Giving Hope
Melinda Gates is sitting cross-legged on the bare floor of a Calcutta slum, holding hands with some of the world's poorest and singing a civil-rights anthem. "We shall overcome," chant 14 AIDS-outreach workers squatting around her. "We shall overcome, we shall overcome, someday ..." The singing stops for a moment and Gates tries to stand, but the singers have a firm grip on her and are determined to finish the last four verses. "Oh, we are not alone," they start again, pulling a laughing Gates back down to the floor. "We are not alone, today ..." Granted, a moment of connection cannot bridge the huge divide between a multibillionaire and paupers with holes in their shoes. But the Gateses are serious about tracking what happens to their donations on the ground in India. Melinda Gates remarks: "One thing you can say about Bill and I: when we decide to take something on, we're very possessive about it."

That degree of engagement is almost unheard-of among India's own financial élite. In a nation divided by caste and wealth, rich Indians in their Bombay mansions and Bangalore estates exist in a world apart from the poor. A constant complaint of Indian charities is that the well-developed Indian sense of duty to family and religion extends no wider. "Where is philanthropy, where is civil society? Why is Big Business doing nothing about AIDS?" asks Avahan's Alexander. NACO director general Quraishi agrees: "I had one CEO tell me that millions dying in Africa was very sad, but why should he worry about 10 or 20 deaths in India? Frankly, the corporate sector doesn't understand."

There are exceptions. Parmeshwar Godrej, whose husband Adi Godrej runs a billion-dollar manufacturing empire called the Godrej Group, is setting up a national AIDS-awareness campaign with actor Richard Gere. She bridles at the idea that her activism is atypical and that the indifference of rich Indians to AIDS has obliged a foreigner like Bill Gates to intervene. Yet while the Godrejs have provided office space for this campaign, their funding—as with so many other AIDS projects in India—comes entirely from Gates. India's AIDS pioneer Dr. Solomon says that while Godrej has signed up two big Indian names—cricketer Rahul Dravid and Bollywood superstar Amitabh Bachchan—to help publicize the AIDS issue, it's proved impossible to persuade prominent Indians with the disease to speak out as, say, basketball star Magic Johnson did in the U.S. "I treat film stars," she says. "I try to persuade them to [speak] out. But nobody will."

Silence about AIDS is standard in India—and not just among celebrities with the disease. NACO says that of the 5.13 million Indians officially estimated to have HIV and AIDS, only about 100,000 have braved the stigma to come forward for treatment. Such secretiveness makes it all the more difficult to get any accurate sense of how widespread the disease has become. Nowhere is this lack of information more unsettling than in the adjoining central and eastern states of Uttar Pradesh (U.P.) and Bihar, the hindu heartland along the Ganges. Research has shown that AIDS tracks the poor in India: poverty turns fathers into migrants, mothers into sex workers, and leaves health care out of reach for most. And these two states, home to 250 million people, are marked by an enduring destitution that keeps average annual wages as low as $166 in U.P. and $105 in Bihar. That would suggest AIDS would be especially prevalent there. Yet NACO's statistics claim U.P. had only 1,383 AIDS cases by April this year, and Bihar a mere 155. The experts are incredulous. Says Solomon: "U.P. and Bihar must be hot spots. They have all the ingredients. But the state governments still deny the disease is there at all."

While that denial persists, India has much to fear. Yet there are seeds of hope in its growing scientific prowess. India is the world's leading producer of generic drugs for the treatment of AIDS. It is also one of eight countries currently conducting human trials of an AIDS vaccine: the Indian Council of Medical Research announced last month that the first round of IAVI's tests had been successful, and predicted a marketable vaccine within five years. Yet neither drugs nor vaccines will help without government funding for distribution and subsidies to make them affordable. The bulk of India's treatment medicines, for instance, is currently exported to Africa.

Manmohan Singh's government is now readying a bill outlawing discrimination against people with HIV and AIDS, and Berkley of IAVI says the support New Delhi has given IAVI is "unique." Enlightened self-interest underlies the government's concern, said Gates: "India is really on the rise and, other than a war, this is the only thing that could stand in the way." But there is an enormous amount still to do. The Gates Foundation says India currently spends just $7 million a year on HIV/AIDS. Even including money from donors like Gates, India's average expenditure on the disease is just 29¢ per head, compared with 55¢ in Thailand and $1.85 in Uganda. As Richard Feachem, head of the Global Fund to Fight AIDS, Tuberculosis and Malaria said last month, unless "something big or serious" happens to transform and accelerate India's war on AIDS, "millions and millions and millions of Indians are going to die." It's not hard to figure out one big, serious thing that India needs to do: recognize and admit to the scale, complexity and hidden social underpinnings of a crisis that could yet wreck its golden prospects.

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