These numbers are thought to be underestimates, as the stigma attached to harboring the HIV virus precludes some individuals from being tested and treated. This stigma is perhaps particularly pronounced in India, where religious and social forces repress expression and discussion of sexuality.

The first documented case of AIDS in India was reported in Chennai in 1986. The ensuing debate about the appropriate legal recourse was varied and intense. Some officials called for the deportation of African students and outlawing sex with foreigners. Some members of the government offered to pay sex workers to retire, while others drafted legislation to tattoo HIV-positive sex workers and made public appeals for a return to traditional national values. The first legislation passed, however, was an HIV quarantine law. Because the disease was thought to have been imported by a tourist, the government felt that containment could prevent an outbreak. The ensuing legislation had the opposite effect. By mandating severe repercussions for those harboring the virus, the policies reinforced the stigma attached to the disease, and thereby discouraged individuals from seeking testing and clinical care. The law’s focus on foreigners as the souce of infections associated popular conceptions of HIV with the more sexually permissive West.

To combat the spread of AIDS, the Indian government created the National AIDS Committee in 1986 and launched the National AIDS Control Programme in 1987. In its first years, the program promoted public awareness through educational programs, conducted surveillance activities, and mandated blood screening during transfusions in AIDS hotspots. Since privatization had previously led to transfusions without screening, blood banks underwent a mandated licensing process designed to slow the transmission of AIDS, syphilis, malaria, and Hepatitis B. The government also sought to phase out professional blood donors and reduce the use of whole blood for transfusions, but the mandate was impossible to enforce due to the large number of successful private blood banks in the country.

In 1992, the Indian government formulated a multi-sectoral strategy for the prevention and control of AIDS. The program was implemented both at the national level through the National AIDS Control Organization and at the state level through local legislation. The strategy concentrated on surveillance, research, information, education, and communication in cooperation with non-governmental organizations. It also aimed to control the spread of sexually-transmitted diseases through condom distribution and blood safety education.

Educational campaigns were initiated but were few and far between, largely due to cultural aversion to discussion of AIDS-related topics. Within five years, government studies showed that awareness levels had risen from nothing to 80 percent in urban areas. Disappointingly, they remained around 30 percent in rural areas. This supposed increase in awareness calmed the government and reduced incentives for further action.

Widespread fear of the virus, fear of stigma, lack of available testing, low testing availability, and bias in testing groups generated faulty data and prevented the government from creating effective anti-AIDS programs. Literacy levels are especially low among women, undercutting the effectiveness of print-based educational programs designed to avoid awkward person-to-person contact. As a result, women do not know how to guard against HIV or negotiate condom use with their partners. Interviews with HIV-positive women have revealed that many understand the importance of condoms only after they are infected.

The widespread migration of AIDS to more progressive, larger cities, coupled with the public’s lack of awareness, has put strain on the hospital infrastructure in cities like Mumbai and Chennai. There have been cases reported in which AIDS patients were refused care in hospitals and nursing homes in the private as well as the public, government-sponsored sector. This is often due to the widespread misconception that AIDS is a simple airborne contagion, able to spread like the common cold. As a result of this misconception, some hospitals set aside entire wards for HIV/AIDS patients, which can prevent isolated individuals from seeking medical care.

The problem of testing aversion extends to other illnesses. According to the Indian Embassy to the United States, nearly 60 percent of reported AIDS cases are opportunistic tuberculosis (TB) cases. There are currently over 14 million TB cases in India, and a large percentage of these individuals are also HIV positive. This poses a severe concern because many of the drugs commonly prescribed for TB cause complications for HIV-positive patients. As a result, TB patients are often tested for AIDS, but this has caused large numbers of individuals to forego TB treatment for fear of an HIV diagnosis.

In Western states, some of the most effective preventative means have been condom distribution and needle exchange programs. In India, however, both are socially unacceptable due to the implications of condoning premarital sex and drug use. Nonetheless, commercial sex is on the rise in the Sonogachi part of Calcutta, as is the intravenous use of drugs in Manipur.

The government has intensified its educational campaigns and condom distribution, but these policies continue to fail. Some are unwilling to use condoms, women and the illiterate are unable to access print-based safe-sex information, and the culture of stigmatization discourages contact with educational campaigns. Some have suggested that India needs to revise its social standards. This could occur by a process of Westernization, but social reforms premised on India’s own religious roots would surely produce better results. A more traditionalist, cultural, and religious approach based on regional considerations is necessary. With 25 million lives at stake, it must happen now.