his State of the Union speech on January 28th, 2003, President
Bush stunned AIDS advocates around the globe by making the global
AIDS epidemic the first foreign policy issue on his evening agenda.
He urged Congress to approve $15 billion in funding for AIDS over
the next few years for many African and Carribean countries.
President's pledge of $15 billion over the next five years will
benefit 12 African nations, and Haiti and Guyana. The goal is
to provide treatment and care for 10 million Africans and orphans
already infected, prevent 7 million new infections, and provide
antiretroviral medications for 2 million people. A little over
half the money will pay for drugs, 15% for treatment and care,
and the rest will go for prevention - abstinence, education media
campaigns and, surprisingly for the Bush administration, condom
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
President has been skeptical about funding AIDS relief in the
past fearing that American tax dollars would be wasted and the
money carelessly spent. Jeffrey D. Sachs, Director of the Earth
Institute at Columbia University, who has strongly advocated increased
global AIDS spending, recalls great skepticism in
early meetings with administration officials, including Secretary
of State Colin Powell.
Sachs describes the Presidents recent initiative as a historic
breakthrough. Observing that the President is both morally
and geo-politically astute, Mr. Sachs maintained in an February
2, 2003 article in The New York Times editorial (2/2/03)
that the President's call to war against Iraq needs to be balanced
by the good that America stands for: It's the notion of
needing to deploy weapons of mass salvation, together with weapons
of mass destruction, he said.
years ago, Senator Bill Frist, who has volunteered his services
as a surgeon on medical missions in Africa, pressed President
Bush to do more to fight Global Aids when he was invited to ride
with him on Air Force One. Since then, administration officials
have seen the tragedy in Africa first hand: Dr. Anthony Fauci,
a leading federal scientist, Tommy Thompson, the Secretary for
Health and Human Services and Secretary of State Colin Powell
were deeply moved by what they saw. Dr. Fauci told the President
it was a great catastrophe. Babies were dying infected.
Dying mothers were infected. When the price of the AIDS
"cocktail" dropped from $12,000 to $300 per year - and
the AIDS cocktail became simpler to take - successfully implementing
relief seemed possible.
critics of the President's previous hesitation in combating the
global AIDS epidemic, Dr. Fauci, who visits the White House frequently
to discuss bio-terrorism and vaccine research, confirms that he
and other officials have been working on the AIDS initiative since
last June, under the Presidents explicit direction. In past
months, Colin Powell, National Security Advisor Condaleeza Rice
and Bono, the Irish rock star - among many others - have made
a passionate case for AIDS relief on humanitarian grounds: The
administration isnt afraid of rock stars and student activists
they are used to us. But they are nervous of soccer moms
and church folk. Now when soccer moms and church folk start hanging
around with rock stars and activists, then they really start paying
attention, Bono declared in a February 2, 2003 article in
The New York Times.
recognize the importance of Mr. Bush using the authority of his
office to take up their cause: This is a moment where the
United States has drawn a line in the sand. If they want to paint
the drugs red - white and blue, I dont care. And neither
do the millions who are about to go on them," Bono maintained.
anyone who has seen the enormity of the AIDS problem in developing
nations that do not have health-care centers in every community
like the West and cannot afford medications, skepticism about
where the funds actually go is easier to understand. Widespread
stories of corruption and misspent funds increase the need to
administer relief through carefully screened national and international
aid agencies - and individual non-government organizations (NGOs)
formed by citizens who wish to help.
nations writing checks will not end the troubles of developing
countries that do not have the infrastructure to cope with the
impact of massive numbers of new infections, as well as care for
those already infected. It is overwhelming. If programs are not
carefully monitored and supervised and accountability for funds
made a prerequisite for further funding, corruption will rear
its ugly head. This ultimately undermines the generosity and the
efforts of those whose focus is moral, caring and responsible.
In the long term, accountability ensures that those who are suffering
will get the treatment and care they deserve, which is the whole
point of sending aid in the first place.
societal values and stigmas against people with HIV/AIDS in developing
nations should be a prerequisite of any charity or aid organization
sending relief and workers to help PWAs (people with Aids). Unlike
some other diseases like smallpox that can be prevented with one
vaccine injection, AIDS requires consistent, long- term treatment
and care and an educated framework. Taboos, rumors and superstitions
must be transformed into concern, involvement and knowledge about
the disease. In many local communities in developing nations HIV/AIDS
is often regarded in much the same way as people in biblical times
viewed lepers, as a punishment from God for wrong-doing,
or the hand of fate. It is only with committed local support,
including the Government and hospitals in developing nations that
the epidemic will be pushed back and the threat to the wider community
eradicated. At present, most PWAs in India end up in government
hospitals, learning for the first time of HIV/AIDS. By then it
is often too late.
are 42 million people estimated to be living with HIV/AIDS globally.
Of this number, 38.6 million are adults, half women, and 3.2 million
children under 15 are also infected. The virus is now in its third
now indicate that there are 25 million persons suffering from
AIDS in Africa and that 6 million have now acquired the virus
in Asia. Asia is now the focus of many experts, with the sharpest
rise in new infections: Dr. Peter Piot, executive director of
adds that in order to push back the epidemic, a $10-15 billion
dollar per year international collaboration in low- and middle-income
countries involving governments and civil society, and public
and private sectors from all countries is needed. Dr.
