San Francisco Chronicle - Tuesday, July 27, 2004
Marshall Kilduff

The notion of AIDS as a change agent isn't a flip remark. For India, and other countries slowly waking to the disease, the stakes are major. In India, there are 5 million infected with the virus that causes AIDS. Only South Africa has more cases.

This devastation has brought on a frank brand of reverse thinking. The epidemic is so dire, India has to try something brand new. The threat should yank social thinking and institutions forward in ways that other changes such as politics, the Internet, religious fervor or popular culture could only dream about.

Is it callous to think that AIDS can produce positive changes? To several Indians, it's the only way.

Consider a list of nearly taboo subjects that go along with any serious effort to curb AIDS: women's rights, domestic violence, sex education, political leadership and government responsiveness. "This epidemic allows us to talk about all these things. It's an opportunity we never had before," said Dr. Revathi Narayanan, a United Nations AIDS planner.

With AIDS creeping into Indian society from all sides, what can be done? This is where the revolution begins.

First the disease needs to be understood. In a tiny schoolroom in Mombai, former street children are taught the basics: AIDS comes from drug use, tainted blood and failure to use a condom. Just as important, the young audience is taught about AIDS myths: You don't get it from a handshake, a hug or a shared glass of water. It's tentative and dumbed-down, but it's a start in a country skittish about sex ed.

Next comes prevention. Handing out condoms is one heavily promoted concept because it's cheap and simple-sounding. Condoms work fine for men who patronize prostitutes. But many males don't like using them, contract AIDS during paid-for sex, and then return home to infect wives.

In India, this infection-spreading dynamic is enormous. The country has a huge military and migrant population of truckers, railway workers and factory hands who patronize brothels or street prostitutes during months away from home.

Here comes the challenge. Wives need the social support to ask husbands to drop outside partners or use a condom at home. Right now, a questioning wife risks a beating or divorce. A simple condom becomes a powerful symbol of male responsibility and women's rights.

Government can't escape the blame either. Former President Ronald Reagan famously looked away from the brewing AIDS scourge in the 1980s. This failure can't be repeated in even bigger countries such as India and China.

What worked in the United States with its population of gays under siege from AIDS can't be transplanted overseas. The anti-AIDS message, safeguards and target audience need to be tailored for maximum impact. Said U.N. official Dr. Maxine Olson, "What India needs is a Magic Johnson," a national celebrity who admits carrying the AIDS virus. India's pop culture hasn't produced such a figure.

So far the fresh thinking comes from outside Indian government. For example, the Bill and Melinda Gates Foundation has launched a five-year, $200 million effort targeting truck drivers and roadside prostitutes on the country's heavily used highways. But the work taps private health groups and gas-station chains, not the country's notoriously obstructive bureaucrats.

A terrorist couldn't design a more dangerous challenge than AIDS. Nearly every social institution is under assault, from the central government to the intimacy of husband and wife. But if a country like India can find a response, it will be a huge victory over AIDS and the injustices that allowed it to spread.

Marshall Kilduff is a Chronicle editorial writer. E-mail him at mkilduff@sfchronicle.com

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