Doctor Peter Piot

DATE October 24, 2001 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Dr. Peter Piot discusses the world's AIDS epidemic and
ways to combat it
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

My guest Dr. Peter Piot has observed how countries around the world deal
with
epidemics and he's come up against the political, social and sexual denial
of
many political and religious leaders which prevents him from effectively
dealing with the spread of disease. Dr. Piot is executive director of
UNAIDS,
the United Nations agency coordinating the fight against AIDS. He also
co-discovered the Ebola virus, which we'll talk about later. Dr. Piot is a
physician and microbiologist who grew up in Belgium. Earlier today he went
to
a studio in Geneva and we recorded this interview.

I'd like to ask you briefly, first, what it's like to have dealt with the
AIDS
epidemic for so many years, now watching terrorists use anthrax to attack
Americans. I mean, after all the time you spent trying to stop an epidemic,
here are terrorists trying to create one. What goes through your mind when
you see that?

Dr. PETER PIOT (Director, UNAIDS): Well, first, the September 11th events
and the terrorist attacks on New York and Washington are something that was
certainly a major blow to the international interest in AIDS. And the way I
look at it now is that, first, we've got to--we need a world without terror,
that's for sure. And at the same time, we've got to take care of those
issues
that are major factors of instability in the world. And AIDS is one of
them.
It's one of the top issues for the 21st century. There's no doubt about it.

For me, they're fairly unrelated issues, AIDS and bioterrorism, in the sense
that we've got to fight both, but HIV is something that is, in essence, not
so
easy to transmit. It's not a virus that would be very interesting from the
perspective of a bioterrorist; at least that's what we can say. But on the
other hand, it's spreading at an incredible pace throughout the world
continuously.

GROSS: Now you've said that AIDS is causing a lot of instability in the
world. What's the connection between AIDS and political instability?

Dr. PIOT: Well, in January 2000, nearly two years ago, the UN Security
Council, then chaired by Vice President Gore, held a debate for the first
time
on AIDS as a security issue. And it was both a breakthrough in the concept
of
how we look at AIDS, but also in how we look at security, where
traditionally
security's seen as the absence of armed conflict and of daily threats. And
now the concept is that security is more than that. It's the absence of
fear,
absence of hunger, absence of fatal epidemics, just as AIDS is. And AIDS is
definitely a factor of instability, suffice to look at--particularly at the
worst-affected countries. I'm thinking here in the first place of Southern
Africa, where we have countries where 30 to 40 percent of the adult
population
is infected; in other words, one out of three people, nearly one out of two
adults. And what are the implications of that?

First, that these people will die prematurely, to say the least. And that's
particularly the case in poor countries where modern treatment is not
available for a variety of reasons, mostly economic ones. And, secondly,
AIDS
doesn't only affect the poor; it also affects the skilled, the
well-educated.
For example, in several countries, a country like Zambia in Central Africa,
today there are as many teachers who die from AIDS as the country trains
every
year. So that's a disaster. We see the same thing in businesses, managers,
engineers, doctors, nurses, agricultural workers. They're all dying from
AIDS
and so that means that the countries are destabilized because they're driven
more into poverty.

And then we've got the orphans, those who are left behind. For every adult
dying from AIDS there are certainly in societies where they have many
children, like in Africa, there are many children left behind, orphans.
Who's
going to educate them? Who's going to feed them? They often become street
children. They're potential reserves for warlords. Put a Kalashnikov in
their hands and, you know, they have no future.

We have, also, the fact that many of the armies in Africa are very, very
heavily infected with HIV, well over 50 percent. Much of that information
is
confidential, but it's available. And so that means also that defense
systems
are collapsing. And so all that is illustrating the same point: AIDS is a
factor of instability in the world today.

GROSS: You mentioned that in some countries 50 percent of the army is
infected with AIDS.

Dr. PIOT: Yes.

GROSS: I'm wondering if you worry about AIDS every time a new war breaks
out?
Even in this current war with terrorism, do you worry that that's going to
just further spread AIDS because, after all, in any war you have different
populations coming together, bleeding a lot.

