AIDS: We Live and Learn But Not the Wiser Grow

"No country can continue to be affected by a global disaster of this magnitude" wrote the UN Secretary-General, Kofi Annan, in the New York Times. The article coincided with the opening of an event that has lifted the United Nations General Assembly out of the obscurity of specialist journals and on to the nightly television news.

The event is, of course, the General Assembly's special session on the AIDS pandemic held last week in the UN's New York headquarters. For the occasion the whole building had been decked out in the red ribbon of the AIDS logo - a symbol to the world that, we are told, will find its way onto the face of a US postage stamp early next year.

But it is what has gone on inside the building that has been of real importance. Some have called it a global 'wake-up' call and that indeed is perhaps how it should be characterised. For there is little doubt that AIDS today poses as great a threat to the potential long term survival of mankind as any of the other great issues with which the United Nations grapples on behalf of us all. We are aware of the creeping menace of climate change, of environmental destruction, of conflict, of world hunger. Yet we barely take notice of AIDS.

At least until now. For there is the beginning of a realisation that AIDS could hit us, our children and grandchildren, harder and more deeply than anything else. In the twenty years since the first cases of a new and unusual disturbance to the immune system came to light the disease has caught a hold of country after country. Long ago did it break out of the isolation it was once thought to have had within specific communities of drug users or those who practised unprotected gay sex. Today, AIDS is everywhere; the only difference between different communities, different countries is in the level of infection.

And the level of infection is rising. According to the UN over sixty million have caught the disease, and over twenty million have died. New infections are thought to be running at some 5 million a year. Thought to be - because in reality nobody knows. In some places, in some countries, there are no facilities for an HIV test, and even where there are people ask themselves why they should bother. They know they cannot afford the expensive cocktails of drugs that may delay the onset of the immune deficiency symptoms from which illness and death inevitably result. Moreover, they may be rejected by the community, and lose the chance of employment.

So the level of infection grows. From a small and almost insignificant problem affecting a few thousands in defined communities AIDS has become a widespread pandemic affecting millions. Sub-Saharan Africa has shown what can happen. Here the UN reckon that more than 25 million people are infected and in some countries the level of infection is more than one in four.

Kofi Annan's Special Envoy on AIDS in Africa is Stephen Lewis. He estimates that among 15-49 year olds in Botswana, 38.8 per cent of all people are HIV positive - the highest rate in the world. The statistics for women alone are even grimmer; infection rates for females were 26.7 per cent among 15-19 year olds, 43.6 per cent for 20-24 year-olds, and 52.3 per cent for 25-29 year olds, he said.

What does it mean when one in two women in their twenties are HIV positive? How can the spread of infection be controlled with an infection rate at this level if normal family life is also to be preserved? How many children will be born with HIV only to die before they see their teenage years?

If AIDS does target communities then it targets the poor and the dispossessed. Men driven by poverty to seek work in the mines or in cities, leaving their families behind for long periods, are more likely to contract the virus than if they stayed at home. They then infect more women in turn. At the same time someone who is poor and malnourished is more likely to succumb to full blown AIDS than someone well fed.

Dr Peter Piot is in charge of the UN programme on AIDS (UNAIDS). He is a respected physician, from Belgium as it happens, who is in no doubt of the potential enormity of the threat. In an interview with the 'Earth Times' newspaper he gave his opinion that 'hundreds of millions' of people would die if the world community failed to take action to address the pandemic.

He is known to be particularly concerned that countries which until now have had only minor AIDS problems will see their HIV rates swell until they too become raging torrents of infection on a par with Botswana. Many countries in Asia and Eastern Europe are in this position. And as AIDS attacks it takes out young people in their prime of life, it takes the mothers and the fathers leaving the children and the grandparents orphaned and without support. The effect on a country's economics is devastating - less productive workers, more dependants, high medical bills.

These are the problems with which the General Assembly is grappling. The far-sighted Annan has called for a Global AIDS fund of '$7 - 10 billion' each year to fight the disease. This is less than what the world spends on armaments and its defence in a single week. Maybe this is what is required in money terms- though with all the research needed to produce a vaccine that protects against the HIV virus, with the cost of making available medicines that halt the onset of the disease and with the cost of prevention measures worldwide - it seems still a lowish figure.

But whatever the figure needed, the response to Annan's appeal has been disappointing. Although new contributions are coming in far less than $1 billion has so far been pledged and even some of that is restricted. It is the same old story of talking big and spending small, of failing to heed the warning signs. Over AIDS as over so much else the gap between what the world community wants and what it is prepared to spend to achieve it continues to mock efforts at serious progress. As the English philosopher John Pomfret said three hundred years ago "We live and learn, but not the wiser grow."

Just back from a trip to the southern African country, said Botswana was "the epicentre of the pandemic in Africa, and yet, the way things are evolving, it may also be a model of the international response."

Speaking to reporters in New York, Mr. Lewis used stark statistics to portray the devastation caused by AIDS in Botswana. In the face of this catastrophe, the Government was committed to the "most ambitious combination of programmes" on the continent, Mr. Lewis said. Botswana was aiming to provide treatment for 60,000 to 100,000 people by the end of the year.