The next item on the agenda is a discussion with Dr. Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS. I welcome the delegation to today's meeting, which is a landmark meeting — it is the 100th meeting of the Joint Committee on Foreign Affairs in the 29th Dáil. If we were at the EU, we would break out the champagne at the end of the meeting.
Global Response to HIV/AIDS Epidemic: Discussion with UN.
We have water provided by the State.
Before we commence, I draw attention to the fact that while members of the committee have absolute privilege in respect of utterances made in committee, the same privilege does not apply to witnesses appearing before it. Accordingly, caution should be exercised, particularly with regard to references of a personal nature.
It is our great pleasure this afternoon to welcome to Ireland and to our meeting Dr. Peter Piot. Dr. Piot is the executive director of the Joint United Nations Programme on HIV/AIDS and is here to address the committee on the global response to the HIV/AIDS epidemic. Dr. Piot is accompanied by his assistant, Mr. Morten Ussing, and Ms Nicola Brennan from the Department of Foreign Affairs. Dr. Vincent O'Neill from Irish Aid is also here.
Dr. Piot has served in his position since the establishment of Joint United Nations Programme on HIV/AIDS in 1995 and under his leadership the programme has become the chief advocate for worldwide action against HIV and AIDS. He is a distinguished academic who has had a substantial and significant scientific career. He has done a great deal of work to establish the foundation of our understanding of HIV and AIDS.
The global statistics on HIV and AIDS are shocking. A total of 39.5 million people were living with HIV in 2006. That figure continues to grow at an alarming rate. It represents an increase of 2.6 million on the figure for 2004 and includes 4.3 million adults and children who were infected in the past 12 months.
Sub-Saharan Africa is worst affected by this epidemic. Two thirds of all adults and children in the world with HIV live in that region. The impact of the epidemic on weak and vulnerable societies particularly in Africa is devastating. It has reversed development gains, rapidly decreased life expectancy and undermined advances in education and literacy. It is particularly depressing that more than 14 million children under the age of 15 have lost one or both parents to AIDS, mostly in Africa.
In face of these facts international governments have a clear obligation to take every action possible to combat this epidemic and ease the plight of victims. Ireland is strongly committed to the fight against AIDS and Irish Aid is fully committed to addressing the challenge through national and international policy, and through financial commitments. Many members of the committee have travelled in Africa and supported and seen the work done in this effort.
I call on Dr. Piot to make his presentation to the committee.
Dr. Peter Piot
I thank the Chairman for inviting me to this committee and congratulate the committee on holding its centennial session. I am pleased to be back in Ireland which is a key partner in the Joint United Nations Programme on HIV/AIDS and is a growing actor in the whole area of international development. I have also had the pleasure on two occasions to attend the UN General Assembly with the Taoiseach who was the only Head of Government to attend both special sessions of the General Assembly devoted to AIDS. These sessions, particularly that held in 2001, were turning points in the global response to AIDS. After this session funding to combat AIDS in developing countries rose dramatically and 40 Heads of Government and State from the developing world took personal charge of the fight against AIDS. They recognised it was a security issue affecting the survival of their nations that required the involvement of every sector, which in turn required leadership from the top.
This morning I signed a co-operation agreement for five years with the Minister of State at the Department of Foreign Affairs, Deputy Conor Lenihan. We appreciate not only the financial support this promises but also that this is a multi-annual agreement because predictability of funding is an important factor. Lack of it is often a problem not only for international organisations, which is the least of the problems but also for the developing countries. We have a privileged relationship with Irish Aid and can speak the truth in a constructive way and then make the best move. I also applaud the fact that more than 10% of Irish overseas development aid resources is spent on the response to AIDS, an example for other donors. It is appropriate because 25 years after AIDS was described for the first time, it has become one of the make or break issues of our time. In sub-Saharan Africa, if the AIDS epidemic cannot be brought under control, we can forget about development in general. Members have travelled in Africa and will have seen it with their own eyes but this is a global problem. Under the 2004 Irish EU Presidency, a conference was held on AIDS in Europe. That was a turning point because it was an eye-opener for the European Commission and member states. Much action has been taken since then. In several months, the German EU Presidency will hold a similar conference which will be opened by the German Chancellor, Angela Merkel. AIDS is spreading in eastern Europe and the former Soviet republics at the fastest rate in the world. We must consider this a global issue.
