"Pending development of a vaccine (still not in sight), the only effective way of dealing with the African AIDS epidemic is adoption of safe sex. The AIDS drugs will retard that adoption by reducing the benefits."

So then subsidize safe sex too! Pay for condoms and for non-catholic, realistic sex-ed. No rational human being who understands the disease and the possibilities for free prevention will decide to have unprotected sex in Africa just because new AIDS drugs will prolong certain death by 4 years. That is absurd.

I agree that education and legal/political reform are the highest priorities, but you MUST treat the sick and the dying. What kind of respect for the rule of law will people develop when they are told that they can't have AIDS drugs for their sick child because the G8 is trying to teach Africans personal responsibility!

Imagine going to the hospital in Boston and hearing "We are going to let your child die now instead of giving her 5 more years of life because we want to make an example of her to all those people who aren't taking this disease seriously enough." People would storm the building!

Technology carries with it responsibility. The ethics of the Medical Profession demand that doctors treat the patient without regard to deservedness or broad economic policy. You don't fight homelessness by letting the homeless die, and you don't incent sexual norms by refusing to treat dying people.

This kind of thinking is what led to the decade of sanctions on Iraq that even the US administration admitted were responsible for the deaths of 500,000 children. If the leaders are corrupt and the economic system is broken, then you work on that, but you do NOT stop helping the innocents in the meantime, and you most certainly do not use those the lives of those innocents as leverage against corruption.

And Bush wondered, "why do they hate us?"

Neither Becker nor Posner mentioned capital flight from these resource rich African countries. Nor the fact that a large part of what is different about India and China is their ability to send large numbers of their people to get technical educations in the west. Remittances from Indian citizens working in the US and UK was a major contributor to the % growth of India's economy in the 90s.

Unfortunately, African countries are developed on the third world "free investment" model, in which G8 companies strip resources while providing no education or social benefits to locals. There is no reason that Shell should be able to operate in Nigeria without the same level of spending on local universities, charities, and the like as Shell puts out in exchange for operating in Texas. Eli Lilly Co. practically built much of Indiana University, but has it built any schools in South Africa? (it employs 41,000 people outside the US) Note how that would also circumvent the assumed corrupt government.

But corporations have no incentive to act thusly. So we tax the money they bring back to the US, and we spend some of it on Foreign Aid. (But most of it on bombs and planes) Is there a better way? Most certainly. But it does not involve denying help to africans dying of treatable diseases.

I apologise for the long comment, but that made me mad.

They "hate us" for many false reasons, including the ones Corey preaches above. When they stop listening to the Corey's of the world, and stop "hating us," their lot, poltically and economically, will improve quickly. Bad relations based on foolishe hatred and dishonest beliefs slow down improvement of relations and economics.

I wholeheartedly agree although I don't see how the availability of free AIDS drugs make AIDS less of a problem. One still gets to die and live a mostly miserable life until then, and drugs only alleviate some of the symptoms and prolong the sufferer's life, on a case-by-case basis. The reduction of the cost of the disease is an impractical way of formulating the situation.

I can't imagine *anyone* thinking to himself: well, yes, I *could* use a condom but I'm going to *risk it* because I can get free AIDS medicine. That's just nonsense.

Anyway, out of the 3 demands made by the fashionable protesters, I think that only free trade makes sense to me, and that's because universal free trade makes sense to me, especially if universally implemented.

Overall, a great post! It's awesome to see voices which oppose the statist, interventionist, redistribution-happy trend in foreign affairs. (not "heartless" but with the right amount of heart)

The argument "Nobody is going to risk it because I can get free AIDS drugs" is something of a straw-man because it assumes that the person doing the deciding knows enough about AIDS to avoid taking the risk. But, that's not true. For example, in Nigeria only 16% of girls between 15 & 24 know about HIV.

We're still trying to teach these people "AIDS can kill you. You get AIDS from sex. Condoms can help you not get AIDS from sex." Drugs that delay death actually undercut that message by creating counter-examples.

