Hospital Practice
ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage: http://www.tandfonline.com/loi/ihop20
A Not-So-Distant Mirror Jonathan M. Mann M. D. To cite this article: Jonathan M. Mann M. D. (1992) A Not-So-Distant Mirror, Hospital Practice, 27:11, 11-15, DOI: 10.1080/21548331.1992.11705516 To link to this article: http://dx.doi.org/10.1080/21548331.1992.11705516
Published online: 17 May 2016.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ihop20 Download by: [University of Toronto Libraries]
Date: 27 June 2016, At: 05:29
Hospital Practice
November 15, 1992
ANot-So-DistantMirror
Downloaded by [University of Toronto Libraries] at 05:29 27 June 2016
Editorial
Now in its second decade, the AIDS crisis has forced us to reexamine our institutions and acknowledge some deeply unsettling truths. In the early stages of the U.S. epidemic, we were brought face to face with the pervasiveness of homophobia and the fact that disclosure of positive HIV serostatus could result in job loss, housing discrimination, and the tragic rupture of family ties. It soon became clear that the virus was not an isolated phenomenon confined to the gay community (Figure 1) but was spreading, through heterosexual contact and drug use. Reports of growing devastation in Africa, Latin America, and the Caribbean were followed by signs of rapid expansion in Southeast Asia and India. Gradually, a new concept of AIDS began to take shape-a con-
This editorial is by Jonathan M. Mann, Professor of Epidemiology and International Health, Harvard School of Public Health, and Director, International AIDS Center, Harvard AIDS Institute, Boston. Dr. Mann was Conference Chairman of the VIII International Conference on AIDS/Ill STD World Congress.
Figure 1. Cumulative data reported from around the world show that heterosexual contact is by far the dominant mode of transmission for HIV infection, accounting for fully 71% of all cases in
adults. By contrast, homosexual contact accounts for just 15% of cumulative cases of HIV infection in adults, and injection drug use for only 7% of such cases. (Adapted from Mann JM et al, 1992)
cept that placed HIV infection in the context of other sexually transmitted diseases and emphasized the role of economic and social vulnerability in its spread. Like other sexually transmitted pathogens, HIV selectively targets disadvantaged and socially marginalized groups. The mirror of AIDS reflects a reality that physicians and other care providers who work in public health have long recognized: From cradle (continues)
Hospital Practice November 15. 1992
11
Hospital Practice
Editorial
Downloaded by [University of Toronto Libraries] at 05:29 27 June 2016
(continued}
to grave. the poor and those who are disadvantaged for any reason are more vulnerable-to communicable diseases, occupational accidents, intentional injuries, environmental hazards, and premature mortality-than the rest of us. In dealing with the AIDS pandemic, we have learned that preventive messages aimed at high school and college students may seem irrelevant to street youth who view life as precarious anyway; that testing and counseling services are not used by those who fear, on the basis of past experiences of discrimination. that their confidentiality will be violated; that antiviral drugs and agents to treat AIDS-related opportunistic infections cannot help patients who cannot afford them. Thus, the challenge of conquering HIV goes beyond the technologic problem of outwitting a single retrovirus. It goes to the heart of the social fabric of a nation that prides itself on believing that all people are created equal, yet denies over 30 million of its citizens adequate medical coverage-a nation in which women and racial minorities consistently get the short end of the health and health care stick. Of course, unequal distribution of health and health care resources is not a problem that is confined to the United States. The consequences of economic vulnerability are even more profound for the many millions throughout the developing world who lack clean water, basic immunizations, or access to family planning clinics and condom promotion programs. A recent analysis by the Global AIDS Policy Coalition identified 57 countries at high risk for HIV spreadincluding countries such as Indonesia, Egypt. Pakistan, and Bangladesh that until now have remained relatively untouched by the pandemic. Irrespective of national boundaries, poverty and social marginalization create a climate of helplessness and hopelessness in which diseases such as AIDS can flourish. The World Health Organization constitution states that health is a fundamental human right encompassing physical, mental, and
social well-being. Yet that glowing abstraction has yet to be transformed into a reality. Although individual nations have cooperated successfully to combat regional health problems, and industrialized nations have often shown willingness to lend a hand to developing nations, there is no coordinated global leadership championing the cause of health as a human right, not a privilege. Finally, the Universal Declaration of Human Rights. issued in 1948, has not provided sufficient protection against discrimination or even guaranteed the physical safety of HIV-infected persons in many countries. Without clear, enforceable safeguards to protect human rights, there is an ever-present risk that public health programs may degenerate into vicious or insidious campaigns of harrassment against vulnerable persons and groups. We have the capacity, in the United States, to provide excellent and humane health care to all of our people, including those with HIV infection or AIDS. As a major world power. we have a responsibility to help ensure that the citizens of less developed nations share in the scientific gains that the coming decade will surely bring. And as an exemplar of democratic values, we have a duty to insist that marginalized groups be brought into the political process and that respect for human rights-for allprevails. The 1990s could be remembered as a time when public health programs finally came of age; when health as a universal right was acknowledged; when outdated, parochial attitudes were replaced by more global ones. As physicians. we have a mandate and the skills to contribute leadership. Let's get to work. JON A THAN M. MANN, M.D.