Dr. PIOT: Yeah. First, historically, we know that wars have been major
conduits for the spread of classic sexually transmitted diseases, be it
syphilis in Europe in the 16th and 17th century, gonorrhea during World War
II
or the Korea War, the Vietnam War. So that's one thing. And that has to do
with the fact that war is associated with violence. Violence often
includes,
also, sexual violence. And this is what we've seen throughout the world,
that
women get raped and that they're often, in addition to being raped, are also
being infected with HIV. We've seen it during the genocide in Rwanda a few
years ago. There is less social control. You have the military, with
uniform, with some money and with arms. There are displaced populations,
sometimes millions, on the run; refugee camps; people, particularly women,
having only their body to sell in order to survive to feed their kids. You
know, all that means that every time, indeed, there is an armed conflict and
there are lots of refugees--I think here we have it again. This is going to
increase the spread of HIV. We've seen it in Sierra Leone, in Liberia, in
West Africa. We've seen it in Rwanda, in eastern Congo. So that has been a
historic fact and it's unlikely that that will change.

GROSS: How much of an issue is HIV in Afghanistan, for instance, or in
Islamic countries near Afghanistan, where the social code is really quite
strict and quite conservative sexually?

Dr. PIOT: In general, one can say that in the Middle East, going up to
Islamic countries such as Pakistan, that up till now HIV has been a very
small
problem. It's not that it's not there, but Afghanistan--we have hardly any
information, but in Pakistan we know that HIV is there, particularly in
injecting drug-use populations, but not so much in the areas near Pakistan,
but in the major cities like Karachi. Iran also has a growing injecting
drug-use problem and we know that in prisons there are quite a few people
with
HIV, but it's--there's no comparison with what we're seeing in other parts
of
Asia or in--certainly not in Africa.

Central Asia, also, with countries like Kazakhstan, Uzbekistan, it's growing
but still very low levels, but conflict will undoubtedly have a potential
for
more transmission through sexual contact, be it, as I mentioned, violent
sexual contact, rape or, also, commercial sex, which is often accompanying
conflicts, even in very traditional Islamic societies that exist.

And then we are also in the middle of the area in the world of production of
opium and heroin and one question that I have is that whereas people are
using
heroin through sniffing, smoking, and opium, are they going to switch to
injecting drugs, which is a phenomenon we are seeing already happening in a
country like Pakistan? And that, from an AIDS perspective, is also
disastrous. But, in general, one could say safely that the Middle East, in
most of the Islamic countries there that HIV has been much less of a problem
than in the rest of the world.

GROSS: Now do you think that's because of the very conservative social and
sexual code?

Dr. PIOT: Well, there's far stricter social control. Contacts between men
and women are more difficult, between men, as well--sexual contacts. On
other
hand, it's there, HIV, and it may be that it's more a matter of the pace of
spread and that it's going to go much slower, just as we've seen in most of
Asian countries that the spread of HIV has been much slower than in Africa,
but at the end of the day, we only get to the same type of levels of
infection. It's just slow. It just takes longer. And we have to look at
this epidemic in terms of decades, not in terms of the quarterly report.

GROSS: My guest is Dr. Peter Piot, executive director of the United Nations
agency UNAIDS. We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is Dr. Peter Piot. He's the
executive director of UNAIDS, the UN agency coordinating the fight against
AIDS.

What stage of the epidemic would you say we're in now? Where are we?

Dr. PIOT: From a historic perspective, meaning taking the long-term view,
we're definitely only in the beginning of the epidemic. And why am I saying
that? In the beginning because we are still seeing an increase in the
spread
of HIV wherever there are no effective programs. We've seen decline of new
infections in a country like Thailand, in Cambodia recently, in Uganda, in
Brazil, in most of the Western countries, although there it's quite stable
now
because of failure, I would say, of prevention programs. But everywhere in
the world every year we have the sad job to announce that more people are
infected, that the rate of increase in the spread of HIV has gone up. And
that is typical for a beginning epidemic. And as I've said before, we've
got
to look at this in terms of decades. Even in Africa, even in countries
where
30 percent are infected, we still see an increase in the number of
infections,
but there, fortunately, prevention programs are being put in place. But
when
I look at Asia, when I look at Eastern Europe, then it's clear that we are
at
the very early stage of the epidemic. And, by the way, Eastern Europe is
the
part of the world where HIV is spreading fastest at the moment.

