When it comes to equality in health, one immediately thinks of the unacceptable gaps between North and South. But here in Canada, in Quebec, are we sure that we have done everything we can to make services and care accessible to everyone? Very hard to believe when just a few days ago, an HIV-positive mother transmitted HIV to her newborn baby because, without medical coverage, she had not taken antiretroviral drugs that would have prevented the transmission of HIV. virus to the child. We are far from immune to health inequities right here. This situation is disgraceful in a province and a country where we preach for humanitarian aid.
This 1er December, World HIV/AIDS Day, reminds us that nearly 40 years of struggle have not yet eradicated this virus, it continues to reach some of the most vulnerable populations and no effective vaccine is still available. In 2021 and in figures, HIV was: 38.4 million people living with the virus, including 1.5 million newly infected; 40 million people have died since the start of the epidemic, including 650,000 in 2021. About 4,900 young women between the ages of 15 and 24 contract the virus every week. “Let’s push for equality” is the slogan of the 1er December 2022.
This year, UNAIDS is calling on communities to challenge the inequalities that stand in the way of ending the epidemic. Despite the masterful advances in research, nothing will be gained as long as vulnerable populations, those hit hardest by HIV, do not have access to the positive spinoffs of scientific progress. We know that the HIV epidemic is not just a virus or a physical health issue, any more than tuberculosis in earlier times, or COVID-19 more recently.
Epidemics operate like predators by insidiously infiltrating the weaknesses of vulnerable people. Vulnerable people are not only people whose health is fragile; and therefore it is not only by taking into account their physical health that one will make them stronger.
It is essential to consider the social determinants of health. These determinants act upstream of health, on the living conditions that shape a universe more or less favorable to the overall health of the person, including education, genetic background, but also gender, culture and events. experiences of stigma and discrimination. This multifactorial arrangement fuels the epidemic by limiting access to services and care, whether screening or treatment.
We will not win by ignoring social injustices or failing to tackle them head-on. Respect for rights makes it possible to improve health and guarantee patients dignity, security and equity, all of which are essential values for overall health.
In recent years, the arrival of migrants with precarious status has revealed many challenges that are often difficult to overcome. From the outset, migrants face major obstacles. First, not all migrants have access to medical coverage (RAMQ or Interim Federal Health Program). Second, having access to it does not mean that the healthcare system is accessible to them.
Finally, health is not always a priority when food and accommodation are themselves issues. Added to this are the effects of the recent pandemic which have considerably slowed down the administrative processes for obtaining medical coverage, as in the case cited above. Unacceptable in 2022.
The care and maintenance in a corridor of care of a migrant living with HIV and without coverage is a real obstacle course. For the person and for caregivers. In the current context, the person must pay for their medication and the necessary samples to assess the effectiveness of the treatment. In other words, impossible. For each case, it is therefore necessary to organize a support network, if possible in the person’s native language, bringing together privileged collaborators from the community, the CIUSSS and pharmaceutical companies in order to orchestrate the most appropriate care. possible. At the Clinique l’Actuel, several people in this situation are seen each week.
It has long been known that a person whose viral load is undetectable cannot transmit HIV. We can well repeat loud and clear that HIV is a public health problem, this seems to disappear when it comes to care and the associated costs. In 2022, in Quebec, all people living with HIV must have access to the same care, regardless of medical coverage, because it is indeed a public health issue. And if it were TB rather than HIV, would the situation be different? The question needs to be asked.
In 1952, the World Health Organization (WHO) defined public health as the science and art of preventing disease, prolonging life, and improving physical and mental health at an individual and collective level. Seventy years later, it is clear that the modus operandi remains reactive rather than preventive, including in Quebec, located in a so-called developed country. And yet, the preventive approach is a very effective way of reducing diseases and the costs they entail, financially, but also and perhaps above all socially. It is high time that the health system stopped neglecting prevention.