Stem the AIDS Epidemic in India

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By Pramit Mitra
Special to washingtonpost.com's Think Tank Town
Friday, December 1, 2006; 12:00 AM

The newly-released 2006 UNAIDS/WHO update on the global HIV/AIDS epidemic is a bag of good and bad news. While promising steps have taken place, including increased access to treatment and prevention programs in countries like Thailand, the number of HIV-infected people continues to grow at a steady pace in populous countries like India, where a total of 5.7 million people were living with HIV in 2006 -- 2.6 million more than in 2004.

From the point of view of overall American interests, what happens in India is of great consequence to the United States, and AIDS is one of the principal question marks hanging over India's future. Strategic relations between the United States and India have dramatically strengthened in the past decade, especially since September 11, 2001, as evidenced by the recent bi-partisan support in the U.S. Senate in favor of legislation permitting civilian nuclear cooperation. India, a secular democracy, occupies a vital space -- and has become a key U.S. friend -- between the two traditional areas of heavy U.S. security involvement in the Middle East and South East Asia.

Bi-lateral economic relations between the two nations are also growing dramatically. India, which expelled Coca Cola and IBM in the 1970s, is now one of the most sought-after destinations for U.S. companies like General Electric and Microsoft (and Coca Cola & IBM too). India, in short, has become one of the fastest growing economies in the world and a key market for American companies.

Acceleration of the spread of HIV/AIDS in India puts all this at risk, with potentially disastrous consequences for U.S. strategic interests. The parts of India that have been the engine of its impressive economic growth for the past 20 years include the states where the epidemic has already moved into the general population. At present, HIV prevalence is estimated to be 0.9 percent of the adult population (between 15 and 49 years of age). Most health professionals believe these figures vastly underestimate the dimension of the epidemic since large parts of the country remain outside the survey that is used by the Indian health ministry to come up with these figures. Though infection rates in India are far below those of sub-Saharan Africa, where up to a third of people are infected in some countries, the sheer population of the country means even small statistical gains equate to huge numbers of people.

The new Congress and the President, therefore, must put HIV/AIDS high on the bilateral agenda with India. Working together, the two countries can not only make a substantial contribution to the fight against AIDS, not just in India but other parts of the world as well since many of the lessons learnt in India are applicable in other countries as well. For Indian policymakers, the HIV/AIDS pandemic is perhaps the gravest danger to the nascent economic expansion that has put India on the world stage.

There is already a significant interaction between the two countries on HIV/AIDS and other health issues. These existing relationships must be strengthened. To begin with, the U.S. government should treat India not just as a recipient of financial and technical aid, but also as a major contributor to the global fight against AIDS and must increase the resources it devotes to India's HIV/AIDS problem. There is no doubt that the Indian government must increase is spending on health, which, at present, is roughly 5.2 percent of GDP, according to World Bank figures, one of the lowest in the developing world. But India also should receive steeper U.S. funding, given India's strategic importance. The key point here is to expand the relationship in a collaborative style and increase its scope and volume. In addition, the U.S. government should work with the business communities in both countries to explore new ways to take advantage of India's dynamic private sector. Expanding partnerships with India's private medical sector and the Indian-American community may be especially useful in this area.

But perhaps the most immediate way the U.S. government can help is to support the creation in India of new Institutes of Public Health, which will have substantial ties to American universities and will be partly funded through private financing and will have an autonomous management structures along the lines of some of India's best schools such as the Indian Institutes of Management. Most Indian and western health experts agree that strengthening India's overall public health infrastructure is perhaps the best long-term strategy to fight the AIDS pandemic. These public health institutes could serve as centers of world-class expertise on public health and a successful model of U.S.-India scientific collaboration. Previous experience from India suggests that creating an institution is perhaps the best way to engage the Indian government and create durable change.

By now there could be no doubt that AIDS is one of the greatest threats facing India's future. It can become a human tragedy even if the infection rate never goes near the 20 percent that has afflicted many African countries. The migrant workers that have fueled India's economic growth are particularly vulnerable to the disease. So are military units in insurgency prone parts of India's Northeast, already one of the focal points for the epidemic. And so are police in major cities like Mumbai . Aside from the humanitarian argument, an epidemic that hits populations like these will have major implications for India's security, and for U.S. security interests.

Pramit Mitra is a Fellow with the Center for Strategic & International Studies (CSIS).

The Center for Strategic and International Studies (CSIS) is a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions; accordingly, all views, positions, and conclusions expressed in these publications should be understood to be solely those of the authors.


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