THE Indian subcontinent is a major cause of concern in the global AIDS epidemic, with India alone accounting for two-thirds of HIV cases in the whole of Asia, according to a new report by the United Nations released Tuesday.
The world's second-most populous nation has overtaken South Africa as the country with the most people living with the HIV virus, the specialised agency UNAIDS said.
An estimated 5.7 million Indians were infected by the end of 2005, the Geneva-based body said in its biennial study of the global epidemic.
That compared with an estimated 5.5 million people in South Africa, which is grappling with one of the highest infection rates per capita in Africa, the hardest-hit continent, said UNAIDS.
However, India's overall rate of adult infections paled compared to South Africa's because of the relative size of the population of the two countries.
While 18.8 percent of South African adults were living with HIV, the figure in India was 0.9 percent.
Overall, Indian HIV cases accounted for two-thirds of Asia's total. Estimates of total deaths in India since AIDS was first identified globally in 1981 range from 270,000 to 680,000.
Most of the infections there were caused by unprotected heterosexual intercourse, according to UNAIDS.
States in southern India have traditionally been the hardest hit by the disease: in Tamil Nadu, for example, HIV rates of 50 percent have been found among prostitutes.
However, these regions have also made strides in fighting the disease. Tamil Nadu scaled up prevention efforts in the 1990s.
In northern states, injecting drug use was the main driver of HIV infection, and there was little or no progress in cutting rates there even though they were lower than in the south, said UNAIDS.
Nationwide, only seven percent of Indians who needed antiretroviral HIV/AIDS drugs were actually being treated last year.
In addition, only 1.6 percent of pregnant women who needed treatment to prevent mother-to-child HIV transmission were receiving it.
UNAIDS also sounded a warning about neighbouring Pakistan.
Around 85,000 people there were estimated to be infected with HIV by the end of 2005, representing just 0.1 percent of the adult population. Deaths due to AIDS reached 3,000.
Drug use was at the core of the problem in Pakistan, said UNAIDS.
"The country will need to improve its prevention efforts if it is to avoid serious HIV outbreaks", the agency said.
Only two percent of HIV-infected people in Pakistan were receiving antiretroviral drugs, UNAIDS said.
Elsewhere in the region, an estimated 75,000 people -- 0.5 of adults-were HIV-infected in Nepal.
In Bangladesh, HIV rates remained low -- 11,000 people, or 0.1 percent of adults-thanks in part to prevention efforts which have focused on homosexual men and female prostitutes, said UNAIDS.
In Sri Lanka, around 5,000 people were estimated to be living with HIV, or less than 0.1 percent of adults.
Another report from Washington says: Rich donors must lavish as much as 70 billion dollars in extra annual aid to curb killer diseases that are ravaging poorer nations, the World Bank said.
It said in a new report that without much more aid and far better healthcare policies in the developing world itself, United Nations targets to slash diseases cannot possibly be achieved.
"The global estimates of what it would cost to achieve the health Millennium Development Goals range from an additional 25 billion to 70 billion dollars a year, much of which must come in the form of aid," it said.
The MDG targets, set by world leaders at a 2000 summit, include a goal to halt and begin to reverse the spread of HIV/AIDS, and the incidence of malaria and other major diseases, by 2015.
They also envision cutting by two-thirds the mortality rate among children under five, and to reduce by 75 percent the ratio of women who die during childbirth. Roughly 500,000 women die annually during pregnancy and childbirth.
Yet the World Bank said the funds now being devoted to healthcare in the developing world fall woefully short, as does the patchy approach to the problem by both donors and poorer governments themselves.
"Many studies show that just throwing money at the problem is not going to solve it," Pablo Gottret, a World Bank senior health economist and one of the report's authors, told AFP.
"Unless we get our act together and make sure that aid is given appropriately, then we're not going to get a lot of additional aid in the first place," he said.
In its own report Wednesday, the World Health Organisation said poor countries should waive patent protection and turn to cheaper generic copies of drugs to tackle millions of deaths caused by chronic diseases every year.
Treatment on diseases such as diabetes, cardiovascular problems, epilepsy and asthma needs to grab some of the attention from the higher profile given to infectious diseases such as HIV/AIDS, tuberculosis and malaria, the WHO said.
According to the World Bank report, rich nations spend 100 times more on health per person than low-income countries, even though the world's poor are "under siege" from 90 percent of the disease burden.
Three million people died from HIV/AIDS last year alone. Average life expectancy in Africa is now 47 years of age, but would be 62 years without the ravages of HIV/AIDS.
"Worse still, most of the meagre health spending in developing countries is paid by poor people themselves because most poor countries cannot provide their citizens with even the most basic essential health services," the report said.
To have a meaningful impact, the 20 poorest countries would have to triple or quadruple their current spending on healthcare, the report's authors said.
Rich donors share some of the blame for throwing their money at high- profile healthcare causes without always taking poorer countries' needs into account.
The report said that ear-marking development aid for specific diseases can be effective when developing countries have too little money to finance their health budgets.
"But as their health systems develop, having separate mini- health systems for each particular disease can lead to waste and inefficiency.
"Moreover, given the severe shortages of trained health workers in many African countries, these programmes compete with each other to hire away the few skilled professionals needed to run public health systems."
Developed countries are not immune from trawling the developing world for scarce healthcare workers.
There are more Nigerian doctors in New York than in Nigeria, more Malawian doctors in the English city of Manchester than in Malawi, noted the report's other author, George Schieber.