By Robin Lustig
BBC presenter

It's now more than three years since I met Pepile, but I still think of her often.

She died of Aids soon after I met her.

I'll be thinking of her even more than usual over the coming weeks as the BBC launches a two-week season of programmes and online coverage devoted to the HIV epidemic.

Pepile was seven years old, and had been infected when her neighbour raped her. He thought that he would be cured of Aids if he had sex with a young girl.

She lived, and died, in South Africa, the country where there are more people living with HIV/Aids than anywhere else in the world. Globally, the number of those infected is now more than 42 million; by the end of the decade it will have grown by another 45 million. Half of the people living with HIV/Aids are women; more than half are under the age of 24.

Stark statistics

Enough numbers? Here are some more: the populations of India, Russia and China make up half of the world's total population.

In all three countries, there are already clear signs of an Aids epidemic taking hold.

Nearly a million people are believed to be infected in Russia; more than a million in China, between four and five million in India. Every time I see those numbers, I think of Pepile. Her father and brother had already died of Aids by the time I met her: the estimate now is that there are 14 million children around the world who have lost one or both of their parents to Aids.

Hitting the poor

Perhaps you live in a country where Aids is under control. Lucky you.

But do you, or people you know, travel to countries where it is widespread? Do people from those countries come to where you live? Globalisation means that viruses can cross borders just as easily as people can.

It is, of course, the poorest countries that suffer most. But whereas in the past it was the weakest who died in epidemics - usually the very young and the very old - AIDS is different.

It kills young adults: the producers, the parents, the farmers. If factory workers die, production falls. If parents die, children are orphaned and their education brought to a halt. And if farmers die, food production suffers, and those who are left behind go hungry.

Funds for the fight

In 1999, the world's richest countries made available about $300 m to fight HIV/Aids. Within three years that figure had risen 10-fold to $3 billion. By 2005, it's estimated that at least $10.5 billion will be needed.

The money is needed to buy drugs, to enable people with HIV/Aids to live longer. It is needed to pay for education - to teach girls how to say no to unwanted or unprotected sex. And it is needed to pay for health care, because all the available evidence shows that where basic health care is deficient, Aids spreads more quickly.

Wake-up call

When political leaders talk about it openly and honestly, when the world's richest countries wake up to the scale of the disaster, and when individual men and women learn how to change their behaviour to minimise the risk of infection - then, and only then, might we able to say that the race is being won.

Stephen Pincock

London

The number of people infected with HIV in the United Kingdom increased by almost 20% between 2001 and 2002, from 41 700 to 49 500, says a report published by the Health Protection Agency to mark world AIDS day, 1 December.

Also, the proportion of people who acquire their infection in the United Kingdom, as opposed to overseas, is increasing, the report says.

Kevin Fenton, a public health consultant on HIV at the agency, said, "World AIDS day reminds us that the problems we face with HIV are not going away, despite it being a disease that is largely preventable. The group most at risk of contracting HIV in the UK remains gay and bisexual men, accounting for about 80% (1500) of the new diagnoses in 2002 that were likely to have been acquired in the UK."

An increase in high risk sexual behaviour among gay and bisexual men has also led to major rises in the rates of other sexually transmitted infections. For example, the number of cases of gonorrhoea among gay men has almost doubled (from 1842 in 1999 to 3363 in 2002), and cases of syphilis have increased from 52 to 607 over the same period. As sexually transmitted infections facilitate the transmission of HIV, it is possible that the rise in these diseases may have played a part in the increase in HIV infection among gay men.

Among heterosexual people the number of infections of HIV likely to have been acquired in this country increased from 147 in 1998 to 275 in 2002. Again, increases in sexually transmitted infections—which have been most marked in young people and some ethnic minority communities—mean that the risk of onward transmission of HIV among heterosexual people in the United Kingdom remains a public health concern.

These rises are putting sexual health services under increasing pressure, and services will need to respond to the growing number and varied needs of people who are HIV positive, the report says.

It highlights a number of prevention strategies, including offering annual tests for HIV to gay and bisexual men attending genitourinary clinics, and doing further studies of sexual behaviour among HIV positive people.

Fiona Fleck

Geneva

The number of children left as orphans because their parents have died from AIDS related diseases in sub-Saharan Africa is expected to almost double—to 20 million—over the next seven years and could account for as many as 12% of all the region's children, says a new Unicef report.

