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It's care that counts
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Dr. Suniti Solomon has done pioneering work in treating AIDS victims and spreading awareness through the Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, which was set up in 1993. In conversation with SASHI NAIR.
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AS THE old man walked along the beach at dawn, he noticed a young woman ahead of him picking up a starfish and flinging it into the sea. Catching up with the youth, he asked her why she was doing this. She answered that the stranded fish would die if left in the morning sun. "But the beach goes on for miles and there are millions of starfish," countered the old man, "How can your efforts make any difference?" The young woman looked at the starfish in her hand and threw it to the safety of the seas. "It makes a difference to this one," she said.
It was in 1986 that the first HIV (human immunodeficiency virus) positive cases in India were reported from Madras. A professor of microbiology at the Madras Medical College's AIDS Research Cell and a post-graduate student assisting her, decided to collect 100-odd blood samples from sex workers and send them for testing to the Christian Medical College, Vellore. Six of the samples tested positive for ELISA (enzyme-linked immuno-sorbent assay); the Western Blot test conducted later in the United States confirmed these as HIV-positive. The professor, Suniti Solomon, and the student, Nirmala, were naturally taken aback by the results. Their discovery had frightening implications. Six Madras women had been identified as being carriers of the AIDS (acquired immune deficiency syndrome) virus.
"As we began conducting more ELISA tests, we found more and more people testing positive for HIV. The situation was alarming. The HIV-positive persons faced a lot of discrimination with even doctors unwilling to touch them," says Dr. Solomon. The Indian Council for Medical Research provided her with the money to start the AIDS Research Centre. And in 1993, Dr. Solomon set up the Y.R. Gaitonde Centre for AIDS Research and Education, with initial funding of Rs. 45 lakhs by the Ford Foundation.
Born in Chennai, Dr. Solomon studied at Ewart School and spent a year each at Ethiraj College (pre-university) and Queen Mary's College (pre-professional) before joining the Madras Medical College in 1959 for her M.B.B.S. In 1967, she married Dr. Solomon Victor, cardio-thoracic surgeon. Dr. Victor received a Commonwealth scholarship in 1967 and she accompanied him to London where she worked as a pathologist at King's College Hospital and the National Heart Hospital.
In 1969, the couple moved to the U.S. where Dr. Solomon continued her studies in pathology at Baylor University in Houston, Texas, and later at Chicago's Cook County Hospital. In 1971, she returned to Madras and registered for a post-graduate course in microbiology at the Madras Medical College. After acquiring an M.D. in microbiology (she stood first in the university), Dr. Solomon was posted as assistant professor in the same college and there she taught for 20 years, eventually settling for voluntary retirement in 1993.
"I was always fascinated by microbiology, especially since immunology, was a growing subject then. Also, after our findings in 1986, I wanted more than just a laboratory job. I knew even at that point that it was not enough to treat HIV-positive people with immuno-modulators. We needed to start with education and counselling, focussing also on nutrition and how patients should change their lifestyles," remarks Dr. Solomon.
Today, Tamil Nadu has 21,813 AIDS patients, the largest for any State in India. "These are only reported cases. As against every case reported, there are likely to be up to 20 unreported cases. So, these numbers do not mean much," she points out. What is heartening, however, is the fact that the State is in the forefront as far as spreading awareness about the disease and intervention are concerned. Dr. Solomon explains that 80 per cent of HIV-positive cases are sex-related. Almost 50 per cent of the AIDS cases in India is reported from the lower-income group comprising migrants, truckers and sex workers; 40 per cent from the middle-income group in which most of the affected persons are travellers, drug users and alcoholics; the remaining ten per cent is accounted for by the high-income group comprising mainly of professionals. Housewives account for 22 per cent of the HIV-infected, followed by unskilled workers (17 per cent), skilled workers (17), professionals (10) and truck drivers (9).
Anti-retroviral drugs were earlier imported, when it cost Rs. 30,000 for a month's course for a person. Today, these drugs are manufactured by Indian pharmaceutical companies and are available for Rs. 2,000 in the market. "Yes, anti-retroviral therapy has improved the quality of life of HIV/AIDS patients and it is easier to treat them now. The side effects are less. Patients are given micronutrients or immuno-modulators such as zinc and selenium and that helps raise their CD4 (white cells that fight infection) levels. Patients, too, feel better. Unfortunately, 30 per cent stop taking medicines once they start feeling better. Such complacency is dangerous because the virus can set in again," cautions Dr. Solomon.
The National AIDS Control Organisation (NACO) has set up voluntary counselling centres across India, 40 of them in Tamil Nadu, with at least one in each district. YRG Care field staff are engaged in conducting an observational study on risky sexual behaviour among alcoholics, covering more than 100 wine shops in Chennai.
"Our work has borne fruit but we have to step up our counselling efforts. We have found that when people have not been properly counselled, many of them become depressed, some attempt suicide, while a few even go to the extent of spreading their infection with a vengeance," says Dr. Solomon, adding, "Sex education is a must in schools, colleges, offices and factories. With every new generation, there is an increase in risky sexual behaviour. It is best we start educating children early in schools." YRG Care started the first AIDS prevention programme in schools and colleges in 1993. So far, 94 schools and 65 colleges have been covered in Tamil Nadu. The result has been a reduction in the number of HIV-positive cases.
The centre trains peer educators as well as trainers. Twelve NGOs in Tamil Nadu and 16 NGOs in Andhra Pradesh, Karnataka, Kerala and Pondicherry have been trained in spreading AIDS prevention messages. The centre's 107-strong staff fan out to 40 slums in Chennai every day and target sex workers with AIDS awareness messages. In rural areas, messages are conveyed through oyilattam (dance), painting, villupattu (folk art), street plays, puppetry, cartoons, mimicry, writers' workshops and debates. The centre also conducts awareness programmes in several companies and factories. YRG Care works with Brown University, Rhode Island, on clinical research, and Johns Hopkins, Baltimore, and the University of California, San Francisco, on behavioural research.
"AIDS is now a chronic disease. It is no more a killer. We may not be able to remove the last virus from the body but the quality of life has improved considerably with good treatment and counselling. In fact, some patients who tested HIV positive 15 years ago are working at our centre," says Dr. Solomon.
For all that, HIV has brought a number of social issues to the fore, she says. Marriage, bride inheritance (in north India), fertility pressure, preference for son, forced abstinence and breast-feeding are some of the pertinent issues. "In a HIV-infected person's family, usually nobody, except the patient and the spouse, is aware of the truth. This results in complications. For example, when the pressure for a child from the elders becomes unbearable, the woman is forced to resort to artificial insemination. Since 90 per cent of the women who test positive have a single partner (husband), isn't it time parents insisted on a blood test instead of just matching horoscopes," wonders Dr. Solomon.
Dr. Solomon has won several awards for her pioneering work in AIDS research and education in India. YRG Care, now ten years old, operates at the VHS campus, Taramani, complete with 17 beds, intensive and after-care units, consultancy rooms and outpatient care services. The family counselling centre was established in 1999 and the infectious disease laboratory a year later. The VHS-YRG Drug Centre was set up in 2001.
"I feel happy that I have been able to work among and care for people who have been stigmatised."
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