IHT: India strives to block explosion of AIDS

[Guest guest]

Dear All:

This is the last line in the article reproduced below.

" It is a grave problem, " he said. " What can happen in Africa can happenhere. We

have to scale up our efforts; we can't behave like ostriches. " (Quraishi)

Best,

Bobby

E-mail: <bj@...>

_______________________________

India strives to block explosion of AIDS

By Amelia Gentleman

International Herald Tribune

THURSDAY, MAY 5, 2005

NEW DELHI Riffling through multiple condom packets in his office here, the man

responsible for battling India's exploding AIDS crisis was eager to display the

latest weapons in his arsenal.

There were condoms for the nation's trucking community, titled Dipper -inspired

by the request for dimmed headlights painted on the back of every truck in the

country, " Use Dipper At Night, " which S.Y. Quraishi, head of the National AIDS

Control Organization, hopes will provide plenty of free advertising.

There were condoms named simply, but with less obvious logic, " Woh. "

There were new advertisements, due for release in a few days, showing three

cricket stumps, sheathed in condoms, beneath the slogan " Save your wicket from

the unwanted googlies of life, " a googly being a cricket bowling term. For India

this is a risqué image, and Quraishi said that if the government did not like it

he might soon be looking for a new job.

For now, he has his work cut out.

According to a leading nongovernmental organization in the battle against AIDS,

India has outstripped South Africa and has more people living with AIDS than any

other country in the world.

Feachem, executive director of the Global Fund to Fight AIDS,

Tuberculosis and Malaria, made that provocative assertion last month. " The

official statistics show India in second place and South Africa in first place, "

he said, adding: " The official statistics are wrong. India is in first place. "

According to the latest figures available from Unaids, South Africa had an

estimated 5.3 million infected adults and children at the end of 2003, while

India's total was thought to be 5.1 million.

In India, however, Unaids indicates an enormous estimated range of error, from

2.5 million to 8.5 million, reflecting the absence of precise statistics.

Feachem said that, such was the speed with which the disease was being spread,

the true figure in India must by now exceed that in South Africa.

" We know from a number of other countries that the epidemic can grow from a

fraction of 1 percent of the population to 10 or even 20 percent within a

decade, " Feachem wrote in a letter to the National AIDS Control Organization.

" An infection rate of 10% in India is too terrible to contemplate, " Feachem

wrote. He said the government needed to take much stronger action to contain the

epidemic.

His assertion, which was broadcast globally, triggered first alarm and then

denials in India.

" This is technically incorrect and misleading, " Quraishi said, stressing that

the Indian government does not sanction the range in possible figures cited by

Feachem. Quraishi said he welcomed the international attention on India but

viewed comparison with South Africa as counterproductive.

" According to our figures, 0.9 percent of our adult population is currently

infected, compared to 23 percent in South Africa, " Quraishi said. " The gravity

is not the same, and highlighting this will just make people in India

complacent. "

" We realize the seriousness of the problem here, " he said. " The number of people

affected grew by over half a million last year; that's like having a tsunami

every week. We know we have to do more, and we are accelerating our response. "

But even those AIDS organizations that are not interested in the numbers dispute

wish that the government would accelerate more swiftly. India has not been in

denial about its AIDS problem, as South Africa and China once were.

But while it has been more forthright, it has also been sluggish in

developing a national strategy and nationwide awareness campaigns.

" The UN is extremely concerned about the rate of increase in AIDS cases, which

is much higher than we thought it was, " said del Prado, a senior Unaids

official in Delhi. What is clear is that we have to act much faster otherwise it

will explode. "

" Things should be on a war footing, and they aren't, " said Ashok ,

director of the Bill and Melinda Gates Foundation's India AIDS Initiative,

called Avahan. Government attitudes have changed in the past three years,

said, from indifference to an understanding of the urgency of the

issue. But he said there was still " a lot of talk and not enough action. "

The vast scale of India's problem is visible at the Sanjay Gandhi truck depot,

an hour's drive northwest of Delhi, where about 10,000 trucks stop every day to

refuel and unload. India's population of about three million long-distance

truckers is classified as a very high-risk group. Making deliveries on 8,000

kilometers, or 5,000 miles, of national highways, the men are away from home for

long stretches, and many of them are regular clients of roadside prostitutes;

from 8 to 12 percent of them are estimated to be infected with HIV.

Tackling this aspect of the AIDS crisis is a priority nationwide, because these

men take their infections home to their families, usually in remote rural areas

previously untouched by the disease.

The campaign to make them use condoms is a difficult one. Together with a local

nongovernmental organization, Avahan has dispatched a team of men to walk

through the truck stop, brandishing flip charts illustrating the risks of unsafe

sex, with graphic drawings of pustular sores and dead babies.

In the profoundly masculine environment of the oil dealers, engine workshops and

tire suppliers, bravado rules.

" Most of the truckers have heard about how the virus is spread, but very few

have changed their behavior, " Deepa Bajaj, the local project coordinator said,

at a small clinic where truckers are encouraged to go to be treated for sexually

transmitted infections. " We think only about 15 percent use condoms. "

" We're on the road for a long time; we have no choice but to use prostitutes, "

Sonu Singh, 25, a long-distance driver from Rajasthan said, adding that from his

10,000-rupee, or $230, monthly salary he spent 50 rupees having sex twice a week

with women he picked up on the roadside. He became aware of the threat of AIDS

when a fellow driver from his village died of the disease three years ago but

acknowledged that he still resisted using condoms.

''I don't see myself as at risk, " he said.

Officials of Unaids and Avahan are reluctant to be too critical of a

government they are working alongside, but also unable to disguise their

frustration with the slowness of change.

''In Africa we are looking at an epidemic which is mature and has done its

damage, " said of Avahan. " In India it is an early stage epidemic where

hardly 1 percent of the population is affected, so there is a huge potential now

for prevention here.

And yet only 30 cents per member of the adult population is being spent on AIDS,

compared to $5 in Cambodia and $2 in Uganda. "

In defense of the government's commitment, Quraishi lists numerous

initiatives. The prime minister, Manmohan Singh, has recently agreed to head a

national council on AIDS, which will require that the government ministries pay

attention to the risk. Health care resources were increased in the last budget:

New sex-education programs are under way, more antiretroviral therapy programs

have been started.

The National AIDS Control Organization wants to create 24,000 voluntary testing

centers across India in the next five years; at the moment there are just 700.

This shortage largely explains why the national statistics are so

unreliable, and is also responsible for one of the most worrying aspects of the

Indian AIDS crisis: Of the 5.1 million people believed to be infected, the

government thinks that 95 percent of them do not know they are HIV-positive.

Cultural taboos make it difficult to broach the subject in the necessary detail,

and across India there is still a high level of ignorance about the disease. One

survey indicated that in some rural communities 40 percent of the people had

never heard of AIDS.

Because of the difficulty of the job, officials of the National AIDS Control

Organization have not had long tenures. There have been six directors since the

body was formed in 1992. But Quraishi is determined to fight on.

" It is a grave problem, " he said. " What can happen in Africa can happen here. We

have to scale up our efforts; we can't behave like ostriches. "

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BOBBY JOHN| bj@... | 5, Chandan Gardens, NIBM Road, Kondhwa, Pune 411 048,

India