Second Opinion:In 2003 I visited a community-based HIV and Aids programme in the urban slums of Nakuru, a city northwest of Nairobi, with a population of 250,000.
What I witnessed in terms of human suffering was profoundly challenging.
In these slums, one in three is HIV positive. The people are living in shanty huts made from galvanised sheeting; they have no water, electricity or sanitation.
For those who were critically ill, there were no Aids drugs, no pain relief, no medical care whatsoever - and yet this is one of the most devastatingly cruel viruses ever to strike mankind.
The suffering I saw has been created by the cruel combination of Aids and poverty, one fuelling the other, in an endless cycle of destruction.
When I visited the mortuaries the bodies were stacked on top of each, such was the death toll. I was witnessing a people in mourning.
Three years later, the situation, though slow, is beginning to change.
In urban areas, people are beginning to receive treatment. Where this is happening, people are responding quickly, feeling better and returning to work in a fairly short time.
The transformation is so dramatic the Africans have named it the "Lazarus effect".
However, only one-fifth of the patients requiring treatment are receiving it. The remainder face a profoundly disturbing and grim death, for the most part with no pain control.
Observing this is unsettling.
Before Aids struck African countries, the majority of medical systems were overstretched; with the advent of Aids they are overwhelmed.
Lack of infrastructure and human resources are the principle causes. Many healthcare workers have succumbed to the virus or have been lured to developed countries, for better salaries.
There are more Malawian doctors in Manchester than in Malawi where there are five doctors to 100,000 patients.
Developed countries have a responsibility in this matter.
Last week's UNAids report states clearly that the pandemic is outstripping the response.
Infection rates and deaths continue to grow. There are approximately 8,000 new infections each day in Africa.
Given that only 10 per cent of people know their HIV status - due to shortage of services - this is no surprise.
What hope is there for stopping the transmission of any virus if people do not know if they are infected?
Prevention of Mother to Child Transmission programmes are equally vital, yet only a tiny percentage of pregnant women have access to this.
In some countries, 30 per cent of pregnant women are delivering HIV-positive babies and yet placing the mother on anti-retroviral treatment from 24 weeks of pregnancy reduces the risk of transmission of the virus to less than 2 per cent.
Nine out of 10 children contract the virus from their mother. Should the children be infected, very few have access to treatment.
The feminisation of Aids is devastating in its effect. In some African countries, young women, aged 15-24, are four times more likely to be infected than young men.
Sexual and economic subordination of women is fuelling this pandemic.
Women have absolutely no right to refuse sex - even if their partner is HIV-positive.
The disease is often preceded by violence, the diagnosis succeeded by further abuse and rampant stigmatising within communities. This is a ferocious assault on women.
With so many women succumbing to the virus, there are bewildered and lonely children everywhere.
As you move around the slums, they all want to be lifted and hugged, grandmothers everywhere are struggling day and night to mend the broken hearts.
The Africans have been portrayed for too long as passive recipients of charity, yet nothing could be further than the truth. From grassroots to leaders of civil society, heir response has been heroic.
This Friday, December 1st is World Aids Day, and on this day 5,700 people in Africa will die as a result of the virus.
The international community's failure to respond has been described in many ways: genocide by apathy, death by diplomacy. History will make that decision - but when you are on the ground moving from hut to hut, the paucity of response is difficult to comprehend and impossible to accept.
Mary Donohoe is founder of The Rose Project which is funding 18 HIV and Aids programmes in six east African countries. The focus of funding is on the delivery of medical, nursing and psycho-social care
For more information visit: roseproject.com
RTÉ1, on Thursday night at 10.15pm, will feature a programme called A missing generation - Aids in Africa - The Rose Project's response.