recent interview by trenton times.
A quest to battle HIV in India
Monday, January 26, 2004
By JOSEPH DEE
Staff Writer
WEST WINDSOR - Sreekanth Chaguturu is willing to let someone else grab for the glory of an AIDS cure.
The fourth-year Brown University medical student, who grew up here starting at age 6, has a slightly less ambitious mission - to spare India's approximately 1 billion people from the public health nightmare that would result from an explosion of HIV infections.
The Indian government estimates 4.5 million of its citizens already harbor the virus that causes AIDS. That translates into a relatively low infection rate, but it's rising, Chaguturu said.
"The U.S. government projects that by 2010, 20 million people in India will be infected," he said. "So in that sense, time is running out. As more people get the infection, the faster it will spread. The low infection rate provides a perfect opportunity to address this epidemic before it devastates the country."
The 25-year-old, whose parents immigrated to the United States from the subcontinent in the 1970s, spent last year in the southern Indian city of Chennai, working at the YRG Care Center for AIDS Research and Education.
At the center, he and his colleagues are developing what they hope will be a big part of India's response to the disease. Among the realities shaping Chaguturu's research are the stigma of AIDS, cultural obstacles to proven prevention techniques and the high cost of AIDS drugs.
His temperament seems perfectly matched to the challenge. During a prolonged interview recently in his parents' spacious home, Chaguturu was a model of equilibrium, simultaneously focused and laid back. His broad smile flashed easily beneath large, brown eyes. If Brown University's medical school has a course in bedside manner, he'd ace it.
When he's not studying, Chaguturu likes to exercise, read and listen to music. "I like to keep in shape - I play a lot of squash and tennis, and I play the violin and piano."
Drugs have transformed AIDS from a virtual death sentence to a chronic condition, at least for those who have access to an increasing number of expensive but effective medicines. Most of the estimated 40 million people worldwide who are infected with HIV, however, cannot afford them.
An Indian pharmaceutical company, Cipla, is producing inexpensive generic copies of AIDS medicines, U.S. patents be damned. The company combines three separate drugs in a single pill and charges a patient about $30 for a one-month supply, Chaguturu said. It's a fraction of the price charged here, but even $30 is beyond the means of many Indians, he said.
So Chaguturu and his colleagues are studying a drug-stretching tactic called structured intermittent therapy.
"Right now, when you are diagnosed with HIV and start taking drugs, you have to keep taking them for the rest of your life. We're looking at whether you can take the drugs in short bursts and still get the same outcomes," Chaguturu said. "This could cut costs in half, potentially."
Drug treatment, however, brings with it the added cost of monitoring patients. State-of-the-art tests measure how well the drugs are working, but they are simply too expensive for most Indians, Chaguturu said.
Here, too, Chaguturu and colleagues are looking for innovative approaches to reduce costs.
"My philosophy is that the great should not be the enemy of the good," Chaguturu said. "In America, we have a certain standard of health care, including expensive tests to monitor progression of disease and outcome of therapy. What we're trying to do is to develop less-expensive tests that would substitute for the gold-standard tests here in America."
The substitute tests include tracking body weight and inexpensive blood tests, he said. "Our research has shown that these are good markers," Chaguturu said. "Now the World Health Organization is working to incorporate these tests into guidelines for HIV care in resource-limited settings."-- -- --
Traditional Indian culture presents a set of problems for anyone aiming to stem the spread of AIDS, Chaguturu said. It is a land where most marriages are arranged and where many women defer to men.
Asked if a woman could demand her husband-to-be to submit to an HIV test, he simply shook his head and said, "That doesn't happen."
The imbalance of power doesn't shift much after marriage, either. "And if he wants to have unprotected sex without a condom, she'd be compelled to because of cultural constructs about marriage and what a devoted wife should be."
Asking a husband to wear a condom is tantamount to accusing him of infidelity, Chaguturu said. Housewives make up a significant number of India's AIDS patients, statistics show, which indicates that such accusations wouldn't be entirely unwarranted.
Men whose work takes them away from home often return with HIV, thanks to a tryst with a female prostitute, or, if money is tight, a less-expensive male prostitute or eunuch, Chaguturu said.
Instead of embarking on what presumably would be a lengthy effort to change social attitudes, Chaguturu is seeking solutions that mesh with the cultural landscape.
The center's research shows women who might not feel entitled to demand condom use are receptive to the idea of using vaginal microbicides, which kill HIV, prior to having sex. "Now it's a matter of testing products and then introducing them on a large scale," he said.
Indians promote a perception that infidelity is rare, Chaguturu said, so the sudden appearance of HIV in a family fuels a particular stigma. "AIDS is primarily a heterosexual disease in India," he said. "The stigma isn't that you inject drugs or are homosexual, it's more that you're immoral."
Chaguturu says India needs its own Magic Johnson or Rock Hudson to help shatter the stigma.
"India reminds me of the early years of the epidemic here," he said. "We've treated politicians and actors, but none are wiling to come to the center. They'll get a room in a hotel, and we'll go to them. Because there has not been a high-profile person who has come forward, there is still a lot of stigma, especially in the rural areas."-- -- --
Chaguturu said he looks forward to being part of another research project the center is sponsoring with international partners. AIDS treatment and prevention measures often compete for funding, but Chaguturu says research will show whether treatment can be considered a form of prevention.
"The idea is, if you treat someone and control the level of HIV in their blood, they'll be less likely to transmit it to an uninfected partner."
Upon completing medical school in the spring, Chaguturu faces a three-year residency in internal medicine and then plans to seek a two- to three-year fellowship to specialize in HIV and infectious diseases.
He hopes to practice medicine internationally from a base in the United States. "As one of the richest diaspora or minority communities in America, it's our responsibility to provide something back to India," Chaguturu said.
What drives him is a sense of being part of an international effort to fight the pandemic of AIDS. "It's not you yourself trying to change the world but being part of a larger effort to make the world a better place."
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