South Africa has the world's fastest-growing HIV rates: 20 per cent of the workforce is estimated to be infected. In six years there are expected to be one million "Aids children", left homeless because they are HIV- positive or parentless because of Aids.
"There are villages outside Durban where you find grannies with 20 or 30 children in their care," says Heather Reynolds, who runs an orphanage for 35 children in Kwa Zulu-Natal, the area of South Africa worst affected. "When the granny dies, we have to find another adult to care for children. Aids is referred to as a national emergency. It is already a national catastrophe. One in five children ... is born HIV-positive. The deadly effect of Aids is capable of obliterating the benefits of the end of apartheid and replacing them with something much more ruthless.''
Aids is a taboo subject in southern Africa, helped by ignorance. A common view is that an HIV-positive man can cure himself by sleeping with a virgin. Another is that the condition can be treated with herbs, roots and vegetables, sold for exorbitant prices by traditional healers and generally only good for easing symptoms.
The government says it would take one-quarter of the health budget to treat HIV-positive people, including those who are pregnant, with life- prolonging drugs such as AZT. Studies have shown that pregnant women, given a three-month pounds 150 course of AZT, can be prevented from passing the virus on to their child. But the cash-strapped government, to save money, has decided not to treat anyone, pregnant or not. It says the reason is that AZT is not safe.
Statistics about child rates of HIV and the number of orphans are scarce but the trend is sufficiently alarming for Tony and Cherie Blair to have "adopted'' a seven-year-old orphan, known as "Mary'', when they were in Cape Town in January.
The child lives in the Nazareth House orphanage, funded by a religious order, in west London.