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Last Updated: Monday, 17 November, 2003, 11:54 GMT
Talking Point: You asked the head of UNAids
A hospice worker gives an Aids patient his medicine in San Jose, Costa Rica
As part of a BBC season on Aids, you put your questions to our panel of experts in a special two-hour edition of Talking Point, our worldwide phone-in programme.

HOUR ONE:


  • Transcript - Part I

    In the first hour of the programme, we spoke to the Head of UNAids Peter Piot.


    HOUR TWO:


  • Transcript - Part II

    In the second hour of the programme, we were joined by Carol Bellamy of Unicef and actress / campaigner Gillian Anderson.


    Peter Piot
    Peter Piot, head of UNAids:
    Peter Piot, UNAids Executive Director since 1995 and Under Secretary-General of the United Nations, has been a central figure in the response to AIDS in Africa and has declared AIDS "one of the greatest moral issues of our time".

    Carol Bellamy
    Carol Bellamy, head of Unicef:
    Executive Director of the United Nations Children's Fund (Unicef) since 1995, Carol Bellamy has called the HIV epidemic "the world's most terrible undeclared war" and has highlighted the plight of Aids orphans.

    Gillian Anderson
    Gillian Anderson, actress and Aids campaigner:
    Film, television and stage actress Gillian Anderson is a campaigner with Action for Southern Africa (ACTSA), which lobbies Western governments to contribute to the fight against HIV/AIDS in Africa.

    Are the UN agencies doing enough in your country? What more could they do? Has the UN pushed world leaders hard enough?


    Transcript

    Robin Lustig:
    Welcome to Talking Point. I'm Robin Lustig, broadcasting on BBC World Service on radio and BBC News Online on the internet. For the next two hours we're going to be discussing the global epidemic of HIV and AIDS in the first in a special season of programming over the next two weeks here on the BBC World Service.

    Every five seconds someone somewhere is infected with HIV - that's the virus that leads to AIDS. That means that during the course of this programme another 1,440 people will become infected. There is no cure for AIDS. More than 40 million people worldwide are now living with HIV and AIDS, more than two-thirds of them are in Southern Africa. But now HIV, the human immunodeficiency virus, to give it its full name, is spreading fastest in the countries of Central Asia and Eastern Europe with the number of people who are infected almost tripled between 1999 and 2002. Over the next two weeks here on the BBC World Service we're going to be reporting in depth on this global epidemic, we're going to be hearing personal stories from those directly affected, we're going to be asking what can be done to beat it.

    We're starting today with the results of a global survey, especially commissioned by the BBC, as we want you to contribute to the debate. Our survey shows that more than half of the people questioned in 15 countries think that their governments are not doing enough about HIV and AIDS. In Tanzania and Nigeria more than half of the people surveyed said that HIV and AIDS is what worries them most. Yet in India, Russia and China where there is a real risk of a major AIDS disaster the figures were much lower, fewer than one-third of the respondents in India said it was their main concern, fewer than one in ten in Russia, fewer than one in twenty in China. The survey also suggests that a lot of people, even in countries where HIV and AIDS are already a major problem, still have serious misconceptions about what it is. In China about one-third of our respondents said wrongly that HIV can be caught by sharing personal items like a cup or a towel with someone who is already infected. More than half of the people questioned in Brazil and Nigeria said wrongly that AIDS is not life threatening. And when they were asked if children under the age of 14 should be taught that using a condom can protect people from the virus there were huge majorities in favour, more than 90% in Brazil and Mexico, which have two of the largest Catholic populations in the world, that's despite the Catholic church's opposition to the use of condoms.

    So what are your concerns? Are you living with HIV and AIDS, do you know someone who is? We want to hear from you.

    Well I'm delighted to welcome as our guest for the first hour of this programme Dr Peter Piot, who is the head of the United Nations agency that coordinates the global fight against HIV and AIDS. For the second hour we're going to be joined by Carol Bellamy, who's the head of the United Nation's children's agency, UNICEF, and by the film and television start Gillian Anderson, who is an active campaigner in the fight against HIV and AIDS.

    Well Peter Piot joins us now from Geneva. Dr Piot thanks very much indeed for coming on to this special edition of Talking Point. The results of that survey, that's been commissioned by the BBC, 15 countries, more than 16,000 people, what do you make of it?

