Nevertheless, governments in Europe and the USA reacted quickly and resolutely to the new virus. Large-scale propaganda campaigns were organised, explaining clearly how the disease was being passed on. Every individual who had indulged in unprotected sex with a stranger was urged to undergo tests. The campaigns were successful, and the spread of the virus was curtailed. Indeed, the campaigns were so successful that most people in the industrialised world no longer consider HIV a potential threat. This is true not least of the younger generation. As a result, the number of those infected has again risen, most of all in the USA.

The HIV epidemic is a catastrophe for Africa

While the situation is largely under control in the OECD countries, the picture is much more gloomy in the rest of the world. It is most serious in Africa. There, the disease has spread like wildfire. UNAIDS, the UN organisation devoted to Aids, calculates that there are at least 30 million people testing HIV-positive in Africa. Almost 10 per cent of the adult population of sub-Saharan Africa is estimated to be infected. The situation is even more serious in certain countries. In Botswana, for instance, 39 per cent of adults are infected, and in neighbouring Zimbabwe the figure is 33 per cent.

Most of those who test positive for HIV develop the immunodeficiency disease Aids and die within a few years. Nowadays, of course, there are antiretroviral drugs (ARVs) on the market. In the correct dosage, they have been able to prolong the life of many hundreds of thousands of HIV-positive patients in the USA and Europe. But they are expensive and, moreover, it is difficult to administer them in poor villages where there are not usually any health-care facilities. The combination of these circumstances means that only a tiny fraction of those afflicted in Africa have access to the new medication.

The rapid spread of the infection and the increase in the number of deaths has resulted in a drastic fall in average life expectancy in many countries. Take Zimbabwe, for example. Before HIV/Aids, mean life expectancy was 60. But the onset of Aids means that has now sunk to below 40 years of age. The US Census Bureau forecast recently that the mean life expectancy in at least eleven countries in sub-Saharan Africa would be around 30 years of age by the year 2010! Despite an increase in the birth rate, the Aids epidemic will lead to decreasing population levels in the near future.

From the demographic point of view, the main problem in the short term is that thousands and thousands of people will die in their prime. Those left behind will for the most part be children and the elderly. This will lead in turn to an acute shortage of labour, mainly in agriculture but also in other professions. The catastrophic famines that have afflicted some countries in southern and eastern Africa in recent years are not entirely due to a lack of rainfall. The Aids catastrophe is at least as important a cause. There is simply not enough manpower in agriculture. Another grave and worsening problem is how to replace all the teachers who are succumbing to Aids.

The HIV epidemic is estimated to have caused the deaths of between 20 and 25 million people throughout the world, of which 90 per cent have been in Africa. Last year at least 3.1 million people died of Aids, and it is now the fourth largest cause of death in the world. As the disease affects mainly those of a sexually active age, one of the tragic consequences has been a rapid increase in the number of orphans. It is estimated that overall more than 13 million children, most of them in Africa, have lost one or both parents due to Aids since the end of the 1980s.

Not only Africa is affected

We are now quite sure that HIV originated in Africa. It was then spread to the USA and Europe by a small number of individuals. Reports from other continents referred at first to only a very few cases. Exceptions were Brazil and the Caribbean countries. The virus spread rapidly there, leading to the same humanitarian and socio-economical difficulties as in Africa.

Asia is about ten years behind Africa when it comes to the advance of HIV. This meant that when the epidemic was first identified, it was not possible to discuss prevention programmes with representatives of countries such as China and India.

It will be a long time before I forget a visit I made to New Delhi in the autumn of 1987. I was general secretary of the Swedish Red Cross at the time. We had been working closely together with the Indian Red Cross for many years, especially in connection with disaster relief. After the experiences I had of the HIV epidemic in various African countries, I found it natural to discuss the matter with my Indian friends. The Indian Red Cross plays an important role in ensuring that there are sufficient stocks of blood in the country. I therefore offered help from Sweden in the form of equipment to screen the supplies of blood held centrally for HIV. The response I had from my colleague, Ajit Bhomwick, was a mixture of superiority and contempt. He said that the HIV epidemic was not a problem in India. This was because Indians did not have the loose sexual mores characteristic of us Europeans, not to mention Africans. He therefore declined any offer of assistance in this area.

I met Bohmwick ten years later. We had both left the Red Cross by then. I asked him if he remembered our conversation from 1987. He smiled in embarrassment and admitted that he had made an error of judgment. Today, it is estimated that India has nearly five million citizens who have tested positive for HIV. The infection is spreading rapidly, especially in the big cities. It transpires that Hindu men in general visit prostitutes at least as frequently as men in Europe and the USA.

The HIV epidemic has also reached China. For a long time the authorities refused to acknowledge the problem, but in recent years they have turned officially to WHO and UNAIDS for help. What is extremely tragic in the case of China is that a lot of the spread of the infection is due to flagrant negligence in the health service. Hundreds of thousands of poor people in rural areas were infected when they gave blood. Just as in India, promiscuity is relatively widespread, and in the longer term an extremely serious situation is in prospect.

What is now happening in India and China is very ominous. If the epidemic develops in a similar way to what we have seen in many African countries – and the risk of this cannot be ruled out – it would mean that several hundred millions of Indians and Chinese would be affected. The human catastrophe would be scarcely imaginable in its proportions. It would also have a very serious detrimental effect on the economy of the two countries, and hence also on the world economy in general.

Another region where the disease is spreading rapidly at the moment is eastern Europe. Authorities there are also very badly prepared when it comes to prevention programmes and direct nursing care for the afflicted.

The HIV epidemic is a security problem

During the first decades of the epidemic it was considered to be primarily a health problem in most countries. International meetings to discuss the implications were organised by WHO in the early days, and thereafter by UNAIDS. Those who attended were mainly health ministers and their colleagues. There was nothing wrong with that, of course, but as the epidemic spread it became obvious that more was being affected than merely health. For a number of countries in Africa, what is at stake is their survival as a nation. Decades of development aid are at risk. Whole sectors, such as agriculture and education, are facing more or less total collapse in some countries.

For Africa as a region, the epidemic is also a security problem. How will certain countries be able to function, how will law and order be maintained, if the disease is not brought under control in the near future? This was the theme of a conference organised by the UN Security Council a few years ago. The initiator was the then American Ambassador to the UN, Richard Holbroke. As far as I am aware, it was the first time the Security Council had taken up a theme of this kind for detailed analysis.