Wall Street Journal - November 11, 2002
David Bank, Staff Reporter of The Wall Street Journal

The commitment, the Gates Foundation's largest single-country initiative, is intended to underscore the urgency of AIDS in India, where at least four million people are already infected with the AIDS virus. A recent report from the U.S. National Intelligence Council projects 20 million to 25 million infections in India by 2010, the most of any country.

Helene Gayle, who heads the Gates Foundation's AIDS efforts, said the first grants will be awarded early next year, but full details of the program have yet to be worked out. The foundation has hired the director of the New Delhi office of McKinsey & Co., Ashok Alexander, to coordinate the initiative. Grant decisions will be made from the foundation's headquarters in Seattle.

The foundation is seeking to reach India's mobile populations, which have shown infection rates far higher than the general population. It plans to fund prevention efforts that have proven successful elsewhere, including condom distribution, treatment of other sexually transmitted diseases, and high-profile public-education efforts featuring popular celebrities as well as civic leaders.

Mr. Gates said the initiative will complement India's National AIDS Control Program, and the foundation will establish partnerships with government ministries, the national railway and oil companies and other organizations.

Many AIDS experts have been disappointed by the efforts of India's leaders so far. "There's still a lot of room for a more outspoken, aggressive approach," Dr. Gayle said. "You don't hear the high-level messages from leadership that have made a difference in Uganda, Thailand and Senegal."

As a private organization, the Gates Foundation hopes to tackle aspects of the epidemic that have been difficult for government agencies. "At the truck stops, there's a thriving commercial sex industry," Dr. Gayle said.

"That's clearly a population we would work with. We also know there's same-sex activity in some of these mobile populations."

Dr. Gayle said the foundation would support advocates of policy reforms.

For example, she said shortening the time truckers spend waiting to cross borders between India's states could reduce opportunities for transmission of HIV, the virus that causes AIDS.

The initiative underscores the Gates Foundation's strategy of promoting AIDS prevention while leaving treatment of those already infected largely to others. While the number of HIV infections in India is large, it represents only about 1% of its population, far lower than infection rates in southern Africa.

Write to David Bank at david.bank@wsj.com

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