Julia was born in Mombasa in 1989. Her father died of AIDS when she was a baby. When she was just 4 her mother died of AIDS. She wasn’t supposed to see her mother die, but she peaked through the crack of a hospital door and witnessed her mother die a slow, agonising death.She didn’t know it at that stage but she too was HIV positive.Following her parents death, her two brothers, Julius and David, weren’t able to look after her. An aunt sent her to the Nyumbani orphanage in Nairobi. Nyumbani means “home” in Swahili, and the orphanage was home to 92 children, all HIV positive. But because there was no anti-retroviral medicine available, it was more of a hospice than a home. Around one child would die every month, with a devastating effect on the morale of staff and children.Julia’s luck in being sent to one of the very few orphanages for AIDS orphans was about to run out. When she was 12 her best friend at Nyumbani, Caroline, succumbed to AIDS and died. She was buried in a well-tended piece of garden at the rear of the orphanage. Julia lost all her confidence, rarely speaking and walking around with a hood permanently over her head.Then she herself started to contract full-blown AIDS.People who are HIV positive and do not take medication don’t know how long it will take to develop full blown AIDS. The virus attacks the immune system, gradually weakening it to the point where it cannot resist even mild infections. The process normally takes about 8 years, but in Julia’s case had taken longer.But just at that point her luck turned, because the orphanage managed to raise enough money to put one or two of the children on anti-retroviral drugs. She was selected because of the advanced state of her illness. The results were dramatic. The pock marks and lesions on her face cleared up, and she started to turn into a pretty young girl. She looked about four years younger than she was, and remained much weaker than most children. She still wore the hood, but she was out of the danger zone.I met Julia in 2003 when I visited her orphanage. I had previously had little interest in Africa or AIDS, but happened to visiting a friend in Nairobi who had been a volunteer there. What I saw shocked me.According to UNICEF, one child is dying from HIV/AIDS every minute of every day. To get an idea of the scale of the tragedy it is worth comparing it to the tsunami, which claimed around 300,000 lives. Last year 8 times more people died from HIV/AIDS than died in the tsunami. 8 tsunamis-worth of deaths, not as a one of freak event, but year in, year out.A quarter of those deaths are children and young people like Julia’s friend Caroline.Even now, with the arrival of anti-retroviral drugs, the problem of children with HIV/AIDS is getting worse not better. For every child that dies from HIV/AIDS, 1.3 children are newly born with the virus. Why is this? We have worked out how to eliminate mother to child transmission of the virus in the developed world. The virus is transmitted not in the womb, but through contact with the mother’s blood during childbirth. So if the mother is given a high dosage of anti-retroviral drugs immediately before childbirth, her viral loads can be reduced enough to prevent transmission of the disease.The process is simple, but as with all AIDS treatment expensive. The result is it is virtually non-existent in Africa, where mother to child transmission rates are often greater than 35%, compared to less than 1% in the developed world.Many people argue “why AIDS?” Given all the other appalling and deadly diseases in Africa, should we not be focusing on them instead? TB, for example, can be cured with a simple and cost-effective programme of injections, and malaria easily prevented by anti-malarial bednets. Most other diseases are cheaper and easier to treat, so would be not save more lives if we devoted resources to them rather than HIV/AIDS?The answer is yes and no. AIDS is indeed notoriously difficult both to prevent and treat. An effective treatment programme requires huge investment in testing facilities. Anti-retroviral drugs prolong life, potentially to a normal life-expectancy, but are only administered when the viral load has become high. For this you need expensive testing equipment, where machines can cost as much as $50,000. This is not a realistic possibility in many parts of Africa.The drugs themselves are expensive. They used to cost several thousand dollars per person per year. The price has now dropped to less than $200 per annum – but in a continent where millions live on less than one dollar a day, it is unrealistic to expect people to afford even the reduced costs. Furthermore, the drugs do not work if the person with HIV is not on a proper diet. Nutrition is vital, but also virtually impossible to guarantee in many parts of Africa.Although the short term results of treating other diseases may appear better, AIDS is a monster lurking beneath the surface. In the end, if it is not tackled, it renders ineffective all other poverty alleviation strategies. To tackle AIDS is to tackle the cause of poverty as much as the symptom.It is instructive to note just how much damage AIDS has done to global targets to eradicate poverty. In 2000, the United Nations published its “millennium development goals” for eliminating extreme poverty. These have been signed up to enthusiastically by world leaders, prompted perhaps by the huge political constituency that has mobilised in support of “Make Poverty History” and the Live 8 concerts in 2005.Yet none of these goals are on track to be met. Extreme poverty is not being reduced in Africa, largely because of AIDS. Universal primary education, supposed to be implemented by 2015, is held up by massive teacher shortages, again often caused by AIDS. Progress towards improving the lot of women, a key development