    Peter Piot:
    Well first of all I think that this is a very important thing to do, there aren't that many surveys of this kind. And I think it demonstrates, in the first place, that AIDS is now part of life. It's part of the human condition - that's number one. Secondly, what I also found very interesting is to see that indeed AIDS is a top concern for certainly those who are living in Africa, not surprisingly, it should be, there's hardly any family who hasn't lost someone because of AIDS. But of course what's really very concerning is that in countries like China, like India, Indonesia, where HIV has started to spread, that it's still far from people's concerns. I was also interested by seeing that its misconceptions, the myths of AIDS persist over 20 years in this epidemic and that particularly the knowledge about the fact that the virus can be transmitted from mother to baby is not well known. And finally I thought that the idea that the majority of people - of adults - are in favour of teaching children that condoms can protect is very encouraging and coming from the deeply religious countries such as Bangladesh, Mexico, the United States, that tells us that there is a disconnect between mainstream political thinking and what people really want. And I know from my own experience and from talking particularly to parent groups and parents in sub-Saharan Africa that their number one concern for the children is how to make sure that they remain HIV free and that they can grow up in a world without AIDS.

    Robin Lustig:
    Well as you can imagine we've had a huge number of calls and e-mails, people who would like to talk to you, questions that they would like to ask you. So let's go to our first call which comes appropriately enough from South Africa, that's the country where there are more people living with HIV and AIDS than in any other country in the world. Mally Bishop is on the line, Mally hello.

    Mally Bishop:
    Hello there Robin.

    Robin Lustig:
    What do you want to contribute to the debate?

    Mally Bishop:
    Well I wouldn't actually know where to begin, there is so much to contribute, especially on this particular issue. But basically I think that the more positive - and I don't mean it in any form of pun - the most positive someone can live, the better it is.

    Robin Lustig:
    Somebody living with HIV?

    Mally Bishop:
    That's right yes.

    Robin Lustig:
    You are?

    Mally Bishop:
    Yes I am.

    Robin Lustig:
    And how do you deal with that?

    Mally Bishop:
    Well I am on a medication and I have been for the past five years which helps a lot. I also think that a positive attitude and just a real zest for life does help a lot.

    Robin Lustig:
    What do you think Mally is the single most important message that you would like to put out to people? A lot of people are going to be listening to this programme, some of them HIV positive, a lot of them not but worried?

    Mally Bishop:
    A message - well naturally prevention is far better than cure but if it is there I mean the best thing is just to accept it and to live with it. And there are many medications, medication is not always necessary but in many cases it certainly does help. And really the best thing I can tell anyone is that the period between diagnosis and death is called living and to live it to the fullest.

    Robin Lustig:
    Thanks for that Mally. Peter Piot is that a message you hear a lot from people in Africa?

    Peter Piot:
    Well Robin it's unfortunately not a message I hear enough and several reasons for that. One is that most people in Africa or outside Africa who are infected with HIV have no clue that they are because there is no access to testing facilities but above all there is no incentive to know because there's no treatment at the end of the test, all there is is discrimination, rejection, losing your job. So positive living is absolutely possible but it means that the whole of society has to be supportive, the families starting with, and also that treatment is available. But I think that points again to the fact that it's not only about prevention of HIV infection, it's also about treating people, so that they have a longer and better life. And thirdly we have to resolutely say no to any stigma and discrimination associated with HIV because that is what often kills people before the virus kills them, literally sometimes.

    Robin Lustig:
    We'll take another call, Charles Delevigne, originally from Zambia, now living here in England, Charles hello.

    Charles Delevigne:
    Hi there, good afternoon.

    Robin Lustig:
    Hi good afternoon. What do you want to say?

    Charles Delevigne:
    There is so much stigma still attached to HIV and AIDS in South Africa. Basically a lot of people live under denial, they think that HIV and AIDS will never touch them, until unfortunately it's too late. And when they finally realise that this is it, I have got it, they set about going through a denial pattern where they lose their jobs, they become unemployed, they haven't got money to back themselves to get medication, there is no welfare state in South Africa to help people with this, to help them with education. We've had so many past leaders in our country that have said - well let's rather give some free condoms to people, let's rather teach them, sort of like rejecting everyone that is HIV already.

    Robin Lustig:
    And you speak from personal experience Charles do you?

    Charles Delevigne:
    Yes, I have full blown AIDS. I've actually come to England because I had a CBC count of 10, which is pretty bad and my health situation was worse.

    Robin Lustig:
    That's the blood count which is used to diagnose the condition?

