The scale of the HIV/AIDS epidemic is almost beyond human comprehension. Over 20 million dead and nearly twice that number serving out their indeterminate sentence. Life expectancy in regions of Africa reduced from 60 to 30 years.
Whole regions laid waste socially and economically. Bewilderment, sadness, tragedy, tears, death.
A speaker at the UN General Assembly said it was the worst outbreak of disease for several hundred years, a clear reference to the Black Death which took 75 million lives, devastated medieval cities and stalled civilisation in Europe for decades. The Taoiseach said they were the worst casualty figures since the second World War.
It is the biggest public health challenge facing the United Nations and the world since the smallpox epidemic which was killing two million people a year when the UN World Health Organisation launched its vaccination campaign in 1967. Twelve years later, the disease appeared to have been fully eliminated. The AIDS threat is even greater and more complex and besides there is no vaccine although the quest to find one continues.
Few if any countries have escaped this modern plague but the extent of the outbreak in Africa can only be understood by comparing it with the Great Famine or with a more large-scale version of the TB epidemic in the 1940s.
An Irish woman with long experience of dealing with this human tragedy is Breda Gahan from the development agency, Concern. Gahan is a nurse and midwife from Boolavogue, Co Wexford, who first came across HIV/AIDS in St James's Hospital, Dublin, in the mid-1980s. But she first encountered it as a mass phenomenon working in refugee camps on the Thai/Cambodia border in the early 1990s.
As UN delegates swept past us on their way to various meetings this week, she spoke of how ordinary Cambodians, mystified by the outbreak, dubbed it "the Slim Disease" because one of its major effects is loss of weight, with advanced patients becoming emaciated. "In Africa it's called the Thinning Disease." As in Ireland in former times, people in some of these countries regard being mildly overweight as a sign of health and prosperity.
Gahan conveys a vivid sense of how ordinary people in the Third World reacted to the strange and alarming new phenomenon. She recalls that there was "a lot of denial" in Cambodia with nobody admitting that they, or their relatives, had contracted HIV/AIDS. "They were scared of discrimination."
They also attributed the outbreak to supernatural causes. "Some people believed it was bad Karma: you had done something bad in your life." Raising awareness was a huge challenge: "In Uganda, they initially thought it was from witchcraft or a punishment from God."
She later carried out research on AIDS in a remote province of Tanzania : "People thought I had come to bring a cure". She was particularly affected by the sight of teachers in their late 20s or 30s who had contracted the disease and were now walking with sticks, old men before their time. "They looked like they walked out of Auschwitz."
There was a great deal of misinformation, as when contraceptives were being distributed by A US aid agency and the rumour went around that the lubricant for the condoms had been deliberately infected with HIV "to reduce the number of Africans". She has also worked in Rwanda where AIDS came as a further curse on top of the bloodsoaked civil war: "Privately, some people in Rwanda are saying to me, 'This is the new genocide'."
This week, more than 20 years after the first reported incidence of HIV/AIDS, the United Nations finally got around to holding a special session on the disease. The UN is like Winston Churchill's definition of democracy as the worst form of government - except for all the others. For all its imperfections, if the UN cannot do the job then it won't get done. It is, in a word, our only hope.
UN headquarters on Manhattan's East River this week was a curiously invigorating yet in some ways dispiriting place. The swirl of costumes and the melange of colours from all over the world conveyed a heartening sense of the international community coming together for a common purpose. But the rundown state of the place, where even getting a chair to sit on was a problem for reporters and little incidents such as certain delegates chatting audibly in the General Assembly while the Taoiseach was giving his thoughtful speech, showed all was not as it should be.
Last April UN Secretary-General Kofi Annan announced the establishment of the Global Aids and Health Fund. He wrote in the New York Times last Monday that AIDS could eventually be brought under control in the developing world by spending an additional seven to 10 billion dollars each year. "It is only a quarter of New York's city budget," he said.
But the pledges were coming slowly at the start of the week and the Taoiseach's offer of $30 million, including an unspecified amount for the fund, must have been welcome. Sometimes criticised for failing to give leadership in other areas, Bertie Ahern at least was showing the way on AIDS. There was a lot of cynicism when he announced at the Millennium Summit last September that Ireland would gradually increase its development aid budget over a seven-year period to reach the UN target of 0.7 per cent of GNP but this is proceeding apace and the extra funding on AIDS comes from that swelling purse.
