HIV/AIDS POSES A THREAT TO INDIA: A GLOBAL PERSPECTIVE
Various issues are discussed in the form of questions
and answers in order to emphasize the fact that the views and
opinions presented here are of an individual. Also, some of the
issues were, in fact, raised as questions to me.
What is HIV/AIDS and how
does it spread amongst the people?
HIV, short for Human Immunodeficiency Virus, is a retrovirus that attacks
and destroys a vital component of the human immune system: its host cells
are the CD4 T-lymphocytes, a type of white blood cells. Once the
immune system is effectively destroyed, all sorts of infections
normally kept at bay (called opportunistic infections) take hold and
kill the individual. This final stage, when the immune system is highly
compromised, is called AIDS (Acquired Immune Deficiency Syndrome).
HIV's only known host is the human, and it survives in the bodily
fluids -- blood, semen, vaginal secretions, breast milk. It is, therefore,
transmitted by sex with an infected person, from mother to child
at birth or via breast milk, or by contact with infected blood.
The latter can occur by transfusion of contaminated blood, use of
contaminated needles or surgical instruments, or when sharing
needles as by IV drug users.
Thus, an inadequate/corrupt/uncaring medical-dental establishment
poses a significant risk of infection to all the population irrespective
of whether an individual has risky sexual behavior and/or IV drug usage or not.
HIV is very fragile outside the human body and is easily destroyed
by contact with air, water, soap, etc.. Nevertheless there is
a tiny risk of infection through use of (i)
infected razor blades when visiting barbers, (ii) infected
needles when getting tattoo's, (iii) puncturing of skin with
infected needles during ear, nose piercing.
HIV is a very fragile virus -- its fast spread in any society is,
to a very large extent, facilitated only if there already exists
a breakdown in the educational, social, and political infrastructures
and not just the medical. Unfortunately, since all four play a role,
stopping the spread will require "fixing" the relevant problems in each.
Some of these issues are elaborated on later.
What are the prospects for remission, cure, or vaccine for HIV/AIDS?
So far as we know, almost all people infected with HIV have progressed
to AIDS if they are not being treated with anti-retroviral drugs.
Certain groups of people, called long term non-progressors, offered
a hope for cure and vaccine as their immune system was somehow resisting
the advance to AIDS. Unfortunately, after 15-17 years, they too have
started to suffer from diseases indicative of AIDS. So at present
there is no evidence of remission or escape. We do not have
a cure either -- the very costly treatments using
anti-retroviral (ARV) drugs only keep the disease under control
and it is not yet clear if, in time, even these will fail to protect.
Worse still, these drugs are completely beyond the reach of over 99
percent of the Indian population. Even if the drugs were cheaply available,
their prescription requires very careful monitoring of effectiveness and
toxicity by a specialist, and a very strict schedule of ingestion.
do not exist in India. Lastly, the consensus amongst researchers trying
to find a vaccine is that there is very little hope for a low cost, high
efficacy vaccine in the next 5-10 years and perhaps for much longer. So
prevention is, at present, our only hope.
Having said that current ARV therapy is not a solution to the long
term goal of stopping the spread of HIV/AIDS in developing countries,
it is also equally essential to understand that we absolutely need
these drugs to be available cheaply. There are a number of reasons
for this. As more and more HIV+ patients come into hospitals with
serious opportunistic infections that are not immediately life threatening,
the doctors need the ARV therapy to control HIV so as to speed up the recovery
from the other infections. Otherwise the hospital stay of the patient can
become indefinite, leading to frustration amongst the doctors and misery
for the family. Second,
in cases where the HIV infection is diagnosed very early, ARV therapy
can keep the patient healthy and functional for a much longer period of time
so that they can remain productive and take care of their family. Lastly,
the human race survives best when there is hope, and ARV provides the
best we have to offer at the moment for anyone who does get infected.
Removing hope can lead to severe emotional trauma and I fear will result
in a very high social cost.
If there is no cure or a vaccine in sight, how can the spread be stopped?
