"We have seen nothing like it in human history. It is already worse than the Black Death of the 14th century." This arresting description of the HIV/AIDS pandemic was given by Dr Richard Feacham at the international conference on the disease which ended in Dublin yesterday.
It was echoed in many other presentations which highlighted the startling speed with which HIV/AIDS is spreading in eastern Europe and central Asia.
The 30,000 people living with the disease in the two regions in 1995 have now grown to 1.5-2.1 million, the fastest increase in the world and affecting young people and women especially. It is a fearsome public health crisis which, as the Taoiseach, Mr Ahern, said, "threatens development, social cohesion, national security and political stability" in many of the 55 countries represented at the conference. The disease is a worldwide problem, not one restricted to sub-Saharan Africa, where it is still most widespread.
This conference was intended to kick-start and deepen public awareness about the scale of the crisis and agree on measures to tackle it. The Dublin Declaration, adopted yesterday, the publicity attracted, and the arguments stimulated, have gone some way towards achieving these objectives. Archbishop Desmond Tutu brought the message home effectively: "Silence kills. Stigma kills. Speak up. Speak up. Speak out." HIV/AIDS thrives on ignorance of its devastating impact on the most vulnerable; refusal by political leaderships to admit its startling growth; and a failure to debate its effects - often because of taboos about publicising sexual practices, or religious condemnations of condoms and safe sex. In western Europe, where numbers have stabilised and deaths diminished because of the widespread use of anti-retroviral drugs to prevent HIV infections developing into full AIDS, there has been a dangerous complacency about the disease.
The importance of public education and political leadership are insisted on in the declaration. Questions of political will and good governance are as important as financial resources in tackling the crisis. So are human rights: for women who need access to condoms, drug users to needle exchange, prisoners to as much advice as other vulnerable groups, and all with the disease to representation in preventive programmes. The declaration mentions abstinence from sex and drugs and fidelity to partners, but recognises they cannot realistically be the only approaches adopted.
It would be all too easy for such a conference to salve consciences by raising these issues, rather than setting real and achievable targets to tackle them effectively. Ireland's initiative in organising the conference as part of the EU presidency has been justifiably commended; it now needs to be followed up at the highest political levels and the most diverse forums, from world trade talks to the United Nations. Unless these lessons are learned and applied within each of the 55 states involved, millions more people will suffer.