    Charles Delevigne:
    That's right yeah. It just gives you what your healthy T-cells are. There was no help for me in South Africa, I didn't have any medication, I didn't have any money to fall back on to pay for it. I'm actually in England at the moment, I have applied for asylum here and I am getting antiretrovirals right now, through the NHS. Ashamedly I'm admitting this because I just don't think that it should be happening. South Africa has had so many international countries offer help, either subsidised medication or free medication, and they continue to say - look, HIV is not a death threat - but there are so many people dying each day, so how do we explain that all? I am talking about my own experience in life where I was given an option - should I come to England, should I stay, should I die? The choice was very hard. I've had to leave people that I cared for greatly in South Africa, a country that I care for greatly to be in and I've had to come to England, apply for asylum, where my identity has been taken away from me, in order for me to live. And ashamedly I'm doing it for maybe selfish reasons because I'm scared of dying and I think the will to live is far greater.

    Robin Lustig:
    Charles, thank you for the call. Peter Piot I want to come on to medication in a moment but first on the question of stigma. We've had an e-mail from Colin Murray in Northern Ireland who says: What can be done to de-stigmatise this disease worldwide?

    Peter Piot:
    Well first I'd like to say Robin that stigma and discrimination associated with HIV is not specific to any single country. I've seen it in every single country I've been in. And it can go down - we've seen it where there are good campaigns but it's everywhere. I was in China and in India last week and I can tell you there is a lot of stigma that makes it very difficult to speak openly about HIV and to even offer treatment to those who have it because why would they come forward .

    Robin Lustig:
    And bluntly the reason - sorry to interrupt you - but bluntly the reason the stigma is there is because it's about sexual behaviour.

    Peter Piot:
    I think it's because - yes it's about sex, it's about drugs in some societies, I mean injecting drug use, so it's associated with shame, it's a shameful condition, also in many societies it's thought that it's those bad people who have it. Whereas in practice it's often the more entrepreneurial members of our society who also are sexual risk takers. So all this has become a patient of the bad thing, the shame with AIDS makes it so more difficult to deal with it than with any other health problem.

    Robin Lustig:
    Is it possible to deal with stigma - is it possible somehow?

    Peter Piot:
    I think so. Yes in UNAIDS it's been one of our top priorities and with several countries what we've done is campaigns. First of all there's information, when people know that you can't get AIDS from sitting next to someone on a bus that already helps but information isn't everything. There are campaigns where people living with HIV, who are open about it, appear with public figures - can be the president of a country, we've got a whole series of posters with famous football stars, cricket stars, pop singers, there are also politicians, and they're there and they say look these are our brothers and sisters. Supporting people living with HIV to come out. In many countries the fact that Magic Johnson, that Philly Lutaya, a famous singer in Uganda who's now unfortunately died from AIDS, they came out and they said - I have it, I'm HIV positive. That also changes it from a statistic, from a bad boy or a girl who has it, it's now a famous person, a role model often for youngsters particularly who has it, that also helps. And then finally one of the things we're doing is supporting groups of people living with HIV to come out, provide safe space, it's important that they go and talk in schools, on the radio and the TV and at the same time that we have laws that protect people from being discriminated. So it's a number of different approaches that we have to use but it is a tough - a really tough nut to crack in most societies because it's associated with sex, often also with homophobia - homosexuality, it's illegal in many countries, injecting drug use is of course illegal everywhere, so that makes it very, very hard and especially hard to deal with AIDS.

    Robin Lustig:
    We've had a number of questions which have been sent in to us on tape. I'd like to play you one of them now. This one comes from Moscow.

    Roman Doubnik:
    My name is Roman Doubnik, I am HIV positive about nine years. HIV treatment costs more than a thousand dollars per year per person in our country in Russia. According to the latest estimates of international experts there are more than one million HIV positive people in this region. To treat everybody with HIV in the near future there will be a big problem for our Russian government, what action will be done by UNAIDS to reduce the prices for treatment?

    Robin Lustig:
    Dr Piot, prices, what can you do?

    Peter Piot:
    Yes very good question and this is valid for Russia but for most other countries in fact - lower middle income countries. Let's not forget that in Africa alone about 75,000 people with HIV who need treatment have actually access to so-called antiretroviral drugs, I mean that's less than 2% of those who need it, four million who need it. What have we done to start with? First a few years ago we reached an agreement with several pharmaceutical companies resulting in a 90% decline in the price of antiretrovirals. In the meantime the price has gone down further, thanks to generic production - production of copies - particularly in a country like India. And then lastly it was a few weeks ago President Clinton announced that he had succeeded in bringing down the price further to about half a dollar per person per day for treatment. So a lot has happened but it wasn't enough because even at lower price someone has to pay for it. And certainly for the poorest countries it will only be possible to provide this kind of treatment to those who need it if there is money coming also from the outside. Of course South Africa can contribute a lot from its own budget and it has recently, this week actually, increased tremendously the budget going to AIDS and programmes including treatment. Brazil has done it, even if it was supported by a World Bank loan. Russia would also have the means but the bottom line is treatment for all those who need it in poor countries will only be possible if there is massive external funding from the rich countries. And that's where WHO - the World Health Organisation - and UNAIDS are working together to make sure that from a few hundreds of thousands of people treated in the developing world, in the former Soviet Union, to several millions and that will require massive training, also of physicians of nurses and making sure that people have access to tests and that they're not going to be discriminated when they come forward as being HIV positive.

