In a country of a billion people, about 6 million are HIV positive. If the problem is left unchecked, that number could reach 20 million to 25 million by the decade's end. A single country could have an HIV-positive population larger than the total populations of London, New York, and Tokyo combined. India’s epidemic can be stopped before it approaches the proportions seen today in sub-Saharan Africa—but only by building a vast network of public-private alliances. With each partner bringing distinct skills and assets to bear on the crisis, careful coordination is essential.
Conditions in India could promote the rapid spread of AIDS in coming years. Although among adults its prevalence is only 0.8 percent—compared with almost 39 percent in Botswana and 33 percent in Zimbabwe, the two most heavily stricken countries—overpopulation and widespread poverty are already straining the government’s resources. The public-health infrastructure, facing a variety of gigantic health challenges, can’t cope. Public and private attitudes continue to stigmatize people with AIDS and obstruct efforts to combat it. Already, it is spreading beyond the high-risk populations.
So far, India’s response has been fragmented. The government spent about 11 cents a person on AIDS-related programs in 2003, compared with past expenditures of about $1.85 in Uganda and 55 cents in Thailand, two countries that have had some success in fighting the pandemic. Non-governmental organizations (NGOs) often lack the scale or management capabilities to face such a Herculean task and generally work in isolation from one another.
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