Universal Access to HIV Drugs

Published February 27, 2009 @ 09:44AM PT

The Students for Global Health equity has posted a response to my criticism of the New Scientist article on ending HIV. In that response, Jon Shaffer asks a provocative question - why am I not in favor of universal access to anti-retroviral drugs?

My answer is not so controversial. I am in favor of universal access. Wholly in favor. It should be our ultimate goal in AIDS treatment. It's the effective thing to do, as it motivates people to get tested for HIV. And it's cost effective. Last, providing life-saving drugs to people who need them is the ethical thing to do; that's obvious.

Here is what I am not in favor of: overblown rhetoric that detracts from the seriousness of the situation and the challenges we face. The New Scientist proposed requiring people to be tested for HIV, and making treatment mandatory, even for people who will not personally benefit from it. That's inflammatory, and it distracts us from what matters. We need systems in place that let us provide treatment for everyone with HIV. Without those health systems, neither money nor drugs will solve the problem.

In my opinion, the New Scientist article comes very close to saying something very ugly. You can't ignore the role of individual choice, and individual rights without going some bad places.

Here's one of the bad places. If you want to end the epidemic of AIDS without building health systems and supporting training, this is what you do: test everyone in your country for HIV. Send teams out to comb the countryside and force everyone to get tested. Then, imprison everyone who tests positive. Create a giant prison colony and put everyone with AIDS there. Keep them there until the end of their lives. There you go, problem solved.

If treatment for HIV is a right, then refusing that treatment is also a right. You can't have one without the other. Pretending otherwise is naive and dangerous. Providing treatment, ethically, to everyone who wants it is a challenge that will take both time and money.

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Comments (2)

Yes, Alanna, a very well written, reasoned blog. I am a physician, and I am so glad someone with your knowledge and entusiasm is out there working for this wonderful cause.

Posted by Lee Dorsey on 02/27/2009 @ 03:01PM PT
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I already asked about this on that other blog entry, and reading this one answered it a bit, but not entirely. Of course I don't think that everyone with HIV/AIDS should be imprisoned. But I really don't see why people should have the right to refuse treatment for a disease that they could pass on to others. If people can refuse that, how can we ever get rid of the disease? I mean, unless everyone who doesn't get the treatment agrees to never have sex with anyone who doesn't have the disease, which needless to say is fairly unlikely.

Posted by Lianne Lavoie on 03/17/2009 @ 11:30AM PT
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Author

Alanna Shaikh has spent the last ten years immersed in global health; she has worked for NGOs, companies, universities, and the US government on projects that ranged from preventing antibacterial resistance to improving maternal and child health.