A Hidden Scourge
India's huge population disguises the growing number of HIV-infected citizens
Tipping point. There are signs that HIV is starting to break out into the general population as, for instance, infected urban hotel and office workers return to visit wives who remained behind in rural towns and villages. In some areas of the country, the incidence rate has climbed as high as 4.5 percent, beginning to create Africa-like consequences such as shattered families and AIDS orphans. If that trend accelerates, India's already strained, underfunded healthcare system will be quickly overwhelmed, and its fast-growing economy hit hard. "We are moving toward a tipping point in this epidemic, but we aren't there yet," says Ashok Alexander, who heads the ambitious five-year, $200 million program of the Bill and Melinda Gates Foundation to help India avert an AIDS catastrophe.
The Indian government, long inhibited by conservative social traditions and political denial, is increasingly facing up to the alternative futures. In January, for instance, new Prime Minister Manmohan Singh met with newspaper executives to encourage more AIDS coverage. In addition, regional politicians are pressing for more action at the local level, such as medical conferences held recently in Bangalore. "There is a lot of political vision now being mobilized," says a longtime AIDS activist, I. S. Gilada, a physician who was among the first to sound the alarm after India recorded its first AIDS death in 1986. "But had the government been more active in the initial period of the epidemic, it could have changed things in a very big way."
Spending in India on HIV/AIDS programs is increasing with help from the United Nations, the U.S. government, and private donors such as the Gates foundation, which estimates that a fully funded HIV- prevention and care program in India would require $1 billion a year. India's actual numbers fall far, far short of that: Spending on HIV/AIDS programs totals less than $150 million a year, or about 29 cents a person--much less, for instance, than Uganda's per capita spending of $1.85 or even Thailand's 55 cents. Thailand's success at holding its prevalence rate below 2 percent--even given its commercial sex industry--is taken by activist groups such as the Gates foundation as evidence that intervention can reverse the spread of the HIV epidemic.
Still, even some well-educated Indians consider all the foreign attention overblown considering that far more Indians now die from dirty water and common diseases than die from AIDS. Vinod Mehta, editor-in-chief of the newsmagazine Outlook, contends that the AIDS alarm reflects a combination of western phobias about the Third World and Indian eagerness to attract foreign financial aid. "It is a scare which is blown completely out of proportion," he asserts.
The truth is that the numbers are uncertain--but not in the way he suggests. Some AIDS experts say that many AIDS deaths are attributed to other opportunistic diseases such as tuberculosis and that the government understates the real infection figure. The Gates foundation is planning a three-month effort to collect blood samples from 30,000 people in high-risk groups to establish a reliable baseline from which to assess counter-HIV measures. The foundation program Avahan (Sanskrit for "call to action" ) is funding local intervention efforts that include clinics aimed at providing the most active sex workers and truck drivers with condoms, testing, counseling, and treatment for sexually transmitted diseases (because those infections can increase the transmission of HIV).
advertisement
