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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 ANTC6
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