No university can shirk from confronting Aids

South Africa's Aids epidemic must be confronted with surgical rather than kid gloves, argues Brenda Gourley

Few vice-chancellors will have given a condom, surgical gloves, and an Aids awareness badge to every member of their staff. Yet this is what I did on World Aids Day in December last year.

I asked staff to wear the badge every day as a symbol of solidarity and support for people living with HIV/Aids and as a symbol of support for the university's commitment to do all we can to educate each other, our students and the public about Aids.

HIV/Aids is a world problem, but in sub-Saharan Africa it is an unfolding catastrophe. In this region alone, more people are HIV-positive than in the whole of the rest of the world and HIV/ Aids is spreading more rapidly.

In KwaZulu-Natal, per cent of the population is estimated to be HIV-positive, the highest incidence in South Africa. The most immediate impact is an increase in illness and death in 20 to 45-year-olds - the economically active population. The highest incidence is in those aged from 16 to 25 - an age profile close to that of students at our universities. If they have not already contracted the disease, they are certainly the most vulnerable.

At the same time they might well be the most effective peer educators, in the community and the universities. That is one reason why staff in higher education must use every opportunity to support and educate students and colleagues, friends and family. If we do not take the lead, it is hard to imagine who will.

Giving staff a pair of surgical gloves was a calculated act. We must be careful not to promote the idea that sufferers are untouchable, yet people must be made aware that there are other means of transmission that may put them at risk - through blood. People need to realise that if they deal with an injured person and there is any blood, there is a risk of infection. My letter to staff said: "This does not mean that our intervention and engagement with anyone should be restrained or cowardly because of the Aids epidemicI But I hope to shock you by showing just how serious Aids has become for every single person in South Africa."

Our medical staff and students get special treatment if they have been injured by a needle while treating an Aids sufferer, but there are no guarantees and the treatment has unpleasant side-effects. We have even had to make it a disciplinary offence for our medical students not to wear gloves when they are at risk, which goes to show why ordinary people fail to take precautions in far less obviously dangerous circumstances.

Natal's medical school is committed to finding ways of treating and ameliorating the effects of this disease. A cure seems as elusive as ever. In our academic hospital, 53 per cent of the beds are occupied by Aids patients. The idea that this is not a notifiable disease and must remain confidential to doctor and patient is not feasible in a situation where doctors have unreasonably high case loads and health resources are stretched beyond the limit. As a country we are unable to afford the treatment that is administered in richer countries. We can hardly afford to look after the people who have diseases that can be cured.

Universities worldwide with considerable resources must ask themselves what they are doing to help in such catastrophic circumstances. For example, they could hardly consider themselves as being in service to the community if the epidemic had no impact on the research agenda.

Natal has joined with local institutions and researchers from Nottingham and London universities, with generous support from the Wellcome Trust, to run a large, multidisciplinary research project. Among other things, it hopes to identify how it is that some communities cope better than others - and design policy and interventions accordingly. Time is hardly on our side, and it is heartening that the project has the active support of so many fine researchers here and elsewhere in the world.

The research initiative that Tony Blair announced during his visit to South Africa earlier this year must be given all possible support. The epidemic is only now starting to affect the system in a serious way. Institutions have to contemplate how they will continue to achieve their goals in the face of staff and students dying at such an unprecedented rate. The University of Natal has commissioned a study to examine the alternatives and to plan accordingly. It is important that we share such insights so that all may benefit. We have few enough university places as it is. We cannot afford to lose what we have.

There are plenty of examples elsewhere in the world to remind us that it is easy to slide into disorder - it is an entirely different matter to rebuild. History will judge us by our response to such a catastrophe. I trust we will not be found wanting.

Brenda Gourley is vice-chancellor of the University of Natal, Durban.