No Exit

Medical Advocates FOR SOCIAL JUSTICE
Editorial

		Date:		August 31, 2003

		Title:		No Exit: Are State ADAP Waiting Lists a Metaphor for Hell?

		Author:		Gordon Nary Executive Director Medical Advocates for Social Justice

What is hell and where is it located? Theologians and philosophers have a diversity of opinions. In Jean Paul Sartre's landmark play, No Exit (Huis Clos), the three characters find themselves in hell which for them is a living-room in France with Second Empire furniture. The most famous line in the play is Garcin’s, who states: ”Hell is other people.” (l'enfer, c'est les autres.) Another character, Inès, counters with: "You are nothing else but your life." (Tu n'es rien d'autre que ta vie. . . .). This exchange is the foundation of Sartre’s existential definition of hell. According to Sartre, our reality is not who we are, but rather the image that others have of us. Our hell is, therefore, the diminished value or lack of value that out life has to others.

This existential definition of hell was reaffirmed by the recent deaths of three West Virginians on the state’s AIDS Drug Assistance Program (ADAP) waiting list that died because of lack of adequate Congressional ADAP funding. Hell for them was the devaluation of their lives by those members of the US Congress who failed to vote for adequate ADAP funding since the predictable consequences of such lack of funding was always the unnecessary suffering and death of those with limited resources who could not access appropriate HIV drugs on a timely basis. State ADAP waiting lists have become a personal hell for the 726 people currently on these lists because of the devaluation of their lives by a government whose failure to adequately fund state ADAP programs implies that their lives have no further value to the nation that they love and to which they pledge their allegiance.

The culpability for such unnecessary suffering and death must be shared by the those members of Congress who failed to vote for adequate ADAP funding and the US HIV/AIDS community. Few of us have done all that we could to advocate for adequate ADAP funding. Although 180 community organizations supported Save ADAP’s recent letter to President Bush, there were thousands of HIV/AIDS and other community organization that did not take the few minutes required to demonstrate solidarity on this important advocacy initiative – the few minutes necessary to reaffirm the value of the lives of those on state ADAP waiting lists. Can any of us admit that the lives of 726 men and women on state ADAP waiting lists are not worth the time that it takes us to telephone, write, or visit our Senators and Congressional Representatives whose votes to support adequate ADAP funding are votes to allow those on these waiting lists to live?

There have been three recent unnecessary deaths in our family and there will be many more among the growing number of people on state ADAP waiting lists unless each of us - individually, and collectively through our organizations – accepts our moral responsibility to serve as advocates for the value of the lives of those on these lists. Where is the passion that once defined the HIV/AIDS community to protect the most vulnerable among us? Each of us needs to write and telephone our members of Congress. Each of us needs to twist the arms of our friends and colleagues, if necessary, to also write and call. Those of us who have the financial means should personally visit and lobby our Senators and Congressional Representatives in Washington, DC, to do what is morally right. Those of us who have the courage and commitment to demonstrate in our nation’s capital should organize and participate in demonstrations for adequate ADAP funding and for the reaffirmation of the dignity and value of the lives of those on state ADAP waiting lists.

We also need to explore more creative programs to provide assistance to resource-limited states as alternatives to the state ADAP waiting lists limbo. Private donations, specialized advocacy to pharmaceutical company drug assistance programs for appropriate drugs, and aggressive enrollment of waiting list registrants in applicable clinical trials need to be explored as a super safety net as soon as possible. Above all, we all need to demonstrate that the lives of those on state ADAP waiting lists have great value to the members of our community and our nation. We need to respond to Garcin’s curtain line in No Exit: Eh bien, continuous. . . . ("Well, well, let's get on with it. . . .").

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