Saturday, December 17, 2005


To put it as bluntly as possible, the main reason that AIDS is spreading to its current deadly dimensions around the world is this: We are practicing the social and political equivalent of laissez-faire when dealing with a killer-virus. And while "hands off" is usually the best approach for generating economic growth, if a virus, on the contrary, gets the equivalent of a free hand, it will also flourish -- but that's the kind of explosive growth we don't want.

Two decades ago, American AIDS activists came up with the slogan, "Silence = Death." But the issue, in practice, wasn't talking about AIDS, but rather doing something about AIDS. So the American slogan became, in effect, "Behavior Change = Life." And the biggest single life-saving change, back then, was behavioral restraint. Gay bathhouses were shut down, and millions of Americans, many of them gay, changed their sexual patterns: They got serious about condoms, safe sex, or outright abstinence. Were these changes tough to live by? Sure. But they beat the alternative. Let's face it: Just as quarantining worked in the past -- remember leper colonies? -- so the same basic idea, of separating oneself from the threat, works today.

Currently in the U.S., it is common for gay men -- especially as one moves up the ladder, in terms of education and health-consciousness -- to say things like, "I don't know anybody who has died of AIDS in five or ten, or even fifteen years." That is, in their medically aware circle -- after the initial wave of deaths in the 80s -- people got the message. And of course, thanks to medical breakthroughs, many of those who are HIV positive can carry on functional lives for the long term.

Today in America, a few incredibly unlucky people get AIDS through freak accidents. But the blunt reality is that AIDS mostly afflicts those who can be diagnosed as terminally reckless. An example is junkies using dirty needles -- or any needle at all. How does society realistically save the life of someone who holds his or her own life in such obvious contempt? As with smoking, drinking, over-eating, gun-playing and drag-racing, some behavior choices simply defy life-saving. Or to take another example, it's recognized by now that anal sex without condoms, known as "barebacking," is widely recognized as a death trip, and yet plenty of people still seem to do it, with the full complicity of modern marketing. At some point, confronted by the lethal combination of lust and greed, even the best-intentioned American public-health advocates have to throw up their hands in defeat.

That's the U.S., where at least the problem has been isolated to a few hard-to-reach, albeit seemingly suicidal, sectors. Around the world, the situation is far worse. And so, on World AIDS Day, it's time for some honest talk: AIDS, having already killed 15 million, having infected 40 million more, is spreading -- because too many people, and too many governments, have been unwilling to change their behavior, and their policies.

We might consider, as an ominous indicator, this recent article, entitled, plainly enough, "HIV Is Spreading Via India's Highways." The Associated Press' Margie Mason reports, "Just as in Africa two decades ago, truckers and the sex they buy have helped fuel India's spread of a disease that revolves mainly around sex and injecting drugs." Now let's think about that: 20 years after it became obvious that sex-working (known less politely as prostitution) was a major AIDS vector in Africa and elsewhere, India seems to be doing little to put a stop to those same deadly practices. Oh sure, no doubt any number of Indian government agencies and NGOs are busy "working" on the problem, but with more than five million Indians infected, it's obvious that they are not working effectively.

So what would AIDS effectiveness look like? Most obviously, it would begin with a stern, even fierce, crackdown on the sex and drug trades. Such fierceness explains why Singapore, to name a healthy counter-example, doesn't have this widescale problem.

Which do we prefer? India or Singapore? The AIDS Establishment has made its choice apparent to all: It puts freedom, most obviously sexual freedom, ahead of strict public health measures. That is, the preservation of the Sexual Revolution matters more than people's lives. That disturbing reality came clear to me last summer at the World AIDS Summit in Bangkok, in which brazen sexual braggadocio overwhelmed modesty, let alone safety. And yes, it does seem that AIDS activists are better at announcing holidays and staging summits than stymieing the disease; if media-savvy showmanship were the same as public-health stewardship, the world would be well. But instead, the Band Plays On, at the modern equivalent of a Masque of the Red Death.

The AIDS Establishment argues that it's simply not reasonable to demand that Africans and Indians, or anyone else, for that matter, change their behavior patterns. If people wish voluntarily to change their behavior, that's OK, but never, ever, should serious suasion or sanction be applied -- no matter how many lives might be saved. And so it is that the dubious values of the American Civil Liberties Union are being applied to the whole world....

And extreme cynicism, of course, is the obvious result of, first, "do your own deadly thing," and, second, "let others make a good living off of your dying." After a quarter century, many in the AIDS Establishment must know that they are facilitating the disease, not eradicating it. But they have carved out a good living for themselves, financially, as well as a high status for themselves, morally.

This arrangement is working, on its own cynical terms, and working well. It's working so well, in fact, that top figures from around the world are visibly prostrating themselves before the putative pieties of the AIDS Establishment. Earlier this week Jim-yong Kim, director of the HIV Department at the World Health Organization, actually apologized for his failure to implement WHO's "3 by 5" program. As with so many other AIDS-related efforts, "3 by 5" had a catchy title, but never the prospect for success. And since the WHO-crats should know that by now, their apology, absent profound changes in their methods, should not be accepted. Although, of course, failure, now and forever, won't stop the WHO from receiving more funding, for as far into the future as the eye can see.

More here


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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