Young bear the brunt as Aids spreads through the world on a biblical scale

WE THOUGHT we had Aids beaten. The worst infectious disease of modern times was in retreat in the West and there were signs that it had peaked in parts of the developing world. New drug combinations had brought spectacular improvements in survival, adding to the impression that a global crisis had been averted.

How wrong we were. In 1998, another 5.8 million people have joined the legions infected with the virus, half of them aged under 25. Today, more than 33 million people across the planet are carrying the disease and the speed at which it spreads shows no sign of slowing. Villages, towns and countries face ruin on a biblical scale.

In Western Europe, the incidence of new Aids cases began falling in 1995 as new drug cocktails improved survival. In the US, the number of people dying from Aids dropped by two-thirds between 1995 and 1997, testimony to the success of the drugs.

But that therapeutic advance has bred complacency on prevention. The dramatic rises in HIV infection in the early Eighties were reversed by the late Eighties because of campaigns that increased condom use among gay men from zero to 50 per cent. But over the past decade, the number of new HIV infections in North America and Western Europe has failed to fall further, with close to 75,000 acquiring the virus this year.

Today almost 1.4 million people in the region are living with HIV and the total is growing because of improved survival, imposing an increasing burden on health services.

In the UK, the drug bill alone is expected to grow to pounds 300m by 2002.

Across the world it is the young who are taking the brunt of the epidemic - an estimated 40 million teenagers and adolescents will have contracted the virus by 2030.

The worst hit region is sub-Saharan Africa, where 70 per cent of all new infections and 80 per cent of the deaths occur. In four countries - Zimbabwe, Botswana, Namibia and Swaziland - more than one in five adults is now infected with HIV.

"If we do not invest in HIV prevention today we will have to invest in food aid tomorrow," Peter Piot, executive director of UNAids, the world Aids campaign, said yesterday as the latest figures were released.

Clare Short, the Secretary of State for International Development, declared the picture the statistics revealed "truly terrible" and said gains in life expectancy and infant mortality were being wiped out. "This is a further obstacle to Africa's liberation and development," she said.

There is, however, cause for hope. Although countries of the developing world will never be able to afford the expensive drug cocktails now saving lives in the West - if only 25 per cent of Malawi's HIV-infected population was prescribed the drugs it would consume 84 per cent of the country's Gross Domestic Product - there are other measures that have been proved to work.

In Uganda, the first African country to be ravaged by Aids in the Eighties, infections among pregnant women have fallen from 30 per cent to 10 per cent. As families have watched their breadwinners suffer a lingering and distressing death, the messages about safe sex have got through.

Backed by political and religious leaders, there has been a huge increase in condom use, a reduction in the number of sexual partners and a postponement by two years of the age at first intercourse.

In Tanzania, studies have shown that early treatment of sexually transmitted infections with cheap antibiotics cuts the spread of HIV by almost half.

In Senegal in west Africa, where Aids struck later than in east and southern Africa, 66 per cent of men now use condoms, compared with less than 5 per cent at the start of the decade, which has prevented the epidemic taking off.

Young women, who are often infected by older men, are at greatest risk. The first sexual experience of between a third and a half of all girls is from coercion or violence. "That alone is bad enough, but with Aids it becomes a lethal thing," said Mr Piot.

He added: "We have to do something about older men but their behaviour is the most difficult to change. It requires a major cultural shift."

The prospect of an Aids vaccine remains a distant hope. One candidate is on trial in the US and is about to be tested in Thailand, and several others are in the pipeline, but no product will be available for at least four to five years. Ms Short said: "Because Aids kills poor people, the market will not bring a vaccine. Science suggests it is possible... the World Bank is involved - but we must mobilise countries to put money in."

Until a vaccine is developed, condoms and sex education remain the best defence. The music television channel, MTV, has joined forces with UNAids and is to broadcast an Aids series fronted by the British pop star George Michael to a billion viewers round the world.

William Roedy, the president of MTV Networks International, said: "We try to use the influence of pop culture to deliver a message. Condoms are cool, and using them is cooler. We want to make it trendy, hip and cool to use condoms."

Even here, commercial imperatives interfere with humanitarian measures.

Although pharmaceutical companies have donated huge sums in drugs to help to eliminate diseases such as tuberculosis from the developing world, no condom company wishes to be associated with the mass supply of cheap sheaths because of the damage it could do to sales at home.

"Condoms have got to be affordable," said Ms Short. "That means in many cases they must be subsidised."

Leading article,

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Nigel Wrench, Review page 8