The epicentre

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(This is a sidebar to The coming epidemic, an article about the AIDS epidemic in India, and part of a special package on Indian science called Nature Outlook: India.)

In Bangalore, the bustling capital of the southern state of Karnataka, people drive shiny new cars, work in gleaming new buildings and carry mobile phones. Just a few hundred kilometres north, the residents are poorer than many in sub-Saharan Africa. In Bangalore, dubbed India’s Silicon Valley, the land is green, but here it is brown and dry. This is the home of one of India’s two AIDS hotspots.

“Someone’s got to wake up to the fact that there are two Karnatakas,” says Ashok Alexander, director of Avahan, the Bill & Melinda Gates Foundation’s AIDS programme in India.

Driven by poverty and unemployment, women from northern towns such as Bijapur and Belgaum travel across the border to work as prostitutes in the richer cities in the adjoining Maharashtra state. When they return home, they bring the money they’ve earned — and HIV. On a map (right), the districts along this ‘AIDS corridor’ are immediately visible. “This is the epicentre of the whole Indian AIDS epidemic,” Alexander says.

He has discussed his theory with several people in the government. “We entirely agree with him because those pockets are surely high-prevalence,” says S. Y. Quraishi, director-general of the National AIDS Control Organization.

Yet until Avahan — meaning ‘call to action’ in Sanskrit — was launched in April 2003, Karnataka was largely ignored by AIDS groups. Most donor agencies ‘adopted’ other high-prevalence states: the US Agency for International Development earmarks its money for Tamil Nadu and Maharashtra, for instance, and Britain’s Department for International Development champions states such as Andhra Pradesh.

Avahan has already spent more than US$17 million working with sex workers, truck drivers and drug users. It is also backing research on migration patterns in the corridor, large-scale surveys to measure behavioural changes and mathematical models that chart the epidemic’s course. “We’re going to be here as long as it takes to make an impact,” says Alexander.

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