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ANTC68H3 Chapter Notes -Social Contract, Multi-Drug-Resistant Tuberculosis, Structural Violence


Department
Anthropology
Course Code
ANTC68H3
Professor
Bryce

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ANTC68 WINTER 2013
Week #8: The Persistent Plagues Biological Expressions of Social Inequalities by Farmer 1999c
Average HIV patient mean age less than 30, half are women, clear majority are living in poverty
3 drug cocktail for HIV treatment includes reverse transcriptase and protease inhibitors and
heralded a new age of optimism in 1996 with its release as possibly the cure or the end of AIDS
The negative part about this new development was the sheer exorbitant cost
Nothing was done to subsidize these prices initially and people in poor nations could not afford
20,000 dollars it might take per year
One can be impressed by the power of modern medicine and yet dejected by our failure to deliver
it equitably
AIDS spread and distribution is influenced by social inequalities and compounded by structural
violence such as gender inequality, racism, and poverty
More women than men have AIDS, being married is the singles greatest risk factor for women
Great inequality of outcomes of those living with AIDS
o Women and people of color having short life expectancies than white men
o Some hypothesized reasons such as biological differences, cultural and psychological
differences were in great supply but there was scant research actually confirming these
hypotheses
o Regardless of cultural and psychological factors, patients with poor outcomes were those
who have barriers in access to effective care overrepresentation of women, poor people
and people of color
Access to medical care is a more important predictor of survival than sex, race and income level
but these factors mediate the access to care through structural violence
AIDS medication is heartening use but the history of the continued high prevalence of TB
suggests that there are great philosophical and logistical challenges ahead to ensure all those
affected are treated in a timely and dignified fashion
New interventions are going to further deepen the divide between the haves and have not
The better the treatment, the more injustice meted out to those not treated
Gotta clean up your act
There are many reasons heard in large international bureaucracies at the supposed unrealistic and
impractical reasons against universal access to combination therapy
Concepts of noncompliance and lack of adherence are common but not at all appropriate
o Fear that there will be resistance to drugs and thus lead to wastage of important drugs
Withholding treatment because of supposed poor compliance is unethical but they claim it would
be disastrous for the patient and public at large
Fact of infection is turned into a character flaw and now point to unsuitability for these people to
get combination therapy
Erratic non compliers apparently breed resistant strains making it worse for everyone, rationed
care, screening for compliance
Past noncompliance does not necessarily predict poor adherence to a new regimen
Its not appropriate technology argument is seen as a justification of the unfair allocation of the
world’s wealth
Cleaning Up Our Act
We dole out drugs to only those who can afford it or through a lottery, what happened for health
for all, even those on the fringes of society
Medicine is not simply the wonders of science but a way of moral persuasion the case for AIDS
treatment may not be the most cost effective one but of justice, compassion and the best we can do
for our patients
Tailoring a Time Bomb
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