AIDS, Population, and Policy--Posner Response

This is my response to the Becker posting on "Disease, Population, and "Wellbeing." A recent international conference of economists (�Copenhagen Consensus 2004�) tried to determine the best uses for the monies that international organizations and wealthy nations donate to poor ones. Contributing to the eradication of HIV-AIDS came out first on the list. Becker�s posting does not rank programs but does suggest that HIV-AIDS is a worthy object of �international assistance from philanthropic and other groups.� I disagree on two grounds. First, I do not think that foreign aid is a good use of public or private money. All the problems that foreign aid seeks to alleviate are within the power of the recipient countries to solve if they adopt sensible policies. If they do not adopt such policies, then foreign aid is likely to be stolen by the ruling elite, strengthening its hold over the country, or otherwise squandered. What we can do for poor countries is reduce tariff barriers to their exports. With money saved from eliminating foreign aid, we could compensate our industries that would be hurt by import competition from poor countries and thus reduce political opposition to tariff reform. HIV-AIDS is an especially good example of a problem that is not going to be solved by foreign aid. The spread of the disease is easily prevented by the use of condoms, which are cheap; any nation can afford both to inform its population concerning the risk factors for and the consequence of the disease and to make condoms available at zero cost to its sexually active inhabitants. Treatment of the disease once it is contracted is very costly and is a poor method of fighting it, since once a disease is curable, the incidence rises because the expected cost of catching the disease is lower. So, for example, when syphilis was discovered to be easily curable by penicillin, the incidence of the disease soared. Unlike an air- or waterborne disease, HIV-AIDS is easily avoidable by an inexpensive change of behavior, namely using condoms in sex, or by a more costly but still feasible change, namely by avoiding promiscuous sex. To the extent that these methods of avoiding the disease are infeasible in certain poor countries because of intractable social and economic problems, providing money for costly AIDS �cocktails� is a band-aid solution which, as I have just suggested, may actually make matters worse by reducing the incentive to avoid contracting the disease in the first place. Second, I am not as optimistic as Becker is about the positive benefits of increased population in poor countries. What is true is that the growth of population in such countries will prove self-correcting if they become prosperous, because wealthier nations have lower birth rates than poor ones for a variety of reasons, such as that educated women with good job opportunities have a higher opportunity cost of having children and that reducing the role of subsistence agriculture in an economy reduces the demand for children as farm workers and old-age support for their parents. But a population increase that is due to a reduction in the death rate need not be correlated with rising prosperity; indeed, by raising the ratio of population to land and other resources, a reduction in the death rate may reduce economic growth. While Becker is correct to point out that healthier people are more productive workers, on balance HIV-AIDS may, as argued in a recent paper by Alwyn Young, "The Gift of the Dying," increase per capita incomes in poor countries by causing wage rates to rise, since the epidemic has reduced the supply of labor. Hence the disease may have both a direct and indirect negative effect on population. Increased global population can create large negative externalities. (The present world population of about 6 billion is expected to reach between 9 and 14 billion by 2050.) Global warming has been shown in a paper by Anqing Shi to be influenced by population growth. Such growth results in increased burning of tropical forests and thus increased emissions of carbon dioxide, as well as leading to increased output of energy produced by fossil fuels, the burning of which is a major source of such emissions. Moreover, population interacts with economic growth to produce sharp increases in economic activity, resulting in heavy demand for energy. For example, at a population growth rate of 1 percent a year and a per capita income growth rate of 2 percent a year, WGP (world gross output, i.e., the total of all nations� GNPs) will increase fourfold between now and 2050. There is, as Becker emphasizes, a positive side to population growth. A greater population enables additional specialization of labor, with resulting cost savings. It also increases the incentive for technological innovation, by increasing the size of the market for new intellectual property without a corresponding increase in cost. The cost of producing and distributing a new software program, for example, is essentially invariant to the size of the market, so the larger the market, the greater the net revenues to the producer and so the greater the incentive to create the software in the first place. But new technology is a source of risk as well as benefit, as I emphasize in my book Catastrophe: Risk and Response (Harvard University Press, 2004), so the effects of population growth in increasing the rate of technological advance cannot be considered an unalloyed blessing.

Comments

[joel]

Two objections:

One.
Is it truly ecomically efficient to squander the monies that would have been spent on foreign aid to prop up noncompetive domestic industries?