This suggests refining the message to mention the benefits from drugs. But, every time you refine it, the message becomes somewhat more complicated and more nuanced. The next questions are "How much extra time do the drugs give me?" and "How bad is it to be on those drugs?" and so on. Pretty soon you're doing the education that Posner is calling for.

At some point, unprotected sex in these countries may actually be rational: if you only have a 30% chance of hitting age 65 (in Congo, for example), then you might not be losing as much by having unprotected sex and taking the drugs -- there's a very good chance that you will die of something else first. And, when you consider the front-end benefit, the marginal risk from AIDS may not seem that high.

I know this logic drives some poeple crazy, but we see similar logic in the US all the time -- why do so many people smoke? It's the #1 cause of death in the US and everybody knows it. But, people still smoke because they'd prefer to have the "joy" of smoking over some extra years tacked onto their lives. (Or at least they'd prefer to forgo the pain of quitting.)

"They "hate us" for many false reasons, including the ones Corey preaches above."

What did I say that was false and why.
Did you actually want to try and debunk my
assertions or simply attempt to apply a
label to them in the hope that people are
stupid and don't think for themselves?

I think the aid should be directed at promoting and facilitating the distribution of birth control, and, in particular, forms of birth control over which African women can exercise control. (Pills, vaccinations, IUDs, and the like, as opposed to condoms.) Ideally, this would empower women to counteract the strong cultural mores favoring unprotected sex and women assuming submissive, familial roles. Then, they might still be pressured into having sex, but the control over the decision to become pregnant -- of momentous consequences for these women, especially -- would shift to them, from the men in their lives who now seem to dominate them. Once they gained control over their reproductive capacities, it would be easier for them, personally and culturally, to assertively take measures to protect against getting AIDS. They would also be able to explore other economic roles besides child-bearing, which eventually could change the economic landscape. I am advocating birth control as a major catalyst for systemic cultural change there, just as birth control has been a similarly wondrous catalyst in our own country. I worry that religious conservatives would virulently oppose such change, however, and I suspect that this kind of proposal is not on the table, in terms of U.S. foreign aid, because of the opposition of religious conservatives here.

"Anyway, out of the 3 demands made by the fashionable protesters, I think that only free trade makes sense to me"

The organizers of Live8 were NOT asking for
"free trade" in the sense that economists use "free markets". Their slogan is "Trade Justice" so perhaps a more accurate label would be "Fair Trade"

The Live8 web site includes the quote: "Rich countries used trade rules to protect themselves as they developed - which is how they got where they are now. Now we need to use trade rules to end world poverty as we know it."

That is hardly a call for "Free Trade" so much as it is an endorsement of protectionism and management of trade rules for the benefit of specific, previously under-represented interests.
I'm guessing that the actual Live8 programmers ideology is way more planned economy than many here would be comfortable with.

Maybe I'm just cynical but I was under the impression that very little foreign aid was given with the intention of increasing economic growth in the recipient country.

At worst, a foreign aid official simply arranges to have money go directly to a corrupt leader in exchange for personal favors (high living in the recipient country, etc.).

Most of the time the foreign aid is given directly to a corrupt leader in exchange for some sort of cooperation that benefits the donor country at the expense of the recipient country (exploitation of natural resources, military cooperation, etc.).

At best, the foreign aid is intended to temporarily alleviate a humanitarian crisis such as a drought or civil war induced famine. It should be noted here that economic security (not starving to death, in particular) is more directly important to people in developing countries than economic growth. Foreign aid can directly provide economic security (preventing people from starving to death) regardless of its effect on economic growth.

Even to the extent that foreign aid has been intended to increase economic growth, saying that foreign aid can't increase economic growth because it hasn't in the past is like saying that science can't cure cancer because it hasn't in the past.

Two things cause economic growth. The first thing is technology. You don't make Mercedes and cell phones by banging rocks together. The second thing is utilization of labor. People need the freedom to find jobs that maximize their productivity. If all the economic power is in the hands of a few individuals (corrupt communist politicians or corrupt capitalist CEO's) then people will not be assigned jobs that maximize their productivity.

Now, foreign aid can actually help with both things but, like science, it takes a lot of time.

