If HIV were just a bug that people were fighting against, it would be hard enough. But it is difficult not to think of the human immunodeficiency virus as an intelligent and calculating enemy: "This is one of the smartest viruses that people have ever seen," says Lisa Price, the policy manager for the Terence Higgins Trust, the best-known British AIDS charity. "It changes all the time."
In the time it took to read that paragraph, three more people became infected with HIV. The virus's spread is not slowing; both deaths and new infections reached record levels last year, at 3 million and 5 million respectively, more than 20 years after it was first identified among US homosexuals in 1981, and neither a cure nor a vaccine is in sight.
I am not winning the war because I don't think the leaders of the world are engaged enough. I feel angry, I feel distressed, I feel helpless. What is lacking is political will.
UN's Kofi Annan
Instead - because HIV exploits the tiniest weakness in the body's defenses and mutates to confound attempts to kill it - every time the world's scientists and politicians think they understand how to tackle the virus, they discover that it is more complicated still.
Some people thought that HIV only affected homosexuals; they were wrong. Some scientists suggested that HIV did not cause AIDS. They were wrong too, though some people have stuck with that line - most notably South Africa's president, Thabo Mbeki, who insists he has never known anyone who has died of AIDS. (In a sense he is right - it is the opportunistic infections that HIV enables which kill you. Most people with full-blown AIDS die of pneumonia.)
The disease has has set First and Third World governments at odds over the anti-retroviral drugs needed to treat it and has even split the Catholic Church over the Vatican's insistence that condoms spread, rather than restrict the spread of, HIV.
While the World Health Organization unveils a scheme today for the annual World AIDS Day that it calls "3 in 5" - aiming to provide the latest anti-retroviral drugs to 3 million people by the end of 2005 - the UN secretary-general, Kofi Annan, has spoken of his frustration at trying to get the healthy to help the sick.
The statistics are numbing. More than 42 million people are infected with HIV worldwide, of whom 26.6 million live in sub-Saharan Africa. The largest number of infections is in South Africa, where about five million, or one in 10 citizens, is HIV-positive. And a combination of unprotected sex and drug abuse is fueling an explosion of the epidemic around the world. And since you started reading this article, 20 people have become infected with HIV.
Yet in the West, being HIV-positive is no longer the death sentence that it was in 1983, when doctors had little chance of preventing the infection turning into full-blown AIDS, at which point a patient would typically live for less than a year.
A veiled Bangladeshi woman takes part in a rally on World Aids Day in Dhaka on December 1, 2003. The United Nations unveiled plans on Monday to rush life-saving anti-retroviral AIDS drugs to three million of the world's poor in a $5.5 billion emergency strategy to fight a disease now killing 8,000 a day. Photo by Rafiqur Rahman/Reuters
Now, modern drugs mean HIV has become a disease that one can live with. The drugs bring unpleasant side-effects, such as nausea, occasional hallucinations and, in some cases, a strange redistribution of fat around the body. But you can live with them, for years - perhaps indefinitely.
In Africa, those treatments have been too rarely available. The WHO estimates that 4.2 million people need anti-retrovirals in sub-Saharan Africa; but only 50,000 get supplies.
Mr Annan thinks many political leaders do not care enough to fight the disease, which has killed 28 million people since it was first reported.
"I am not winning the war because I don't think the leaders of the world are engaged enough," he said. "I feel angry, I feel distressed, I feel helpless. What is lacking is political will."
Only one thing - the use of condoms - dramatically reduces the spread of HIV. (Needle swapping programs for intravenous drug users also work, but on a smaller scale.) And only one thing - anti-retroviral drugs (often called "triple-therapy cocktails") - makes it possible to live with HIV.
Given those facts, you might expect the world's leaders to focus on them. You'd be wrong. And since you started reading this article, 30 people have become infected with HIV.
Catholics for a Free Choice, a pressure group, said yesterday it would begin an advertising campaign against the policies of the church - which has millions of followers in Aid-hit countries - saying "Good Catholics Use Condoms" as "a direct challenge to the cardinals and bishops who recently claimed that condoms were helping to spread HIV/AIDS".