    Robin Lustig:
    Alright thank you for that. Our next caller is Chris Hyde, he is here in England, in Canterbury, Chris hello.

    Chris Hyde:
    Hello, good afternoon. My question was, it's more of an observation than anything else, AIDS has been a very emotive subject, which has concerned pretty much everyone over the last 20 years, I think everyone's come across it, we've read about it and we still seem to have trouble finding hard facts, especially when we're talking about a virus which doesn't lead to a disease for another 10 years, there obviously a lot of people which haven't been tested etc. Now we're launching a huge programme to help people in Africa, in China, in Russia etc., now how does the UN come to the conclusion that 20% of South Africans, for example, are HIV positive, have they all been tested?

    Robin Lustig:
    Right, so you have questions about the statistics?

    Chris Hyde:
    Yes.

    Robin Lustig:
    Okay, Peter Piot how do you know how many people there are in any particular place who have HIV?

    Peter Piot:
    Good question because the reality is that the overwhelming majority of people living with HIV in the developing world don't know that they're infected, they've not been tested. But what are we doing - we're working with the national health ministries and using statistical tests taking samples of the population, particularly women who are pregnant and who come to antenatal services. There are studies being done, surveys in terms of population base in a community, also those who are more at risk like among sex workers, injecting drug users. And according this kind of statistical methodology we can come to quite accurate estimates of how many people are infected. I actually think that there is probably no other health problem in Africa certainly where we know so well what the situation is. For India, for China it may be a bit less precise because there are less people infected, well over a million in China, four and a half million approximately in India, but we're working there with authorities province after province, state after state, to have more accurate figures. So I'm not so worried about that. And the original problems of nearly 20 years ago when the tests weren't that good, that is also gone, again there are very few tests in medicine that are so accurate as the test we're using to detect HIV infection today.

    Robin Lustig:
    Chris does that help you at all?

    Chris Hyde:
    Well I'm curious about one thing because I understand in Western Europe when you have a test which turns out to be HIV positive they usually give you several other tests to confirm that result because false positives can be caused by things I understand such as flu or even I read somewhere pregnancy. Now if it takes this battery of tests to prove that someone is HIV positive in Western Europe is this the sort of testing which takes place in Africa where I would imagine the immune system is under attack from a lot of things because of the conditions under which people live which may cause a lot of false positives and may - I'm not saying that HIV doesn't exist but I'm just wondering if the statistics are may not a little bit higher than what we really believe?

    Robin Lustig:
    Peter Piot there are people, aren't there, who worry that, for example, tuberculosis, which can often be a manifestation of HIV infection but isn't necessary so and that can muddle up the figures sometimes.

    Peter Piot:
    Well it's true that there are - it's possible to have a so-called false positive test but it's extremely rare. Also in these surveys that I just talked about in Africa the same scientific standards are being applied, initial positive tests are being verified with other tests. I really think that that's not the problem. I mean it could be that in South Africa instead of five million people infected - living with HIV - it could be a hundred thousand more or a hundred thousand less but the figure itself - the order of magnitude - is definitely correct. And by the way and South Africa has an excellent, what we call, epidemiological surveillance system for HIV and I would say now throughout most of African countries, except those like Angola who've just come out of conflict or Democratic Republic of Congo. And as far as tuberculosis is concerned there is no cross reaction with other infections, the tests are very accurate. The problem is that tuberculosis is often the first way that AIDS manifests itself in someone who's HIV infected, it's the most common so-called opportunistic infection. When the immune system collapses because you're infected with HIV in an environment like Africa many people will develop then tuberculosis. And that's an additional problem, really the TB epidemic follows the AIDS epidemic as its shadow and that can infect other people but through airborne roots and that you can catch on a bus.

    Robin Lustig:
    Let me read an e-mail that's come from West Africa from Douala in Cameroon. Where, he has written to say, in my part of the world, Cameroon, HIV/AIDS victims are viewed as the most promiscuous unclean outcasts of society. It's the number one killer - malaria and cancer also kill. Let's accept and deal with them.