With respect to technology, educating someone to the level that they can design a Mercedes or a cell phone takes about 30 years. African countries have not had foreign aid programs that aggressively targeted education for such time scales so it is not surprising that little increase in economic growth is seen.

With respect to utilizing labor, economic (and political) reform requires that the population of the developing country understand the reforms that are needed. This requires educating the majority of the population which, again, requires education programs lasting at least a generation.

What the G8 nations should do is fund and administer schools in the poorest neighborhoods/villages in the world and provide selected children with the level of education available in G8 nations. This would require providing the children with enough to eat and probably some sort of stipend so the children wouldn't have to drop out of school to work to support their families. It would also probably require some program allowing them to go to college in G8 countries.

For $25 billion a year it would be possible to have thousands of schools serving a million or so students. That is, admittedly, a drop in the bucket of poor children in the world but if the very poorest areas were targeted then after 30 years or so those areas could see substantial economic growth resulting in reduction of poverty in the poorest areas of the world.

I am in much agreement with both Becker and Posner on these latest posts. With respect to the AIDS issue specifically, I find myself in some disagreement with Posner.

Though I agree that providing free AIDS drugs may in fact increase the prevalance of infection, it does not follow that we should not provide it. If the inreased prevalence of AIDS resulted in not only greater infection rates but also lower average life expectancy, then I would concur with Posner's view of witholding AIDS drugs. Because providing it would result in lower average life expectancy, therefore worsening the Africa human and demographic tragedy significantly. However, that is far from certain. It is entirely possible that providing AIDS relief to Africa will cause BOTH infection rate to increase (Posner's reason for withholding AIDS drugs) and the average life expectancy to increase (what we are trying to accomplish, I presume, by providing the aid). If we're interested in prolonging and saving lives, then providing AIDS relief to Africa makes sense, even if it increases the prevalance of AIDS infection.

Good choice of topic. Thanks.

With regard to Posner's comment that providing AIDS drugs will decrease the costs and therefore possibly increase the spread of infection Judge Posner is certainly right about the first point but probably wrong in his conclusion. On the margin some people who are considering whether to engage in risky behavior will choose to do so if the downside (dying) is reduced. We have seen this to some extent in the US as rates of HIV infection have crept up (when more effective drugs have become available). Of course, people who are compeltely clueless about AIDS would not change their behavior either way, but these people's behvaior is determined exogenously to this question (i.e. risk of dying from AIDS presumably does not impact their decision).

I actually see a close analgoy to an argument made in the 1970's that mandatory seatbelt use would increase bad driving (since you were more likely to survive an accident) and therefore seatbelts killed people. The data I have seen support the first part of this argument (and it fits nicely with economic theory). However jsut looking at risky driving presents an incomplete picture. Rather it is necessary to look at the icnrease in risky driving compared to how much how much seatbelts reduce death. For example if seatbelts cause 1 person to drive more dangerously but save 1000 people seatbelts are clearly beneficial. Obviosuly if the converse is also true. Setting aside risk to pedestrians (who of course are not helped by seatbelts) most data I have seen indicates that on balance seatbelts are highly beneficial.

For this reason I would suspect that Judge Posner's ultimate conclusion is wrong (although I have not data to support feeling). I would suspect that if effective AIDS treatment were more avaiable in Africa marginally more people would engage in risky behavior. This would mean more people would get AIDS. However, I would suspect that this would be more than outweighed by the number of people who survive who otherwise would not have. Of course if people believe effective treatments exist but they do not (or are not available) you could end up with the worst of all worlds, riskier behavior but no benefit. Also I am somehwat leary of more people walking around with AIDS even if they are surviving longer, since that would seem to increase th possibility of drug resistant mutations etc. However, this last point is well beyond my (and Judge Posners) area of expertise.

M. Webb, just made the same point. Increases in infection rate need not cause increases in deaths for AIDS or as I put it, lower average life expectancy (ceteris paribus). That seat belt analogy is perfect for the question raised by Posner, btw.

Becker and Posner are, in my opinion, too limited in their criticism of the Live 8 concept in view of the serious questions they raise about whether the money raised will actually do any good.

