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There is just a chance that, ten years from now, the most significant event in the world last week will not have been held to be the earthquake in Peru - nor the extraditing of Slobodan Milosevic to the Hague, - but the conference that took place in the United Nations in New York which was billed as a global alarm call on HIV/AIDS.

The UN General Assembly's Special Session, held from June 25th -27th, was the first time that the Assembly had ever devoted itself to a health issue. Government leaders and heads of state from all over the world came to state their case and call for action. Now they have departed leaving behind a Declaration running into 103 paragraphs of text - a supposed blueprint for fighting the pandemic in the years to come. The general conclusion is that the Declaration is somewhat underwhelming. The conference may have been billed as a global alarm call but whether the world has yet fully awoken is doubtful. But at any rate it is a first step.

There were certainly valiant attempts to raise awareness that the world is now facing a global emergency of hitherto unimagined of proportions. In the twenty years or so since AIDS first came to light 60 million people have been infected and more than 20 million have died, 90 per cent of them in the developing world. Three-quarters of infections occur within sub-Saharan Africa. Moreover, the spread of the disease is accelerating. AIDS is present now in virtually all countries of the world. Infection rates may vary widely from fractions of a per cent in some places to in excess of 25 per cent in others, but the number of countries with stable or declining infection rates is dwarfed by the number in which rates are rising. Even Botswana - where according to the UN every second young woman in her twenties today is HIV positive - once had an infection rate of only a fraction of a per cent. It is the growth that is frightening.

Richard Holbrooke, the former US Permanent Representative to the UN has called AIDS the most serious problem facing the world today and the worst heath crisis since bubonic plague wiped out a third of the population of Europe and other regions 700 years ago. It constituted, he said, a direct attack on the social, political and economic structure of nations all over the world.

Building on this theme others have likened AIDS to a new slave trade because it takes young, fit and productive men and women leaving behind a crumbling society of dependants. Dr Peter Piot, the Belgian who heads the UN AIDS programme, has estimated that the death toll in coming years could run into 'hundreds of millions' unless action can be taken to halt, and then to roll back, the disease.

Given this state of affairs the wordy 103 paragraph declaration, drafted to meet all concerns, is not calculated to inspire nor to generate much action. The targets that it sets already have a feeling about them of being too little, too late. Nations agreeing the Declaration will have national strategies and financing plans in place to combat AIDS by 2003 ( two years hence) and will attempt to reduce the incidence of the disease by a quarter by 2005. Principal efforts will go into prevention, 'the mainstay of our response' says the Declaration, but despite the language of global emergency ('a global problem requiring a global emergency response' as Owen Arthur, the Prime Minister of Barbados, called it), the Declaration insists on every country doing its own thing in its own way.

Prevention has clearly been successful in reducing infection rates and even in reversing the rate of growth in some cases. In Africa, Uganda and Senegal are singled out as countries with particularly effective anti-AIDS strategies. Prevention strategies have been proved to work in reducing infections particularly through casual sexual encounters and dirty needles. In so far as the Declaration may help to lift the veil of bigotry and prejudice that some communities prefer to draw over themselves it will help health workers to talk openly about how AIDS can be transmitted (and also in other communities about how it is not transmitted).

That there is still widespread ignorance is in little doubt. Despite the horrendous toll HIV/AIDS is taking in some countries, Carol Bellamy, Executive Director of UNICEF, has pointed out that an incredible number of young people still don't know the basic facts about the disease. She quoted some recent research done in the developing world which showed that in 15 countries nearly half of all teenage girls didn't know that a healthy looking person can have HIV/AIDS.

In Mozambique, where the infection rate is 13 per cent, 74 per cent of girls and 62 per cent of boys aged 15-19 were unaware of even a single way to protect themselves; and in Zimbabwe (infection rate: 25 per cent) more than half of sexually active girls aged 15-19 don't think they run the risk of HIV infection, she said.

But where infection rates are 25 per cent plus and higher among young women, it is not easy to practice prevention within a family setting arranged to conceive, bear and raise children. Many families in such communities will be infected with AIDS - no matter how careful they may be. Furthermore, mother to child transmission of the disease will ensure that it passes to the next generation. And so on.

The only real way to halt the virus permanently in its tracks is to develop a vaccine that will render it harmless. Prevention is like trying to plug a jet of water from a smashed fire hydrant; sometimes that it works better than others, but it is never totally effective. A vaccine is like turning off the tap.

Not only would a vaccine halt new infections but it would save the vast potential burden of treating those who have the HIV virus to keep it from developing into full-blown AIDS.

So it is somewhat surprising that vaccines are not mentioned before paragraph 70 of the Declaration. Of course, vaccine research is on-going and equally there are as yet no positive results - at least that are generally known about. There are no striking proposals to galvanise the world's researchers to renew their efforts. No sense that this really is a global struggle against a global enemy. As the Burkina Faso Prime Minister, Paramanga Errest Yonli, put it at the end of the conference "many good intentions have been expressed and many promises made, but the words and intentions have not been followed up by concrete actions."

The real test of whether June 2001 will enter the history books will be whether the world is prepared to stomp up the hard cash to meet Kofi Annan's call for a Global AIDS Fund with $7 - $10 billion dollars a year to spend year in, year out, until the disease is licked. It is only that kind of spending that stands a chance of making many of the individual country programmes work.

Annan has made fighting AIDS a high priority. His reward was the acclamation by which the Security Council this week agreed to recommend him for a second term in the office of UN Secretary-General. The General Assembly is expected to follow suit. Dollars for the fund, however, remain in short supply at the present time. Kofi Annan may need to set the alarm again.