By Sujata Rajpal

Dr. Jyoti Dhar, an HIV Physician and GUM (Genitourinary Medicine) Consultant for over 24 years at Leicester, UK, was in Mysuru recently to deliver Dr. Suniti Solomon Lecture on AIDS in Women at HIVeMysore – ART Update 2018, an international conference on HIV organised by Asha Kirana Hospital. Dr. Dhar is a specialist in the management of HIV and AIDS. She has served on the Board of the British Association of Sexual Health and HIV.

A Regional Speciality Advisor and Training Programme Director for GUM and, Head of Specialist Training for East Midlands, she is particularly recognised in the field of medical education for having designed and developed GUM/HIV curricula, core learning outcomes for medical graduates and recently the HIVonline toolkit for undergrads.

Dr. Dhar was conferred the title of Professor in Medical Education in 2016 by the University of Leicester in recognition of her educational and research contribution. On her maiden visit to Mysuru, Sujata Rajpal spoke to her on behalf of Star of Mysore. Excerpts…

Star of Mysore: Give us an outline of the treatment of HIV women in the UK?

Dr. Jyoti Dhar: It is not that every pregnant woman with HIV gives birth to an HIV infected baby. The ratio of transmission is only 1: 4 but all HIV pregnant women are put on medication to target at zero transmission of the disease. In UK, almost all pregnant women undergo HIV detection test. There is no mandate by the government to do so but the patients are counselled by the doctors to get themselves tested. They are advised that it is for the good of their baby to get the test done. Those women who are HIV positive are immediately put on antiretroviral drugs. UK has now almost eliminated the mother-to-child transmission of HIV. In the last 13 years, out of 700 pregnant women with HIV virus, only 3 gave birth to babies with HIV virus. So we are doing good as far as the mother-to-child transmission is concerned but still a lot needs to be done to combat the menace otherwise.

SOM: In your view, what does India need to do to control HIV?

Dr. Jyoti Dhar:  (Laughs) It is surprising that the country which gave the world Kamasutra shies away from talking about sex. For most of the young population in India, internet is the only source of information about sex because neither family nor educational institutions want to educate them about safe sex. A birth control pill can prevent pregnancy but it can’t prevent STDs and AIDS. There is an urgent need to create awareness about AIDS not only for the general public but also for the medicos. And the only way to combat the spread of this menace is to test people, especially high risk sections of our society such as sex workers, drugs users and people travelling to Africa and other such countries which have a high percentage of HIV positive people.

In India, only 30% of pregnant women with HIV are put on medication so the rest are missing out on this; it happens because all the births are not registered. The deliveries are also done at home by midwives who have half-baked knowledge. There is also a need for better coordination between private and public sector. Apart from medication and everything else, instead of scorning at patients, we need to show empathy towards them.

SOM: Now when the drug for HIV is easily available and the patients can live a normal life then why there is still a stigma attached to AIDS?

Dr. Jyoti Dhar:  I don’t see any difference between Diabetes and AIDS. If AIDS medicine has to be taken lifelong so is the case with medicine for diabetes. One can die of diabetes but if one is taking HIV medicine regularly and adhering to a single sex partner, one can live a normal life. There is a stigma attached to AIDS because illicit sex is mainly the cause of this disease and the word sex is a dirty word in our society.

SOM: How far these conferences like the HIVe help in creating awareness about AIDS?

Dr. Jyoti Dhar:  (Pauses for a few seconds) Such conferences are mainly attended by the medicos and researchers; it is like preaching the already converted. There is so much more which needs to be done. The message, the awareness, the knowledge that we gather here need to reach health workers in small hospitals and government dispensaries in semi-urban and rural areas. The HIV patients even in luxury hospitals are given step-motherly treatment; so one can imagine the condition of such patients in backward areas. More than creating awareness to the public, there is an urgent need to educate the medical fraternity.

SOM: What are your impressions about Asha Kirana Hospital?

Dr. Jyoti Dhar:  Asha Kirana is doing an amazing job. The commitment of Dr. Mothi and his entire team is highly commendable but the task before us is so mammoth that we need thousands of Asha Kiranas to combat the menace.

SOM: Should testing for HIV virus be made mandatory before getting married?

Dr. Jyoti Dhar:  Why make it mandatory? People are usually averse to anything which is mandatory. Most of the marriages in India are arranged by the parents where the boy and the girl don’t know anything about the past sexual lives of each other. It is in their own interest that before deciding to tie the knot they should walk into a STI clinic and get themselves tested for HIV or any STI diseases. Getting tested for HIV before marriage is now catching up in UK.

SOM: Tell us about your Kashmir connection?

Dr. Jyoti Dhar:  I hail from Kashmir. I did my MBBS and MD from Sher – I – Kashmir Institute of Medical Sciences, Srinagar.  I was the first consultant at Gastroenterology Department at Sheri-I- Kashmir Hospital. In fact, my batch started the Department but due to the tense atmosphere in Kashmir, my parents asked my siblings and me to leave the country. Along with my husband and son, I shifted to the UK and couldn’t visit Kashmir for 21 years. In UK, at that time HIV was a new disease. Most of the Gastroenterology patients had HIV. Since it was a new disease, I decided to educate myself in it and gradually shifted to HIV as my area of specialisation.

Facts about HIV (as told by Dr. Jyoti Dhar)

• When on antiretroviral drug, the HIV infected patients can carry on with their normal life including their sex life.
• Through the drug, the virus is brought down to a permissible limit where it can’t be transmitted. All the patient has to do is take the medicine every day.
• The old drug had a lot of nasty effects but the new tablets have no side-effects.