It gives me great pleasure to have the opportunity to write the introduction of my good friend Mario Testino’s book, a project that gives women from around the world who have been affected by HIV/AIDS a rare opportunity to be seen and heard. There are now 39 million people throughout the world who are living with HIV/AIDS. This number is not just growing, it is rocketing. Just a few years ago, it was estimated that there would be around 40 million people living with the disease by 2010. Needless to say that estimate has been revised – upwards.

For over 20 years I have campaigned for human rights, and social and economic justice and during that period have met women throughout the world who are victims of unspeakable crimes, mass rapes and domestic violence. The effect of globalisation is leaving more and more women trapped in poverty, which in turn leaves them more exposed to violence and less able to escape discrimination. As a result, these women are the first to feel the lack of social services, the first to be denied education and health care. Worldwide, women have a higher incidence of poverty than men.

During my many travels I have witnessed first hand the devastating effects HIV/AIDS is having on women and children, especially in developing nations. Their tragedies opened my eyes to the magnitude of the problem.

I recently visited Calcutta where I spoke to countless women and children in red light areas for whom safe sex is simply not an option. I went to India with Christian Aid to support and learn about the work of Sanlaap, a grassroots’ organisation working with sex workers and children who had been trafficked for sexual exploitation. I visited one of their shelter homes for girls, called Sneha which means affection, where 48 girls ages 10 to 18 had been rescued by the police after being trafficked.

Children who are rescued have to undergo a mandatory HIV/AIDS test; sadly 28 of the 48 girls in the shelter were already infected with the virus. I had a very upsetting conversation with a group of girls who told unspeakable stories of abuse, cruelty and betrayal. One of the girls was visibly upset and after much hesitation she described how men who look sick, emaciated and often covered with scabs would come to solicit their services at the brothel.

She was sobbing when she told me how the children would beg the madam not to have to sleep with these men, because they feared they would contract HIV/AIDS. However, the madam wouldn’t hear their pleas and if they refused, they would be abused, beaten and burned with cigarettes. She was talking about herself but she didn’t dare tell me because she would have had to admit that she had contracted HIV/AIDS. In India and elsewhere, there is a myth that HIV can be cured by having sex with a virgin.

If any of the girls succeeded in escaping and went to the police to seek protection, they were likely to be returned to the brothel by an officer bribed by the madam, and if they returned to their villages their fathers would refuse to take them back.

In this and in so many other ways governments are failing to address the real terror which millions of girls and women face every day. HIV/AIDS killed over three million people in 2004 and UNAIDS estimates that another five million contracted HIV. Every minute, six people die of an AIDS-related illness. With such horrific statistics, it is no exaggeration to say that HIV/AIDS is the scourge of the modern world. Yet AIDS is not only a killer disease; it all too often brings with it stigma, prejudice and social exclusion.

Nor can it continue to be characterised as a disease affecting only those with high risk lifestyles: gay men, sex workers and intravenous drug users. In fact, the main targets for new infections are women. Of the five million new HIV infections worldwide in 2004, nearly 50% were among women and girls. In Africa, 75% of the six million 15 to 24 year-olds infected are female. It is a growing trend.

A woman is twice as likely to become infected with HIV through heterosexual sex than a man, and in some parts of Africa 25% of all women are infected by the time they are 22. In some African cultures where sexual fidelity in marriage is only expected of wives, young married women are becoming infected even faster than those who are unmarried but sexually active.

For years, many women assumed that they couldn't be at risk because they didn't fall into the classic stereotypes formulated in the early days of the pandemic. Yet some women who have been faithful to the same man all their lives, are finding that isn’t necessarily enough. After all, it takes both partners to be faithful for that to work. In India, for example, over 80% of HIV positive women are believed to have been infected by their husbands. In the UK, some women in their 50s and 60s have been shocked to discover they are HIV positive after long and - what they had supposed were - faithful marriages.

In the developing world, women’s vulnerability to HIV is fuelled by several things, not just ignorance of whether they are already infected or not, or a lack of understanding of how to protect themselves in the first place.