Two.
It is incorrect to assert that HIV is "easily avoidable by an inexpensive change of behavior. If were so easy and inexpensive, wouldn't the rules of the marketplace have eliminated those behaviors? I would guess that in those parts of the world where life is still "nasty, brutish and short", the costs of acquiring HIV do not outweigh the percieved gains of the behaviors that cause the disease.

And finally, my own question. Would the monies currently being spent on on foreign aid to cure HIV be better spent on offering rewards to the head of gov't who shows the greatest reduction in HIV infection in his country?

[James]

I wonder if it really makes sense to eliminate foreign aid entirely. A few points:

1. Much aid is given for political reasons - carrots. If I remember correctly, the two biggest recipients of US foreign aid are Israel and Egypt. I suspect that this is not because we think that Israel is underdeveloped, or because we think that Egypt spends the money well.

2. Some countries are poor yet have good government. The only example that comes to mind is Botswana, but surely there are others. In these situations, perhaps foreign aid will find its way to worthwhile programs in health, education, or infrastructure. The returns to such spending are probably high enough to justify our sacrifice.

3. I still don't understand why more aid money doesn't go to clean water systems. Although the real problem is water-borne illness, there are other considerations. In the status quo, tap water in India is unsafe, and wealthy people buy filtration systems. If the tapwater were safe, everyone would have clean water and the wealthy could cut out spending on filtration. This might even be an example of multiple equilibria. You can imagine that as incomes rise, more and more people get filtration systems, and eventually everyone has one. This is inefficient if the same cleanliness could have been provided by municipal water plants. Nevertheless, those municipal plants will be redundant once enough people have household filtration systems.

4. Much private foreign aid goes through NGOs that can bypass the corruption of the ruling elite.

5. We are currently dropping tariffs on textiles, if I remember correctly, and while this is probably wealth-maximizing, it has the undesirable effect of removing income opportunities for many developing nations (as the jobs move to China). Tariff reductions are not simple one-dimensional development tools, in other words.

6. Finally, the great hidden trade barrier is our program of farm subsidies. This is a political problem, one that I doubt would be ameliorated by the reduction of foreign aid. It seems like the sort of obvious pork that people could be shamed out of, but it hasn't happened yet, and people are awfully good at rationalizing programs that provide their income.

[Dr. Ernie]

While I agree with your basic premise, I'm skeptical of your claim that remedies are entirely "within the power" of poor governments. That seems to assume that money is the only limiting factor, and that (at least in the limit) humans will ultimately make rational choices. In my experience, all cultures (including academic culture!) have systemic irrationalities that persist for generations despite negative economic impact.

At some point, the scarcest resource is arguably what the ancients called 'wisdom', which is perhaps what we moderns call 'character.' Proper incentives may well be necessary to form character (which is why I support your general approach), but I'm not sure they are sufficient. In fact, I would argue that relationship is the most effective context for developing character, which is why at least some type of foreign aid could be beneficial -- if used as part of a character-building relationship, not a character-destroying handout.

[Dave]

The foreign aid question, as one writer noted, is really one of politics. By giving aid to a country, we endear them to us politically and hope that they will return the favor someday, if necessary - for instance, if we need a vote in the UN or a base in a foreign war. That may be bribery, but unfortunately it is also realpolitik. The question is whether the expected benefit of the "bribe" outweighs the cost.

Also, regarding such issues as AIDS, clean water, etc., the fact is that some countries are badly managed and could benefit from somewhat of an example. If we spend a little money to teach them about condoms, or about water treatment, then perhaps they will get the message and eventually put their own house in order. The world is made less safe by the presence of dysfunctional governments, and a little bit of leading by example might go a long way.

Finally, I'm not sure I understand the relevance of the discussion about population growth. Of course, population growth can have certain negative externalities, but is that a reason to let people die of AIDS? I hardly think so. Countries with population explosions might want to encourage birth control, but it is inhuman to let sick or starving people die in the streets, whatever the "externalities." The "positive" effects of lower population should not be a factor in the foreign aid calculus, unless we are funding birth control.

[Carl]

I wonder if you could discuss in a little more detail the differences between increased total fertility rates and decreasing adult death rates and the economic implications. It would seem that increased fertility rates have a Malthusian effect on the labor force and wage rates, but this doesn't hold true for adult life expectancy as far as I can tell.