It is important for me that the leadership in the response to AIDS is broadly based. I am happy this is happening in Ireland with a technical advisory group established from various Departments. The UN AIDS programme has promoted the idea that this is not just a matter for doctors and the health sector. The impact of AIDS goes far beyond that. One of my goals when I took this job ten years ago was to develop a broad coalition. I was convinced we could not stop this epidemic if it remained in the domain of AIDS doctors and activists. It must be a broad coalition with the churches, business, education system, legal system and armed forces. We do much work with peacekeeping operations for example. All these groups must be brought together in a broad front.
The AIDS epidemic is quite grim. I could give many statistics. Some 25 years ago, it was described as a mystery disease in five homosexual men in California. In the meantime it has become the world's leading cause of death among both women and men under 60 years of age. Up to 65 million people have cumulatively become infected, of whom 25 million have died.
I see three trends in the epidemic. The first is globalisation. The first outbreaks were in the West and Africa, particularly southern Africa, spreading to eastern Europe and parts of Asia. It is linked with economic development as much as it is with poverty. The second trend is the feminisation of the epidemic. It started as a problem for white homosexual men. Now 50% of all people living with HIV in the world are women. This proportion is growing in every region; in Africa it is close to 60%. That has many implications on how we approach the problem. More children will be become infected if measures are not taken. The third trend we are beginning to see is the impact of AIDS. The Chairman referred to orphans. However, in southern Africa, we have seen an increase in by-elections because members of parliament have been dying from AIDS. Zambia has had a phenomenal increase for that reason. In other words, leaders and society's brightest are affected just as badly, with a very significant impact quite apart from driving families into poverty and hampering business.
All the same, we have now built up real momentum in the fight against AIDS on which we should capitalise. There is political momentum, with strong leadership in many countries. I mentioned how it started in 2001, and it is as true of the developed world as of developing countries. The situation is not as it should be everywhere, and that will always be a challenge for us. Looking into the future, I am concerned about sustained political leadership.
Second, there is certainly funding momentum. When the Joint United Nations Programme on HIV/AIDS was created in 1996, approximately $250 million was spent on fighting AIDS in developing countries. Last year, we estimated that the total was close to $9 billion. It is not only donor money, since to a large extent funding comes from developing countries and from the pockets of poor people.
Third, and most importantly, there is momentum when it comes to results. Last May, as it does every two years, the Joint United Nations Programme on HIV/AIDS issued a report on the global AIDS pandemic. For the first time, we could provide some hopeful facts. There are now approximately 2 million people with access to anti-retroviral therapy in the developing world, whereas five years ago the figure was approximately 150,000, most of them in Brazil, the first developing country to offer the therapy to its citizens free of charge. Now there are approximately 2 million such people, saving several hundred thousand lives through employing substantial capital. We should not forget that approximately 3 million people died from AIDS in 2006, some 8,000 per day.
Results can also be seen in the reduction in rates of infection, which is our ultimate goal. We see that in east Africa. In Ethiopia, Rwanda, Kenya and Tanzania there has been a decline in new infections, especially among young people. We are not there yet, but for the first time, instead of saying that the epidemic is getting worse in every country, we can report a decline. We see that in some of the southern Indian states, many of which are bigger than almost any individual African country. We also see it in Cambodia and the Caribbean. In economic or business terms, we are finally starting to see a return on our investment. However, we still have a long way to go.