GROSS: One of the things you're up against is that AIDS awareness means
talking openly about sex, heterosexual sex, homosexual sex and it also means
empowering women to have some control over their sex lives; insisting, for
instance, that a man use a condom or having some kind of sexual protection.
And apparently not all countries support this. For instance, over the
summer
there was a UN meeting in which a declaration of commitment to combat AIDS
was
drawn up. And one of the clauses in this was to be about protecting the
human
rights and fundamental freedoms of groups who were at risk, and that that
included homosexuals. What kind of opposition did you get to that?

Dr. PIOT: There is no way we can tackle AIDS and the AIDS epidemic without
talking about sex. And we can't dance around the issue. It is impossible.
And I was actually, in a sense, happy that during these debates of the
special
session of the General Assembly at the UN--June--that homosexuality, women's
rights, women's control over their sexuality, sex education--that all that
was
discussed in rather non-diplomatic terms. I was--my major fear was that, as
is sometimes the case in international bodies, that some incomprehensible
diplomatic language would have covered up all this knowledge. We went to
the
heart of the discussion. And that's a real problem for us. I would say
that
the two main issues that we have to deal with when fighting AIDS is the
denial
that it exists and that it has to do with sex. And on the other hand, the
stigma associated with HIV, which has also to do with the fact that it's
mostly transmitted through sex or is associated with drug use or drug abuse.

And this is not only an issue for some backwards countries or Islamic
countries. This is an issue about every single country I have been in and
is
also a problem in Western countries. How many of the Western countries have
advertisements on AIDS and how to prevent it and being explicit or on condom
use on TV on prime time? Not after midnight; prime time. My children went
to
school in France and their--you know, they didn't get any sex education in
school accept for the biology of reproduction, which is a totally different
matter. Sex education has to do with relations; how to, you know, make sure
that boys and girls are empowered to go through life and have a responsible
sex life, but also looking at sex as an integral part of the human condition
and of the--and of life. So we have a real problem. That's what AIDS
reveals.

GROSS: Now one of the issues for AIDS prevention is the use of condoms.

Dr. PIOT: Mm-hmm.

GROSS: Has the pope and the Catholic Church been an obstacle for you on
that?

Dr. PIOT: Yeah, the condom issue is one of the more difficult ones in our
daily work. And there--it is still true that the Catholic Church objects to
the use of condoms. When we look at what happens in practice, it's a bit
different. First, our position in UNAIDS is the following one, and that is
that we--when it comes to preventing sexual transmission of HIV, we have
A, B, C. And by that I mean, A for `abstinence,' B for `be faithful,' and C
for `condom.' It's easy to explain. The Catholic Church says A, B and we
complete the alphabet to go to A, B, C. And what I'm asking the church is
not
to object actively against promotion of condoms and to stick to the
scientific
facts. For example, not to say that condoms would promote the spread of
HIV,
which some clergy have said.

Now on the other hand, I know that from our daily work in the field, be it
in
Africa, be it in Latin America and Brazil or in Asia, that Catholic nuns and
priests that--in health centers, for example, that they're managing, that
condoms are available. I'll never forget an encounter I had with a Catholic
nun in Ivory Coast, in West Africa. And she was in charge of a big program
of
health services, but also dealing with orphans because of AIDS. And she
showed me the education material they had for the community and one of those
flip charts. And suddenly I saw a condom on there and I said, `Oh, Mother
Superior, you are promoting condoms?' And she said, `Well, you know, when I
show this I show this as a woman and not as a nun because people are dying
here.' So she had decided for herself what is the best, but it remains a
problem and--whereas in Uganda, for example, we have a Catholic bishop who
is
the chairman of the National AIDS Commission and which openly promotes
condoms
in a big way. And that's part of the success they had in Uganda. In a
neighboring country, in Kenya, the church is quite opposed, actively,
against
the promotion of condoms and is now in conflict, even with President Moi
about
it.