Fortunately, the way to stop the spread is completely in our hands if
we have the will. If people abstain from risky sex (unprotected sex
with casual partners whose HIV status is not known) and the
medical-dental community implements very strict control
over blood transfusions and sterilization of instruments, the spread
of HIV/AIDS can be stopped overnight.
In reality both these are
proving very hard to carry out. For example, cheap anonymous sex is one
of the very few pleasures available to the poor, and over time they have
gotten used to the prevalence of sexually transmitted diseases like
syphilis and gonorrhea and know that these can be treated easily. So the
morbidity of a new disease, HIV/AIDS, that is incurable and kills after a
long infectious, but largely asymptomatic, period of years has not
sunk in. Furthermore, risky sex abounds in all socio-political segments
of society. The elaborate call-girl rackets and schemes for willing/unwilling
induction and seduction are so many that one could fill many evenings
narrating them. The tragedy is that while these are considered fun topics
for conversation at social gatherings and the elite are in general very familiar
with these practices, the disastrous consequences of such risky behavior
has not sunk into even this elite.
Changing people's life styles regarding sex is hard in India since
sex is a taboo subject and people don't like to discuss it. Many of the
politicians, policy makers, administrators, senior doctors, industrialists
are over 50 years old. They are not willing to accept that sexual freedom and
experimentation is common amongst today's youth. (Indian youth are, today,
going through their version of the sexual revolution that the US went through
in the 60's. Needless to say, the timing could not have been worse. )
This elite believes that by denying it, they will somehow curb the explosion.
They would like to believe in the existence of a high moral force
that is generated spontaneously and is independent of the reality -- deep
rooted and pervasive corrupt practices,
get what you can as soon as you can attitude, complete lack of care for
anyone outside a small group of relatives and friends, and the lack of
role-models amongst their generation. Since the generation in control
is in denial, it is no surprise that effective dissemination of
information and awareness is proceeding very slowly.
Next, the lack of proper handling of blood and sterilization of instruments
reflects the wide spread conditions of poverty and corruption endemic
in India. One cannot expect the medical community alone to be honest
and free of corruption when the rest of the society is not.
Therefore, to curb the spread of HIV/AIDS and many other diseases like
tuberculosis and hepatitis, we will have to also address issues of poverty,
marginalization of large segments of society, and corruption. Even
issues like social conditions for women, for example eliminating
sexual and physical abuse and providing them with the ability to negotiate
better conditions at home and at work, play a crucial role. The more one
reflects on the issue, the more it becomes clear that in the absence of a cheap
and highly effective vaccine the solution requires re-inventing society.
Given this Herculean task one should rightly ask why suddenly focus on this
latest killer HIV/AIDS when the need to improve the economic, political, and
social conditions in India has been apparent for decades and people are
proceeding at some convenient pace. The reason is that the very rapid spread
of HIV/AIDS we are seeing in India has dramatically reduced the time allowed
unless we are prepared to lose a very significant fraction of the most
productive segment of society. In addition, there will be millions of
victims of contaminated blood and surgical instruments who will get infected
in spite of the best of their precautions. Socio-economic status is not
sufficient to eliminate all the risks for HIV infection.
To bring about the required change in a very short period of time needs
a massive grass-roots movement as we have to educate one billion people
and make them aware of the disease and its tremendous consequences for
the individual and the family. This
requires the status of a top national priority which can only be achieved
by if there is political stability and there is the direct and personal
involvement of the prime-minister.
How serious is the problem today in India?
The truth is that no one really knows exact figures because of
inadequate surveillance and reporting. The latest official government estimate
is 3.5 million at the end of 1998 (for details see NACO Web page
http://www.naco.nic.in/naco/). These estimates are based on a statistical
analyses starting from the number of cases reported by participating
hospitals. The general pattern is that these are underestimates because many
of the afflicted don't seek help as they are too poor or too marginalized.
