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    AIDS epidemic in India

    India on the verge of full-blown AIDS epidemic / Some say up to 10 million are HIV-positive,overwhelming health resources
    Special to the Chronicle
    MIRAJ, India - In a squalid hut on the outskirts of this thriving sugar cane center, a young woman lies dying, her half-naked body resting limply on a rough, straw cot. She has never heard of the disease that has transformed her once-rounded figure into that of a starving child, scaring off even the poorest clients.

    The disease is AIDS, and it has killed 20 women so far this year in the sprawling red light district of Miraj. Of the 2,000 sex workers, more than half are believed to be infected with the deadly HIV virus and most likely will die from it over the next decade.

    "A doctor came and told me I had too much water in my stomach. He injected some needles and now I cannot eat," said Yellava Gaste, who started working as a prostitute 10 years ago but said she had never heard of AIDS or condoms. "I must have done something wrong to deserve this," she said, referring to the traditional Hindu belief that misfortunes are the result of sins committed in a past life.

    Prostitutes are only the most visible victims of the burgeoning AIDS epidemic in India. Officially, the country has between 3 .5 million and 4 million people infected with HIV, a figure that places it ahead of even the hardest-hit African countries in terms of the sheer number of HIV cases. But some experts say the real number may be closer to 10 million, a critical 1 percent of the population that indicates the start of a full-blown epidemic.

    Miraj, an eight-hour train ride from Bombay, is at the epicenter of the AIDS crisis. One in 20 people here is believed to be infected with the disease, compared with the national average of one in 200. The town's location at the crossroads of several major national highways, its proximity to Bombay and its sprawling red light district also make it a prime feeder of the disease across Maharashtra state and beyond.

    Despite a seven-year government campaign to stem the spread of HIV, an additional 6 million Indians will become infected by 2005 if the current trend continues, according to World Health Organization estimates. Most, like Gaste, will be left to die as the country's overtaxed health system struggles to cope with the spreading disease.

    "It is very difficult for the government to think about the people who are suffering from AIDS. They want to stop more people from getting infected," said Dr. Ravi Tate, a government doctor in Miraj.

    So far, that goal has meant focussing on so-called target groups, mainly prostitutes, truck drivers and drug users, in what critics say has fed the general misconception that only marginal groups are at risk of the disease.

    "By this kind of targeting, you've ensured that certain groups are seen as high-risk groups, but anyone who doesn't belong to that group is safe," said Angeli Gopalan, director of the Delhi-based Naz Foundation, a nongovernmental organization that provides counseling to AIDS patients.

    She and other AIDS activists are pushing the government to invest more heavily both in AIDS education and treatment. "The government should be doing something, forget about more," she said. "They should accept that we have a problem."

    Government officials deny they are taking the disease lightly. The government recently signed on for a $191 million dollar loan from the World Bank, most of which will fund treatment of AIDS-related infections, though officials say they cannot afford to treat the disease itself. Even if locally produced drugs are substituted for pricier Western ones, the cost of the standard AIDS treatment is $400 a month - four times the $100 average salary in cities and eight times the average rural earnings.

    Much of the World Bank loan will go toward training health workers to provide better care to HIV-positive patients, many of whom have been denied access to hospitals once their infected status is revealed.

    Bombay, which has been hardest hit by the disease and is at the forefront of AIDS prevention, recently issued strict guidelines forbidding discrimination of HIV-infected patients in government hospitals. However, cities such as New Delhi and Calcutta, which have fewer AIDS cases, lag far behind in teaching health workers to cope with the disease.

    "We are now at a stage where Thailand was three years ago," J.V.R. Prasada Rao, the head of India's AIDS control program, told an AIDS conference last week. He was referring to the point at which the epidemic in Bangkok began to level off, largely due to a massive public awareness drive there. However, he added, "any slackening can loosen our grip on the situation."