Piot concedes that such an expanded collaboration does not
mobilize spontaneously, citing leadership and advocacy for
effective action and the promotion of civil society engagement.
to a UNAIDS press release in October 2002, outside sub-Saharan
Africa, Asia has more people living with HIV/AIDS that any region
on earth. The epidemic in Asia threatens to become the largest
in the world, warned Dr. Piot. With more than half
the worlds population, the region must treat AIDS as an
issue of regional urgency. The question is no longer whether Asia
will have a major epidemic, but rather how massive it will be.
year, for the first time in the epidemics history, the number
of women living with HIV has risen to 50% of the global total,
Dr. Piot declared in his World AIDS day message in December, 2002.
We need to remind ourselves," he continued, "of
ways in which stigma and inequality push women to the end of the
treatment queue, exacerbate HIV risks, sustain sexual violence
and deprive girls of schooling. Yet we also need to remember that
womens organizing in care support and community education
has been one of the keys to success against the epidemic.
tragic part of the increase in women with HIV is that - unlike
men with HIV/AIDs - they face the double-whammy of
being able to transmit the deadly virus to their babies through
breast milk - most of these women are monogamous housewives or
widows who lost their husbands to AIDS, followed by sex-workers
and Injection Drug Users. It is women who represent the majority
of HIV/AIDS infected citizens even though the actual number is
50% - because they can and do have babies.
antiretroviral (ARVs) medications that make HIV/AIDS a manageable
disease must be administered in the infected (HIV-positive)
stage of the disease to prevent full-blown AIDS from occurring.
Antiretrovirals are readily available for many people living with
HIV/AIDS, but not for everyone. The dividing line between
those who receive the medications and those who do not is money,
exacerbated by the need for a prevention and care
infrastructure that most developing nations do not possess.
researchers and scientists pursue the vaccine for the cure for
HIV/AIDS, the disease has begun to be contained in the West. However,
even in the United States - the wealthiest nation in the world
- there are babies being born to a life of AIDS. Their mothers
were either infected through heterosexual contact, injected drugs
with infected needles, or had sex with an HIV infected partner
and did not know it. Those who now succumb to HIV/AIDS in the
United States are no different from those who get the disease
in low income countries: it is about gender, socio-economics,
and lack of education and youth. There is a disturbing
rise in the prevalence of HIV/AIDS in young Americans of all socio-economic
levels and backgrounds:
statistics for the United States from the Center for Disease Control
indicate a sharp increase of AIDS in the 19-29 age group, the
most experimental sexual years, where one exchange
of unprotected sex between heterosexual partners, sex with an
injecting drug user, amongst othe causes, can result in HIV infection.
The HIV virus can lie dormant for up to 10 years. Getting tested
for HIV (the virus that causes AIDS) is vital for prevention of
the disease. Once detected, the virus can be treated with medications
is also an increase in heterosexual women with HIV/AIDS in the
United States. However, in low-income and developing nations
- where the virus is gaining momentum at an alarming rate - women
head the list of heterosexually transmitted HIV/AIDs. Total United
States infections are 816,149, reported to the Center for Disease
Control through 2001. Of the 147,000 women in the US with HIV/AIDS,
77,000 acquired the virus heterosexually. While the majority of
those with HIV/AIDS in the United States are still MSMs (men sleeping
with men, 368,971, the remaining numbers have become infected
predominantly through heterosexual contact and IDU (Injection
Drug User). Vigilant education/prevention through the use of condoms
is crucial in combating the virus.
advocates have maintained from the outset that the neglect of
those suffering with HIV/AIDS by discrimination, poverty and stigma
deprives them of the fundamental human right to care and treatment.
In the case of women with HIV the disaster doubles - because unlike
men, women transmit the virus to their babies in breast milk without
the block of an antiretroviral called Nevipirene.
Breast-feeding is the food of choice for the babies in developing
nations, both culturally and economically - it is free.
his speech to opening session of the 13th Meeting of the Programme
Coordinating Board of UNAIDS, Dr. Piot said: We have not
yet begun to fully comprehend, let alone measure, the magnitude
of the impact on human and economic development in the most affected
communities and countries. The role of AIDS in compounding the
famine in Southern Africa may be just a harbinger of what is to
.It is clear that our highest priority for action must
be in those countries with high prevalence and those most threatened
by rapidly rising rates of HIV infection
must be multi-sectoral and at full scale. They will require human
and financial resources that can only be maximized and sustained
through effective partnerships between governments, civil society,
religious and cultural institutions and businesses.
good news, according to Dr. Piot, is that even the most severe
HIV epidemic can be turned back: In every continent across
the world, from cities and rural areas, we have examples of safe
behaviors resulting in markedly lower HIV rates. The extension
of access to care is slowly gaining momentum, and brings hope
.The World AIDS Campaign for 2002-2003 is all
about stigma and discrimination - tackle them and we are well
on the road to winning the fight against AIDS. I therefore challenge
each and every one of you to fight discrimination related to HIV/AIDS
wherever you find it.
and discrimination endanger women far more than men in developing
countries, where cultural pressures, lack of education and poverty
often set them up for acquiring the HIV virus.