I believe that Becker has made this fertility/life-expectancy distinction, emphasizing that while increased fertility has mixed effects on economic growth, the increasing returns to investment in human capital makes increased adult life expectancy a great good for economic progress.

[Stephen]

Is a policy of dispensing condoms really less costly than reducing promiscuity? Perhaps in the short term I can see how one might argue that point successfully, but over any timeframe longer than a week, I sincerely doubt that promiscuity with condoms is less costly to a State than a policy of monogomy without condoms. Promiscuity, even with condoms, rarely attains the pair-bonding strength of a family tie, adn family-centered and neighbor-centered support systems are more efficient in identifying and assisting neighbors in need than any state-sponsored social welfare system yet devised.

[The Poor make good test subjects]

The interest by "the west" in the 'underdeveloped' countries with HIV is as a testing ground for (in an ideal world) a pill that keeps you from dying. In a less ideal world, a vaccine. And in the least ideal world a cure.

The 'underpriviliged' are nothing more than lab test animals. The environment of 'try this or die' allows various methods to be tried that can not happen in countries with stronger laws and where the economic value of the people is far less than 'in the west'. (example - Bhopal)

When you have a situation where the actions are not fully explained by various actors, how can an economic analysis be correctly applied. Alas, trying to apply one set of rules to a rigged game with a different set of rules will lead to an incorrect analysis.

[Steve Sailer]

Regarding the AIDS epidemic in Southern and Eastern Africa, Judge Posner is naive about the appeal of condoms and, perhaps, too cynical about the degree of "promiscuous sex" among Africans.

First, condoms: For as of yet unexplained reasons, there seems to be a cultural preference among South and East African men for "dry sex" (Google on the term for a description -- not work safe, however). Not surprisingly, this contributes to the spread of AIDS through vaginal abrasions. Also, not surprisingly, it's harder to get men who like unlubricated coitus to use condoms.

Second, "promiscuous sex:" It's probably _not_ true that promiscuity is a major reason that Southern and Eastern Africa have so much worse of an AIDS problem than the rest of the world. Unfortunately, the more rapid spread of AIDS in that part of the world is facilitated by a locally traditional form of sexual structure that Westerners have had a hard time understanding.

An article in Discover Magazine by Helen Epstein, Feb 2004 ( http://www.discover.com/issues/feb-04/features/why-aids-worse-in-africa/?page=3 ) explained the major upgrade that Western statisticians finally realized they had to plug into their models to explain why HIV spreads so much faster in sub-Saharan Africa -- "multiple concurrent relationships." Originally, American computer whizzes assumed that the sexual behavior of Africans resembled to one degree or another various American models -- monogamy, serial monogamy, promiscuity, mistress-keeping, prostitution, etc. But they missed the key difference between Africa and much of the non-tropical world: a large proportion of both the men and women of Africa are involved in simultaneous long term relationships with two or more members of the opposite sex.

This is not widely discussed in the West, where interest in sub-Saharan African life has vastly diminished in recent decades, but James Q. Wilson's recent book "The Marriage Problem" has a couple of chapters on African family structures that are most illuminating for anyone concerned with fighting AIDS.

The author of the Discover article fails to pick up on the cause of "multiple concurrent relationships," but it leaps out from her interviews with African men: the lower level of male jealousy in Africa. The men the journalist interviewed drinking beer in a Botswana bar one morning all claim to have more than one long-term girlfriend. There's nothing surprising in this. What is very surprising for Westerners, though, is the complacency with which they assume that their multiple girlfriends probably have multiple boyfriends, as well. Feminists should be delighted by their enlightened commitment to sexual equality, their assumption that what's sauce for the gander is sauce for the goose, too, but you can see how it contributes to the spread of HIV.

An anthropologist friend of mine living with an African tribe went off on a multi-day trip with some of the men of the tribe. They were supposed to be back, say, Wednesday morning but on Tuesday evening they were making such good time that he suggested they drive onward and get home late that night. His hosts were dismayed at this ungentlemanly suggestion. A good husband, they explained, never unexpectedly showed up late at night. It could create the most embarrassing scenes with his wife and her lover.