The Vatican supported that bizarre claim in October, saying that condoms had tiny holes which allowed the virus to pass through - so that to use them would encourage its spread. The WHO angrily called the advice "incorrect" and "dangerous"; Catholics for a Free Choice called the Vatican's policy "a disaster".
The lack of availability of treatments for those who are infected could be called a disaster too - though it has not resulted from any dogma. Instead, it grows from a fundamental dispute between the giant pharmaceuticals companies, the only organizations able to rapidly and effectively research new therapies, and the governments of the countries which need them. Western governments have tried to please both sides, and generally failed.
The drug companies want to price the drugs to fund the expensive research needed to develop the next generation - and perhaps find a chink in HIV's armour that might lead to a vaccine, or a cure.
But African countries cannot afford those prices, and have sought ways around the companies' patents to make generic versions of the drugs - exactly the same chemicals, but without the brand name. That led to threats of trade wars.
Former US president Bill Clinton set up a deal in October for four drug-makers in South Africa and India to sell generic versions of anti-retroviral treatments for a quarter of the price of the patented version.
Dr Bernard Pécoul of the medical charity Médecins Sans Frontières said: "One pill, twice a day at this reduced price is exactly what is needed to rapidly expand the numbers of people receiving anti-retroviral treatment in developing countries. With that announcement, the WHO's '3 by 5' objective becomes much more feasible."
Feasible, yes. But will it happen - and by the time it does, will even more people need the treatment?
Meanwhile, the search for better treatments goes on. "We've been saying that a vaccine is five to 10 years away for 15 years," said Ms Price. "But it is looking more realistic that we will [have one] in the next five years." And since you began reading this article, more than 40 people have been infected with HIV - and more than 20 have died from AIDS.
BOTSWANA: MEDICAL STAFF POACHED BY THE WEST
BY AFRICAN standards Botswana is a success story. Rich in diamonds and with potential for tourism, it is relatively prosperous. Transparency International ranks it among the least corrupt countries in the world.
Yet nowhere is the devastation wreaked by AIDS more evident than in Botswana. When Kofi Annan, the United Nations secretary general, warned last week of the "genocide of a generation" he must surely have had this small southern African nation in mind. More than 35 per cent of a population of 1.6 million are HIV-positive. That makes Botswana the country with the highest infection rate in the world. In the sexually active age group, (15 to 49), the infection rate is close to 40 per cent.
By 2010, half of all children in the country will be AIDS orphans, and the average life expectancy will have fallen from 47 to 27. AIDS is killing the people Botswana needs to mine its diamonds and teach in its schools. The 6,000-strong Botswana police force loses 10 people a month to the virus and the army also has high rates of infection
Unlike many African leaders, Botswana's President Festus Mogae has taken the lead in mobilizing his people to fight AIDS and has spearheaded Africa's first antiretroviral drugs program. But Botswana's nurses, doctors, pharmacists and other health workers qualified to run such a program. are leaving. Britain, America and other European countries have poached them. Botswana recently lost 130 nurses to Britain and the country's 6,000-strong nursing workforce is not large enough to deal with the country's health needs. Only 9,000 out of a possible 110,000 patients have been enrolled on the antiretroviral program.
Mompati Merafhe, the Foreign Minister, has raised the issue of poaching with the British Government. To the private agencies that recruit the staff, he said: "How heartless can you be? Why do you recruit medical personnel from countries which are so afflicted by AIDS?" At Princess Marina Hospital in the capital, Gaborone, 3,000 patients are enrolled on a program. but there are only 30 nurses trained to run it.
Mr Mogae has pursued other avenues. He has told his ministers to include AIDS awareness in every speech. "Even when opening a building, the President has instructed us to talk about AIDS" Mr Merafhe said. The President had an AIDS test to try to remove the stigma. He admits that the taboo about AIDS hampers efforts to combat it. "People are not willing to talk about the HIV/AIDS pandemic" he said.
© 2003 Independent Digital (UK) Ltd