Henning Mankell - I Die, but the Memory Lives on

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.

We shall be condemned by future generations if this kind of passivity is allowed to continue.

With hindsight it is relatively easy to say what ought to have been done in the way of preventative measures at the end of the 1980s. There was already enough knowledge and experience to organise an effective prevention programme, but this experience did not lead to the action we now know should have been taken. Governments ducked the issue and the international community failed.

A few countries have managed to buck the trend. This is true of Uganda and Senegal in Africa. It also applies to Thailand, and to some extent Brazil. The common denominator in these countries is very active government involvement. President Museveni has played a pivotal role in Uganda. All taboos have been stood on end. Ministers and other opinion formers have actively and systematically preached "safe sex". The distribution of condoms was a matter of course. But serious attention has also been paid to questions of abstinence before marriage and faithfulness within a relationship. These countries could serve as models for others.

There is no contradiction when it comes to putting resources into prevention, and also providing support and assistance to people who have already been infected and/or fallen ill. Prevention and nursing care must go hand in hand. What is the point of undergoing tests if there is no care available if you turn out to be carrying the virus? In this respect an individual firm can play an important part. Many companies, especially in South Africa, have become actively involved in preventative work and also help to pay for and distribute ARVs among their employees.

What we must now work to achieve is co-operation between all countries of the world in a long-term and systematic campaign to slow down and eventually stop the advance of the HIV epidemic. We must not allow the worst-case scenario to become reality, and must prevent the epidemic continuing to spread for another 60 years.

What is needed first and foremost is total frankness about the disease and the ways in which it is passed on. A stop must be put to all those who continue to agitate against sex education and the use of condoms, and who think, like some parts of the Bush administration, that the disease can be controlled simply by preaching sexual abstinence.

Just as important is to mobilise sufficient funds to pay for preventative measures and the care of those who have the disease. We have a special responsibility for the welfare of the millions of orphans that the epidemic has already left in its wake.

We must think big. Even if the USA and the EU have increased their contributions significantly, it is not nearly enough. We must work towards a tripling or quadrupling of the current levels of funding. At the same time the countries at the receiving end must revise their budget priorities and make health care their number one concern.

Special efforts must be made in funding research to produce a vaccine, and to develop better and cheaper drugs. In this respect the US government has a major responsibility. Hitherto it has turned a blind eye to the activities of the giant pharmaceutical companies instead of making clear the self-evident fact that drugs must be distributed at the lowest possible prices in the poorest countries, and that the only alternative is the imposition of a compulsory licence for countries where Aids is widespread.

Finally, it is important to do everything possible to prevent the spread of the epidemic in countries like China and India. It is estimated that so far only 0.5 per cent of their population has been infected. It should still be possible to prevent a catastrophe of the kind that has befallen a large number of African countries. In order to achieve this, everything possible must be set in motion now. In a few years it will be too late.

Anders Wijkman, 2003

Member of the European Parliament,

formerly Assistant Secretary General of the UN,

member of the board of Plan Sweden

"Through my photos, I wanted to make people more aware of Aids, to show the consequences of the disease and to give advice. But I also wanted to demonstrate the hope that I still have in life, despite my illness"

Julie, former photographer

Fondation Femme Plus, Democratic Republic of Congo

In 2000, Christian Aid, one of the UK's leading aid and development agencies, gave cameras and photographic training to HIV-positive women working with the Kinshasa-based women's organisation Fondation Femme Plus so that they could record images from their own lives – create their own testimony of life in the time of HIV.

Fifteen women documented their day-to-day lives with families and friends, and doctors and hospitals, and their vision of the social tragedy caused by HIV. The result, the exhibition Positive Negatives, which opened in London and Kinshasa before touring the UK and Ireland, was a unique and powerful record for their children and future generations.