The Other AIDS Crisis.(India)(Statistical Data Included)

3,860,000: THE NUMBER OF MEN, WOMEN AND CHILDREN IN INDIA CARRYING THE AIDS VIRUS AT THE ENDOF 2000, ACCORDING TO THE WORLD HEALTH ORGANIZATION'S LATEST FIGURES. IN SOUTH AFRICA, 4.2 MILLION PEOPLE WERE INFECTED, AND IN BOTSWANA, 190,000. INDIA IS IN DANGER OF SUFFERING AFRICA'S FATE IF THE EPIDEMIC IS NOT DEALT WITH QUICKLY

BY IAN MACKINNON AND ADAM PIORE

AIDS is not new to India. For many years the disease was confined mostly to drug users and prostitutes, which made it easier for the rest of the country to pretend it didn't exist. And with a raging tuberculosis epidemic and periodic outbreaks of the bubonic plague, there's been no shortage of health crises. But while nobody was looking, AIDS crept into the general population. Currently 0.7 percent of all adults are thought to carry the virus; health officials consider 1 percent an epidemic. Now India is at a crossroads. Even the most favorable prospect is downright chilling. Public-health officials are happy to contemplate a mere sixfold increase in infections by 2004-- about 20 million adults. The alternative is even grimmer. If infections are allowed to climb beyond 5 percent of the adult population, scientists believe the chances of keeping the disease from greatly accelerating, at the cost of millions of lives, would be slim. India, in other words, is teetering on the brink of becoming another sub- Saharan Africa. "It's like a fire," says Dr. Salim Habayeb, the World Bank's lead public-health specialist for South Asia. "In the beginning, it's easy to control because you can go to the source. We are trying to put out the fire before it is too late."

But what if society keeps that source under wraps? India may be the land of the Kama Sutra, but sex is not a topic for polite conversation. Public-health officials have long despaired of this taboo because it makes the task of raising the public's awareness of sexually transmitted diseases all the more difficult. Some swimming-pool owners maintain separate hours for women and men. Marriages are often arranged. And sex education is virtually nonexistent. But in the big cities, in truck stops that dot the country and in towns where migrant laborers toil far away from their families, an underworld of illicit sex supports 2 million to 5 million prostitutes. Most Indians prefer to ignore it. So when the first AIDS case surfaced in Chennai (formerly Madras) in 1986, the government argued that AIDS was a Western disease that wouldn't affect their uniquely moral society.

It was a big mistake. Insidiously, the disease spread into high-risk populations--prostitutes, IV drug users, patients with sexually transmitted diseases. It spread from brothel to brothel, through the blood supply and shared needles. It spread from the cities to the country. Eventually it spread to innocent women like Manisha Talwar. Her in-laws banished her and her 2-year-old son to the streets after the death of her husband. She found out five months later that he had died of AIDS--and had passed it on to her and her son, Rajan (not their real names). The in-laws had hidden not only her husband's illness from her but also the results of her own blood test, which showed positive for HIV. "I felt as if a mountain had fallen on my shoulders," says the tiny, dark-eyed woman. "I cursed my husband. If he knew he had AIDS, he had no business ruining my life and his child's."

There were warnings of the epidemic to come. In the region of Manipur on the Burmese border, the number of HIV-positive drug users rose from 5 percent to 50 percent during a two-year period in the late 1980s. "Back then I barely knew anything about HIV," says Tuanz, a former addict from the region who is HIV-positive. "By the time we knew about AIDS it was too late for precautions." In Mumbai (Bombay), nearly 40 percent of the city's prostitutes were infected with the virus by 1991. In southern Tamil Nadu province in 1992, tests revealed that only one quarter of blood supplies were tested for the virus, and that 15 percent of local cases reported were caused by contaminated blood.

That year the government began accepting aid from abroad. The World Health Organization and the U.S. Centers for Disease Control helped design a program to combat the epidemic, and the World Bank contributed $85 ...