So I think there is much less of a monolithic position of the church than
one
would think. And we are working very actively, not only with the Catholic
Church, we have even an agreement and a memorandum of understanding, as we
call, with Caritas International, the big church--Catholic NGO--but also
with
other faith-based organizations, with Islamic groups. UNAIDS has produced a
video and a booklet on the role of imams in the fight against AIDS with
quotes
from the Quran and so on. And I can't quote them, but that was made with
imams so that they can use that in their community, because they're
influencing the lives of so many people, although it's limited in their
impact
because otherwise we wouldn't have an AIDS epidemic.

GROSS: Well, what is--I'm sure it's your inclination to respect the
religions
of the world.

Dr. PIOT: Mm-hmm.

GROSS: At the same time, sometimes religion is an obstacle for you because
it's the religion that stands in the way of sex education and of the
dissemination of condoms and education about condoms. So what--can you talk
a
little bit more about your strategy in dealing with religion when you
sometimes, you know, run into a religion that's an obstacle to your cause,
an
obstacle to stopping AIDS?

Dr. PIOT: It is a fact that we need to have the religious groups on our
side
and so rather than to be confrontational, what we're trying to do is to look
for common ground and to see where they can contribute and what we can do.
So
our strategy is--to answer your question, is to--to identify the common
ground. I'm asking that their not opposing condom promotion and they have
an
increasing role, also, in treatment and care of people with HIV. Now all
that
doesn't mean it's a rosy picture. We have daily problems, but we've made
enormous progress.

GROSS: Dr. Peter Piot is the executive director of UNAIDS. He'll be back
in the second half of the show.

I'm Terry Gross, and this is FRESH AIR.

(Soundbite of music)

GROSS: This is FRESH AIR. I'm Terry Gross, back with Dr. Peter Piot,
the executive director of UNAIDS, the United Nations agency that is
coordinating the fight against AIDS. He also co-discovered the Ebola virus.
Dr. Piot is a physician, a microbiologist who grew up in Belgium. Our
interview was recorded earlier today.

When and where did you first see AIDS?

Dr. PIOT: The first man with AIDS I saw was actually in 1979, but I didn't
know it was AIDS. It was a Greek fisherman who was working in what was then
called Zaire, now the Democratic Republic of Congo, and who had come to
Belgium for medical care and had died from unknown causes, and we had kept
his
blood and his other specimens from his body, and later on, we could
demonstrate it was AIDS. But I really got basically full-time involved in
it
in 1983 when I went to Kinshasa, the capital of Democratic Republic of
Congo,
to investigate whether AIDS was a problem there, because we were seeing an
increasing number of AIDS patients in Belgium. And what was so interesting
then in these days is that--with not only men but also women, and in these
days, it was thought to be a homosexual disease, which, by the way, I never,
never understood why a virus would care about the sexual preference of its
host. And also, I was thinking if we see, let's say, 10 people with AIDS
coming from Congo from Central Africa, that means there must be thousands
there because who can afford to come to Europe for medical care? And since
then, I've been working full time on AIDS, yeah. That has changed my life.

GROSS: Why have you stayed with the AIDS epidemic for so long? Some people
burn out after a while because it's so devastating to watch the spread of
the
epidemic. You've stuck with it for years.

Dr. PIOT: I think there are several factors. First, I was mainly involved
in
research. And then I moved into what I would call at the moment more of the
politics. My ambition is more of a political nature now in the sense that
to
make sure that AIDS is at the top of every country's agenda in the world and
that the money is there. So it's because probably I've dealt with various
aspects from the virus to the people to the politics. And secondly, I think
in general, I'm someone who's more of, let's say, a marathon runner than a
sprinter, so I guess we get less easily burned out, take it on one step at a
time.

GROSS: Have you ever been worried about contracting AIDS yourself because
you
have worked with people with AIDS for so long? Have you ever had any close
calls in which you thought you were infected?

Dr. PIOT: Well, I've had an HIV test, but also there was one incident
certainly in '83 in Kinshasa where I had a needle injury after I had
collected blood from a woman with AIDS, and we even isolated the virus from
that blood, so there's no doubt it was in there. And so then I was really
worried, but there was no test at that time. And the HIV diagnostic test
only
became available in '85, so that was--yeah, that was really worrisome.
Yeah.