Selected Reading Mann JM. Tarantola DJM. Netter TW (Eds): AIDS In the World. Harvard University Press. Cambridge, Mass. 1992
Hospital Practice November 15, 1992
15
ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage: http://www.tandfonline.com/loi/ihop20
A Not-So-Distant Mirror Jonathan M. Mann M. D. To cite this article: Jonathan M. Mann M. D. (1992) A Not-So-Distant Mirror, Hospital Practice, 27:11, 11-15, DOI: 10.1080/21548331.1992.11705516 To link to this article: http://dx.doi.org/10.1080/21548331.1992.11705516
Published online: 17 May 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ihop20 Download by: [University of Toronto Libraries]
Date: 27 June 2016, At: 05:29
Hospital Practice
November 15, 1992
ANot-So-DistantMirror
Downloaded by [University of Toronto Libraries] at 05:29 27 June 2016
Editorial
Now in its second decade, the AIDS crisis has forced us to reexamine our institutions and acknowledge some deeply unsettling truths. In the early stages of the U.S. epidemic, we were brought face to face with the pervasiveness of homophobia and the fact that disclosure of positive HIV serostatus could result in job loss, housing discrimination, and the tragic rupture of family ties. It soon became clear that the virus was not an isolated phenomenon confined to the gay community (Figure 1) but was spreading, through heterosexual contact and drug use. Reports of growing devastation in Africa, Latin America, and the Caribbean were followed by signs of rapid expansion in Southeast Asia and India. Gradually, a new concept of AIDS began to take shape-a con-
This editorial is by Jonathan M. Mann, Professor of Epidemiology and International Health, Harvard School of Public Health, and Director, International AIDS Center, Harvard AIDS Institute, Boston. Dr. Mann was Conference Chairman of the VIII International Conference on AIDS/Ill STD World Congress.
Figure 1. Cumulative data reported from around the world show that heterosexual contact is by far the dominant mode of transmission for HIV infection, accounting for fully 71% of all cases in
adults. By contrast, homosexual contact accounts for just 15% of cumulative cases of HIV infection in adults, and injection drug use for only 7% of such cases. (Adapted from Mann JM et al, 1992)
cept that placed HIV infection in the context of other sexually transmitted diseases and emphasized the role of economic and social vulnerability in its spread. Like other sexually transmitted pathogens, HIV selectively targets disadvantaged and socially marginalized groups. The mirror of AIDS reflects a reality that physicians and other care providers who work in public health have long recognized: From cradle (continues)
Hospital Practice November 15. 1992
11
Hospital Practice
Editorial
Downloaded by [University of Toronto Libraries] at 05:29 27 June 2016
(continued}
to grave. the poor and those who are disadvantaged for any reason are more vulnerable-to communicable diseases, occupational accidents, intentional injuries, environmental hazards, and premature mortality-than the rest of us. In dealing with the AIDS pandemic, we have learned that preventive messages aimed at high school and college students may seem irrelevant to street youth who view life as precarious anyway; that testing and counseling services are not used by those who fear, on the basis of past experiences of discrimination. that their confidentiality will be violated; that antiviral drugs and agents to treat AIDS-related opportunistic infections cannot help patients who cannot afford them. Thus, the challenge of conquering HIV goes beyond the technologic problem of outwitting a single retrovirus. It goes to the heart of the social fabric of a nation that prides itself on believing that all people are created equal, yet denies over 30 million of its citizens adequate medical coverage-a nation in which women and racial minorities consistently get the short end of the health and health care stick. Of course, unequal distribution of health and health care resources is not a problem that is confined to the United States. The consequences of economic vulnerability are even more profound for the many millions throughout the developing world who lack clean water, basic immunizations, or access to family planning clinics and condom promotion programs. A recent analysis by the Global AIDS Policy Coalition identified 57 countries at high risk for HIV spreadincluding countries such as Indonesia, Egypt. Pakistan, and Bangladesh that until now have remained relatively untouched by the pandemic. Irrespective of national boundaries, poverty and social marginalization create a climate of helplessness and hopelessness in which diseases such as AIDS can flourish. The World Health Organization constitution states that health is a fundamental human right encompassing physical, mental, and
social well-being. Yet that glowing abstraction has yet to be transformed into a reality. Although individual nations have cooperated successfully to combat regional health problems, and industrialized nations have often shown willingness to lend a hand to developing nations, there is no coordinated global leadership championing the cause of health as a human right, not a privilege. Finally, the Universal Declaration of Human Rights. issued in 1948, has not provided sufficient protection against discrimination or even guaranteed the physical safety of HIV-infected persons in many countries. Without clear, enforceable safeguards to protect human rights, there is an ever-present risk that public health programs may degenerate into vicious or insidious campaigns of harrassment against vulnerable persons and groups. We have the capacity, in the United States, to provide excellent and humane health care to all of our people, including those with HIV infection or AIDS. As a major world power. we have a responsibility to help ensure that the citizens of less developed nations share in the scientific gains that the coming decade will surely bring. And as an exemplar of democratic values, we have a duty to insist that marginalized groups be brought into the political process and that respect for human rights-for allprevails. The 1990s could be remembered as a time when public health programs finally came of age; when health as a universal right was acknowledged; when outdated, parochial attitudes were replaced by more global ones. As physicians. we have a mandate and the skills to contribute leadership. Let's get to work. JON A THAN M. MANN, M.D.
Selected Reading Mann JM. Tarantola DJM. Netter TW (Eds): AIDS In the World. Harvard University Press. Cambridge, Mass. 1992
Hospital Practice November 15, 1992
15