HIV loves poverty, marginalisation and desperation. Women frequently do not enjoy equality with men. Sexual violence is appallingly commonplace, and requests for a partner to use a condom can be interpreted as the woman admitting to extra-marital relations of her own. Sex may also be a bargaining or trading tool for some poor women and girls to obtain food, shelter – whatever the man is prepared or able to offer in exchange.

Poor women are also less likely to receive medical attention for HIV/AIDS – they don’t have the time or the resources. They are too busy caring for the family to acknowledge their own illness. In a world where women are already discriminated against, they fear the stigma and ostracism from family, friends and entire communities, including from other women who think that they must have done something to deserve it. They are often blamed for bringing the virus into the family.

HIV rates may be much higher in some countries than others, but the factors which cause the spread of HIV and fan the pandemic are common to all countries, and the UK and USA are no exceptions. The UK has the highest teenage pregnancy rate in Western Europe and the US the highest in the Western world; domestic violence is a big problem and divorce rates are high in both societies; sexually transmitted infections are spreading rapidly; sex education, particularly around behaviour change, is generally poor.

Many richer countries have let their guards down and there is a lack of continued public awareness of the dangers of HIV/AIDS. The arrival and ready availability of anti-retroviral drugs in wealthier countries has wrongly convinced some that a cure has been found and they are taking less care to protect themselves. Complacency can kill.

In the US the rate of new infections is growing faster than efforts to keep it under control. And there is a frightening increase among those who would not normally fall within one of the high risk groups – women. Among those newly infected – about 44,000 a year - one in four is now a woman. There are now one million people living with HIV/AIDS in North America. In Western Europe, there are over 600,000. Those are the ones the statisticians know about – the true figures are likely to be much higher.

Anti-retroviral therapy, though effective in its ability to allow those who are infected with the virus to continue to lead long and healthy lives, is not the answer. It is not a cure. It does not prevent the spread of HIV. It also costs huge amounts to deliver effectively. UNAIDS estimates that $12 billion is needed for worldwide treatment and prevention efforts, twice what we are spending now. And those costs can only increase further whilst the infection spreads unchecked.

Then there is access. Less than 10% of those who need anti-retroviral therapy have access to the drugs. Another brutal truth is that some of those who can access the treatment can’t afford it. In the UK treatment is provided free. In the US, though, access to affordable treatments may depend on which state you are in, your health insurance, local HIV/AIDS policies, or other factors. And in the developing world, only the tiniest minority have been able to access these drugs.

We need to wake up fast, not so much to the cost of providing drugs to everyone who needs them, but to the cost to the world of not providing them.

HIV does not discriminate. But people do. Rejection and discrimination are usually fuelled by fear and ignorance. It can be devastating for those who discover their status to then have to cope with rejection from those whose support they depend on most. For this reason families and friends may be the last to know, if they are told at all. HIV positive mothers may be especially anxious to protect their children from stigma.

The best defence against ignorance and fear is knowledge. That is why publications such as Women to Women: Positively Speaking are so important. The women featured are courageous. They haven't allowed their status to cow them into depression and hopelessness. They stand tall and declare they are proud of who they are. They are wonderful, warm, intelligent women leading strong, productive lives. Those who are positive have learned to use their status to empower themselves and to empower others with their support and understanding.

And Mario’s portraits capture the essence of their beauty, spirit and dignity, and their absolute defiance of this disease.

It is up to all of us to support these women and the millions like them around the world who struggle daily to cope with stigma and illness, to protect their families and communities, to carry on with their lives.

There may be no cure but there are still ways of supporting and helping those who are directly affected and those who are dedicating their lives to preventing others from becoming infected. Organisations like the ones involved in this project – Marie Stopes International, Interact Worldwide and the United Nations Population Fund – are at the heart of that effort.

We live in an interconnected world – Africa, Europe, Asia, the Americas and Australia. We cannot regard Africa as a far away continent that has no impact on our society. If we want to create a world that is more equitable and based on justice, then we need to face up to the challenges of preventing and combating HIV/AIDS and provide whatever support we can, wherever it’s needed.

The plight of women suffering - often in silence - with HIV/AIDS is of particular concern to me and the HIV/AIDS epidemic is certainly a cause which each and everyone of us needs to address.

To the women in this book and the countless others whose voices have not been heard, I salute you.

Bianca Jagger