Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date.

Reuters NewMedia - Monday, November 18, 2002
Terry Friel

Already, 4 million Indians have HIV or AIDS, making it second only to South Africa, and a U.S. intelligence report warned that could balloon to 20 million to 25 million by 2010.

Microsoft Corp chairman Bill Gates underscored the urgency of the crisis during a visit to India last week during which he donated $100 million to help battle the disease.

"There is no doubt that India has a serious problem on this front," Gates said.

But human rights groups and HIV/AIDS workers say spending is being undermined by ignorance and prejudice in deeply conservative India, where even health workers often refuse contact with infected people.

Sufferers in the world's second-most populous nation are frequently denied treatment by hospitals and clinics, thrown out by their families, evicted by landlords or fired.

AIDS workers say some hospitals refuse even to treat someone living with a victim or deliver babies from HIV-positive women.

"They can't even get basic emergency treatment," said one.

AIDS activists and rights groups say violence ranges from police harassment of AIDS workers helping prostitutes to neighborhood assaults against people with the disease.

"Bill Gates is right that the AIDS epidemic is poised to explode in India," New York-based Human Rights Watch's HIV/AIDS program chief Joanne Ceste said.

"But his generosity will be undermined if the Indian government doesn't do something about the widespread violence against people who are affected by the disease."

Indian officials, however, are infuriated by the U.S. report projecting a five-fold increase in people infected.

"We shouldn't get overpanicked on the basis of some reports," Health Minister Shatrughan Sinha said at the announcement of a separate AIDS initiative.

NUMBERS COULD ROCKET

"I don't know how they arrived at this data," he said, adding the World Bank estimated the number of victims would rise to 10 million by 2010.

Unless authorities dramatically shift their priorities, the number of Indians infected with HIV/AIDS could reach up to 25 million by 2010, a U.S. National Intelligence Council (NIC) report for the Central Intelligence Agency said.

This could put serious strains on the government and impede economic growth, said the report released last month.

The NIC report also said the number of Indians already infected could be twice the official estimate -- which would put it well ahead of South Africa.

The study of the "next wave" of HIV/AIDS looked at five countries -- China, Ethiopia, India, Nigeria and Russia -- and the potential fallout for the world.

But AIDS workers warn against being distracted by debate over numbers in what everyone acknowledges is a serious epidemic.

"The size of the number is probably less important than the way the thing spreads," Greg Manning, who works with HIV/AIDS group Sharan, told Reuters in New Delhi.

In addition to a lack of resources and the costs of fighting other major health problems such as tuberculosis in a country with tens of millions of poor, the government and health workers also face a cultural and social battle because of the enormous stigma attached to the disease.

Added to this is a belief among many that only "certain groups" can be affected.

"People think it only happens to 'bad' people," Manning said. "It won't happen to me."

HIV, carried in the blood and other bodily fluids, has spread from traditionally high-risk groups such as prostitutes, drug users and homosexuals to rural and urban areas with large migrant populations.

"HIV/AIDS will drive up social and health care costs in India and China," the NIC report said. "But the broader economic and political impact is likely to be readily absorbed into the huge populations of these countries."

ECONOMY HIT

Partly in India's favor is the fact that while numbers are high, its infection rate is relatively low -- less than 1 percent of the adult population compared with South Africa's 20.

"But if current rates of increase were to continue beyond 2010, the effects could be significant," London's Financial Times newspaper said in a recent editorial.

The spread of HIV/AIDS among young urban professionals could also hit the skills India needs to fuel development and feed its poor.

Panicked by the spread of HIV/AIDS, some Indian states are reacting with policies AIDS workers say could make things worse.

Bihar, one of the poorest and most populous states, this week became the first to force health workers to report fresh cases.

But the move highlights a critical dilemma: Although reliable data is desperately needed to combat the spread of HIV/AIDS, mandatory reporting forces people underground and scares them away from help.

"They will drive the problem of stigmatization even further," said Manning.

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