COLUMN ONE : Bombay--Epicenter of Disaster : India is heading for an AIDS epidemic spread mainly by the sex industry in its leading metropolis and prostitutes nationwide. Deaths could exceed those in Africa.

Falkland Road, home to many of Bombay’s 100,000 or so prostitutes and the most infamous of India’s red-light districts, surely ranks as one of the lower rungs in hell.

Behind barred windows known as “cages,” thousands of women are captives, having been kidnaped or sold into bondage. Others are rape or incest victims, exiled in shame from rural villages. Many are devadasi , devotees of a Hindu goddess who were forced into prostitution by unscrupulous priests. Still others are male prostitutes known as hijras , or castrated men.

Crammed in dark tenements, in the stench of raw sewage, most prostitutes serve four men a night. The lucky ones make $15 a month; others, including 9-year-old girls, are paid only in clothes, food and makeup. Waving and hissing from every doorway, dressed in bright saris, blood-red lipstick and jangling bracelets, the sad-eyed sex workers of these muddy lanes and dingy brothels draw hundreds of thousands of men every night from across India.

Millions may die as a result. At least 35% of Bombay’s prostitutes now carry the virus that causes AIDS, according to the World Health Organization. That’s up from only 3% in 1988. By early next century, experts say, Bombay will be the epicenter of a catastrophe: India, the world’s second-most-populous country, could outpace sub-Saharan Africa as the chief killing ground of the deadly disease.

“It’s out of control,” warned Dr. I. S. Gilada, head of the Indian Health Organization and Bombay’s best-known AIDS activist. “And now it’s too late.”

On a recent humid night, Gilada stood on a sidewalk in the red-light district armed with a bullhorn and garlanded with blue foil packets of condoms, like Hawaiian leis. He exhorted the passing parade of men to practice safe sex. As he handed out free condoms and talked, a rat ran out of a dark alley and across his shoes. Hawkers peddled betel nut and peanuts. Music screeched and horns honked as women hissed and shouted at potential customers in the sex bazaar.

Gilada, 35, is an outcast to the medical establishment for such unorthodox ways. He has denounced other doctors, ridiculed expensive World Health Organization consultants and challenged hospitals and the government in newspapers and the courts for seven years. For most of that time, he was the only doctor publicizing and fighting AIDS. No longer.

“In five years we will have AIDS cases in every block of the cities and probably in most villages,” said Dr. Lev Khodakevich, a WHO medical officer and AIDS specialist in New Delhi. “It will go everywhere.”

So far, India has confirmed 10,730 human immunodeficiency virus infections and 238 full-blown cases of acquired immune deficiency syndrome, which destroys the body’s immune system. But experts say far more cases are misdiagnosed and unreported. WHO and Indian officials publicly estimate that 500,000 to 1 million Indians carry the virus, and some privately put the figure far higher.

“HIV patients are discovered by chance,” said Dr. Subhash Salunke, health director of Maharashtra state, where Bombay, India’s largest city, is located. “They are only found if they happen to go to the hospital, and their blood happens to be tested, and the doctors happen to know about and do the testing for HIV. It is not systematic.”

By 1996, according to reports at the International Congress on AIDS in Asia and the Pacific held in New Delhi this month, at least 3 million Indians will carry HIV and 179,000 will suffer from AIDS. That will more than double by the end of the decade. How many will die after that is beyond estimate.

“We’re seeing an exponential increase year by year,” said Dr. J. P. Narain, head of regional AIDS programs at World Health Organization headquarters in New Delhi. “And this is just the beginning.”

Also just starting, however, is an ambitious $100-million, five-year attempt to fight AIDS in India. The obstacles are immense in an impoverished country with widespread illiteracy, strong cultural taboos, inadequate medical care, legendary bureaucracy and a population twice that of sub-Saharan Africa.

Unlike most of the West, where homosexuals were hit first and hardest, AIDS is spreading across India chiefly via prostitutes to the general population. Worst stricken, so far, are Bombay and Madras. But thousands of intravenous drug users also are infected in two northeastern states, where heroin is widely available. Contaminated blood supplies are also a danger.

Unlike Africa, where the epidemic has ravaged lives since the early 1980s, the first AIDS case in India was not recorded until 1986. That should have given officials time to prepare for the crisis.

Until this year, however, little was done except to deny the problem. Last year, for example, the national government announced a three-year AIDS prevention program--but allocated only $1.8 million for a nation of 885 million people, or one-fifth of a penny per person. There was nothing in the plan about public education, medical training or providing condoms.

