Not very long back, a strange controversy engulfed the Indian health ministry prior to and during the Microsoft magnate's visit to the Subcontinent. The subject was HIV/AIDS and apparently Mr Gates had alluded to a CIA report in one of his widely circulated write-ups on the magnitude and the trajectory of the infection. Two reports, one of the National Intelligence Council (NIC), a United States government organisation, and the other by a private institution, partly funded by the Bill and Melinda Gates Foundation, had predicted a large number of HIV/AIDS cases in some developing countries including India and China. Mr Gates had extensively quoted from the former report, which was titled 'The next wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India and China'. The next wave countries, the report noted, were likely to seek greater technical assistance from the US in tracking and combating the disease. For many it did not seem an irony that despite a being self-sufficient democracy and a sovereign state, India had in the new millennium to take counsel from corporate heads on how to manage and prioritise its health sector.
The NIC report also suggested that if an effective vaccine were to be developed in the coming years, Western governments and pharmaceutical companies would come under intense pressure to make it widely available. The two reports projected India as one of the biggest pockets of the infection by the year 2010; the NIC report put the number at 20 to 25 million HIV cases, the highest estimate for any country. The Bharatiya Janata Party (BJP) led government, which otherwise goes completely ballistic with jingoistic fervour on issues of cultural nationalism, found nothing amiss in these prognostications as long as they had not entered the public domain of discussion. Once they became known, much credit for this goes to a non-governmental organisation called the Joint Action Council, it became difficult to obfuscate the implications of such intelligence reports for any sovereign state. The union health ministry, under the charismatic Bollywood actor Shatrughan Sinha (who was recently relieved from his cabinet responsibility), issued a denial regarding the 2010 projections.
But interestingly, the prognosis of the NIC and similar such reports have been taken very seriously by the Global Fund for AIDS, Tuberculosis and Malaria, a multilateral public-private partnership, and coincidently, the United States recently assumed the chair of the Global Fund board. This fund has committed USD 866 million over the next two years in the form of grants to 60 countries, India included, and a major part of the funding will go to non-government organizations, leaving elected governments very much without control. The Indian government has of course welcomed this largesse – national pride can be set aside – and is willing to play second fiddle or what is called in sanitised terms – a complementary role. Currently, India spends USD 300 million on the National AIDS Control Programme, and has taken a World Bank loan of USD 191 million. Multilateral and bilateral development agencies support the HIV/AIDS response at state and central levels.
Threats from the second wave
But what is left unsaid is that even if the Indian cases constitute 10 percent of the global HIV burden and are deemed to merit global sympathy and largesse, the government's national health policy recognises a totally different list of priorities for the health sector. And AIDS is only one of those concerns, though most of the time it seems to be getting all the attention. If tuberculosis (TB) has attracted attention, it is mostly because of its association with AIDS. Another aspect is that since there has been a resurgence of communicable diseases even in the developed world, the global concern should reflect as much. The developing countries are after all seen as pockets of disease. Therefore, if HIV/AIDS has become a national security threat to the US, as per a paper (jointly funded by the Gates' foundation and the Catherine Marron Foundation) prepared by a Task Force of the Centre for Strategic and International Studies – a Washington DC based organisation – then it becomes a global threat. The paper is called 'The Destabilizing Impacts of HIV/AIDS – First wave hits eastern and southern Africa, Second wave threatens India, China, Russia, Ethiopia, Nigeria.