At the same time, it is obvious that clinicians in Haiti are faced with different, and, in fact, greater, challenges when attempting to treat complications of HIV disease.
But as for activism, my parents did what they could, given the constraints, but were never involved in the causes I think of when I think of activists.
But if you're asking my opinion, I would argue that a social justice approach should be central to medicine and utilized to be central to public health. This could be very simple: the well should take care of the sick.
Civil and political rights are critical, but not often the real problem for the destitute sick. My patients in Haiti can now vote but they can't get medical care or clean water.
For me, an area of moral clarity is: you're in front of someone who's suffering and you have the tools at your disposal to alleviate that suffering or even eradicate it, and you act.
Anywhere you have extreme poverty and no national health insurance, no promise of health care regardless of social standing, that's where you see the sharp limitations of market-based health care.
I recommend the same therapies for all humans with HIV. There is no reason to believe that physiologic responses to therapy will vary across lines of class, culture, race or nationality.
I've been impressed, over the last 15 years, with how often the somewhat conspiratorial comments of Haitian villagers have been proven to be correct when the historical record is probed carefully.
In fact, it seems to me that making strategic alliances across national borders in order to treat HIV among the world's poor is one of the last great hopes of solidarity across a widening divide.
It is clear that the pharmaceutical industry is not, by any stretch of the imagination, doing enough to ensure that the poor have access to adequate medical care.
We've taken on the major health problems of the poorest - tuberculosis, maternal mortality, AIDS, malaria - in four countries. We've scored some victories in the sense that we've cured or treated thousands and changed the discourse about what is possible.
