India is on the brink of an AIDS disaster and should get a control over the HIV epidemic by next year or risk seeing it spiral out of control warned Ashok Alexander, the director of the Bill & Melinda Gates Foundation and a senior United Nations official.
According to Ashok Alexander who directs the $258-million Indian HIV-prevention project, "The signs are still ominous."
He said that the rising prevalence of HIV in more than 100 districts in which the foundation operates showed that a decade of government efforts had still not slowed the virus, which is now estimated to have infected 5.7 million Indians.
Alexander added, "The huge challenge is scaling up prevention efforts. 2007 is when we need to have done this by. It's very urgent."
Speaking at the foundation's New Delhi offices on Friday, Alexander said that old-fashioned and inefficient management within the government's National AIDS Control Organization (NACO) was the main obstacle to success.
Denis Broun, India coordinator for the U.N.'s HIV-prevention agency, UNAIDS, has predicted that in the worst-case scenario, the virus could spread to infect 3 percent of India's billion-plus population in the next 5 to 10 years, up from 0.9 percent now.
UNAIDS says that India already has more HIV-positive people than any other country.
Presently the AIDS-causing virus is assumed to be largely confined within a sexual triangle of poor, male migrant workers, the prostitutes they visit, and their wives back home. It is mainly for this reason that the Gates Foundation spends much of its efforts telling the first two groups to use condoms.
Broun said that it was essential that India aims to get 80 percent of its prostitutes to insist on their clients using condoms if the number of new infections each year is to drop significantly below the estimated 400,000 annual deaths from AIDS in India.
According to Broun safe sex messages from the government and NGOs are currently heard by about a quarter of Indian prostitutes.
India failure to convince many more of the importance of condoms as well as their repeatedly delayed efforts to get ever more people with AIDS on life-prolonging antiretroviral drugs are doomed to forever lag behind new infections.
Broun said, "We have slow growth -- it's not an explosion -- but it's enough to make any expansion of the treatment program unsustainable, financially and technically."
Although Alexander praised India's recently finalized HIV strategy with a budget of $2.5 billion over the next five years towards prevention and treatment he expressed his doubts as to its effective carrying out.
Referring to the recent poll of Indian parliamentarians showing widespread ignorance of HIV, with nearly two-thirds wrongly believing it could be spread by sharing clothes with an infected person, he said,
"The interesting counterpoint is that the same thing was done with sex workers in Mumbai and they scored over 90 percent. Your average Mumbai commercial sex worker is probably the most informed in the country when it comes to HIV."