Activist campaigns to stave off AIDS calamity in India

"No one should get infected because no one told them about (HIV)," Magry says

In this story: Schools initially resisted AIDS spread quickly in India Politics, culture impair prevention Poverty complicates battle RELATED STORIES, SITES

By Kevin Drew
CNN Interactive Editor

ATLANTA -- Having been a nurse for most of her life, Sujatha de Magry has developed a professional acceptance of mortality.

But an AIDS patient's slow march to death so moved her that she has ever since been demanding better care for India's growing number of HIV and AIDS patients and better prevention efforts.

"When I first saw an AIDS patient, I said 'What's the big deal? He looks fine, he has no obvious sickness'," Magry said.

That attitude changed as the person's health degenerated. "To see someone who's sick, who has absolutely no hope, how it affects the relatives, is something that is unimaginable," she said.

AUDIO Sujatha de Magry says accurate statistics about HIV and AIDS are not available 684k/32 sec. AIFF or WAV sound De Magry says she looks at the individual victim 654k/30 sec. AIFF or WAV sound     RESOURCES Leading nations by cases Deaths from HIV/AIDS     MESSAGE BOARD AIDS prevention

With international experts warning that India could become the AIDS epidemic's next battleground, Magry is at the forefront of a campaign to educate her nation's public about the disease.

"No one should get infected because no one told them about (HIV)," she said.

Schools initially resisted

Magry was in the United States in September, winding down her involvement with the International Services Association in India (INSA/India) and its parent group, Atlanta-based Global Health Action.

First trained as a nurse in the 1950s, Magry, 65, graduated from INSA's International Health Program at Atlanta's Emory University in 1975. She has served as program director for INSA/India since 1982, helping run the group's training programs for village health workers in India, Bangladesh and Nepal.

Magry said it was her work with INSA/India that led her to a 1989 AIDS conference in Nashville, Tennessee. In 1991, she wrote to 400 schools in Bangalore to offer to educate children about HIV and AIDS.

She met with resistance, she said, "because they did not understand the severity of the disease. Only 36 of them replied, 34 of them agreeing to the idea and two of them condemning me."

"In 1990, very few people knew about AIDS," Magry said. "We just plowed ahead. Our attitude was, 'Let's start with those who are going to accept us.'"

By 1992, Magry and Global Health Action had started one of India's first HIV/AIDS education and prevention programs.

The group initially was concerned with teen-age students. Magry said that with eighth-graders her group discusses hygiene and substance abuse. With ninth- and 10th-grader, talks deal in more detail with reproductive health, drug abuse, AIDS and other sexually transmitted diseases.

Today, sex has almost become part of the curriculum in many schools, Magry said.

Magry's organization has expanded to reach out to street children, prostitutes and gay and lesbian groups. HIV and AIDS information is now included in INSA/India's health care programs in various youth and women's clubs, and the group has included HIV/AIDS information in its training of health care workers.

Nonprofit groups use a variety of resources, including illustrations, to teach about health issues in India

AIDS spread quickly in India

India's first case of AIDS was recorded in 1986. But the disease has spread quickly.

A 1999 report by UNAIDS, the United Nations agency confronting the global AIDS battle, estimated that 3.7 million Indians are infected with HIV -- 0.37 percent of the country's estimated population of about 1 billion. By comparison, the Centers for Disease Control and Prevention estimates that in the United States 900,000 people, or 0.33 percent of the population, are HIV-infected.

Magry said the situation may be far worse than the UNAIDS estimate indicates. She said the figure could be 5 million or greater.

Though low by comparison, the UNAIDS estimate is high enough to give India 60 percent of Asia's HIV cases.

"Nobody really knows, especially in the rural areas," Magry said. "We do not have accurate statistics, and the surveillance done is very, very selective. Statistics won't give hard facts, only projections."

The United Nations estimates 35 million to 40 million Indians could be infected in another five years. This prompted the director of the World Health Organization in September to warn that India's next big health battle -- with the nearing eradication of polio and leprosy -- could be against AIDS.

Politics, culture impair prevention

A deeply conservative country, India has had problems addressing many of the issues linked to AIDS, such as intravenous drug use, homosexuality, prostitution and teen-age sex.

International organizations and workers in India's non-governmental organizations have repeatedly butted heads with an Indian government that has accused groups of irresponsibly inciting fear about the number of AIDS cases in the country.

India's Health Ministry objected to a UNAIDS report released earlier this year that put at 310,000 the number of deaths that occurred in India due to AIDS in 1999. India's National Aids Control Organization said only about 11,000 deaths could be attributed to AIDS in India during that period.

Public awareness of AIDS has been slow to develop in India, Magry said. Reports have come into her office of small communities running out of town a family with an AIDS sufferer.

Some physicians and hospitals have refused to admit an AIDS patient, she said.

"They're scared that if the general public knows that they have an HIV case in their hospital, others (patients) may not come," she said. "If people could be given enough information, a lot of the problem could be overcome."

Candid discussions about sex by women's groups are increasing in India

Poverty complicates battle

The cost of medical care is also complicating the battle in India.

Magry said anti-AIDS cocktails are priced out of the reach of the average Indian. According to the All India Institute of Medical Sciences, a patient in India would need to spend 44,000 rupees (US$1,000) a month for anti-AIDS drugs. By the late 1990s, fewer than 5 percent of all Indian households had an annual income equivalent to $2,300.

But Magry said many Indian doctors have developed similarly effective treatments based on domestically produced drugs. "Western drugs are extremely expensive and it would be totally unrealistic for us to even think of making Western drugs available," she said.

With the AIDS problem growing, India's government has shown signs that it may be changing its attitude toward the AIDS problem. A 1999 government report acknowledged that in 1998, an estimated 3.5 million cases of HIV and AIDS could be confirmed. In addition, the Indian government is now taking part in the international anti-AIDS efforts.

Civil organizations -- associations of prostitutes, rights groups and some journalists and media organizations -- have been responsible for some of the most effective and supportive efforts on HIV in India.

A widespread public movement, rather than a donor-driven one, is needed to combat HIV and AIDS, Magry said. As part of that effort, Magry said her organization has held seminars for many of India's Hindu, Muslim and Christian leaders.

But Magry has not lost sight of the individual patient's suffering.

"Personally, I'm not interested in statistics," she said. "Because it doesn't matter if it is a thousand, or a million, or 5 million that are going to be infected. When a person becomes infected, it is just that one person. He or she will not draw comfort from the fact that she's among 5 million others."

India immunizes millions in massive polio campaign
September 24, 2000

AIDS-India.org
Global Health Action
UNAIDS - Asia
Global HIV/AIDS & STD Surveillance
World Health Organization
India Government Resources

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