Sitting on a wooden bench under a slowly whirring fan, 43-year-old Prempal says he urgently needs anti-retroviral drugs to fight the HIV illness in his body.
"I just might die before I can start my treatment," Prempal said with a hysterical laugh as he waited in a doctor's consultation room in Eka, a small town of some 15,000 people in India's most populous state of Uttar Pradesh.
"We need help," he said, the pitch of his voice rising as he spoke in the sparsely furnished medical clinic.
The tall, gangly tailor was diagnosed with HIV in July but he has not yet managed to get hold of anti-retroviral (ARV) drugs or even arrange an HIV test for his wife.
Prempal is unsure how to get free drugs from the government and the closest hospital offering free treatment is nearly 200 km (120 miles) away in New Delhi.
Drugs from private chemists are too expensive at around 1,400 rupees ($30) a month, more than half Prempal's monthly salary.
He has twice taken his wife to the nearby town of Etah, only to find the state-run testing centre had not received its supply of HIV-testing kits for over a month.
India has a fight on its hands to win its war against AIDS in the northern state of Uttar Pradesh, a key battleground if the country is to conquer the epidemic, activists say.
A dangerous lack of information about HIV together with an overburdened, poorly-run state healthcare system make the state a potential AIDS time bomb, the activists said.
"States like Uttar Pradesh are grey zones which could blow up in our face," said Anjali Gopalan, head of the New Delhi-based Naz Foundation India, a leading AIDS activist organisation.
Political apathy, bureaucratic sloth and desperate poverty compound the problem in a state which is home to 170 million people, more than Germany and Britain combined. The United Nations AIDS agency, UNAIDS, says 5.7 million Indians are infected with HIV, the world's highest caseload.
One of the poorest of India's 29 states, Uttar Pradesh has an official HIV caseload of just 15,000 people but activists say this figure could be a gross underestimate due to inadequate testing facilities in the state.
A lack of testing kits has meant that dozens of people - some of them potential HIV carriers - have been turned away from the Etah medical centre in recent weeks without being tested.
The staff are not sure when authorities in the state capital, Lucknow, will send them the badly needed kits. The state's AIDS control chief Shashi Prakash Goyal admits the official count of HIV-positive people in Uttar Pradesh is an underestimate, as social stigmas discourage people from reporting cases.
But activists believe that it is almost impossible that a state with nearly three times as many people as Britain has less than a quarter of its caseload. Especially since India has one of the highest HIV rates in the world.
Many people with AIDS in the state die of secondary infections and their cause of death is listed as tuberculosis or viral fever, activists say. "My wife died seven months ago because of AIDS but that was not listed as the cause of death," said a former insurance agent who is also infected with the virus in Etah, a town of 100,000 people surrounded by lentil, millet and paddy fields.
"I did not want the stigma of AIDS attached to her," he said, requesting that his name not be made public. There are only three state hospitals in Uttar Pradesh that provide free ARV drugs, roughly one centre for 55 million people.
In India, government centres provide free treatment to nearly 50,000 people, a fraction of those who need it.
Officials are worried about the lack of data on Uttar Pradesh and plan to double the number of testing and surveillance sites in the state to more than 80 by the end of the year.
"We need to be pro-active rather than reactive and go after information, rather than wait for it to come to us in a format we like," said Denis Broun, UNAIDS country co-ordinator for India. Grinding poverty has led to the large-scale migration of workers to more prosperous states in western and southern India, where HIV is more prevalent.
These migrant workers sometimes contract HIV from prostitutes and then pass it on to their wives when they return home. Women now make up about 40 percent of HIV cases in India, many of them are infected by their husbands.
"People who have tested positive often do not come forward for treatment," said Pavan Sharma, head of the Etah Positive Peoples Welfare Society, adding he has to go undercover to villages to arrange treatment and give counselling.
Shortly afterwards, Sharma counsels a young farmer and his wife who tested positive this week. "Don't cry. Being HIV positive does not mean you will die soon," he told the young woman as she wiped tears with the corner of her pink-and-gold sari.
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