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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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The web can’t bring people together to fight HIV/AIDS: documentarist

In our tech-driven world, the key to HIV/AIDS activism still lies in the human body, according to film director and activist Dr. Alexandra Juhasz, who came to Concordia last Thursday as part of the university’s ongoing community lecture series on HIV/AIDS.
“Something happens that’s absolutely imperative for activism in real rooms where people feel things together,” she said, inviting the audience to let their thoughts wander during her lecture “Remembering AIDS Online: Networking, Viruses, Virality, and Arteries,” which analysed the advantages and the shortcomings of the web as a medium for AIDS documentaries and activism.
Juhasz, who has a doctorate in cinema studies from NYU and teaches media studies at Pitzer College in Los Angeles, performed rather than presented her hour-long slideshow of documentary clips and text, occasionally reading aloud quotations from other activists in between gaps of dramatic silence.
However, it was in the Q&A session that Juhasz expressed her real frustrations with using the Internet as a medium for activism, calling it “an unimaginably vast and incredibly powerful resource to bring things together — but not people.”
“I showed you clips of things that are not made to be shown as clips,” said Juhasz, agreeing with one audience member’s complaints that HIV/AIDS documentaries lose effect when viewed in parts, criticizing her own digitally-based presentation for not accurately expressing the complex emotions that these videos should provoke in viewers.
According to Juhasz, the problem is that online information is typically consumed by individuals sitting alone in front of a computer, clicking too rapidly to allow for the deeper thought or emotion to occur. In order to achieve this, she said that people need to interact body-to-body in marches and protests, rather than in sterile environments like online discussion boards or YouTube comments.
She did praise the Internet for helping filmmakers expose their works to a much larger global audience.
“Digital documentaries allow links and movement across boundaries of time and space and material,” said Juhasz.
Because HIV/AIDS documentaries often double as memorials for those featured in them who later die of the virus, uploading these videos to the Internet also serves to archive the memory of those who have been lost.
Juhasz’s lecture was sponsored in part by the Fine Arts Student Alliance and is the first of four upcoming lectures in the 19th annual community lecture series presented by HIV/AIDS Concordia, which also offers a six-credit course on HIV/AIDS for students.
Lecture series coordinator Elvira Parent explained that the guest speakers take the topic of HIV/AIDS “out of the classroom.”
“It allows us to meet with people who are in the field every day, either living with HIV/AIDS or working with people who have it,” said Parent. “In our academic lives, that’s not something we get to do every day.”

The next lecture, “La Republique du traitement: triage et souverainete au temps du sida en Afrique de l’Ouest,” will take place on Nov. 10 at 6 p.m. and will be given by Dr. Vinh Kim Nguyen.

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