Whole nations at risk from virus that has bred a generation of orphans

A child's drawing of a man and a woman in tears is pinned to the wall in the antenatal clinic of the Chris Hani Baragwanath Hospital in Soweto, South Africa. Underneath runs the legend "Aids hurts the ones you love". The poster is next to the condom dispenser.

A child's drawing of a man and a woman in tears is pinned to the wall in the antenatal clinic of the Chris Hani Baragwanath Hospital in Soweto, South Africa. Underneath runs the legend "Aids hurts the ones you love". The poster is next to the condom dispenser.

In South Africa, half a million children have been orphaned by Aids and the number is projected to treble by 2010. For perhaps twice that number, their parents are in the process of dying.

Their futures depend on the success of Gordon Brown's appeal to Western nations to drum up the billions of pounds needed to beat the disease. Nobody knows what impact this explosion in the number of parentless children will have on the social order. Across the continent, more than 12 million children have lost at least one parent and the number is expected to rise to 18 million in the next five years.

Not only lives but nations are at risk, too. In Kwa Zulu Natal, South Africa's fertile coastal province where almost 40 per cent of the adult population are infected with HIV, 27-year-old Nokulunga reaches an emaciated arm from under the blanket where she lies to grasp the water bottle by her bed. Ting, her five-year-old daughter, goes to her mother's side and removes the cap. She is already a carer and soon she will join the ranks of Africa's orphans.

What will Ting's future be? A huge number of children being raised without parental guidance is likely to spell trouble. You see crowds of them congregating at traffic lights in major towns, begging, pilfering, offering themselves for sex. Orphans are more likely than other children to miss school, slip into delinquency and prostitution and pass on the disease.

The impact of Aids on Africa's children is only one of the many uncertainties about the future of the epidemic. The economic future of African nations is under threat as the disease targets the most productive members of the population - young adults - leaving their dependants, the elderly and the young, with no support.

Sub-Saharan Africa is by far the worst affected region, with more than 25 million people infected out of 39 million worldwide. Almost two-thirds of all people living with HIV are in the countries of Africa that lie on or below the equator, as are more than three-quarters of all women with HIV.

There is some good news. Intensive public awareness campaigns and prevention programmes have resulted in falling infection rates in some countries in Africa, such as Uganda. Governments and political leaders are, at last, catching up with grassroots movements and speaking out about the need for action. As more leaders speak out as Nelson Mandela did last week with his admission that his son died of Aids, stigma and discrimination are beginning to lift.

The worst feature of the epidemic in the developing world has been the absence of hope. While HIV has been transformed from a death sentence to a chronic condition manageable with drugs in the West during the past decade, the same treatments have been denied to people in Africa and elsewhere.

The World Health Organisation's "three by five" initiative to get anti-retroviral drugs (ARVs) to three million people - half of those who need them - by the end of 2005 was launched in September 2003. The drugs are beginning to arrive but, a year before the target date only 440,000 people are receiving them.

Without the drugs to treat the disease, most people see little point in coming for testing. Without testing, people remain ignorant of their HIV status, do nothing to protect their sexual partners and the disease continues to spread. Drugs are essential, not only for humanitarian reasons to treat those afflicted, but also to underpin prevention.

In July last year, UNAids said $20bn (£12m) would be needed by 2007 for prevention and care in the developing world. That would provide drugs for six million people, support for 22 million orphans and voluntary HIV testing for 100 million adults.

The current level of spending is $4.7bn, requiring a four-fold increase in spending over the next two years if this target is to be reached. Meanwhile, 14,000 new infections occur worldwide each day.

President George Bush pledged to increase US investment in the fight against Aids before his re-election in November. But there are fears the pledge will be eroded by the US protecting its own interests.

Cheaper, generic ARV drugs that have appeared on the market in the past few years are helping countries get national treatment plans under way. But according to Christian Aid, that encouraging situation is being severely threatened by trade negotiations, notably between the US and developing countries.

The powerful pharmaceutical lobby is using the negotiations to apply pressure in order to protect its own profits at the expense of cheap drugs for poor nations, the organisation said in a report, If not now when? in November.

Drug treatment, however, cannot cure Aids and no matter how extensive, it will not curb the epidemic. Prevention remains critical. The most effective measures are giving people access to condoms, voluntary HIV testing, treatment for sexually transmitted disease and drugs to prevent mother-to-child transmission.

Ten years of efforts to develop an Aids vaccine have yet to show significant progress. The Aids virus is one of the most difficult to devise a vaccine for and further advances may prove difficult to achieve.

But there are other targets for research. Without an Aids vaccine, the best hope is for a microbicide, a gel that could be used by women to destroy the virus during sex. UNAids said a first generation microbicide could be ready in five years if investment in research were expanded. A microbicide that was 60 per cent effective and used by one in five women could prevent 2.5 million new infections over three years.

An effective microbicide would increase the power of women to protect themselves. In South Africa, one in four women are HIV positive by the age of 24, twice the rate in men. Teenage girls have sex with, and are infected by, older men - one symptom of the gender inequality that drives the epidemic. Men become infected later.

What began as a male disease that mainly affected male homosexuals, injecting drug users and men who used prostitutes, has turned into a female epidemic. Globally, the fastest increase in infections is among women and girls, who now account for 57 per cent of all those infected with the virus in sub-Saharan Africa.

HARD FACTS AND FIGURES

3.1 million Aids-caused deaths in 2004

39,400,000 people were living with HIV in 2004.

14,000 people become newly infected each day

$20bn is needed by 2007 to tackle the disease according to UNAids.

In some countries, such as Uganda, infection rates have fallen, giving grounds for hope.

$4.7bn has been given so far.

95% of people with HIV live in the developing world.

12,000,000 children have been orphaned by Aids in sub-Saharan Africa.

18,000,000 The number of Aids orphans expected in five years' time.

The disease is rising fastest among women and girls.

57% of people with HIV in sub-Saharan Africa are women.

3,000,000 The number of people the World Health Organisation wants to be treated with anti-retroviral drugs by the end of 2005.

440,000 The number of people receiving this treatment, according to the latest figures for 2004.

22,500 lives were claimed by Aids in North America and Western Europe last year.