The lawns of the restaurant at the Mahalaxmi Race Course in Mumbai was crowded. Dr I S Gilada welcomed the guests who had assembled to celebrate the 20th anniversary of the Public Health Organisation which he founded and nurtured. Long before AIDS activism became fashionable in India, the Public Health Organisation -- born the Indian Health Organisation -- worked to highlight the condition of thousands of HIV-affected Indians.

Dr Gilada claims his organisation is the largest AIDS NGO in the world. On the occasion of World AIDS Day, the AIDS activist spoke to rediff.com Special Contributing Correspondent A Ganesh Nadar at his office in south central Mumbai.

Is the Indian government playing down the AIDS crisis? Do you think there is an AIDS crisis in India as stated by Bill Gates and Jeffrey Sachs recently? What is the true dimension of the AIDS crisis in India?

The government is hiding the facts, not out of ignorance but out of indulgence. Earlier, you could say they were hiding figures out of ignorance, but now you cannot say that. It is 17 years since we first diagnosed a case of AIDS in India. Earlier, they did not have the technical expertise or guidance. Now the knowledge is much more. It is a mature education now. From high risk groups the AIDS virus has spread to children and to the low risk category.

Now if they say there is no big problem, then it is not right. They might be under some political compulsion. They must be thinking our image will go down. Our industry will go down. Tourism will go down. Outsiders might think India is a land of AIDS. If you take the percentage into consideration we might be 52nd or 54th in the world. But because we have such a large population that is more than double the population of sub Saharan Africa. A slight change in percentage is a large number for us.

We have the largest number of AIDS victims in the world because of our population.

Our government plays a double game. In 1991 they said we have an estimated 100,000 HIV cases. At that time our estimate was one million. In 1992 when the World Bank said they have $80 million to fight AIDS the Government of India said we have 1.6 million cases. In one year they increased the estimate 16 times. At that time we were saying 2 million.

In 1996 at the International Aids Conference in Vancouver, UNAIDS said India had the largest number of patients in the world estimated at 4 million. The government endorsed that view. In 1997 government official Prasad Rao went to Manila for a AIDS conference and said, 'My aim is to protect 99.5 percent of the population and look after 0.5 percent.' There, he admitted we had 5 million cases.

But in Durban two years later UNAIDS changed the figures. They said South Africa had more patients than India. Even today they are saying 4 million. They do not want to cross that figure while the AIDS virus has travelled from the urban to the rural, from the high risk to the low risk, to children.

My estimate is currently it is not less than 10 to 12 million. The only consolation is it is not increasing at the speed it was increasing earlier. Earlier, it (AIDS cases) was doubling in one to two years. Now it takes 10 years to double. In Mumbai it has plateau-ed. From 0.1 percent in 1987 it increased to 2.1 per cent in 1997. Now it has decreased to 1.68 percent. It has remained constant.

Do you think if the real figures were published, then a fear wave would prevent further spread of the virus?

If the disease was one where people die in two, three days like plague, then people would get scared. In HIV we cannot fool people.

Which are the worst affected states in India?

Maharashtra, Andhra Pradesh, Tamil Nadu, Karnataka, Manipur and Nagaland.

In your estimate, how many people die of AIDS a month in a city like Mumbai?

10,000 deaths a year, about 800 every month.

How many children are orphaned by AIDS every month?

Every day about 2,000 to 3,000 children are orphaned. At the end of the decade this will go up to 8,000 to 10,000 every day.

You have been working in this field a very long time. How has the treatment of AIDS changed over the years?

In 1991 it was called a ghastly, deadly disease. Now it is a chronic, manageable disorder. Earlier, it was one way. Now, it is not. Then it was HIV to AIDS to death. Now it is two way traffic. We can pull back a patient who is dying to AIDS, to HIV and then maintain him as HIV and prevent him from going to AIDS. Three years back, the cost of treatment was Rs 30,000 to Rs 40,000 a month. This has come down to Rs 1,500 a month. It has become affordable.

Earlier, only 2 percent of patients could afford treatment. Now 31 percent of victims can afford it.

What about the attitude towards AIDS patients? Has it changed over the years? Are hospitals still refusing to treat patients?

