I PAID A high price for the secrecy getting little support, , and falling into depression twice." These are the words of a former colleague of mine who is HIV positive. He, like millions of HIV positive people around the world, has felt the stigma and discrimination that have accompanied the epidemic for nearly three decades. Many people have paid a higher price, choosing death over a life of what they imagine to be disgrace.

Yet, twenty seven years since the discovery of HIV I have seen , much progress. My mind takes me back to the early nineties when I first witnessed the shame and denial associated with HIV and AIDS. Over a series of regular visits to an African country where the disease was unfolding fast, colleagues would be absent without any explanation. The cause of death was never revealed. Over time this changed, as awareness and knowledge increased. People started talking openly about the disease. I saw a change from ignorance and denial to family support, understanding colleagues and the provision of care, treatment, and services.

The problem of stigma and discrimination goes beyond the impact on individuals and their families. It undermines public health efforts to fight the disease. It leads to silence and denial and a refusal to acknowledge and deal with HIV As a result, people may con . tinue to spread HIV unknowingly . Those who know they are HIV positive might refrain from using condoms with their regular partner - often their spouses - to avoid the risk that the partner will suspect they are positive. It marginalises people living with the disease and contributes to their social isolation and rejection. It denies vulnerable groups access to HIV testing and from access to the treatment services that they need to fight the disease.

For a long time, people in South Asia considered HIV and AIDS to be an African problem. Today it is much different. India, which has some 2.5 million HIV positive people, deserves much praise for its national AIDS programme, with strong leadership from the government and civil society Yet,. much remains to be done, especially to change people's attitudes towards people living with the disease. The HIV epidemic here is driven by selling and buying sex and injecting drugs, which itself compounds the fear and stigma. Stigma is everywhere in society , even among medical staff. A study in India found that onethird of students, faculty and, technical staff of the public health services said they would not associate with people living with HIV and AIDS.

The impact of stigma for HIV and AIDS is particularly acute for South Asia's women who are often economically culturally and , , socially disadvantaged. For in stance, mothers often choose not to seek health care for fear that if others learn their status, it will threaten their ability to earn a living or their children's ability to continue in school or play with friends. These concerns are very real. I recently learnt of a nineyear-old girl in West Bengal who was denied entry to her primary school after it became known that she was HIV positive. We need to make sure that people like her are cared for, not rejected.

In India and elsewhere in South Asia we have a window of opportunity Ninety-nine per cent .

of the population is uninfected. Halting the spread of the epidemic will depend on effective prevention programmes that reach and involve people at risk of HIV This . is maybe the greatest challenge in South Asia because those at risk are frequently marginalised in their own communities because of what they do and who they associate with. But our experience shows that where governments, civil society and other partners , make a determined effort to work closely together, including people at-risk, positive results can be achieved. I have seen this in parts of India, where HIV prevalence seems to be declining due to effective intervention programmes involving vulnerable groups. The world has much to learn from India's data-informed approach. The country has earmarked almost 70 percent of its HIV and AIDS budget for prevention, onethird focusing on prevention coverage of vulnerable groups at highest risk of HIV .

We now need to tackle stigma and discrimination by changing attitudes and perceptions through actions. We know that actions against stigma work. There are local police who enables peer educators and outreach workers to provide preventive services to vulnerable groups at high risk, instead of harassing them. Private companies are taking the lead to put in place workplace policies to support their workers and families so they dare seek care, and governments are endorsing national policies to protect the human rights of people with HIV and AIDS facilitating testing and care seeking. In order to encourage these actions, the World Bank and partners are hosting a South Asia wide Development Marketplace competition that will support innovative approaches to fight the ignorance, fear, and denial associated with HIV and AIDS. This week 75 civil society organisations from Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lanka will display their ideas here in Mumbai on how to change the attitudes and practices that undermine effective HIV and AIDS programmes. The goal is to encourage, showcase and learn from innovative approaches that can be incorporated into the national AIDS strategic planning and programming.

We hope this initiative will challenge common myths and misconceptions about the disease throughout South Asia and beyond. Ignorance of the facts leads to fear and drives the epidemic underground. My HIV positive colleague did not go underground. Disclosing his status did not slow down his career development, but led him to some of his greatest assignments.

Let's open the debate. Let's fight HIV and AIDS, not the people living with it.

Praful Patel is World Bank Vice President for the south Asia region This week 75 civil society organisations from Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lanka will display their ideas here in Mumbai on how to change the attitudes and practices that undermine effec tive HIV and AIDS programmes

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