Despite a decade of record economic growth in India, poverty and tragedy remain as commonplace as ever. A mounting HIV-AIDS epidemic is increasingly to blame. More than 2 million adults have died of AIDS, overwhelmingly in the country's most dynamic states. Some 300,000 died last year alone, far more than in any other country. More than 4 million people are infected or sick. Many of these adults are from India's middle classes, skilled and often well-educated. Even more are from the vast ranks of the poor.
Almost certainly, far worse lies ahead. Because the government's prevention efforts are lagging dangerously behind the epidemic's growth, the number of adults infected is doubling every 18 months or so. On average some 3,500 Indians are contracting HIV every day. A World Bank report warns that without adequate prevention efforts, 35 million Indians -- 5 percent of the country's adults -- could be infected by 2005, a number equal to the current global total of people with HIV-AIDS.
Since the ending of colonial rule, India has been transformed by vast population growth, urbanization and wider prosperity. Single men crowd the cities, only rarely able to visit their wives in the countryside. A gigantic commercial sex industry flourishes. Each new study confirms how sexual mores have changed irrevocably. The only vestige of tradition is the powerful taboo on public discussion of sex. But this serves only to leave the majority grossly ignorant of sexual matters. One in every 10 adults suffers from one or more sexually transmitted diseases, increasing the risks of HIV transmission.
India's epidemic began in the prospering western and southern states, where it is now at its worst: Maharashtra, an industrial and financial powerhouse, and Andhra Pradesh and Karnataka, leaders in the information technology boom. In the first two states, well over 2 percent of adults are infected. In Mumbai and another half-dozen cities and towns, 3 to 5 percent of adults are infected.
At first glance, the Indian government's failure to curb HIV-AIDS is baffling. In 1992, faced with evidence that large numbers of middle-class men and women were infected -- not just the poor and "sexual degenerates" -- the government ended its reliance on penal methods, such as forced testing. It has since borrowed nearly $300 million from the World Bank for HIV-AIDS prevention, and top-level official concern is finally evident.
But India's epidemic is running far ahead of the government's response. The programs in place today would possibly have been sufficient to curb the epidemic a decade ago; today they serve only to mask the fact that it is all but unchecked. Even in the worst-hit cities, sex workers still lack the information and support they need to protect themselves and their clients.
Prevention programs for men who have sex with men are all but nonexistent. Few schools and colleges have meaningful sex education programs. Because public information campaigns evade sexual issues they have spawned dangerous new myths, such as that HIV is spread only by vaginal sex. Unsafe blood and contaminated medical equipment are infecting tens of thousands more each year. And those infected, sick or dying -- or their survivors -- can expect virtually nothing by way of counseling, medical care or other support.
Moreover, human rights abuses linked to HIV-AIDS are still legion. People with HIV-AIDS are often dismissed from their jobs, forced out of their neighborhoods or denied medical care. The police, politicians and even judges routinely order the arrest and forcible testing of sex workers and homeless women. Legislators in Maharashtra and Karnataka continue to push for laws that would allow the branding of infected sex workers. A Supreme Court ruling that bars people with HIV-AIDS from marriage has further demonized them and the disease itself.
India's leaders have barely any time left before HIV-AIDS dooms tens of millions. There is proof that they can succeed against this disease, if they are truly committed and act early. The chief minister of the southern state of Tamil Nadu quelled a severe epidemic by promoting frank information campaigns, better treatment for sexually transmitted diseases and some sex education in schools. In communist-led West Bengal, sex workers have been allowed to unionize and so to protect themselves: HIV rates remain low.
Most Indian states are still only mildly affected, giving their leaders the chance to avert full-blown epidemics through such relatively painless programs. But for every reason, from disbelief to discomfort, few are likely to rise to the challenge. It is even less likely that the leaders of the worst-affected states will take the necesarry steps to control their epidemics and prevent infection. This failure of leadership will mean a calamity for many million Indians.
The writer's most recent book is "Sex, Lies and AIDS."