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India’s efforts to control the spread of human immunodeficiency virus (HIV) can be split into 2 eras: before the work of Suniti Solomon, M.D. (1939-2015), and after. The country’s response in the “before” era is easy to summarize—it didn’t exist. In fact, at the dawn of the 1980s when HIV was ravaging populations in the West, many considered the virus’s presence in India an impossibility. Solomon and her colleagues flipped that assumption on its head with their identification of the country’s first documented cases of HIV in 1986. The findings jumpstarted Solomon’s decades-long career at the forefront of the nation’s HIV epidemic, where she facilitated access to education, testing, treatment and support for those impacted by the virus.

The Early Years

Born in 1939, Solomon was the seventh of 8 children in a family of leather traders in Chennai, Tamil Nadu, India. , sparked by annual home visits from health officers to vaccinate her and her siblings against smallpox. Solomon carried this interest into adulthood, going on to study medicine at the Madras Medical College in Chennai, India. Her training included trips abroad, including a position as a junior physician at King’s College Hospital in London, followed by a pathology residency at the Cook County Hospital in Chicago. In 1973, Solomon returned to Chennai, where she. It was here Solomon and her colleagues made the discovery that shook India to its core.

Uncovering HIV in India

In the early 1980s, the world was just becoming aware of HIV and its devastating impacts. If untreated, the virus can lead to acquired immunodeficiency syndrome (AIDS), in which the body’s immune system is unable to fight infections or disease. At the time, HIV was wreaking havoc in the U.S. and other world regions; however, the general view in India was that HIV was strictly . Solomon, who was reading about HIV in international medical journals, wasn’t convinced.

She persuaded her student, Selleppan Nirmala, to help answer a single question: is HIV in India? They focused their sampling efforts on members of the sex worker community, who they perceived . In 1986, Nirmala and Solomon collected blood from 100 people in Chennai and tested the serum for the presence of HIV—6 samples tested positive, results that were confirmed via independent analysis at Johns Hopkins University.

Solomon had her answer: HIV was in India. And not only that—if the virus was as prevalent as this initial study suggested, . When the news broke, it solicited its fair share of critics. “Initially, there was denial,” said , Solomon’s son and a professor of medicine and epidemiology at Johns Hopkins University School of Medicine. “[People said] ‘there's something wrong with her, her data are incorrect. It can't be true because we are culturally conservative, and there can't be HIV in India.’” , Assistant Professor in the Department of °®¶¹´«Ã½ at Gauhati Medical College and Hospital in Assam, India similarly noted that, comparatively speaking, “convincing an individual is easy, but to convince a nation is tough.” She explained that HIV was, and in many places still is, a taboo subject in India, which only fueled the fire of disbelief and fear.

However, within the same year (and as a result) of Solomon and Nirmala’s discovery, the government recognized the scale of the issue and to try to combat the disease pervading the population. The discovery also set Solomon on a path to become India’s crusading HIV educator, researcher and activist. This is a path that Parasmita—who submitted an agar art portrait of Solomon as her favorite microbiologist for ASM’s 2022 Agar Art Contest—finds even more notable, given there were only a handful of female doctors and researchers in India at the time, like a lack of institutional support and pervasive gender biases/norms, which persist to this day.

 

Sunil Solomon pegs his mother’s success, in part, on her persistence. “She wouldn't take no for an answer,” he said. “She was always pushing the boundaries.”

Fighting HIV/AIDS by Fighting Stigma

, Solomon highlighted that combatting HIV is complicated by the perception that a positive status is considered a mark of immorality. “What is killing people with AIDS is the stigma and discrimination” associated with the disease, she said. Solomon was deeply empathetic and moved by the stories of people she met affected by HIV/AIDS, and she dedicated much of her life to fighting discrimination faced by those living with the virus. “Medicine can cure disease, but it is only compassion that can save lives,” said Parasmita. “Through her compassion, [Solomon] not only saved, but also improved, countless lives. She was not only a doctor, but she was also a teacher, mentor [and] a counselor.”

Sunil Solomon further emphasized that his mother “was always putting the people before the disease."

