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US Programs in India Make Gains in Battle Against AIDS - 2004-07-06


In India, two high profile Americans are taking on the battle against HIV and AIDS: former president Bill Clinton and software pioneer Bill Gates. Their innovative approaches toward combating the deadly virus have won praise from international health organizations for helping spur the Indian government into action.

The Sanjay Gandhi truck stop on the outskirts of India's capital New Delhi is like a city unto itself. At any given moment, thousands of truckers may be gathered for a few days of rest between cross-country trips.

It is also a battlefield in India's efforts to fight HIV - the virus that causes AIDS.

India's truck drivers are often on the road and away from their families for months at a time. Many visit commercial sex-workers - making truck drivers a group highly susceptible to HIV. That is why truck stops like the Sanjay Gandhi depot are being increasingly targeted for AIDS education.

Here, health care educator Ajmad Ansari from a local group financed by the Indian company, Apollo Tyres, uses a wooden model to demonstrate to a group of curious truckers the proper technique for putting on a condom - which prevents the transmission of HIV during sex.

"People say that condoms break or that they take away the pleasure from sex. It's a misconception that there's no pleasure," says Mr. Ansari. "It's just not true."

Targeting high impact sites like truck stops for AIDS awareness campaigns is one of the programs also embraced by Avahan, the Indian office of the Bill and Melinda Gates Foundation - started by the U.S. software billionaire.

Last year, the Gates Foundation through Avahan pledged $200 million on AIDS prevention in India over the next five years- its biggest grant program in any country.

Avahan's director, Ashok Alexander, is a 17-year veteran of the international business management firm McKinsey and Company. He says that experience comes in handy in the fight against AIDS. "I think most fundamentally what we're trying to do is bring a kind of business solution to a public health problem," he says. "What do I mean by that? Using business concepts like an integrated solution, or market segmentation, or very careful measurement."

The "market segmentation" applied by Avahan involves identifying the most frequented truck stop on the eight thousand kilometers of highway - to educate highly mobile drivers who are a sub-group most likely to spread the AIDS virus.

"What we've tried to do is narrow down that, by identifying 50 major halting points, where the truckers typically stop for hours and days, and there we're bringing a packet of services to them," says Mr. Alexander.

India's National AIDS Control Program estimates there are close to five million HIV positive people in India - which is relatively low compared to nations like South Africa. But health workers warn that the Indian government has a poor infrastructure in place to educate people and treat HIV sufferers, and the infection rate could spiral if action is not taken now.

The Avahan program has won praise from international groups like the United Nations, because its "market segmentation" is more direct. It means it deals with individual states and local non-governmental organizations, or NGO's, rather than the central government. It therefore bypasses a great deal of bureaucracy. Kenneth Wind-Andersen is the U.N. AIDS Country Coordinator.

"What Bill Gates is doing is just the opposite," says Mr. Wind-Andersen. "He's going to the states, working directly with the states, taking collaboration with civic society NGO's and creating a project which is covering some of the main vulnerable groups in India."

India has also caught the attention of another high-profile American, former president Bill Clinton.

The Clinton Foundation AIDS Initiative focuses on providing cheaper anti-retroviral drugs used to prevent HIV sufferers from developing AIDS itself - meaning infected people can live longer.

In November, four Indian pharmaceutical companies signed on to the Clinton Foundation plan - in which they agreed to provide the medicines at a cost of $139 per person a year - down from the market rate of $255. In exchange, those companies get a guarantee of continued drug purchases by the governments that have agreed to participate.

During his most recent visit late last year to India, Mr. Clinton said the affordability of treatment alone could help stem the tide of HIV.

"The incentive to get tested - if you're going to find out you can live a normal life and by taking proper precautions you can prevent the infection of other people - is quite high," he said. "So this should be seen, the medicine should be seen as a very important part of a prevention strategy as well."

The irony is that the Indian government does not participate in the Clinton Foundation plan and so those cheap Indian drugs are going to the Caribbean and Africa, where governments have signed on.

At the time of Mr. Clinton's visit, the Indian government was formulating plans of its own to provide cheap anti-retroviral drugs to six Indian states where HIV is most prevalent. But The U.N.'s Mr. Wind-Andersen says that program did not take shape until Mr. Clinton came to town.

"I wouldn't say it was a coincidence, but it was good timing Bill Clinton came. And he managed, quite quickly, to make a good deal with Indian companies among others to supply drugs for Africa," he says. "It gave also, an incentive for the government to say, "Yes, but now we make drugs available for the international market, but we still haven't had it available for the Indian market. That is a situation we cannot stand for."

Observers say the high profile, big-money projects launched by Mr. Clinton and Mr. and Mrs. Gates ruffled feathers within the Indian government, which had been accustomed to more control over its health care plans. But since then, a new government has taken office, and has pledged to devote more national resources to the fight against HIV and AIDS. To millions of Indians at risk of contracting the deadly virus, the shift in attitude may come just in time.