The report, Africa's Orphaned Generations, published this week, said that the new findings signal dire consequences ahead for a region already devastated by the pandemic. It said that many affected countries still have no national policy to tackle the growing needs of AIDS orphans, and this could have grave consequences not just for the children but for communities and society as a whole. Many households have become poorer owing to the pandemic, and increasing numbers of families are headed by women and grandparents and are struggling to care for these children.

According to Unicef and UNAIDS figures for 2003, only 1% of some 29 million people with HIV or AIDS in the region are receiving this treatment. Botswana, Lesotho, and Swaziland, which have some of the world's highest prevalence rates of AIDS and HIV, and Zimbabwe are expected to have the most AIDS orphans. The report said that a fifth of children in these countries were likely to be AIDS orphans in 2010.

Unicef found that in 1990 about 3.5% of orphans had lost a mother, father, or both parents to the AIDS pandemic. By 2001 this figure had risen to 32%, but by 2010 more than half the region's orphans are expected to be AIDS orphans, the report said.

By Clare Murphy
BBC News Online

To its critics, Project Prevention or Crack - an American organisation which pays drug addicts and alcoholics to be sterilised - is a terrifying throwback to the neutering of "defectives" during the 20th Century.

But the woman who runs this not-for-profit programme believes she is offering a service to everyone: the drug addict, the taxpayer, the child who has not yet been born, and if she has her way - will never be born.

As the programme - which offers both sterilisation and long term birth control - reaches its fifth anniversary, Barbara Harris also believes she has cause to celebrate. Some 1,050 addicts have taken up the offer as part of her programme over the past five years.

Increasing presence

There is no way of independently verifying the figures given by Project Prevention, nor will the group divulge the names of institutes whose counsellors allegedly refer their clients to the programme - arguing that those people could fall foul of the authorities if their identities were revealed.

Some prisons - such as the Bernalillo County Detention Center in Albuquerque - have apparently allowed the group to host information sessions for their female inmates, but have stressed that this is not tantamount to a referral.

But what is undisputed is that the programme has expanded significantly over the past five years - growing from a small establishment in California to a nationwide programme with a presence in most major cities. As it has expanded, the tone of the group has also shifted.

Her project was initially referred to simply as CRACK (Children Requiring A Caring Community). Now it frequently uses the warmer term Project Prevention.

But the essence of her project remains the same. It offers drug addicts and alcoholics a sum of $200 for opting for a long-term form of birth control, such as sterilisation or a contraceptive implant. Those interested are asked to submit documents proving that they have been arrested on narcotic offences, or provide a doctor's letter as evidence that they use drugs.

Historical analogies

Organisations like the National Advocates for Pregnant Women do not deny that there can be problems with children born of addicted parents but stress that many drug addicts become loving mothers and that their children in many cases do not suffer life-long health problems.

Laws authorising coerced sterilisations were passed in more than half of US states in the 1930s after lobbying from the American eugenics movement, which sought to further the existence of what it deemed to be the "genetically superior" and prevent reproduction among those it saw as inferior: "the licentious" and "the indolent".

America's legislation served as a model for the Nazis' programme of eugenics, which led to the extermination of Jews and the murder of many gypsies, the mentally ill, and homosexuals.

Ms Harris rejects any comparison.

Time and reason

Ms Harris also has some influential, and wealthy, people on her side. Dr Laura Schlessinger, one of the nation's most popular radio talk-show hosts, has made hefty donations and has frequently plugged the project.

Richard Scaife, heir to the Mellon fortune in Pittsburgh, is also reported to have donated, along with Jim Woodhill, a right-wing venture capitalist from Texas. African-American writers favourable to the programme have also helped to rebuff criticism that the programme targets black people. Despite these luminaries, the group continues to attract negative coverage in the media and it raises hackles whenever it opens a new branch.

Nelson Mandela’s prisoner number for the 27 years he was in prison. I saw the concert with friends in a noisy central London pub and heard his speech. In a speech that was greeted by a hush he asked that people with HIV and AIDS not be reduced to mere numbers.

Highlights of the Saturday concert should be available today and you can also donate one minute of your life (and more) by mobile phone or internet.

Come on, it’s nearly Christmas.