Who gets treatment for AIDS is political and economic, and surely not fair, said Dr. Paul Farmer, addressing a crowd of nearly 400 people last week at the Medical School.
Farmer, associate professor of medical anthropology in Harvard's Social Medicine Department and founder of the Institute for Health and Social Justice, presented evidence collected in Haiti that made a direct link between class, race and gender, and the availability of prevention and treatment tools.
His field research in rural Haiti was conducted at a time when few doctors were studying the transmission of AIDS among women or the poor, and he has done extensive field research on AIDS in Russia and parts of the developing world.
"In 1990, when we did this exercise, there was nothing you could find about poor women and AIDS," he said. "The real nature of risk in rural Haiti was social inequality."
He linked AIDS treatment to the simpler treatments for tuberculosis. "What is the leading cause of death from AIDS in the developing world? It's tuberculosis - very easy to treat. That's why we should look at it as a human rights issue."
Farmer visited Siberian prisons in order to study tuberculosis among men there.
"The people who say it's not cost effective to treat TB were the first to put on breathing masks in the prison," he said.
In addition to the research in Haiti, Farmer and his colleagues worked hands on with local women's groups there to stop the spread of AIDS through educational intervention and medical treatment, before financial support for the latter waned.
"When we say treatment is not 'cost effective,' who are we saying this about? We are saying it about the poor."
He said academics had to get involved in the real world politics of AIDS treatment.
"We can't disassociate ourselves from social justice movements. As physicians, this is a part of what we do."
Farmer's speech was the last of a year-long series sponsored by the Penn Interdisciplinary Dialogues on AIDS, dedicated to the memory of Dr. Thomas Mann, who was instrumental in linking human rights to AIDS treatment and encouraging the United Nations to apply the Universal Declaration of Human Rights more vigorously to issues of medical coverage.
Originally published on May 13, 1999