AIDS Out Of Control In India
AIDS is out of control in Africa, and everyone knows it. But by some estimates, the most AIDS-infected country is no longer in Africa.
It's in Asia, and the country is India -- our closest ally in a dangerous part of the world. In fact, it's perhaps the only country in that region that has not been infected with al Qaeda.
But according to a CIA report, if the epidemic isn't contained soon, it could come back to haunt us -- weakening India's army, and damaging India's economy, which is closely tied to ours.
nd it could even lead to a new epidemic of the virus back in the United States. Correspondent Bob Simon reports.
Nobody is more aware of what the scourge of AIDS could do than Colin Powell, as he told the UN more than a year after 9/11: "AIDS is more devastating than any terrorist attack, any conflict or any weapon of mass destruction. AIDS can destroy countries and destabilize entire regions."
One of those regions is Africa, where in some places, 1 in 4 soldiers is infected with HIV -- putting the very stability of the continent at stake.
The CIA says India could be next -- a nuclear power and a key ally in the war on terror in a part of the world where al Qaeda has a strong foothold.
That's one reason CIA director George Tenet has taken notice of the AIDS epidemic. "The national security dimension of the virus is plain," says Tenet. "It can diminish military preparedness and further weaken beleaguered states."
That hasn't happened yet in India, but it could if the epidemic spreads any further. Experts say India is close to the tipping point -- after that, the virus will have spread too far to be contained.
Right now, it's still India's prostitutes who have been hit the hardest. A local outreach doctor showed 60 Minutes around Bombay's red light district, where we found a madam who says she just lost two girls to the disease.
Most of the women were reluctant to talk about AIDS. The few that did, however, said condoms, the only thing between them and virtual-certain death, are simply bad for business.
AIDS was first detected in India among prostitutes more than a decade ago, by Dr. Suniti Solomon. But she says that, as in so many parts of the world, the virus has spread well beyond the red light districts.
"I used to see one patient, new patient every week in 1991, 1992," says Solomon. "Today, we see 10 to 11 new patients every day."
That's why Solomon set up one of the first AIDS hospitals in India, in the southern city of Madras. They take anyone who walks in. "We don't throw them out," she says.
Solomon says roughly about 20 percent of their patients are truckers, because drivers at truck stops often frequent prostitutes – and, as 60 Minutes found when we spoke with them, many have little understanding of how the HIV virus is spread.
In fact, some truckers think bathing after being with a prostitute will do the trick, and they then go on their way making deliveries across this huge country -- delivering, among other things, the HIV virus to other prostitutes, and often to their own wives.
One trucker said he knew of drivers who had gotten HIV, but said: "If a person gets HIV, he doesn't go to the hospital, because people will come to know about it. And his wife will come to know about it. His friends will make fun of him; they'll isolate him."
That's why 90 percent of Solomon's female patients are not prostitutes, but monogamous women who've contracted HIV from their husbands. These are women like Periasamy Kousalya, whose husband from an arranged marriage was a trucker. He had HIV before they got married.
But Solomon says, even if this patient did know, women in arranged marriages often have little say about protection.
"You just can't talk about like she said on sex and sexuality," says Kousalya. "Girls don't want to know about it. And it's like immoral to talk about these things."
It's the same thing 60 Minutes found throughout our trip to India: men and women with some understanding of the virus, but not enough to stop it from taking on epidemic proportions in a country of a billion people.
"We have to save the next generation. We need to educate, we need to give information," says Kousalya. "But that doesn't say that you can sacrifice this generation of people with HIV Just if it happens to be your brother or sister or wife, I don't think an Indian or anyone in the world would say, 'I'd sacrifice that person.'"
And they may not have to, in large part because of Dr. Yusuf Hamied, who runs an Indian pharmaceutical company called Cipla, which makes inexpensive knockoffs of expensive Western drugs that have extended the lives of so many HIV-infected Americans.
"AIDS today is not a death sentence. It can be treated as a chronic illness, or a chronic disease," says Hamied.
But can American companies accuse Hamied of making knockoff drugs for India? "If I'm a pirate, I'm a thief. If I'm a thief, I must have broken some law. What laws have I broken," asks Hamied.
In fact, he hasn't broken any laws, at least not in India, because the country's loose patent rules still allow pharmaceuticals to be copied.
That's brought the cost of treating someone with AIDS down from $12,000 a year to less than $300.
Money, of course, is key to the whole AIDS dilemma, which brings us to Bill Gates. The world's richest man recently donated $200 million specifically to combat AIDS in India.
"This is the largest initiative focused on a single country we've ever done," says Gates.
"India's very important. It's the world's largest democracy. It's doing a great job in its educational institutions and developing a lot of programmers. Microsoft, my day job, has benefited from a lot of very smart people from India."
So has the United States. Indians field customer service calls from Americans. It has one of the world's largest software industries. It's one of America's key trading partners, and the CIA report warns that "The rise of AIDS will have significant economic... implications."
"India's on the brink of success. And one of the only things that stands in the way of that, achieving the incredible potential that India has, is making sure that there's not a widespread AIDS epidemic," says Gates.
For now, Bill Gates' priority in India, he says, is to save the next generation by funding AIDS education and outreach programs: "India faces a catastrophe that would set the country back a generation."
But what about this generation?
"I don't know where the Gates money will go," says Hamied. "Will he buy my medicines, or not? I don't know. I think you should put that question to him."
"Well, the focus that we have in India at this stage is prevention. That's our expertise, what we're bringing a lot of energy and visibility to," says Gates.
He's avoiding the whole touchy generic issue by concentrating on prevention, not treatment, because, he says, even the $300 price of a year's supply of generic drugs would not be cost-effective in India -- where the yearly health budget is around $20 per person.
But that's a big mistake, according to Solomon, who says her patients would never have come into the clinic for education and condoms in the first place if she weren't offering Hamied's generic drugs.
"Just preventing it doesn't work. People need to be taken care of. Otherwise, why will people listen to you," says Solomon.
The issue of treatment is at the heart of the CIA's threat assessment. If patients don't take their AIDS medications every day, strains of the virus could evolve which are resistant to the drugs, and that could make the expensive triple-cocktail therapy that has saved so many lives in America obsolete.
Solomon says that's more likely in India than in poorer AIDS-ravaged countries in Africa where patients often die without any treatment at all. Many of her Indian patients have some money for drugs to treat the disease -- just not enough to treat it right.
"They take it when they have the money. And they stop it when they don't have it. And what is going to happen to the virus over a period of time," says Solomon. "The HIV virus become resistant, and then it spreads back to America and all the other countries."
In fact, the CIA report says resistant strains of the virus "have spread around the world," in part because the triple cocktail drug regimen is not only expensive, but complicated.
But Hamied has a solution: By ignoring the patents held by the different big pharmaceuticals that manufacture the three drugs in the cocktail, he and other generics-producers have created an all-in-one pill that's much easier, and cheaper, to take.
"The reason we can do it is because the three drugs in question belong to three different companies," says Hamied. "I am able to put it all together. They can't. So, when you called me a generic, we may be generic. But in some cases, we are more advanced than even the multinationals."
After resisting to acknowledge its growing AIDS problem for years, this past December, the Indian government announced it plans to provide widespread treatment to infected people throughout the country.
"Now is the time to be very worried about this, to draw people together, to get the right resources. We can hold this to a very low level. This catastrophe can be prevented," says Gates.
Despite the CIA's warning, the U.S. government has focused almost all of its AIDS programs so far on the parts of the world where the virus is already out of control -- Africa and the Caribbean.
It has offered comparatively little money - less than 1 percent of the entire AIDS expenditure - to address the epidemic in India.