The Business of HIV/AIDS

In this 2005 article that originally appeared in the McKinsey Quarterly, McKinsey & Co. consultants Joydeep Sengupta and Jayant Sinha interview Ashok Alexander, the director of Avahan India AIDS Initiative (Avahan means “call to action”), a program started in 2003 by the Bill & Melinda Gates Foundation to fight against HIV/AIDS in India. Alexander told them that the private sector must be involved in the battle through public-private partnerships between the government and business.


7 Responses to “The Business of HIV/AIDS”

  1. 1 Chow Chui Yin, Kuma 12/11/2009 at 9:53 pm

    I read another article with a more updated figure of HIV infection in India. I have pasted an excerpt at the end of my comment.
    I got the impression that Avanhan is run with the mindset that is needed to run a corporate. The director mentioned how within Avanhan, goals are translated into initiates which in turn are broken down into actions, and within the organization, everyone’s job is extremely clear with achievable and noticeable results. I really like how that is in contrast to many other NGOs which operates like a corporate but only in the sense they’re doing marketing and they measure success by measuring how much money they raise.

    “In 2006 UNAIDS estimated that there were 5.6 million people living with HIV in India, which indicated that there were more people with HIV in India than in any other country in the world.17 In 2007, following the first survey of HIV among the general population, UNAIDS and NACO agreed on a new estimate – between 2 million and 3.1 million people living with HIV.18

    In 2008 the figure was confirmed to be 2.5 million,19 which equates to a prevalence of 0.3%. While this may seem a low rate, because India’s population is so large, it is third in the world in terms of greatest number of people living with HIV. With a population of around a billion, a mere 0.1% increase in HIV prevalence would increase the estimated number of people living with HIV by over half a million.

    The national HIV prevalence rose dramatically in the early years of the epidemic, but a study released at the beginning of 2006 suggests that the HIV infection rate has recently fallen in southern India, the region that has been hit hardest by AIDS.20 In addition, NACO released figures in 2008 suggesting that the number of people living with HIV has declined.21

    Some AIDS activists are doubtful that the situation is improving:

    “It is the reverse. All the NGOs I know have recorded increases in the number of people accepting help because of HIV. I am really worried that we are just burying our head in the sand over this.” Anjali Gopalan, the Naz Foundation, Delhi22

    Peter Piot, Executive Director of UNAIDS, stresses:

    “the statement that India has the AIDS problem under control is not true. There is a decline in prevalence in some of the Southern states… In the rest of the county, there are no arguments to demonstrate that AIDS is under control”23

    For more detailed information on HIV prevalence and AIDS deaths, see our HIV and AIDS statistics for India.”


  2. 2 Ng Ka Yin, Karen 13/11/2009 at 10:37 am

    AIDS problems in India has been talking for a long period of time but no one ever succeed in tackling it in a sustainable and wide-spread way. I am pretty sure that everyone in the world know how serious this problem in India is, but do not know how difficult it is.

    I agree that tackling with this problem needs the help from both private and public sectors. NGOs are really important for reaching the people we are trying to help, while corporations have assets and infrastructure that can be used to fight the epidemic. That’s very important that public sectors are not able to do.

    I hope the India’s HIV problem will be alleviated through this project after few years

  3. 3 Ma On Ki 15/11/2009 at 9:57 pm

    Yes AIDS is a great concern in most of the countries in the world. Recently i read an article talking about the AIDS Vaccine. It is modestly effective in fight against AIDS as it can reduce infection 31% among those receiving the regimen vs. those getting a placeo. Yea and the article said, though the vaccine is not approved for use yet, “it’s the first to make any headway against HIV, and that’s a start”.

    I believe that if the AIDS vaccine can successfully pass the test and is available for use, it would help saving much human life in the world.

