Dr. Indira Brar, MD and Dr. Norman Markowitz, Managing Director, Infectious Disease Specialists at Henry Ford Health Systems, Detroit, US, were in Mysuru recently to participate in the HIVe Mysore-ART Update-2017 conference by Asha Kirana Charitable Hospital. Held at SDM-IMD, this was the fourth year that the HIVe international conference was organised by Asha Kirana. As part of their itinerary, Dr. Brar and Dr. Markowitz visited Asha Kirana Charitable Hospital. They were highly impressed with infrastructure, procedures and the practices followed at the hospital. They also expressed a possibility of initiating research in collaboration with Henry Ford Hospital. On behalf of Star of Mysore, Sujata Rajpal spoke to them. Excerpts:

“HIV treatment is much simpler today, it’s only a single tablet a day. Studies have shown that if one takes medication regularly, the life expectancy of an HIV infected person can be as good as anyone else.”

By Sujata Rajpal

Star of Mysore (SOM): The first case of HIV/AIDS was diagnosed in 1982. Thirty-five years later, what has changed with respect to diagnosis, treatment and treatment outcomes like life expectancy and quality of life?

Dr. Indira Brar: A lot has changed since the first case was diagnosed. AIDS is no longer like a death sentence. It is more like diabetes, hypertension or any other chronic disease. The treatment is much simpler today, it’s only a single tablet a day. Studies have shown that if one takes medication regularly, life expectancy of an HIV-infected person can be as good as anyone else. Today, the side-effects are also better controlled. With treatment, HIV positive patients can live a fulfilling life so much so that there is almost 100% success rate in mother-to- child transmission of the disease. In the past decade, I have come across only one case where virus was transmitted from mother to child.

Dr. Norman Markowitz: I don’t think HIV can be considered like diabetes or any other disease. It is true that the life expectancy has gone up for HIV positive patients and the side-effects are controlled. But there is a major difference between sexually transmitted diseases and the rest. The HIV patient has to take medicines life long. If he/she stops medicine, virus comes back and becomes drug-resistant which is not so in other diseases.

SOM: What do you think about  the stigma and discrimination attached to AIDS?

Dr. Indira Brar: There is not so much discrimination but there is still stigma. Even in the US, people don’t want to disclose their HIV status. It is not because there is yet no cure for the disease but because of unethical and immoral values attached to the cause of HIV. The moment people know about an HIV-infected person, they form an impression — if he has got AIDS he must be a bad person living an immoral life. Because of the diagnoses of the virus, there will always be stigma attached to it.

Dr. Norman Markowitz: We can announce openly about diabetes, TB, cancer and other diseases but we can never say the same about AIDS.  The moment people know about your HIV status, they start judging you.

SOM: Who are regarded as high-risk groups?

Dr. Indira Brar: People with multiple sex partners are the high-risk people. In India, the sexual activity is less defined when compared to western countries so men bring HIV home to their wives.

Dr. Norman Markowitz: People with active sex life such as sex workers and drug users are high-risk groups.

SOM: What are your thoughts about quality of care and treatment in the   US and India?

Dr. Indira Brar: After visiting Asha Kirana Hospital, I can say that there is not much difference between quality of care and treatment in the two countries. It is one of its kind as far as treatment is concerned. Dr. S.N. Mothi and his group are doing an excellent job. The hospital follows the same practices and procedures as we do in the US. They know everything we know so there is no difference except for us it is easier to practice because of the resources we have. The hospital is very well-maintained. So the treatment depends on the hospital one gets the treatment.

Dr. Norman Markowitz: We are really impressed with Asha Kirana Hospital. There is absolutely no difference between the two countries. The doctors here are as qualified and knowledgeable as in western countries. The hospital has a good amount of acceptability and it is funded by the community which is a huge thing.

SOM:  Are we closer to finding a cure for AIDS?

Dr. Indira Brar: As of now, complete cure to AIDS is a distant dream. Viruses are becoming smart. Our research is guided towards prevention than cure. We are looking at some kind of prevention where the anti-virus can be injected once in a month to prevent the transmission. None of the vaccines have shown promise. There is a lot of focus on research. In future, it won’t be any one single approach but a couple of different approaches to treat AIDS.

Dr. Norman Markowitz: As of now, there is no vaccine for the disease. I don’t think complete cure is possible because the virus gets integrated into the gene and it is difficult to flush out totally.

SOM: Now that many medicines are available to improve life expectancy, is there an overall complacent attitude towards prevention strategies?

Dr. Indira Brar: Yes there is complacent attitude towards prevention strategies. Since now AIDS is a treatable disease, the emphasis on awareness is scaling down. Even in the US, in suburbs, no one is talking about HIV, they are not aware of it any more. Activism is also going down. People have become complacent because not many people are dying from it. There is no hysteria about AIDS as it was earlier. People ask, does HIV still exist? But we need to be talking about it to control its spread.

Dr. Norman Markowitz: Contacting AIDS is not the end of the world. We tell patients to live with the disease rather than die from it because once contacted, nothing can be done but by following good practices, one can live a fulfilling life. It is not so much about treating but about preventing.

SOM: What is the main objective of research on HIV?

Dr. Indira Brar: The focus is more on prevention. Treating the infected is needed but it is more important to prevent unaffected person from getting infected.

Dr. Norman Markowitz: Prevention is now actively practiced. Cure is the ultimate. Some time ago people didn’t think about cure but now they are.

SOM: What is your message for community?

Dr. Indira Brar: HIV is not the end of life. It is about living with HIV and not dying from it. It is important to get ourselves tested for HIV, the way we get ourselves tested for other diseases. In arranged marriages, people match horoscopes, they should also think of getting themselves tested for HIV so that we can prevent it from spreading to others. We are trying to recommend everyone between the age of 13 and 65 to get themselves tested for HIV. ‘Thank God I am HIV negative’ — let them flaunt the slogan on their sleeve.

Dr. Norman Markowitz: People don’t come forward to test themselves for HIV. I will recommend it should be made compulsory for everyone. It will definitely control the spread of the disease.

SOM: What are your impressions about Asha Kirana – a 30 bed standalone Hospital to care and treat  people living with AIDS?

Dr. Indira Brar and Dr. Norman Markowitz: Asha Kirana is much more than we had expected it to be. It is a complete package. The patients are not just treated but they are also provided with vocational training and given counselling to enable them to live a complete life.

The entire model is phenomenal. We would like to collaborate with them to learn from each other the best practices followed at our respective hospitals. They are welcome to visit us to learn how we practice, how tests are done and the treatment.