    We'll take a call now from Africa, Tendayi Kureya is on the line from Harare in Zimbabwe, Tendayi hello.

    Tendayi Kureya:
    Hello.

    Robin Lustig:
    Yes, hi go ahead.

    Tendayi Kureya:
    Yes my question is to Peter Piot. I look at the recent Sars outbreak where there was evidence of strong political commitment, a high level of integrated response and rapid mobilisation of resources and I wonder if this level of commitment is apparent for HIV and AIDS? Specifically I would like to ask Peter Piot what indicators of criteria UNAIDS is using to measure progress in addressing the epidemic?

    Robin Lustig:
    Okay thanks for that Tendayi. Peter Piot, first of all the comparison between the way in which the Sars epidemic was handled and the way in which the AIDS problem is being dealt with.

    Peter Piot:
    Yeah, first perhaps also before that I'd like to stress that the number one killer in Africa today is AIDS, that is now very well established.

    Robin Lustig:
    More than malaria?

    Peter Piot:
    Yes absolutely. Malaria's the number one killer for children, for very young children, but overall AIDS is now number one unfortunately and it's a macabre competition - worldwide it's number four as a killer. But yes when I look at the response to Sars in Asia particularly that tells me that it is possible to mobilise a whole society against an epidemic. And as I mentioned before I was in China last week and I see really a much greater openness to deal with AIDS, a greater commitment at the top to deal with AIDS because I think of - because of Sars. Because Sars has shown that an epidemic can create major economic and political casualties. And AIDS is just much, much worse but it's silent, Sars is acute. And in addition when Sars is finished, the epidemic is finished the problem is solved in a sense, whereas with AIDS even if by some miracle today all transmission of HIV would stop nobody would become infected we still would have 15 million orphans in Africa, we still would have all those who are infected and who need treatment and otherwise will die. So it is an example, a good example, Sars. But on the other hand we know one thing that is a big difference and that is with Sars, to contain Sars, quarantine, isolating people, has been very effective. In the case of AIDS it's neither effective nor practical, you just can't imagine that in countries one would have to isolate millions and millions of people and in addition most don't know that there is this 10 year period that you're perfectly healthy.

    Robin Lustig:
    It's interesting you should say that because it goes some way to answering a question that came in an e-mail to us from Mexico City. Christian Valley wrote to say: The Sars infection control was so efficient, I'm concerned that some of the rudiments of the most important scientific discipline that could be used to tackle the HIV/AIDS epidemic are not being implemented, could we apply knowledge gained in beating Sars to HIV? You seem to be suggesting, Peter Piot, that not really.

    Peter Piot:
    Well yes and no. I think the big difference is as I said that quarantine only works for epidemics that are short-lived, that are very acute where you get infected after a few - easily, ill after a few days and then quickly die - so an acute thing - the plague, Sars, yellow fever, that will work. But for an epidemic like AIDS, like HIV, we have very good evidence that it doesn't work. But the similarities are that strong political leadership, that that is absolutely a condition. I don't know of any country that has been successful in bringing down the number of new infections of HIV where political leadership was not there - from Uganda to Brazil, Thailand, Cambodia - they've shown that leadership. Secondly, a similarity between Sars and AIDS is the absolute necessity of openness, confronting the issue, recognising that we are having this problem, and mobilising the whole of society. This cannot be left to specialists, to doctors, when it comes to dealing with AIDS. We need the doctors for treatment, we need the nurses for treatment but when it comes to prevention of new infections the BBC is as important as doctors and information literally saves lives here.

    Robin Lustig:
    But this whole issue of openness is a crucial one and it's obviously a difficult one. It was raised in an e-mail that came to us from Portland in the US, Robert wrote to say: With nations like China and India doing very poorly in reporting and treating HIV/AIDS what can the rest of the world do to force these nations to admit that there is a crisis and that HIV exists? You can't force them can you.

