India: Success Tainted by AIDS

[Guest guest]

India: Success Tainted by AIDS

Economic stats aren't all that's soaring. So too are HIV-positive cases, but

many won't acknowledge the urgency and extent of the threat

By most measures, India is booming. On Mar. 9, its Sensex stock index hit a

five-year high. The economy is growing by 6% a year and is projected to climb as

high as 9% by 2007. Trade in information-technology services is swelling every

year by double digits

Largely due to outsourcing, the U.S. now ranks as India's biggest trading

partner, which explains why it has accumulated a $135 billion pot of foreign

reserves. The Congress Party-led coalition government is pushing ahead with

reforms that will open India to more foreign investment and accelerate the

building of roads, a modern electric grid, and other crucial infrastructure.

With its newfound prosperity, India is confidently asserting its rights as a

global power.

But in the view of many health experts, all the progress could be sent reeling

by a single problem: AIDS. India now has 5.1 million people living with

HIV/AIDS, and the number will increase by 500,000 this year. That places India

second only to South Africa in the number of HIV-infected citizens. Some 400,000

Indians died of AIDS or AIDS-related tuberculosis last year. If the epidemic

continues at this pace, experts say, it could affect 20 million people by 2015.

It's already costing billions of dollars in lost productivity and health-care

expenses.

HETEROSEXUAL PROBLEM. Enter Ãvãhan, the Bill & Melinda Gates Foundation's India

AIDS initiative. Sanskrit for " call to action, " Ãvãhan resides in a modest

unmarked office on the outskirts of New Delhi. But it will spend an immodest

$200 million over five years to establish a full-scale AIDS education and

prevention campaign in the worst-affected Indian states.

The goal, says program director Ashok , is to repeat what countries

like Uganda, Thailand, and Brazil have accomplished: stop the rapid growth in

the AIDS population before the disease reaches a tipping point and spins out of

control. In Thailand, notes, the government and private agencies

launched a huge safe-sex public-education campaign that has kept the incidence

of AIDS below 5% of the population. In South Africa, which has had no such

education campaign, 24% of the adult population is now HIV-positive.

As in Africa and developing countries around the world, AIDS in India is largely

a heterosexual problem. Just 3% of those affected, studies have shown, fall into

the category AIDS workers call MSM -- men who have sex with men. The disease

spreads mostly via two groups: prostitutes and their clients and, in northeast

India near the Burmese border, intravenous drug users.

BUSINESS MODEL. Across India, the incidence of AIDS is just under 1%. But that

figure is deceptively low, argued , when speaking to a group of U.S.

editors traveling in India as part of the s Hopkins University International

Reporting Project. In the worst-hit areas, he says, the incidence has climbed as

high as 4.5% -- enough to overwhelm the local health-care system and create

Africa-like conditions, with dozens of families in a single village dying of the

disease.

Moreover, among high-risk groups the infection rates are staggering. One study

found that 55% of the sex workers in Bombay's brothels have HIV.

, who spent 17 years as a McKinsey & Co. consultant in India and New

York City before joining the Gates program, says he's applying a business model

to the AIDS problem. He has segmented the " market " for Ãvãhan's AIDS-prevention

" products " into various high-risk groups, including drug users, sex workers, and

India's 4.5 million truck drivers.

STILL IN DENIAL. Working through 18 local organizations to which it has given

grants, Ãvãhan is running a highly focused " sales " effort to change the behavior

of high-risk groups. Ãvãhan-paid doctors and other workers are also making

forays into brothels and drug dens in the six most heavily infected states:

Tamil Nadu, Maharashtra, Karnataka, and Andhra Pradesh in the south, and Manipur

and Nagaland in the northeast. They're offering not only AIDS counseling but

also treatment for sexually transmitted diseases, because the likelihood of HIV

infection increases for those with ordinary venereal disease.

But Ãvãhan's battle is daunting. The government took years to acknowledge the

seriousness of the AIDS problem. And even today critics say foreign donors like

the Gates Foundation have declared a crisis where none exists. AIDS " has been

blown completely out of proportion, " says Vinod Mehta, editor of the

newsmagazine Outlook. He argues that 5 million AIDS infections in a population

of 1 billion makes for no reason for panic, and that the problem can never reach

African proportions because India is such a " sexually conservative " society.

SÃvãhan's considers this head-in-the-sand thinking. But lacking a

drumbeat for action, funding is inadequate. The total amount to be spent in

India this year to fight AIDS totals $146 million, or 29 cents per capita -- and

that includes the Gates money, $13 million from the U.S., and grants from the

World Bank and other multilateral agencies. Uganda, according to Ãvãhan

calculations, is spending $1.85 per capita.

MISSING " ROCK STARS. " also criticizes the Indian business community

for failing to join in the anti-AIDS initiative. The only business organizations

cooperating with Ãvãhan's effort, he says, are the trucking companies, the

truckers' union, and Hindustan Lever, whose village saleswomen are distributing

AIDS literature along with their packets of soap. India's newly minted high-tech

billionaires are the country's " rock stars, " notes, but not one of

them has come forward to help fight AIDS.

Hindrances to the fight against AIDS include not only inadequate funding and a

sense of denial but also what calls a " staggering " amount of stigma

and prejudice attached to those who suffer from the virus. Hardly a week goes

by, he says, without a report of " a woman stoned to death or a suicide. " The

answer, he says, is education, followed by " community mobilization " to fight the

scourge.

Unless that happens, the worst-case scenario: Within a few years, India's

soaring economy, burdened by the high human and financial cost of battling AIDS,

could come crashing back to earth.

Gaurav Alreja

resident 1st year, NJ

E-mail: <drgauravalreja80@...>