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12/30/2004

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Kelly Scott

Re AIDS care and prevention. Provision of AIDS drugs is integrally linked to prevention of its spread. They provide incentive to test AND lower infectivity. Without them, prevention quite literally doesn't work.

Your comment re provision of AIDS drugs increasing sero-incidence is well taken however. And in fact, one could equally apply it to a vaccine. If a vaccine is 25% effective but its existence leads to much greater indcidence of risk behaviors it MIGHT be a net loss as far as prevention.

Then again, this logic applies to ANY prophylactic: the jey is how MUCH more risk behavior stems from provision of care or remedy. Given that a host of factors can change in the equation (e.g. the finding that provision of care actually reduces transmissions), who would deny life saving treatments on the extrapolated logic of changing factors?

In addition, the argument is really no different in kind than saying that AIDS sufferers should be let die, since by so doing one could stem the empidemic thorugh reducing those who can spred it and enhance cost effectiveness thereby. Finally, rarely are such arguments made for all prophylactics, where it is equally true. I mean no personal statement, but somehow one suspects that application of it to AIDS sufferers is as much due to antipathy to people with AIDS or the poor as any heartfelt desire to be pragmatic.

scott cunningham

This is a question for a commenter - how does female circumcision increase susceptability to STD infection? I'm assuming the wound heals and scars and therefore there shouldn't be any exposure to blood or fluids that would necessarily increase infection susceptability, right?

Alone

Of course, I meant SLEEPING SICKNESS.

Corey

"And that is what I criticize, since the basic problem of poor countries is not that they are poor, but that they are badly managed"

That is so typical, it seems like every time the question of money transfers for purely social benefits comes up, the right does the same two things. 1) begin raving about the possibility of bad actors. 2) confuse cause and effect.

The problem with poor countries is that they are poor! They are badly managed because they are poor. They lack the socio-economic resources to collectively restrain tyrants and the education to provide reasonable alternatives to them.

Posner's argument against foreign aid is exactly the same as the "cadilac driving welfare mom" that Reagan repeatedly conjured in the 80s as a reason to cut domestic social programs. It is the same mindset that makes people like him admonish homeless people to "get a job" or say "you would just spend it on beer" rather than giving them a quarter.

The possibility of bad actors appropriating aid is a reason to add safeguards to the aid distribution process... NOT a reason to discontinue aid. At a time when tens of thousands of people in southeast Asia will be soon dying of disease without foreign help, I find it disgusting to stand around worrying about misallocation in a public forum. It can only discourage generosity to see "respected" public figures coming out against foreign aid. (But then again, I suppose in L&E land, generosity has no content)

An interesting question, what would we say is the "basic problem" in the poor country of Iraq, now that we are managing it ourselves?

Sam

"How does female circumcision increase susceptability to STD infection?"
My guess is that the scar tissue interferes with natural intercourse and makes exposure to blood more likely. Supposedly sex is more painful after circumcision, which would support this theory.

Matt

Sir, you make the apt connection between treating AIDS patients and treating those with other preventable diseases in our own country, but then fail to see the point - we are right then, and you are wrong now.

Unless you believe that there should be no social insurance at all, our society protects the unfortunate at some basic level - small disability pensions from OASDI, Medicaid, food stamps, etc. Do you find yourself qualified to judge which illnesses are the product of poor choices and thus disqualify the sufferer from the safety net? I do not find you so qualified. That is why the services are basic (to avoid too much moral hazard) and universal (to avoid making the decisions you are advocating).

Of course, the practical arguments I should probably make as well are also obvious ones, that a) real economists like your esteemed fellow blogger think treating AIDS is beneficial rather than harmful to developing nations, and b) a significant number of AIDS victims are guilty of no moral misjudgment but rather of bad luck. These include children, rape victims, and the less common transfusion recipients. Judge them if you will

Anonymous

Sir.. i'm also ask this question: if condoms are so cheap, why is HIV-AIDS so prevalent in Africa and certain other poor countries? thanks for the answer :)

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