When the President of the United States makes the global AIDS
epidemic the first foreign policy issue on the agenda of his 2003
State of the Union address, and India's Prime Minister Atal Bihari
Vajpayee calls for an "effective and undelayed response from
all sections of society" to the rising number of Indians
with H.I.V. at India's first-ever National Convention of Elected
Representatives on HIV/AIDS at Vigyan Bhawan, New Delhi on July
26-27, 2003, there is hope for millions around the world who suffer
daily with HIV/AIDS. The convention was organized by Oscar Fernandes,
Ministry of Health and Family Welfare, the National AIDS Control
Organization (NACO) and UNAIDS.
The Secretary-General of the United Nations, Kofi Annan, addressed
the New Delhi gathering via video message:
"As elected representatives
of the world's largest democracy, you can show leadership in many
ways. By making laws, by passing budgets, by deciding policies,"
he said, adding "All of us can draw inspiration from Mahatma
Gandhi, who fought stigma and discrimination against those living
with leprosy. Today, our challenge is the fight against stigma
related to HIV/AIDS."
More than 1000 politicians from around India, including lawmakers,
senior central and state officials, AIDS workers, mayors and local
leaders attended the two-day conference.
"Never before, in any nation of the world, has there been
such a large and committed gathering of leaders from every level
of decision-making, dedicated to the common cause of fighting
AIDS," said Dr. Peter Piot, Executive Director of UNAIDS
and Asst. Secretary General of the United Nations, the UN's top
AIDS official, who attended the convention. "Today, this
National Convention takes the commitment of Indian leadership
against AIDS one step further. It marks the transition to a full-scale
response taking leadership to every corner of the nation, in the
largest democracy in the world. The global AIDS epidemic is already
the most devastating humanity has ever faced, but even so, we
are in the early stages," he said.
Dr. Piot offered India a positive message: "India already
has the resources available to turn the epidemic back, because
the most important resource is leadership. The Parliaments, legislative
assemblies, governments, municipal corporations and Zilla Parishads
that you collectively represent, possess the power to halt HIV
in its tracks."
"H.I.V./AIDS is not only a grave global challenge, it is
equally a national concern," said Mr. Vajpayee, whose speech
came a day after the government of India announced that the number
of people in India with H.I.V., the virus that causes AIDS, had
surged to 4.58 million people from 3.97 million since 2001, narrowing
the gap with South Africa, which currently has the largest H.I.V.-positive
population in the world at 5 million.
On July 27, 2003, a glorious Sunday morning in New York, it was
heartening to read "Indian Premier Urges Major Push on AIDS"
in The New York Times. At last, the assault on the HIV/AIDS
virus had begun at the highest level of world leadership and in
the media, both crucial players in the future of the epidemic:
"The media can save lives," said Dr. Piot.
There has been a noticeable increase in AIDS-related editorials
and programming in the media recently. In June, the Bill and Melinda
Gates Foundation sponsored Rory Kennedy's "Pandemic/Facing
Aids" which aired on HBO (available on HBO On Demand) featuring
the toll the epidemic is taking in five very different countries,
including India. In July, Senator (Dr.) Bill Frist, Senate Majority
Leader, spoke candidly on PBS about his commitment to the cause
of HIV/AIDS; he has visited Africa numerous times and operated
on Africans with AIDS who could not afford the cost of surgery.
Mr. Frist stressed the necessity of a solid healthcare infrastructure
to implement the anti-retrovirals successfully in Africa and in
other developing nations. ( www.pbs.org )
Bill Frist has worked tirelessly for years to facilitate the $15
billion that the President has promised to Africa, the Carribbean
and Haiti over the next 5 years. Whenever he has had the President's
attention, Dr. Frist, who is a firm believer in saving lives,
has taken every opportunity to push forward the global AIDS agenda,
as have Secretary of State Colin Powell and Condaleeza Rice.
The devastation that HIV/AIDS causes without the mercy of anti-retroviral
medications is a horror outside the realm of experience of those
fortunate enough to live in developed nations. In President Vajpayee's
India of 1.2 billion, the World Bank has predicted that there
will be 35 million infected with HIV/AIDS by 2005. If this is
not prevented, it will far exceed the tragedy we are now witnessing
in Africa, with 25 million infected - which is hard to imagine.
"Many of those being infected are from the most vulnerable
people in society: the poorest, sex workers, injecting drug users,
men who have sex with men but increasingly many are also are middle
class youth and women whose only `risk' for HIV is sex with their
husband," warns Mr. Piot.
