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Resource centre on India's rural distress
 
 

Gates Foundation’s AIDS Program in India Has Made Uneven Progress Over 8 Years by Donald G McNeil Jr.


A large and costly AIDS prevention program that the Bill and Melinda Gates Foundation pioneered in India eight years ago has had mixed results, according to a preliminary analysis published on Monday in The Lancet.

The foundation spent $258 million on the program from 2003 to 2008. It has since put in $80 million more, but is shifting responsibility to the Indian government.

The program, called Avahan, focuses on high-risk groups, like drug addicts, gay and bisexual men, and prostitutes and their clients, including truckers. It pays for education campaigns, safe-sex counseling, syringes, condoms and treatment for other venereal diseases. (Above, a sex worker at a prevention meeting.)

When the program began, it was assumed that India, with its huge population and government officials reluctant to discuss the problem, would quickly surpass South Africa as the country with the most AIDS cases. A 2007 household survey allayed those fears; the epidemic had stayed largely within the risk groups. India is now thought to be in third place, behind Nigeria.

Avahan operates in six Indian states, and the analysis, by epidemiologists from India and the University of Washington, concluded that infections dropped significantly in three populous southern states, a little in Tamil Nadu, and not at all in northern Manipur and Nagaland. It did not suggest a reason. The epidemic is driven in the south by sexual transmission and in the north by drug injection.

The authors estimated that the program prevented 100,000 infections, at a cost of about $2,500 per infection prevented — not cheap, but far less expensive than the lifetime cost of treatment.