Before concluding, I will move to what I see as the main challenges for the future and our priorities in the Joint United Nations Programme on HIV/AIDS. Our first priority is to sustain leadership. This year President Obasanjo of Nigeria will retire, and President Konaré, the head of the African Union, is to be replaced this week. Both were very strong advocates in the fight against AIDS. We are also seeing a change in leadership in the large, high-income countries. How will we sustain leadership, not only at that level, but in every business and community? The reality is that AIDS will be with us for a lengthy period, since it is now part of life. We must see that we reduce the impact as much as possible.
Second, the overall priority of the Joint United Nations Programme on HIV/AIDS is, as we say in our slogan, "making the money work for people on the ground". We must ensure that all this development money reaches those who need it and that it is used to good effect. That is the prime task of the Joint United Nations Programme on HIV/AIDS, and I believe it will remain so for many years. It is about improved co-ordination in terms of better use of resources for aid so that there is less duplication and fewer gaps. It is incumbent on us to work in a complementary fashion with the global fund to fight AIDS, tuberculosis and malaria, which is the largest source of multilateral funding for HIV/AIDS. That synergy is getting better all the time. The global fund is an investment fund with staff in Geneva. Some 80% of Joint United Nations Programme on HIV/AIDS resources is in the field, in the developing countries and we know how to unblock problems and provide technical assistance. We are also involved in strengthening the engagement of civil society. While the leadership of a state is essential, it is crucial that civil society groups have the resources to reach the people who need aid.
One of the main tasks for us is in monitoring evaluation, and we are quite competent now in this regard. We evaluate programmes so that we know precisely what is happening, what the impact is and where the money is going. A third priority is strengthening HIV/AIDS prevention. With close to 12,000 new infections in the world every single day, there is no way to offer treatment for everybody. We must do everything we can to save the lives of those who, unfortunately, are already living with HIV/AIDS, and we need to ensure that the young generation in particular is HIV-free. That is not so easy partly because we are touching on deep beliefs as regards sexuality, drugs, gender inequality, etc., but there is no choice. In the long run, many societies will have to change their social norms and what is acceptable in terms of sexual behaviour. This will require a major effort and we are working on that.
A fourth priority is the need to ensure that while HIV/AIDS involves crisis management, now that we are starting to get ahead of the epidemic in some countries, it is important to address what is driving it, for example, stigma and discrimination. At the same time I applaud the anti-stigma campaign that is taking place, domestically, here in Ireland. That is really an example for other countries. After all, good practice starts at home, before we can preach to others, because the discrimination and the AIDS-related stigma exist everywhere, including Europe. We need to address the fundamental drivers of this epidemic, as regards gender inequality, homosexuality and deprivation. In terms of the challenge for the future, we need to develop a long-term agenda. How are we to maintain the millions of people on treatment? Who is to pay for that and where will the money come from? Where will new drugs come from? What is the level of social sustainability and so on? These are unanswered questions that we are working on now at the Joint United Nations Programme on HIV/AIDS to ensure the decisions we take today are informed and will lead to the best possible outcomes in the long run.
The Joint United Nations Programme on HIV/AIDS is a special animal within the UN system. It is a programme that co-ordinates the HIV/AIDS efforts of ten UN-system organisations, from the World Bank to the World Health Organisation, UNICEF and so on, ensuring that each of them delivers in its specific area and that there is no duplication, to ensure maximisation of our efforts. We are ten years old and have also been at the forefront of reform initiatives to make the UN more effective globally by ensuring there is policy coherence. We all speak with the same voice and have the same policies — all that took quite a while — particularly at individual country level. There are now 40 countries where everybody working on AIDS across the system sings from the same hymn sheet, and with appropriate divisions of labour where everyone is part of the one team and is accountable. We are also introducing a number of management reforms, including performance-based pay, mobility and other measures to make us more effective.
I am glad to share with the committee our position on the AIDS epidemic and the big challenges for the Joint United Nations Programme on HIV/AIDS. I am looking forward to the views and suggestions of committee members. I again thank them for the wonderful support we have received from Ireland.
