The World Bank has warned that India and other South Asian nations could be devastated by the AIDS epidemic like Africa if the political leadership does not tackle the crisis swiftly. The warning comes as the disease spills over from high-risk groups into the general population, and from urban to rural areas. India's HIV cases have increased 10-fold over the past decade, and it now has the second largest number of cases after South Africa.
Thirty-three-year-old Padmaja has been living with HIV for almost six years in the southern Indian city of Chennai. She says her husband, a bank employee selected by her parents, infected her. "Initially I also felt very bad. How it came? But my husband revealed everything to me, he had some extra-marital relationship then only he got this infection."
Padmaja is among the growing number of Indian women infected with HIV by their husbands. They usually discover their condition during routine pregnancy testing.
Meenakshi Datta Ghosh is project director of the government's National AIDS Control Agency. She says health officials are seeing more women - traditionally considered a low-risk group - getting infected with the AIDS virus.
"We used to believe that for every eight men getting the infection maybe one woman will get it. But now we believe that is not so," says Mrs. Ghosh. "For every eight men getting this thing [HIV] maybe three women will be getting it."
Suniti Solomon diagnosed India's first AIDS cases among prostitutes in 1985 in Chennai, and now runs one of the country's best known AIDS care centers. She says the profile of her patients has changed dramatically and is no longer confined to high-risk groups such as homosexuals, long-haul truck drivers who use prostitutes, sex workers and drug users. "Today we have people from all strata of society, we have doctors, lawyers, housewives," she says. "Twenty-two percent of women I am taking care of are housewives who have a single partner."
Health experts warn this is a turning point because the disease becomes harder to control once it spreads from high-risk groups to the general population.
Studies so far suggest this spread may have occurred only in the six Indian states where the HIV infection rate is far higher than the national average of less than one percent. Across Tamil Nadu, Andhra Pradesh, Maharashtra, Karnataka, Manipur and Nagaland the virus has effected nearly three percent of the adult population. These states generally have better health care, better education and it is possible that health records are maintained better here than in other states - accounting for more accurate albeit higher numbers.
The government estimates India has about four and a half million cases of HIV - making it the nation with the second highest total number of infections. But many experts believe the actual number is higher - as tens of thousands of HIV sufferers may live in villages without adequate health care and go unreported.
In rural regions, public ignorance is fueling the spread of the disease, brought to village homes by India's huge population of migrant workers.
Ishwarprasada Gilada began a program to prevent AIDS among Bombay's sex workers 14 years ago. He says the disease is spreading in rural areas where 70 percent of the population lives. "We can see that the spread is much more rural. Rural people think they are not at risk because they are living in a very secluded atmosphere," he says. "While the interaction between sexual activity in urban and rural is very common."
India's government acknowledges that AIDS prevention programs have been slow to reach the country's 650,000 rural villages. A survey by U.N. AIDS found that people living in villages are much less likely to use a condom compared to those in cities. Mrs. Ghosh says the National AIDS Control Agency is moving aggressively to change that. "We have tried and attempted very hard during the past two years to bridge this gap by using mass media, television and community radio? and it is incredible how awareness levels have improved over the past 12 to 18 months," she says.
The government says it is confident about breaking the transmission of HIV, and says eventually the number of AIDS victims will begin to come down.
Experts are not so sure. They say India stands at the crossroads. Stepping up successful prevention programs will be the key in keeping prevalence low. Otherwise the country could find itself coping with an epidemic.