A demon slumbers

Perhaps the largest potential AIDS factory in the world, India remains blissfully apathetic to a scourge that could rip its social fabric apart

By Aravind Kala
Published: Sunday 31 July 1994

-- WHEN is India going to wake up to its AIDS crisis? Michael Marson, chief of the World Health Organisation's AIDS-control programme, says that India should declare an "AIDS emergency". Jacob John, one of India's top virologists, puts the doubling time of HIV incidence in India at 2 years, maintaining that last year's 1 million estimated carriers will become 12 million by 2000. But The Indian government continues to sleep over the problem.

In Britain, children from the age of 11 are taught about AIDS. In the US, proposals are being considered to introduce AIDS education at the kindergarten level. The Indian government, in contrast, has made no headway in introducing AIDS education into schools and colleges.

Invisible epidemic
Six years ago, only 3 per cent of Bombay's estimated 100,000 prostitutes were HIV-positive. Today, its 50 per cent. Infection among 2 million high-risk individuals tested has gone up 5 times in 8 years -- from 2.5 per 1,000 in '86 to 11.2 per 1,000 in '92. Infections among blood donors have doubled between '91 and '92. These are figures provided by the National AIDS Control Programme and not by any alarmist doctor. Surprisingly, the reality fails to dawn on the Indian policy makers just because the epidemic is yet invisible.

"Make no mistake, we are in the 3rd and final stage of the epidemic," says I S Gilada, secretary-general of the Bombay-based Indian Health Organisation. "In the 1st stage, prostitutes and blood donors got infected, which in turn infected the clients of prostitutes and the recipients of blood. But now the virus has spread to the general population." Gilada bases his observation partly on the results of a blood-screening programme conducted by IHO in Bombay's Wadia hospital over the past 1 year.

Twelve thousand pregnant women from working-class families were screened during the programme and 72 turned up HIV-positive. Gentle questioning revealed that all of them but one had been infected by husbands who visited prostitutes on the sly. "If I extrapolate this figure for the rest of Bombay, then this city alone has 150,000 HIV-infected men," Gilada says.

About 1,000km away in Tamil Nadu, Jacob John has come up with evidence of the virus spreading to rural areas. Young men in selected villages of Arcot district were tested and some were found to be HIV-positive. Investigations revealed that they had been infected by prostitutes they would visit whenever they went to a nearby city on work. The scourge spreads
The Union health minister recently told the Lok Sabha that 230 cases of AIDS were detected in India between January and November last year. Now, that figure seems deceptively small unless seen in perspective. Those 230 cases in 11 months are nearly as many as 264 cases detected in the 5 years before that, revealing the fast accelerating spread. Till March 31 this year, 713 full blown cases and 15,017 infections were reported in India.

John's assessment that the incidence of AIDS will double every 2 years sounds too frightening to be true till you realise that this is probably an understatement. The doubling time of the epidemic was 4.9 months in Kenya, 13.9 months in Zambia, 7.5 months in Mexico and 13 months in the US. This relates to the period between '1983 and '1987, but considering that the virus entered India a few years later, we are going through the stage Africa and the US have already travelled.

In the US, for instance, the second 100,000 cases of AIDS came 4 times as quickly as the first. But we still fail to grasp the fact that the spread of AIDS can become so uncontrollable. The whole world knows today that the only answer to AIDS is awareness of how the virus spreads so that it propels people to take steps to protect themselves.

Gilada has an excellent suggestion. He says that the AIDS epidemic in India should be fought the way elections are fought. Political leaders and workers should fan out to every village and hold public meetings on AIDS. Only then will India's 890 million people be jolted out of their complacency. But so far, the cry for action on AIDS remains a cry in the wilderness of chronic apathy.

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