Edinburgh Evening News Article

Sat 15 Sep 2007
Mission to end HIV's stigma
JOANNA VALLELY

WHEEZING and undernourished, the delicate-looking boy was brought by a neighbour to the hot Indian HIV clinic. His mum and dad had HIV and there were strong suspicions that the 12-year-old was also suffering from it. Edinburgh doctor Adam Black ran tests on the weakened youngster and confirmed that he had indeed contracted the deadly virus - probably at birth.
Huge stigma surrounds HIV in India, where those who are open about being infected are often shunned and risk losing their jobs and homes. As a result many don't seek medical help for the devastating effects of the illness till it is too late.
Such was the case for Ashish, who lived with his aunt and alcoholic uncle. Through fear and ignorance they made him use separate cups, plates and towels and forced him to sit on the dirt floor like an animal. But with his chirpy manner and lovely smile, the 12-year-old quickly endeared himself to staff during his regular visits to the clinic in Thane, a city near Mumbai.
He responded to HIV medications and was attending school, where he was doing well. Even the uncle who had treated him abysmally became more understanding after receiving counselling and education about HIV at the clinic. But cruelly, just as it seemed the youngster was making progress, he was diagnosed with an aggressive bone tumour, completely unrelated to his HIV, and died six months later.
Adam, 33, from North Meggetland, reflects on the injustice of Ashish's short life. "He got HIV from his mother when he was born and it was unusual that he had it for 12 years. His father had died and his mother abandoned him and he lived with his uncle, who was often drunk and used to beat him. He was such a lovely boy and I thought how easily our roles could have been reversed. I'm so privileged to have been born in the west."
Working with people with HIV in an area of grinding poverty, Adam witnesses extreme suffering on a daily basis. He says: "They are often thrown out of their home and job, and their friends and family cut them off. The stigma is very great. The dominant religion is Hinduism, with its concept of Karma. People feel that if something bad happens to you, it is your own fault and you deserve it."
The Edinburgh GP has been in Thane since September 2005 with his wife Jo, 32, and children Alistair, three, and one-year-old Freya, who was born there. He is completing a three-year stint as a volunteer, providing out-patient care at the Jeevan Sahara Kendra HIV/Aids project at Lok Hospital.
Adam sees around ten patients a day, mainly in the 13-30 age group, with the help of a Hindi translator. Many of those affected have contracted the virus as a result of sexual contact with an infected person. "Most of the people I see are family members - maybe the husband sleeps with prostitutes and brings HIV back to the family. It's very sad."
Education on the prevention of sexual diseases is not as ingrained as in Britain. A pack of three condoms can cost a day's wages so many people decide to do without and, in a patriarchal society, women are often afraid to insist.
Adam lives with his family in a five bedroom flat, luxurious by local standards, with fans, running water and unreliable electricity.
It's a far cry from how most of his patients live, in homes eight feet square, with mud floors, only one toilet between many homes, and without running water. "Half the population of Thane live like that. It's challenging working here."
Patients are given medicines to suppress the virus and help their immune systems recover and preventative antibiotics. However for people with HIV in India, life expectancy is less than in the UK.
The former George Watson's pupil became aware of the HIV problem in India when he spent a month in Chennai as part of his medical training.
For Adam, a major difficulty is that because of the stigma attached patients don't come to the clinic until they are already very ill. "Often they will be really dehydrated and half-paralysed before they come to see us."
The most rewarding part of Adam's work is the satisfaction he derives from knowing he has saved lives. "It is nice to look around and say 'that patient should really have died'."
The Blacks are due to return to Scotland in July when Adam will resume his work as a GP.