    Peter Piot:
    No we can't force, even if an epidemic like AIDS is a truly global phenomenon. When you think of the fact that in 20 years time about 70 million people have become infected with HIV they're all connected with each other. And secondly, that no country will be safe from AIDS when there are still others who have a major AIDS problem. So it has become a global public good, as economists would say. And therefore it is important that there is international political dialogue on this. We can't force but we can use the arguments. When I got into this job seven years ago and when we created UNAIDS I can tell you that very few doors were open and including in Africa very few doors at a top level. Today about every single president, head of state, prime minister has taken on AIDS as a personal issue. Not enough perhaps and in many countries definitely not but in Africa I would say it is on the agenda and it was not seven years ago, it was only in Uganda or in Senegal that it was taken on. Now we've got facing the same challenge in Eastern Europe, in China and in India but good progress has been made. For example in India in July I assisted in a major gathering of 1500 elected representatives of the people, the Prime Minister of India opened it, there were chief ministers from all the states, representatives from local councils etc., it is moving. And in China particularly after the Sars epidemic there is now clear commitment for openness. We're working with the Chinese government in refining the estimates to have a better idea of how many people are infected in every single province. We're not there yet but I think there is good progress and this is where international awareness and making sure that AIDS is on the agenda of, for example, the Security Council is important, for example, tomorrow I'll give a presentation to the UN Security Council in New York and that's about AIDS and AIDS in peacekeeping operations. That is the kind of political activities that ultimately will make a difference in addition to the media and to AIDS activism in these countries themselves.

    Robin Lustig:
    Let's take another call, this comes from Singapore Qian Xiaofeng is on the line from there, hello?

    Qian Xiaofeng:
    Hello good afternoon.

    Robin Lustig:
    Good afternoon. Qian Xiaofeng what did you want to contribute to this debate?

    Qian Xiaofeng:
    Actually I'm from China, mainland China and I'm currently studying in Singapore and I agree with you when you said just now that you cannot force the Chinese government to do something. But here I want to emphasize the importance of negotiation and communication because you'll see that if you want to improve a situation in China which was considered poor by your standards. But I hope you can draw your attention now to the new Chinese government, I mean the new generation of leadership, they have done quite a lot to improve the situation in China, I think more attention has been given to this area. I think currently the progress is quite encouraging. But I also want to ask - what has the international community has done to help the new government to deal with this problem?

    Robin Lustig:
    Before we put that question to Peter Piot let me just ask your response to what our survey seems to have found, which is that there is still a very considerable level of ignorance in China about what HIV/AIDS is, how it can be caught, how it can be transmitted, now does that surprise you or does that fit with you own understanding of what the situation is?

    Qian Xiaofeng:
    I admit that the public awareness of this epidemic is quite poor, a very low level in China, especially in the rural areas where they don't have enough access to advertisements, they don't have enough professionals to teach the local people. But I think here if you want to make something change in China, if we learn from the history, we learn the lessons from history, if the change goes from the top to the bottom it will make things there much easier. If you want to do it in other ways, I mean from bottom to the top, it is much more difficult. So I think the primary consequence here is that we should encourage the government to take the leading role. If the government takes that I think the situation will be improved very quickly.

    Robin Lustig:
    Okay Qian Xiaofeng thank you for that. We've had an e-mail on a similar subject, also to do with China, this comes from P. Ramu in Chennai in India: China's a permanent member of the UN Security Council, shouldn't the UN question them on their AIDS policy? Peter Piot do you detect a change in attitude among senior Chinese government officials?

    Peter Piot:
    Yes definitely, as I said before, and I fully agree with Qian Xiaofeng, that there is much greater openness today, the government actually a few weeks ago and first announced at the General Assembly in New York in September, announced that it had five commitments to deal with this epidemic - an openness about the problem, organising and intensifying awareness campaigns because indeed it is so that the level of knowledge on AIDS, even the existence of AIDS in China, is quite low particularly in rural communities and also offering free treatment for HIV to poor patients. And there is a growing international cooperation. I was last week not only there to discuss this with senior leaders but also with the business community, there was a China business summit and that was organised by the Federation of Industry in China and World Economic Forum and AIDS was on the agenda. I was a rapporteur for the closing ceremony. I think things are starting to move and when I look also at Chinese television, CCTV, it's clear we're seeing more and more ads on AIDS. But again I think that in terms of the actual work it is work that will have to be done at the community level, not every province in China, not every provincial governor considered this as a top priority and this is where the central government is now working on. And tomorrow, for example, in the Security Council I'm very much looking forward to the intervention from the Chinese ambassador.

    Robin Lustig:
    Okay we're going to take a call from a Catholic bishop in South Africa. Bishop Kevin Dowling who is the Catholic bishop of Rustenburg in South Africa. Bishop good afternoon, thank you for taking part in our programme. What we want to talk to you about obviously is condom use because there's much debate about that, what's your view?

    Kevin Dowling:
    Good afternoon. Well my view is that the traditional, as it were, official Catholic teaching around the issue of prevention emphasises values, obviously values such as abstinence from sex before marriage and faithfulness to one's partner within a stable marriage relationship, as the only sure way of preventing infection by the virus. However, having said that and having promoted these values, and continuing to promote these values and all the programmes that the church does in terms of peer ministry among young adults and youth one has to recognise that this pandemic is a totally different reality that we are facing and I believe it demands a rethink in terms of our traditional approach to moral theology ethics and to the preservation and protection of life. I believe in terms of Africa, in particular, where I minister I'm very personally involved in the AIDS pandemic in the area where I work, so many hundreds of thousands of people, particularly single women, economic refugees from other countries north of South Africa who have streamed into South Africa, places a tremendous challenge to the church in terms of its traditional approach.

