Philanthropist or commercial opportunist?

Abstract

Bill Gates, chairman and chief software architect of Microsoft, and co-founder of the Bill & Melinda Gates Foundation, courted controversy last week while mixing business with philanthropy and by publicly endorsing a US government report predicting an AIDS epidemic in India. The report, issued by the US National Intelligence Council in September, 2002, predicts that India will have 20–25 million cases of HIV/AIDS by 2010—the highest estimate for any country in the world. Official Indian government statistics state that 4 million adults currently have HIV/AIDS, but the report states “expert estimates” of the real figure as between 5 and 8 million. Heterosexual transmission is the main driver of HIV infection, except in two regions (Nagaland and Manipur) where intravenous drug use is widespread. Between 30% and 60% of prostitutes and up to 15% of truck drivers are infected with HIV/AIDS in India. The report accuses the Indian government of a failure to give HIV/AIDS the sustained high priority that has been the key to stemming the tide of the disease in other countries such as Uganda, Thailand, and Brazil. Inadequate health services, the cost of education and treatment programmes, other demands on health resources such as tuberculosis, the social stigma attached to HIV/AIDS, and the cultural and moral traditions and values in India will all contribute to the rapid rise in HIV/AIDS prevalence, states the NIC report. Writing in The New York Times on Nov 9, Gates states that much of India's progress towards becoming a global economic superpower will be threatened by AIDS. Quoting the NIC report's projected HIV/AIDS prevalence figures, Gates says that there is still time to prevent a widespread AIDS epidemic in India. “The humanitarian imperative for action is undeniable. But there are other reasons for the West to be concerned about India's future”, says Gates, adding “With one of the largest scientific and technical work forces in the world, it is also an increasingly important business partner for many countries … India's rapidly growing software sector has made the country a critical partner to many American companies, including Microsoft.” On Monday, Nov 11, during a visit to India, Bill Gates announced that the Bill & Melinda Gates Foundation will give the Indian government an initial US$100 million to tackle HIV/AIDS. This generous donation is to be used to expand access to proven HIV prevention strategies among mobile populations, to combat societal stigma surrounding the disease, and to increase awareness and leadership on HIV/AIDS. Both the press release issued by the Bill & Melinda Gates Foundation and Gates' own article in The New York Times quote the NIC report's projected HIV/AIDS prevalence figures for India. However, the Indian Health Minister, who will chair the board that will manage the Foundation's programme, has publicly disagreed with these projected figures (see Lancet Nov 16, p 1576), describing them as “completely inaccurate”. On Tuesday, Nov 12, wearing his Microsoft hat, Gates announced the company's largest investment outside the USA. At a press conference in Hyderabad, home of Microsoft's research centre in India, Gates said that Microsoft will be putting US$400 million over 3 years into product development, software testing, and education and business partnerships in India, so enhancing the company's presence. Gates announced that the investment would enable Indian businesses to exploit Microsoft's .NET tools, such as by developing software for financial service companies, a rapidly growing market segment in India. The .NET platform, anti-piracy technology, and new database technologies are part of Microsoft's research portfolio, aimed at extending the company's reach despite the threat from potential competitors, including open-source operating systems such as Linux. Philanthropy and commerce can make uneasy bedfellows. The “humanitarian imperative” of the AIDS epidemic in India is clear, as documented in the NIC report, but so are the investment opportunities for Microsoft in India. Having just emerged from a 5-year antitrust lawsuit in the USA, and with the European Commission about to rule on its investigation into the company's practices, could Microsoft benefit from Bill Gates being seen as a responsible industry leader? By acting as spokesman both for his Foundation and Microsoft, cynics may feel that Gates has distracted attention from the very problem that his Foundation is, rightly, trying to address-the impending HIV/AIDS epidemic in India.