women in a small village in the middle of India or Africa - with
very strict codes of conduct for women - will assume that sexual
misconduct or drug use or some negative action has brought the
scourge of HIV/AIDS to her as a punishment. The blame and suspicion
never lies with the husband or the man involved. And - because
of discrimination and stigma - they will punish her because they
are afraid of catching the disease or because they think she is
bad (extra-marital affairs, prostitution etc) by ostracizing
her and her child - or children.
this might sound harsh, to the uneducated, it is a life-preserving
reaction that is ages old. Education about protection and prevention
methods will help local women in developing and low-income countries
understand that they cannot catch the virus by standing next to
an HIV-infected person - as with smallpox. Viruses are commonplace
in developing countries, but it is hard to explain AIDS to Upper
East Side New York children let alone a woman in a tiny village
with a regional dialect. Through education they will also understand
that anyone - including celibate monks through shared razors with
HIV- positive men - can get HIV/AIDS.
does not guaranty immunity to HIV/AIDS anywhere in the world any
longer, as the statistics demonstrate. Across the globe, east
and west, heterosexual transmissions are on the rise. If one partner
has had unprotected sex with an infected person -even once - he
or she can become infected and then pass it on to a spouse or
partner. Intravenous drug injection with shared needles is lethal.
For all the categories of infection with statistics, check www.cdc.gov/hiv/stats.htm.
a healthy mother, regardless of nation or culture, breast milk
offers the best nutrition to a newborn. It is inconceivable
to imagine the guilt and pain of an illiterate, impoverished mother
when she learns that she is dying and that her baby will die because
of a killer virus she unknowingly fed it through her own milk.
Double the torment when she discovers that she might have prevented
it, if she had been empowered by education, free medications and
a support system to do so.
a graphic illustration of this tragedy, one has only to look at
photographs from Africa. The hospitals are inundated with row
upon row of tiny newborns, with none of the perks - gifts, flowers,
loving friends and relatives - that the arrival of a baby born
to health and comfort in the West brings with it. Most of all,
there are no loving arms to cuddle them, because mothers are wasting
away helplessly from AIDS in the next ward, wondering what demon
brought this horror into their lives. It is the most inhumane
beginning for a small life. The infected babies live for up to
two years - suffering - before the virus claims them. The sight
of this skewers the concept of morality and humanity to the conscience
of civilized mankind, demanding an accounting.
warns that, while the pace of the response to AIDs is rapidly
accelerating, we have not caught up with the pace of the epidemic.
In December 2002 in Portugal, at the 13th (UNAIDS) Meeting of
the Coordinating Board, the evaluation report credited UNAIDS
with creating a clear global mandate with objectives that can
be used to hold international leaders to account.
degradation of a punishing, slow death by AIDS in Africa, India,
China and numerous other developing countries is chilling, because
people with AIDS often die shunned and alone. Well-intentioned,
helpless doctors, clinicians, caregivers, family and AIDS organizations
can do nothing to prevent the ferocity of the AIDS virus once
the disease is entrenched in the patient.
Headlines like China Now Set To Make Copies of Aids Drugs:
Says a Million Infected Reversal in Policy, (The
New York Times, Sept. 7, 2002), are followed by As Aids
Spreads, India is Still Struggling for a Workable Strategy,
(The New York Times, Nov. 11, 2002), and in the same paper
two weeks later Aids Imperiling African Armies, Key to Stability
of Many Nations, (Nov. 24, 2002) on a weekly, even daily
basis in the media, the urgency of implementing a world-wide strategy
to block the path of the virus becomes clear.
countries with huge populations like India and China, where the
disease is exploding, the question of who will live and who will
die in the short tern will be a matter of money - because of the
cost of antiretrovirals, and the lack of infrastructure to cope.
question of human rights is a tragically poignant one in this
scenario because inevitably the rich will live (because they can
afford to buy the medications) and the poor will die, and die
horribly. People already infected with HIV/AIDS might conceivably
be written off as high-risk by the bill-payers or
financial distributors of individual nations - including their
own - and sacrificed for the sake of the healthy because they
are already dying. The low risk HIV/AIDS populations
might be considered a more valuable commodity to a government
- and therefore worth funding - because ultimately they will be
more useful. In a success driven world, funds given
for prevention end up looking better on paper, because
the result is a healthy, useful individual.
approach to the global HIV/AIDS epidemic may be interpreted by
history as an insidious - even subtle - form of genocide, or as
some have callously put it population control, because
the medications that offer relief exist. This mentality can be
especially dangerous in countries with large populations, where
a life is cheap, philosophy prevails, the stigma against
the disease encourages its increase and the diseased are considered
a liability. A deadly combination for those already infected,
who desperately need care.
predicament of an Angolan soldier sadly demonstrates this trend.
In a November 24, 2002 article in The New York Times by
Henri E. Cauvin, Sergeant Leira in Angola is quoted as saying
If I was like other people who have a lot of money - they
go abroad to buy medicines, they go to South Africa for treatment
- then I could continue (in the army). Weakened by HIV,
and without an infrastructure in Angola to help him, Sergeant
Leira will leave the army, a painful decision for someone who
has known only a soldier's life - and his future prospects (at
the time of writing) were hopeless. In South Africa, one in four
soldiers has HIV/AIDS. When the soldier tested positive for HIV
in 2000, the stigma connected with the disease resulted in his
relatives turning their backs on him - a man who had spent his
life defending his country in a war. He, like many in developing
nations, considered suicide. However, an AIDS support organization
helped avert that tragedy, and also recovered the support of some
of his relatives through education against the stigma of the disease.