In the wake of the 1986 discovery, Solomon founded India’s first center dedicated to voluntary HIV counseling and testing at Madras Medical College. From 1988-1993, the center was a key resource for HIV education, treatment and outreach. In 1993, Solomon transitioned to running her own non-profit organization, the (YRGCARE) in Chennai.

YRGCARE, now headed by Sunil Solomon, concentrates on raising awareness about HIV, providing HIV testing and care and fostering a supportive environment for people living with, or affected by, HIV/AIDS. In the beginning, YRGCARE focused on school education, as well as inpatient, outpatient and palliative care. It eventually broadened its outpatient services and began conducting research on HIV natural history and treatment. According to Sunil Solomon, his mother aimed to provide holistic care to patients not just for their HIV, but in all aspects of their lives. In fact, her work even extended into matchmaking—the 2017 documentary, , documents her experiences matchmaking HIV positive individuals.

Though it started with only 3 employees in Chennai, YRGCARE now has over 1000 employees in 28 Indian states; the organization is working with the Indian government, as well as numerous international institutions, on projects related to HIV diagnosis, prevention and treatment.

Despite its broadening reach, the center's values have remained the same since its founding. “Our core driving value is that everybody who comes through our doors leaves happy,” Sunil Solomon said, whether they are there to receive HIV medications or simply need someone to talk to. He highlighted that YRGCARE’s initiatives are guided by the needs and desires of the community it serves. As a result, the center's services and projects continue to evolve and expand to meet those needs and desires. Moving forward, Sunil Solomon hopes to employ virtual services to offer greater flexibility and care for a larger proportion of the population.

Solomon's Legacy

HIV is still a prominent issue in India, with . However, there has been . The number of annual new cases of HIV in India have declined by roughly half since 2010. Approximately 77% of people infected with HIV know their positive status, 65% are receiving antiretroviral therapy and 55% on treatment have suppressed viral loads; these data represent key steps toward reaching the .

“We're getting closer and closer,” said Sunil Solomon, pointing to the growing repertoire of tools available for preventing, detecting and managing infection. “What we need to figure out now is how to deliver [these tools] to the people who need them in a meaningful way.”

India’s successes in handling the HIV epidemic so far are due to national policies that promote HIV treatment initiation, viral load monitoring and other practices. These efforts are, in part, tied to Solomon, whose dedication to raising the alarm bells about HIV/AIDS in India—and actively working to improve HIV education, treatment access and support—laid the groundwork for the progress seen today.

Solomon’s work did not go unnoticed. She received many awards throughout her life, including a Lifetime Achievement Award by Tamil Nadu State AIDS Control Society, an and a fellowship with India’s National Academy of Medical Sciences. After her death in 2015, Solomon was also recognized by the government of India with the —the fourth highest civilian honor in India—for her distinguished service in medicine.

But Solomon was never pining after accolades. “It wasn't about publications, it wasn't about awards or recognition,” Sunil Solomon said. “The recognition was the smiles on the people who left the clinic or the smiles of the people in the waiting room to the clinic. That's really what motivated her.”

During the held by YRGCARE in 2021, Sunil Solomon used 3 words to describe his mother: integrity, humility and passion. She was, at the end of the day, someone who nurtured a strong sense of wonder and curiosity, who helped people because it was simply the right thing to do. She was also, according to Sunil Solomon, a lot of fun. “She was very fun-loving. She wasn’t like one of those task masters…She was working with her staff and working with the communities to actually make things happen.”

With that in mind, Sunil Solomon thinks the key takeaway from his mother’s work is to “always put the people that you want to serve in the middle of your program. That’s the most important thing that you can learn from her. And that's what she did. It wasn't about anything else. It was about making a difference.”

Solomon’s legacy is undoubtedly captured in the thousands of lives saved through her work at the frontline of the HIV/AIDS epidemic, and the continued efforts of YRGCARE. It is also mirrored in the drive and pursuits of microbiologists like Parasmita, who have long admired Solomon’s career. When asked about her foray into agar art, and the portrait of Solomon in particular, Parasmita explained it represented a “beautiful” step toward her broader goal of “bringing microbiology to the forefront” in India and introducing it to all her students—a pioneering spirit reminiscent of Solomon herself.