HIV/AIDS Challenge in India - A Success Story
by Thilaka Ravi on November 30, 2010 at 1:11 PM Medindia Exclusive - Interviews and In depth Reports G J E 4
HIV/AIDS crept into India when the country to some extent was unaware of its existence. As soon as the news appeared in the media there was a great hue and cry and people accused that yet another 'Western' disease had struck India. The advent of HIV/AIDS in a way served to rip off the mask of a 'tradition bound' society that held sex education taboo and the rude shock forced the government and the people to take one hard look at themselves like never before.
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- Bioethics Symposium January 2009
Medindia met Dr. Suniti Solomon, Founder-Director of the Y.R. Gaitonde Center for AIDS Research and Education (YRG CARE), a premier HIV/AIDS care and support centre in Chennai and heard her insight on tackling this serious pandemic that almost destroys a person more emotionally than physically, given the social stigma attached to it. Dr. Suniti Solomon and her colleagues documented the first evidence of the HIV infection in India in 1986. She is the Indian Principal Investigator of several pioneering HIV research studies and has published extensively on HIV epidemiology, prevention, care and support, biomedical research, research ethics and gender issues. She has deep interest in community education and mobilization and leads an effort that supports a Phase I HIV vaccine trial at Chennai with community education and volunteer enrollment.
Q. You sensitized the Indian public to the HIV/AIDS emergency in a very effective manner; tell us the trigger that set you on this pioneering discovery of the presence of HIV/AIDS in India?
A. In 1986, I was a Professor of Microbiology in Madras Medical College and Government General Hospital when 2 post graduate students wanted me to suggest a suitable research topic for them. Since news on HIV/AIDS was just then trickling in from the USA, I told them it would be interesting to study its possible prevalence in India, beginning with their current location, Chennai. The students were truly horrified saying, "We'll surely fail in our exams," and besides, where do we find a 'gay' community in Chennai that is labelled the most 'conservative' city in a very traditional country like India. I assured them I would work with them in this survey and when the results were out that HIV/AIDS was very much in India, we were unprepared for the storm that followed the news of AIDS prevalence in India.
Q. It must have been difficult to do a survey of this kind way back then. How did you go about it?
A. We decided to test blood samples of women sex workers and approached the police for help. The police often raid hotels and other places tipped off as brothel houses and the sex workers caught are temporarily kept in a government remand home until further action is taken on them. Beginning at 6 am one morning, we collected 100 blood samples from the women over a period of days and sent them to CMC Vellore for testing.
Six women tested positive for HIV. We sent the sample to Indian Council of Medical Research (ICMR) which sent the samples to US for further confirmation. US labs used advanced 'Western Blot test' and confirmed the presence of HIV in the samples sent from Chennai, India.
The storm that broke out in the Tamil Naadu Legislative Assembly when we accompanied the then Health Minister of Tamil Nadu, Dr. Hande to announce the prevalence of HIV/AIDS in Chennai, left with mixed feelings of joy and shame. MLAs were upset with the news and groaned, "This shame has to come to light first in Chennai?"
Very soon college and school students came forward for HIV testing, without their parents' knowledge, of course, and it was then that the gravity of the situation dawned on me and I decided to go out to people and talk—to promote awareness on the prevalence of HIV/AIDS in Chennai and the health risks and safety education that should reach the public first, in order to check the spread of this highly communicable disease.
Q. How difficult was it to spread awareness in a country that is steeped in misconceptions where even sex education is considered taboo?
A. I appealed to some city colleges to allow me to talk to students on HIV/AIDS and was promptly refused permission on the pretext that students were "too young to know about all these things." Fr. P.P. George Principal of Sacred Heart College at Tiruppathur near Chennai invited me to address his students and that day was an eye opener of sorts to all of us. In the question hour that followed the HIV/AIDS awareness talk, the college students were so full of doubts on sexuality and sexual health that I felt totally inadequate to answer them. Some of them would certainly need help from a counselor, I thought. Some worried students wanted to speak to me in private and one even asked if having 'just' oral sex could pass on AIDS.
Following this I received several requests from city college principals to talk to their students. I prepared a team of counselors and volunteers and did our round of sensitizing students and the general public about the HIV condition. I still remember, the principal of a city women's college called me to speak and told me her students won't ask questions on sex, so I would just have to say my message and go. Contrarily, after my talk the girls begged for a question round and had so many questions to ask on gay sex, oral sex and a lot other matters that left me gaping and the Principal left the hall in embarrassment, requesting my counselors and me to deal with the situation.
