Although at first muted in his approach to the issues surrounding HIV/Aids, Nelson Mandela eventually became a dedicated and extremely effective advocate for a more vigorous approach to the disease.When Mandela was released from prison in February 1990, HIV/Aids had yet to make its full impact on South Africa.Following his election as president four years later, Mr Mandela faced huge challenges and, like so many other world leaders at the time, failed to fully understand the depth of the problem and did little to help those with Aids.At the time, the African National Congress (ANC) was gripped by an ongoing debate about both the causes of, and treatment for, Aids.Some figures such as Thabo Mbeki, Mandela’s successor as president, questioned whether Aids was caused by HIV.After Mandela left office in 1999, he campaigned for more research into HIV/Aids, for education about safe sex and for better treatment for those affected. However, most South Africans still did not mention the disease in public.Controversy within ANCAccording to UN figures, the rate of HIV infection among adult South Africans rose from less than 1 per cent in 1990 to about 17.9 per cent by 2012.South Africa is currently home to more people with the virus than any other country - 6.1 million of its citizens were infected with HIV in 2012, including 410,000 children (aged 0-14), out of a population of just over 51 million.The causes of an epidemic on this scale have been many - primarily poverty, but also economic migration, the poor status of women, and unsafe sexual practices, have all contributed to the rapid spread of the disease.Apart from the human misery caused by Aids, its economic impact has been huge, with South African economic growth rates badly affected.Having put the issue of Aids on the back burner when in office, Mandela began to make strong pronouncements on the subject after he stepped down in 1999.On World Aids Day, in 2000, he sent out a hard-hitting message, saying: "Our country is facing a disaster of immeasurable proportions from HIV/Aids. We are facing a silent and invisible enemy that is threatening the very fabric of our society. Be faithful to one partner and use a condom... Give a child love, laughter and peace, not Aids.”Mandela said his country should promote abstinence, the use of condoms, early treatment, counselling and drugs to reduce mother-to-child transmission.UrgencyAt the time, there was a marked reluctance on the part of the South African government to fund anti-retroviral drugs for those with HIV.The then President Mbeki outraged many when he told a US journalist that "personally, I don’t know anybody who has died of Aids” and that he did not know if he had ever met anyone infected with HIV.One of his ministers suggested that people with HIV eat garlic and beetroot to combat the infection.In November 2003, Mandela–and his Nelson Mandela Foundation–stepped up the campaign, launching an HIV/Aids fundraising campaign called 46664, after his prison number on Robben Island.He compared the urgency and drama of his country’s struggle against HIV/Aids to the fight against apartheid.Pop stars such as Beyonce, Youssou N’Dour and Dave Stewart supported the campaign, and a star-studded concert in Cape Town in 2003 was seen by a worldwide television audience of two billion.The money raised by Mandela’s initiatives has been used to fund research projects and provide practical support for South Africans with HIV/Aids.The campaign received a further boost in 2005, when Mandela shocked the nation by announcing that his son, Makgatho, had died of Aids.He urged people to talk about HIV/Aids "to make it appear like a normal illness”.It was a significant move, which had a huge impact, said Michel Sidibe, head of the UN’s Aids agency, Unaids."The country has become a leader in the Aids response because of Mandela, and is moving towards an Aids-free generation thanks to his campaigning,” he said.Mandela also became a central figure in the African and global Aids movement."He was instrumental in laying the foundations of the modern Aids response and his influence helped save millions of lives and transformed health in Africa,” Sidibe said."He was a statesman who had Aids at the top of his agenda and he used his stature and presence on the global stage to persuade world leaders to act decisively on Aids. His legacy will be felt by generations.”