If you’re involved in primary health care or global health, you may have heard that primary care is all about “horizontal” programs. Those of us who live and breathe the wonders of primary care regularly cite the benefits of health care that is broad and comprehensive. We even point to evidence that shows how a focus on primary care results in better health outcomes at lower costs that is more equitable and accessible.
I believe in the benefits of primary care with all my heart, soul and mind.
So how can I simultaneously devote so much time and energy to something like GAD that seems clearly based on “vertical” interventions focused on a single issue like HIV? What a good question!
Well, my first line of defence would declare that even a dedicated primary care doctor can recognize that there must sometimes be an exceptional emphasis on certain issues. HIV is one of these. I remember former UNAIDS Director, Dr Peter Piot, who repeatedly declared the exceptional nature of HIV. That always resonated with me. HIV is exceptional because of the sheer numbers of people affected. (By this measure, other illnesses such as tuberculosis would also qualify as exceptional.) HIV is exceptional because, more than almost any other infection, its spread is driven by the social determinants of health (economy, education, gender). Piot used to describe how HIV has “revealed the fault lines of society”.
But my other line of defence in any accusation about the validity of focusing on a vertical program comes from recognition that solving the problem of HIV in the world requires the very essence of what primary care is all about.
Addressing HIV requires public infrastructure and strong health systems along with broad-based educational and economic solutions.
Countries, regions and communities that have successfully reigned in the impact of HIV have done so through great public health systems with the aid of excellent primary care.
Gregg Gonsalves said this in Mexico in 2008: Without continuing sustained focus on AIDS treatment, many millions of the poorest and most marginalized people in the world will die, period. And without breadth, not only will AIDS treatment be incomplete, but we will miss the greatest opportunity in history to build functioning health systems in some of the poorest countries of the world.
Finally, the organizations to which GAD recommends donations (Stephen Lewis Foundation and Dignitas International), do their remarkable work for people affected by HIV at the community level using the very principles on which primary care depends (including engaged communities and patient-centered care).
So I will continue to advocate on behalf of those affect by HIV. I will continue to ask everyone to give a day’s pay on World AIDS Day (December 1) in response to the exceptional issue of HIV.
As we address HIV we must use the principles of primary care to build the public health capacity that will have lasting impact on the communities most severely affected by this scourge.
What do you think? If you believe in primary care, will you join me in recognizing World AIDS Day by giving one day’s pay to one of GAD’s recommended recipients?
And while you’re at it, here’s how you can help now!