Thank you, Dr. Piot, for the informative presentation. Time does not allow for a great deal more, but you are on top of the situation. The HIV/AIDS epidemic is truly shocking and presents a great challenge to the international community. We are all humbled by what you have told us today and we wish you continued success in your work. The Taoiseach, the Government and the Opposition have shown a strong commitment to this issue.
It is shocking that there has been a 50% increase in this disease in eastern Europe and Asia between 2004 and 2006. That is a warning to all of us. We are aware of much of the work of missionaries and NGOs as we have done considerable work with them. The fact that your organisation has reached 2 million people with the anti-retroviral therapy in a relatively short time is an extraordinary achievement. Will you comment on the emergence of an untreatable tuberculosis among AIDS sufferers? That represents a major challenge as it is a very serious situation.
I join the Chairman in welcoming Dr. Piot and applauding his work. It is salutary that a distinguished scientist can give such public service in a way that benefits humanity when so many scientists have had their professional lives locked up in weapons of mass destruction, especially in nuclear weapons. We will gain enormously from keeping in touch with the Joint United Nations Programme on HIV/AIDS as we stay in touch with Irish Aid.
Dr. Piot has achieved a great feat in co-ordinating ten agencies of the UN on the ground. For someone who has worked in the development area for a long time, one of the great disappointments to me is how far we are from a rights-based perspective in development. We are far away from the vindication of the right to development, or the right to be treated equally, which is in the universal declaration of human rights. Within that failure, the different forms of activity break into factions. I am not convinced that the UNDP has adequately addressed the issue of the importance of having an integrated AIDS strategy, in terms of prevention and in terms of consequences.
In the short time available, I would like to list a few points. My background is as a sociologist. There has been a failure regarding social sciences, which is based mainly on prejudice against having an adequate cross-cultural sociology of sexual practice. In looking at the African continent, it is hard to find that the migratory experience is not central in the analysis. The figures certainly show this, if one considers the figures for Lesotho, South Africa and so forth. Tools of sociology and social anthropology were developed in the 19th century when Africa was being examined as the location of exotic peoples, but they are not being applied now within programmes to the degree to which they could, with wonderful results.
We must also think about social policy issues. I very much agree with the suggestion made in the presentation with regard to the multifarious consequences of HIV infection — for example, it is related in a micro way to the lower participation rate of female children in education in terms of who stays at home to look after the person who is ill and so forth. We should match the figures for the pledges made and state how near or how far they are from the millennium development goals that are required to be achieved with regard to HIV/AIDS. I am glad reference is made to orphans, as it would be worth developing a separate programme relating to the participation of orphans in the education process.
My final point is that when history comes to be written, no African leader will be respected for having used sovereignty as a basis for putting a barrier of ignorance between the people and the universal right of all citizens on the planet to have access not just to information but also to anti-retroviral drugs, which should be a basic right.
I welcome Dr. Piot and his colleagues. How important is education in AIDS prevention, particularly in western Europe? What percentage of the budget is being spent? I come from a teaching background. I taught social geography but seldom heard it mentioned in school, even in religious classes. I would like to hear Dr. Piot's opinion on this. How much of the sum of €9 billion goes on research? Are we any closer to finding a cure? Does Dr. Piot have statistics for western Europe, given that the figures for eastern Europe have increased by 50%? I am particularly interested in statistics for Ireland, if he has any. Is anti-retroviral therapy the answer? Speaking purely from ignorance, it does not prevent the disease.
I welcome Dr. Piot. I had the pleasure of hearing him speak at a conference in Lisbon some years ago and was very impressed. Those were much darker days in the sense that there was no light on the horizon, no anti-retroviral treatment and no prospect of a vaccine. I am glad Dr. Piot finds the situation here positive, although hypocrisy is partly responsible for this.
I was involved in the very early days before AIDS had been named as a leader in the gay community implementing a programme, when it was illegal under the Indecent Advertisements Act to provide information such as this. I authorised a mass education programme which had the result of reversing the trend. As one can imagine, somebody from my background has a particular sensitivity to this issue which I have raised on many occasions at the Interparliamentary Union and in places such as India where the presence of the disease was denied. When I requested the excellent ambassador in India to get me profiles of the 88 organisations working with AIDS, only one mentioned gay men. In the Ashok Hotel, where the conference was being held, the first national AIDS conference had been held the previous year but women sex workers and homosexual men had been excluded by the police force. This ignorance is a disaster.