    Robin Lustig:
    So bishop what do you say to your own congregation if they come to you individually and ask for your advice, they are concerned about protecting themselves from the risk of infection and they say to you bishop can we, should we in the eyes of the church use a condom for sex?

    Kevin Dowling:
    I believe we must - we must give people correct information on condoms, on the use of condoms, that all scientific evidence shows that the proper sustained use of condoms can significantly reduce the infection rate.

    Robin Lustig:
    But that's not the message that comes from the Vatican is it?

    Kevin Dowling:
    No I agree with you there, it's a very strong message, I believe that the situation that I know personally demands that we help people form their conscience on the basis of correct information and many of the people with whom I directly minister do not have the option, many women, single women, are forced into prostitution just in order to survive for another day economically, just in order to put a little food on the table for their little ones. I know this personally, I've seen it so often. These people they have no options in terms of choices along the moral lines that the church proclaims. I believe we must offer them a message of hope by showing them that their life is precious, it needs to be protected and in their particular situation where they don't have any other options the main issue is how to protect their lives. And I believe our teaching allows that interpretation.

    Robin Lustig:
    Bishop let me ask you to stay on the line just for one second because I want to take a call from India, Ralph Coelho on the line from Bangalore. Ralph on this issue of condoms what's your view?

    Ralph Coelho:
    Well my view is the whole about condoms starting with promoting contraception as a way of life. And .

    Robin Lustig:
    We're not talking about condoms as contraceptives here, are we, we're talking about condoms as a possible way of protection against infection.

    Ralph Coelho:
    Well it fulfils both things. The thing is that the Catholic church, when it started teaching about - against condoms the teaching was not adequate and I think it is this which we are paying for now.

    Robin Lustig:
    How do you mean not adequate?

    Ralph Coelho:
    Well the reason why the church refused to accept contraception was the indivisibility of the procreative and the unitive aspect of the marital act. Now that has not been really taught very well even to this day. I think it is not taught enough.

    Robin Lustig:
    But do you support the official Vatican line that condom use cannot be encouraged even if it is for the purpose of reducing the risk of infection of HIV?

    Ralph Coelho:
    I don't know it reduces the infection - it probably does reduce the possibility of infection but it doesn't make it hundred per cent secure. And the other aspect of it is when people say that it is secure then it also encourages them to take further risks.

    Robin Lustig:
    Alright Ralph, thanks for that. We've got an e-mail from Germany, Alan Halls, says: Abstinence and strong government's all very well but there will be no real progress until all churches, including the Catholic, start educating their followers and offer free condoms and advice, particularly in countries with inadequate education.

    Now Bishop Dowling your position clearly places you in a different camp to that of the official church teaching but are you now of the view that you as a Catholic bishop can say to your congregation I will talk to you about condoms and I will, in certain circumstances, recommend the use of condoms?

    Kevin Dowling:
    Well I've actually said that I believe, I've called for the church, we must debate this issue, it needs serious consideration in the light of the whole issue of the survival of humankind in sub-Saharan Africa, that is the issue. We are facing millions of people dying who have no other option in terms of life and where in the developed world AIDS is a manageable disease it is not so in sub-Saharan Africa and I believe the pro-life stance of the church must be consistent from conception to death, the life of a person is sacred and in these circumstances one must put before people the correct information and when options are not available to people that I've indicated already we must help them to make informed choices in terms of their conscience to protect themselves and their life and those for whom they are responsible.

    Robin Lustig:
    Bishop Kevin Dowling thanks very much for that. Peter Piot do you have a dialogue with the Catholic church at Vatican level?

    Peter Piot:
    Yes I do, we do. First of all I would say that nobody can formulate the painful dilemmas of theology as well and of daily life as Bishop Dowling and I fully agree with his analysis. Here we are trying to prevent a transmission of death and saving lives. And from my experience also is that Bishop Dowling is not the only person in the church, only clergy even only bishop, who thinks like that and acts like this. I know numerous Catholic missions, hospitals, dispensaries, where condoms are available and I know also that in some cases the condoms are promoted. And the dialogue with the Vatican has been going on between us for many years. I think it's important to keep the channels open, I think it's very important that the church is engaged in terms of promoting indeed abstinence, faithfulness and fighting the discrimination, the stigma, love their neighbour, your brothers and sisters, people living with HIV, the church has a major role in caring for those who are infected, for the orphans. But must also provide or accept scientifically sound information.