India's Premier Mr.Vajpayee said "It is obvious that political
parties in our country need to pay far greater attention to issues
of health and care than they do now" and he expressed regret
that in India, public health issues did not normally find a place
on the nation's political agenda: "This is not so in other
democracies, where sometimes even elections are won or lost on
the basis of health issues."
The United Nations believes
public ignorance is encouraging the spread of HIV/AIDS in India,
and that the government has been slow to tackle the problem in
part due to conservatives who oppose prevention methods that could
be interpreted as promoting promiscuity. Attitudes are changing
as the epidemic spreads like wildfire through India's vast population.
A staggering 85% of infections are heterosexually transmitted,
which together with intravenous drug injections are the primary
infection routes of the virus.
"Just as legislative, constitutionally-backed protection
has helped to bring down the historic barriers around untouchability,
so too, people living with HIV must be afforded protection and
dignity and I hope such protection will be a prominent part of
the national HIV/AIDS legislation being devised," said Dr.
Tragically, 50% of global HIV/AIDS infections are amongst women,
(most of them "set up" to acquire the virus through
no fault of their own), mainly in the developing nations. Mothers
can transmit the virus to their unborn children and also transmit
it to newborns through breast milk, the food of choice for the
poor, as cost is a factor.
Gender discrimination, inequality and the vulnerability of women
are a driving force behind the AIDS epidemic in developing nations,
including India. "An effective response to AIDS can only
be one that strongly incorporates a gender perspective,"
said Dr. Piot. For the prevention of sexual transmission of HIV
he advised a combination of approaches: abstinence, being faithful
and condom use. At the conference he said the stigma associated
with AIDS made it tougher to handle in India, where 40% of people
infected with H.I.V. were women.
Secretary General Kofi Annan supports this view:
"It would be a terrible
mistake to see AIDS as a problem affecting only the poor, or to
dismiss those infected with HIV as immoral. For hundreds of thousands
of HIV-positive Indian women, the only infection risk they ran
was to have sex with their husbands. India still has the chance
to curb the epidemic before it spins out of control by stepping
up prevention efforts, and by ensuring that care and antiretroviral
treatment go to those who need it."
"Young people are especially
vulnerable and we must help them to make the right decisions in
life. Let us not forget that for the decades to come, India will
have the largest cohort of adolescents in its history. We have
learned in the last two decades that people, particularly young
people, change their behavior and behave responsibly when they
are given choices and not simply lessons based on morality,"
Amongst those gathered at the conference in New Delhi was Ms.
Nafisa Ali, founder and Chairperson of the NGO "Action India,"
a citizens motivated Trust. A former Ms. India and a well-known
movie star in a land of ardent Bollywood fans, Ms. Ali has been
advocating for people living with HIV/AIDS for years, fearful
of the dangers the disease poses for the future of India, especially
the young(See The City Review article at http://www.thecityreview.com/aids3.htm.)
Infected citizens who found their way to "Action India's"
HIV Clinic in Central New Delhi were living proof that there was
an urgent need for small NGO clinics for the desperate to turn
to. The stigma associated with the disease keeps many more hiding
in secrecy fearful of the retribution of moralistic attitudes
and discrimination. Typically, the infected are ostracized and
isolated. The taboo surrounding HIV/AIDS in India is a dangerous
deterrent to containing the spread of the lethal virus. The subject
is avoided or not discussed at all way it is in the US within
families and in schools.
In August, 2001, Ms. Ali
invited this reporter to the village of Rajokri on the outskirts
of New Delhi, near Indira Gandhi International Airport. She said
she had committed herself to establishing the first AIDS care
center in New Delhi, and that she hoped the government of India
would help her by leasing the property we were about to visit:
"I can try and raise funds to care for the patients, but
I cannot afford rent as well," she explained as we drove
through the dense throng of humanity mingled with bicycles, mini-buses,
bullock carts and bumper-to-bumper cars. The entire scene made
me marvel at her optimism and energy. Acquiring a building for
an AIDS shelter in the midst of the bedlam, heat and blaring horns
sounded like a dream, but she gave me a dazzling smile as if to
say, "You just wait and see." She also spoke of the
support of the government in helping local villagers and elders
to understand rather than stigmatize the infected.