Presidents State of the Union address pointed to the underlying
- if not directly mentioned - concern for the fate of nations,
especially Africa, succumbing to the HIV/AIDS virus. The disease
is leaving soldiers wasted, parents dying and millions of orphaned
children alone - easy targets for terrorist organizations waiting
like birds of prey to recruit them. Without armies to defend them,
nations can destabilize fast.
his article, Mr. Cauvin wrote that A new Central Intelligence
Agency report on AIDS cites Nigeria and Ethiopia, sub-Saharan
Africas most populous countries, as crucial American security
concerns, and its rising toll on their armed forces is part of
the West, education and consistent anti-retroviral medications
would make Sargeant Leiras condition manageable and
probably allow him the dignity of inclusion within his family.
He views his lack of control over his fate as poverty even
though antiretrovirals exist to help ease his suffering and prolong
his life. At present his government is not in a position to help
him. This soldiers fate can be multiplied thousands of times
in many African countries, and will most likely follow in other
Secretary Donald Rumsfeld was advised in November by Frank Griswold,
presiding bishop of the Episcopal Church in the United States,
that AIDS was destabilizing armies in Africa. Taking that scenario
into the Indian sub-continent, where AIDS is exploding, a similar
threat may occur if swift action is not taken against the virus:
India is the only democracy in the region. At present a million
troops are mobilized on its borders, which neighbor Pakistan,
China and Bangladesh.
tragedy of Africa, a country with more children orphaned by a
specific disease than any civilization in history, will repeat
in countries like China (1 million officially, but
realistically far more if a meticulous head-count were taken)
and India, with 3.7 million infected, (making it the country with
the highest number of citizens living with HIV/AIDS after South
Africa), unless swift action is taken. The Central Intelligence
Agency has warned that AIDS in Africa, India, China and Russia
pose a real threat to the national security of the United States.
like Brazil, and more recently, Cambodia, have been torch bearers
and a sign of hope in proving - without any doubt - that a combination
of involved, active citizens and responsible government can contain
the spread of the disease and offer its PLWHA relief without
being a wealthy nation with an educated population, as has been
suggested in the past.
communities who speak their own dialect have been educated about
aids in Brazil and provided with free condoms. Individually marked
bags of medicines - with a magic marker sketch of the sun indicating
daytime medication and the moon indicating night-time medication
- helped to overcome the language issue, thereby disproving the
theory that illiterate, uneducated people cannot administer medications
to themselves. Now, with advances in medical science, the antiretrovirals
are much easier to take and to administer.
eradication of aids is not just a matter of rocket science, despite
the mind-blowing advances in research and medications for those
suffering with HIV/AIDs. One only has to see the ravages the virus
wreaks merciless -upon those who do not receive antiretrovirals.
Curbing the epidemic is also a matter of implementing simple,
hands-on procedures to help frightened, uneducated people feel
comfortable enough within their community to seek and accept help
in the treatment of a disease that will spread like wildfire if
they do not.
stigma associated with the disease is, at present, the most pernicious
and insidious cause of its spread in developing countries like
India - a country of over a billion people. Despite a concerted
effort to control the disease by support groups and by the government
and local health organizations - by supplying condoms to local
stores, for example - a man going to buy condoms in a small village
is a marked person because culturally condoms are
not accepted or used. They are expensive and the purchase of one
indicates - in some uneducated minds - the presence of disease.
Then comes the stigma and discrimination.
at the World Economic Forums (WEF) East Asia Economic Summit,
which he co-chairs, in October 2002, Dr. Piot warned: HIV
has already spread to more than 6 million people across Asia.
By not tackling it now while it is still manageable, the epidemic
will have far-reaching effects, destabilizing societies and damaging
productivity. This is the first time someone outside the
business sector has been invited to chair the summit, giving an
indication that businesses are growing concerned over the toll
HIV/AIDS could have on productivity and stability long term if
the conference, attention was drawn to the information that China,
with a fifth of the worlds population, registered a more
than 67% rise in reported HIV infections in the first six months
of 2001, 70 percent occurring among injecting drug users. The
total HIV/AIDS reported in China is 1 million.
is one of several countries reporting record rises in HIV infections.
Haiti, which has the highest rate of HIV infections outside sub-Saharan
Africa, were relieved at the timeliness of President Bushs
promise of AIDS relief. More clinics and laboratories will enable
accurate data to be collected. Experts predict a 50 percent rise
in the number of people identified as infected with the virus
as a result of more sophisticated diagnostic services. Given the
rudimentary clinics - if any - in many countries, especially in
rural areas, it is impossible to tell how many people actually
have the virus at present. The global totals are for known
2002, after pressure from AIDS advocates, the World Trade Organization
essentially granted countries the right to break (bypass)
patents if the medications were essential to combating a
national health emergency and were otherwise unaffordable.
According to Elizabeth Rosenthal of The New York Times,
insufficient access to medications has been especially infuriating
for AIDS advocates in China, since China has an impressive pharmaceutical
industry well-known for its expertise in Western medicine.
Desano, a company based in Shanghai, already legally makes the
raw ingredients of the AIDS cocktail, and ships it
overseas for profit.
