By Kofi Annan
ABUJA, Nigeria — The incidence of HIV/AIDS, tuberculosis and other infectious diseases is higher in Africa than on any other continent. Of course, this fact is connected to Africa’s other problems. Africans are vulnerable to these diseases because they are poor, undernourished and too often uninformed of basic precautions, or unwilling to take them.

Many are vulnerable because they have neither safe drinking water nor access to basic health care. They are vulnerable, in short, because their countries are underdeveloped. And therefore the best cure for all these diseases is economic growth and broadbased development. We all know that.

But we also know that in the best of cases development is going to take time. And we know that disease, like war, is not only a product of underdevelopment. It is also one of the biggest obstacles preventing our societies from developing as they should.

That is especially true of AIDS, which takes its biggest toll among young adults — the age group that normally produces most and has the main responsibility for rearing the next generation. AIDS has become our biggest development challenge. We cannot treat it as just one aspect of the battle for development, because it will not wait for us to win that battle. We have to turn and face it head-on.

Prevention can save many millions of lives, and in several African countries it has been shown to work.

Everyone who is not yet infected must know what they need to do to avoid infection. We must give young people the knowledge and power to protect themselves. We need to inform, inspire and mobilize them, through an awareness campaign such as the world has never seen — using radio, television and professional marketing techniques, as well as more conventional tools of education.

That campaign must reach girls as well as boys. At present, in sub-Saharan Africa, adolescent girls are six times more likely to be infected than boys. That is something which should make all of us African men deeply ashamed and angry.

We must prevent the cruelest, most unjust infections of all: those that pass from mother to child. All mothers must be able to find out whether they are HIV positive or not. And those who are must have access to short-term anti-retroviral therapy, which has been shown to halve the risk of transmission.

In some cases, the risk can also be reduced by alternatives to breast-feeding. But these cases must be approached with caution, since breast-feeding is the best protection against many other diseases.

We must put care and treatment within everyone’s reach.

Even a year ago few people thought that effective treatment could be brought within reach of poor people in developing countries. Those already infected with HIV were condemned to be treated like lepers in earlier times— as people from whom the healthy had to be protected but for whom nothing could be done.

Now, however, there has been a worldwide revolt of public opinion. People no longer accept that the sick and dying, simply because they are poor, should be denied drugs which have transformed the lives of others who are better off.

This month I met the leaders of six of the world’s biggest pharmaceutical companies. They now accept the need to combine incentives for research with access to medication for the poor. They are ready to sell drugs to those countries at greatly reduced prices.

This crisis is so grave that developing countries must exploit all options to the full, including the production and importation of "generic" drugs under license, within the terms of international trade agreements.

Everyone who is infected should have access to medicine and medical care. Now that we know it is possible, it is surely an ethical imperative. It is also essential to any successful prevention strategy, because so long as testing positive is a death sentence without hope, many people will not even want to know their HIV status.

We are still a long way from finding a cure for HIV/AIDS, and a long way from finding a vaccine against it. We must make sure that the search is given the highest priority in scientific budgets, and be ready, as soon as it produces results, to make them available where they are most needed—not only to those who can afford them.

Finally, we must protect those made most vulnerable by the epidemic, especially orphans. Millions of children, because they have lost one or both parents to AIDS, are growing up malnourished, under-educated, marginalized and at risk of being infected themselves. We must break this cycle of death. And we must not wait for parents to die before we intervene. We must help them secure their children’s future while they are still fit enough to do so.

What are the means we need to achieve those ends? First of all, we need leadership.

The leaders of Africa can mobilize fellow citizens for this great battle. They can give it the priority it deserves in national budgets. Above all, they must take the lead in breaking the wall of silence and embarrassment that still surrounds this issue in too many African societies, and in removing the abuse, discrimination and stigma that still attach to those infected. The epidemic can be stopped if people are not afraid to talk about it.

Second, we need to involve local communities. It is ultimately at that level that the battle will be fought and won. It is only with the fullest support of their families and communities that young people will be able to change their behavior and protect themselves.Above all, we must involve those already living with HIV/AIDS in the struggle against it. They, after all, are the ultimate experts.

Third, we need a deep social revolution that will give more power to women, and transform relations between women and men at all levels of society. It is only when women can speak up and have a full say in decisions affecting their lives that they will be able to truly protect themselves and their children against HIV.

Fourth, we need stronger health care systems. This should be obvious, but both governments and development agencies often lose sight of it when setting their budgets and priorities.

If the aim is to make care available to all those infected, we need a far more efficient and extensive system of public health than most African countries even begin to provide at present.

Cheaper anti-retroviral drugs, however vital, will not by themselves provide the answer. Without proper health care, they may even do more harm than good — for example, if potentially life-threatening side effects are not addressed, or if the therapy is interrupted, leading to drug-resistant forms of HIV.

And too many patients still do not have access even to relatively cheap

antibiotics and other effective drugs for the many illnesses that prey on their weakened immune systems.

Finally, we need money. The war on AIDS will not be won without a war chest, of a size far beyond what is available so far.

Money is needed for education and awareness campaigns, for HIV tests, for condoms, for drugs, for scientific research, to provide care for orphans, and of course to improve health care systems. At a minimum we need to be able to spend an additional $7 billion to $10 billion a year on the struggle against HIV/AIDS in the world, over an extended period of time.

It sounds a lot, and it is a lot. Somehow we have to bring about a leap in the scale of resources available. But it is not at all impossible given the amount of wealth in the world. In fact it is little more than 1 percent of the world’s annual military spending. We just have to convince those with the power to spend, public and private donors alike, that this would be money well spent.

In the past few weeks and months there have been several exciting suggestions for a new fund or funds from a variety of people-governments, private foundations and academics. All these initiatives must now converge toward a common vision of what we are trying to achieve.

I propose the creation of a Global Fund dedicated to the battle against HIV/AIDS and other infectious diseases. This fund must be structured in such a way as to ensure that it responds to the needs of the affected countries and people. And it must be able to count on the advice of the best experts in the world, whether they are found in the United Nations system, in civil society organizations or among those who live with HIV/AIDS or are directly affected by it.

Africa is no longer being left to face this disaster alone. Its plight has caught the attention and the conscience of the whole world. I believe the world is ready to come to our aid. But it will do so only if we convince the world that we ourselves are making the war against AIDS our personal priority, and have a clear strategy for waging it.

The writer is secretary-general of the United Nations. This comment has been adapted by the International Herald Tribune from an address this Thursday to an African summit conference.