Evolutionary psychologists explain why men are more sexually jealous and women are more romantically jealous (i.e., a man more hates the idea of his wife sleeping with another man, while a woman more hates the idea of her husband caring for another woman) by reference to the old rhyme:

Mother's baby
Father's maybe

In other words, a man has to police his wife's sexual fidelity in order to not get saddled working like a dog for 18 years to support another's man's child. But what happens in the large swathes of the world where the husband doesn't expect to slave away to support his wife's children, legitimate or not? Evolutionary psychologists aren't very good at thinking about diversity. They simply assume that humanity is so homogenous that they can understand the whole human race by giving questionnaires to their UC Santa Barbara students.

Indeed, African men are more likely to insist than to object to their women going out into the workplace. By one estimate by an African feminist organization that appeared in the Washington Post, women do not just 50% of the work, but 80% of the work in sub-Saharan Africa.

That's why you sometimes see, for instance, particularly handsome African men who have 100 or so wives: he doesn't keep them locked up in purdah with eunuch harem guards and all the other paraphenalia that traditionally goes along with having lots of wives if a man wants to keep them all faithful. African mega-husbands send their many wives out to work in the fields, where some are seduced by all the lonely bachelors lurking about. But the Big Man isn't too outraged by this because his wives are going to grow enough food to feed their own kids, whoever the father is.

So, the good news is that Africa could kill two birds with one stone by adopting patriarchal monogamy: it could put a big dent in the HIV crisis, and it could greatly lessen poverty by getting men to work as long and hard as women.

On the other hand, adopting patriarchal monogamy would be about as fundamental a change in the family, social, and economic structure as is imaginable.

[Andrew Leigh]

"All the problems that foreign aid seeks to alleviate are within the power of the recipient countries to solve if they adopt sensible policies."
Surely this is only true in the long-run. A matter of hours before you wrote your post, the Indonesian province of Aceh lost ten times as many people as the US did on September 11, 2001. With foreign aid, more lives can be saved than without it. I entirely agree about tariffs, but right now, the Acehnese need more than the freedom to export.

[beberlei]

I think Posner is right with the "Rapid Population Growth is not too good" point. The Western Worlds Aid is massivly influencing the infant death rates in third world countries, but their traditional insights on family clans (many childrens) are not changing from one year to another. It is also still the fact, that families need their children for everyday surviving (work for their family income and rent).

The problem is see is, that the third world countries want to get over a process from the age of enlightenment to todays modern world in about 1/5 - 1/10 of the time the western worlds did. their population is going to explode, which will lead to food shortages and wars. In the meanwhile the leading 1% population of the countries get richer and richer, because they can exploit the poor population.

[Mr. Econotarian]

Economic growth solves the overpopulation problem.

"For developing countries having passed a certain income threshold, rising income is accompanied by exponentially falling fertility rates..."

"Tracing the income-fertility nexus: Nonparametric Estimates for a Panel of Countries"
Holger Strulik & Siddiqui Sikandar, Economics Bulletin, 2002, vol. 15, pages 1-9.

http://www.economicsbulletin.uiuc.edu/2002/volume15/EB-02O10001A.pdf

[AdamSmithee]

"With money saved from eliminating foreign aid, we could compensate our industries that would be hurt by import competition from poor countries and thus reduce political opposition to tariff reform."

If the impact of free trade on the losers in the US is small enough to be compensated for by current (pitiful) levels of US foreign aid, then free trade will clearly have almost no economic impact at all. If the impact of free trade is that small, it suggests that factor endowments worldwide must be pretty much the same. i.e., everywhere is already equally rich. Good news, indeed.

[Abiola Lapite]

"But they missed the key difference between Africa and much of the non-tropical world: a large proportion of both the men and women of Africa are involved in simultaneous long term relationships with two or more members of the opposite sex."

What a lot of nonsense! You know absolutely nothing about Africa, and it's well past time you stopped speaking as if you did. Your very willingness to speak of the entire continent as if all its peoples were the same gives away the depths of your ignorance.

There's absolutely no need to reach for "dry sex" or "multiple relationship" theories to explain the scope of the AIDS epidemic in Southern Africa. All one needs to take into account is that:

1 - HIV is a lentivirus which originated in Africa, and which has been spreading amongst humans there since the mid 1960s at the latest, well before it took off anywhere else in the world.

2 - The dormitory system set up for black transient miners during the South Africa during the apartheid years facilitated the spread of the "shebeen" culture which you are so eager to ascribe as typical of Africans in general. What else would one expect poor young men far away from their families, working long hours in arduous conditions, sleeping in disgusting hovels and forbidden any forms of social release in the "white" parts of the country (i.e, most of it) to do but drink and consort with prostitutes?

