Peter Piot - Böcker

As we approach the 25th anniversary of the first recognition of HIV/AIDS in 1981, this book reflects on the international impact of the disease. It has persistently remained a global issue, with more than 50 million people worldwide estimated to have been infected since that date. This ambitious book, written by 165 authors from 30 countries, offers a multi-country comparative study that examines how the response to the common, global threat of HIV is shaped by the history, culture, institutions and health systems of the individual countries affected.Increasingly the shift of health systems has been from prevention only as the main containment strategy, to a strategy that includes scaling up HIV treatment, and care and prevention services, including antiretroviral therapy. Thus, all parts of the health system must be involved; policy makers, healthcare professionals and users of the services have been forced to think differently about how services are financed, how resources are allocated, how systems are structured and organized, how services are delivered to patients, and how the resulting activity is monitored and evaluated in order to improve the effectiveness, efficiency, equity and acceptability of the response.This book is unique in attempting to describe and assess a range of responses across the globe by situating them within the characteristics of each country and its health system. Most chapters combine a health policy expert with an HIV specialist, allowing both a 'top down' health system approach and a 'bottom up' HIV-specific perspective. There are thematic and analytical sections, which provide an overview and some suggestions for solutions to the most serious outstanding issues, and chapters which analyse specific country and organisational responses. There is no perfect health system, but the evidence provided here allows the sharing of knowledge, and a opportunity to assess the impact and reactions, to an epidemic that must be considered a long term issue.

Peter Piot, founding executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), recounts his experience as a clinician, scientist, and activist fighting the disease from its earliest manifestation to today. The AIDS pandemic was not only catastrophic to the health of millions worldwide but also fractured international relations, global access to new technologies, and public health policies in nations across the globe. As he struggled to get ahead of the disease, Piot found science does little good when it operates independently of politics and economics, and politics is worthless if it rejects scientific evidence and respect for human rights. Piot describes how the epidemic altered global attitudes toward sexuality, the character of the doctor-patient relationship, the influence of civil society in international relations, and traditional partisan divides. AIDS thrust health into national and international politics where, he argues, it rightly belongs. The global reaction to AIDS over the past decade is the positive result of this partnership, showing what can be achieved when science, politics, and policy converge on the ground.Yet it remains a fragile achievement, and Piot warns against complacency and the consequences of reduced investments. He refuses to accept a world in which high levels of HIV infection are the norm. Instead, he explains how to continue to reduce the incidence of the disease to minute levels through both prevention and treatment, until a vaccine is discovered.

Reproductive tract infections (RTis) have become a silent epidemic that is devastating women's lives. Each year, thousands of women die needlessly from the consequences of these infections, including cervical cancer, ectopic pregnancy, acute and chronic infections of the uterus and the fallopian tubes, and puerperal infections. For many women, this happens because they receive medical attention too late, if at all. The terrible irony of this tragedy is that early diagnosis of and treatment for many RTis do not require high-technology health care. For the hundreds of millions of women with chronic RTis acquired from their sexual partners, life can become a living hell. Infection is a major cause of infertility, and it leads to scorn and rejection in many countries. These women may experience constant pain, have festering lesions of the genital tract, be at enhanced risk of second­ ary diseases, and endure social ostracism. The problems associated with RT!s have grown even greater in the past decade with the emergence of human immunodeficiency virus (HIV) and AIDS. Preexisting sexually transmitted disease, particularly when associated with genital tract ulcers, raises women's vulnerability to the transmission of HIV 3-5 fold.

When Peter Piot was in medical school, a professor warned, “There’s no future in infectious diseases. They’ve all been solved.” Fortunately, Piot ignored him, and the result has been an exceptional, adventure-filled career. In the 1970s, as a young man, Piot was sent to Central Africa as part of a team tasked with identifying a grisly new virus. Crossing into the quarantine zone on the most dangerous missions, he studied local customs to determine how this disease—the Ebola virus—was spreading. Later, Piot found himself in the field again when another mysterious epidemic broke out: AIDS. He traveled throughout Africa, leading the first international AIDS initiatives there. Then, as founder and director of UNAIDS, he negotiated policies with leaders from Fidel Castro to Thabo Mbeki and helped turn the tide of the epidemic. Candid and engrossing, No Time to Lose captures the urgency and excitement of being on the front lines in the fight against today’s deadliest diseases.