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Defusing the HIV/AIDS time bomb

An HIV-positive child at an orphanage near Chennai, India. (laxmanpix/

An HIV-positive child at an orphanage near Chennai, India. (laxmanpix/

By Jamie F Metzl & Elizabeth H Williams

Originally published in Business Standard, May 6, 2006

India's had enough concerts and charity events, now it needs some sustained action.  

A time bomb is ticking beneath India’s future. India’s remarkable growth and its ability to address its monumental social problems will all be compromised if the country does not quickly and aggressively address its growing HIV/AIDS crisis, and if the global community does not do more to help.  

India estimates it has approximately 5.25 million people with HIV/AIDS, by far the largest number in the Asia Pacific region and only second largest in the world after South Africa. More concerning, up to 95 per cent of those infected do not even know they have the disease, allowing the disease to spread at exponential rates.  

Addressing this growing crisis will require tremendous political will, the commitment of significant resources, and a strong willingness to overcome cultural norms deeply embedded in Indian society. India will either take these steps and realise its great potential, or fail to do so and watch the process it has made erode unnecessarily.  

To be sure, India has made great strides in addressing this epidemic. Prime Minister Manmohan Singh established and chairs India’s inter-ministerial National AIDS Council and this past December spoke publicly for the first time about responsible sex education. India, on paper at least, endorsed access to anti-retroviral treatment through its public health system. India’s National AIDS Control Organisation, NACO, is making much needed progress in blood safety, access to testing, and surveillance. One of the country’s top corporations, Tata Steel, implemented its first HIV/AIDS awareness programmes in 1994 and more recently, new industries, including those which part of India’s vibrant outsourcing sector, are getting involved. Small and large civil society organisations are making inroads with some of the most vulnerable communities. From street theatre in the red-light districts of Mumbai to reproductive health service clinics in the resettlement colonies of Delhi to care and treatment programmes in Chennai — model programmes for prevention and care are starting to take hold.  

These actions are admirable for a number of reasons. But India’s response to the looming HIV/AIDS crisis remains insufficient. Traditional attitudes towards sex and sexual behaviour prevent open discussion of HIV/AIDS and basic education about condom use and safe sex.  

The social and cultural stigma associated with people living with or affected by HIV/AIDS prevents those at risk from getting tested and those with the disease from seeking treatment. This is most evident in rural communities, where young, monogamous married women are often blamed for their HIV positive status, even though they are often infected by their husbands. In India, as in many countries, the low status of women weakens their ability to protect themselves.

Most people who have HIV or AIDS do not know their status because systematic testing is not taking place on a sufficient scale. Testing alone may not be a magic-bullet, but it is a necessary first step in prevention. The poor quality and bureaucratic nature of India’s medical treatment infrastructure provides little incentive for those at risk to seek medical diagnosis or treatment.