The churches were referred to by Dr. Piot and the Chairman. I am a practising Anglican. I am horrified by the attitudes of all religions. There may be a few positive patches but, by and large, it has been an absolute moral disaster. I know Dr. Piot must be diplomatic but I am an Independent Member of the Upper House and do not suffer such constraints. I can say the impact of the Roman Catholic Church, for example, has been extraordinarily negative, although I am glad to see there is a degree of change in prospect.
Within my own church, the Anglican archbishop of Nigeria, Peter Akinola, is a disgrace. His ignorant views on sexual matters are tolerated because he is black. People are afraid to challenge him in case they are accused of being racist. In addition, internal politics within the Anglican Church have allowed him to get away with his behaviour. Similar problems arise in respect of Islam. The United Nations is a compendium of many different cultural and religious traditions. Does Dr. Piot find it difficult to implement positive changes because of the prejudices of Islam, Christianity and other groups?
Dr. Piot made particular reference to sub-Saharan Africa and Africa in general. Nigeria, the jurisdiction of Archbishop Akinola, has just enacted laws further criminalising not only homosexual behaviour but also those who provide assistance to gay people. This represents a time bomb. It must be difficult to stand up against such restrictions. As a Christian, I am deeply ashamed of the attitude of the religious group to which I continue to have an affiliation. That attitude has been virtually uniformly negative.
In places where there is an increase in the incidence of HIV infection, including parts of sub-Saharan Africa, we can see the impact of Islam. This meeting will include a consideration of a motion on Iran, for instance, where 16 year old mentally handicapped girls who were raped by their neighbours have been hanged for offences against chastity. Homosexual people receive the same treatment in that country. Similar prejudice is evident in parts of eastern Europe. In Poland, for example, the most reactionary government in Europe oversees a campaign of xenophobic attitudes towards Jews facilitated by the state's appalling radio stations. It is no surprise that there are explosions of HIV infection in these areas.
How does the Joint United Nations Programme on HIV/AIDS respond, in its diplomatic role, to the churches on these matters? How can Ireland, a country whose people are only recently released from ignorance and subservience in matters of sexuality, help Dr. Piot in the international forum? I very much welcome his compliments to the Taoiseach.
I endorse other members' welcome for Dr. Piot. The first time I became aware of his activities, strangely enough, was in a Hollywood context. I am sure he is aware of the movie "Outbreak", starring Dustin Hoffman.
Dr. Piot
Yes.
A question I wised to put to him in the context of this film was whether he believed there is any credibility to the notion that we in the West should be concerned that we no longer hear so much about the exceptionally lethal ebola virus.
My experience of efforts to deal with the HIV/AIDS epidemic is based on a visit I made to Zambia 18 months ago as part of an Ireland Aid contingent. I met people being treated with anti-retroviral medication, ARVs, and could see the effect of that treatment from photographs of the same patients taken some years before. It was astonishing to see the improvement. I also met AIDS sufferers in the compounds in Zambia, people for whom there is no hope. This is a country where the average mortality rate is 32 years of age.
In contrast to the opinions voiced by my friend and colleague, Senator Norris, I found that church workers in Zambia, including those working in the archdiocese of Lusaka, for example, are doing extraordinary work. I saw widows of AIDS victims bringing ARVs to people in the compounds. Our contingent travelled through the copper belt, including Ndola, where we met religious brothers and sisters who operate under exceptionally difficult challenges in coping with the suffering caused by AIDS. My experience in seeing these efforts at first hand puts me at variance with the perhaps more ideological view of Senator Norris in attacking the various churches at a more established level. We must be careful not to throw out the baby with the bath water because exceptional work is being done.
