Addressing inequality is major health challenge of our time

By the end of this year, the international community has to agree on a new set of sustainable development goals, ensuring universal health coverage must be a priority.

Prisca, 36, was diagnosed with HIV three years ago, but as an unemployed mother of two, she is more concerned about feeding her children than getting HIV treatment.

In fact, Prisca, who lives in the Ivory Coast, has only been to the clinic to get her CD4 count tested once, even though this test is important for people living with HIV, as it measures the level of infection-fighting white blood cells in a patient’s blood.

“I have to be very careful with my resources,” Prisca says. “I do petty jobs for my daily income. And I cannot afford such exams. I rely on providence.”

In contrast, Marietta, 27, also from the Ivory Coast and living with HIV, does not worry about paying for the CD4 test, is very observant and has her count checked on a regular basis. As a manager in a business company she can afford such exams. She says: “I travel abroad for my monitoring tests and I get my drugs from there.”

Addressing the dramatic inequalities between those who can afford access to health care and those who can’t is one of the biggest challenges of this century. HIV infection represents a very clear example of these inequalities: AIDS is a disease that the rich can treat and the poor cannot.

Disconnect in access to treatment

Though HIV treatment tends to be provided free of charge, the vast majority of people living with HIV in developing countries cannot afford treatment for related opportunistic infections, such as tuberculosis. Adam, who is HIV positive and lives in Abidjan, says: “We have to pay a lot of money to be treated for opportunistic infections. These drugs are not free. Moreover routine tests are also not free. And people living with HIV with minimum or low resources cannot afford them.”

When someone is diagnosed as HIV positive, they need to take routine tests to assess the evolution of the virus in their body. Unfortunately accessing such tests is still challenging for many.

A medical doctor from Treichville Teaching Hospital in Abidjan, who did not want to be identified, said: “Routine tests such as viral load tests are necessary in the monitoring of HIV patients. These tests help determine when a patient has to switch from one treatment to another. Unfortunately less than 10 per cent of people living with HIV in limited resource settings have access to these tests because they are expensive and only available in laboratories in capital cities.

“Rich patients just go to private clinics or travel abroad to have these exams while those who are not that rich rely on providence. Another exam necessary for HIV patients is testing for drug resistance which tells a patient if he needs to make a switch. Unfortunately we do not have this test in our country.”

The state of public health infrastructure is just one more issue that people living with HIV in places with poor resources often have to face. Mariama, who lives in Guinea, says: “Here there is only one public facility where we can do our CD4 test. And sometimes the machine goes down. When we face such a situation, we just have to go back home and wait for the machine to be repaired. If you have money you can go to a private facility to have your test done.”

Fulfill the rights of all people living with HIV

Health is a human right, and social conditions shouldn’t change that, but sometimes poor people find themselves in situations where their health can seem like a luxury. Williams, a young Togolese man living with HIV, nearly died last year due to latent tuberculosis.

He says: “I had TB which was not being treated well and as the years passed my lumps were getting infected. I had to undergo a surgery costing 1.500.000 XOF [around USD 7,500]. I did not have this money and I just thought I would die. But my colleagues gathered the sum and today I am alive.”

Unfortunately Anna, a young Ivorian woman living with HIV, was not so fortunate. She died after a long battle with cervical cancer. Her mother said: “When she was diagnosed we did everything we could to treat her. I sell food in the market and am a single mother. I used all my savings. And when all my money finished I just sent her to the village because I knew there was no hope. I am very sad because as a mother I just watched my child die. All this because I am poor.”

Universal health coverage

Ending Aids will never be achieved without a holistic and human-rights-centered approach, and as with many other health issues equity is vital if progress is to be made.

By the end of this year, the international community has to agree on a new set of sustainable development goals. As one of the biggest challenges of our time, ensuring universal health coverage must be prioritized. Everyone has a right to access health care regardless of their bank account and other social determinants. Human rights must be at the heart of service provision.

As Marietta says: “I can afford my treatment and exams because I belong to a higher social class. But I personally think that everyone, no matter what their social status, should enjoy the right to health.”

Read more about sustainable development goals in the post 2015 development agenda

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