In lieu of ART

Old news from Kaiser Daily: “Malawi plans to provide HIV-positive civil servants in the country with an additional $35 monthly in an effort to improve their nutrition, Health Minister Marjorie Ngaunje said on Monday, Reuters South Africa reports (Reuters South Africa, 1/7).” The news has started a really interesting conversation with SY, colleague and super-friend, which I’m attempting to summarize here.

What are some possible outcomes?
A) Few take them up on this. You have to tell your superior who tells the bureaucracy, who tells the MoH, and you get visibly different pay than everyone else so you are definitely outed.
B) Money is a better motivator than drugs. A VCT counselor we know died of AIDS last year. He lived a stone’s throw from the ART clinic. Maybe he didn’t know. Maybe he knew and tried and didn’t get drugs. Maybe the drugs didn’t work. I bet he would have gotten the extra $35 though. He might have spent some of it on food but probably would have spent the rest on better corn seeds or fertilizer. The end result may not have added to the diversity of his nutrition but to the economic well being of his family. Or he could have bought a phone or something else flashy and used it to impress women and have sex with more women attracted by his “success”.
C) People hear about this and fake HIV, initiating a black-market for positive test results. Or people start to think HIV wouldn’t be so bad — After all, $35 per month is a 15% raise.

The consequences of the policy will be interesting for those of us interested in interpreting the course of the AIDS epidemic in the part of the world. A suggests that stigma is strong and problematic. If we observe C, we can rest assured that revealing your status is worth a bit of cash, and “stigma” may not be the barrier to treatment it’s been made out to be.

SY votes for B and explains: I think B, but B is lots of things. You will still be “outed” most of the time, but the policy recognizes that it is an individual’s choice to come forward, and I think people will slowly start to take them up on this. Will they use the money to improve their nutrition? Unless they are truly not getting enough calories (unlikely for civil servant) probably not. They’re likely eat more nsima. If nutritional support is the goal, initiatives to educate *everyone* on nutritional issues (i.e., to grow other fruits and vegetables in their gardens) should be the priority. Economists will say letting people choose is better and that may be true. But it should at least be tied to something related to awareness about the importance of nutrition and what that means in practice.

 

AIDS numbers

Failed Attempt At Hyperbole Yields Dead-On Statistic

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I actually found this while skimming someone else’s blog. It’s simultaneously very funny and not funny at all.

 

Compassionate Consumption

Seems I was really onto something when I wrote about the Product(RED) campaign a few weeks ago. Earlier this past week, a colleague forwarded me this working paper with instructions to “read and chuckle.” She and I are apparently of the same mind on this issue. What more, yesterday’s New York Times Magazine featured an article by Peter Singer (always thought-provoking) on charitable giving, which was the most emailed article before a list of questions you should ask before you get married topped it, but I’ll save my thoughts on that list for another post.

Apparently I’m not the only one contemplating such issues.

 

Circumcision

Over the past few years I have developed quite the reputation for being the person who ends up talking about circumcision at cocktail parties and other social situations in which circumcision is not the most obvious (or appropriate) thing to be talking about. I’m actually not a socially awkward disaster of a person – I make a genuine effort to stick to the topics we all know are appropriate for party talk. But people I meet in social situations almost always ask what I do, they often find my work (my research) interesting, they ask more questions, then I get excited about it, and boom – I’m waving my hands and talking about foreskin.

So I’m very pleased to know that this week (FINALLY) I am not the only person talking about circumcision at a holiday party. Just about every major news source has covered the big news that circumcision greatly reduces one’s risk of contracting HIV from an infected sex partner. It’s the most emailed article on the New York Times website right now!! The evidence is so strong that clinical trials have been suspended because they’ve concluded that it would be unethical not to offer circumcision to all the adult men taking part in the studies.

There’s lots to say about circumcision and HIV prevention in sub-Saharan Africa, but two things are on my mind right now:

1. Cost efficacy. How much does a circumcion cost? I read one estimate that puts the cost per circumcision at about 56 USD, but I’m not sure I believe this figure. Does it factor in the opportunity costs involved? Any other estimates?

2. The “get circumcised” public health campaigns are going to be great. I can’t wait.

 

World AIDS Day

Do most major diseases have their very own day? Since I do research related to sexual behavior and HIV in sub-Saharan Africa, I have a heightened awareness about this one and all the fanfare surounding it. Americans are fed a steady diet of bad news from Africa – stories about disease, drought, child labor, sexual abuse, corruption, civil war, and “cultural practices” (e.g., widow cleansing and initiation rituals) that strike most of us as absolutely horrifying. Well-intentioned Americans – young and old, liberal and conservative, religious, athiest, and antitheist – hear and read these stories and are left wondering: what can we do to help?

I’m strongly ambivalent about the response I’ve been seeing more and more of: consume. Buy stuff. Not just stuff. Buy the right stuff. Perhaps you’ve seen advertisements for the (PRODUCT)RED initiative. Buy a red ipod or a red Gap t-shirt. You can do good and help end the spread of AIDS by simply buying the right stuff – plus you’ll look cool. Really? On one hand, tacking a few extra dollars on to a luxury good (nailpolish, electronics, designer threads) is a compelling, efficient, and apparently effective way to raise money for what is undoubtably a very good cause. It’s easy to do. If a person can afford to purchase a certain widget, they may be willing to pay just slightly more for said widget in order to feel good about their purchase. There’s at least one additional perk; perhaps the widget is somehow distinctive (i.e., red) and displaying this distinctive widget helps one cultivate a desirable identity: that of an aware, cosmopolitan, socially responsible person who has achieved an enviable level of expendable income.

Realistically, the person making this purchase is probably not deciding between buying a new watch and donating $200 to charity. Simply put, the purchase results in a net gain for The Good Guys. Surely this is a good thing. Right? On the other hand, however, is consuming more really the answer? Is it responsible? Can it really help? Help whom? The person making the purchase? The exec behind the massive ad campaign? The Global Fund? A young Malawian professional trying to avoid being infected with HIV without giving up sex completely? A poor Zambian woman who has already been infected and has no access to drugs?

Of course, charitable consumption is not only limited to AIDS-related charities. You can buy gourmet tea to support breast cancer research and a whole lot of other pink things I won’t bother linking to. You can buy and proudly wear yellow bracelets to signal your support for cancer resarch more generally and for a certain super-human athlete I once saw tooling around town on a bicycle with three kids in tow. True story.

Interesting arguments about charity and altruism have been made by many a brilliant mind (Rawls & Aquainus just for starters), so I won’t embarrass myself publicly with an attempt to contribute something new here. For me, the (PRODUCT)RED campaign brings up more interesting questions about the way we consume, the way we give, and the way we manage our guilt. Is charitable consumption (or consumable charity) a new thing? Is it an American thing? Is it charitable? Is it controversial? Should it be? Does it even matter?

Many years ago I spent time in Chile as a Fulbright scholar, affiliated with the Universidad Alberto Hurtado. Father Alberto Hurtado, a beloved Jesuit priest, had this to say about living responsibly: Hay que dar hasta que duela. Translation: Give until it hurts. I wonder what Padre Hurtado would say have to say about the red campaign.

I can’t afford a new ipod, and I have yet to buy myself a red t-shirt, though I probably could actually use one. I wonder if the purchase would help me feel just a little bit better about living so abundantly in a world where so many have so little – even for a moment.