    Robin Lustig:
    You talked earlier about the success in Brazil, now Brazil an overwhelmingly Catholic country, a country also where, according to our survey, a huge majority of people believe that children ought to be taught about condom use and its role in preventing the transmission of HIV. Now what has been the role of the church in Brazil?

    Peter Piot:
    Well I think there there has been a very constructive dialogue but Brazil is also a country where talking about sex in public is much easier than even in surrounding Latin American countries. Even if it is predominantly a Catholic country and certainly a Christian nation. And there are advertisements for condoms and also talking about AIDS is very, very public in the media, very explicit and I think it is an example of how one can reconcile belief in faith, including the Catholic church and Catholic faith, and saving lives and having good public programmes. Yes we've seen it also on the Islamic side - I mean in a country like Senegal, for example, predominately Muslim country, it's been very successful in prevention of HIV and condom promotion was high on the agenda and the heads of Islamic congregations have played a major role in this.

    Robin Lustig:
    Let's take a call from Wisconsin in America, Nancy Wilson is on the line from Oregon, Nancy hello.

    Nancy Wilson:
    Good morning. I'm a scientist, I work with HIV vaccine development and I have also been a lifelong Catholic, until recently I found out that my church, the Catholic church, discourages condom use to prevent transmission. But the part that caused my break is they also promote the inaccurate view that condoms are ineffective in preventing HIV transmission and as a scientist I know this is just plain wrong. The only thing we have as a vaccine developer is condoms, we don't have a vaccine, drugs are not available for most of the world and even the parts of the world they are they're only a stopgap measure. So we have to rely on condoms and for the Catholic church to come out and say that condoms not only should not be used morally but there's no point in using them because they're ineffective is wrong and I could not stay within that church.

    Robin Lustig:
    But Nancy do you not agree with those who say that one way of dealing with the crisis is to persuade people to change their sexual behaviour, to educate women, particularly in the poorest countries of the world, to say no to unwanted sex, to say no to unprotected sex, to demand the use of condoms and to persuade men in those countries where promiscuous sexual behaviour perhaps is very widespread to be less promiscuous?

    Nancy Wilson:
    I think that's absolutely an important part of the puzzle, if we could solve that in a day that would be great. But that is not going to be solved in the short term, these viewpoints are endemic in these countries, we have a woman in our lab from Africa and it's wonderful to have her in the lab because she provides a great perspective and she says these behaviours are not going to change overnight, they're not going to change next week or next month or next year. They have the information, they have the education what we need is to prevent the transmission while the behaviour is changing.

    Robin Lustig:
    Nancy thanks very much indeed for that. We've been talking about China a little earlier in the programme, we now have a caller on the line from China, Chung Yang is on the line, Chung Yang hello.

    Chung Yang:
    Hello Robin.

    Robin Lustig:
    Hi, what are your thoughts on this?

    Chung Yang:
    I'd just like to put a question to the specialist because he's been talking about his visit last week to China and I'd like to know what his advice perhaps to our government, on our handling of the potential crisis just after our successful handling to the Sars virus here?

    Robin Lustig:
    We dealt with it a little bit Peter Piot but do you still have advice for the Chinese government?

    Peter Piot:
    Last week also President Clinton, former President Clinton, was in Beijing and meeting with the present prime minister and I would say the advice was one, openness about it, confront AIDS, apply the five commitments that the government has issued, put some resources again in, hold local authorities - governors and people in charge at the district level and county level - accountable for what they're doing on AIDS. And my message was also China will be judged not whether it has an AIDS problem or not but how it confronts a difficult and complex issue. That was the message.

    Robin Lustig:
    Just one specific, shortish question that's come in, an e-mail from New York, Yvonne wants to know: How much money and technical assistance has UNAIDS contributed to help the affected patients in Yunan in China? That's where a lot of the HIV infections was the result of contaminated blood.

    Peter Piot:
    Yeah what we've done is in the first place is work with the Ministry of Health to first of all to unveil the problem. Let's not forget that this was in Yunan Province that for many years the problem was hidden, so that is where we've invested a lot of work. And at the moment we're supporting the government to establish about 100 treatment centres so that the poor farmers who became infected through this illegal blood trade, that they will have access to treatment. So this is now just starting.

    Robin Lustig:
    Peter Piot thank you very much indeed for that. I'm afraid that is all we have time for, for the moment.



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