Battling AIDS in India: Building the Network

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Battling AIDS in India: Building the Network

By: Joydeep Sengupta and Jayant Sinha, 05/21/04

Some problems are too big to be handled alone. AIDS in India is one

of them.

In a country of a billion people, about 4.6 million are HIV positive.

If the problem is left unchecked, that number could reach 20 million

to 25 million by the decade's end. A single country could have an HIV-

positive population larger than the total populations of London, New

York, and Tokyo combined. Ashok is the director of Avahan

(Sanskrit for " call to action " ), the India AIDS initiative launched

in April 2003 by the Bill & Melinda Gates Foundation.

He believes that India's epidemic can be stopped before it approaches

the proportions seen today in sub-Saharan Africa—but only by building

a vast network of public-private alliances on a scale rarely

attempted. With each partner bringing distinct skills and assets to

bear on the crisis, careful coordination is essential.

Conditions in India could promote the rapid spread of AIDS in coming

years. Although among adults its prevalence1 is only 0.8 percent—

compared with almost 39 percent in Botswana and 33 percent in

Zimbabwe, the two most heavily stricken countries—overpopulation and

widespread poverty are already straining the government's resources.

The public-health infrastructure, facing a variety of gigantic health

challenges, can't cope. Public and private attitudes continue to

stigmatize people with AIDS and obstruct efforts to combat it.

Already, it is spreading beyond the high-risk populations.

So far, India's response has been fragmented. The government spent

about 11 cents a person on AIDS-related programs in 2003, compared

with past expenditures of about $1.85 in Uganda and 55 cents in

Thailand, two countries that have had some success in fighting the

pandemic. Non-governmental organizations (NGOs) often lack the scale

or management capabilities to face such a Herculean task and

generally work in isolation from one another.

Against this background, the Gates initiative seeks to lower the

prevalence of AIDS in India's high-risk populations and to stabilize

the overall prevalence by 2008. Armed with a five-year, $200 million

budget, the initiative focuses on high-risk groups, particularly the

country's two million to three million commercial sex workers, as

well as the five million truck drivers and their crews along the

nation's highways. To mount a coordinated campaign, the foundation is

forging alliances with dozens of public, corporate, and nonprofit

organizations.

Ashok brings his experience as a McKinsey consultant to

bear on this enormous problem, employing management tactics to

implement prevention programs, build awareness, and tap the resources

of India's powerful business community.

The take-away:

Although the initiative has received support from some corporate

partners, India's businesses have been slow to recognize the severity

of the AIDS threat. Pointing to the devastation in parts of Africa as

a cautionary example, warns that businesspeople must go

beyond altruism by looking at HIV prevention as an essential

prerequisite for avoiding economic and social disaster.

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