Norman Fowler: A global menace needs a global solution

In the mid 1980s, the Government of Margaret Thatcher was confronted by a new and threatening public health issue - HIV/Aids. We knew there was neither cure nor vaccine. We knew also that it was increasing at an alarming rate.

The issue was how to respond. As Health Secretary, I did not lack for advice; some (quite seriously) said we should not try to help, since homosexuals and drug addicts had brought their sufferings on themselves.

A more popular proposal was that we should preach a "moral" message that, in the words of one religious leader, would plainly say that Aids was the consequence of putting "pleasure before duty and discipline".

My nightmare was that young people would become infected without understanding the risks. I believed our role was to promote knowledge in the most effective way possible - hence the slogan "Aids: Don't Die of Ignorance".

To that end, we sent leaflets explaining the risks to every household in the country and ran a high profile poster and television advertising campaign trying to spread the word. There were charges that we would offend the public but the number of complaints we received was minimal.

The HIV figures improved and were helped also by the policy of having free needle exchanges for intravenous drug users. Again we were attacked for "encouraging drug use" but the policy radically reduced HIV infection.But the latest British figures show that, last year, HIV prevalence increased by no less than 20 per cent and that there are now 50,000 people living with HIV. Gonorrhoea, syphilis and chlamydia have also increased at an alarming rate.

The Department of Health has been off the air for far too long. We have done far too little to educate and inform and if you look at the figures you can see the rising trend of HIV infection dating from the mid 1990s.

But our concern should not just be the position in Britain. So far the HIV/Aids pandemic has claimed 28 million lives worldwide - four times the toll of the holocaust. What has been so extraordinary has been the lack of true public outrage in the West.

A recent poll in Britain showed that HIV/Aids was last out of 26 charitable causes for which the public would give money or time.

And the pandemic is not remotely at an end. There are some who believe that the epicentre is now moving to Asia. India is particularly under threat. Estimates are difficult to make but the semi-official figure of 4.5 million living with HIV could well be 7 or 8 million in reality. In China, there is an estimate of 1.5 million but the real figure could be much more. Russia also has a probable figure of more than 1 million people.

The depressing feature is that, in spite of the clear evidence, some of these countries are still debating the measures that are needed. In India, there is an official reluctance to promote the use of condoms. In Russia, which is having to cope with the impact of shared needles used by intravenous drug users, there is official reluctance to promote free needle exchanges.

If we are not to see further catastrophe we must greatly increase the resources being devoted to HIV/Aids, including support for the new Global Fund but we must also share our experience of the proven policies that can have a real effect in reducing infection.