With AIDS, as with all diseases, prevention is better than cure. As we propagate the ABC of Aids prevention (Abstinence, Being faithful to a partner and Condom use), we must stress the importance of the A and B just as we do the C.

A new commitment has been made by Western governments, especially the UK and US, to devote more resources to fighting HIV/Aids globally. The question on many lips, however, is why has it taken so long? Since the world became aware of the first clinical case of Aids in 1981, the disease has affected 60 million people. Twenty million are already dead and 40 million are living with the virus or the disease, about 75% of them in Africa. More than 20 per cent of the adult population in Botswana, Lesotho, South Africa, Namibia, Zimbabwe, Swaziland and Zambia is infected. The next decade will be far worse if effective treatment, along with a radical shift in people's readiness to be faithful to one sexual partner, do not become widespread soon. Reasons given for the level of the epidemic in Africa include: ineffective education about the disase; poor health services which still cannot screen blood properly before transfusions nor treat the vctims effectively; cultural practices which continue to perpetuate the disease; HIV-infected men sleeping with children in the belief that this will cure them; and, most important, poverty. Structural adjustment programmes carried out in the last decade by African countries at the instigation of the World Bank have left many of them bankrupt. Little remains for social programmes. Local industries in Africa have collapsed under competition with Western and Asian industries. Unemployment has risen, and many former rural people now live in urban slums. Unable to find jobs in the cities, many women have turned to prostitution to keep their families together. The lack of effective political leadership in the face of Aids, with some countries denying its existence to protect international tourism, has also fuelled the spread of the epidemic. Aids not only thrives amidst poverty, it is a major threat to development. The most productive members of society are, in general, the worst affected. A drop in the labour force due to disease has had an enormous impact on national productivity. The media tell us that the food shortages in Zimbabwe are due to its new land reform programmes. We are not told about the contribution of Aids. Classrooms in East Africa are battling with a lack of teachers due to this scourge. Family income is being hit by the loss of breadwinners. This has led to malnutrition, limited access to education and other social services, and a breakdown of family structures. What is the way forward? In the developed world during the last decade, antiretrovirals (drugs which prevent the virus from further damaging the immune system) have dramatically improved the quality and expectation of life of HIV-infected patients. Unfortunately, only 50,000 Africans have access to these life-saving medicines. If the US, the UK and other Western countries stick to their recent commitments, the World Health Organization (WHO) plans to make the antiretrovirals available to three million people by 2005. The Director-General of WHO says that to make this happen, it should not be 'business as usual'. We should acknowledge Aids as a global emergency, big pharmaceutical companies should be more charitable, rich governments should 'walk the talk' and, above all, developing countries should put their health systems in order to make full and judicious use of committed resources. Would antiretrovirals be the panacea for this global threat? Unfortunately not. We all have a moral responsibility to prevent infections in the first place. The truth is, in Aids as in all diseases, prevention is better than cure. As we propagate the ABC of Aids prevention (Abstinence, Being faithful to a partner and Condom use), we must stress the importance of the A and B just as we do the C. Africa is showing the way. Most of the population in even the hardest hit countries is still not infected, and children under 15 years of age (except those infected at birth from their mothers) are largely free of the virus. Uganda already has a number of youth clubs addressing this, and ABC campaigns in that country are credited with reducing the level of infection from perhaps 30 to five per cent. In Ghana I was recently invited to give a talk to a 'Virgins? Club'. Yes, Virgins? Club! If you think they do not exist for 15 - 30 year-olds, come with me to Ghana!