  4. 4 Wong Kam Yiu 15/11/2009 at 10:44 pm

    I agree particularly to the below passages:

    “Community involvement, for instance, is needed to get sex workers to change their behavior. The answer is not education – that’s necessary, of course, but barely sufficient. ”

    “So a key way to reach sex workers is to address the larger issues about their social and economic well-being. A commercial sex worker does not have the economic power to stand up to the client, because of the system around her: her madam, the pimp, local enablers. They all work against her. You have to have a solution that persuades all of them that the good health of the sex worker is in everyone’s interest.”

    When it comes to AIDS and many other issues, people often refer to “education” as the key to solving problems. But as this article suggests, more than 94% of sex workers knows the risk of AIDS related to their work. The problem is not because they don’t know, it’s because they can’t do anything about it. And this writer has made a particular right point that in order to really solve the problem, you must first identify it as a bigger social problem, which involves many actors and then move on to align all relevant actors’ interest to the same direction. This calls for people to look at interest on a long term and sustainable and communal basis, instead of just short-term, individual interest.

    Asking people to see beyond their own short term interest however, is a very difficult task, and I see a very difficult task in aligning the interests of the prostitute,her madam, the pimp and local enablers together. Therefore, it is in my opinion a task that needs to be driven by law enforcement. When people don’t see their interest at stake in the short term, they simply won’t do anything about it. So one way to make them change their behaviour is to enforce laws and punish them for not changing. When the risk of getting punished is counted in their decision making, the cost would go up and they would refrain from acting the way the shouldn’t. And the only way to get law reforms and enforcements going is for the government to step up and be the major driving force.

  5. 5 Senia Ng 17/11/2009 at 1:47 pm

    In response to Onki’s comment, I think it is vital to ensure that the vaccines are accessible to the people most in need. Think about it, even if we have vaccines. If the price is so high that the people in South Africa cannot afford it, what would be the effectiveness of inventing the vaccine? It is the people in developing countries who are most vulnerable and need protection.

  6. 6 Wan Pui Yin (Evelyn) 17/11/2009 at 5:33 pm

    I personally am quite skeptical towards the private sector’s involvement in targeting HIV/AIDS, as mentioned in the article, “businesspeople look at efforts to control AIDS as philanthropy”, and this statement probably still rings true today in the eyes of companies.

    The key question then is how can you get companies involved in this campaign to fight AIDS?

    The first example I can think of is the Product(RED) campaign, joined by companies like Apple, Gap, Converse, Hallmark etc. But was it really effective in sponsoring the Global Fund to Fight AIDS, Tuberculosis and Malaria? (see

    Companies can help bring funds into programmes fighting AIDS, but I agree with Kamyiu, ultimately, the real action has to be based on NGO advocacy and law enforcement.

  7. 7 Cheung Yan Victoria 20/11/2009 at 12:23 am

    Ashok Alexander stressed that public-private partnerships are essential in tackling the AIDS epidemic; governments can contribute by improving infrastructure and the public health systems, corporations bring in capital and NGOs provide direct services to those in need. But how can we persuade these players, in particular, governments and businesses, to assume a bigger role? For instance, how can we persuade governments to invest more in vaccine-related research and subsidize the production of vaccines as suggested by Onki and Senia?

    I think the key is to tell these players that the success of global efforts in reversing the AIDS epidemic will benefit them too at the end of the day. Laurie Garret pointed out in her research report ‘HIV and National Security’ that if prevention campaigns like vaccine-investments are aggressively funded, the security dimensions of the pandemic would be greatly softened. Governments should also realize that the spread of HIV will significantly drain their economies as they will have to put in a lot of resources to cover the direct epidemic costs sooner or later.

    When it comes to businesses, I agree with Evelyn that it is more difficult to make them contribute. Nonetheless, several years ago, after protests from the scientific community, one of the world’s biggest drugs companies relaxed its patent on two AIDS remedies, allowing manufacturers in Africa to produce cheaper drugs for local use. Today, I believe with the will of the society and the prominence of the idea of corporate social responsibility, convincing corporations to give back to the community is not an impossible task.

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