Ideology and AIDS in Africa

The history of the response to African AIDS can be divided into two phases: (1) fiddling while Rome burns, and then (2) trying to use the fiddles to put out the fire.

So writes William Easterly in the New York Review of Books. The World Bank and aid organizations were slow to act.

Western scientists flew into Africa, collected blood samples, and flew out, seemingly much more interested in getting recognition in the Western press than in communicating useful and sensitive knowledge to African leaders and the public.

Western scientists were tactless; western media played up to this:

[B]eing accused of promiscuity and having Africans labeled as the equivalents of Typhoid Mary did not make their leaders or the general population all that receptive to messages from Western scientists on how to confront the epidemic. Many Africans reacted with a mixture of denial and conspiracy theories. Maybe the CIA had targeted Africans during the cold war with a scientifically engineered virus....

Helen Epstein in The Invisible Cure, the book that Mr Easterly is reviewing, understands that the AIDS crisis in Africa is caused by 'concurrent relationships'. As Easterly puts it:

To oversimplify a little, Africa's AIDS tragedy is that it combines greater Western-style sexual equality for women with social norms that permit simultaneous long-term sexual relationships for both partners.

Infection rates in Uganda fell, largely because of its crucial 'Be Faithful' message. Tragically, this message has been ignored by ideologues of both the left (who favoured condom use) and the right (who favoured abstinence). A huge share of the current western effort:

has been concentrated on getting antiretrovirals [ARVs] to those in Africa with full-blown AIDS. There is nothing wrong with the urge to treat the sick, but in practice it has crowded out nearly every other response to the epidemic. ARVs are now reaching only a tiny minority of those in need and it will never be feasible to treat everyone. .... The "Be Faithful" message was neglected because it was not of interest to the bureaucracy concerned with AIDS. As Epstein muses acidly: "Zero Grazing" had "no multimillion-dollar bureaucracy to support it."

This appears to be another distressing case of well-meaning, hard-working people being hampered by their own ideology in their genuine efforts to alleviate a human disaster. I think this is a clear case where a Social Policy Bond approach that rewarded people for reducing AIDS infection rates, however they do so, would be far superior. Aid organizations, and others, would direct funds impartially to where they would generate the greatest return per dollar outlay. Idelogues would go somewhere else: Social Policy Bonds would enlarge and motivate the pool of people who are solely concerned to reduce the incidence of AIDS, rather than validating their worldview.