As a result, the true numbers maybe as high as 10 million. What is even
more scary is that the rate of increase is very high: it could be as
large as 1-2 million per year already with the total number of infected
doubling every 2-3 years. Thus, if unchecked, there could be 100
million people that are HIV+ by the year 2010. A second tragedy is that
due to poor health conditions in India, the mean life after infection
is likely to be only 4-5 years. Thus, my estimate is that hospitals
all over India will soon start to see large numbers of patients daily.
This very disturbing and dangerous situation has already been reached
in the states where the pandemic is more advanced -- Maharastra,
Karnataka, Tamil Naidu, Andhra Pradesh, Manipur, and Mizoram. When asked,
any doctor from Bombay, Bangalore, Chennai or Hyderabad will tell you of the
increasing numbers of infected people, both rural and urban, coming in
every day. In my home city of Ludhiana in Punjab, even private hospitals that were
seeing maybe one AIDS case every few months in 1996 are now seeing, on average,
two cases a week. The mean age of the patients is 25-30 years, and by profession
they are mostly businessmen, servicemen, farmers, and truck drivers.
The third problem is that in most cases the patients are seeking
medical help at very late stages of the infection when they are already
debilitated by a serious opportunistic infection (AIDS). At this stage
they need hospitalization, and over the 10-15 days in which their HIV
status is ascertained and the family comes to grips with the situation,
their hospital bills have zoomed to at least Rs. 50,000 - 100,000.
This sum is significantly greater that the family's savings and assets.
At this point they have no option but to take the patient home to die.
In addition, the family is left in debt which they have no way of paying
back (money lenders are routinely charging 20% interest per month).
Solutions are gut-wrenching -- for example selling off the young
children for sex work, or for bonded labor. Even if the children escape
this gruesome future, they still live a stigmatized life. For example
girls have a hard time getting married. In short HIV/AIDS is
destroying not just individuals but entire families.
Another worrisome trend is the number of people from the armed
services and the police that are showing up. Given the "macho"
complex that is common in these communities, the long periods of time
they spend away from families, and the power of exploitation that the
police have over the poorer commercial sex workers, a high rate of
infections is not unexpected. However, the fact that the lead group
has already advanced to the stage of AIDS implies that this serious
social and political situation is already at our door steps.
Because of the many social, economic, medical, and political
ramifications, stopping the spread of HIV/AIDS should be
considered a national priority. It my opinion it constitutes a
national emergency as it has the potential to create social, economic,
medical, and political chaos throughout the nation, including the
possibility of a collapse.
The current rates of infection, even if one accepts your aggressive
estimate of about 5 million per year who will die in a few years,
are much smaller than the population growth of about 20 million a year.
Since India already is overpopulated, why then do you see HIV/AIDS
as posing a grave risk to the nation?
The largest spread of HIV/AIDS is amongst the most sexually active
who are also the most productive people in the prime of their lives
(age 15 - 50). The mean age of people currently coming to hospitals
is between 25-30 years. Society is, therefore, losing the bread
winners and at the same time having to take care of increasing numbers
of orphans and the elderly. Thus, to consider HIV/AIDS as a form of
population control, an unfortunate suggestion that some people have
made to me, is completely misguided and misinformed. HIV/AIDS causes
a growth in an unproductive sector (orphans) and a depletion in
the most productive. Second, a more important issue is that the
rate of infection is increasing rapidly and may soon overtake the
India has throughout history faced many plagues, famines, and pandemics.
It has survived these situations. So why is HIV/AIDS being given
such special status?
It is true that the human race is very resilient. People will survive,
just as Germany and Japan survived World War II. However, the cost
was very high. They had to restart from scratch, and the survivors
paid a very high price in terms of losing loved ones, watching their
property and assets destroyed. Germany got divided and it took 50
years to recover. The misery of HIV will be greater as people watch
their loved ones die slowly over years and then leave behind children
as orphans and elders without any means of support. I don't believe
that enduring such misery is the way to move ahead, especially since
the well-being of society itself is at risk.
