Wall Street Journal - February 24, 2005
Marilyn Chase at marilyn.chase@wsj.com

In India, where 5.1 million people are infected with the virus, the disease's powerful stigma typically forces young men and women to keep their HIV status secret. Yet they also feel the yearning, and sometimes societal pressure, to marry. Some turn to Suniti Solomon, who as one of the country's best-known AIDS doctors is in a position to know thousands of HIV-infected patients and who among them is looking for a spouse.

A 65-year-old physician and microbiologist, Dr. Solomon, is fusing modern medicine with ancient matchmaking tradition to help men and women caught in India's AIDS epidemic to marry and have children.

"Marriages are not made in heaven in India," she says. "They are arranged." And so it is with HIV marriages.

Dr. Solomon has made 20 matches in which both partners are HIV-positive, a practice she began in response to demand from patients at her AIDS clinic at the Y.R. Gaitonde Center for AIDS Research and Education (YRG CARE), in Madras. For married couples wanting to start families, she uses modern techniques involving HIV drugs and artificial insemination to help them have healthy babies. She has played stork to 50 babies born to uninfected mothers who conceived using donated sperm because their husbands are HIV-positive. And she has helped 200 HIV-positive women deliver uninfected babies by giving mother and baby antiviral drugs and then delivering the baby by cesarean section.

At the 12th Annual Retrovirus Conference in Boston this week, scores of research reports outline the issues involved in treating AIDS, including access, cost, toxicity and drug resistance. The complexities underscore the value of preventing new cases. In India, where the epidemic is young, prevention stands a real chance of success.

One of Dr. Solomon's aims is to prevent HIV-infected men from marrying uninfected brides, a major problem in India's largely heterosexual epidemic. AIDS first infected people in the trucking and sex trades, entering the middle class via sex clients who brought the virus home. Now Dr. Solomon says about 80% of the female patients at her AIDS clinic are monogamous and married.

One patient, a young engineer under intense pressure from his parents to wed, asked Dr. Solomon to find him "a nice-looking girl" with HIV . "He didn't tell them he was positive because it would break their heart," Dr. Solomon says. She wrote to colleagues in search of a bride. Some candidates were infected AIDS widows or recipients of tainted transfusions. A woman infected by unknown means captured the man's heart.

"They sent a photo. It was really beautiful with the light shining on her hair. Anyone would have fallen in love," says Dr. Solomon. The engineer flew to Bombay, courted and married the woman, and then told his folks that he had found a wife. In three months, his wife was pregnant. With antivirals and a C-section, the baby was born HIV-free.

Daughter of a leather magnate, she wed cardiac surgeon Victor Solomon -- "It was a love marriage," she says -- and now their son, Sunil, 25, is a physician at his mother's clinic. Her golden retriever, Lara, works at the clinic as its "pet therapist," she says.

About 18,000 patients have walked through the doors of YRG CARE for voluntary HIV counseling and testing. Often, the patient is a young bachelor, who learns he is HIV-positive after being tested for AIDS before taking an overseas job. If he wants to marry, Dr. Solomon discusses the obligation to disclose his infection or to consider an HIV-positive woman.

Some men ask her to find them a spouse. "Instead of matching horoscopes," she says, "I match their serologic [blood] status."

Factoring in faith, caste and beauty to seal the deal is "a Herculean task," she says. "We have all strata of society -- doctors, lawyers and engineers who are infected," she adds. She has matched "a doctor to a nurse, a politician to a social worker," she says.

Though controversial, because of its suggestion of social engineering, Dr. Solomon's matchmaking is similar to the practice of "sero-sorting" among gay men who date men with the same HIV status. Researchers in San Francisco say the trend, which is strictly voluntary and informal, is growing. "I'm not sure that [physician matchmaking] would be acceptable in most countries," adds Peter Piot, chief of the Joint United Nations Program on HIV/AIDS.

A large part of Dr. Solomon's work is counseling uninfected women with HIV-positive husbands, especially in how to get pregnant without infecting themselves and their babies. In arranged marriages, early motherhood is expected.

In risk counseling, she advises all patients to practice safer sex with condoms. Yet most couples want a child and hence take risks. "There is so much pressure to have a baby," Dr. Solomon says. "Patients say, 'If I get the virus, it will kill me in 10 years. But if I don't have a baby, I'll be on the street in one year.' "

Dr. Solomon offers uninfected women artificial insemination with uninfected donor sperm. "Many girls raise their eyebrows," Dr. Solomon says. She explains, "You pretend it's your husband's child. The mother-in-law is happy." Most women weigh the option with their husbands.

As a last resort, for women who insist on their husband's sperm, Dr. Solomon uses an unconventional technique: She will treat the husband with six months of AIDS antiviral drugs, lowering the virus to undetectable levels. Then she'll give the couple a green light to abandon condoms for one week. "It's a big risk," she admits. "Two years ago this would have been called unethical."

The risk has mostly paid off, she says. In four tries, three healthy babies have been born and one was stillborn. The four mothers remained uninfected.

Nancy Padian, an AIDS researcher at the University of California at San Francisco, worries the practice "is not risk-free." If popularized, she fears infected men receiving drug treatment might decide to abandon condoms in an effort to conceive without medical supervision -- and end up infecting their wives and unborn children.

Dr. Solomon's clinic is participating in the HIV Prevention Trials Network, a research group set up by the National Institutes of Health in the U.S. The international group is studying 1,750 couples with one HIV-infected partner to see if giving antiviral drugs to the infected people can block transmission to their partners. Volunteers are told to use condoms at all times.

To Indian singles isolated by HIV infection, arranged marriage offers relief, says clinic administrator Rochelle D'Souza Yepthomi. A 31-year-old patient wrote that his wife became his "true friend and better half," and a mutual understanding of their HIV makes each day "most precious to us," Ms. Yepthomi says.

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