Equity in Health

AIDS treatment must adapt to poor communities, says MSF

AIDS treatment procedures must be demystified, simplified, and adapted to the needs of the world's poorest communities in order to be effective, according to the NGO Medecins Sans Frontieres (MSF). "To scale up treatment on a large scale, we have to adapt treatment models to real life," Dr Morten Rostrup, President of MSF's International Council told reporters in Nairobi. "Adaptation means fewer pills per day, fewer lab tests and free treatment, dispensed in the communities where people, live, that is at district facilities and at community health posts."

Further details: /newsletter/id/30099

In a July 11th article, the British weekly The Economist recounts the latest grim statistics on AIDS, noting emphatically that the 9,000 people who die each day from AIDS represents three times the number killed in the World Trade Centre attacks. "If all men are created equal, all avoidable deaths should be regarded as equally sad," says the editorial, adding that "common decency suggests that the rich world should do whatever it can to help." The editorial concludes ominously: "Cynics in the West might write Africa off. Are China, India, Indonesia and Russia to be written off as well?" Translation? Africans are poor and black. Thus we (the Economist) realize, dear reader, your greed for profits is not whetted by viewing them as consumers. Nor is your compassion stirred sufficiently by viewing them as fellow human beings. However, be mindful that the fire that has scorched that continent is spreading and is now threatening places populated by people who are prosperous enough - barely, but still above the threshold - to count as potential consumers and pale enough -barely, but still above the threshold - to awaken your caring. Read this commentary from www.zmag.org.

AIDS-drug cocktail to be given to poor South Africans

The French humanitarian group Medicines Sans Frontieres (MSF) has launched an independently run and financed programme in Khayelitsha township outside Cape Town, South Africa, that provides a small group of impoverished people with AIDS access to a cocktail of three antiretroviral drugs. The programme will assess the feasibility of providing the therapy in a poor township from primary health-care centers run by local government. "Given the heatedpolitical context, we will be monitoring the project carefully," said Toby Kasper, coordinator of MSF's Access to Essential Medicines Campaign.

AIDS: Africa's doctors
International Herald Tribune

"Here in my country, ten people die of AIDS every hour. About one million people are infected with HIV out of a population of some 12 million. Our government is working hard to try to slow down this epidemic: We have an extensive voluntary counseling and testing program and hope to treat as many as 80,000 people with antiretroviral drugs by the end of the year. Unfortunately, there is only so much we can do. One of our biggest obstacles, which many nations on our continent share, is a shortage of health care workers. Simply put, Africa cannot fight poverty and disease without more doctors and nurses."

Alarm at flight of health workers

Wealthy countries "deliberately" enlist doctors and nurses from poor nations, costing developing states US $500 million a year in lost training, Ndioro Ndiaye, deputy director-general of the International Organisation for Migration, said. According to Ndiaye, the UK drafted more than 8,000 nurses and midwives from outside of Europe in the year 2000. This was in addition to the 30,000 hired over previous years. Some 21,000 Nigerian doctors were working in the US the same year, while there were more doctors from Benin working in France than in their own country, she said.

Alarm over HIV resistance

One in four new HIV infections in the UK may be resistant to current drug treatments, say experts. The annual conference of the Public Health Laboratory Service heard that the growing problem of resistance made measures to prevent initial HIV infection ever more important.

Albinism in Africa: a medical and social emergency
Brilliant M: International Health 7(4): 223-225, 2015

People with albinism (PWA) face a variety of medical and social problems, ranging from poor vision and skin cancer to murder for their body parts for witchcraft in East Africa. PWAs are reported to face enormous challenges in East Africa. They have very poor, uncorrectable vision and, as a result, they are disadvantaged in schools and in employment opportunities. At best, the authors report, they are discriminated against; at worst, they are hunted and often killed for their body parts for witchcraft use. If they survive these attacks, they are very likely to develop skin cancer that is most often untreated, leading to a preventable premature death. However, awareness and activism can help PWAs to lead more normal lives by addressing their medical and social needs. Above all, the authors urge people to make efforts to stop atrocities against PWA.

Almost 100 million people a year forced to choose between food and healthcare
Bowman V: The Guardian, UK, December 2017

The author raises that almost 100 million people are pushed into extreme poverty each year because of debts accrued through healthcare expenses. Citing a report, published by the World Health Organization and the World Bank, she highlights that the poorest and most vulnerable people are routinely forced to choose between healthcare and other necessities for their household, including food and education, subsisting on $1.90 (£1.40) a day. Researchers found that more than 122 million people around the world are forced to live on $3.10 a day, the benchmark for “moderate poverty”, due to healthcare expenditure. Since 2000, this number is reported to have increased by 1.5% a year. She cites Timothy Evans, senior director of health, nutrition and population at the World Bank Group: “Universal healthcare coverage is not just about better health. The reality is that as long as millions of people are being impoverished by health expenses, we will not reach our collective sustainable development goal of ending extreme poverty by 2030.”

Alternative world health report calls for radical change
Global Health Watch 2: launched 16th October

Civil society organizations and scientists from around the world are calling for 'a new development paradigm' to address the toxic combination of climate change, growing poverty and inequality and poor health. The new report, Global Health Watch 2, says that unfair social and economic policies combined with bad politics are to blame for the poor state of the health of millions of people in the world. The report makes stinging criticisms of key global actors, and calls on governments to stop the Bank from meddling in health politics. Global Health Watch 2 provides examples of civil society mobilization across the world for more equitable health care and more health promotion, although more is needed to bring about significant improvements in health.

An analysis of the nutrition status of neighboring Indigenous and non-Indigenous populations in Kanungu District, southwestern Uganda: Close proximity, distant health realities
Sauer J; Berrang-Ford L; Patterson K; Donnelly B: Social Science & Medicine 217, 55-64, 2018

This paper analyzed the estimated prevalence, and modeled possible determinants of, moderate acute malnutrition and severe acute malnutrition (SAM) for Indigenous Batwa and non-Indigenous Bakiga of Kanungu District in Southwestern Uganda. The authors characterize possible mechanisms driving differences in malnutrition. Retrospective cross-sectional surveys were administered to 10 Batwa communities and 10 matched Bakiga Local Councils during April of 2014. Individuals were classified as moderate acute malnutrition and SAM based on middle upper-arm circumference for their age-sex strata. Malnutrition is high among Batwa children and adults, with nearly half of Batwa adults and nearly a quarter of Batwa children meeting moderate acute malnutrition criteria. SAM prevalence is lower than moderate acute malnutrition prevalence, with SAM highest among adult Batwa males. SAM prevalence among children was higher for Batwa males compared to Bakiga males. Models that incorporated community ethnicity explained the greatest variance in middle upper-arm circumference values. This research demonstrates inequality in malnutrition between the Indigenous Batwa and non-Indigenous Bakiga of Kanungu District, Uganda, with model results suggesting further investigation into the role of ethnicity as an upstream social determinant of health.