Chinese Government - not long ago in complete denial that they
had an AIDS problem - ultimately threatened to break patents by
the end of 2002, despite World Trade Organization restrictions,
because of the toll the disease is taking in China.
an article last fall in The New York Times entitled China
Now Set to Make Copies of Aids Drugs Says a Million Infected
Reversal in Policy, Elisabeth Rosenthal reported
that one of Chinas most outspoken aids advocates, Dr. Wan
Yanhai, who disappeared in Beijing on August 24th, 2002, was in
the custody of the State Custody Bureau. According
to the article, Dr. Wan, who had been followed and harassed
by security officials all summer, had been taken into custody
because he had posted a classified document prepared by
the Henan Health Bureau on the Internet in late August, showing
that officials there were well aware of a serious HIV problem
as early as 1995.
Wan Yanhai exposed seven years of governmental secrecy while the
practice of blood-selling by poor farmers continued. Farmers sold
their own blood with the full knowledge of the government, for
money, because they were desperately poor. The Government knew
that the blood being collected was drawn by
using communal needles. The good blood was used for
blood products, while unwanted blood was re-injected back into
the donors - thereby spreading the disease to innocent Chinese
Wans wife, who is studying in Los Angeles, said that one
of Wans colleagues said that the State Security Bureau admitted
Dr. Wan was being held for disclosing the secret report.
Dr. Wan Yanhai, an aids activist and advocate, founded the Aids
Action Project, a small organization that ran a web site and conducted
AIDS advocacy work in China. He was to have received a prestigious
Canadian human rights award in September.
a November 11, 2002 article in The New York Times entitled
As Aids Spreads, India is Still Struggling for a Workable
Strategy, Amy Waldman tells the story of a widow living
in a small village in Tamilnadu, whose husband died of AIDS and
who, like many wives or widows in the area, were infected by their
husbands years ago. Since then, others have learned through AIDS
support groups that condoms prevent such transmissions and they
are being used; but the women already infected, like the Angolan
soldier, are left to battle the disease alone. The widow is in
despair over the fate of her already fatherless children:
Her greatest concern is that no one in the village know
what is making her ill, wrote Ms. Waldman, adding that the
woman maintained that "If they know, they will isolate my
children. she said. The woman was monogamous. If you
want to stay in your village, dont tell anyone, advised
state of Tamilnadu has the largest number of infections in India
and is one of the most advanced in addressing the issue of HIV/AIDS
but the government and local support groups indicate that despite
supplying condoms in small village stores, there is the stigma,
which can only be removed through education.
disturbing trend in new infections at one Government hospital
in Tamilnadu is that the patients belonged to a group previously
considered low-risk. Most of them were monogamous
housewives and most of them were women. Previously high-risk
patients were commercial sex workers and truckers criss-crossing
the country, who had significantly reduced their number of infections
thanks to the combined efforts of local AIDS groups, Indian Government
agencies, and financing from the United States Agency for International
Development (USAID), at a cost of $6 million a year.
local peer-groups in the state of Tamilnadu in India on safe sex
and condom use resulted in an increase of condom use amongst sex-workers
to 88 percent in 2001, from 56 percent in 1996, and among truckers
to 78 percent from 44 percentm according to an APAC study.
August 23rd, 2001, a hot, sultry day in New Delhi, India, I accompanied
Ms. Nafisa Ali, Chairperson and founder of "Action India,"
a citizens motivated trust to the village of Rajokri
on the outskirts of the city, near Indira Gandhi International
had been invited by Ms. Ali to see the vacant building and land
which she had asked the Government of India to donate to Action
India for the purpose of caring for people living with HIV/AIDS
(PLWHA). At that time, rent appeared to be the problem: I
can try and raise funds to care for the patients, but I cannot
afford rent as well. We need this facility rent-free if there
is any hope for the project, she said.
to the hopes and goals of the activist as we sped past a throng
of humanity - bicycles, mini-buses, bullock carts and the dense
traffic of central Delhi - made the reality of acquiring the building
sound like a dream. The sheer volume of humanity in Indias
magnificent capital is something to behold. Every set of traffic
lights brought vendors swarming round the car peddling everything
from sliced coconut and hot-pink visors to high-end Western glossy
magazines and incense: Sweeeeeeeet sandalwood, bellowed
the vendor through the rolled up window.
listened in admiration to Ms. Ali who spoke matter-of-factly of
taking on the responsibility of caring for people living with
HIV/AIDS. As we drove, she discussed why many of the patients
she knew had succumbed to the disease: it was a roll-call of Dr.
Piot warnings. Most horrific of all were the stories of mothers
who transmittied the deadly virus to their infants through their
own breast milk. Without free HIV testing, they do not know they
have the virus.
the drive to Rajokari I learned that a single dose of a new drug
called Nevipirene, administered to the mother, blocked the transmission
of the AIDS virus to the baby. The cost of one dose of Nevipirene
is $4 in India, considered cheap in the United States, but prohibitively
expensive for someone who earns nothing.
holistic, the spiritual, side of healing is also very important
together with medications and treatment, said my
companion, who felt strongly that health care was a human right,
especially in situations of great poverty. The stigma associated
with the disease was a persistent and painful reality: People
with AIDS must not be discriminated against because of their disease,
said Ms. Ali.
asked how Action India was going to afford the constant
round of medications and health care costs once the government
gave Action India the center. I mentioned two articles
in The New York Times describing the involvement (and apparently
heroic contribution) of Dr. M. C. Habieb, chairman of the Indian
pharmaceutical company, Cipla India, acknowledged by many as the
first pharmaceutical company to offer affordable anti-retroviral
medications to Africa on humanitarian grounds after
he had seen the holocaust the disease had wrought
on the African sub-Continent.
offer was made at the height of the debate over the sanctity
or inviolability of patents established between the
wealthy nations and the developing nations.
