India: World's Richest Men Tackle World's Worst Epidemics

India, with more than 1 billion people, has some 5.7 million HIV/AIDS cases, making it the country with the most HIV/AIDS patients in the world. The Bill and Melinda Gates Foundation's effort in India, called Ahavan, has a $200 million five-year grant to operate an HIV prevention program. "Ahavan" means "call to action" in Sanskrit.

The AIDS fight in India could easily cost $1.5 billion a year, according to Ashok Alexander, the foundation's India director, citing U.S. government figures. The challenge is complicated by the fact that the sex trade, a main route of transmission, is nearly invisible. Prostitutes often work out of truck stops or small village homes, and sex workers move from city to city.

In the country's remote northeast, near the poppy fields of the Golden Triangle, HIV is transmitted mainly by heroin users sharing needles. Logistics are difficult in rural areas lacking basic infrastructure.

Another difficulty is the stigma attached to HIV/AIDS. Ahavan has adopted a businesslike structure, with a pyramid strategy to get the product -- prevention -- to consumers. It contracted with 15 organizations that work, in turn, with about 150 grass-roots groups. The groups employ some 5,000 prostitutes, many HIV-positive, to get the message out.

Using sex workers ensures quick feedback when there are problems. "In talking with sex workers, our team found that the women felt the condoms available in the market did not suit them," said Sanjeev Gaikwad of Family Health International, which runs a Gates-funded clinic. The group asked for stronger, better-lubricated condoms, which it now distributes.

"The [Gates] foundation is one of our major partners in helping us reduce the transmission of the disease," said Sujata Rao, director general of India's National AIDS Control Organization.

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