It is only in the past two years that the Chinese government has acknowledged HIV/AIDS to be a serious issue. In late 2001 the world media focused attention on the very high rates of HIV/AIDS prevalence in the central province of Henan. Henan is China's most populous province, apart from being the home of Mao. The severe AIDS outbreak here was apparently caused by blood-buying companies using unclean methods. These methods have continued. Blood donations have become a widespread source of supplementing incomes in many parts of rural China. The breakdown of the rural commune-based health system over the past decade and a half and massive urban migrations appear to be contributing to the crisis.

Not surprisingly, provinces adjoining Henan like Anhui, Heibei and Hubei are also suffering serious consequences. In other provinces like northwestern Xinjiang, HIV/AIDS has been spread on account of intravenous drug use. In provinces like Yunnan, Guangxi and Sichuan in the south and southeast, resurgence of prostitution is being seen as contributing significantly to the spread of HIV/AIDS. Yunnan is where the AIDS epidemic was first noticed and it is estimated that it accounts for almost half of all HIV/AIDS cases, although this could also be the result of better epidemiological monitoring. Just last month, Li Liming Director of the Chinese office of the US Centre for Disease Prevention and Control revealed that almost two-third of HIV/AIDS patients were infected through intravenous drug use and about one-tenth each through unsafe plasma sales and sexual transmission.

India too was in denial mode for long. But since the mid-1990s, an active National AIDS Control Organisation (NACO) with its counterparts in states has come into being. Unlike the Chinese programme, India's programme is better organized and better funded. NACO has been spending close to $ 50 million a year and this could increase to around $ 80 million a year during 2004-2010. This excludes whatever financial support organizations like the Gates Foundation are expected to provide to NGOs directly. But even with the involvement of such organizations, NACO's investments will drive the country's programme.

India's investment in AIDS control may appear impressive in relation to the numbers for China which vary currently between $ 15-25 million a year. But clearly NACO is substantially under-funded. One casualty of the under-funding is antiretroviral therapy which is not used by NACO since it costs around $ 1 per patient per year. Ironically, Indian companies are global leaders in anti-HIV/AIDS drugs. Other countries like Brazil, South, Botswana and now South Africa have made such therapy an integral element of their AIDS control efforts.

India's HIV/AIDS incidence has distinct regional variations with Andhra Pradesh, Karnataka, Maharashtra, Manipur, Nagaland and Tamil Nadu being the high-prevalent zone where epidemic levels may already have been reached, measured by HIV prevalence in antenatal women. Manipur and Nagaland suffer on account of intravenous drug use like in Xinjiang and Yunnan. That Manipur, Nagaland and Yunnan are close to Myanmar and Thailand has surely impacted on widespread drug use leading to high HIV/AIDS prevalence rates. India has also registered some successes. A very high rate of condom use in Sonagachi, for instance, is widely heralded as a major breakthrough for NACO, as has been the significant improvements in the blood supply chain all over the country. Political leadership has provided momentum to AIDS communication and control, especially in Andhra Pradesh and Tamil Nadu. It has also helped that India's most populous states are low HIV/AIDS prevalence zones, unlike the populous Chinese provinces. Whether this has to do with cultural practices or poor reporting or low urbanization or because of low in-migration is difficult to tell. That low-prevalence must remain so since these poor, populous states have appalling health infrastructure unlike the peninsular states with high HIV/AIDS prevalence rates.

What about vaccines? Presently, a number of vaccines developed by various companies like AlphaVax, Chiron, Aventis Pasteur, GlaxoSmithKline, Merck, Therion, VaxGen and Wyeth are under different stages of clinical trials. VaxGen's human clinical trials in Thailand have just been announced to be a failure but hopes have not faded for making a safe and efficacious vaccine available in the market by the beginning or the middle of the next decade. Interestingly but not surprisingly, many of the top researchers in the US are scientists of Indian or Chinese origin. David Ho who discovered drug "cocktail" therapy is Taiwan-born and the head of Emory University's Vaccine Research Centre whose vaccine is under trial is headed by Hyderabad-born Rafi Ahmed. But neither India nor China can afford to sit back waiting for such a vaccine even while they participate in clinical trials themselves.

AIDS is no longer considered a health or a social or an economic issue. It is now being reckoned as a "security" issue. The UN Security Council and the UN General Assembly have both debated HIV/AIDS. The possibility HIV/AIDS being used to check labour flows into the West also cannot be ruled out. Both India and China face a stupendous challenge. They can and must cooperate in mounting an effective and credible response, learning from the success that one of their close partner countries---Thailand-has had in this area.