In his speech in Lusaka, was Dr. Piot making oblique reference to Zambian society and culture? Astonishingly, I found that many women who could have been tested and who would have had access to anti-retrovirals were being denied such access by their husbands for cultural reasons. It appears there was a gap between what was desired by the Government and the Joint United Nations Programme on HIV/AIDS and the reality. This appears to be part of the problem. I repeat my question as to whether expansion of the AIDS virus in the sub-Saharan region is in part caused by cultural obstacles and whether Dr. Piot, his associates and the various Governments might have made more progress.
How can the cultural issue be addressed? For example, I am sure Dr. Piot has seen a billboard in downtown Lusaka for the sale of roof tiles. However, I was astonished to note that it drew a certain comparison. It attempted to draw attention to what appears to be a prevalent belief among the male population of sub-Saharan Africa, namely, that having sex with babies and children will somehow prevent one from contracting AIDS. There are public information billboards to that effect.
While I appreciate that time is short, my perception is that although the Joint United Nations Programme on HIV/AIDS tries to address such issues, there is a gap between its expenditure, agendas and priorities and the actual cultural reasons. Perhaps the male population of sub-Saharan Africa is as great a stumbling block to the erosion of AIDS as is anything else.
It is now almost 3.15 p.m. While Deputy Carey was most anxious to contribute, he has been obliged to leave. He is also joint chairman of the British-Irish Interparliamentary Body and consequently has been obliged to leave. He has travelled with me on some of the joint committee's visits and is greatly concerned by this issue.
There are a number of significant issues, including feminisation and many matters that flow from it. Members encountered high rates of incidence among teachers and this was highly disappointing because they found themselves in difficulties despite having had the benefit of education. This was for a range of reasons, some of which were mentioned by Senator Mooney. The presence of 14 million orphans means one must follow through on this issue. Members witnessed the scale of work that is required in this regard and saw some non-governmental organisation, NGOs, and missionaries carrying out such work. Unless this is done, such orphans are at enormous risk. Dr. Piot may wish to make a brief response.
Dr. Piot
I thank the Chairman. First, we are happy to stay in touch through Irish Aid and to provide all the information. I promise it will be in small and concise papers rather than in large volumes.
In response to Deputy Higgins, we take a rights-based approach to this epidemic. I say this because at some point one needs to make some judgments. On the one hand, the scientific evidence we possess should guide us as to where our money should be put. In addition however, based on the right to life, we must also consider the value placed on the lives of the poorest, the most marginal and the discriminated. Our guiding light in this respect is the Universal Declaration on Human Rights. I will return to this point because it pertains to several aspects.
I agree with the Deputy that we have failed to involve social anthropology and the social sciences in general. We are now trying to so do by developing new programmes, in which we attempt to ascertain the nature of the epidemic and to analyse the situation locally, both biomedically and in terms of the identities of the people behind the figures and the reasons they are vulnerable. Sexuality is not endocrinology and is not simply a matter of hormones. It takes place in certain contexts, including legal, cultural and so on. We must involve the social sciences to a far greater extent for a long-term response. At present, we have a group that is considering what we call positive social change, to ensure this helps the AIDS epidemic.
As for the issue of orphans, although our cosponsor, UNICEF, carries out some excellent work, we are struggling with it. What is the best approach in places such as Zambia, in which there are so many orphans? What is the best way to handle that? The extended family which consists mostly of poor people is already enormously stressed but orphanages are not the solution. We need a community approach where we do not distinguish between and discriminate against non-AIDS orphans and AIDS orphans. It is a matter to which we will have to pay far more attention. Even in eastern Europe there are thousands of orphans because of AIDS.