GROSS: What's the most devastating example of AIDS you've seen in your
travels around the world?

Dr. PIOT: I think the most moving experiences--well, let me mention two.
One
is in Rwanda, you know, a country where one million people were killed in a
genocide several years ago. And I met with a group of women who were
survivors of the genocide and who were HIV positive and who had been raped
during the genocide and who their rapists had left alive, as even a worse
punishment, if you want, than if they would had been killed. And that was
absolutely just--I couldn't imagine how people could behave like that. And
they were without treatment. It's the same story in most developing
countries. People with HIV have no treatment. They lose everything.

And another experience where I felt really--particularly being a man, I felt
really ashamed was when I walked through an area in Bombay in India where
you
have a lot of prostitution with very young girls coming from Tibet, from
Nepal, from other parts of India, basically locked up, and I wonder, also, I
mean, how can humankind do something like that? I mean, families selling
their daughters, of course, because they're poor, and this whole sex trade
and
trading in girls and women who 50, 60 percent are HIV positive. Yeah, that
was really not only shocking, but on the other hand, this keeps me going
also.
It's certainly a boost for motivation for the work, which is very often
frustrating.

GROSS: Maybe you can choose a country for us that you think has been doing
an effective job in stopping the spread of AIDS and give us a brief
description of what they've done that's been so helpful.

Dr. PIOT: There are now a growing number of countries that have less
infections today than they had five years ago, and that's our goal, to stop
that. Let me take one country that has done particularly well, and that's
Uganda. Uganda is in eastern Africa, and in the early '90s, over 20 percent
of the adult population in the country was HIV positive. Today that's
something around 8 percent; still very high by any standard, but a major
drop.
And what's the secret there? Well, there's no secret: hard work,
leadership.
The president, Museveni, took it on as a national cause, and imposed on all
his Cabinet, on all leaders in the country, to talk constantly about AIDS,
to
take this on in their work, whether they are in charge of a business, of a
church or of the Ministry of Health. And secondly, far more openness about
AIDS. Thirdly, people with HIV got themselves organized so that they
developed support groups. Major investment in sex education for young
people,
in condom promotion, and it has resulted in a later age of first sexual
intercourse, less sex partners in the population and far more condom use.
The
problem now is to make sure that the people who are already infected, that
they have access to treatment and care, because that's not the case yet in
Uganda.

GROSS: My guest is Dr. Peter Piot, executive director of the United Nations
agency UNAIDS. We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: Dr. Peter Piot is my guest. He's the executive director of UNAIDS,
the United Nations agency coordinating the fight against AIDS.

You co-discovered the Ebola virus. What and where did you first see Ebola?

Dr. PIOT: The first and only Ebola epidemic occurred in 1976 in what was
then
called Zaire, and I was then working as a young physician in training for
biology in Antwerp at the Institute of Tropical Medicine where we had
received
specimens from a Belgian nun working in then Zaire. And that was my first
contact.

And after we had isolated the virus, we shut down the laboratory immediately
because we were not equipped for this high-risk type of viruses, as the
Centers for Disease Control in Atlanta, for example. And together with
them,
I went into Zaire and stayed there for three months to investigate the
epidemic and saw many patients with Ebola--all of them died--collected
specimens and lived among them for three months.

GROSS: It seems to me that Ebola must be a particularly horrible disease to
witness because toward the end of the illness you bleed from every orifice.
And it just must be horrifying to see that.

Dr. PIOT: Yeah. In Ebola virus infection, basically, what happens is that
one week after the infection that you got into contact with--the virus,
through blood or, you know, other body fluids, you start getting ill,
flulike
type of disease. And then a week later you're dead and, as you say, by
bleeding from your ears, gums, eyes, intestines and so on. And it's--yeah,
it's a horrible site.

And in '76, we had absolutely no clue how Ebola virus was transmitted. Was
it
mosquito bites, water, food, shaking hands, blood or sex, you know, all the
classic ways of transmitting viruses. But today we know that it's through
contact with blood and with other body fluids, and it's not so easily
transmittable. And every Ebola epidemic we've had had died out
spontaneously.
So...

