re: prudery, AIDS, freedom, foreign aide:
When a person (gay or straight, African or American) has unprotected sex with lots of partners, and gets the HIV virus, they are without symptoms, for several years. While they are still feeling well, and looking healthy, they frequently continue the same sexual behavior. That's how the disease spreads. It's a very effective evolutionary strategy, for the virus. If the infected person has access to medications, they are never cured, but the drugs can make them feel better, and not show symptoms, for years longer than without the expensive drugs.
Before the antibiotic era, TB was, in many ways, a public health threat similar to AIDS today. The solution, in the US and everywhere the disease was eventually contained, was: public education, sanitariums, separating the sick people from the general population, enforcing correct behavior. Public health laws were passed, which restricted individual liberties. Immigrants were quarantined, and refused entry if they were infected. People with symptoms were required to restrict activities that spread the disease. When antibiotics became available, an infected patient was required to take the lengthy medication course (a year, sometimes longer). If the public health nurse thought you were not taking your medications, she could require you to come to her clinic, for every dose, so she could hand you the pills and watch you take them. It was the law. Noncompliance brought a public health nurse to your door, and then a policeman. Those laws are still on the books, and being used again, as the antibiotic era ends, and as diseases like TB become resistant to multiple drugs. Sometimes, the only way to complete a course of therapy, and protect the public, is to jail the patient.
Bottom line: if you provide medical care to HIV+ people, without changing sexual behavior, the end result is more infected people, more suffering, more death.
I am a libertarian, and a liberal. I don't like this conclusion, but, having watched people die from AIDS, I conclude it is the moral choice, and it is in the public interest, to focus resources on changing behavior, and stopping the disease's spread. One very effective way, to do this, is to couple the short-term personal benefits (medications) with the long-term public health benefits (changing behavior).
It is possible to have many sexual partners, and have a low risk of getting HIV. To do this, you need to use condoms correctly, every time, beginning to end. Or, you need to get a totally accurate sexual history from all your partners, and avoid having sex with anyone who has any symptoms, or has done any risky behavior in the last 10 years. Or, get all your partners to take an HIV test, and get the results before any intimate contact. Or only have sex with virgins. These methods are, in the real world, impractical. They just don't work. People lie. The flesh is weak.
So, here is the only workable behavior change: a committed and honest lifelong mutually monogamous sexual relationship. The short term for this is: marriage.
Humans are not naturally monogamous. The only way to make it happen consistently, is to make Rules, and then give power, to the Authorities (policemen, priests, imams, parents, teachers, doctors, and, yes, foreign aid donors) to enforce them.
You may not like this restriction on your very personal and very private behavior. You may insist your freedoms are being violated. But freedom ends, when one person's freedom is killing other people.
Everywhere in Africa, women don't have the social status to make men use condoms. Women cannot deny sex to their partners, even if they know their partners are infected. Poverty leaves many women with the choice of selling their bodies or starving. Sex before and outside of marriage (for men, at least) is the community standard. Muslim nations stone adulterers; their HIV rates are very low. There is a connection between these two facts.
<it looks as if the program was drafted more to win American votes than to save African lives.>
Well, whose money is being spent? When I give money to a charity, I expect the money to be spent in a way that conforms with my basic beliefs. When my government gives aide to foreign nations, I expect the same. There are many Americans, who vote, and feel deeply about the issues of abortion and pre-marital sex. You or I may differ on those issues. I think "values-free charity" is a waste of money, and a concept without mass appeal. |