Education is extremely important. At the beginning of an epidemic all over the world it is often the most educated who are infected most. I heard that in China the risk factor for AIDS was a mobile man with money. Once there is a prevention campaign I understand the most educated respond best, particularly girls who have been through secondary school. They will marry later, have more job opportunities, be less likely to go into prostitution through transactional sex and go less with "sugar daddies" than some. All this means that it is absolutely vital AIDS prevention becomes a normal part of the curriculum. This requires two things to happen: first, that teachers know what to say to children, as communicating about sexuality is not easy. There are different ways of doing this and it should form part of a life skills programme. Second, teachers should give good example: I am not infecting the girls and the boys, which is the case. This is a big issue which is high on our agenda. I wish that the fast-track initiative of education for all would devote more attention to and incorporate AIDS prevention much more as part of the reality of the 21st century.
Statistics for western Europe show that in 2005, the latest year for which statistics are available, in the United Kingdom there were 7,500 new infections. The total number living with HIV was 75,000. In other words, in one year an extra 10% was added to the number. All over western Europe there is an increase in the number of new infections brought about by a combination of younger and older gay men, the fact that people do not die any more in western Europe from AIDS as a result of treatment, and migrant populations from parts of the world where there is a high incidence of AIDS which is prevalent in every country in western Europe. It is a big issue. It is important therefore that efforts at home continue. While this is a committee concerned with foreign affairs, the problem is encountered everywhere.
I should say to Senator Norris that the Joint United Nations Programme on HIV/AIDS pays extra attention to marginalised groups in society. In India there has been a sea change also. Last September a major conference took place on male sexuality and gay men in Asia and the Pacific region attended by representatives of most governments and local groups trying to start dialogue. It is clear that the criminalisation of homosexuality is a factor that promotes the spread of HIV. This is happening in a number of countries in the Caribbean, including the Bahamas. There is also a debate taking place in Barbados on abolishing these laws. Looking at it from a pragmatic perspective, it makes our work very difficult.
I would not agree that all religions are bad in terms of their response to AIDS. In a sense no religion is monolithic. Speaking about the church, I was in Windsor Castle where there is an Anglican think-tank, the name of which escapes me. There are various opinions on the issue but we work with those who are open to the idea. The churches have done a great job but I must confess that 15 years ago I had major difficulties. I saw most churches and religions as a major obstacle to our work but I have changed my opinion and I see that they can be major allies. The easier part is the care and compassion, but there is no doubt there has been much discrimination and stigmatisation within the churches in that regard. Even some of the evangelical churches in the United States, which I believe are at the basis of the reason President Bush, perhaps unexpectedly, took a leadership role in the fight against AIDS and put $15 billion on the table in 2003 in his State of the Union address, which surprised everybody—
He did it in his application.
Dr. Piot
I will come to that also but the reason he did that, which his predecessor did not do, is that there was a strong push from what we would call religious Christian groups, particularly on the fundamentalist side, and that gave a broad support. We do not agree with everything that is in the programme because it is not based on science, but the pragmatism I see, particularly in Africa, is a major change from previously. If I am not wrong, Desmond Tutu is an Anglican. There was a poster on which he was quoted, with his characteristic smile, as saying that sex is a beautiful gift from God, and he is the Archbishop of South Africa.
There are major debates going on. From day one I engaged in a dialogue with the Catholic Church. Coming from Flanders, which used to have as many missionaries as Ireland in the old days — every family had at least one member who was a nun or a priest — I have seen how one can turn this into either a problem or an advantage. We have had many dialogues. We have even brought together the various components of the Catholic Church dealing with AIDS because they were not talking to each other. That is the type of thing we have been doing in UNAIDS.
It is important to determine what are the expectations of each other. I do not expect that, say, the Church would promote condoms but sexuality exists to transmit life and bring couples together, not to transmit death, as is the case with AIDS. That is where protection, the condom, is a moral imperative. There are theologians who will say the same. We brought together Christian theologians in Windhoek in Namibia to debate among themselves. I am a strong believer in peer education, not only for teenagers but bishops to bishops and businessmen to businessmen. That works much better than me telling them what is good for them.