indicator, is being held up as young girls have to stay at home to look after sick parents. Child mortality was supposed to be reduced by two thirds by 2015 but again in Africa AIDS means it is increasing. The lesson is clear: no effective strategy on AIDS means no effective progress on eradicating poverty.AIDS destroys the fabric of societies and with them the hopes of poorer countries to escape the grind of poverty, corruption and destitution. This is because it displays an evil genius in the way it works.Most viruses eventually die out because they kill their hosts, the people carrying them. But this is not the case for HIV/AIDS. It affects young people in the prime of their sexual life. But most do not know they have been infected and remain apparently healthy for many years, giving them ample opportunity to spread the virus to others before they themselves fall ill.When they do finally succumb, they are no longer able to fulfil the role of family breadwinners, and end up creating the poverty that makes it even harder to fight the disease. Mothers literally work until the day they drop dead in order to provide for their children – but in slums the easiest way to do this is often prostitution.The virus thus behaves in the optimal way to perpetuate itself, creating the conditions that Alan Whiteside of the University of Kwazulu Natal describes as “social involution” – the opposite to social evolution - in which a society follows behaviour patterns leading to its own destruction rather than its ongoing survival.This is already happening. On current trends by 2010, three quarters of South African teenagers will not live until their 60th birthday.Children like Julia point to why a failure to tackle AIDS is like ignoring a bomb on a timer just because it is not going to explode in the next few minutes.When people die from AIDS, they leave children behind. The number of AIDS orphans is currently around 14 million, and expected to increase to 18 million by 2010. A whole generation of devastated children who should be the future of their country end up living in poverty and destitution. An orphan is defined by the UN as a child who has lost either both its parents or its mother. On this definition, according to UNICEF, 15% of all children in Mozambique, 19% in Zambia and 20% in Botswana were orphans in 2003.What will happen to these children? Many have HIV and end up simply dying the slow agonising death suffered by their parents. Only one in twenty of the children who need anti-retroviral drugs are currently getting them. Those that are not infected often end up as street children, begging for scraps in order to find the food for younger brothers and sisters. School is a distant dream: even when primary schools are free, as they are in Kenya and Uganda, few can afford the obligatory uniforms. Anyway, what is the point of going to school which can be little more than a distraction against a daily battle to scavenge enough food to fight off hunger?Often it is the grandparents who end up looking after these children. In one village in Kenya I saw a grandfather looking after 7 grandchildren whose parents had died from AIDS. The youngest child was just one year old, and she was being carried by her four year old sister who was acting as a surrogate mother. One organisation in Kenya is building villages designed simply to be populated with AIDS orphans and their grandparents.Experts like Tony Barnett of the London School of Economics describe how the massive growth in orphans is seriously affecting the social structure in many African countries. Children are often not only looking after younger brothers and sisters, but caring for sick adults. They can also very easily turn from saints to sinners. Children who grow up without parents or adults, with no schooling to educate them about economic opportunities for the future, are at far greater risk of turning into criminals and joining gangs.They may also become child soldiers. There are 13 current or recent conflicts in Africa involving child soldiers. Child soldiers I have met in the Congo and Northern Uganda have often been abducted from their villages, sometimes forced to go back and kill their own relatives. The lack of a family to go back to then makes them “adopt” their army as their new family. The atrocities they go on to commit create yet more orphans and so the cycle continues.So what have politicians been doing about the crisis of AIDS orphans and what should the Conservative response be?First of all it is extremely important for us to engage with these issues, which for too long have been abandoned to the left. The instinctive right of centre response global tragedies such as AIDS has been caution, with many Conservatives preferring to give practical support to small organisations on the ground than supporting grand government initiatives.This response has not come from hard-heartedness. It has rather come from the hard experience of many who have actually lived and worked in Africa in particular, and seen for themselves how corruption has destroyed the very infrastructure needed to tackle crises such as AIDS.Our approach is vital in two ways in particular. Conservatives have always believed in two things: practical action in preference to grand rhetoric, and the fundamental importance of wealth creation as the first step towards achieving other social goals. Both approaches have been severely lacking with respect to policies on Africa.Despite huge increases in aid to Africa, we have still not been able to head off the catastrophe of AIDS. The political strings, potential for corruption and necessary compromises that go with large scale government aid always seem to render it far less effective than it should be. Many people think that the Gates Foundation, backed with the wealth and determination of