Peter Piot: Why Aids demands an exceptional response

From a speech by the executive director of UNAIDS to the London School of Economics

Aids is exceptional. This pandemic is exceptional because there is no plateau in sight, exceptional because of the severity and longevity of its impact, and exceptional because of the special challenges it poses to effective public action.

The pandemic has broken with the general pattern of diseases and natural disasters, which usually create their own brutal equilibrium, eventually enabling societies to cope. Aids, so far, appears to be doing the opposite. Thus, in Botswana, Swaziland and other parts of southern Africa, HIV prevalence among adults is around 40 per cent and rising. At the same time, the epidemic is globalising rapidly, from West Africa to Eastern Europe, from China and India to the Caribbean and Central America.

And in country after country, the tipping point is being reached - that ominous point, which varies between countries, after which Aids no longer remains concentrated in "hot spots" but becomes generalised across the entire population.

This has already happened in several countries in West Africa, including Nigeria. Within the next decade, the Asia-Pacific region, with a population five times that of sub-Saharan Africa, could become the next epicentre, with every small increase in HIV prevalence translating into tens of millions of people infected.

Think about this: a mere disease, a preventable disease, a medical curiosity, a disease that is not easily contagious, a disease that was a circumscribed epidemic just 25 years ago, has morphed into a pandemic of cumulatively over 65 million people.

Only an exceptional response will suffice - a response that hinges on significant changes being made in the way poor and marginalised people are treated, in the relationship between rich and poor countries, in the way governments work.