    Critics dismiss such statements as overly optimistic. They say that while there are signs that cities such as Bombay and Chennai have managed to slow the spread of the disease, much of the country has yet to wake up to the threat.

    "We may see that the number of cases are evening out, but there are so many hidden foci of AIDS (where the disease is spread) . . . what we see doesn't even touch the reality," said Dr. Hema Jerajani, an AIDS expert at Sion public hospital in Bombay.

    Jerajani said the governments of populous states such as Uttar Pradesh, Bihar and Madhya Pradesh "are refusing to accept that their people are getting infected," warning of a "huge epidemic" in those areas if officials there continue to drag their feet on AIDS prevention.

    In Miraj, most of the prostitutes said they had heard of AIDS but did not know what it was. Their confusion stems in part from a deliberate policy among health workers of providing limited information.

    One doctor working in the red light district said he chose not to inform women who were HIV-positive, since "they might become too depressed and commit suicide and then we would be blamed."

    Dr. R.R. Gawai justified that strategy, saying health workers had been able to increase condom use from virtually nil in 1992 to more than 90 percent today by convincing prostitutes of the need to protect against "a deadly disease."

    Despite a massive government awareness campaign, AIDS remains a taboo subject in most rural areas, where there is little understanding of the ways in which the disease is spread. As a result, women, whose status in society is lower than that of men, typically are blamed for contracting the virus.

    One victim, Sangita Pramod Nhalve, was forced from her home and barred from seeing her two daughters after her husband died of AIDS-induced tuberculosis last year. She now lives at a home for HIV-infected women and orphans in the nearby town of Sangli.

    "They said, `You are a bad omen in our house and you should be shunned,' " said Nhalve, breaking into tears as she related how her husband's family held a meeting to decide whether she should be allowed to continue to live with them.

    When they turned her out, forcing her to leave behind her two daughters, she went to her parents for help. "But I was turned down in my own house," said Nhalve, who tested positive for HIV but has yet to show signs of the disease.

    Ironically, the tendency to blame women has diverted attention from another high-risk group: gay men. In Bombay, more than half of those tested at a center for gay men were HIV-positive, according to the center's director, Ashok Row Kavi.

    Kavi has been single-handedly running a condom distribution program in gay cruising areas and pressuring the government to include gay men in its awareness campaign.

    "I'm saying stop targeting the women. Look at male sexuality," said Kavi, who is torn between the need to halt the spread of the disease and his fears that such a campaign will trigger a backlash against gays in India. He accused the government of shying away from focusing on gay men, because "they don't want to acknowledge that we exist."

    He and other critics also accused the government of trying to cover up the disease while discriminating against HIV-positive patients. A bill outlawing discrimination against AIDS patients has stalled in Parliament, while the Supreme Court recently issued a judgment banning HIV-positive people from marrying.

    Without a concerted campaign to change attitudes toward the disease, HIV-infected people will have to keep their status a secret or face social ostracism - a grim prospect for those who have yet to develop AIDS.

    "Maybe I can keep quiet about the disease. I won't even touch people," said Nhalve, the AIDS widow, who spends her days teaching HIV-positive children and dreaming of the two she left behind. "I just want to earn enough to support my daughters. I want to see them grow up."


    AIDS is a US government military biological weapon to wipe out the third world population....


      Dear Asif,

      Where is the 3rd world? There are more HIV+ves in USA alone than in the entire 3rd world (excluding sub-Saharan Africa) combined. Please support your argument with data. This is the most stupid observation made by those who just want to look for anything anti-USA.

      In terms of the original post, it is true that India has done little to spread the virus, but it won’t be long before Pakistan is faced with this monster. Everyone needs to work on this together. The only real obstacle in developing a vaccine is the domination of big pharmaceutical companies. Each one is working out independently to make the big buck. Had there been a concerted and joint effort, there would have been a vaccine by now to treat this monstrous disease.


        I am a Pakistani and feel sorry that our nation does not have HIV awareness like India does.