Spread of AIDS to Asia

India Seen as Ground Zero In Spread of AIDS to Asia

Prof K.V. Rao
Thu, 11 Sep 1997 14:32:49 -0400 (EDT)

WP 08/17 India Seen as Ground Zero In Spread of AIDS to Asia
By John Ward Anderson
Washington Post Foreign Service

CALCUTTA Mohammed Israel has been a truck driver for 2 1/2 years, ferrying loads across India and visiting four to five prostitutes a week to satisfy his voracious appetite for sex — created, he says, by the hot, spicy food served in roadside restaurants. He has never used a condom, and he has never heard of AIDS. Truckers like Israel are an important catalyst of the rapid spread of AIDS, carrying the HIV virus that causes the deadly disease along India’s highways from urban red-light districts to small-town flophouses to their family homes in remote rural villages. A battery of recent surveys of truckers in and around Calcutta found that more than 5 percent of the drivers had the HIV virus, more than 90 percent visited at least one prostitute a week, and 68 percent never used a condom.

But it is not just truckers who are uninformed about AIDS and HIV. In a survey of 57 doctors in Bangalore — often described as India’s most technologically advanced city — 25 percent said HIV could be spread by casual contact, 35 percent said HIV patients should be denied first aid, and 81 percent believed that a syringe could be reused if the needle were changed.

Such ignorance has helped make India ground zero in the newest phase of the global AIDS epidemic, which has killed 3 million people since the late 1970s. By some estimates, India now has more HIV carriers than any other nation, propelling South and Southeast Asia to a gruesome milestone: For the first time, more people will contract HIV in Asia this year than in Africa, the world’s AIDS hot spot, where entire nations are being ravaged by the sickness. “Clearly, the center of gravity of the world’s AIDS epidemic is moving rapidly toward Asia,” Columbia University economist and AIDS specialist David Bloom said in a recent speech. “Many experts now believe that India will soon have the unfortunate distinction of being the AIDS capital of the world.” The epidemic here comes as India is trying to integrate itself into world markets with economic reforms that are creating huge social changes, ushering in better transportation and quicker exchanges of goods and services that could contribute to the spread of AIDS, making projections about the disease daunting.

There are about 80,000 AIDS cases in India and 1.5 million people infected with HIV, according to recent statistics from the World Health Organization (WHO) and the Indian government. By the year 2000, experts predict, 1 million people will have AIDS in India and 5 million will be HIV-positive. And, if trends hold, India could have as many as 30 million people with HIV by the year 2010 — about 1 1/2 times today’s worldwide total. “If the pattern of an expanding HIV epidemic that has been observed in other parts of the world continues to occur in India, the consequences for this country of 858 million people will be catastrophic,” said a recent article in Medicine magazine. “The HIV/AIDS epidemic in India now threatens to undermine the considerable achievements in public health made over the past 60 years,” when life expectancy in India more than doubled and the infant mortality rate was more than halved, the story said.

It generally takes about 10 years for HIV to turn into AIDS, for which there is no cure and no vaccine. There have been about 4.5 million AIDS cases since the early 1970s, and 13 million to 14 million current HIV cases globally, according to WHO. Nearly two-thirds of all the current HIV cases are in Africa. AIDS came late to Asia — about 10 years after it first began ravaging the Americas, Europe and Africa. Now, as the spread of the disease in those areas is leveling off or declining, AIDS is charging full-throttle into Asia, an underdeveloped region with an under-educated populace, representing more than half the world’s population.

If the disease spreads here the way it spread in Africa — and experts believe it will, given similarities such as high illiteracy, slow government response, discrimination against women and sexual promiscuity — tens of millions of adults could die, creating millions of orphans and overwhelming government health facilities and social services. Currently, only 0.2 percent of India’s population has HIV or AIDS, while in the worst-hit countries of Africa, almost 20 percent of the adult population is infected.

Unlike the United States and other developed Western countries, where the disease initially was spread primarily through homosexual contact, AIDS is spreading in India primarily through heterosexual contact, as was the experience in Africa. India also has a sizable population of intravenous drug users, like the Western countries, and a network of professional blood donors, leading to the spread of AIDS between people who share needles or to those who receive contaminated blood. India, then, is under assault from a multitude of threats. In the far northeast state of Manipur, where India borders a notorious Southeast Asia heroin region called the Golden Triangle, the first HIV carrier was identified in October 1989, but the most recent survey found that 85 percent of the intravenous drug users tested were HIV-positive.

In Bombay, India’s financial capital, 53 percent of the city’s estimated 80,000 prostitutes had HIV in 1993, compared with 1.6 percent in 1988. The prostitutes average four clients per day, surveys show. About 30 percent of India’s annual requirement for blood comes from paid blood donors, but much of the blood is not adequately screened because of a lack of equipment or high costs. The Indian Red Cross recently supplied HIV-infected blood to 10 hospitals in Bombay, where a 1992 study by the Indian Health Organization found that 86 percent of commercial blood donors surveyed were infected with HIV.

As experts urge India to get on to a war footing — the annual AIDS budget is about $20 million, or slightly more than 2 cents per person — the country is facing the same problems that other developing nations confronted in the early phase of the epidemic: Because AIDS generally has a roughly 10-year incubation period during which no symptoms are apparent, the effects of the disease in India are still largely hidden, making it difficult for politicians to justify large budget outlays when other killer diseases, such as malaria, typhoid and hepatitis, are rampant. And with a 50 percent illiteracy rate, health workers spend much of their time trying to debunk myths and to correct misinformation.

More than 70 percent of the rural health practitioners surveyed last year in the state of Maharashtra, for instance, believed that AIDS could be transmitted by mosquitoes and could be cured if diagnosed early enough. The Indian Parliament’s committee on human resources blasted the World Bank 18 months ago for its “totally lopsided” anti-AIDS funding, arguing that more money should be spent on research into plants and herbs that might cure the disease. The education process is slow, but it is having an impact in some areas.

An intensive AIDS awareness program in Calcutta’s biggest red-light district is credited with keeping the spread of HIV in check — only 1 percent of the prostitutes there are infected with the disease — while it is raging out of control in most other urban sex districts. Another program that officials hope will slow the spread of AIDS is designed to educate India’s long-distance truck drivers and their assistants. Studies in Africa showed that AIDS often spread along migration and transportation routes — particularly national highways — carried by truckers, soldiers, miners, construction workers and young men moving from rural to urban areas in search of better-paying jobs.

Truckers are particularly important, according to As\ha Rao of the Bhoruka Research Center for Hematology and Blood Transfusion, which runs a trucker education program, “because they are the link between the general population and the high-risk groups,” such as prostitutes. While Rao’s studies have found that about 5 percent of the truckers in the northeastern part of the country are HIV-positive, the British Overseas Development Agency reported earlier this year that 25 percent of the truckers it surveyed in the southern state of Tamil Nadu were infected with the virus.

At a clinic run by the Bhoruka Research Center in a seedy shed at the Port of Calcutta, the busy dock area of India’s second-largest city, few of the two dozen truckers had heard of AIDS, and none could explain how a person gets it. Only one of the truckers knew that condoms can offer protection against sexually transmitted diseases, in addition to preventing pregnancies. “We have to educate these people,” said B. Bhowmik, the personnel manager of a factory that employs many truckers. “They are away from their wives for months, and this is the easiest pleasure, but first they become the victims in one place, and then they become the carriers.”