Needs-based public health service provision ensures equity

Abstract

We welcome the contribution of Iversen, Hope, and McVeigh (2016) to the debate about the allocation of scarce HIV prevention resources. In our paper we raised the dilemma posed by competing demands for the Kirketon Road Centre’s needle syringe program (NSP) in Sydney’s Kings Cross. Iversen et al. suggest that the more targeted approach we adopted recently to preventing blood borne infections (BBIs) among people who inject performance and image enhancing drugs (PIEDs) is inequitable and discriminatory (Iversen et al., 2016). We feel they may have over interpreted its ‘‘restrictiveness’’. They also appear to conflate demand with need for such services, and being discriminatory with being discriminating in the use of scarce resources. While Iversen et al. point to the WHO/UNODC/UNAIDS Technical Guide, which advocates universal access among people who inject drugs (PWID) and recommends that services should be equitable and non-discriminatory (without exclusion criteria), being inequitable and discriminatory would also contravene KRC’s own longstanding explicit commitment to WHO’s Primary Health Care philosophy stating that health care should be accessible, acceptable, affordable and equitable (van Beek, 1994, 2007; World Health Organization, 1978). We would like to point out that this Technical Guide goes on to state that: ‘supply should be determined by need’ (World Health Organization, 2012), which we strongly endorse. We suggest that the Needle Syringe Program (NSP) supply to PIEDs injectors in Australia has primarily been driven by demand, which does not necessarily coincide with need, and can even be inversely proportional in the case of socially marginalised populations. A R T I C L E I N F O