LONDON (Reuters) - South African democracy icon Nelson Mandela has challenged leaders of rich nations to ease the plight of the world's poor millions by slashing debt, boosting aid and making world trade fairer.

On the eve of a meeting in London of G7 finance ministers, the political prisoner turned world diplomat told a cheering throng of 22,000 people in Trafalgar Square that now was the time for decisive action.

Looking very frail, supporting himself with a stick and with his wife Graca Machel holding his other arm, Mandela descended the steps towards the podium with evident difficulty.

But his voice was firm and clear when he told Thursday's rally: "Massive poverty and obscene inequality are such terrible scourges of our times ... that they have to rank alongside slavery and apartheid as social evils.

"In this new century, millions of people in the world's poorest countries remain imprisoned, enslaved and in chains," he added. "They are trapped in the prison of poverty. It is time to set them free."

The crowd of young and old with banners and whistles -- and a lot of cameras to capture the occasion -- cheered loudly as they stood under leaden skies in front of South Africa House that was for decades a symbol of the evils of apartheid.

Prime Minister Tony Blair has vowed to make Africa one of the priorities of his presidency of the Group of Seven (G7) industrialised nations this year.

Adult prevalence of HIV/AIDS in sub-Saharan Africa is the highest in the world by far at 7.5 percent against a world average of 1.1 percent, according to the United Nations.

Life expectancy at birth in 2003 was 46 years against a world average of 63 and, while globally life expectancy has risen by seven years since 1970, it has actually fallen in 18 African countries over the same period.

Mandela will take his message on Friday directly to the finance ministers when Chancellor Gordon Brown opens the meeting.

Brown shares some of the same aims. He wants debts that are costing the world's poorest nations -- mostly African -- $39 billion (21 billion pounds) a year wiped out, trade rules to be made more even-handed and new sources of long-term aid.

Although he formally declared his own retirement from politics and diplomacy last June just before his 86th birthday, Mandela said he couldn't resist the call to help Africa's poor.

"I recently formally announced my retirement from public life and should not really be here," he said on Thursday. "However, as long as poverty, injustice and gross inequality persist in our world, none of us can truly rest."

He was speaking as part of the charity-driven "Make Poverty History" campaign.

"In 2005, there is a unique opportunity for making an impact," said the Nobel peace laureate who spent nearly 27 years in apartheid jails before becoming the country's first black president from 1994 to 1999.

"Tomorrow, here in London, the G7 finance ministers can make a significant beginning," he added. "Do not look the other way. Do not hesitate. Recognise that the world is hungry for action, not words. Act with courage and vision."

© Reuters 2005. All Rights Reserved.

Since July 2004, only 260,000 new patients have benefited from ARV therapy in developing countries. Treatment expansion is moving at a snail's pace. From the perspective of a medical humanitarian organisation working in resource-poor countries to treat people with AIDS, the global picture is bleak. PEPFAR could be treating thousands more people with the funds it is spending.

MSF:†The World Health Organization released its "3 by 5" progress report on January 26, 2005, at the Davos World Economic Forum congratulating itself on progress made in the drive to fight the HIV pandemic. But only 700,000 or 12% of the nearly six million people in need of antiretroviral treatment in developing countries have access to it today.

Looking at these figures Médecins Sans Frontières (MSF), who provides ARV treatment to more than 25,000 patients in 27 countries, comes to the exact opposite conclusion.

Instead of celebrating, WHO, UNAIDS, the Global Fund, the US President's Emergency Plan for AIDS Relief (PEPFAR) and other institutions should be sounding the alarm.

Every day, more than 8,000 people die from AIDS and every year another five million become infected with HIV. Since July 2004, only 260,000 new patients have benefited from ARV therapy in developing countries. Treatment expansion is moving at a snail's pace. From the perspective of a medical humanitarian organisation working in resource-poor countries to treat people with AIDS, the global picture is bleak.

Crucial issues around AIDS treatment remain untackled:

Children continue to be a neglected population. There are few adapted and affordable paediatric formulations for the 2.2 million children living with HIV, and few diagnostic and monitoring tools suited to their needs. WHO and UNICEF continue to fail to address this.

