Anthony Sampson: Break through the wall of silence to confront the harsh truths behind Aids

The most effective warnings would come from those products that are associated with hedonism, such as alcohol and cars

Next Wednesday is World Aids Day, which comes as the annual report from the UN reveals still more victims. Over three million people died from Aids last year, and women are now suffering more than men. The sufferers are appealing more loudly for the world to take action. As Nelson Mandela, the most influential campaigner, said in London this week: "If we can help, we must help."

Next Wednesday is World Aids Day, which comes as the annual report from the UN reveals still more victims. Over three million people died from Aids last year, and women are now suffering more than men. The sufferers are appealing more loudly for the world to take action. As Nelson Mandela, the most influential campaigner, said in London this week: "If we can help, we must help."

And the world's concern has been emphasised by the publication this week of a remarkable anthology of short stories called Telling Tales, by 11 publishers round the globe, including Bloomsbury in Britain. The authors include five Nobel prize winners - among them Nadine Gordimer, the South African novelist who organised and introduced the collection. They have all given their stories free, to help the victims of Aids, which Gordimer calls "the plague of our millennium". They decided, as she said, "to contribute in our way to the fight against this disease from which no country, no individual, is safely isolated".

But it is South Africa that is most devastated by Aids, and it is doubly appropriate that this anthology should originate from a woman writer in Johannesburg. As I revisit South Africa every year, I have watched the plague escalate, and have been faced with the still more urgent question: what can be done about it? The first answer must be to face up to the terrible reality.

One of the stories in the anthology, "Down the Quiet Street", by the veteran South African novelist Es'kia Mphahlele, conveys with vivid simplicity the fearful impact of deaths and coffins on a Johannesburg township, where the residents "looked at one another and sensed a hundred years' plague round the corner".

The story conveys the fearful ordinariness of the plague, as part of everyday life: the deadly repetitiveness of the deaths of young people which leave families anguished and impoverished, with little prospect of improvement. And it is this kind of publicity which is most needed in the campaign against Aids, for it breaks through the taboo on discussing the subject, and shows it in the context of ordinary communities.

All sudden plagues have been accompanied by widespread denial, by people from the top to the bottom who could not face up to the extent of the catastrophe - like the denial which accompanied the Black Death in the 14th century, or the Great Plague of London in 1666, as recorded by Pepys and Defoe, when families concealed their dead lest they were found to be infected.

The taboo puts a special premium on those leaders - most of all victims - who are brave enough to break it. Two weeks ago, one of these South African heroes, Zackie Achmat, delivered the prestigious John Foster lecture in London, which provided a passionate account from the battlefield.

Achmat was uniquely qualified to understand the subject, as a gay Muslim who is himself HIV positive and who had played a crucial role in campaigning for effective remedies. Having been a brave ANC activist, he initiated the Treatment Action Campaign which forced the South African government of Thabo Mbeki to take more effective action, and to compel the multinational drug companies to lower the cost of the treatment. He refused to be treated himself until the drugs were more readily available.

He was determined to break through the wall of silence that surrounded the subject; and he gained crucial support from Nelson Mandela who - after neglecting the threat during his presidency - now put all his weight behind removing the stigma. Mandela literally embraced Achmat, in a photograph which went round the world, following the example of Princess Diana who had much influenced him. And he led the campaign to bring the disease into the open - even referring to members of his own family who had died of Aids.

Achmat, like many other passionate campaigners in South Africa, has put much of the blame on the current President Thabo Mbeki, for having refused to campaign openly against Aids, and for having previously denied the link between Aids and HIV. In his London lecture Achmat called Mbeki "a crazy denialist" and accused him of a "crime against humanity". He even unfairly blamed Sussex University, where Mbeki was educated, for having given him English inhibitions about talking about sex.

It is certainly true that Mbeki, and his much-criticised Minister of Health, Manto Tshabalala-Msimang, have been exasperatingly slow to face up to the Aids pandemic, preferring to depict it as part of the wider problem of poverty and deprivation. But serious campaigners who really want to help victims of Aids cannot allow themselves to be deflected by putting all the blame on Mbeki and his minister.

While the South African government has seriously misrepresented the crisis, it is right to emphasise that Aids is linked to the wider problems of poverty. It is not now preventing world organisations from providing resources and funds. And the world - most of all the drug companies - cannot escape the responsibility to do everything possible to confront a global crisis.

Many international foundations and agencies, led by the American Kaiser Family foundation, are now pouring both money and activists into South Africa; the more enlightened corporations, including the Independent group, which has many newspapers in South Africa, are systematically providing costly treatment for their staffs.

But the taboo about Aids remains part of a wider resistance that goes beyond government. Many big corporations that advertise the pleasures of a fun-loving consumer society - which has become much more prevalent in the new South Africa - remain very reluctant to be associated with any bad news about sex.

The most effective warnings about Aids would come from just those products that are associated with hedonism, such as alcohol and cars - as the most effective warnings about lung cancer come from cigarette ads. But companies selling pleasure do not wish to be tarnished by mentioning diseases.

And it is dangerous for white South Africans and foreign critics to condemn the black leadership for the mishandling of the Aids crisis, without understanding the social problems that lie behind it. For that can easily be counterproductive among Africans who (including Mbeki himself) see it as having racial undertones, implying that blacks are uniquely responsible for the plague, through their own fault.

All politicians faced with Aids crises in the past have had problems with candidly addressing the sexual inhibitions and taboos among their voters. Mrs Thatcher was at first strongly opposed to publicising condoms, as her home secretary Kenneth Clarke well recalls.

It is much harder to persuade African men in rural areas, with macho attitudes, to limit their sexual activity and accept the strict discipline of treatment. They can easily become suspicious of the motives of white visitors telling them how to change their ways, and think that Aids stands for "American Idea for Destroying Sex".

The most effective campaigns to confront Aids in Africa will always require not just health care and cheaper medicines but also a real understanding of the problems of African society, and particularly of the women who bear the brunt of the suffering.