It was a beautiful bouquet of red roses. A traditional way of saying "I love you". But the occasion was far from traditional. The man and woman who occupied center-stage were exceptional.
The scene was a doctor's room in Chennai. A young HIV+ widow with a little daughter had brought the well-to-do businessman who had fallen in love with her to meet her doctor, Suniti Solomon. Dr Solomon, one of the founders of the AIDS Society of India and founder-director of the YR Gaitonde Centre for AIDS Research and Education (YRG-CARE), was to break the HIV-status news to the aspiring husband.
So she talked to him, informed him about HIV/AIDS, and added that if he wanted to go ahead with the marriage, she and her team would stand by the couple and counsel them so he could remain safe from the infection. "The man heard me out in complete silence," recalls Solomon. "Then, he walked out of the room. I was saddened, and tried to offer words of comfort to the woman. We were sitting there when in he walks again, with a beautiful bouquet of red roses."
That was about one-and-a-half years ago. The two are now happily married, he is free from infection, and the little girl, who tested negative, makes the family complete. This is only one of the many, happy, real-life stories Solomon has made possible.
In India, there is enormous societal pressure on people to get married, says Dr Solomon. It comes mostly from parents, and most often, HIV-infected people don't want to reveal their status to their family. They offer one excuse after another, not wanting to go in for a marriage without disclosing their medical history. When they run out of excuses, they come to Dr Solomon.
Dr Solomon networks with 15 NGOs in the country, and tries to find the best matches for HIV+ people wanting to get married. Matching caste and creed is formidable enough, but this goes one step further. If one partner is very sick, and the other is in the initial stages of infection, then the latter might end up being a widow or widower soon. "That's a trauma we try to avoid," says Solomon.
But it isn't just HIV+ people that Dr Solomon brings together. Many a time, a woman or a man who is negative agrees to marry an HIV+ person - like the man who said it with roses! What wins the hearts of many people is that the chosen partner has been upfront about the illness instead of hiding it and going ahead with the marriage.
YRG-CARE offers counselling and care to people living with HIV/AIDS (PLHA). Today, if an HIV+ case is detected early and the patient follows instructions precisely, he or she can live a normal life for 20 years or so, says Dr Solomon. The person, does, of course, need to go in for annual tests to determine the count of CD4 cells (or T-cells) in her or his body.
Most people without HIV have 700-1000 CD4 cells, which are attacked by the virus and are an indicator of the strength of their immunity system. HIV+ people are considered to have "normal" counts if their CD4 cells are above 500.
These CD4 cells are the key to Dr Solomon encouraging her patients to marry. The more calm and relaxed a person is, the more these cells are produced. Stress and worry cause their count to drop, endangering the life of the HIV+ person.
Most people who test positive do not want to talk about it to their loved ones, but Dr Solomon encourages them to confide in someone or the other. And who better than a spouse to share your fears and go to for comfort? Hence, the doctor plays matchmaker. She's found that infected people who are (happily) married do much better in fighting the illness.
Then comes the question of children. Dr Solomon generally advises married persons to adopt a child. But sometimes, they insist on having a biological baby. Some couples agree on artificial insemination, but some don't. Although sophisticated techniques by which sperm is washed free of the virus are available in the West, they are not an option in India.
If an aspiring father is infected, Dr Solomon gives him heavy doses of anti-retroviral drugs to reduce the infection, and his wife is allowed to conceive. If the woman tests negative after conceiving, then she's left to have a normal delivery. If however, the woman is infected while conceiving, or is positive to start with, then she is given anti-retroviral drugs, and encouraged to go in for a Caesarean delivery to minimize the risk of infecting the baby. The mother is also encouraged to use formula foods, but if this isn't possible for economic or other reasons, she is told to go for exclusive breast-feeding for a brief period before weaning the baby.
Since 1993, YRG-CARE has delivered about 200 babies of couples living with HIV/AIDS. Of these, the later 42 babies have tested negative, says Dr Solomon proudly. With practice, the team has learned how to avoid pitfalls and follow a procedure that results in a healthy baby. Of the 42 babies, three are from marriages facilitated by Dr Solomon.
When detractors ask why she is helping the birth of babies who have a poor chance of growing up with their parents, Dr Solomon says most of the couples wanting children have parents, property, and something to live for and on. But longevity or the lack of it is a problem, she knows.
Recently, a new avenue of action - a Mothers' Project - was catalyzed by a mother from Los Angeles who lost both her sons to AIDS. Beginning April 2005, the AIDS Patients Los Angeles (APLA) project will initiate a holistic approach. Besides treatment, it will offer nutritional support, psycho-social counselling and funding for education, so that HIV/AIDS-affected women live longer for their children. A team from the US will bring both expertise and funds.
Dr Solomon has already "arranged" over 20 marriages. "I'm always invited," she says, "but I don't go. If I do attend, questions are bound to be asked." Sooner or later, someone will put two and two together, and then the couple will find themselves fighting the stigma that clings so tenaciously to those four innocuous letters of the English alphabet.
Today, YRG-CARE provides care to about 8,000 PLHA; follow-ups are done rigorously and this has vastly improved the life expectancy of the HIV+. But the quality of their life still depends on acceptance, by society or a loved one. Which is why the marriages facilitated by Dr Solomon are a giant step forward.