Perhaps the most chilling statement to be made about AIDS for quite some time came this year from Dr Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). The AIDS epidemic, he said, is still in its early stages: "HIV is characterised by a relatively long gap between infection and major illness," he said.
"Its natural dynamic is to show up first among those at heightened risk, while at the same time it gradually moves across the whole of the sexually active population."
In the past 20 years, HIV has infected 58 million people, killing 22 million. The ravages of the disease are redrawing the social, economic and demographic map of Africa and is almost certainly in the course of producing profound, but not yet evident, political changes there and elsewhere.
That this disease, first officially reported on June 5th, 1981, in a nine-paragraph report by the US Center for Disease Control should still be in its early stages is shocking news. But are we shocked? No, we are not. It may be that for many of us, here and elsewhere, AIDS is something that happens to someone else.
Somehow we have insulated ourselves from the whole subject. The National Disease Surveillance Centre (NDSC) recently pointed out that the number of HIV cases tripled in the Republic between 1994 and 1999. New HIV infections are running at about 350 a year, the highest ever in this country.
Never mind whether anyone is shocked by this - has it raised the faintest ripple of concern among the public? The answer, of course, is that it has not - perhaps because AIDS is seen as a disease which affects outsiders. An NDSC report on AIDS in Ireland between 1983 and 1999 found that 40.6 per cent of cases were among injecting drug users, 34.3 per cent among men having sex with men and 13.4 per cent among heterosexuals.
Injecting drug users are generally perceived as outsiders. Gay and bisexual men are perceived by many - though perhaps a declining number - as outsiders too.
Did haemophiliacs suffer from the same public attitude? The infection of haemophiliacs with HIV simply was not seen as the tragedy and scandal it was when it began to emerge. There was no sense of public outrage - passive sympathy yes, outrage no. It was as if, by becoming infected with HIV, haemophiliacs had joined the ranks of the outsiders.
AIDS and HIV are also largely a Dublin phenomenon. Just under 80 per cent of diagnosed cases of AIDS are in the Eastern Regional Health Authority counties of Dublin, Kildare and Wicklow and it is very likely indeed that Dublin accounts for the overwhelming majority of these. Therefore AIDS is not really an issue outside Dublin and in Dublin it is seen as something happening to outsiders.
All the same, it is remarkable that so little concern has been aroused by the fact that we are developing cases of HIV at a faster rate than ever before and that, yes, Dr Piot is right. Here in Ireland too the AIDS epidemic is still in its early stages.
Now it is heterosexuals who account for the highest numbers of new HIV cases. In 2000 there were 125 new cases among heterosexuals, 72 among gay and bisexual men and 70 among injecting drug users.
What also accounts for public complacency, perhaps, is the arrival, in the mid-1990s, of medicines which delay the progression from HIV to AIDS. According to the NDSC report, the number of deaths from AIDS fell from a peak of 50 in 1995 to 17 in 1999. This is largely thanks to these medical therapies.
On a global scale their availability is what separates the rich countries from the poor. Up to this year, the therapies were closed off to the poor countries because they could not afford them.
Licensing concessions made this year should alter that picture considerably. But there are unimaginable numbers of people for whom the therapies come too late - many countries lack the distribution and health systems to make best use of them, and many just cannot afford the cheapest medicines.
But, even if all this can be overcome, the prevalence of HIV and AIDS makes this disease one of the forces which will continue to define our world.
How do countries deliver on promises to improve quality of life for coming generations when 40 million children will grow up orphaned by AIDS? - the question was asked by Dr Rene Loewenson, director, Training and Research Support Centre, Zimbabwe, and Professor Alan Whiteside director, Health Economics and HIV/AIDS Research Division, University of Natal, South Africa, in a recent briefing document for the UN.
"How does a country like South Africa deliver on its goal of being a regional engine of growth with over four million HIV-positive people and the fastest growing infection rate in the world? The devastation caused by HIV/AIDS is unique because it is depriving families, communities and entire nations of their young and most productive people.
"The epidemic is deepening poverty, reversing human development achievements, worsening gender inequalities, eroding the ability of governments to maintain essential services, reducing labour productivity and supply, and putting a brake on economic growth." That's what HIV and AIDS is doing to our world.
And it gets worse. Infection is rising rapidly in Asia. In Guangxi province in China, 9.9 per cent of sex workers were found to have HIV in the second quarter of 2000 but the figure rose to 10.7 per cent by the fourth quarter. In certain cities of Vietnam, infection levels are rising quickly and in some cases exponentially. In Ho Chi Minh City, HIV infection rates among sex workers and their clients increased from virtually nil in 1996 to more than 20 per cent in 2000, according to UNAID. Indonesia has recorded a jump in HIV among sex workers from 6 per cent to 26 per cent in three sites, with several recorded HIV outbreaks among injecting drug users around the country.
The AIDS epidemic is, indeed, in its early stages and may, in the future, do more than anything else to shape the world in which most of the people on the planet live. And, amazingly, the figures suggest that the HIV epidemic is in its early stages in Ireland as well.
Are we ready to take notice?
Padraig O Morain is Health and Children Correspondent of The Irish Times