GROSS: Well, why? Why does it die out spontaneously?

Dr. PIOT: What happened classically is that people with Ebola virus
admitted
to a hospital will infect others, either--in the first place, the medical
staff, doctors and nurses, particularly when they don't respect hospital
hygiene precautions, which is often the case in developing countries. And
then also there's transmission through injections, when one doesn't use
disposable needles. So just closing down the hospital makes that patients
with Ebola have no opportunity to infect many people except for their
closest
relatives. But then it dies out. It dies out.

It's not--it's a virus which is probably not well-adapted to human beings
but
comes from some animal. We don't know which one. And it kills its host,
also, immediately. It's a very badly adapted virus to people. HIV virus,
that's the ideal relationship with a host, because you can have HIV and be
healthy for 10 years, 15 years, transmit it. So the virus doesn't have to
jump from one host to another, as is the case with Ebola.

GROSS: So the rapid death of the person with Ebola is bad for the virus in
the sense that the virus doesn't get an opportunity to spread.

Dr. PIOT: Yeah. These epidemics are of relatively short duration.

GROSS: Right. When you're a doctor studying an illness like Ebola, before
you know much about the illness and before you really know how it's spread
or
how it's even caught, what do you do to protect yourself? I mean, you're
not
even sure exactly what you should be protecting against.

Dr. PIOT: Yeah, that's a problem. But we know what the ways of
transmission
of infectious diseases are of enough viruses, and so you try to protect
yourself from that. And it's making sure you don't cut yourself, no needle
injuries and so on; you don't have any direct contact with--certainly not
with
body fluids. So you can wear gloves, masks, goggles. So you protect the
potential entries of the body. But the problem is that if it's mosquitoes,
there's nothing you can do if you don't know it except for repellants. But
you can't completely avoid that. So, you know, it's risky and everybody who
had been working there had certainly--we all share their fears.

GROSS: Wasn't there a part of you that wanted to go home and not be in the
center of this disease?

Dr. PIOT: Well, I was 27. I was quite adventurous, and curiosity, the
excitement of the discovery and of doing something new was--at that time
that
was stronger than my fears. The fear came afterwards, I must say.

GROSS: When the fear did hit you, were you worried you might still come
down
with Ebola or was it just the acknowledgement of the risk you had taken
while
you were there?

Dr. PIOT: Yeah, more the risk I'd taken, and I had had some fever. I mean,
when you're four months, three months in a tropical rain forest in Africa,
it's absolutely normal that you have diarrhea, you get some fever. You work
very hard under extreme stress and then you wonder, you know, is this it, is
this Ebola or is this just a bit of a cold or diarrhea because yesterday I
ate
something that was not well preserved and so on. So that's the kind of
daily
fear. But as I said, it's--the team that was there was just incredibly
dedicated and we didn't take, say, stupid risks. These are calculated
risks,
but they remain risks.

GROSS: Did your team name the illness?

Dr. PIOT: Yes. What we did was that a virus, of course, needs a name, and
we
didn't want to name it after the village where the first cases had appeared,
the Ambuku(ph), because we had experience in the past that these villages
got--or places or cities got a very bad name and be stigmatized. So we
looked
for a river which was not too far from it, and that's the--Ebola is the name
of a river. We only had a very small map of a very big country, and so it
wasn't after all the closest river, but it's a nice name. It's a very
poetic
name, Ebola.

GROSS: But now the river's stigmatized.

Dr. PIOT: Yes. Yeah. But it's a river of--How do you say?--in the
tropical
rain forest hardly anybody will cross or come across.

GROSS: Now, you know, in listening to you, the news all the time in this
atmosphere where anthrax has been sent through the mail and people are
wondering what's next, I have heard people speculating, is it possible that
Ebola can be weaponized? Is that possible?

Dr. PIOT: Well, saying that it's impossible would be not scientifically
correct, but I think it's unlikely because it's not easy to transmit. But
in
today's technical possibilities in terms of genetic engineering, nothing is
impossible if you really work towards it. Ebola, at the moment, has always
occurred in very isolated populations in close contact with forest, tropical
rain forest and so on. So I don't think it would be, to say so, a great
candidate for bioterrorism. But again, you never know.