India also offered Brazil affordable medications, when prohibitive
costs were threatening the containment of the disease there. Cipla
is a supplier of antiretrovirals to Brazil and many other nations
battling the disease. Ciplas action had the effect of forcing
the large multi-nationals to follow suit - or stand by and watch
the governments break patents, as Brazil threatened to do - and
produce the medications cheaply themselves.
we passed a group of smiling, brightly dressed, Rajastani villagers
on the way to Rajokri, Ms. Ali said the center would be the first
of its kind in Delhi, a city with 22,000 HIV-positive and 600
AIDS patients. The AIDS project is one of several Ms. Ali has
pioneered for her organization. An important program targets gender
discrimination and is called Empowering the Woman
and the Girl Child." These educational programs are crucial
to making inroads in the current HIV/AIDS epidemic in India. Having
more control over their own lives and bodies - will ensure
women the protection they deserve. (For more information, visit
Ali stressed that government involvement was crucial to the Aids
care center, both in terms of acquiring the property in Rajokari
free of cost and as "perceived support" within the local
community and Indian society at large that the government was
a partner in fighting the stigma of AIDS in India. In her
view, with government backing, other centers would follow: We
need hundreds of centers all over India to combat this disease.
We will face an epidemic like Africa if we do not, she said.
their western counterparts, the majority of women in Asia (in
the uneducated, low-income bracket) still continue
to suffer from the same social, religious, economic, political
and legal discrimination that their mothers did. They do not have
the rights that we take for granted in the West. Raising
the standards of all women is crucial to the battle against the
global AIDS epidemic To help inform citizens in remote rural areas,
Ms. Ali has pioneered educational films and tapes on HIV/AIDS
in her country, which are translated into several languages. India
has over 200 languages and dialects, making HIV/AIDS education
a particularly challenging issue.
AIDS advocate spoke of the difficulties of winning support for
her cause: I have fund-raised for so many charities in the
past, she said sadly, but I have never encountered
such resistance as towards AIDS....They say, We will give
you money for another charity, but not for this. The
stigma in India is deep-rooted and must be removed if we are to
succeed and Government backing is vital.
months ago Ms. Ali, a former Miss India, photographer, National
Swimming Champion, and well-known actress in the land of millions
of Bollywood movie fans, gave me a collection of newspaper and
magazine articles she had written on Indias AIDS situation.
At the time, I was completely in the dark about the prevalence
of the disease in India - a country I love deeply. Amongst the
articles were photographs of a prostitute who had HIV/AIDS. As
my plane bound for London and New York lifted up and away from
Indian soil - always a sad moment - I realized for the first time
that India had a severe problem. Even though I have seen great
poverty, nothing prepared me for Ms. Alis photos of the
poor woman, who had literally been eaten away by the virus with
enormous open wounds - because she had not received antiretroviral
treatment. She also had tuberculosis, a common side-effect of
HIV/AIDS. I recalled my first horrified encounter with the photos
on the drive to Rajokri. The woman had been the impetus for Ms.
Alis commitment to people suffering with HIV/AIDS.
she had been a prostitute, the womans disease was perceived
as her own fault and the stigma of it left her isolated. Her story
can be multiplied in countries and communities around the world.
No one wanted to touch her or go near her. The only support she
had received was from her sister, a nurse, who attended to her
daily needs when she eventually became bedridden, which included
dressing bedsores the size of craters, leaving internal organs
matter how great the love, it is tough territory to take on a
dire health situation without assistance and education. The prostitutes
physical condition would warrant full time professional care in
the west. Ms. Ali remembered every detail of the time she spent
with this woman, who died a few days later. She said she was haunted
by the womans smile and lack of bitterness or reproach against
the community that had shunned her. The chilling fact remains
that many men continue to become infected during relations with
prostitutes - or infect them - and then return home to unsuspecting
monogamous wives or partners.
government and AIDS organizations have since then made concerted
efforts to address the issue of condoms through education: Men
must understand that a condom is necessary for everyones
sake, said Ms. Ali.
was a chilling to hear Ms. Ali describe being taken by concerned
AIDS workers to villages where fear and ignorance had led the
townspeople to leave those suffering with AIDS, including small
children, in isolated rooms or enclosures from which they could
not escape. For basic survival they would throw them left-over
chapattis and food. Fear of catching the disease and an age-old
instinct to protect their own young cause ignorant, poor people
to take extreme measures. They see HIV/AIDS as something that
can be caught like chicken pox or measles: only education will
eradicate fears and panic.
the density and congestion of central Delhi gave way to the release
of the highway and signposts to Rajokri, I wondered if there were
any people in the homes we passed suffering from the kind of isolation
and indignity we had been discussing. Ms. Ali had said so often
in the past that it was the stigma of AIDS that hurt the most,
because it made the patients feel like outcasts.
the village of Rajokri, we encountered a major obstacle; the road
leading to the house was impassable, blocked by construction clutter.
