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India Faces Uphill Task in Battle Against AIDS

Health experts say India confronts an uphill task in halting the spread of AIDS due to widespread ignorance about the disease. More than five million Indians are suspected of being infected with HIV/AIDS - the world's second largest number of infections.

Yallawa, 40, grew up in a busy Bombay red light district with her two sisters. Fifteen years ago, activists from a volunteer group, the People's Health Organization explained the risks she faced of getting AIDS, a disease she and other sex workers there had never heard of.

Later, Yallawa joined the volunteers. She now visits the tiny alleyways of the city's red light areas to educate sex workers about the infection and the need to ensure their clients use condoms.

Yallawa says she is lucky she escaped getting HIV, the virus that causes AIDS, and the risk of death.

But many others are not so fortunate. Programs such as those conducted by the People's Health Organization have helped reduce the incidence of HIV among Bombay's sex workers, but the infection rate is still 50 percent.

Health experts say that is because efforts to raise awareness about the disease among high-risk groups, such as sex workers and those who buy their services, like truck drivers, have been sporadic and piecemeal.

Studies show ignorance is widespread. One-third of the country's sex workers are unaware condoms can prevent HIV and more than 40 percent think they can tell whether a client has the disease by his appearance.

The head of the United Nations AIDS program, Peter Piot, says lack of knowledge continues to be the biggest stumbling block in halting the spread of the virus.

"You would expect that in sex workers that you would see a much higher awareness, but it illustrates the fact that even those at highest risk are not all reached," he said. "It is hard to believe that 25 years into the epidemic people still don't know. But that is the truth."

Indian social activists say the stigma attached to HIV drives the epidemic underground in a country where few talk openly about sex.

I.S. Gilada, the head of the People's Health Organization, was among a handful of volunteers who set out a decade and a half ago to raise awareness of the threat.

In recent years, hundreds more volunteer groups have joined the battle. Officials, who once denied the risk posed by the virus, now proclaim their resolve to halt the epidemic.

Despite these efforts, health experts say 80 percent of India's estimated five million HIV carriers are unaware they are infected.

Mr. Gilada says India's biggest challenge is to identify these people. "Our effort should be to reach out to those people," he said. "Otherwise we are trying to manage patients who are already knowing [their status] and we do not have much program for people who do not know, and they do not think they are at risk."

With AIDS already entrenched in the country, health experts say it is not clear the government's efforts will be enough to keep the epidemic from spiraling out of control.