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India’s AIDS Epidemic

August 6, 2003 at 12:00 AM EDT
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FRED DE SAM LAZARO: Reality TV may be the rage elsewhere, but in India, fantasy and escape reign supreme and the new detective series “Jasoos Vijay” is a big hit, not just to its audience of tens of millions, but also to public health workers.

In each episode between sending off the bad guys, detective Vijay takes time to allow one of India’s grimmest realities into the plot. It’s a message about AIDS.

FRED DE SAM LAZARO: AIDS awareness messages are getting on Indian TV and public health advocates say it’s about time, in the country with what is probably the world’s largest HIV epidemic. Dr. Suniti Solomon diagnosed the first AIDS case in India in 1986 in the southern city of Chennai.

DR. SUNITI SOLOMON: I used to roughly see one new patient a week at that time. Today, I see at least five to six new patients a day — 40 to 50 patients coming in. So that will give you a range over ten years how the numbers have multiplied.

FRED DE SAM LAZARO: Solomon and other experts believe there are now about 10 million HIV-infected people in India, by far the highest in any nation. The Indian government’s figure is less than half: About 4.5 million. Many public health workers complain it reflects widespread ambivalence about AIDS.

For example, last year when Microsoft chairman Bill Gates offered $100 million to fight AIDS, there was both gratitude for the money and indignation at the assumption it was needed, according to Bombay physician Dr. Ishwar Gilada.

DR. ISHWAR GILADA: One of our central ministers says that we don’t need this kind of money and Bill Gates is overdoing it. Then the question was put to him, what is he overdoing?

FRED DE SAM LAZARO: He is overdoing?

DR. ISHWAR GILADA: Overdoing!

FRED DE SAM LAZARO: Exaggerating, you mean?

DR. ISHWAR GILADA: Exaggerating. So, on one hand, you want this money. On the other hand, you don’t want to acknowledge what he’s saying.

FRED DE SAM LAZARO: The sore point was a Gates’ prediction that HIV Infections here could more than double to 20 million by 2010. The prediction came from a U.S. Government source but it’s disputed by Meenakshi Datta Ghosh, head of the government’s anti-AIDS effort.

MEENAKSHI DATTA GHOSH: We are ourselves concerned that our figures should be robust, and that the methodologies adopted should be those which have been tried and tested.

FRED DE SAM LAZARO: So you think it’s by a half, by 100 percent How exaggerated, even in a ballpark sense, are those figures do you think?

MEENAKSHI DATTA GHOSH: Difficult to say. Difficult. I wouldn’t like to hazard a guess, no, until we get more substantial data.

FRED DE SAM LAZARO: Ghosh says a comprehensive survey is now underway to measure HIV prevalence and design a response accordingly. But critics say the argument over numbers is irrelevant since they’re high either way, and could soar without prompt action.

DR. ISHWAR GILADA: From top to bottom, there’s no ownership. The government of India has not spent one rupee or one dollar from its coffers on HIV programs.

FRED DE SAM LAZARO: He says India’s entire AIDS budget has come from international loans and grants. It all traces back to the origin of this disease, stigmatized in a conservative, class-conscious nation.

MEENAKSHI DATTA GHOSH: Because the first six infections, which we detected in Chennai for the whole country were in prostitutes. So the message which went out that it is a disease of the prostitute, just like in the U.S., it was the disease of the gay community. So I always tell people, if HIV was first detected in a baby, we would never have had the stigma today what we have, or if it was through blood transfusion.

FRED DE SAM LAZARO: The AIDS epidemic did begin in the red-light district of Bombay or Mumbai, India’s commercial capital. And it garnered lots of public attention thanks to Dr. Gilada, seen here in a 1994 NewsHour profile delivering a safe-sex sermon.

He says such measures have helped stabilize infection rates in urban areas, but they are growing in areas of low prevalence, including the vast rural hinterland.