Due to lack of generic competition, much-needed second-line medicines are already two to 12 times more expensive than the most affordable WHO-recommended first-line generics. WHO itself describes ARV prices as an "increasingly serious public health hazard". Thus far, however, WHO and others are demanding nothing of governments or pharmaceutical companies and offer no practical solutions.

Trade rules are interfering with generic competition, which has brought the prices of AIDS drugs down dramatically and was a prerequisite for getting donors and national governments to commit to treatment. January 2005 marks a new threat to access to medicines.

India, where most of the largest producers of generic ARVs are located, no longer has the right to produce generic versions of new drugs because it is implementing the World Trade Organization (WTO) Agreement on Trade-related Aspects of Intellectual Property Rights (TRIPS). This will most likely lead to a steep rise in the prices of any new drugs to treat AIDS: if the prices of second-line medicines are any indication, we are in for steep price increases.

WHO must do much more to strengthen its pre-qualification project and the US government and pharmaceutical industry (and the private groups they fund) must stop undermining confidence in generic medicines through inaccurate and irresponsible public campaigns, but there was little discussion of this in Davos.

"This is a disaster because it means that the country is losing 240 people every day to HIV/AIDS and at the end of 10 years an estimated 876,000 will die if the trend continues," Ntaba said in an interview late on Monday.

Malawi, with a population of about 11 million, is one of the countries at the center of the AIDS pandemic in sub-Saharan Africa, which is home to almost two-thirds of those infected with HIV/AIDS worldwide.

The government estimates that about 1 million Malawians are infected with the HIV virus and about 640,000 have died from AIDS-related causes since 1985.

Ntaba said Malawi was increasingly finding itself outpaced by the disease, unable to spend the money necessary to develop proper strategies against it while simultaneously losing medical personnel to AIDS-related illness or better jobs overseas.

Malawi now spends about $12 per capita on health annually, far below the $36 per capita recommended by Health Ministry officials.

"Spending $12 per capita on health ... we are not going to make a dent in the fight against HIV/AIDS," Ntaba said.

Research by Malawi's Health Ministry shows that about 46 percent of all new adult infections occur in people younger than 24 with about 60 percent of them being girls.

Malawi last year launched a $196 million plan to distribute free anti-retroviral drugs under a five-year program paid for by the global fund set up to tackle AIDS, malaria and tuberculosis.

Fifty sites across the landlocked country were identified to receive the drugs, but Health Ministry officials said only about 50,000 people were now getting them, well below target.

Ntaba said poverty, lack of recreational facilities and high unemployment were some of the factors driving particularly girls into early and unsafe sex or marriage.

Ntaba said Malawi's health sector was struggling because many medical professionals leave for better paying jobs overseas and others die from AIDS, leaving some 90 percent of physicians' posts and 35 percent of nurses' jobs in the country vacant.

"This is mainly due to HIV/AIDS and of course other factors like brain drain," he said.

HIV link to trek tourism studied          

The study will look at factors leading to infection

The £8,500 funding for the study came from the Department for International Development-funded Safe Passages to Adulthood programme.

But most foreigners in the Afghan capital Kabul know exactly what business these establishments are in -- defying an Islamic ban on alcohol and prostitution that has just led to a number of them being closed down.

One advertises its presence with a few strings of lights, nothing more. It looks like it could be one of the restaurants patronised by foreign security companies, diplomats and aid workers here since the fall of the Taliban.

Inside the lights are dimmed and young women, all Chinese, walk round the room or warm themselves next to a boukhari -- an Afghan gas or wood stove.

Sitting at the bar, or installed on comfortable sofas, men from various Western countries watch the girls go by. Here there are no loving touches, only women who from time to time disappear with a client after a slow dance.

"These places have really flourished recently in Kabul," says one regular on condition of anonymity, adding they are also frequented by the rare Afghan.

"Some close down then reopen under another name," and at least a dozen are operating in Kabul, he says.

All this in Afghanistan, where wives are jailed for cheating on their husbands and young women are killed for losing their "honour".

Islamic law strictly forbids prostitution, as well as the sale of alcohol.