Whether aid actually helps or hinders a nations ability to raise the living standards of its citizens is an essential question in view of Live 8s objectives, yet it seems this question has not been addressed. This is criminal.

The parallels with the response to that other great issue, global warming, are striking: an over-reliance on centralised decision-making, a failure to recognise that incentives matter, and a failure to ensure solutions work. In both cases, it seems, it is good enough to be doing something.

Well, its not good enough when the lives and health of millions in Africa will be needlessly destroyed. I agree with Becker and Posner that rather than throw money at the problem, better to focus on the development of systems and institutions that facilitate permanent, long term improvements in prosperity. The hard-won lessons from Asia will be usefully harnessed in solving this deeply complex problem.

Corey, your leftist jargon and limited thinking has no currency here. You claim, amongst other things, that FDI is exploitative and causes capital flight. Yet the reduction in poverty in the Asian tigers, India and China associated with FDI is clearly inconsistent with any sensible definitions of exploitation and capital flight.

I would like everyone to know that I wrote a comment critical of Posner's view on AIDS treatment that was apparently censored from the blog.

My last comment was intercepted with a message that a feature had been enabled to allow Posner to approve posters. The comment has yet to appear.

Some mentioned that Africa differs from China and India because they do not have access to "Western" education. Anyone who has been to Europe's universities lately know that Africans are getting educated.

Also, my brother just returned from living in Zimbabwe and Malawi for a long period of time. He informed me that most people are unaware that people in G8 countries have a higher standard of living. He desribed their overall desire to change as indifferent, if not defiant. Why have them change to a Western system if they do not desire it?

I agree that HIV+ People are probably not walking around thinking that, if AIDS drugs are available, then I can have more risky sex.

However, HIV+ people live longer with AIDS drugs. Therefore, they will infect more people as they continue to have sex.

Thus, it's better to focus on prevention than on treatment. We should let people with dangerous infectious diseases die as soon as possible to limit their time to infect others.

Of course, one problem is that it would be unfair to those (African women, I suspect) who have little meaningful ability to refuse sex.

Wolf (2004:147) points out the phenomenon of 'resource curse'. Countries endowed with natural resources (oil or minerals) have generally failed to match the economic growth of their un-endowed counterparts. This is because a) resources tend to corrupt politics and produce internal struggles, leading in some instances to war; b) prices of natural resources fluctuate widely, creating unstable terms of trade; and c) they generate a high real exchange rate that hinders the development of manufacturing, the major breadwinner in more successful developing economies.
Wolf points out that all but six of the 45 countries that have experienced unsustained economic growth since the 1960s possess significant natural resources.
Might aid mimic the resource curse? Specifically, might it a) also create damaging internal struggles for control of resources, if not resulting in civil war at least causing greater corruption b) create an unstable source of income that is dependent on the whims of politicians and charitable organizations and which mimics the uncertainty of natural resources income, and c) inflate a recipient's exchange rate, harming exporting industries not targetted for aid?
Both Becker and Posner make a case for a); b) is empirically testable; and whether c) can be expected requires input from a macroeconomist (anyone?)
Aid comprises more than 10% of GDP in some African countries; if these effects are real they may be significant.

On another topic, do you think there is a housing bubble in the U.S.? Globally? Why or why not?

Great post. How about this suggestion: Instead of foreign aid to countries how about money for the international development of vaccines and medicines for tropical diseases (and AIDS) that then can become part of the public domain so that anyone can freely produce them. If you're worried about the lack of a profit motive turn it into a global prize- the winners get tens of millions for developing new cures and treatments. Or how about the same concept applied to biotech- a huge international fund with the sole purpose of developing crops specifically for poor countries?

J.S.

http://voicesofreason.info

I agree with Alex W that AIDS treatments will tend to increase the likelihood that the person with the virus will spread it, as those with the disease tend to have promiscuous habits. It is entirely possible that the best prevention method for AIDS may be monogamy. Condoms are greatly disfavored by males, and carrying and using them tends to be a bit more in the hands of the person with the virus, not the one with the exposure. So, while there is some potential there, it is probably not nearly enough.

