2019 LEAD Fellow Lancet Profile – Sai Subhasree Raghavan

March 3, 2020

Sai Subhasree Raghavan: building health solidarity in India

Subha

When Subha Raghavan was growing up in southern India in the 1970s, she witnessed caste discrimination and violence and vowed to “create a more just society” and “give back” to her community and others like it. Raghavan is the Founding President of the non-profit Solidarity and Action Against the HIV Infection in India (SAATHII), which, for 17 years, has worked to increase access to health care, justice, and social welfare for marginalised communities in India. Long-term colleague, Shobana Ramachandran, Senior Manager of Strategic Information and Evaluation at the Elizabeth Glaser Pediatric AIDS Foundation, describes Raghavan as “an extraordinary activist, leader, and collaborator” and says: “Under her charge, SAATHII has become one of the pre-eminent HIV prevention, care, and treatment actors in India, and has gone on not only to serve communities marginalised by their HIV status but also those discriminated against on account of their gender and/or sexuality.”

One of four children, Raghavan comes from a middle-class farming family in Andhra Pradesh and recalls how her brother, Venkateswara Rao, “taught me to cross gender barriers, be confident, and believe in myself”. She adds that the “unconditional support” of her husband has been important over her career. Raghavan excelled at science in school and after a masters in nutrition at Sri Sathya Sai Institute of Higher Learning and a PhD in Human Nutrition at SNDT Women's University in Mumbai in 1992, she moved to Columbia University in the USA, where she worked on growth and development of children with HIV under the mentorship of Sally Ann Lederman. At the height of the HIV/AIDS epidemic in the mid-1990s, Raghavan spent almost a decade at Columbia, combining research to prevent HIV wasting and assessing the metabolic complications of antiretroviral therapy with overseeing HIV/AIDS nutrition services at Harlem Hospital Center, under the guidance of Wafaa El-Sadr. As Raghavan explains: “At the time, research was mainly focused on white, gay men. Our team was one of the few in the country that focused on minority communities”.

The millennium marked a turning point for HIV/AIDS and for Raghavan. Global events, including the XIII International AIDS Conference in Durban in 2000 and the UN High-Level Meeting on HIV/AIDS in New York, galvanised her thinking and advocacy efforts in treatment access. From these meetings, an international network of HIV/AIDS activists—the International Treatment Preparedness Coalition—was born. “Being part of that group was a big inspiration for me to go back to India and work on treatment access”, she says. “I decided to mentor local people and build a local organisation.”

It was that vision that inspired Raghavan to help set up SAATHII in 2002, with a focus on prevention of mother-to-child transmission in the private health-care sector. SAATHII now offers a range of HIV and tuberculosis services in partnership with government, private, and civil society. “We test and treat prisoners in over 900 prisons and closed settings in 12 states, and are responsible for training doctors and nurses providing antiretroviral treatment and HIV care across the country in the public health sector”, she explains. “As principal recipient of the Global Fund, we have been working side-by-side with the government and Plan International towards eliminating paediatric HIV in India by 2020.” Although Raghavan recognises that this deadline will not be met, she remains optimistic: “The government has committed to a scale-up of community-based HIV testing of pregnant women at the village level—which is a gamechanger”. “We have to test 27 million pregnant women every year. A lot of these women are in the private sector, so SAATHII is also working to integrate testing across the private sector in 22 states of the country.” The challenge is, she says, “identifying strategies to reduce new pockets of HIV infection among younger women and men.” Raghavan adds that human rights and social protection must be at the heart of the response: “If you don’t reduce the vulnerability of the population you are not going to protect them against HIV and ensure health access. So we have made improving access to housing, livelihood, child support, pensions, and legal services as part of many programmes.” Her ongoing projects include providing inclusive health and education services for LGBTQI populations. “This requires persistence and patience”, she says. “Homophobia, transphobia, and cis-binary gender norms are entrenched in medical and educational systems, rendering the pace of attitudinal and policy change excruciatingly slow.”

Pradeep Kakkattil, Director of the Office of Innovation at UNAIDS, testifies to Raghavan's dedication: “I first met Subha when she set up SAATHII and was developing a directory of all the NGOs working on HIV in India to encourage them ‘to work together and learn from each other’. She has always looked for new ways of engaging across sectors, and has the ability to focus on areas that are often most difficult but can be transformative.” Last year, Raghavan was awarded a Women in Global Health LEAD Fellowship, from the Harvard Global Health Institute and the Women and Health Initiative at the Harvard T H Chan School of Public Health, to spend 4 months in the USA, and plans to use her leadership skills to mentor other women leaders in south Asia. Looking ahead, Raghavan says: “my ambition is to establish a state-of-the-art global health institute in India in collaboration with academic institutions in the USA and Europe—to provide affordable public health education for people from the Global South.”