GROSS: There's a story I would like you to tell, and this dates back to
when
you were in Zaire in the early days of Ebola, and it's a story of a
helicopter
ride that you decided not to take.

Dr. PIOT: Hm. Yeah, when you're working and investigating a new epidemic
like Ebola virus and that's happening in a very remote area, like was the
case
in '76, the virus may not be the major risk and the major danger. For
example, we had to use helicopters to go to all kinds of villages because
the
alternative was going--you know, walking and it would take days. And yeah,
what happened to me is that one day a helicopter from the president of the
republic in Zaire, President Mobutu, came to pick me up to meet with a
delegation of officials from the capital outside the epidemic zone. And the
weather--it was the afternoon. The weather was getting bad, dark sky,
thunderstorms. I felt that the pilots had had a few beers and I didn't like
that, either. And so I decided I'm not gonna go in that helicopter. I also
had another reason for not doing it. As I said, if these people who come
from
the capital can't come to where the action is, where the epidemic is, well,
then, you know, why should I go to them?

Unfortunately, what happened afterwards, unfortunately for the people in the
helicopter, is that the helicopter crashed. And that was one of the most
important decisions of my life, but you don't know it. But the lesson for
me
is that life depends on--just on nothing. And I think we've seen that also
with the current--with the terrorist attacks that have occurred; that in one
second, one minute you're dead. And you don't know that the decisions you
take to take that plane or not to go on that helicopter, that they're a
matter
of life and death at that time.

GROSS: Do you feel like you've become more of a fatalist over the years?

Dr. PIOT: I'm not a fatalist in the sense that I let things go. I really
try
to have an impact on the course of events, and perhaps a bit too ambitious
way. Look at trying to fight AIDS and bring the AIDS epidemic under
control.
That's something that you can be a fatalist if you do that. But certainly
realize that life is limited and that one has to live every single day and
that it is important to think through what you do; that decisions can have
enormous implications.

GROSS: Well, I wish you very good luck in your fight against the spread of
AIDS. And I thank you so much for talking with us.

Dr. PIOT: Thank you.

GROSS: Dr. Peter Piot is the executive director of UNAIDS, the United
Nations agency coordinating the fight against AIDS. He spoke to us from
Geneva.

Coming up, Milo Miles reviews CDs by two contemporary soul singers, Alicia
Keys and Babyface. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: CDs by Alicia Keys and Kenny "Babyface" Edmonds
TERRY GROSS, host:

As an old soul music fan, music critic Milo Miles was happy that the style
has
made a comeback in the last few years. But until he heard the latest albums
from Alicia Keys and producer/performer Babyface, he feared he was looking
for
love in the wrong places.

MILO MILES reporting:

I can't seem to get past the first date with the new generation of neo-soul
singers. There's the all-pervasive problem with consistent song craft.
Toni
Braxton and D'Angelo are only good for only an isolated track or two. And
then there's the ever-tricky business of balancing body, spirit and heart.
Someone who has trouble with this is Erykah Badu, who to me can sound both
racy and ethereal but not romantic. The most persistent problem, though, is
that so many of the young singers are clearly more children of hip-hop than
any old school of soul.

But suddenly I'm overwhelmed by a newcomer, Alicia Keys, and a veteran
professional, Babyface, not just because they've made sensuous records for
all
seasons, but because I can hear where they come from in the soul clan. When
Alicia Keys performed her potent version of Donny Hathaway's "Someday We'll
All Be Free" during the recent "Tribute to Heroes" telethon, I was
especially
sad that performers' names were not announced or displayed anywhere. But
then
she did have the number one album in the country at the time, "Songs in A
Minor." And one of the joys of my existence is a vivid, rewarding record
that's also a hit.

But Keys works in a style that's always had broad appeal. Back in the early
'70s, us lowbrows called it prep school soul, typified by Roberta Flack and,
yes, Donny Hathaway. This secular gospel flaunted its good taste and classy
eclecticism, but Keys' classical training just enables her to integrate the
"Moonlight Sonata" with a funky beat, and the blunt attitudes and rough
language of hip-hop keep her from going too smooth. Her song "A Woman's
Worth" is the "Killing Me Softly" for our more gender-equal age.

