AIDS Catastrophe Looms in India

Reports prepared for the 15th International AIDS Conference now taking place in Bangkok confirm what many have been predicting: that India, with 5.1 million people living with HIV/AIDS, is poised to overtake South Africa as the nation with the most cases in the world. South Africa has 5.3 million infected people.

The story is not just about numbers, however. It is about attitudes, and the willingness to admit that catastrophe looms and that national responses have to equal the scale of the problem. South Africa, it is now accepted by AIDS activists and many government officials alike, wasted precious years in denial, followed by arid debate about whether HIV really causes full-blown AIDS. Is the bungling of South Africa about to be replayed in India?

In Asia, India is not alone in being slow to rise to the potential damage ahead. China, with at least a million AIDS cases, tried to cover up not only the epidemic but also a scandal about tainted blood transfusions that contributed to the toll. In countries such as Thailand and Cambodia, where early and effective measures were taken to stem the spread of the disease, experts fear that a dangerous complacency has set in.

But India is by far the most powerful and influential country in South Asia; that broad expanse that stretches eastward from Afghanistan to Bangladesh, north to Himalayas and south into the Indian Ocean. The brothels of India are peopled by women from Nepal and Bangladesh, among others. AIDS knows no borders.

There are paradoxes aplenty. India has a large pharmaceutical industry making antiretroviral drugs for AIDS patients around the world. But that industry has not flooded the Indian market on a sufficient scale to bring relief to fellow Indians, as Brazil's drug industry has concentrated on making these medicines available to every needy Brazilian.

Furthermore, Indian drug firms, whose quality control standards have long been suspect among Indian consumer organizations, are beginning to attract more scrutiny abroad. Substandard drugs or the careless control of their use, AIDS experts are saying this week in Bangkok, can fuel hazardous variant strains of the virus, possibly unresponsive to current medications.

More than that, the World Bank said recently, other social and economic factors point to a very high risk setting for South Asia. More than 35 percent of the region's people live below local poverty lines, often equivalent to earnings of about $1 a day. Illiteracy is high. Sex is not considered a fit topic of conversation in polite society. Men resist the use of condoms and the status of women is generally abysmally low, so they have no power to insist.

In research done for the East-West Center in Honolulu, Tim Brown, a senior fellow focusing on the Asia-Pacific region, wrote recently that there are huge gaps in available data; a perennial problem in too many Asian nations where not knowing is preferable to facing unpleasant statistics that require tough action. Model "boutique" programs are not enough when the numbers are climbing at this rate.In January, Brown wrote in Asia-Pacific Population and Policy, a publication of the East-West Center, that "political leaders find it difficult to acknowledge the level of HIV risk in their own societies."

He added, "They may find it even more difficult to work with the stigmatized population groups who can help halt the epidemic; clients and sex workers, drug users, men who have sex with men and people living with HIV."

Throughout much of Asia, with the exception of Thailand, newspapers and television largely lack serious reporting on issues of human behavior and sexuality. Gay life is rarely covered in the media.Most people, especially women, remain woefully ignorant of the way AIDS spreads into the general population. In India, as in southern Africa earlier, the disease is now affecting women in large numbers; most of them, sex workers aside, are innocent wives who are not aware of (or are in denial about) their husbands' premarital or extramarital sexual activity, homosexual or heterosexual.