A Rotary Club initiative brought together 78 college principals in Chennai city and things got easier from there. Our team has visited many high schools and spoken to the students on sexual health and preventing HIV transmission. Once I founded YRG-Care, AIDS management picked up tremendous speed and today after 22 years of exciting experience in tackling AIDS I'm happy there is a 50% drop in the spread of HIV/AIDS as per statistics from NACO . A lot of committed NGOs are on the field and we hope to do more to wipe out this menace from the face of the earth.
Q. Your life must surely have many moments that you cannot forget, can you single out one such moment for our readers?
A. I cannot forget April 14, 1996 - the day a baby was born for the first time in Chennai to a HIV positive mother. The lady had come from Salem ahead of her due delivery date and those were days when obstetricians refused to take in HIV pregnant women for delivery. We managed to persuade one doctor to deliver the baby, but unfortunately when the woman went into labor the doctor was not in town. We took the woman in an ambulance and knocked many doors to no avail and we could almost see the baby's head pushing out. A gutsy team member asked me to step aside (because people started identifying me with AIDS cases), took the ambulance to a maternity clinic, admitted the lady as an emergency case without telling anyone the lady was HIV positive, had the baby delivered by the obstetrician and we quietly had the mother and baby discharged in couple of days. It was such a relief that the baby tested HIV negative.
Q. What would you consider a serious road block in spreading HIV/AIDS awareness in India?
A. People's ignorance and lack of the right sort of education makes it very difficult to get across any important message. Let me tell you about one instance. We had a patient who had contracted HIV from a kidney transplant that he had in the 1990s in Chennai. We wanted to trace the source of the donated kidney and people said, "He got it from Kidneyvakkam. Oh you don't know Kidneyvakkam? It is actually Villivakkam, but most people there have only one kidney because they have sold it for money." We visited the place and true enough people there were very willing to sell a kidney. One old lady approached me and said, "I have already sold one kidney. Please take my other kidney too; my son says he has some debts to re-pay." This means the donor was probably not thoroughly evaluated by the doctor before undertaking the transplant. So the ignorance also extends sometimes within the medical community too.
Another challenge to overcome or diffuse is the social stigma attached to AIDS. There was a flight lieutenant in his 50's who approached our Centre to be tested for HIV. He was so nervous when he came to get his result and when I told him his test showed he did not have HIV, he broke down and cried like a baby. He said, "I've applied for a job in the Gulf and HIV test is mandatory there. I thought I'd get the result, whatever it is, from here first. If I die on a plane or in a war they will say I died a heroic death. If die of AIDS, it is such a shame. I am so relieved now." If this is the reaction in elite circles, the poorer classes are worse off. Children born to parents with AIDS are still denied admission in some schools. AIDS is a great social leveler -it was initially thought only truck drivers and sex workers would test HIV positive, but doctors, engineers, lawyers, teachers—list of such people with AIDS is long and cuts across all strata of society.
Q. YRG CARE is internationally known for research, medical support and community education in the field of HIV/AIDS. As its founder and head what are your future plans?
A. YRG CARE Medical Centre operating from Voluntary Health Services (VHS) has provided medical and psychosocial care to more than 15,000 people living with HIV till date. We have many clinicians, counselors, clinical nurses, nutritionists, case management staff and patient facilitators. Currently we offer our services to about 80 to 100 patients daily. The Centre provides outpatient services six days a week with clinicians on call round the clock. YRGCARE currently has satellite clinics in Nellore, Vishakapatnam (Andhrapradesh), Bengaluru (Karnataka) and Namakal (Tamilnadu). We have a host of other activities and community projects which you can see on our website.
Personally, I'm beginning to concentrate on other communicable diseases like dengue and exploring ways to detect and manage these diseases better. Also, when I started community education for HIV/AIDS I realized there were more problems that poor people were grappling with - alcoholism, domestic violence and a host of others, all affecting womenfolk. Last year I launched an ECO Kitchen, a not-for-profit project to supply quality food packets to underprivileged women in the community at subsidized rates. They in turn sell them at mark up prices and earn their living each day. We are planning to come up with more of these initiatives to empower women in the lower rungs of society.
On the occasion of World AIDS Day, Medindia wishes Dr. Suniti Solomon all success in her future ventures to empower underprivileged people and to spread greater awareness to check the spread of HIV/AIDS.
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