The second issue is medical. HIV/AIDS is the first fatal sexually
transmitted disease in recent times. Historically, society has a very
poor track record in overcoming and eliminating sexually transmitted
diseases. Even the developed nations are struggling to eliminate
gonorrhea, herpes, chlamydia, etc., since sex is a closeted subject.
In spite of the fact that HIV is not easy to transmit (syphilis,
gonorrhea, hepatitis, etc., are 10-100 times more virulent), nevertheless,
we are witnessing an explosive spread of HIV worldwide. In addition, HIV
by attacking and destroying the immune system is allowing the
proliferation of many other opportunistic diseases that are killers.
For example tuberculosis, and especially multi-drug resistant TB, is
being seen in increasing numbers in conjunction with HIV, as are
certain other rare diseases like toxoplasmosis. With modern day global
mobility, these communicable diseases will spread worldwide into the
Lastly, the world is far more interconnected and interdependent now. The
explosion of HIV throughout the developing world could create a panic in
the global economy leading to global economic and political chaos. Note
that four of the regions where the spread of HIV is now exploding are the
countries of the former USSR, India, Pakistan, and China. These regions
have unstable political systems, contested borders, restless citizens,
strong armies, and nuclear weapons. Thus, in my opinion, HIV can
accelerate and spark a very volatile situation.
Why do you think that HIV infection rates will not start decreasing
on their own as people see more deaths around them?
At some point this will happen. However, the long and in many cases
essentially asymptomatic period before the onset of AIDS, and the
ways of spread (sex, blood transfusion, contaminated needles and
surgical instruments) make it very hard to predict when this point will
be reached in the developing and third world countries. For example,
in almost all of Sub-Saharan Africa, including South Africa with its
large infrastructure of medical and educational institutes, 10-26
percent of all adults in the age group 15 - 50 are already infected
and even so the rates of infection are still increasing. While some may argue
that the risk factors in other developing countries are no where as severe
as in Sub-Saharan Africa, I feel that the risk in all of Eastern Europe and
Asia, including south-east Asia, are sufficiently high to create a very
scary situation for the whole world. Even in the most developed countries,
Australia, western Europe, Canada, USA, and Japan, we are no where near
having solved the problem. For example in the US there now are a steady
40,000 - 50,000 new infections a year. Thus, the total burden of the HIV
infected is growing as drugs are keeping people alive longer but cannot
cure them. It is unfortunate that the success of ARV therapy
has lulled us to sleep for the moment.
Since you make the case that the means of spread, sex and contact
with infected blood, are so difficult to control, why do you
think that an education and awareness campaign will have an impact?
The two example we know of amongst the developing world where progress
has been made are Uganda and Thailand. In both these countries the
respective leaders of state, president Yoweri Museveni and prime minister
Anand Panyarachun, personally led the campaign and impressed the
message (behavior change, condom use, sex education, and the need
to remove corrupt practices in all walks of life) on the public
continuously via newspapers, billboards, radio, and TV.
In India, in spite of the efforts of many, overall we are still
in a state of denial. Prime minister A. B. Vajpayee addressed the
National AIDS conference in Delhi on December 12, 1998 and
highlighted the gravity of the situation (the full text of the speech
is available from http://www.nic.in/naco/). This speech was not
even carried by the newspapers. In May 1999, when a parliamentary report
revised the figures from 3-4 Million (PM Dec. 1998) or 5 Million
(UNAIDS) to 8.2 million, there was just a 6 line statement in the Hindu.
The current political instability (6 governments in seven years)
and the war in Kashmir have, unfortunately, diverted the attention
of the politicians. Thus, we have so far failed to mount even the
kind of campaign that was necessary in the much smaller countries,
Thailand and Uganda, to have a positive effect. Until we make such
an all out effort, it is not possible to answer the question how well
even an all out effort will succeed in India. What is nevertheless clear
is that if we don't try, India faces the potential of a collapse under the
burden posed by the current health pandemics of TB, hepatitis,
malaria, and HIV/AIDS.
