In March 1987, Larry Kramer stood up and asked two thirds of the room to do the same. He told those that were standing that they would all be dead in five years: “If my speech tonight doesn’t scare the shit out of you, we’re in trouble. If what you’re hearing doesn’t rouse you to anger, fury, rage, and action, gay men will have no future here on Earth. How long does it take before you get angry and fight back? The Aids Coalition to Unleash Power, or ACT UP came into being, Jim Eigo explained recently,” when a critical mass of people with AIDS recognized: my body, the site of a devastating disease, has become the site of a social struggle as well”. Using their bodies in protest, Act Up forever changed the regulatory framework for drugs, and the relationship between ordinary people and the healthcare system. They changed the system from an unjust one, to a less unjust one.
More than 10 years later, across the Atlantic , Zackie Achmat, influenced strongly by the tactics of both the Anti-Apartheid movement and ACT UP, started the Treatment Action Campaign whose protest songs (in four-part harmony) have echoed the world over; echoed in falling drug prices, echoed in the ability for ordinary citizens to make claims on their governments regarding health. Not only have the movements guided by Mr Kramer and Mr Achmat helped to secure treatment for people with HIV in their home countries, they have helped to do the same around the world.
Over the closing months of my time I have read and re-read that oath that we took on our first day at Mailman, and that we took today. I have been trying to understand exactly what I signed up for, what it means to be in the company of my fellow graduates, what it is that I (a biostatistician) should have in common with friends from all our disciplines, and what responsibilities we all bear?
The oath seemed at odds the recent history (and present!) of struggle for health. If we truly believed and allowed ourselves to be guided by the idea that “Health is a human right, The public health community exists to safeguard that right”, how could this community have failed so dismally to act quickly, decisively and morally to a human crisis – the HIV crisis? “There is a feeling among members of any of a number of professions or just the general population” explained Dr Anthony Fauci, a leader in the National Institutes of Health at the height of the crisis in the late 80s, “that patients with aids, many of whom are homosexual, are a little bit different… [this] has led to a little bit of a complacency about the approach towards this disease.”
To me, this history’s distance from us now, and also its haunting closeness, should give us pause. If this community of people who aimed to take care of other people’s health was capable of failure at such scale, around the world, aren’t we capable today? What failures, what lethal silences, will we commit daily in our well-intentioned careers? Who is it that is “a little bit different” than “us”? Who is the “us” that we imagine? Does “us” include my friend who runs a tiny HIV program for men who have sex with men in the small town of Thika in Kenya? Does it include Johannesburg sex workers who band together to improve their own health and that of their colleagues? If it does, what will we do to make sure that all our knowledge and ideas and voices will not be dominated by those of us who hold privilege over others?
What ought we do now to ensure that when we are written about in 50 years time, we will read our deeds without shame? How can we be righteous? How can we avoid the need for Zackie Achmats and Larry Kramers?
Maybe the oath is a good start. Maybe if we read it closely and figure out what all its implications are to our practice, we will not repeat the mistakes. But maybe it’s not; maybe what is needed is the kind of introspection about ourselves, our power, and our capacity to fail that most of us are ill-equipped to do.
Either way, here we are, about to get intimately involved in other people’s lives – most of whom we will never meet, most of whom we know only through our 2×2 tables. I hope we will all grapple with the history and the politics of what we do.
Good luck to us all, and in the words of my (s)hero RuPaul, “don’t fuck it up”.
Yours in (qualified) optimism,