Located in southeast India, Chennai is the largest metropolitan area in southern India. It is known for its effectiveness in combating HIV/AIDS. Curious about how the local community and doctors are tackling the epidemic, I visited a nearby hospital and two doctors known for their community-based response to treatment.

In 1986, Dr. Suniti Soloman was the first doctor to identify an AIDS case in India. Since then, she has devoted her life to the issue. Today, she runs an organization called YRG Care, whose work is based in a community hospital. YRG Care utilizes a multi-faceted approach, which includes a research lab, an office handling prevention and psycho-socio programs, and a clinic for testing and treatment.

I would characterize Dr. Suniti and YRG Care’s work as a bottom-up approach. When I first walked into the clinic, I couldn’t help but feel a bit uncomfortable. Keep in mind, I am used to those extra clean hallways, bright white doctors’ robes, and modern elevators found in the United States. As a naïve American, I simply did not have a firm appreciation for the work of Dr. Suniti and YRG Care. Her patients are primarily from the greater Chennai area and most of them are walk-in clients. Dr. Suniti acknowledges that “most of our patients come in first for free testing if they suspect of having HIV; and if the test result is positive, we work with them to develop a comprehensive treatment and support plan.”

When Dr. Suniti showed me the levels of HIV-positive clients by occupation category, I was shocked by the numbers. Of over 12,000 clients she has treated, 22% are housewives, 9% are truck drivers, 3% are students, 10% are white-collar employees, 2% are commercial sex workers, and 17% are skilled workers. By gender, over 40% are women today in comparison to less than 20% many years ago.

This led me to ask, why are housewives the largest category? Logically, shouldn’t housewives be one of the safest categories since they are less likely to engage in risk-associated behavior? “You have to understand the status of women in India” replied Dr. Suniti. Today, the majority of Indian women are still secondary to men. Unfortunately, it is commonplace for Indian husbands to buy sex, contract the disease, and infect their wives with HIV. It’s not like the wives can easily ask their husbands to use condoms, even if they suspect that they could have STDs or HIV.

“The bottom line is gender equality and we cannot ignore the increasing faces of women” stated Dr. Suniti. “I am almost 70 and an old generation. I am also religious. I didn’t feel comfortable talking about sex education or asking housewives to negotiate for condom use with their husbands in the beginning. But we need to be realistic. We are talking about a disease that still has no vaccine and no cure. We must know what works the best to prevent the spread of HIV.” She continued, “Abstinence is always what we promote. But after abstinence, I talk about having one partner and use condoms.”

There has been an increasingly concerted effort to tackle the issue of HIV/AIDS at the global level. Dr. Suniti’s work focuses on a bottom-up approach emphasizing treatment and care. “I think there has been too much talk at the macro level and not enough at the micro level. We need to develop a response that is most appropriate for the local community. In India, we need to empower women to protect themselves. We need to have sex education for young students and instill the concept of gender equality so they grow up to respect women and their wives.” “We need to closely monitor treatment and make access available to as many people as possible.” India is still a developing country and without ensuring close follow-up with HIV-positive patients and cutting down drug costs, most patients will not be able to afford treatment. Currently, it costs about 1,000 Rupees per month (about 30 USD) per patient. As of 2006, the GDP Per Capita in India was only $3,800 USD.

In Part II, I’ll have more to share about talking to Dr. N.M. Samuel and visiting commercial sex workers in Chennai.

Wenchi Yu Perkins
Human Rights Program Director