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Access To Treatment and Health Care

CVC and its member organization are very aware that the public health landscape for vulnerable communities is much larger and significantly more complicated than just sexually transmitted diseases, making it even more critical to get in-depth knowledge about these groups. They share many common challenges yet also have conditions and diseases of particular relevance to specific sub-groups, such as anal cancer in gay and other men who have sex with men, bacterial vaginosis in lesbians and other women who have sex with women, higher rates of depression and unsupervised hormone treatment in transgender people, infectious outbreaks due to overcrowding in immigrant and prisoner populations, reproductive healthcare problems among young people, and rehabilitation challenges among substance users.

CVC therefore insists on raising awareness of the health, social, legal and ethical issues inherent in providing healthcare to vulnerable communities, advocating for a model that addresses the concerns of the general population as well as the physical and psychological issues that affect many vulnerable communities. We strongly believe that ultimately the only way to ensure that healthcare is provided in a way that is appropriate and effective for vulnerable groups is to involve them in the design, implementation, and evaluation of the programmes and services offered.

CVC’s Working Group on Access to treatment and healthcare is a collective cautionary voice that seeks to bridge the gap in access to treatment and health care for vulnerable communities. While universal access to treatment is being achieved in Cuba, and coverage is relatively high in the Bahamas and Barbados, access to treatment is poor in three of the worst-affected countries in the Caribbean. About one third of people in need of antiretroviral treatment were receiving it in Trinidad and Tobago in September 2005, as were only 12% in Haiti and 10% in the Dominican Republic (PAHO, 2005).

Thus, there are many barriers to overcome. These include the inequities in health care services available to culturally disenfranchised populations; the overt prejudice they often face as well as outright discrimination by healthcare providers; the characteristics of the health facilities and the design of services; the problems, particularly among mobile populations of failure to follow-up; the assumption by health professionals of risk factors based on sexual or gender orientation rather than individual behaviours and health history; the confidentiality of medical records; the reluctance to disclose personal information for fear of being treated with contempt; the effect of the laws and policies that segregate certain groups from the rest of society; cultural and language differences; violence and the threat of violence; emotional stress and depression associated with managing stigma and discrimination; to name but these.