Shahid Naqvi looks at how cases of HIV and Aids are increasing again and what can be done to raise awareness of the issue

It's been voted one of the scariest moments in television history. First broadcast in 1986, it featured a bleak, grey tombstone with the word AIDS written across it.

The apocalyptic image was accompanied by a chilling voiceover by actor John Hurt.

"There is now a danger that is a threat to us all. It is a deadly disease and there is no known cure," he said.

The Government-funded TV advertisement, with its "don't die of ignorance" slogan, was backed by a poster campaign and leaflets sent to every home in the UK.

As a health promotion drive, it was a phenomenal success, awakening the nation to the threat posed by Aids and shocking people into changing their sexual behaviour.

It ended the promiscuous party of the 1970s and early 1980s as people changed their sexual habits and became more selective about who they slept with.

But today things are swinging back in the other direction.

A generation fed on "lads mags", lap dancing clubs and greater exposure to pornography is showing less restraint when it comes to sex.

And, correspondingly, HIV and Aids is on the increase again.

In 1999, the rate of newly diagnosed infections among heterosexuals overtook the rate of diagnoses in gay men for the first time in the UK. And it's been rising ever since.

In total, 58,000 people in the UK are living with HIV, according to the Health Protection Agency. An estimated 19,700 of them are unaware they have the infection.

That in itself should be enough to justify the need for a new health awareness drive.

Although recognising the need, Dr Steve Taylor, lead consultant for HIV services at Birmingham's Heartlands Hospital, is concerned about creating another health scare.

"We need to have an infrastructure to be able to cope with the demand," he said.

"If we put a scare story out and everyone wants to get tested, we are going to be in trouble because access to our current sexual health service isn't that great.

"Many sexual health clinics have unacceptably long waiting times. The Government target is that all patients who think they may have an infection should be seen within 48 hours by 2008.

"If you have a sexually transmitted infection and you can't get into a clinic there is a risk that infections to others will increase.

"Sexual health has become one of the Government's top priorities. Unfortunately, it has become a Government target and priority in the very year when there is little money for investment in service development."

That concern was echoed by the British Association for Sexual Health & HIV (BASHH).

"BASHH has consistently stressed that improving sexual health services and tackling waiting times is an essential part of disease prevention," said a spokesman.

"Failure to treat infections promptly, or at all in some cases, means untreated patients remain sexually active in the community, and further increase the spread of sexually transmitted infections."

There are currently 1,283 people diagnosed as HIV positive in Birmingham and Solihull.

Half of them are treated by the HIV unit at Birmingham Heartlands Hospital, with the remainder at Selly Oak Hospital.

In 2000, the unit had 178 patients. By 2005, it had more than 600. Most worrying has been the significant increase in children who are HIV positive.

In 2001, there were nine cases diagnosed at the regional paediatric unit at Heartlands Hospital.

By March of this year, the figure had risen to 62.

Steve Hayward, Birmingham City Council's HIV coordinator for adults and communities, said: "The biggest growth is among children in terms of new diagnosis.

"A lot of it is because the population living with HIV has changed.

"Also, antenatal screening is testing a lot more women who weren't traditionally tested because they weren't gay or drug users."

Figures from Heartlands Hospital show there were 20 pregnant women diagnosed as HIV positive in Birmingham and Solihull in 2001, 29 the following year, and 39 in 2003. In the first four months of 2004, there were 20 diagnosed.

According to the hospital, it means the HIV rate in pregnant women in the area is one in every 1,000.

Mr Hayward claimed dispersal of asylum seekers from countries with high rates of Aids was partly to blame for the increase in the UK. "We are moving HIV positive people around the country," he said.

Aids in the World:

* There are currently more than 40 million people living with HIV worldwide

* Almost five million were reported newly infected in 2005

* Almost 25 million people have died of Aids since 1981

* Sub-Saharan Africa remains the hardest hit with almost 26 million people living with HIV

* Nearly 77 per cent of all women living with HIV live in sub-Saharan Africa

* There is a growing epidemic in Eastern Europe and Central Asia

Aids in the UK:

* Twenty people are infected with HIV every day

* Currently there are 58,300 people HIV positive

* Since 1999 there has been a steep increase in the number of HIV diagnoses

* The proportion of HIV infections acquired through injecting drug use is much smaller in the UK than in many other European countries

* There have been 6,746 children born to HIV infected mothers. Of these, 1,388 were diagnosed with HIV

* The number of children born to HIV positive mothers more than tripled from 163 during 1988/89 to 515 during 1998/99

* It then nearly quadrupled to 2,017 during 2003/04

Aids in the West Midlands:

* There are 1,283 people HIV positive in Birmingham and Solihull

* The number of HIV positive children has risen from nine in 2001 to 62

* A further 29 babies born of infected mothers could develop the virus

* 58 mothers in the West Midlands were HIV positive in 2005

* The biggest increase is among heterosexuals

A new website providing local information on HIV and sexually transmitted disease is to be launched next week at www.sexualhealthbirmingham.co.uk. For confidential advice on HIV testing call 0121 424 1316/3213/1366

What is HIV?

HIV stands for "human immunodeficiency virus". It attacks other living cells and uses their metabolism to make copies of itself.

It can be caught through unprotected sex, blood-to-blood-infection and - among children - during pregnancy or after delivery through breast milk from a mother who is infected.

HIV attacks some of the cells that are vital to a healthy immune system, including the white blood cells known as T-helper cells.

It can only be detected six to 12 weeks after the infection when white blood cells have produced so many antibodies against HIV that they can be measured in the blood.

Someone with HIV antibodies in their blood is referred to as HIV positive.

They can feel no ill-health for a long time, but the infection is still active inside the body.

As the number of Thelpers in the blood reduces, and the immune system weakens, the infected person will start showing symptoms of Aids.

What is Aids?

Aids stands for "acquired immune deficiency syndrome". It sets in when the HIV virus has killed so many T-helper cells the immune system is weakened and no longer able to recognise and react to attacks from infections.

Between five and 15 years can pass from the time of infection until Aids actually develops.

Previously, those infected only lived for a couple of years after developing Aids. Fortunately, with new types of treatment available, the survival rate has greatly improved.

HIV may also attack the nervous system. A number of different symptoms can be observed.

They are fatigue, inexplicable weight loss, repeated bronchial and skin infections that do not react to normal treatment, fever, swollen nodes, diarrhoea, ulcers and night sweats.

Antiviral medicines are given to stop the HIV virus spreading in the body. The treatment strengthens the immune system so that the risk of getting ill is reduced. It is not known how long the effects of the treatment will last.