There was ample time to hear Ms. Ali's concerns as the throng
gave way to the quieter suburbs: gender discrimination, mother-to-child
transmission of AIDS, the human rights aspect of denying anti-retroviral
medications and operations to the infected, and stigmas over and
over again. "It makes them feel like outcasts" she said
" and they die alone, suffering."
It was a photograph of a prostitute taken by Ms. Ali that caught
the attention of this reporter a year earlier, included with a
note amongst literature on Action India's projects. Without anti-retroviral
medications to combat her HIV/AIDS infection, her physical condition
was unlike any I had seen, and I have seen dire poverty and illness.
I never turned away from HIV/AIDS again because of the power of
that single image. It is my belief that anyone who saw the photo
would do the same.
Ms. Ali said the prostitute asked her to take the photograph "to
help others, so this does not happen to them" she told Ms.
Ali. Condoms were not required in the sex trade that earned her
a living, and Ms. Ali said it was the plight of this woman that
made her vow to commit herself to the cause of people living with
HIV/AIDS with relentless determination. This woman had not received
the chance, the education or the support in life to prevent the
indignities that the ravages of the world's most vicious virus
wrought upon her body. She died shunned and stigmatized, as if
her entire fate was her fault.
Condom sales have actually dropped in India in the last year according
to a BBC World report (http://news.bbc.co.uk/2/hisouth_asia/3067325.stm) and continue to fall. One of the
hotspots for transmission of the disease is in Bombay, where nearly
6,000 prostututes and sex workers live in just one red-light area.
Many are struggling to survive and do not consider the condom
a priority. Living in utter squalor, many of these women come
from poor backgrounds and offer services for less than a dollar
an hour. If a client is willing to give them more money, they
agree not to use a condom. The next meal is more important than
getting HIV and then dying a few years later.
Moralistic attitudes and discrimination can be more vicious than
bullets and knives in the manner in which they kill. The way HIV/AIDS
kills without anti-retroviral medications is a violation of the
most fundamental human right to die with dignity. A poor person
in a developing country with HIV/AIDS is no less deserving of
a shelter or hospice or loving family and friends around them
than their brethren in wealthy nations, and it would be a tragedy
if the commitment to care for the dying became lost in the race
to eradicate the spread of new infections in developing nations.
The village of Rajokari, near Indira Gandhi International airport,
was tranquil and traditional, just the kind of community that
might shun the person with HIV/AIDS, because there was nowhere
in the narrow, medieval lanes hugging small rows of attached homes
where anyone could keep a secret for very long. There was simply
The proposed AIDS shelter was set in a glorious two-acre plot
of land, filled with trees. The birdsongs competed with the life-affirming
sound of Rajokari school children at play next door. Ms. Ali brightened
as we walked through the empty rooms: "It will be called
'Ashraya,'" she said happily.
It was hard to leave Rajokari
and a few days later India itself, not knowing the outcome of
the project. As the plane bound for New York swooped over the
constellations of towns and villages I thought of Rajokari, and
the need for AIDS shelters across the nation. The virus had begun
its corrosive journey into India's population of 1.2 billion people.
In December, 2002, a very special invitation arrived in New York:
"Dearly beloved Friends,
"It has been a long and eventful journey, our quest to start
an AIDS care facility which eventually bore fruit. Our relentless
crusade and dedication will translate this dream into reality
on the 17th day of December, 2002.On this day `Action India (Trust)
Aids Projects'Holistic Care Centre `Ashraya' will be formally
inaugurated by the Honorable Chief Minister, Mrs. Shiela Dikshit
at Rajokari. It is our proud privelige to mention that this is
a pilot project, a Bhaagidari Scheme (Citizen-Government Partnership)
of Government of NCT Delhi and Action India Trust."
In June 2003, Ms. Nafisa Ali visited New York, and was much moved
by the sight of Ground Zero, which she visited many times. "I
wish for peace for both our countries" she said, "and
freedom from terrorism." She spoke of her hopes for a support
group in the United States for the work she is doing in India
for people living with HIV/AIDS: "Please ask America and
President Bush to help us in our struggle," she said, "This
is the only country that really understands the problems of HIV/AIDS,"
said Nafisa Ali.
In New Delhi on July 29th, 2003, after the National Parliamentary
convention on AIDS, Dr. Peter Piot, Executive Director of UNAIDS,
Ms. Penny Wensley, Australian High Commissioner and Dr. Anderson,
Country Director, UNAIDS were invited to visit Action India's
Holistic Care Home for HIV-positive people in Rajokari.
