AIDS in India: A Case of Denial

EYE ON ASIA:
By Bruce Einhorn

Richard Holbrooke, head of the Global Business Coalition on
HIV/AIDS, says the country tops his list of nations not doing enough
to fight the disease


At the annual World Economic Forum meeting last week in Davos,
Switzerland, the rise of India was at the top of the agenda. Proud
to show off its development as one of the world's top outsourcing
destinations, the New Delhi government offered all sorts of Indian
goodies to visitors (see BW Online, 1/30/06, "Selling India Inc. at
Davos").

The country's political and business leaders have good reason to
show off, thanks to innovative local companies like Infosys
Technologies (INFY ) and Wipro (WIT ), as well as the influx of
multinationals that are launching or expanding their Indian
operations. The latest example: Dell (DELL ) on Jan. 30 announced
that it would be hiring 5,000 more people in India over the next two
years, bringing its total Indian workforce to 15,000.

Richard Holbrooke, the former Clinton Administration ambassador to
the U.N., isn't joining the India cheerleading squad. The outspoken
diplomat is currently chief executive and president of the Global
Business Coalition on HIV/AIDS, a nongovernment organization that
U.N. Secretary General Kofi Annan asked him to lead. At Davos,
Holbrooke's GBC made headlines by teaming up with U2 star Bono to
launch a new initiative, with such companies as Nike (NKE ) and
American Express (AXP ), to help raise funds for AIDS work in Africa
(see BW Online, 1/27/06, "For Bono, Star Power with Purpose").
Outside of Africa, the country with the most serious AIDS problem is
India, which has more than 5 million people with HIV or AIDS.

HIGH-CLASS DENIAL. Holbrooke, who spoke to me and my colleague,
Frederik Balfour, in Hong Kong last month, doesn't mince words when
discussing the frustration of combating AIDS in India and other
countries. "The Indians will tell you over and over again that what
happened in Africa can't happen in India. And that's just bull," he
said. "Here's a country with a billion people spending about $5 per
capita on health right now -- and reusing contaminated needles
continually" (see BW Online, 12/2/05, "Asia Owns Up to AIDS,
Slowly").

He blamed India's denial on the upper-class males among the
country's leaders, who spoke of "cultural differences" that make it
difficult to talk about condoms or promote widespread testing. Those
subjects, the leaders claimed, brought up awful memories of Indira
Gandhi's draconian, forced-sterilization population-control policies
of the 1970s.

The situation was totally different situation in a slum Holbrooke
later visited, he recalled. "We sat down on the mats with 40 or 50
women from the community. Then some teenage boys and girls [came]."
Quickly, the conversation turned to sex and getting men to use
condoms. Holbrooke was impressed with how relaxed they seemed,
compared with the higher-class Indians he had spoken with
earlier. "It was totally different -- the [young people] laughed and
joked," he told us. "I sat there thinking to myself what horseshit
we were hearing at the hotel."

CHINESE AGGRESSION. For Holbrooke, the contrast between India and
the other Asian giant, China, is striking. The way that the Chinese
government is tackling its HIV/AIDS problem has been one of the few
bright points in the struggle. "China is making progress," he said.
And while China's government is capable of being less than
forthcoming about the disease, Holbrooke no longer considers it to
be in denial. "Last March, in my gut, I removed it from that list,"
he said.

The latest news from China seems to support Holbrooke's view. Around
the same time that the world's luminaries were gathering in the
Swiss Alps, the top Chinese government official for AIDS, Vice-
Minister of Health Wang Longde, announced that 200 Chinese people
were infected with HIV every day. According to Wang, the total
number of HIV/AIDS patients in China -- some 650,000 -- is actually
lower than previously thought: The official estimate had been
840,000.

That's a hard number to verify: Given outsiders' difficulty
collecting such sensitive data in China, and Beijing's history
covering up health problems -- from SARS to HIV -- there's good
reason to be suspicious. Still, in the past few years, the Chinese
government has been much more aggressive in facing up to its AIDS
problem, encouraging nongovernment organizations like the GBC and
the Clinton Foundation to enter the country and work to fight the
virus.

"THE REAL WEAK LINK." The disparity between India and China
couldn't be greater, according to Holbrooke. While China is off his
list of countries in denial, "India is at the top of the list," he
asserted. And Indians aren't alone on Holbrooke's list. He also
voiced frustration at officials who claim that the world is making
progress in stopping the spread of HIV/AIDS.

Dec. 1 was the 18th World Aids Day. "On every one of the World Aids
Days, the number of people who are HIV-positive has increased, right
or wrong?" Holbrooke asked rhetorically. The answer, of course, is
yes. "Without question," he emphasized.

Officials should pay more attention to stopping the spread of the
virus by increasing testing, he argued, so people with HIV won't
infect others. "Are we just going to go on and spend more and more
money treating people, and not addressing the real weak link --
which is prevention?" he asked. He characterized the reluctance to
test as "the most massive breakdown of rational medical
application."

Calling for testing can be controversial, though, something
Holbrooke has admitted. "My critics say that there's no proof that
knowing your status reduces the rate of prevalence," Holbrooke
said. "And to which I can only reply, 'you're right, there's no
proof. But every once in a while, common sense ought to prevail.'"

OFFICIAL PRODDING. Meanwhile, the fight continues, with some
officials trying to look on the bright side by pointing out signs of
progress. That's another thing that angers Holbrooke. "How can you
call it progress when every year more people die than go on
treatment? And every year the number gets bigger, and every year we
have to spend more money, and every year more people are infected.
You call that progress? I call it the road to the worst health
crisis in recorded human history," he said.

It's understandable that some people want to publicize that their
groups are making some progress, and that the situation isn't
completely hopeless. Likewise, it's fine for India's top leaders to
hobnob with the elite at Davos and promote India as a 21st-century
economic power. But AIDS already has devastated lives and economies
in Africa. It's good to have someone like Dick Holbrooke around to
prod officials in India and elsewhere to start doing a lot more to
ensure that the devastation doesn't spread further.

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