The stigma against AIDS continues. Many hospitals still continue to refuse treatment. But the situation is better than it was before. In a city like Mumbai the patient does have a good choice from high level hospitals to cheaper ones. I am not saying every doctor will care for you but there are some who will. The care you get in Mumbai is not available in the rest of the country. Mumbai should not be called the AIDS capital of India. It should be called the AIDS manageable capital of India.

How has the personality of the AIDS victim changed in India?

Earlier, they used to have a lot of negative reactions. Suicide, running away from home, hiding from society was the trend. Now it is better. People even marry, earlier they couldn’t even think of marriage. Now they feel they will survive another 10 years and this gives them hope. Thus, they continue to work. Earlier, they used to stop working, sell their properties and close down their businesses.

Earlier, there was a perception that HIV only attacked the poor and homosexuals. Now the middle class and upper class too are affected in India.

In America it did start in the homosexual community, but not in India. Here it started in the heterosexual community, the blood donors and recipients. It is there in all strata of society. But those who have access to information will be able to control it. And those who are unaware will continue to spread it.

If you had to quantify AIDS according to the strata of Indian society what percentage would you give each strata of society?

Those who have access to information will be safer than the ignorant. From a religious point of view, Muslims will be safer for two reasons. One is circumcision, the other is their habit of washing their genitals every time they relieve themselves or have sex. I am not suggesting that everyone has to be circumcised but they can at least wash themselves every time.

You must pick up good habits from everywhere.

How did the government react to AIDS in the beginning?

The government moved very slowly. Only once did they campaign very fast but the campaign was withdrawn equally fast. On International Aids Day they put up big advertisements in the national dailies with photographs of ministers. What is the point of putting ads in The Times of India? Times of India readers already know about AIDS. They should put these messages in regional, language newspapers and also think of people who do not read any paper.

When did the government start taking AIDS seriously?

In 1985 when I spoke about AIDS the health ministry was not bothered. In surgery we have a saying, 'The eyes do not see what the mind does not know.' It was a head in the sand attitude. In 1987 we met Rajiv Gandhi. He was enthusiastic but after him the momentum was lost. One government started a television campaign. Sushma Swaraj was the IB minister for only 11 days. She said our people don’t need it and stopped it. It hasn’t started again. If we take a moralistic or judgmental view then it will not help.

What do you think was the biggest step the government took to fight AIDS?

The biggest step was when the prime minister had a special meeting with MPs to discuss AIDS. The sad thing is only a dozen MPs turned up.

Which state is fighting AIDS best?

Tamil Nadu and Goa have done the best work. The Tamil Nadu government has always been proactive with NGOs. Goa is a small state. When Romesh Bhandari was governor he asked us to do something and we covered the whole state in two years.

Do you think the government is spending enough money on fighting AIDS?

The government has not spent any money. They spend only what comes from the World Bank. Sometimes the money lies unused. Sometimes it is abused, and sometimes misused.

If Bill Gates asked you, 'Dr Gilada, how should I use my $100 million to fight AIDS?' what would you tell him ?

I would tell him not to give any money now. Call the NGOs and work out a minimum programme. What could be done to create awareness, what could be done to train people, and what could be done to cure people. Find out which NGOs can do better work. Make a vigilance committee of public people, journalists, police, NGOs. Everything should be transparent. You must give a press release which tells you these NGOs are receiving so much money to do this. There should be a code of conduct. People who sit on these committees should not apply for funds from this money. Like if I am on that committee my PHO should not receive money neither should my brother.

Where do you think the money is best deployed?

In education, awareness and prevention. One percent is affected. If you care for them the remaining 99 percent is safe.

The government is asking Mr Gates for cash instead of medicines. Do you think that is a valid demand?

It is a valid demand. We can get the same medicines here cheaper. If you buy it elsewhere then you have also to pay for transportation.

Do you agree with Mr Gates' observation that AIDS can affect India's future?

One person with AIDS in a family can destroy the family. In AIDS it is the bread winner that gets it. Five years from now it will be a big problem. Ten years from now it will become worse if we don’t take preventive steps.

What are the five steps you would suggest we do to fight AIDS?

The most important thing is to accept the problem. Once you accept the problem you can solve it.