For a number of years now, our public health authorities have been pushing the idea that we need to respond more holistically to health promotion and disease prevention. To them, this means pushing organizations working in HIV/AIDS to broaden their reach, to address not only the whole spectrum of sexually transmitted and blood-borne infections (STBBIs), but also complicating factors like mental health, addictions and aging.
These things are not news to the community response to HIV/AIDS: we have been doing them for years. Prevention activities have long included information on how to avoid, detect and treat other STBBIs, and many of us remember the bad old days when no one would help the people living with HIV with their other problems, so those fell to us, too. Problems with the landlord, fired from a job, refused dental treatment, getting older faster than one’s peers…all of these came back to the HIV/AIDS organization to deal with.
Somehow, the challenge of learning how to integrate knowledge about HIV into their own work was never the responsibility of those other services, so we took that on to make them do their own jobs for our people.
What is particularly distressing about the current push from government health funders for this massive “integration” is their blindness to their own practices of thinking and acting in silos without regard to impacts in someone else’s field.
Let’s look at a couple of decision put into place by the Minister of Citizenship and Immigration at the federal level in Canada and the reactions of his peers in cabinet.
First, cutting the interim federal health benefits for refugee claimants (since declared unconstitutional, so the coverage is back, probably temporarily, in a reduced form). No analysis on the health impacts of such a move. Response of the then Minister of Health? “Not my file. See the Minister of Citizenship and Immigration.” That’s the person you want in charge of the health of Canadians, right?
Second action, much more recent: travel ban for people coming from countries in West Africa affected by Ebola. The World Health Organization has criticized the move, rightly pointing out that this is an action that will not prevent a single person from contracting Ebola and will instead worsen the crisis by heaping stigma atop misfortune (my words, not theirs). I have even heard people in the HIV movement, or at least its peripheries, express their support for this idea, having forgotten what travel bans and a misunderstanding of the transmission of HIV have done for us. The current federal Minister of Health? “Not my file. See the Minister of Citizenship and Immigration.”
Then there’s that other problem we face with alarming regularity: the criminalization of the exposition to a risk of transmission of HIV (we say HIV criminalization to be brief, but you really have to be precise to grasp the breadth of what is being criminalized in these cases). Public health authorities have pronounced themselves against criminalization and for a more health-based approach to the issue of risk and non-disclosure. [In]Justice marches on, doing what it wants to do without regard to the possible effects on testing, prevention, treatment and the quality of life of people living with HIV.
There’s a duality in how our corporate citizens act, too. I was quite impressed to hear tell of a Canadian mining company doing business in South Africa that had adopted a policy of providing medical care and support to its employees living with HIV and their families. Want to bet that the same corporation here would quietly not hire or let go the person who disclosed his or her status in Canada? I guess the limits of tolerance are inversely related to the alternatives one might have in the situation (greater selection of non HIV-infected candidates, less tolerance and support). One rule for there, a different rule for here.
If we are going to take a holistic approach to health and address the people turning to us for help as whole people (like we have been doing since we were created by the affected communities), when can we start expecting coherence from the government and from our corporate citizens?