Bill Gates, is more likely to get results in tackling AIDS in Africa than yet more increases in the aid budget.Conservatives have always asked the hard questions about what actually works. It has never been good enough for us to say that because we have committed billions to aid budgets “we have done our bit”. All too often, passing money to corrupt governments does not work, in stark contrast to the remarkable work of small church-run charities on the ground.But we need to be careful not to reject the role of governments and states because the reality is that faced with an epidemic like AIDS, we will not be able to solve the problem without their help. George Bush’s hawkish Republican administration turned heads when it committed $15 billion to fight HIV/AIDS, and since then we have had a commitment from the G8 leaders at Gleneagles to provide as near to possible as universal access to anti-retroviral drugs by 2010. On prompting by many MPs, including David Cameron, the government persuaded the UN to insert an interim target for progress by 2008.So thankfully drugs are becoming more accessible and the prospects for AIDS orphans look marginally better than a few years ago. But if we are really going to deal with the threat of AIDS, we need to understand some basic truths about the elimination of poverty.The first is that there can be no poverty elimination without paying proper attention to wealth creation. The three pillars to the Make Poverty History campaign were “trade justice”, increased aid and debt relief. But none of the countries that have successfully attacked poverty have done so following this recipe. Take China, Thailand, India or even Bangladesh. All have made huge strides in reducing poverty. But economic growth and not “debt, aid and trade” has made this possible. The hard figures bear this out. In 1975 GDP per capita was higher in Sub Saharan Africa than East Asia. Since then it has grown by over 6% per annum in the former, whilst contracting at 0.2% per annum in the latter. Over approximately the same period, the number living in extreme poverty has risen to nearly half the population in Africa whilst falling from 58% to 15% in East Asia.AIDS is a growing problem in both China and India. But at least they have a chance of developing the health infrastructure to deal with it in a way that African governments can only dream of.The second awkward truth is that there can be no poverty elimination without proper security. If the prospects for tackling AIDS in South Africa look grim, they are even grimmer in the conflict zones of Africa like the Congo and Northern Uganda. AIDS thrives on the extreme poverty created by conflicts, and AIDS orphans are easy fodder for armed militia looking for new recruits. The conflict in the Congo, sometimes called Africa’s forgotten conflict, has claimed 3.3 million lives according to Amnesty International. Outside Kinshasa there is one doctor for every 30,000 people (compared to about one for every 600 in the UK). Without peace and stability no development is possible. That means having a properly paid and trained Congolese Army with control over its borders. Likewise in Northern Uganda where they are fighting the Lord’s Resistance Army. In this kind of situation we should support the more respectable African governments in building up their military capability. We must also use all the leverage we have through our aid budgets to encourage peaceful negotiated settlements to raging conflicts.The final rather uncomfortable truth about tackling AIDS is that we need to encourage heterogeneity in our response. This is something that Conservatives particularly appreciate with their instinctive understanding of the power of markets in motivating people to find creative responses best suited for their own personal situations.Yet governments are always tempted to go for the “big push” solution to problems like HIV/AIDS. Before adopting yet another grand approach we should ask ourselves why they have all failed in the past. All too often aid budgets come with the grand promises that help western governments get elected, but without the accountability to measure whether they actually work. The Conservative Party supports the target of increasing aid to 0.7% of GDP, and rightly so because humanitarian work is expensive. But we must not forget this is an input measure. People who are really committed to results would rather see outputs.AIDS will only be successfully tackled by a combination of improved health infrastructure and changing social behaviour. Condoms may work extremely well at preventing the disease in some cultural environments, but be an utter failure in others. We must support a variety of responses to improving prevention and treatment techniques and allow proper evaluation to see which ones work best. Top-down solutions have not worked – so we need to encourage diversity of response rather than the stifled uniformity that can come from state-run, state-implemented bureaucracies.The last time I visited Nairobi, I attended the funeral of Christobel Wanju, another HIV-positive orphan. She was 13 years old, and I had met her a couple of years earlier. She was a delightful girl, and was apparently healthy.Then one day she complained of severe headaches, and the next day she died. It started to rain in the Langata cemetery as she was being buried. I will never forget the sound of the patter of rain combined with the sound of shoveling earth and African songs. No one could fail to be moved, and there were tears in everyone’s eyes. Ultimately however the ability to care is less important than the responsibility to act. Without a radical reassessment of the underlying causes of the HIV/AIDS pandemic, with the courage to implement often challenging solutions, there will tragically be many more funerals to attend.