As Rhodri Phillips continues his series on HIV and Aids, he looks at how the epidemic began and spread. And he meets a nine-year-old boy in Uganda who is HIV positive. Pictures by Tim McGuinness.

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In 1981, an obscure scientific journal in America reported a rare form of pneumonia had killed five men in Los Angeles.

Two decades later and Aids has become a global killer - with 20 million dead and 40 million HIV positive.

There is some confusion as to how humans first became infected.

It is now generally accepted that monkeys were the source of the virus and at some point - perhaps as early as the late 1950s - the disease crossed species.

Many assume that humans first became infected in western Africa. But it is possible that HIV emerged at the same time in both Africa and South America, or even that it appeared in the Americas before developing in Africa.

Either way, the virus quickly spread, aided by the advent of widespread international travel and a growth in the blood transfusion industry, which led to infected samples being sent worldwide.

In Uganda, the virus spread during the late 1980s and early 1990s and national infection rates rose to 14 per cent.

Nine-year-old Gerald Lwtu is HIV positive.

He lives in the Rakai region of western Uganda, where the first Aids cases in the country were discovered in 1982.

Gerald became infected through his mother during pregnancy and has begun to develop symptoms of Aids.

Aids has already killed his father, his mother is bedridden and dying of the illness, and Gerald is looked after by his aunt.

He tested positive for HIV last year, but has not yet been told about his condition. His aunt says she is too frightened to explain what is happening.

Gerald speaks in a whisper, his thin, frail legs dangling from a chair far too big for him.

He dabs delicately at his running nose with a handkerchief, and although he is clearly in pain there is a dignity about Gerald, which belies his age.

His face is covered in boils, there is a rash on his neck, his movements are slow and he is beginning to lose his hearing.

But there is no anger or self-pity in Gerald's voice when he speaks. He says: "I am not frightened. I am sad because I cannot play games with the other children. I feel bad because I am always weak."

Gerald's aunt Pauline Nakanwagi, a 30-year-old with four children of her own, says: "He is a brave child. Even when he is really down, he doesn't complain. He doesn't nag when he feels sick. He stopped going to school last term because even the teachers say he is no longer capable.

"He could not concentrate and would often fall asleep.

"He is a very peaceful and friendly person and when he is playing, people come to check on him.

"He plays with toy cars, but does not enjoy energetic activities. If he runs he is sick. Everyone loves him." International charity World Vision has stepped in to help Gerald.

He has been given drugs for opportunistic illnesses such as malaria and flu, which he is more prone to than other children because of his condition.

Pauline adds: "Whenever he feels sick, I take him to the hospital. World Vision gives us transport. If World Vision was not helping, I do not think he would be alive.

"The illness has robbed him of his childhood. He cannot play like a normal happy child. He is in the advanced stages of Aids. I am scared he will die."

The way Aids has spread in Uganda is typical of the way it has ravaged large parts of Africa.

James Kaawha, who works for World Vision Uganda, says: "In the 80s and 90s people would not accept they had to protect themselves. They thought people with Aids had been bewitched.

"Part of the problem is education. Some men have many wives - maybe three or four - and if they catch the virus and have unprotected sex with all their wives, it can spread quickly."

Uganda in the 1980s was recovering from Idi Amin's brutal dictatorship and locked in a desperate cycle of poverty and civil war.

Canon Gideon Byamugisha, 45, a priest, who works with World Vision Uganda, explains: "There was a total collapse. In a situation of war and hunger, they do not have the motivation to protect themselves from disease. They were thinking in any case I am going to die.

"In the late 1980s, there was no proper procedure for blood transfusion in place."

The epidemic was fed by the many myths surrounding Aids in Uganda - such as using condoms leads to infertility or sleeping with a virgin cures the disease.

Uganda's situation is echoed around southern Africa, where one in four people is infected with HIV.

In Botswana, Lesotho and Swaziland, rates are in excess of 30pc among pregnant women. But HIV and Aids are not uniquely African problems.

In the UK, the HIV infection rate has risen every year for the last decade. By the end of 1994, there had been 108 Aids cases and 46 deaths in this country. Last year 6,600 people in the UK were diagnosed as HIV positive - a 20pc increase on 2002.

In the North-East, there was a staggering 42pc increase in the number of people testing positive for HIV - 136 diagnoses in 2003 compared with 96 in 2002.

Dr Barry Evans, a HIV expert at the Health Protection Agency, says: "The year-on-year increase we are observing in the number of newly-diagnosed HIV infections is a cause for considerable concern.

"HIV is an infection that is here to stay. With almost a third of the 49,500 people currently living with HIV in the UK unaware they are infected, the rising trend is liable to get worse. The increase in the last year has been seen among both gay men and heterosexual men and women.

"Increases in unsafe sex are undoubtedly the main driving force behind this epidemic. Changing people's sexual behaviour is one of the most effective ways of reversing the trend. People must be encouraged to take responsibility for their own sexual health."

Page 2: A vision that spreads message of love throughout the world