Sources said the Taoiseach had been "quite agitated" when he saw the devastating impact of AIDS during a visit to South Africa and Lesotho last year and had raised it with European Commission President, Romano Prodi. He was the only EU prime minister at the UN this week.
The bulk of Ireland's development aid goes to African countries but, because the disease has such a devastating impact, the fight against AIDS has become an essential component of the development programme. Ireland also supports greater debt relief, or even debt cancellation, for poor countries afflicted with AIDS and favours a tiered pricing system so these countries can have easier access to life-saving medicines. Minister of State, Liz O'Donnell, won applause for her contribution along these lines at one of the roundtable discussions.
Ireland was also involved, as part of the European Union bloc, in one of the major controversies of the week. This was the row involving western and Islamic countries over a proposal to include references to homosexuals ("men who have sex with men") and other particularly vulnerable groups in the declaration to be adopted at the end of the special session. Sweden, which currently holds the European presidency, spoke on behalf of all EU members but there was regular consultation. Changed times when Sweden speaks for Ireland on a matter related to sexual morality.
There was a parallel dispute over a proposal to invite a representative from a gay and lesbian group to a roundtable discussion on AIDS and human rights.
These disputes were unfortunate but probably inevitable. Homosexuality is generally anathema to Islamic culture but clearly there were many on the liberal side of the argument who felt a point needed to be made and that their opponents were "in denial" about the groups which are especially vulnerable to AIDS.
The row over the declaration marred the proceedings at the Assembly and there was a distasteful procedural row on the issue. In the end, the Islamic countries won a kind of pyrrhic victory when it was agreed to withhold the homosexual and other references from the final text. But it's an issue that won't go away, despite a Libyan spokesman's statement to the General Assembly: "Homosexuality is one of the main causes of this disease. In fact, God sent the prophet Lot with a clear message preventing such practices, and banning them". Given the necessity to build something like a mass movement internationally against AIDS, it is unfortunate that the literature on the subject includes so much jargon.
Kofi Annan at least is a refreshing exception to this rule and in addition to the note of alarm, he also had a message of hope, pointing out that even less well-off countries could confront the disease, as Uganda, Thailand, Senegal and Brazil had shown.
One of the more significant developments of the week was a decision by the US administration to drop a complaint with the World Trade Organisation over a controversial Brazilian law permitting the production of inexpensive local versions of international anti-AIDS drugs.
Sister Maura O'Donohue, who represented the Irish Missionary Union at the special session, points out that AIDS is more than just a healthcare issue. The causes are linked to "poverty, lack of infrastructure, lack of health services and access to health services", she continues.
"If you look at the global situation: one in seven people wakes up every day to starve. If they are hungry, it means they are not getting enough nutrition: their immune system is already compromised. They are going to be much more prone to develop all kinds of infections. If they are exposed to HIV, their whole health pattern is going to suffer. You have a situation where less than every four seconds, one person dies of hunger in the world and three-quarters of these are children. So while you can count to four, somebody dies of hunger. That's the context in which we are trying to look at HIV/AIDS."
Finola Finnan, who represented Dochas, the Irish association of voluntary agencies working in the area of development, at the UN conference, said: "You can't look at just the effects, you have to look at the cause." She stressed that people suffering from the disease should not be just passive recipients of care. "It's no good people just sitting in the UN deciding what the response should be. You have to bring it back down to the people who are infected and affected by it. There has been a lot of discussion in this conference about youth being involved and you need greater involvement with youth because they are the greatest hope for the future."
She explained the high incidence of the disease in Africa: "People have no access to education, to information. Women have limited choices: both socially and economically they are dependent on men. They can't make choices about their own sexual relations. Even if they are in a relationship where they are at risk of HIV/AIDS they can't leave it." She favours a dual approach: "You've got to treat the disease itself and ensure that there is the proper health infrastructure to deal with it but you also have to treat the underlying causes."
Official figures for Ireland show that 362 people have died of AIDS since reporting began in 1985. Last year, there were 342 new HIV cases, or almost one a day. While the scale does not compare with South Africa, it still gives grounds for alarm.
A Zimbabwe delegate to the UN conference, who is HIV-positive, has lost 22 relatives to AIDS since 1994. She now works as an AIDS counsellor with the Red Cross. But a Norwegian delegate, also HIV-positive, summed up the challenge for the UN and for all of us in simple terms: "We are not viruses," he said. "We are humanity."
Website: www.unaids.org