Triage system can harm access to AIDS drugs: specialist

In 1982, an 18 year-old student attended a seminar about HIV/AIDS at Concordia, which inspired him to fight the once highly stigmatized disease.

Nearly 30 years later, this student, now an associate professor in the department of social and preventive medicine at Université de Montréal and a specialist in AIDS research, led a seminar of his own at Concordia on Nov. 10.

Dr. Vinh-Kim Nguyen spoke to students, professors, and AIDS activists from Montreal in French about his time researching the effects of AIDS in Ivory Coast and Burkina Faso.

As part of Concordia’s ongoing HIV/AIDS community lecture series, the presentation drew awareness to the consequences of HIV treatments in Africa, which are largely unknown.

Nguyen focused on the period following the beginning of widespread use of antiretroviral drugs in the 1990s, which lead to a significant drop in HIV/AIDS-related deaths. For many African countries, these life-saving drugs were scarce and the virus was considered an “invisible disease because it was not seen as a problem,” according to Nguyen.

A native-born Ivorian who attended the seminar noted that when he was growing up, his father had told him that “HIV does not exist because gays do not exist.”

With this kind of mindset, the disease continued to spread, and it became increasingly important to get tested, and to talk about the disease. Awareness campaigns were introduced, using such messages such as, “I want to live happily for a long time, so I am adopting a responsible sex life.”

Because of the scarcity and price of drugs, health organizations relied on triage where only certain people would receive the lifesaving drugs, Nguyen said. People were selected based on their ability to communicate and be suitable AIDS activists.

Speaking from an anthropological perspective, Nguyen did not offer solutions. Instead, he criticized the triage system and noted that it was difficult for Africans to talk about themselves. In North America, he explained how “we are swimming in a confessional culture.” For Africans, it is not as easy to confess, Nguyen explained.

A consequence of triage, Nguyen argued, was that it could lead to “therapeutic sovereignty,” or a fight over who should have access to treatment.

Nguyen has observed how communities are now forming with infected people who have access to drugs which have fragmented society, which he said has led to these people living longer and taxing the fragile health care system.

The associate professor wrote about the “therapeutic sovereignty” phenomenon in The Republic of Therapy: Triage and Sovereignty in West Africa’s Time of AIDS, published in 2010.

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