadership – all of them – at the UN General Assembly Special Session on AIDS [UNGASS] last year and in innumerable summits. The pharmaceutical industry must keep its promise to make AIDS drugs available to developing countries at affordable prices, and scientists to keep the promise to work where the real needs are, not just where the money and glory lie.”

He said 30 presidents and deputy presidents have made AIDS a priority by taking personal command of their national responses to the health crisis. He said the same was true of the presidents and prime ministers attending the conference.

“Their response signals a new era: the era of AIDS as a global political issue,” said Piot.

He addressed the politicians directly: “World leaders take note: success is possible. Prevention efforts in a growing number of developing countries clearly demonstrate that significant declines in HIV rates are possible. Antiretroviral treatment has slashed mortality in high income countries. Brazil has shown it can be done elsewhere.”

Piot asked why only 30,000 Africans were receiving antiretroviral therapy “when a hundred times that number need it” and why the world has failed to stop the dramatic expansion of HIV. The answer, he said, was about “power and priorities”.

“Treatment is technically feasible in every part of the world. Even the lack of infrastructure is not an excuse – I don’t know a single place in the world where the real reason AIDS treatment is unavailable is that the health infrastructure has exhausted its capacity to deliver it. It’s not knowledge that’s the barrier, it’s the political will.”

And he went on: “Ten billion dollars annually is all it will take for a minimum credible response to the epidemic. It is three times more than is available today. Every funder – governments, business, citizens and the new Global Fund need to get behind this target and start raising their share.”

“The world stood by while AIDS overwhelmed sub-Saharan Africa. Never again. We cannot stand by as passive observers while other continents repeat history, and we must not fail Africa now, in her attempts to turn back the epidemic’s devastation.”

Piot said the first “delivery date” for promises made in the UNGASS Declaration of Commitment is 2003. He said: “When this Conference gathers again in Bangkok [in July 2004] we will know who has delivered on the first UNGASS promises, due to be achieved in 2003.” He warned: “Bangkok will be a time of accountability.”

Piot said that fighting HIV in the future had to draw on the lessons of how it has been fought in the past: “Whenever and wherever we’ve succeeded against AIDS, it has been by challenging power and turning conventional wisdom on its head. Gay men and injecting drug users forced their way to the decision-making table. We have done it before, and now we must do it again.”