(Soundbite of music)

Ms. ALICIA KEYS: (Singing) You could buy me diamonds. You could buy me
pearls, take me on a cruise around the world.

Chorus: (Singing) Baby, you know I'm worth it.

Ms. KEYS: (Singing) Dinner lit by candles. Run my bubble bath. Make love
tenderly to ...(unintelligible).

Chorus: (Singing) Baby, you know I'm worth it.

Ms. KEYS and Unidentified Singer: (Singing) Wanna please, wanna keep, wanna
treat your woman right, not just so, but to show that you know she is worth
your time. You will lose if you choose to refuse to put her first. She
will
and she can find a man who knows her worth. Mm. 'Cause a real man knows a
real woman when he sees her.

Unidentified Singer: (Singing) When he sees her.

Ms. KEYS and Unidentified Singer: (Singing) And a real woman knows a real
man
ain't afraid to please...

Unidentified Singer: (Singing) Please her.

Ms. KEYS and Unidentified Singer: (Singing) And a real woman knows a real
man
always comes first.

Unidentified Singer: (Singing) First...

Ms. KEYS and Unidentified Singer: (Singing) And a real man just can't deny
a
woman's worth.

Unidentified Singer: (Singing) A woman's worth.

Ms. KEYS and Unidentified Singer: (Singing) Mm-hmm. Mm-hmm. Mm-hmm.

MILES: Kenny "Babyface" Edmonds has been a professional musician about as
long as Alicia Keys has been alive, so you'd expect him to have healthy soul
roots. But beyond the predictable references to Stevie Wonder or Luther
Vandross, you have to go back to his breakthrough group, the Deele. They
were an '80s Los Angeles version of Smokey Robinson and the Miracles. And
Babyface's album "Face2Face" suggests beat-aggressive late-period Robinson
songs, like "Cruisin'." As they were with Smokey, remembering dance rhythms
and pushing your voice a little have been a tonic for Babyface.

(Soundbite of song)

BABYFACE: (Singing) You so busy worrying about all the things you can do
nothing about. Maybe it's time to change your ...(unintelligible). Instead
of looking in so much you should look out. You have so many things to spout
about, like love.

Chorus: (Singing) All the things you ever dreamed, it will work out, so
don't
stress out.

BABYFACE: (Singing) Oh, baby. Oh...

Chorus: (Singing) It will happen if it's meant to be, so don't stress out.
Things could work out, baby.

BABYFACE: (Singing) We go...

MILES: Also like Smokey, Babyface has become an expert scene-setter and a
subtle psychologist. On "Face2Face" he specializes in particularly adult
romantic pain, regret and the memory of unrequited love. The highlights of
the album are four `she should have been my girl' tunes that are as wistful
and wrenching as any lonely grownup could want.

(Soundbite of song)

BABYFACE: (Singing) Baby, baby, baby, ain't gonna lie to you, girl. You
made
a big mistake, yes, you did. Now I'm goin' crazy, crazy, crazy 'cause I
ain't
(unintelligible) much night and day. Yeah. ...(Unintelligible). I keep
callin' your name 'cause it just ain't the same without you. Can't get you
out of my head. Things have changed since you left. I keep hopin' someday
you'd come runnin' my way. Where are you? Are you ever comin' back to me?
Are you comin' home?

MILES: But Babyface and Alicia Keys may be most gripping right now because
their albums don't dwell on squabbles, put-downs and resentment between the
sexes. Whether it's teen-age passion or middle-aged ardor, the strong cuts
deliver romance that's neither easy, nor unbelievable. They offer love to
lighten dark days.

GROSS: Milo Miles lives in Cambridge.

(Credits)

GROSS: I'm Terry Gross.

(Soundbite of music)

Ms. KEYS: (Singing) I keep on falling in love with you. Sometimes I love
you, sometimes you make me blue. Sometimes I feel good, sometimes I feel
used. Loving you darling makes me so confused. I keep on falling in and
out
of love with you. I never loved someone the way that I'm loving you. Oh,
oh,
I never felt this way. How do you give me so much pleasure...
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