It appeared to have been re-paved. We concluded, optimistically,
that the road works were an affirmation that the Government was
showing resolve and commitment to the area, possibly because the
Aids Care Centre was soon to become a reality, requiring reliable
access to the site.
alternative route sent us down medieval, winding lanes barely
wide enough to allow the car to pass, which is typical of Indias
small towns and villages, which were constructed hundreds of years
ago. While it was an architecturally fascinating experience, we
had to proceed at a snail's pace to protect the car from direct
contact with buildings. I made eye contact with a lady exiting
her front door, six inches from the car window and she had to
stand in her doorway until we passed. It struck me that the concept
of privacy was meaningless in small towns like Rajokari. If a
woman or child became ill, everyone would know. If their illness
persisted, they would be perceived as a threat to all the villagers
because of the density of the living quarters. This was communal
few minutes later it looked like we were going to have to re-trace
our steps (in reverse) and return to Delhi because the road became
even narrower. Frustrated, Ms. Ali asked a local man if there
was any way to get to the big empty house with the garden and
minutes later we driving beside a high stone wall.
impressive wrought iron gates, I could see a spacious and graceful
modernist style house of about 6,000 sq ft, set in
two acres of land, most of which lay to the front of the house.
The house and grounds were stunning; a garden and beautiful orchard,
with leaves glittering in the dappled sunlight, dominated the
view. Along the wall to the right were what appeared to be garages:
Those will be the out-patients clinics and workers cottages,
said Ms. Ali, already mentally planning the site.
construction was brand new and unused and I now understood my
companions longing for the place. It was as serene as it
was practical - an emotional oasis for anyone trying to keep a
grip on life because of a devastating illness. From over
the wall came the shrieks of delight of Rajokari school children
released into the playground for recess. Another boon: a childrens
school with the life-affirming sound children always lend to any
environment they occupy. The AIDS care centre will be called
Ashraya, said Ms. Ali as we walked toward the house.
It means sanctuary.
the house the ceilings were high, the proportions graceful, the
rooms silent and windows open to the elements. It was a lifeless
shell except for a shuffling sound which drew our attention to
a dark corner of the entrance hall: from the shadows a delicate
cow peered warily at us, defined by its cream-colored skin. Cows,
of course, are considered sacred in India.
had evidently invaded the cows private sanctuary, and as
the intrepid Ms. Ali approached him, he made for the great outdoors.
We laughed like children: Very lucky, very auspicious, a
good omen, that the cow was in the house, Ms. Ali and I
said to each other. First the newly paved road, and now the cow
in the house - it had to mean something.
Ali identified the purpose of each room: This one is for
the babies and it will have bright colors and posters; this is
for the very, very sick patients. Light poured in from huge
windows as we ventured upstairs, where Ms. Ali immediately headed
for an enormous terrace: The sick children will play here,
she said, beaming with delight. It was remarkable how many times
Ms. Ali mentioned the future children of the center at play, given
the circumstances of their young lives. Lives begun in the womb
with a deadly companion the AIDS virus.
view across the rear of the property was a sea of green under
a pale blue sky with only a hint of the gray clouds that had hung
heavily above us all morning. As we prepared to leave, Ms. Ali
beckoned me out onto a small terrace at the front of the house,
overlooking the garden and orchard. All was peace and beauty.
I felt a pang of sadness as doubt claimed me. What if the dream
of Ashraya became lost in the realities of money,
red-tape and bureaucracy? Beautiful isnt it,
said Ms. Ali. Optimism returned as we walked down the stairs.
This house was not destined to lie empty for long.
closed the heavy gates and I took a final look at the house, nestled
in its serene setting. We rejoined the narrow, medieval road back
to the city center. The pace of the village was ancient and tranquil
- a timeless reminder of the relentless march of civilization.
next day, as my plane bound for London and New York flew over
Indias vast patchwork of multi-colored fields, with constellations
of small towns and villages, I hoped that each one of them had
an advocate like Ms. Ali for people living with HIV/AIDS, because
India is going to need them in the years ahead.
early December, 2002, a very special invitation arrived in New
York from the Chairperson (Ms. Ali), Trustees and Staff of Action
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.
this day Action India (Trust) AIDS Projects Holsitic Care Centre
'Ashraya' will formally be inaugurated by the Honorable Chief
Minister of NCT Delhi, Mrs. Sheila Dixit, at Rajokari (Near Air
Force and the Greens Farms). It is our proud privilege to make
a mention that this is a pilot project, a Bhagidari
scheme with the Govt. of NCT of Delhi and Action India (Trust)."
after, with great joy, I received the announcement from Ms. Ali,
dated December 19th, 2002, that I had been waiting for: the announcement
that Action India (Trust) in association with the Government of
Delhi under the Bhagidari scheme had opened the dedicated care
and support center known as Ashraya.
will include inpatient care facilities, counseling services, nutritional support, HIV/AIDS
education and training,
services & facilities for women and AIDS orphans, and alternative
Sheila Dixit, Honorable Chief Minister of Delhi, inaugurated Ashraya.
The other guests were Dr.