An example of failure is South Africa. It is a country with an
educational and health infrastructure like India's. Last year UNAIDS
estimated that 13% of all adults (that is 1 in every 7-8 adults) were already
HIV+. In spite of such large numbers President Nelson Mandela, one of
the most visionary leaders of the 20th century, did not publicly speak
on the issue until late 1998, or set in motion an intervention
strategy. The real numbers today could be much higher and are
projected to reach 25% in the next few years. Imagine a country with
one in every 4-5 productive adults already waiting to die in the next
few years, leaving behind millions of children and elderly with no one
to take care of them. We certainly do not want India or any other country
to face a similar disaster.
Inspite of the past, I believe that President Mandela can
still play a major role in spreading awareness. He has such a unique
and commanding stature that were he willing to travel across Sub-Saharan
Africa talking to people and the heads of the various countries,
he would have a tremendous impact. My hope is that he is
somehow convinced to do so.
Why do you think that the direct intervention of the prime minister
There are many reasons I believe this. First, the problem is huge and
its causes have deep roots in society. Only the direct involvement
of the prime minister can send a very clear message to the entire
population, and in particular to the medical establishment and to the
bureaucracy, that this issue has the utmost priority. It came as a
jolt to me during my last two visits to India when many top Indian
Administrative and Foreign Service (IAS and IFS) officials refused to
accept the magnitude of the problem and some went so far as to call it
an American plot to subvert the integrity of India. Second, it will
make available the required financial support within India, mobilize
the political machinery, and draw much more support from the
international funding agencies. Third, in a land where we look up to
our leaders for all the solutions, it will give courage to all
to shed their religious, moral, and social prejudices, and to come
together to fight this scourge. Finally, the ensuing open discussion and
acceptance of the fact that HIV cannot be spread by casual contact
will prevent the panic, fear, and victimization of the marginalized,
which I fear will otherwise result.
Suppose a vaccine becomes available for mass administration as early
as 2002, would the cost of the massive education and awareness program
you are advocating be justified?
The grass-roots education and awareness campaign that I am advocating
aims to provide information on a variety of diseases and not just HIV,
and how to protect oneself against them. Understanding and practicing
prevention will reduce the load on an inadequate health care system and
improve general hygiene. For example, the use of a condom campaign in
Thailand has not only curbed the spread of HIV but reduced the incidence
of syphilis and other STD's from about 30 percent to about 10 percent
already. Second, women bear a much larger burden of sexually
transmitted diseases, and are much less in control of their destiny
in poor countries. Education leading to their ability to attain
better conditions at home, a say in the size of family, and better
employment opportunities will have an impact far beyond the control
of HIV/AIDS. Lastly, I believe that all Indians are already aware that
the circle of corruption will one day jeopardize every citizen's life,
and that we must have the courage to stop corruption. All we need to do
is translate this knowledge into action -- each one of us should start
on our own to work towards the collective good rather than waiting for
others to take the first step. In short, I can say with confidence
that every ruppee we invest into the education and awareness
campaign will be returned a hundredfold. In fact it may be the
difference between a strong and prosperous India and no India.
What do you believe is the risk to Indian Industry?
A large part of the spread of HIV/AIDS is now in the industrial
and agricultural work force, especially the migrant worker. This
labor force is about 200 million strong in India. These workers live
in desperate conditions in slums around industrial areas and often
resort to sex with commercial sex workers, hoping to forget their
misery for a short period. Once infected they carry the disease
back to their family in the villages. A large fraction of cases
we are now seeing in hospitals are HIV+ pregnant wives of
A great saving in designing intervention strategies to educate
the migrant workers would have been possible if the associated
commercial sex workers were localized. One could then have approached
the problem from both ends, i.e., have programs to educate both.
Unfortunately, in addition to the localized brothels in some of the
larger cities, a large fraction of the sex workers are also migratory.
