Bad Science Kills, take two: Bush admin. fears sex, other people die edition.
The Bush administration and Congress are arguing about the renewal of the African Aids initiative. At issue: whether or not to preserve the rigid requirement that one third of the funding must go to abstinence programs.
Bush argues (Sunday, February 16, in Tanzania) that there should be no problem with his approach. Why, says he? Because
My attitude toward Congress is, see what works…PEPFAR is working. It is a balanced program. It is an ABC program – abstinence, be faithful and condoms. It is a program that’s been proven effective.
Except, of course, that it is not, for two reasons — both captured in (let’s be kind) two mistatements in the brief quote above.
Does abstinence education work? Not in this country. See this post for my earlier take on that issue. In Africa? Not so much there either. From Britain’s The Independent comes a report from Uganda, once the poster child for successful government-led HIV/AIDS prevention policy.
Aids activists and development officials point to the 130,000 Ugandans infected with HIV last year alone – up from 70,000 in 2002 – and say the recent obsession with abstinence is handicapping the country’s once-successful fight against the virus.
How successful was that earlier approach? Try this:
Under the previous “balanced” strategy, condom distribution grew from four million a year to 118 million by 2001. Thanks to the abstinence message, teenagers lost their virginity about 18 months later than before. People with several partners realised they needed to stop sleeping around so much. In 1992, one in five Ugandans had Aids. By 2001 that dropped to one in 20.
Not bad. Damn good, in fact. To take the Talmud’s view that to save one life is to save a world, here’ s a public health intervention that has preserved a human multiverse.
But what of the claim that Bush’s policy is balanced? Not so much there, either. On the ground where services are actually delivered, the mandated requirement to promote abstinence has squeezed the condom message out of what was supposed to be a program that worked by enabling individuals to exercise choice and responsibility for their own actions. Instead…
What has changed in Uganda is that condoms are no longer promoted to the general population. In line with US Aids policy under Mr Bush, condoms should be promoted exclusively to high-risk groups such as truck drivers, soldiers and “discordant” couples (where just one of the partners is HIV-positive). Everyone else should hear the rubber-free virtues of abstinence and fidelity only. Yoweri Museveni’s government hungrily devoured the American abstinence policy and the attached cash. It is dependent on foreign donors for half its budget.
“We have worked so hard to get people to understand HIV and that there are three options open to them: A, B or C,” says Dr Henry Katamba. “That’s Abstain from sex, Be faithful or use a Condom, whichever is the one for you. That’s what our government used to say – and everyone understood. The message recognised that it wasn’t realistic to ask for abstinence from everyone who’s not married.” Dr Katamba is health co-ordinator of the Uganda Protestant Medical Bureau, an umbrella of churches providing clinical help in the absence of government hospitals.
“Because of the US, our government now says Abstain and Be faithful only,” says Dr Katamba. “So people stop trusting our advice. They think we were lying about how condoms can stop Aids. Confusion is deadly.”
“Deadly.” Let that word sink in.
I’ve written elsewhere on this blog about the way that some of our leaders, at least, choose death before dishonor, as long as it is someone else — someone negligible, like an anonymous heroin addict, or some distant African at risk for HIV/AIDS — who actually does the dying.
The usual analysis of this disgraceful division of labor turns on the political calculus of interest groups and the Rovian tactic of keeping the literalist evangelical “base” calm and happy. But whatever the truth of that argument (and who knows whether Bush argues for abstinence out of calculation or genuine belief), such mind reading misses the larger point.
Scientific illiteracy is not ignorance of any given fact. George Bush does not need to know the curve that fits the data on the rates of infection in different sub-Saharan countries. He does need to pay attention, though, to the fact that such knowledge exists, and says something important about the world and the consequences of US action.
Instead, in the government we have now, facts and the process of inference from facts are subordinate to pre-existing certainties.
Among them: Sex is bad in and of itself, except in certain, tightly defined circumstances. If you choose to go ahead and do the nasty in defiance of that moral “truth,” then be prepared to take the consequences. (Even if you didn’t choose – of course, but I’m not even going to go down that sewer just now). You made your bed, man or woman (or unborn child) … now die in it.
This is how science matters in public life. It’s not, to my mind, the question of funding choices – should physics get more than chemistry; neuro more than endocrine biology or what have you. It’s not about Obama liking NASA and the manned space mission less than Clinton. It’s whether or not our leaders understand the idea that facts have consequences.
When someone makes a claim about material events in the world, scientific thinking provides the only reliable method to test that claim. You have to get the data, analyze it, and expose the tools of your analysis to scrutiny as well. If you don’t you get what we have: policies that defend ideological purity, literally to the death.
I’ve written this before; I’m sure it’ll come up again. That’s what makes the practical consequences of bad science not just tragic, but criminal.
Images: Nicholas Poussin, “The Plague of Ashdod.” 1630-31. Source: Wikimedia Commons
Special costume to be worn by medical men confronting the plague. Germany 17th century. Licensed under a GNU free documentation license Ver. 1.2 or any later version published bythe Free Software Foundation. Source: Wikimedia Commons.