Wall Street Journal - July 6, 2007
Marilyn Chase, marilyn.chase@wsj.com

Big American philanthropies are renewing their commitment to fighting AIDS in India, even though the country is expected to sharply cut previous estimates of the epidemic's size later today.

India's National AIDS Control Organization, or NACO, is expected to announce that the number of Indians infected with HIV, the virus that causes AIDS, is substantially lower than the 5.7 million previously estimated by the United Nations Joint Program on AIDS.

The new estimate, which could be as much as one-third to one-half lower than the old U.N. estimate and would put the size of India's HIV population back behind South Africa's, comes after NACO increased its surveillance and blood-testing efforts nearly tenfold with help from the U.N., the World Health Organization and other agencies.

Even so, U.S. foundations led by Microsoft founder Bill Gates and former president Bill Clinton -- two global-health powerhouses with major involvements in the fight against AIDS in Asia -- said they aren't backing away, but rather affirming and even expanding programs for prevention and treatment of the disease in India. Even if it turns out there are only around three million Indians who carry the virus, that is enough to pose the danger of a wider spread to India's 1.1 billion population, they say.

"We're staying the course. We're going to push [it] forward," said Nicholas Hellmann, director of HIV, TB and reproductive health at the Bill and Melinda Gates Foundation's Global Health Program.

UNAIDS experts say the new estimate is derived from 1,100 sentinel surveillance sites in 2006, up from 155 in 1998. Furthermore, India has broadened its testing beyond prenatal clinics to include household surveys with blood testing. Some experts cautioned that the good news brought by the reduced estimate should be tempered by uncertainty in India's northern states of Bihar and Uttar Pradesh, where HIV is fueled by needle-drug use and data aren't reliable.

The Gates foundation's $260 million program -- called "Avahan," a Sanskrit word that means "Call to Action" -- focuses its AIDS-prevention efforts on people engaged in the sex trade and trucking industry. Dr. Hellmann says Avahan reaches 270,000 sex workers and five million of their clients. The program may be expanded to embrace other public-health issues, such as infant health, according to people close to it.

Officials from the William Jefferson Clinton Foundation also pledged to maintain and increase their efforts in India.

"Whether the numbers go up or down, the numbers of people in treatment versus those who need treatment is still a huge gap. We're committed to help the Indian government scale up treatment," said Ira Magaziner, chairman of the Clinton Foundation HIV/AIDS Initiative. "Use the data to target efforts; don't reduce efforts," urged Deepak Verma, the initiative's chief executive based in New Delhi.

While many international charities are active in India, Messrs. Gates and Clinton have recently set the pace with high-profile, complementary and strategically targeted AIDS programs. The Gates foundation tends to focus on prevention; the Clinton foundation focuses on expanding developing-world AIDS patients' access to antiretroviral drugs.

The Clinton AIDS initiative works with Indian pharmaceutical companies such as Cipla Ltd. to supply discounted generic AIDS drugs to poor countries. It led the drive to simplify pediatric regimens to one pill a day in the developing world and slash AIDS drug prices there to $60 a year from $600.

Among its plans for this coming year, the Clinton foundation says it will train 150,000 Indian physicians in AIDS diagnosis and treatment and expand the training to include nurses. Mr. Magaziner adds that the initiative plans to add more than 10,000 Indian children to its treatment programs this year.

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