International Association of Physicians in AIDS Care, January 2000 Journal
José M. Zuniga

I believe that the moral value of saving people's lives is still recognized. In a world which offers few opportunities for courageous acts, helping the most vulnerable in our society is perceived as one. Indeed, in many situations, people living with life-threatening illnesses, including HIV disease, are still successfully "rescued" through humanitarian efforts spearheaded by individuals, organizations, and governments. Yet, as we cross the threshold into the 21st century, situations occur in which the international community fails to intervene as entire segments of society are threatened by parallel epidemics of poverty, disease, and social isolation. The tragic result is unnecessary suffering and hastened death.

As the newly-appointed executive director of the International Association of Physicians in AIDS Care (IAPAC) and as a public health advocate, I wish that I possessed knowledge of a quick prescription to solving the global crisis in access to healthcare, for example. I cannot offer a quick prescription because solutions to the complex issues we face today are themselves complex. Multiplicities of variables are at play. There are priorities, politic realities, and scarcities with which to contend. More than a few actors are involved. Governments must assume their responsibilities. Corporations, nonprofit organizations, and international relief bodies must assume their responsibilities. And, as important, you and I, as active members of society, must assume our collective and individual responsibilities to each member of the human race.

In this respect, in addition to our mission to educate physicians and other healthcare professionals on cutting-edge clinical management issues, IAPAC's work in 2000 will advance in four core directions, all of which I hope will have the support of our association's existing and prospective members.

1. IAPAC will look for ways to reestablish a consensus on the value and necessity of saving lives. We will work to recreate respect for the international means, channels and instruments through which the needs of those who suffer from parallel epidemics of poverty, disease, and social isolation may be addressed. To achieve this, a sense of international responsibility for the dignity and value of human life must be restored.
2. The most immediate means of ensuring the survival of our most vulnerable citizens is expanding access to healthcare services, drugs, diagnostic technologies, and medical information technology without which good health as we define it at the dawn of a new century is tragically jeopardized. IAPAC will seek a reaffirmation of the irrevocable nature of our human right to healthcare as articulated by the late Jonathan Mann, MD, MPH. Having done so, we will insist that governments uphold this principle--especially those whose resources are limited--and provide them with the necessary means to bear the overwhelming burden of disease.
3. Another way to ensure the survival of those who will likely perish without our intervention is to assist in the eradication of the very conditions that contribute to human deprivation and disease. To concentrate exclusively on the pressing issue of access to healthcare is to deny that in the bigger picture healthcare needs are among a laundry list of human needs begging for our social and financial attention.
4. While striving to guarantee access to healthcare, IAPAC will also examine ways to implement short- and long-term prevention interventions that advance our collective imperative to save lives. Focusing only on life-saving activities is like curing a symptom without really treating its causes. As an association whose members are primarily HIV/AIDS-treating physicians and healthcare professionals, IAPAC's mission is to relieve the immediate symptoms of this devastating disease. However, there is an argument to be made that physicians must also contribute to a larger, longer term effort to prevent the transmission of HIV and other coinfectious diseases.

These four core directions--to refocus on the value and dignity of human life; to promote practical solutions to the global healthcare access conundrum through more comprehensive interventions; to assist in the eradication of conditions contributing to human deprivation and disease; and to prevent the transmission of HIV and other coinfectious diseases--build on years of work advanced by IAPAC and its membership. All depend on the willingness of governments, corporations, organizations and, ultimately, each of us to effect a change in the status quo.

As you advance your role in the fight against HIV/AIDS and other life-threatening coinfectious diseases, I urge you to join IAPAC and our current membership of 6,800-plus physicians and healthcare professionals in 43 countries. As individuals dedicated to saving and improving lives, you are entrusted with the moral duty to advocate on behalf of the most vulnerable members of our society. I am convinced that you and your colleagues share with IAPAC a common agenda to battle complacency and advance commitments that will make a difference in the lives of people living with and at risk for HIV/AIDS. In addition to our ambitious educational and advocacy agenda (see IAPAC Agenda 2000), our association's board of trustees and staff are committed to:

• assuring that IAPAC's work contributes to social progress worldwide;
• engaging IAPAC's membership in plotting future directions in the clinical and social battles against HIV/AIDS and related disease processes;
• providing cutting-edge medical and public health information to effect change in medical and public health practice;
• advocating a global ethic by which to judge practical solutions to the worldwide crisis in access to healthcare services, life-saving and -enhancing drugs, and critical diagnostic technologies; and
• partnering with organizations sharing a common concern to expand IAPAC's reach and influence in the global medical education and health policy arenas.

A new executive director invariably brings not only a change in personality and style but also in pace, vision, and priorities. In agreement with the commitments I have identified, one of my immediate priorities is to engage IAPAC's membership in dialogue around the pressing clinical and advocacy issues of our day. Do not be surprised to receive a call from me seeking your advice. As important, do not hesitate to contact me with your ideas and suggestions. IAPAC's mission has grown significantly in the past five years and will likely continue to grow. Our membership's assistance and support are of primary importance in ensuring that IAPAC fulfills its mandate.

José M. Zuniga is Executive Director of the International Association of Physicians in AIDS Care.

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