This makes it very hard to locate or identify them. This inability
to reach the sex workers puts additional burden on industries as
they have to assume full responsibility for protecting their workers. In
this regard my investigations suggests that training and developing peer
groups amongst the workers to spread the word is one of the best strategies
available to us. There is a very strong network between the migrant
labor -- even though people from a village may work and live in
different parts of a city, they get together very often, discuss
issues important to them, and have a very strong communal bond.
A consequence of the fact that the infection is diagnosed very
late is that most often both parents are already infected by
this time. Once both parents die as a result of HIV, even
the uninfected children are doomed as they are very often left
without anyone to take care of them, and eventually become victims of
sexual and physical abuse. Worldwide 14 million people have
already died of HIV/AIDS and in addition have left behind
9 million orphans. So HIV/AIDS is killing our present and future
generations of skilled labor force in one go. Lastly, one should not
fool oneself into believing that risky sex is only practiced by the
poor. It is equally prevalent in the highest political,
administrative, industrial, and social circles.
What is the current status of the industrial worker in India?
In my opinion, Indian business is in a state of transition. It is
emerging from the psychology and mentality of a family owned concern
to professional organizations looking at global markets. Only recently
have corporations begun to truly realize that their workers are their
biggest assets. This is much more relevant to small companies where
each worker is crucial and absenteeism causes interruptions in
production. Also, there is a popular delusion that, due to India's
large population, labor is easy to come by. My conversations with many
industrialists in India reveal that this notion is false. It takes
1-4 years to train and gain confidence in a new worker. (What is true is
that there is a surplus of warm bodies, NOT of workers that can
be trained and can become skilled in a reasonable amount of time.) Thus,
retaining their workforce and keeping it healthy should be one of the
foremost priorities of the management. It is this mutual interdependence
between the owner and the worker that I am using as the basis of
my intervention work with industries. Until recently, health care
of the workers was not considered the responsibility of the management.
I am trying to convince them otherwise. Surprisingly the owners/CEO's
have been very quick to recognize this, and that, as the pool of skilled
labor shrinks due to HIV, the survival of their business will be
threatened. The challenge now lies in translating this awareness into
action whereby the owners/management takes responsibility for the
protection and welfare of their workers.
Why are you not concerned that all the publicity and attention you
are advocating be given to HIV/AIDS will scare off foreign
investment and tourism to India?
In my opinion the all out effort I am advocating will actually have
the very opposite effect. HIV/AIDS is a global problem and all
developing nations will have to come up with strategies to curb it.
Foreign investors will pay very close attention to countries that
take the necessary steps quickly and act decisively. Such action will
send a very clear message that India means business and has the
infrastructure and the will to take care of its problems and deliver
the goods. At this point HIV prevalence in India is still relatively
small; as a percentage of the total population it is about one
percent. Foreign investment and tourism will therefore not be
affected in the short run, however, if the current growth patterns
in the spread of HIV continue for even a few more years, the
situation will be very different and we may see foreigners and
foreign capital staying away from India.
There are additional benefits to the educational and awareness
campaign. For example, if industries start taking care of their
workers and make them feel a part of the team, productivity and
quality of product will improve. This will invite more and not less
investment. Considerations of such correlated benefits make me say
with confidence that any investment we make will be returned a
Why is it urgent to start a full scale campaign right away?
The solution to health pandemics lies in the behavioral change
of a very diverse and multi-faceted population of one billion people.
Even in much smaller countries with a far more homogeneous
populations like Thailand and Uganda, it took 5-10 years after
the start of the full scale campaign to show definite reversal
in the rise in the rate of infections. So, even if we start today,
we are very likely looking at 100 million or more infections, largely
in the most productive segment of society (mean age 25-30 years) before
we see a definite turnaround. Any business person, analyzing the
situation from a purely financial point of view will, I believe,
come to the same conclusion: there is a need for immediate and
all out action as any delays will prove to be increasingly more
The picture you paint is very grim. It certainly calls for a very
large effort by all Indians in addition to the actions of the
government to change the conditions that give rise to such health
pandemics. The question that I hope every reader is asking
by now is what can and should an individual (including NRI's) do?
