In lieu of an abstract, here is a brief excerpt of the content:

Perspectives in Biology and Medicine 48.1 (2005) 10-16



[Access article in PDF]

Global AIDS

New Challenges for Health and Human Rights

The Maude and Lillian Presley Professor of Social Medicine
Department of Social Medicine
Harvard Medical School
641 Huntington Avenue
Boston, MA 02115.
E-mail: ayang@pih.org (Alice Yang).

Many of you in this audience—unlike most audiences of medical students, physicians, and people from the allied health sciences—have read the Universal Declaration of Human Rights. Several articles in the Declaration are directly relevant to what we're discussing today: health and human rights in the time of AIDS. For example, Article 25 is worth citing at length:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

Another relevant section, Article 27, is about the fruits of scientific progress: "Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits." [End Page 10]

These are two very straightforward messages to people involved in caring for the sick—two messages about health as a human right. I had never laid eyes on the Declaration until 10 years ago or so. My colleagues at Partners In Health and I had already been working in Haiti and elsewhere, places suffering staggering social, economic, and political inequalities. The idea of health as a human right resonated deeply with us and today informs every aspect of our work.

Inequalities in access to care and the consequent outcome gap are perhaps the biggest issues in medicine today. We have enormous problems delivering health care with equity in the United States, let alone worldwide. Forty million people in this country are uninsured, and just as many are underinsured. But even with a pretty rotten health care system, the impact of interventions such as antiretroviral therapy for AIDS has been remarkable.

We're living in a fortunate time: we have many of the tools that we need to confront AIDS and other epidemics. But where the interventions are most needed, they are least available—either overpriced or simply nonexistent. Already steep inequalities of access and outcomes are further exacerbated. Even where there exists sound AIDS research, there is often very little in the way of therapeutics: in a slum in Nairobi, Kenya, for example, it is possible for researchers to check viral loads in cervical secretions, but therapy for the people who are in fact sick with AIDS is simply not available. Given such inequity within just one project, imagine what the situation looks like globally. It's a situation that we should regard as a human rights tragedy.

One aspect of the global AIDS crisis that bears demystification is the often-heard debate that pits the promotion of HIV prevention against the provision of AIDS treatment. Notice that this argument has been set up as if prevention and care are mutually exclusive interventions, when in fact we don't really have any data to support such an interpretation. Many people with whom I've recently spoken think that we've moved beyond this debate—that funding for AIDS treatment is now available through multilateral initiatives such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria. In truth, there still isn't enough funding available to remediate entrenched inequalities, and there still remains a deep rift in the international health community over what should and what shouldn't be done—thus delaying or denying treatment for millions of patients currently living with AIDS.

What are the objections we hear to doing the right thing? What is the point being made when someone asks, "Well, isn't it true that there's not enough infrastructure to use antiretrovirals in Africa?" Is that question being asked to start a conversation...

pdf

Share