AIDS - Too much morality, too little sense

AIDS

Too much morality, too little sense


From The Economist print edition
Jul 28th 2005
Source

Politicians must suspend moral judgments if AIDS is to be defeated

THE world is not winning the war against AIDS. By the end of this year, 3m poor people infected with HIV, the virus that causes AIDS, are supposed to be receiving the treatment they need. So far, though, barely 1m are. At present, about 40m people are living with HIV, some 5m are infected with it each year and over 3m die from it. The human and economic cost is huge. India may well have more infected people than any other country. China's epidemic has the potential to dwarf all others (see article).

In most of the world, AIDS tends to affect fairly discrete groups, usually prostitutes, homosexuals and drug addicts. In most societies these people are frowned upon. Democracies like them no more than autocracies. When it comes to receiving help from taxpayers, they are never at the top of anyone's list, especially in countries so poor that basic health care is not available to most citizens.

But if AIDS is not contained among the groups that harbour it, it spreads into the general population, as it has in Africa. There, it affects every section of the population—slum-dweller and sophisticate, peasant and professional. Everyone who engages in that near universal activity, sex, is at risk. As it is, AIDS is no respecter of morals: it affects babies as they are born, children as they are orphaned, nurses as they are accidentally pricked by a dirty needle, patients of any kind as they receive a transfusion of contaminated blood. Indeed, it affects the entire society in which its victims live and die.

It also affects the faithful wife of the unfaithful husband. That is why the ABC slogan so beloved by the Bush administration—Abstinence, Be faithful and Condoms—is, in practice, a slap in the face to many people. The President's Emergency Plan for AIDS Relief commits at least a third of its promised $15 billion to “abstinence until marriage” as the main way of stopping the spread of AIDS. It also urges that the use of condoms be confined to people who engage in “risky behaviour”—prostitutes or couples with one member who is HIV-positive. Many groups are reported to be ending or reducing their condom-promotion schemes to qualify for American money.

That might not matter if condoms did not matter, but they do. In the absence of a proper vaccine, an absence that is likely to continue for years, condoms are the best prophylactic available to anyone at risk of HIV infection through a sexual encounter, within or outside marriage (see article). Abstinence might, it is true, be better still, but abstinence will not, in the real world, be practised widely enough to bring AIDS under control. Now, in a further demonstration of its moral zeal, the Bush administration is insisting that all groups, American or foreign, that are engaged in the struggle against AIDS must declare their opposition to prostitution if they are to receive American money. The administration is also against all needle-exchange projects for drug addicts, one of the groups most likely to contract, and spread, AIDS in Russia, India and China.

The poor countries that have got on top of nascent AIDS epidemics—Brazil (see article), Thailand, Uganda and Cambodia—have done it by changing behaviour. That is no easy task, involving as it does a variety of actions across a wide front. It has proved possible because limits have been set on the endeavour: people have not been asked to act morally, merely in their own self-interest, which happens to be in the interest of society.

The lesson for rich and poor alike is that to contain AIDS morality must take second place. Politicians may find it easier to yield to sanctimonious lobbyists than to explain why refraining from judging other people makes more sense. But that does not excuse them. Too many lives are at stake.



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