A grant and a controversy

THE four-day visit to India by Microsoft chairman Bill Gates was marked by an unprecedented gesture of philanthropy, with a billionaire businessman announcing a grant of $100 million to slow down and prevent the spread of the Human Immunodeficiency Virus (HIV) and the Acquired Immune Deficiency Syndrome or AIDS. It was clarified that the grant, contributed by the Bill and Melinda Gates Foundation, was meant not to parallel the efforts of the Union Health Ministry but to complement the work of the government's National Aids Control Programme.

It may not been goodwill alone that has been the guiding spirit behind the grant. Gates' interest in AIDS, especially where India is concerned, may be rooted in what United States agencies, including the Central Intelligence Agency (CIA), have had to say on the subject. A paper prepared for the CIA in September this year by the National Intelligence Council (NIC), titled `The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India and China', states that while currently sub-Saharan Africa has the biggest regional burden, the disease is spreading quickly in India, Russia, China and most other parts of Asia. It states that by 2010, a large section of the population in at least five countries that are of strategic importance to the U.S. would be at risk.

In an article published in The New York Times on November 9, Gates lamented that much of India's progress was likely to be hampered by AIDS. He wrote: "India had at least four million people living with HIV and the United States National Intelligence Council predicts that the number of people infected in India could jump to between 20 million and 25 million in 2010, adding: "The humanitarian imperative for action is undeniable."

It is clear that the Microsoft chief is espousing causes that go beyond the software chip. Gates has even identified the target populations for the HIV/AIDS programme in India. "Much more," Gates wrote, "needs to be done now to reach the populations that fuel the spread of the disease in India. For example, mobile populations - truckers, soldiers and migrant labourers - have HIV rates up to 10 times more than the national average and serve as a bridge from high-risk groups to the general population." He avers that India cannot face the challenge of AIDS alone.

The NIC paper builds on a December 1999 unclassified National Intelligence Estimate report on `the global infectious disease threat and its implications for the United States', which focussed on the spread of AIDS in the context of other infectious diseases. It unequivocally states that it would be difficult for any of the five countries to check their epidemics by 2010 without dramatic shift in priorities. The paper predicts that the rise of HIV/AIDS is likely to have significant economic, social, political and military implications on these countries. It would drive up social and health care costs in countries such as India and China. The NIC paper admits that its estimates of infection rates and their likely trajectories go beyond the official statistics as it incorporates the assessment of academics and non-governmental organisations (NGOs).

According to the paper, while China will have 10 to 15 million cases of HIV/AIDS by 2010, in India, 20 to 25 million people - the highest estimate for any country - are likely to be affected.

EVEN if the numbers are viewed as rough estimates as posited by the intelligence paper, they are quite large and the basis on which they were arrived at is unexplained. In a strong reaction to the report after a month of its publication, Union Health Minister Shatrughan Sinha said that although four million people in India live with the HIV, the projections made by the paper were inaccurate. He expressed surprise over the manner in which the figures were being "freely cited". According to Sinha, nationally the prevalence of the HIV was low, although "there may be pockets of high infection - six States of India have a generalised epidemic". He said that even in these States, there were districts where the rate of prevalence of HIV/AIDS in the general population is only about 2 per cent. The Minister's belated reaction has given rise to some curiosity as the NIC paper was given to the governments of these five countries at least two months ago.

The agitation over the exaggerated figures arose after an independent non-governmental organisation, the Joint Action Council, claimed that there was a link between Gates' largesse and the panic that had been whipped up over AIDS figures. Council convener Purushottaman Mulloli said: "Gates' interest in HIV projects in India is not meant for charity but to protect his billions of dollars of investments in pharma companies interested in conducting field trials in India". The NGO suggested that the Bill and Melinda Gates Foundation had funded the NIC partly. However, during the visit, Gates denied this and refused to get drawn into the number controversy.

More importantly, the NGO had to remind the Indian government and the Union Health Ministry that the Indian position had been that while the epidemic was still spreading in the country, there had been a gradual decrease in new infections. According to the HIV estimates for the year 2001 prepared by the National AIDS Control Organisation (NACO), while the estimates of HIV infections stood at 3.91 million, there had been no substantial increase in the number of new infections over the three-year period from 1998 to 2000.

The NACO report stated: "Over a period of time, the new infections may reduce to a negligible number, which is an indicator of the plateauing of the epidemic."

Another paper, brought out by the Washington-based Centre for Strategic and International Studies (CSIS) and called "The destabilising impacts of HIV/AIDS", talks about a second wave threatening India, China, Russia, Ethiopia and Nigeria. But the CSIS project is being funded by Gates.

The paper talks about a "global war" against AIDS and proposes a set of security-specific initiatives to mitigate the destabilising consequences of HIV/AIDS. But the paper's assessment of governance in the five countries seems derogatory. About India, the paper says that health officials are racing against time. "They face weak institutions, significant cultural barriers to education and prevention and a relative shortage of funds. Above all, they face dense bureaucratic barriers and what is to date a conspicuous lack of leadership at high political levels," the paper observes. The paper further states: "Considering India's military and strategic importance, the United States has a strong national interest in offering technical assistance and friendly persuasion to build the high-level political commitment necessary to prepare a sufficient response."