NEW YORK — India’s population of 1 billion, greater than Africa, Australia and Latin America combined, is undergoing the threat of the unrelenting advance of HIV/AIDS. The infection is affecting all ages and social classes, and does not show any signs of abating. As things stand now, it is necessary to implement rapid measures with a strong component of prevention education to stop its deadly progression.

The fastest and better documented spread has occurred in Bombay and the state of Tamil Nadu. It is estimated that in Bombay, HIV has infected 50 percent of sex workers, and is present in 36 percent of sexually transmitted disease patients and 2.5 percent in women attending pre-natal clinics. Eastern India (Calcutta area) and Northern India (New Delhi region) still show a low prevalence of HIV infection (1 to 2 percent) among sex workers.

HIV infection is spreading rapidly from urban to rural areas, mainly through truck drivers and migrant workers. Surveys show that 5 to 10 percent of trick drivers in some areas of the country are infected with HIV. They should be one of the main target groups for prevention education strategies.

India reported its first case of AIDS to the World Health Organization in 1986. Presently, the World Health Organization estimates that 4 million people are infected with HIV. This makes India, after South Africa, with 4.7 million infected people, the second most infected country in the world. India accounts for 60 percent of HIV cases in Asia. Because there are three subtypes of HIV-1 and one strain of HIV-2, accurate diagnosis and treatment are more difficult.

There are several reasons for the rapid spread of HIV in India, mainly connected to cultural taboos, social customs and lack of education. Most people — particularly– in rural areas ignore basic facts about this disease and those infected — both in rural and urban areas– refuse to be identified because AIDS is associated with promiscuous sexual behavior, contagion and death.

Injecting drug use is an increasing threat. In Manipur, in India’s North east region, 55 percent of drug users are HIV-infected, as are also one percent of women attending pre-natal clinics. A group of women, monogamous wives of migrant workers and truckers, are at special risk of becoming infected with HIV. A study by the National AIDS Research Institute concluded that 14 percent of women testing positive for HIV reported no other risk behavior than sexual intercourse with their husbands.

The scare about AIDS has increased people’s bias against the disease. According to Akshay Kolukor, president of a branch of Network for Positive People, a self-help and advocacy organization, none of the local group’s 3,000 HIV-infected members have publicly revealed their condition.

Trafficking of their sexuality continues to be one of women’s greatest risks for becoming infected. Traffickers come from the cities, luring young women with false promises of work. Once they reach the city, girls are frequently put to work in brothels as prostitutes. In many cases, the girls are infected with a sexually transmitted disease by men hoping to get cured themselves through the belief that sexual contact with virgins cures infections. STDs increase the risk of HIV transmission by eight to 10 times.

Consistent use of condoms is one of the most effective weapons against the spread of HIV, but it is very difficult to promote. Prostitutes face a real dilemma when they try to implement protective measures.

Although the total picture of HIV/AIDS in India is particularly serious, some positive measures are being implemented. The Indian government and international aid agencies are making major efforts to promote awareness about AIDS and control the spread of HIV. And at the grass-root level, prostitutes themselves have become leading crusaders against HIV/AIDS. In Sonagachi, Calcutta’s red-light district, they challenge any pimp or madam who insists on the customer’s right to have sex without a condom. As a result, condom use has increased from 3 percent in 1992, when they began this practice, to 90 percent in 1998.

If India acts swiftly, using this as a model for a large-scale battle against HIV infection, and putting special stress on education on preventive measures, it can control the unrelenting spread of the disease. Those who ignore the tremendous importance of education do so at their own risk.

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