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The Great Divide [], Tuesday, December 1, 2009

By Dr. Adrienne Chan

“Sometimes I feel like I’m being treated in the ‘Third World'”, commented a disgruntled patient I was consulting on last December 2008, during a short visit back to Toronto. While I hope my surprise with that statement didn’t show, over the past year I have thought about it a lot, and how representative it is of the divide that exists in health care and how far we are from achieving any semblance of global equity.

I spend the majority of my year working alongside my Malawian colleagues and a handful of international expatriates in Zomba, a small, rural town in southern Malawi, as part of a partnership between Dignitas International – a Canadian based non-governmental organization and the Malawi Ministry of Health (MOH). Malawi is one of the poorest countries in the world and has recently gained international notoriety for being the birthplace of Madonna’s adopted child. Malawi has a population of 13 million people, 12 per cent of whom are living with HIV.

Since 2004, the MOH has succeeded in implementing an ambitious plan to scale up free public access to life saving antiretroviral therapy (ART). In just five short years, we have been able to place 12,000 people living with HIV on ART in Zomba. This means that 12,000 people are living longer and are able to productively contribute to the growth of the country’s developing economy.

Like many of the other poor countries who are hardest hit by the AIDS epidemic, Malawi’s HIV-related drugs are funded by the Global Fund for AIDS, Tuberculosis and Malaria. In the same year donor governments are contributing trillions of dollars to bail out a crisis caused by excess, these same governments are showing signs of retreat from the international commitments they made to universal access to HIV/AIDS treatment in ‘Third World’ countries. With over four million people receiving ART worldwide, an estimated six million people are still in need of treatment.

As a person who lives between two worlds, I feel that today, World AIDS Day, is an opportunity for citizens of donor countries to reflect critically on the divide. In order to meet our five per cent fair share of the global funding shortfall for HIV treatment and prevention efforts, Canada should commit to doubling the $450 million already committed for 2008-2010. We need to lead by example and demonstrate to the international community that as a country we are committed to fighting the global AIDS epidemic.

Dr. Adrienne K. Chan, MD, is the Medical Coordinator for Dignitas International ( in Zomba, Malawi.

Dignitas InternationalThe Great Divide []