Let me answer this question in two parts. First, I would like to
outline what I am doing and then comment on what others can do.
It is very important to understand from the very outset that
re-inventing society is not going to be at all easy. Also, the
magnitude of the problem is astronomical. One has to have a grand
vision but be willing to live with small incremental steps. Influencing
even a dozen people and bringing a change in their lives is a worthy
cause and something anyone should be proud of. Aiming too far too
soon can lead to disappointment, frustration and cynicism. We cannot
I believe that stopping the spread will require both a grass-roots
movement and direct involvement of the Prime Minister. With respect
to the grass-roots movement I am pursuing, through lectures and forming
core groups, involvement of schools, colleges, hospitals and industry in
India. The real work is being done by the local organizations, I am just a
motivator. On the government front I am trying to convince as many
friends and colleagues, who now are senior bureaucrats, that the health
pandemics in India are very serious and pose a very real threat to
stability. Hopefully, persistence, time, and delivery of the same
message from many concerned activists, will result in the message
reaching the PM, convincing him of the urgency, and precipitating action.
Lastly, to reach school and college students and educate them on
social issues, Vasant Valley School, New Delhi, and I are developing
a non-credit course on Health, Environment, and Sexuality. The goal is
to introduce these topics gradually, starting in the nursery and sustaining
and developing them through the twelfth grade. This information based
course will subsequently be made available, free, to other schools and
colleges. It will also be available on a CD (or through the WEB where
internet access is available) to any individual with a Personal Computer.
They can access it and play with it just like a computer learning game.
The basis for prevention is education, spreading awareness, and changing
social conditions that lead to conditions of poverty and destitution. This
requires dedicated knowledgeable people and money, of which the first
are, in my experience, in much shorter supply. The direct
participation of people in intervention and awareness campaigns
will require that they first educate themselves on particular
aspects of the medical, social, political, and economic aspects of the
problem, and then work tirelessly to bring about the needed changes in
life-styles. NRI's to be fully effective may have to make frequent trips
to India, find a "home base" for their activities in India, and build an
organization there to sustain the effort. On the other hand, anyone can,
by repeated exchanges of telephone calls, e-mails, and letters,
communicate the urgency of the situation to their relatives, friends
and associates in India. Hopefully some of them will become actively
involved and the NRI's can then join in their efforts. Another approach
is that there already are a large, but certainly not large enough, number
of very good and dedicated people who have committed their lives to
improving conditions in India and have a proven track record. These
individuals and NGO's are struggling because of a lack of funds. It
is relatively easy to identify these organizations and support them.
The intellectuals, academics, professionals (especially the
medical community), and industrialists have a very critical role to
play. Their collective voice provides a guidance to politics.
It may be very possible that the PM is acutely aware of the potential
for catastrophe posed by HIV/AIDS, and yet may not be willing to take
the lead and maintain personal involvement in the intervention campaign.
He may have been warned of adverse political fallout due to the taboo
against public discussion of sex in India, or he may not know how to
proceed effectively. Through our writing in newspapers, discussions
in public forums, conferences, advertisements in newspapers and on TV,
we can create a very strong base of support for the PM (moral,
intellectual, and political) that allows him to take the
appropriate and urgently needed action with conviction and strength.
In short, we, trained professionals, must assume responsibility for
precipitating action by our commitment of time and resources.
My plea to the NRI's is that only by preserving a great nation can
we keep alive the traditions and values of our parents and have
something to offer to our children in terms of a heritage. India
will continue to be a great place to visit and explore, its people
ever willing to renew the bonds of love and affection, provided we
can help it make the transition from poverty, disease, environmental
degradation, and social and political inequalities to the economic
and cultural giant we wish it to be.
For further information on HIV/AIDS and if you wish to explore ways
in which you can help I can be reached by e-mail at
Links to information on HIV/AIDS and a summary of my work can be
obtained from the web page