Nafisa Ali told Dr. Piot that "Ashraya" is a positive
story that can be replicated in all parts of India. Initially
there was apprehension in the local community, but with accurate
information given by Ms. Sheila Dikshit, the Chief Minister at
the time of the inauguration, the doubts were removed. Ms. Dikshit
said "Knowledge is the key to solving the problem of HIV/AIDS.
Knowledge will save lives." "Today, Rajokari Village,
with a rural population of more than 7,000, has accepted the AIDS
care home with the active involvement of the Village Pradhan and
other village elders. There has been no stigma and discrimination
only understanding and sensitivity."
Peter Piot, acknowledged the hard work that is being put into
"Ashraya" and emphasized the importance of care.
An "Action India" press release commemorating Dr. Piot's
visit to Ashraya states: "Action India is a citizens' motivated
trust working consistently with other NGOs to solve a variety
of problems, extending all possible support to people who are
voiceless, rendering services to them in times of need. We at
Action India believe in a multi-prong approach which includes
prevention, awareness, support and care and advocacy with the
Dr. Piot said the challenge was to rapidly scale up AIDS prevention
programs nationwide, and to ensure that AIDS treatment is widely
accessible to people living with HIV/AIDS.
In his State of the Union address to American citizens President
Bush spoke of an African doctor who told AIDS patients he could
not help them, due to lack of funds: "In an age of miraculous
medicines, no person should have to hear those words," said
In the years ahead India
will hope to hear those same words of reassurance form the most
powerful leader of the free world. Laws that govern trade and
patents will determine the survival of millions of Indians when
the cost of anti-retrovirals is unaffordable to the downtrodden,
sick and weary masses. Only world leaders and laws can help them.
Mr. Atal Bihari Vajpayee, Prime Minister of India's 1.2 billion
citizens called for an "openness and a complete absence of
prejudice towards affected persons," in his speech at India's
first National Convention on HIV/AIDS.
Clearly, every community in India will need its "Ashraya"
in the years ahead. It is not an unrealistic dream; it is an urgent
Dr. Peter Piot concluded:
"UN Secretary-General Kofi Annan referred in his message
to the example of the father of the nation, Mahatma Gandhi, in
his steadfast efforts to attack the stigma attached to leprosy.
We must keep that example uppermost as we tackle the unwarranted
and unconscionable stigma that attaches to HIV. Because we know
that stigma kills. And because stigma is the best ally of HIV."
Dr. Piot laid out a positive "foundation plan" for action:
"Responding to AIDS is obviously a major responsibility of
government, but government cannot do it alone," he told the
conference, "The health sector is a vital factor but cannot
be expected to shoulder the burden alone. All relevant sectors
should join forces, just as we are doing in the UN system through
UNAIDS. The vibrant NGOs, the mass organizations and the business
community and unions, are all key partners in expanding the response."
India's leaders have shown
courage and commitment and sounded the alarm which must be heeded
in all sections of society if a massive health disaster is to
be prevented. It is time for all of India and Indians living around
the globe - to mobilize and to act.
"The media can save lives," said Dr. Piot, by spreading
knowledge and information.
The spirit of private generosity and philanthropy in the United
States is a unique and awesome phenomenon that does not exist
anywhere else in the world. From the lemonade stand bearing a
small American flag in a bottle set up on my New York street corner
by 3 young children to benefit the widows and children of firefighters
who died on 9/11, to the state-of-the-art black tie fundraisers
that benefit every cause known to man and in every small town
and village across this country where community and religious
groups sustain, support and keep the flame of warm hearted charity
and kindness burning, that generosity of spirit is one of America's
greatest national treasures.
In the years ahead, every Indian will have to emulate this spirit
of giving toward their fellow Indians if a massive health disaster
is to be avoided. Similarly, as high-profile leaders like Kofi
Annan and Colin Powell embrace the plight of their fellow citizens
a continent away in Africa, so too must influential successful
Indians living around the world show support for their brethren
in India. Ignoring the problem will result in tragedy.
It is to be hoped that America's leaders and this country will
lend its might, muscle -and heart - to the 21st century's battle
for mass salvation.
The New York support charity for "Friends of Action India/Aids
Projects" will be launched via the web to support the work
of "Action India/Aids Projects" in New Delhi. Stay tuned
at www.FriendsofActionIndia.org on or after August 20th, 2003.