Commentary By Rico Gustav, Executive Director of Global Network of People Living with HIV
“I don’t mind taking the ARVs. But you know that I’ll probably die from hunger or beaten up by silop (slang word for police) anyway, right?” These words by a fellow drug user that I was trying to convince to start ARVs years ago when I was a peer educator in Indonesia echoed for years in me, because of the broken spirit that I saw that day. But these days those words are synthesized in me for a very different reason: because he was entirely right.
You can give someone ARV treatment their entire life, but what will it do if they die from being criminalized? Of domestic violence? Of starvation? Of not being able to protect themselves from those who are supposed to protect and serve our own society?
COVID-19 is just the latest reminder of the fact that health is not only about health. It is also about social justice for those who cannot even wash their hands with clean water because it is not available to them. It is about economic justice for the sex workers that cannot afford to isolate themselves as their work security is not protected, but rather persecuted. It is about political choices for the political parties that wish to privatize the health system, rather than investing in affordable health systems that are available for the public.
When the world moved from the Millennium Development Goals to the Sustainable Development Goals, one primary passion behind it was this understanding that development sectors are interconnected. You cannot address one dimension of society, without developing others.
We can be sure that over the next two to five years, pandemic preparedness and health security will be high on the global development agenda. Society cannot afford to get hit like this again, not with our current economic, social, political systems. We are ‘lucky’ that COVID-19’s highest estimated mortality rate is about 2%. With the 7.7 billion people occupying the earth and the natural progression of globalization, we can almost be 100% sure something else will be coming, something that may be far more fatal than COVID-19.
COVID-19 will not be the last one, it also was not the first one. We have had many warnings. Not only MERS, SARS or Ebola. More than 32 million people have died of AIDS-related illnesses[1], it was ignored for years and some people continue to ignore it and pretend it’s not their problem. For many years, tuberculosis has been the leading cause of death, yet the current global financing for TB response is US$15 billion[2] from being effective to combat it.
Unlike HIV and TB, COVID-19 made everyone feel vulnerable, instead of ignoring it as a disease that attacks certain groups that are marginalized. But COVID-19 should be a reminder that we may be your security guards, your office cleaners, your drivers, construction workers, sex workers, shop keepers, the gay guys you mocked on the street and the women you catcalled shamelessly – but our health is your health. The seconds we spend not being able to access services we need, are the seconds you spend putting your own well-being at risk.
People living with HIV have been advocating for strengthened and modernized health systems for many years. But more accurately, we have been advocating not only for strong and resilient health systems, we have been advocating for something far more important: systems for health. Systems for health is a system that recognizes the centrality of community-led response and person-centered care. Systems for health is an approach that recognizes that health does not exist in isolation and recognizes that the success of health goals fully rely on the success of our society to address overall inequality. Systems for health put the last mile first, by prioritizing the most marginalised and most vulnerable.
On this World Health Day, let us remember that social and economic classes may divide us, but the absolute fact is that humans live as a vulnerable herd, and we can die as one if we do not start recognizing the interconnectedness of both dimensions of our lives, and interconnections between us as individuals.
With solidarity in this difficult time,
Rico Gustav
[1] https://www.who.int/gho/hiv/en/
[2] http://www.stoptb.org/assets/documents/about/cb/meetings/32/32-04%20Global%20TB%20Financing/32-4.4%20Global%20TB%20Financing%20-%20Bridging%20the%20financial%20gaps%20in%20the%20TB%20response_Presentation.pdf