David Miller, Country Advisor, UNAIDS, Dr. Meenakshi Dutta Ghosh,
Additional Secretary & Project Director, NACO, Minister of
Health, Govt. of India, Mr. R. N. Baishya, Director Health Services,
Delhi Govt. and Ms. Dora Warren, Director Global AIDS Project.
on the occasion Ms. Nafisa Ali, Chairperson, Action India (Trust)
India has always been a forerunner in the fight for the fundamental
rights of people with HIV/AIDS to the access and care and treatment.
The birth of Ashraya Care Centre is in continuation
of our endeavor to make a difference in the lives of people
living with HIV/AIDS through care and support. We have always
strived to achieve the objective of bringing the best health-care
facilities within easy reach of the people of the country. Ashraya
will go a long way in not only serving the people of Delhi but
also by providing counseling and guidance against the stigma and
discrimination against people living with HIV/AIDS.
in Hindi, Mrs. Dixit stressed that knowledge is the only key and
the spread of knowledge can stop the spread of this disease. The
Rajokari villagers were very responsive and listened to her attentively.
Dr. Meenakshi Dutta spoke of Action India as a bridge
between the government and the people for the care and support
of people living with HIV/AIDS.
David Miller, Country Advisor, UNAIDS said he could already hear
the sound of the laughter of children playing in the spacious
surroundings of Ashraya and its beautiful garden. He congratulated
Action India and the Government on this unique venture.
last, Ashraya had been launched! If the cow is in
residence it might become as great a delight to the children and
patients as it was to us on that auspicious day in August, 2001.
It must have been a sacred creature.
is a testament to those rare individuals who dare to dream of
making a difference in the lives of their fellow citizens.
Hard work and love have gone into the Ashrayas
creation - and so many will feel its effect. There are endless
hours of work ahead, but Ms. Ali now has a vital ally on board
to help navigate the future - the Government of India.
know what Ms. Ali will say when I see her in the Spring in India:
Now we need AIDS care centers all over India, with
a dazzling smile and a dramatic sweep of the hand, indicating
villages far and wide. I am looking forward to hearing her say
my mind I never lose sight of the myriad constellations of towns
and villages in the vast sweep of the Indian sub-continent, which
I have flown over by plane and traversed on land all my life.
must not be allowed to vanquish Indias ancient spirit and
beautiful people. It must not be allowed to vanquish any human
beings dignity in any country, as it is doing in Africa. While
the Presidents speech brought hope to millions in Africa,
countries like India need help as well. China, Russia and all
nations overwhelmed by the AIDS virus cannot be ignored. It is
always the poor and the innocent who suffer the most - even in
the United States.
e-mails from Action India describe a once empty Ashraya
filling up as Ms. Ali planned on that day when we visited together
and stood gazing into the garden:
have a senior doctor as Chief Medical Officer, a coordinator for
the Care home, 4 nurses, 2 careworkers, 2 security guards,2 sweepers,
a cook, a MSW (Master of Social Work)
little girl at Ashraya playing on the terrace, running
in the garden, sunlight everywhere: that is a sight I am looking
my favorite advertisement - on the side of a phone booth in New
York - dictates: Dream Bigger.
its history, New York has been a sanctuary to many impossible
dreamers. So let us imagine - as John Lennon, a native New Yorker,
would have said - that the inventors of the vaccine for the cure
for HIV/AIDS mandated in the patent that it be given free of cost
to all people living with HIV/AIDS - as a human right. Governments
and taxpayers could conceivably remunerate the inventors of the
vaccine and the pharmaceutical companies. The United States has
helped re-build nations at a fraction of the cost of eradicating
AIDS. This is not a fairytale notion: the great Tim Berners-Lee
mandated in the patent of his invention, The World Wide
Web that it be given free of cost, setting in motion a universal
communications revolution. This story on HIV/AIDS rides on the
wings of Mr. Berners-Lee's free gift to humanity, reaching people
around the globe.
Center for Disease Control recently posted some important AIDS
vaccine news that can be found at http://www.cdc.gov/hiv/pubs/facts/vaccinefact.html.
address the need for an HIV vaccine, Thai officials have been
working with the World Health Organization, the Joint United Nations
Program on HIV/AIDS (UNAIDS), the International AIDS Vaccine Initiative
(IAVI), the Government of Japan, the U.S. National Institutes
of Health (NIH), the U.S. Department of Defence, various universities,
and the Center for Disease Control and Prevention (CDC) since
1991 to prepare for HIV vaccine efficacy trials. In February,
Thailand became the first developing nation to announce a Phase
III vaccine field trial. A Phase III Trial is done to determine
if a vaccine is effective in protecting against infection or disease
and is an important step in the evaluation process leading to
the 60 million inhabitants of Thailand, as many as 800,000 people
are currently believed to be living with HIV.
innovative and persistent prevention efforts, HIV continues to
spread rapidly, particularly among Thailands population
of injection drug users (IDUs). Thailand has experienced a rapidly
escalating and severe HIV epidemic since 1988. Methadone treatment,
which treats the addiction to drugs, education and counseling
on HIV prevention, and access to sterile needles have certainly
helped to slow the epidemic. Yet, among IDUs in Bangkok, 6 percent
continue to be severely affected by HIV. In addition to being
one of the nations most severely affected by HIV, Thailand has
emerged as one of the nations most committed to ending its toll.