Politicians will care about Aids only when we do

What chance these days of an impassioned Commons debate on the death of millions?

Panic. Fear. And do I hear the familiar tremors of loathing, and maybe even a whiff of racism?

Panic. Fear. And do I hear the familiar tremors of loathing, and maybe even a whiff of racism?

We learned this week that up to 10 African nurses - men and women - who are infected with HIV have come to work in Britain. Their condition was discovered after voluntary health checks when they arrived to enrol at the University of Wolverhampton School of Nursing. A scandal, we are encouraged to believe. Never mind that these trainees are being kept from working in what are described as "sensitive" areas, the implication of much of the reporting is that we, the uninfected, have something to fear.

As it happens, these Africans will join the tens of thousands of British people who are living with the reality of being HIV-positive and whose presence in the workplace has quite rightly not been the cause of fearful public debate. Rises in infection rates, a return to unsafe sexual practices - these are all things worth worrying about and debating. An effective Aids-prevention strategy is in all our interests. But rather than address the crisis within our society, there is an alarming tendency to project outwards. The African nurses become "the problem". The ultimate conclusion of believing this is to support the exclusion of HIV-positive foreigners from certain jobs. Nursing, for a start. All those needles and sharp objects. Ouch. But if it's a question of sharp objects and cuts and blood, then what about restaurant work... and barber shops... and dressmakers... and building sites? And many more jobs.

It would make for some interesting legislation. We could call it the "Sharp Objects Act", paragraph 1a of which declares: "Any national of a non-EU country who is tested at the port of entry and found to be HIV-positive is legally prevented from taking any employment which renders him or her likely to come in contact with a needle, knife, razor, certain spoons, cheese-graters, fountain pens, saws, knitting needles, sewing needles, scissors or any object which might in terms of the standard definition be described as sharp." That should sort things out. Of course, we might follow the example of a civilised country like Russia which refuses entry to any foreigner who is HIV-positive. (For the record, the Russians have the fastest-growing rate of HIV in Europe. The infected people are Russians).

I suppose there is some small reason for optimism in all the fuss. There is a slight - only very slight - chance that we might wake up to the most devastating health crisis of the last half century. It is so bad that even the Americans who struggle to engage with the developing world have described it as a threat to world security. In sub-Saharan Africa, 23 million people have been diagnosed as HIV-positive. If you work on the basis that most of them have no access to drugs, and that most will develop full-blown Aids, we are talking about tens of millions of deaths in the next 10 to 15 years. Translate that into orphaned families, and economies deprived of human skills and labour, and you will find it impossible to choose a superlative that is grim enough to describe this catastrophe.

Is there the slightest sign that the richer nations of the world care enough to act? Silly question. There are billions to be wasted on Star Wars defence systems. What do millions of dead Africans count for, when set against the theoretical risk of a nuclear war with China or Russia? It is as if there is - somewhere in the depths of Western government offices - an electronic screen flashing out rates of exchange. Today, Botswanan peasants are worth 40 to the white man. Oh, and look, South Africans are making a late surge. They've recovered to 20 to the white man. If that sounds sick, it is because we are sick. How else do you explain our collective complacency about the millions who are dying? Not since the most depraved moments of King Leopold's Congo has Western indifference to the lives of Africans been so pronounced.

Even then, we had Roger Casement's inquiry and a parliamentary debate on the brutalities inflicted by the rubber planters. What chance these days of an impassioned Commons debate on the death of millions? The drugs to prolong life exist. They are widely in use in this country. It costs, on average, £10,000 a year to the NHS for somebody who is HIV-positive to access the drugs. The problem for Africa is that most families struggle to gain access to clean water, let alone the cocktail of drugs that might allow them to live with Aids. The international drug companies could change this by drastically reducing prices, and allowing the widespread local patenting of anti-Aids drugs. There have been small moves here and there, but nothing concerted or radical.

As it happens, I spent the Christmas holidays reading the new John le Carré novel about Africa and drugs. He rails against the international drug companies, so much so that some reviewers have wondered if he has lost the plot. Well done, John le Carré. You are one of the great truth-tellers.

If we did have political leaders here and in Europe and America who were willing to make the issue an international crusade, there might be some chance of turning the tide in Africa. Think of the impact if George W Bush were to make Aids a key issue in his inaugural address, or if the next prime minister of Britain were to emerge after the election declaring his support for an international campaign against HIV. There is a model for campaigners and politicians to consider. The Jubilee 2000 campaign on developing-world debt succeeded in embarrassing some of the leaders of the wealthy world into relaxing the debt stranglehold on Africa. I would love them to act out of altruism, but a little grace under pressure would suffice in the meantime.

Part of the problem is the conviction in a good many hearts - and not simply those of a more conservative disposition - that HIV sufferers have brought it all on themselves and shouldn't expect us to help them. Because the numbers of infected people in Britain are relatively low, this disgusting moralism has not forced its way to the surface.

This is a very different thing to having an open debate about HIV prevention where behavioural change must be a paramount issue. In that area, only very few African leaders have had the courage to address cultural taboos and campaign for the use of condoms. President Museveni of Uganda did speak out, and the result has been a sharp reduction in the number of Aids cases in his country; on the other hand, President Mbeki of South Africa sows dangerous confusion when he publicly questions the link between HIV and Aids.

I live in hope that the Roman Catholic Church will find a way to open its hierarchical mouth and tell the devout and endangered of Africa that it's morally acceptable to use a condom to save your life. It may require some deft dancing on the heads of pins, but the Vatican has armies of theologians who could help.

To get drug prices reduced and more money spent on Aids prevention in Africa, you need strong political pressure. And to get that kind of pressure you need moral odium. And moral odium comes from people who find this state of affairs an affront to the most basic human values. If you are that person, make the war on Aids your New Year resolution.

The writer is a BBC Special Correspondent