The problem with fostering monogamy, whether it be out of wedlock or in wedlock, is that it does not have a strong root in many local traditions and cultures. Polygamy and casual sex outside a relationship have long been a feature of many African cultures. This lies at the heart of the problem.

Girl's education may indeed be the best way to promote more stable families and sexual practices.

I also agree with Becker and Posner that corruption has become perhaps the primary obstacle to consistent growth across Africa. When I was there, it was just common practice that you brought your money with you every time you needed something from a government official or police officer, and that was just as an insignificant student. In doing business, it must be much more of a mess. Basically, why build a factory in Africa when you can build one in India or China?

Has anyone wondered why AIDS is only a problem in Sub-Saharan Africa? Why not northern Africa? The answer is simple, which is that the predominately Muslim northern Africa has social mores that favor marriage over promiscuity. "Safe sex" is an oxymoron and has never worked in any country in which it has been tried. Here is a good article about the research of Dr.Edward Green of Harvard who has shown that Uganda has seen a substantial drop in AIDS rates by following a primarily abstinence-based program.

http://www.crosswalk.com/news/1317332.html

Amartya Sen, in a book callled "Development as Freedom", has related information on educatin of women in developing nations. If I interpreted the table in his book correctly, historical literacy rates for women in the least-developed parts of some developing nations (including sub-Saharan Africa) are noticeably lower than rates for men.

"The Elusive Quest for Growth" by William Easterly has interesting content related to this topic.

I think there is more to consider here than just the role of personal choice when considering the effect of an AIDS vaccine/treatment (or rumor of it) on the spread of disease. AIDS is cause by a virus which has its own mutation rate. An interesting finding in theoretical work combining traditional epidemiology with evolutionary theory is that vaccination or treatmentcan, under certain conditions, increase the previlance of a disease due both to its effects on human behavior (suggested by Posner) and on the virulance of the disease. A good overview of this work can be found in (with apologies to those who cannot access a copy):

Boni MF, Feldman MW (2005). Evolution of antibiotic resistance by human and bacterial niche construction. Evolution, 59(3):477-491

That being said, I can't say (and likely no one can) if AIDS in Africa fits the models proposed by Boni and others. But it does suggest that until there have been significant reforms in governance and educational systems in Africa, providing AIDS medication now may cost more than we realize both in terms of monies spent and in the loss of the lives of all those we will be unable to treat in the future. If our ultimate goal is saving lives and helping people live as long as possible, as one post suggested, we need to consider the future effect of out actions.

i'm a new reader and i just returned from living and working in the health field in tanzania for 7 months. i know i'm a little late, but here goes. i agree with much of the post, but the argument that subsidized antiretrovirals will increase the incidence of HIV poses a problem. it works if everyone thought like americans, but it's much different over there. the cost of contracting HIV isn't weighed only in how soon one will die. being HIV positive means losing friends, employment, livelihood, being isolated from one's family, being ridiculed, a world of shame, and a whole host of other consequences accompanying the stigma. most HIV positive people where i was will hardly admit it. they are afraid to come participate in a clinical trial for fear they'll see somebody they know. if they do come, they lie about their name and where they live. most of them do not tell their spouses they are HIV positive. the stigma associated with HIV is one of the biggest obstacles in fighting this epidemic. they are scared of this as much as they are of death. and, in my opinion, the stigma will be around long enough to make getting HIV scary enough to outweigh any sort of apathy resulting from free drugs.

"Instead of foreign aid to countries how about money for the international development of vaccines and medicines for tropical diseases (and AIDS) that then can become part of the public domain so that anyone can freely produce them."

The problem is the assumption that a government run bureaucracy would be more efficient that competitive drug companies. In this case the consumers don't have enough money to buy the product so free market development of the drugs isn't a guarantee. Maybe the aid money can be used to guarantee a payoff to the inventor of a vaccine.
I agree though that the war, disease and hunger are all a result of a lack of education. Maybe we can just pay them to study. Then again there was a documentary on North Korea that showed the long term learning disabilities created by malnutrition so it can't just be that simple.