Which is why Afghan authorities on Monday decided to crack down on the trade -- which contributes to the prevalent hatred of foreigners in this conservative country -- and shut down three Chinese guest houses in Kabul allegedly doubling as brothels.

The interior ministry also set up a commission to investigate all foreign guest houses in Kabul.

"Those which are not registered should register with the ministry of information and culture and Kabul municipality, and those accused of immoral activities or selling alcohol to Afghans should be closed," said interior ministry spokesman Lutfullah Mashal.

"There were complaints about some guest houses," he said.

According to the regular brothel-goer, prostitutes in Kabul are divided into two categories: Chinese and those from the former Soviet republics.

The first kind can be found in bars and restaurants and cost around 50 dollars, while the second, who are more discreet, offer the services of young girls for 200 dollars.

"You can be sure these girls have no papers," the client added, suggesting that some were sexual slaves forced to stay by traffickers who would withhold their passports.

"International prostitutes come here to make this place a work opportunity for themselves and to draw our country towards prostitution," said Waheed Mojda, spokesman for the Afghan supreme court, which is responsible for upholding Islamic law.

He made no mention of the destitute Afghan women also drawn into the sex trade to survive.

"One of the main problems that human society faces today is the issue of AIDS and HIV. In Afghanistan the level of HIV is quite low but such guest houses not only spread immoral activities but deadly diseases as well," he told AFP.

"It should be the government's priority to ban such places," he said.