We have made much progress but we need to continue the dialogue. I am not well known for being a diplomat but I am a pragmatist and I have one objective, that is, to save lives in this epidemic. We need a major coalition. Last year I made a speech at Georgetown University, which members will be aware is a Jesuit university in Washington, about diverse voices but a common cause. We must determine how we can work together without preventing others from expressing themselves. That is where the issue of homosexuality and criminalisation comes in.
I started my medical career with the discovery of the ebola virus in 1976, which reminds me of my age. Ebola outbreaks arise regularly. They are spectacular but the advantage, if I may be somewhat cynical, is that people die from it immediately. The person is dead within a week or two, whereas AIDS is a silent epidemic. One could be totally healthy for ten years not knowing one had it, transmit it and so on. That is the perversity of HIV.
We had a board meeting of the programme co-ordination board of UNAIDS, which is like the board of directors, in Lusaka in December at which I had an opportunity to see what was going on. I travel a great deal and sit down with people to listen to what they believe we can do, as against the notion of what are we cooking up in Geneva.
For the long run there is a need to start seriously addressing the drivers of this epidemic. They are linked to culture and there are extreme examples. As to why southern Africa has such a major AIDS epidemic, a large part of that is the legacy of apartheid, which broke up families. Men worked in the mines for 11 months, they lived in compounds and prostitution was prevalent. This is the best possible way of spreading a virus. There is also gender based violence, violence against women and the sugar daddy phenomenon, where girls, in order to have a uniform to go to school, have a relationship with an older man. These are issues we must address, in the same way as we must be upfront about tackling homophobia and so on, because they also partly drive this epidemic.
An exciting aspect of AIDS is that while, sadly, it reveals the inequities and injustices in societies, it can help overcome these injustices. For example, with AIDS, the reality of the exploitation of women and the inferior position of women in many parts of the world becomes directly linked to death. My hope for the future is that we can turn around this position, in the same way as AIDS, in essence, contributed to gay emancipation in the 1980s. That is what we should work on, otherwise we will not fix it. This epidemic does not have a technological fix. We need a vaccine and treatment but science and technology must work in hand in hand with positive social change, which is related to gender in the first instance.
I said to the ambassador to India that matters had changed dramatically there, particularly with the current government having made AIDS one of the elements of the common minimum programme. It has devoted considerable resources to this issue and to promoting openness around it. There are some results on the ground but we need to work at the community level to make a difference in tackling this epidemic.
I thank Dr. Piot for his contribution. We realise the limitations on his time. What he said rings many bells with us, as we have been going through similar processes in examining how the virus is spread and the problems that arise. AIDS is a multifaceted problem, the addressing of which is deeply linked to the community, the development of education and all the other areas in which we are involved. This means that everybody at every level must be interested in it because we all have a part to play in tackling it.
Dr. Piot did not mention TB-related illness. I would be interested to hear his view on it.
Dr. Piot
The emergence of untreatable tuberculosis in southern Africa illustrates that the impact of AIDS goes far beyond the individual who dies from AIDS. Often with tuberculosis, a disease which has been around forever, so to speak, an epidemic occurs because many people with HIV develop tuberculosis due to the decline in their immunity. This is similar to what happened in the place from where I come during the German occupation in the Second World War. People were suffering from malnutrition and many people developed TB because their immune system was very low. However, we now have untreatable tuberculosis. One can catch TB on a bus but not normally AIDS.
The emergence of this problem is a major concern for us. We have to make sure that we can develop containment measures but its emergence illustrates that innovation, research and development in tackling and treating diseases such as TB and malaria have been neglected for many years because these diseases only occurred in the developing world. It is a worrying development of the past year.
We had similar problems in Ireland during the war and in the post-war period. You are correct that it has largely been forgotten now. In fact, many medical people would not recognise it in practice, although obviously they have learned about it. It demonstrates one of the great dangers that can emerge and also the importance of developing the long-term agenda of treatment and research. They are big challenges.
I thank Dr. Piot, Mr. Ussing and Ms Brennan, and Dr. O'Neill of Irish Aid. You can be assured of our support for your work.
Sitting suspended at 3.36 p.m. and resumed at 3.38 p.m.