By Corey Prachniak
Corey is a guest blogger and an attorney, LGBT health consultant, and Harvard Kennedy Fellow.
In newly-published research, my colleague Jimena Villar de Onís and I explore the history of Colombia’s HIV movement, which from the beginning was led largely by gay activists and patients. Their efforts are inseparably tied to a broader movement of patients who, over many years of litigation, slowly expanded the idea of a “right to health” in the court system and in public opinion. Today, Colombia has arguably the most progressive right to health in the world, with a healthcare system based on human rights principles and court access when rights are violated – and HIV activists are largely to thank.
Although Colombia’s healthcare system, legal system, and culture all differ from that of the United States, their history has powerful lessons for those working towards health equity for LGBT communities in the U.S.
Bogota, Colombia – almost 8 million people and growing
Lesson One: Grow the Coalition
What started as a movement exclusively to get life-saving medications for HIV patients grew into a coalition focused on expanding healthcare access for all so-called “high-cost patients.” This included folks with very different backgrounds and conditions, such as people with cancer and those requiring dialysis, but who found common ground in the central failings of the healthcare system. All had been left behind and found strength in numbers.
In this newly-formed coalition, gay activists kept a leading role, which they were prepared for given their experience advocating for LGBT rights and HIV medications. Unlike other patients, HIV and gay activists had a built-in community that gave them organizational strength. They used the power of their community to work with others who had healthcare needs, much as queer activists in the U.S. have fought against Big Tobacco and for improved healthcare coverage, changes that benefit everyone.
Lesson Two: Engage the Public
Together with their new allies, the HIV activists pushed for government reform by helping patients across Colombia file thousands of lawsuits a year against health insurance companies and the government that regulated them. By 2008, the courts were so overwhelmed with the number of cases that the Constitutional Court took action and said in crystal-clear language that health was a human right, and that the government had violated it by not providing sufficient and equitable care.
When the Colombian president tried to override the decision by issuing executive orders, the people took to the streets by the thousands. Some scholars say that the most important result of the landmark decision was that it changed people’s perceptions of health, from a service to a fundamental right, and thus forced the government to comply with the decision.
Needless to say, U.S. discussions on healthcare and particularly the Affordable Care Act can be less-than-inspiring. Yes, there’s a time to get wonky and debate specifics, but how we frame healthcare – and equal access to it – can change public opinion in a way that rules and regulations can’t. Just look at the way a human rights-based argument changed how our society views same-sex marriage.
Lesson Three: Keep it Inclusive
From the beginning, Colombia’s HIV movement was led by people who had experienced marginalization based on their sexual orientation and HIV status (or even association with a condition that carried such heavy stigma). Nevertheless, inclusion of other marginalized groups did not come easy.
For example, women’s groups essentially had a parallel movement running alongside the main HIV groups, and the leaders of the growing HIV coalition remained mostly men. Transgender individuals and sex workers faced even greater marginalization than gay men, and while international organizations have given funding for work targeting this population, trans folks and sex workers have not had leadership opportunities themselves. Finally, with activism centered in the principal cities like Bogotá, rural people and those in the smaller cities often failed to benefit from the changes that those in the urban centers enjoyed.
Therefore, even in a very successful movement designed to help marginalized people, it wasn’t easy to give everyone a seat at the table – or to presume that what helped urban gay men would equally benefit others impacted by the virus.
Palace of Justice
The Bottom Line
Despite facing stigma, a seemingly-unstoppable epidemic, and opposition from a conservative culture, gay activists and others at the forefront of Colombia’s HIV movement achieved what is to date the biggest right-to-health success in the world. By making healthcare for marginalized people a matter of human rights, they changed the conversation and made their criticism of the system one to which every Colombian could relate. If we in the U.S. can follow Colombia’s example, maybe we can do for health equity what we did for marriage equality, and usher in a more just healthcare system for all.
Corey and Jimena’s full publication is available in English and in Spanish here.