A U.S. State Department report last summer partially blamed attitudes of India’s medical establishment. “A recent meeting of experts advised adhering to ‘Indian cultural values’ as the best way of combatting the disease, and foreigners were frequently blamed for transmitting AIDS,” the report said.

“Many doctors are scared to see a case of AIDS,” explained Dr. S. K. Kacker, director of the All-India Institute of Medical Sciences in New Delhi, which recently began teaching interns about the disease. “Many private hospitals refuse to treat AIDS patients. We are getting complaints that people are turned away or discharged.”

India’s five largest cities began screening blood in 1989 after tests found widespread HIV contamination of human blood products manufactured by Indian companies. But there is little or no screening in rural areas and in the countless unlicensed blood banks that reuse needles and unsterilized equipment. Tests show that many professional donors, who repeatedly sell their blood for cash, carry HIV. Up to half of India’s blood supply comes from such unregulated blood banks.

Even tested blood isn’t necessarily safe, said Dr. Zarin Bharucha, chief blood bank officer at Tata Memorial Hospital in Bombay. “Unfortunately, there is no policing to ensure the screening. There is no sudden inspection. We cannot say for certain that the system works. . . . We even hear of unscrupulous suppliers who pick up needles from medical waste and recycle them.”

Now the government and the World Health Organization are gearing up for what experts call a chance to learn from their mistakes in Africa, which already has 6 million HIV cases, and--they hope--to begin to deal with India’s inevitable epidemic. Using an $85-million World Bank loan approved in October and $15 million from New Delhi, the government announced in August a comprehensive AIDS control program. So far, it’s mostly on paper.

“Right now we are taking the first halting steps to begin a countrywide program,” said P. R. Dasgupta, project director of the newly created National AIDS Control Organization in New Delhi. “It will be a gigantic task.”

Using tactics adapted from Ethiopia, the plan is to create a network of 1,000 centers across the country over five years to identify and treat AIDS sufferers, and to reduce spread of the disease through coordinated public education, health care and blood-screening programs.

If all goes according to plan--and little does in India--surveillance teams, blood bank technicians, epidemiologists, virologists, social workers, hospital employees and others will be trained in every state. Movies, puppet shows, village theater and other media will be used. Leaflets will be designed for the non-literate. Taxi drivers, police officers and politicians will be enlisted. Four pilot projects will start, and if they succeed, they will expand to 65 cities.

One of the first steps is to upgrade Indian-made condoms, which tend to rip or break. But in what may be an omen of obstacles to come, India’s slow-moving bureaucracy can’t approve regulations to meet international condom standards before next March, Dasgupta said. “It’s not that our condoms are totally useless,” he said. “They’re just not foolproof.”

And condoms are vital to reducing sexually transmitted diseases, or STDs. More than half of Bombay’s prostitutes suffer from syphilis, gonorrhea or other venereal diseases at any one time, doctors say. Research shows that AIDS spreads fastest during sex when one partner or the other has open genital sores or other symptoms.

“If we can control STDs, we can control AIDS,” said Dr. C. Johannes Van Dam, a WHO adviser.

It won’t be easy. Most medical care for prostitutes comes from thousands of untrained “doctors” who set up unlicensed sidewalk clinics and dispense fake cures with impunity. Nearly every block in Bombay’s red-light areas has a storefront clinic with a red cross on the window.

In the seedy Kamathipura district, for example, Suresh N. Parikh, a self-described doctor, runs what he calls his clinic on a busy street of brothels. Wearing a bloodstained white coat and waving dirty hands, he described how he treats the constant stream of women who crowd his dim one-room office.

“When the patient comes, I say open up,” he said. “I look at the lesion, give them an injection and they go. That’s all. No talking. I don’t tell them to use condom. Maybe they don’t like to hear it from me.”

Asked about AIDS, he shrugged. “I don’t know about AIDS,” he said. “Anyway, it’s not fully proved.”

Such attitudes are common in Bombay, a sprawling port of 10 million that is a major cultural, commercial and transport hub. But Bombay’s attraction is its greatest danger. Truck drivers, migrant workers, salesmen and others who patronize the city’s prostitutes increasingly take HIV out on the road and back to their wives and girlfriends when they leave.

“If I have a problem, I’ll just go to the doctor,” laughed Ramesh, a 25-year-old truck driver who stood on a busy corner of Kamathipura, eyeing the hundreds of women who lounged on broken furniture by smoldering heaps of garbage.

“Many of our customers don’t want to use the condom,” said Kalati, a 30-year-old madam, at the doorway of the three-story concrete brothel where she controls 24 women. “What can we do?”