FEBRUARY 1, 2006
EYE ON ASIA
By Bruce Einhorn
AIDS in India: A Case of Denial Richard Holbrooke, head of the Global
Business Coalition on HIV/AIDS, says the country tops his list of nations
not doing enough to fight the disease At the annual World Economic Forum
meeting last week in Davos, Switzerland, the rise of India was at the top of
the agenda. Proud to show off its development as one of the world's top
outsourcing destinations, the New Delhi government offered all sorts of
Indian goodies to visitors
The country's political and business leaders have good reason to show off,
thanks to innovative local companies like Infosys Technologies and Wipro as
well as the influx of multinationals that are launching or expanding their
Indian operations. The latest example: Dell on Jan. 30 announced that it
would be hiring 5,000 more people in India over the next two years, bringing
its total Indian workforce to 15,000.
Richard Holbrooke, the former Clinton Administration ambassador to the U.N.,
isn't joining the India cheerleading squad. The outspoken diplomat is
currently chief executive and president of the Global Business Coalition on
HIV/AIDS, a nongovernment organization that U.N. Secretary General Kofi
Annan asked him to lead. At Davos, Holbrooke's GBC made headlines by teaming
up with U2 star Bono to launch a new initiative, with such companies as Nike
(NKE <javascript: void showTicker('NKE')> ) and American Express
(AXP<javascript: void showTicker('AXP')>), to help raise funds for
AIDS work in Africa (see BW Online, 1/27/06, "For
Bono, Star Power with
Purpose"<http://www.businessweek.com/bwdaily/dnflash/jan2006/nf20060127_5254.htm>).
Outside of Africa, the country with the most serious AIDS problem is India,
which has more than 5 million people with HIV or AIDS.
HIGH-CLASS DENIAL. Holbrooke, who spoke to me and my colleague, Frederik
Balfour, in Hong Kong last month, doesn't mince words when discussing the
frustration of combating AIDS in India and other countries. "The Indians
will tell you over and over again that what happened in Africa can't happen
in India. And that's just bull," he said. "Here's a country with a billion
people spending about $5 per capita on health right now -- and reusing
contaminated needles continually" (see BW Online, 12/2/05, "Asia Owns Up to
AIDS,
Slowly"<http://www.businessweek.com/bwdaily/dnflash/dec2005/nf2005122_5402_db087.htm>).
He blamed India's denial on the upper-class males among the country's
leaders, who spoke of "cultural differences" that make it difficult to talk
about condoms or promote widespread testing. Those subjects, the leaders
claimed, brought up awful memories of Indira Gandhi's draconian,
forced-sterilization population-control policies of the 1970s.
The situation was totally different situation in a slum Holbrooke later
visited, he recalled. "We sat down on the mats with 40 or 50 women from the
community. Then some teenage boys and girls [came]." Quickly, the
conversation turned to sex and getting men to use condoms. Holbrooke was
impressed with how relaxed they seemed, compared with the higher-class
Indians he had spoken with earlier. "It was totally different -- the [young
people] laughed and joked," he told us. "I sat there thinking to myself what
horseshit we were hearing at the hotel."
CHINESE AGGRESSION. For Holbrooke, the contrast between India and the other
Asian giant, China, is striking. The way that the Chinese government is
tackling its HIV/AIDS problem has been one of the few bright points in the
struggle. "China is making progress," he said. And while China's government
is capable of being less than forthcoming about the disease, Holbrooke no
longer considers it to be in denial. "Last March, in my gut, I removed it
from that list," he said.
The latest news from China seems to support Holbrooke's view. Around the
same time that the world's luminaries were gathering in the Swiss Alps, the
top Chinese government official for AIDS, Vice-Minister of Health Wang
Longde, announced that 200 Chinese people were infected with HIV every day.
According to Wang, the total number of HIV/AIDS patients in China -- some
650,000 -- is actually lower than previously thought: The official estimate
had been 840,000.
That's a hard number to verify: Given outsiders' difficulty collecting such
sensitive data in China, and Beijing's history covering up health problems
-- from SARS to HIV -- there's good reason to be suspicious. Still, in the
past few years, the Chinese government has been much more aggressive in
facing up to its AIDS problem, encouraging nongovernment organizations like
the GBC and the Clinton Foundation to enter the country and work to fight
the virus.
"THE REAL WEAK LINK." The disparity between India and China couldn't be
greater, according to Holbrooke. While China is off his list of countries in
denial, "India is at the top of the list," he asserted. And Indians aren't
alone on Holbrooke's list. He also voiced frustration at officials who claim
that the world is making progress in stopping the spread of HIV/AIDS.
Dec. 1 was the 18th World Aids Day. "On every one of the World Aids Days,
the number of people who are HIV-positive has increased, right or wrong?"
Holbrooke asked rhetorically. The answer, of course, is yes. "Without
question," he emphasized.
Officials should pay more attention to stopping the spread of the virus by
increasing testing, he argued, so people with HIV won't infect others. "Are
we just going to go on and spend more and more money treating people, and
not addressing the real weak link -- which is prevention?" he asked. He
characterized the reluctance to test as "the most massive breakdown of
rational medical application."
Calling for testing can be controversial, though, something Holbrooke has
admitted. "My critics say that there's no proof that knowing your status
reduces the rate of prevalence," Holbrooke said. "And to which I can only
reply, 'you're right, there's no proof. But every once in a while, common
sense ought to prevail.'"
OFFICIAL PRODDING. Meanwhile, the fight continues, with some officials
trying to look on the bright side by pointing out signs of progress. That's
another thing that angers Holbrooke. "How can you call it progress when
every year more people die than go on treatment? And every year the number
gets bigger, and every year we have to spend more money, and every year more
people are infected. You call that progress? I call it the road to the worst
health crisis in recorded human history," he said.
It's understandable that some people want to publicize that their groups are
making some progress, and that the situation isn't completely hopeless.
Likewise, it's fine for India's top leaders to hobnob with the elite at
Davos and promote India as a 21st-century economic power. But AIDS already
has devastated lives and economies in Africa. It's good to have someone like
Dick Holbrooke around to prod officials in India and elsewhere to start
doing a lot more to ensure that the devastation doesn't spread further
--
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