DR. ISHWAR GILADA: That is a dangerous sign, because over 70 percent of the country’s population is rural population. There’s a lot of migration between urban and rural. Most of the people in Bombay have access to information, access to tools like condoms, access to going to doctors for STD check-ups and also get HIV test done, which is not so in rural areas.

FRED DE SAM LAZARO: And awareness about AIDS is frequently sketchy at best. The disease is also growing among women.

MEENAKSHI DATTA GHOSH: Eighty percent of the women who come to us, who are infected, have a single partner, and that’s their husband.

FRED DE SAM LAZARO: Bhagya Lakshmi is 38, HIV-Positive and a widow. She’s raising two young girls and supporting her elderly mother. Her husband died four years ago of AIDS, which he contracted from a sex worker.

BHAGYA LAKSHMI ( Translated ): Soon after our marriage, we had a lot of problems. He stopped working. He was drinking. He used to hit me. But the one thing I’m really happy about is when he told me the truth, when he took the HIV test, that has helped me prepare to deal with it.

FRED DE SAM LAZARO: The truth about sexual mores that many men visit sex workers is rarely discussed not even in India’s influential movie industry. It’s made it hard to craft media campaigns.

This television spot was commissioned by the Charitable Trust of the BBC World Service. A father must confront the reality of his son’s sex life, but the commercial was quickly scrapped. The health ministry deemed it, “too condom-centric.”

Such actions reflect widespread denial and fear that access to condoms promotes promiscuity, says Nafisa Ali. She runs an AIDS care center in New Delhi. A former movie star, Ali is one of few who have gotten publicly involved with AIDS issues.

NAFISA ALI: In the land of the Kama Sutra, the land of a billion, a land where every man can do what he wants, it’s very macho to go and have a relationship out of your family-based relationships. Don’t the parents think that this is a problem for young people, too? I work in the red-light area. I work and I have seen school kids there.

FRED DE SAM LAZARO: For her part, the government’s Ghosh admits this country has been slow to tackle AIDS, but she insists that’s changed, pointing to the Vijay series– one that gets the message across effectively without grating on community sensibilities about condoms.

MEENAKSHI DATTA GHOSH: Subtle messages on HIV/AIDS and the dangers of high-risk behavior and the need to practice safe, you know, social and sexual behavior is being talked about at prime time. So it is definitely beginning to change, and, you know, in a meaningful way, not just, you know, a flash-in-the-pan kind of change.

FRED DE SAM LAZARO: Still, like the “Vijay” series, also funded by the BBC Trust, most AIDS campaigns have come with external prodding and funding, like the Gates grant. Recently, The Global Fund to Fight AIDS, Tuberculosis and Malaria also announced a $100 million grant.

For the first time, many experts say there’s hope and some money for a coherent anti-AIDS program. Among the recipients is Dr. Solomon, who will start an enterprise to distribute anti- retro viral drugs, drugs that greatly prolong the lives of patients with AIDS.

DOCTOR: This is some of the drugs here…

FRED DE SAM LAZARO: The drugs are made in India and are much cheaper than in the West, but they’re still beyond most poor patients. Under the new plan, 1,000 patients from different income levels will get the medicines at sliding scale prices.

DR. SUNITI SOLOMON: So the money which comes from this would be circulated and over a period of five years, it becomes sustainable.

FRED DE SAM LAZARO: If successful, the self-sustaining program could greatly expand access to the drugs. And when an HIV diagnosis is no longer a death sentence, Dr. Solomon says it’s less visible and less stigmatized and more people will come in earlier to be tested. Bhagya Lakshmi will likely be an early beneficiary.

BHAGYA LAKSHMI ( Translated ): Any person who is born cannot live forever. We all have to die sometime. Some of us will die from HIV. Now that my husband has died, I am determined to live long enough to see that the girls are educated well and that they are married.

FRED DE SAM LAZARO: Global Fund dollars will also help women less fortunate than she, with drugs to prevent HIV transmission to newborns. The government estimates that some 92,000 HIV-positive women deliver babies each year in India– another figure that it admits could be grossly underreported.