Basing treatment on rights rather than ability to pay: 3 by 5
Basing treatment on rights rather than ability to pay: 3 by 5
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基于权利而非支付能力的待遇：3 x 5
DOI：
10.1016/s0140-6736(04)15846-7
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
J. Mukherjee
中科院分区：
文献类型：
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作者：
J. Mukherjee
如果3乘5失败了，因为它肯定会没有美元，将没有借口离开。2004年3月3日，联合国秘书长非洲艾滋病问题特使斯蒂芬·刘易斯在新闻发布会上说：“只有被背叛者的万人坑。”卫生组织/艾滋病规划署的“三五”倡议的目标是到2005年底使300万人开始接受抗逆转录病毒治疗。1世卫组织估计，实现三五目标将需要55亿美元。2虽然艾滋病现在是可以治疗的，但在4 000万艾滋病患者中，只有不到5%的人能够获得抗逆转录病毒药物。该倡议针对的34个国家是发展中国家94%需要治疗的人的家园。对当今全球局势的诚实评估表明，决定谁生谁死的是市场。接受抗逆转录病毒治疗的实际标准是有能力支付治疗费用。为了解决过去500年来最大的健康危机，基于人权而不是基于市场的方法是针对这种流行病的唯一现实战略，这种流行病集中在贫困和边缘化社区，他们既无法获得医疗保健，也没有能力支付治疗费用。“三五计划”建议各国政府根据《世界人权宣言》将普遍获得艾滋病治疗视为一项基本人权，该宣言承认获得医疗保健的权利和分享科学进步的权利。“三五计划”还强调，这些权利必须扩大到因社会、经济或地理障碍而可能被排除在治疗之外的弱势群体。“三五计划”的一个突出方面是，它认识到，如果没有国际机构、捐助者和其他非国家实体的大力支持，艾滋病毒负担沉重的国家就无法成功应对这一流行病。1这种支助必须包括持续的财政援助，不仅是药品援助，而且是医务人员援助，以及对负担沉重国家的保健基础设施的资本投资援助。捐助国还必须允许对与艾滋病有关的治疗的知识产权作出慷慨的解释，1978年关于“到2000年人人享有保健”的阿拉木图宣言3也许是我们最后一次听到如此雄心勃勃和以权利为基础的关于获得保健的呼吁。《阿拉木图行动纲领》基于权利的目标并不高; 90%的儿童年龄体重应符合参考值，每个家庭应在15分钟步行距离内获得饮用水，妇女应能在分娩时得到受过医疗培训的助产士的帮助。此外，与会者一致认为，如果不增加国际援助，这些目标就无法实现。然而，国际专家抨击这一拟议的全民基本保健权利是幼稚和过于昂贵的。在接下来的几十年里，有限的卫生资源的分配更多地取决于市场而不是权利。随着外债的增加，国际金融机构呼吁穷国在走向市场经济的过程中减少用于保健的国民生产总值的比例。改革
If 3 by” 5 fails, as it surely will with-out the dollars, there will be no excuses left. Only the mass graves of the betrayed” said Stephen Lewis, UN Secretary-General’s special envoy for AIDS in Africa at a press briefing on March 3, 2004. The WHO/UNAIDS “3 by 5” initiative aims for 3 million people to be started on antiretroviral treatment by the end of 2005. 1 WHO estimates that US $5· 5 billion will be needed to meet the aims of 3 by 5. Yet, to date, less than $2.3 billion has been paid to the Global Fund. 2 Although AIDS is now treatable, less than 5% of the 40 million people living with AIDS have access to antiretrovirals. The 34 countries targeted by the initiative are home to 94% of people needing treatment in the developing world. An honest assessment of the global situation today shows that it is the market that decides who lives and who dies. The de-facto criterion for receiving antiretroviral treatment is the ability to pay for treatment. To address the greatest health crisis in the past 500 years, a human-rights based—rather than market-based—approach is the only realistic strategy for an epidemic that is concentrated in poor and marginalised communities who have neither access to health care nor the ability to pay for treatment. The 3 by 5 initiative proposes that governments consider universal access to AIDS treatment to be a basic human right in accordance with the Universal Declaration of Human Rights, which recognises the right to health care and the right to share in the advances of science. The 3 by 5 initiative also emphasises that these rights must be extended to vulnerable groups who risk being excluded from treatment because of social, economic, or geographical barriers. A striking aspect of the 3 by 5 initiative is that it recognises that highly HIV-burdened countries cannot succeed in tackling the epidemic without massive support from international agencies, donors, and other non-state entities. 1 Such support must include sustained financial assistance, not only for drugs, but also for medical staff and for capital investment in health infrastructure in heavily burdened countries. Donor countries must also allow generous interpretation of intellectual property rights with respect to AIDS-related treatment.The 1978 Alma-Ata declaration3 for “health care for all by the year 2000”, was perhaps the last time we heard such an ambitious and rightsbased call for access to health care. The rights-based goals of Alma-Ata were modest; 90% of children should have weight for age that corresponds to reference values, every family should be within a 15-minute walk of potable water, and women should have access to medically trained attendants for childbirth. Moreover, there was unanimous agreement that these goals could not be achieved without increased international aid. However, this proposed right to universal basic health care was attacked by international experts as naive and too expensive. In the next few decades distribution of limited resources for health was determined more by markets than by rights. With foreign debt mounting, poor countries were called upon by international financial institutions to decrease the proportion of gross national product spent on health as they moved towards market economies. Reforms