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INTERVIEW - Dr. Suniti Solomon |
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| “People have to perceive that
they are at risk, for effective prevention” |
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| One general concern at the
Conference is; will Asia become Africa? When it comes to India,
what is your answer to that question? |
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| No I don't think India will become Africa. The
reason I would say is our curves. If you look at the surveillance
and the prevalence in the country, we are somewhere at one and
two percent. If we reach a prevalence rate of ten or twelve
percent there will be total chaos. You can imagine, we have
one billion people in India. But even with one or two percent
prevalence, we have the largest number of people with HIV in
the world. |
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| And in hard numbers, how many people do
you believe are HIV positive in India versus the official government
figures of 5 million? |
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| I would say maybe it's double of that - about ten million
people are infected. In my clinic, I see people who say you
know I had possible exposure six years ago. I was fine so I
didn't go for a test and then now I have this funny cough or
cold, or pneumonia and I am here. This means people who are
infected don't know they are carrying the virus. So, I feel
definitely the number must be at least double of what is official. |
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| And why are you confident that it won't
escalate to ten or twelve percent of the population? |
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| Because we've been looking. I know India hasn't
done many incidence studies because we are the ones who have
just started incidence studies in Chennai. We are only looking
at prevalence. And if you look at our prevalence over the period
of the last five years, it hasn't really taken off like it has
in Africa. It's still somewhere at one or two percent like in
the antenatal clinics and if you take the high risk population
of people attending the STD clinics, it has gone to like maybe
five, seven percent. It has been, you know, just going up and
down at that level. It hasn't goneover ten, fifteen percent. |
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| And is that because is the
awareness greater? I was reading an interview that you gave
about a year ago and you said that at that moment everybody
perceived it to be an epidemic of sex workers and truck drivers.
Is that still the case or has the awareness in the past twelve
months grown? |
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| I think people still think it is an epidemic
of marginalised communities. It won't happen to me- that is
the perception. The denial is very, very strong. But if you
take the data we have at our center, 80% of women I'm taking
care of have a single partner. It has spread into the housewives
. And they have no way of preventing infection to themselves
because the men don't use the condom. The women have no microbicides.
Female condoms are not popular, they're expensive. |
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| And so education is the key.
A new public awareness campaign has just been launched. Can
you tell us about that? |
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| Heroes Project. I think that's a great idea,
because earlier the cause was being taken up only by people
in the the NGO sector and the government. Now the Heroes Project
has brought the celebrities in and I was there at the launch
of the Hero Project in Mumbai. The crowd, which came in and
the number of questions that came out and the publicity it got
was immense. You know we need such programmes so that when people
learn that somebody from outside the country has had to initiate,
they might realise that we are not doing enough. So, we have
to do more. And there must be something very serious we have
not understood yet, because as Richard Gere said, "I have
lost more than 100 close friends of mine to this epidemic."
And I'm sure in India that even if somebody had died, a friend
of the deceased, would never know that the person died of an
AIDS related disease. |
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| So what is your hope for the
Heroes Programme? |
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| I'm just going along with them trying to talk
about it, because I've been working in this from the time I
detected HIV positive persons in 1986. For fifteen years I have
been screaming at the top of my voice, but none of you even
came and spoke. Now because Richard Gere is here, all of you
are here. I said at least let this be a good beginning for the
Heroes project. |
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| But is your expectation that
other celebrities, famous people, in India will now begin to
speak out because they see others doing that? |
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| I think people in India are still a little worried
about coming out and speaking about HIV and AIDS. But I think
this Heroes project has motivated a few top star celebrities
in India to chip in their little bit to help in building awareness
about HIV. But what I was trying to say is that you have to
make people perceive they are at risk. They always think this
is an epidemic of sex workers and truckers so it won't happen
to me. That attitude has to change. |
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| What about Indian Government's efforts
in terms of money? |
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| I know Indian government spends eleven cents
on health care per person. But in this budget, which just came
out I think three days ago, there's a big chunk for AIDS. It's
earmarked for the first time in Indian budget. This is for AIDS
prevention. The government wanted to put 100,000 people on ARV
this year. But we haven't done very well. I think maybe about
3,000 to 4,000 people have gone on the antiretroviral drug all
over the country under the government's programme. |
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| And what's the greatest obstacle
to providing ARV? |
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| I think the Indian government didn't realise
that this is a lifelong treatment and so it needs to be available
at the clinics month after month. And then we need to train
clinicians to give the right combination and then look for the
side effects. We need to train counselors to talk about adherence
otherwise we are going to have resistance strains. So giving
antiretroviral drugs is just not handing over the drugs. It's
much more than that. I think the government didn't realise it. |
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| What you've just described
is what I've heard elsewhere in the world. The same difficulties
with ramping up for ARVs. Is it the same experience with other
countries you're familiar with? Or are there unique and particular
problems to India in terms of the ARV rollout? |
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I think the problem in India was that people
have to travel quite a distance to come to these places to collect
the drugs and month after month they have to do this. And somehow
in India when people feel better they stop the drugs. This is
what I'm worried about, because we've done a little study in
our Centre and we found 14% of people who have never taken ARV,
are resistant to a few drugs. This means resistant strains are
already present and we don't want the problem to
grow larger. |
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| You mentioned earlier you've
been at this a very, very long time. Where do you think you
are on the road up to conquering this epidemic - midway through,
or at the very beginning? |
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| Maybe somewhere near midway I would say because
when I first used to see patients ten years ago I had nothing
to offer them, except to let them cry on my shoulder and put
my hand around them. I would tell them, look, we have vitamins,
take good nutrition. Maybe three years from now we'll have a
drug, which will help you. But today I say look, this is like
another chronic infection. I have hypertension. I swallow drugs
every day. So it's just like that and you can keep it under
control and the cost of drugs used to be about $800 a month
and that has come down to about $30 a month. 40% of my patients
are able to afford that. So I think we have definitely come
midway and I'm sure in the future we'll have a vaccine or a
cure. |
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| About
Dr. Suniti Solomon |
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