High-flier leads AIDS crusade in India for Bill Gates DHARMAPURI, India (AFP) - Smiling and hands pressed together in greeting, Ashok Alexander sits cross-legged under the tent-covered roof of a house before dozens of women to talk about sex. That's a big change for the former highly-paid McKinsey et Co. director used to restructuring steel companies. He quit that job in 2003 to run a five-year 200 million dollar fund called Avahan (duty call), the India AIDS initiative of the Seattle-based Bill and Melinda Gates Foundation. The meeting is one of seven in two days with sex workers across southern Indian areas with the highest rates of HIV infection. Alexander, 50, isn't squeamish, hugging eunuchs and listening to stories of poverty, rape, beatings and extortion It's all part of a crusade to increase condom use and cut sexually transmitted and HIV infections in six high-risk Indian states. At least five million people, or one in every eight people known to be infected with HIV worldwide, live in India, the largest number outside South Africa. India with more than one billion people can add hundreds of thousands of adult cases yearly with an infection level of 0.9 percent, according to official figures. Places like Karnataka state's Belgaum district, with a population bigger than Ireland, has an infection rate of 4.5 percent. Alexander starts with a briefing by the head of a program the foundation gave a 17 million dollar grant to in December 2003. "We are mobilizing women to care about their health and have a local strategy of where to target, like bus stands -- the high risk areas," says Canadian Dr. James Blanchard, Karnataka Health Promotion Trust director. Information from touts and sex workers feeds maps of sites where work can be concentrated. Bangalore, India's high-tech capital, doesn't have a red light district which makes it difficult to reach sex workers and customers, Blanchard says. Alexander talks about "a cyclone of death" among poor people in the worst infected areas in India. He's not alone in that assessment. The CIA's National Intelligence Council estimated in 2002 that India could have 20 to 25 million AIDS cases by 2010, more than any other country. "There is a very clear notion of where the foundation wants to go in India," Alexander says. "AIDS was chosen because it is on a trajectory to kill the most number of people in developing countries. We need to do this on a war footing." -- An elite son of India -- Ashok is the son of P.C. Alexander, chief of staff to late prime minister Indira Gandhi, a former governor of Maharashtra state and a member of the upper house of parliament. He's a master chess player, a graduate of Delhi University's prestigious St. Stephen's College and the Indian Institute of Management with stints in Hong Kong and New York in management consulting before opening McKinsey's India office in 1992. In Bangalore, he has dinner with cricket star Rahul Dravid who does public service ads for Avahan promoting condom use. "People like us have taken a lot out of the system and it's time to give something back," Alexander says. "Rahul was happy to do that." His elite contacts were important for clients paying McKinsey large fees, but they didn't prepare him for understanding how HIV is cutting a swathe through India's poorest. "I always knew it was a problem, but didn't understand how big it was," Alexander says. "The easiest part, I thought, would be to get corporate India to help." Indian Oil did help with its nationwide network of petrol stations and working with Avahan to get truckers tested for sexually transmitted infections. Still, he says companies in India are ignoring the epidemic. "The fact is ... we're not a philanthropic society." As well, many believe HIV/AIDS isn't a problem because the country is sexually conservative, Alexander adds. The previous Hindu nationalist government played down the AIDS problem in 2002 and 2003. Ads promoting condom use were changed to emphasize abstinence and faithfulness and the Gates Foundation accused of spreading panic. "It's a complete myth the society is sexually conservative. People are having good fun -- and driving the epidemic," Alexander says. India has 146 million dollars available annually to fight HIV and AIDS, or about 29 cents per person, compared to one dollar eighty-five cents in Uganda. Avahan estimates India needs to spend at least one billion dollars a year. Even the current funding isn't wholly spent each year and India caps money from foreign donors by insisting money come through its hands, though an exception was made for the Gates Foundation. For instance, the US Agency for International Development gives 13.5 million dollars to India for HIV/AIDS programs, compared to 27.9 million dollars for Kenya. "A major part of my job is to ask what do we have to do to make our case better" for India to spend more money, Alexander admits. -- Eunuchs wear white jamsine flowers in their hair -- Alexander is five feet nine inches tall, trim with a moustache. The women and eunuchs he meets dress in red, green and blue nylon saris with bangles on their wrists and ankles and white jasmine flowers in their hair. In Dooda Ballpur, sex workers who ply their trade at the inter-state bus stop show how to slip condoms on unsuspecting clients -- one blindfolded places a condom on an eight-inch long black phallus, another pops a condom in her mouth and slips it on orally. Alexander claps vigorously. "Talking to sex workers initially was pretty difficult, they treat outsiders cautiously and I didn't know which questions I could ask -- a bit nervous to ask how much they got paid, how many times they had sex, what kind of sex. But after some time, this is no problem," Alexander says. Condom use is important, he insists, because HIV infection can rise 100 times from people who have open sore sexually transmitted infections. This message came across to eunuchs who adopted him as a brother in a ceremony that included a bath, 200 rupees (in cloth) and touching their guru's feet. "I was highly honored. It was a great privilege they trusted me," Alexander says. The acceptance of the program helps steer people to sex disease clinics. The plan is to have 3,000 of the so-called Key Clinics in the worst affected areas. "The clinics are non-judgmental -- we do a sight exam and use a color code to hand out medical packs for those infected -- such as white discharge means red pack." Taking the stigma out of sex work could bring a change in willingness to use condoms and seek medical help, he says. "But still it's the million dollar question if that will stem the rise." Plight of sex workers At the next stop, Alexander's management skills are tested. "It's grassroots and you have to adapt all the time," Alexander says meeting eunuchs who want loans for emasculation operations -- he tells them it isn't possible. Still it was important to understand about men who have sex with men. Sharp variations in sexual preferences can show in infection rates among receivers or givers or double deckers, a term for people who do both. Sex workers can earn 300 rupees with several customers on a good day (seven dollars), compared to 50 rupees (1.16 dollars) in construction jobs such as carrying bricks on their heads. "People from around the world used to come to me to learn about India and I thought I knew a lot. It's very humbling to realize that I don't know my own country. I now realize there are two India's and you need to understand both," Alexander says. "I had no idea of the plight of the sex workers... I have enormous respect for them." Alexander notes India has a goal of cutting poverty to 14 percent from 26 percent by 2010 and curtailing the spread of AIDS is crucial. "There's a study that says that if AIDS isn't curtailed, the goal could be cut by two to five percentage points as wage earners in families fall sick and die." En route for an evening flight to New Delhi, he discusses strategy with program manager Padma Chandrasekaran who suggests handing out free lubrication for male sex workers. "So it's eight rupees (18 cents) a pack for KY Jelly, but we can use cheaper lubrication," Chandrasekaran says. Alexander is concerned if cheaper lubrication is safe and asks how it could be tested. "That's a big issue," he laughs.

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