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explore: Fighting HIV
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The battle against HIV presents unique challenges in different cultures around the world. In India, Dr. Suniti Solomon and her team at the YRG Centre for AIDS Research and Education are working hard to change attitudes and slow the spread of the disease.

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Segment 1

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explore
DR. SUNITI SOLOMON [Founder and Director, YRG Centre for AIDS Research and Education]
I was working for the government for 22 years, and I couldn't do what I wanted. I used to see young people coming up to me for counseling. I said, "I need to talk." And the government said, "Your job is in the laboratory." So I quit, and I started the center with three people, two little rooms, and a kitchen for my laboratory. At one point of time, I think it was '97, I didn't have money to pay salaries for my staff. So I said, "We need to close down now." So I called my staff and I said, "I don't have money. You want to stay, stay with me; leave if you want." They said, "Pay us when you get money, but we are staying." I haven't had that same problem again; we are managing to run the show. Today, I have 200 people working for me; I have this building with three floors; I have a laboratory, which is 4,000 square feet. I used to see one new patient a week, today I see minimum 15 new patients a day. It's mostly word of mouth. One patient comes here; they go back and tell the others, "Look, I went there. I got the best of treatment. They've got good attitudes, they tell you what to do, they spend a lot of time with you. The doctors are good." And then when we started prevention, people said, "I need to go for a test, where do I go?" So we started a counseling center. "Where do I go for care?" We didn't have a place, except the government center where the attitudes were very bad. So I started day care. And then I need to admit, because people were getting sick, so I took two rooms in a lodge. And put "please do not disturb" outside, and we used to treat the patient inside. Then a lady who was going away to Canada gave me her house, which had three bedrooms. So we put six beds in there. And then I found this block, which was used for patients with leprosy, and was locked for the last 10 years. So then I asked the management, "Can I take this building?" and they said, "No, it's dilapidated, it'll fall." And then I beg, borrow, steal money to make this floor for administration. Today, more than 11,000 patients have been taken care of here. We have 20 beds, we have an intensive care unit, because the President of the Indian Network of Positive People, Ashok Pillai, was a patient.
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Ashok Pillai (1968-2002)
DR. SUNITI SOLOMON
He died in front of my eyes, with fits for four hours. And I needed a ventilator, and nobody would give me one. We couldn't sedate him more, and he died. And that day we decided, and within six months I got an ICU up here, with two beds. And we are able to save a number of lives. So it's been a struggle, but I think it's very rewarding. At the end of the day, you can sleep well. Martin has been with me from 1987. He's been with me for now 20 years. And here we draw blood. I don't think you find this anywhere else in India. You know, all these Vacutainers. We use only Vacutainers. India is a country with culture, religion, and so we thought we are quite safe. But, unfortunately, 85 percent of infections in India is spread through sex. Unprotected, penetrative sex. Because in India, men can do what they want. They have the freedom to have multiple partners, nobody will ask. Today I see software engineers, doctors, chartered accountants, industrialists, businessmen -- it has cut across all these -- because they feel, "I didn't go to a sex worker, so how will I pick up the virus? I went to my friends, or my secretary, or my classmates. So they are safe." Eighty percent of women we are taking care of -- roughly about 4,000 women -- 80 percent have a single partner that's their husband. We need to change behavior, and we know it's so difficult to change behavior. Now we are going down to the outpatient level. This is our Global Fund place, right? And that's Sangita and Pahal. Okay, and this is our outpatient: there are no patients here now, but ... okay, come. These are two of our counselors. They've finished the job for the day, right? That's Mobeen and ...
ARCHANA [Counselor]
Archana.
DR. SUNITI SOLOMON
Archana. Now tell them, whom did you counsel?
MOBEEN
We just saw a male who came in for testing. But he was very much scared about his status. But after he got his report -- it was ... he was tested negative -- he was more worried about what others would have thought about him than actual the result itself.
DR. SUNITI SOLOMON
Now, we have started doing testing free for everybody, because I think unless you really do free testing, people will not come in. And we find our walk-in is just doubling because of free testing. Now we also have a number of projects which are helping. For example, AIDS Project Los Angeles gives three drugs to 100 families, free testing for them, free monitoring for them. We have at least seven major projects. So I think we are trying to do what Robin Hood did. We steal from the rich and give it to the poor. This is Narayan, very well-trained pharmacist. And this is our pharmacy. This is three-in-one tablets: 840 rupees. This is one month's supply. It's about USD$800 in U.S.; it costs us 840 rupees, or USD$20. When we started treating people we had to give about 20 tablets a day. This is a new one, which has just come into India. It's just one tablet a day. So it's easier for compliance, or adherence. In U.S., this will cost you USD$700. Today, the whole scene is different. When somebody comes up, I say, "We have drugs today." Today, HIV is like a chronic disease. We can treat you. You will have a good quality of life for the next 10-15 years. But, unfortunately, in India, there's not even 100,000 people on antiretroviral drugs today. And we are talking of about 5 million who may need the drug, out of the 10 million who are infected. When we started, it was, I would say, 90 percent men, 10 percent women. Because women in India are getting the infection much later than the men. I mean, the ones whom we see here. So ... but today, there's roughly about 60 percent men, 40 percent women. So there are a lot of problems. So the girls don't get all the treatment the boys get. And she's the one who gets all the pressure, all the blows, if you want to call [it], in the family. But still, she has to keep a smiling face, and manage the show. In our center, when women come, either it's the man who comes and gets tested, and then he says, "I'm married." So we tell them, "Bring your wife." "No, no, no, she doesn't need." "She needs as much care as you need. Bring her, otherwise we are not going to treat you." So we literally push the man to bring his wife in. That's how we test the woman, and then do couple counseling. We did a trial for HIV phase-one vaccine here, and to get 32 volunteers, we had to talk to more than 3,000 people to come forward. That's because of the stigma attached to HIV; they don't want even to participate in a vaccine against HIV. If the priest, a Hindu priest, comes and says, "It's okay, that's alright, there's no problem being HIV positive," you know, the stigma attached to HIV will disappear in India. When the virus was first detected in the U.S., it was among gay community, among drug-users, and sex workers. So we knew that it was among a marginalized community. When we detected it in India, it was sex workers. So, naturally, all the stigma to this disease is because it was in this group of people. I always tell people who participate in my programs: If only we had detected HIV for the first time in a baby, things may have been different. There may not have been today the stigma we have for this disease.
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To learn more: www.yrgcare.org
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