The telling sign that these points get to the heart of the matter while your "just so" stories do not is that AIDS rates in Eastern and (especially) Western Africa are still much lower than they are in Southern Africa, despite their populations also having played host to HIV for several decades by now. Anyone who deigns to talk about "Sub-Saharan Africans" without any qualification as to what part of this vast continent he's talking about is nothing more than a quack pretending to an expertise he doesn't possess.

[Abiola Lapite]

Let me also add that the following comments of yours are particularly (if unintentionally) hilarious:That's why you sometimes see, for instance, particularly handsome African men who have 100 or so wives: he doesn't keep them locked up in purdah with eunuch harem guards and all the other paraphenalia that traditionally goes along with having lots of wives if a man wants to keep them all faithful.And where exactly have you seen these mythical handsome guys, I wonder? The despotic potentates of yore would have been glad to have done near as well as this, and yet according to you this is something one just sees every so often amongst African men? Are black men all giant scrotums with heads in your eyes? How could any man sleep with that many "girlfriends" otherwise?

This "hypersexualized Africans" rubbish says a lot more about your own fervid fantasies (nightmares?) than it does about any realities on the ground in a continent you've probably never even stepped foot on in the flesh (and no, flying into Cape Town for a Safari doesn't make you an "old Africa hand"). Come visit sometime and try asking some African male to lend you his girlfriend for the evening - you'll count yourself lucky if you manage to escape unscratched ...

PS: It amazes me to no end that so many "respectable" news organizations are so ready to carry your ludicrous claims as if they were being made by someone who actually had a clue.

[Mr. Econotarian]

I think that health is the result of a good economy, not the other way around. Bad health does have a negative effect on the economy, but keep in mind that countries like the US have had horrific health problems (1918 flu, polio, etc.), yet as GDP per capita grew, life expectancy grew as well.

In 1930, US life expectancy was below 60 years (which explains why Social Security seemed like a good idea), while GDP per capita was $8000. Today, with US GDP per capita at $33,000, life expectancy has grown to 77.2 years.

Rich countries can afford the infrastructure it takes to deliver medicine. They can afford, for example, the AIDS treatment that keeps people alive. They can afford to have effective public health campaigns. They can have refrigeration for vaccines, etc.

I know someone in Western Africa who has more than one wife - but I also know plenty of people in the US who sleep around. I rather doubt there is a cultural difference when you come down to it.

[Steve Sailer]

Lots of people, such as Abiola, would rather see Africans die in massive numbers than for the relevant facts to be understood in the West even among the elite audience that frequents this website.

For the role of "dry sex" in the spread of AIDS in Southern and Eastern (but not in Western) Africa in spreading AIDS, note this article from that font of reactionary racism, the Village Voice:

http://www.villagevoice.com/issues/9948/schoofs.php

"Sipewe Mhakeni used herbs from the Mugugudhu tree. After grinding the stem and leaf, she would mix just a pinch of the sand-colored powder with water, wrap it in a bit of nylon stocking, and insert it into her vagina for 10 to 15 minutes. The herbs swell the soft tissues of the vagina, make it hot, and dry it out. That made sex "very painful," says Mhakeni. But, she adds, "Our African husbands enjoy sex with a dry vagina."

"Many women concur that dry sex, as this practice is called, hurts. Yet it is common throughout southern Africa, where the AIDS epidemic is worse than anywhere in the world. Researchers conducting a study in Zimbabwe, where Mhakeni lives, had trouble finding a control group of women who did not engage in some form of the practice. Some women dry out their vaginas with mutendo wegudo�soil with baboon urine�that they obtain from traditional healers, while others use detergents, salt, cotton, or shredded newspaper. Research shows that dry sex causes vaginal lacerations and suppresses the vagina's natural bacteria, both of which increase the likelihood of HIV infection. And some AIDS workers believe the extra friction makes condoms tear more easily."

[Steve Sailer]

African Family Structure -- On the prevalence of polygamy in Africa, Abiola should argue with Judge Posner and Professor Becker, who wrote in his 1992 book Sex and Reason, "Polygamy is common in African tribal society in part because each wife of a polygamist works as well as breeds, thus reducing the cost to the polygamist."

In a footnote to that sentence, Judge Posner writes, "For a rigorous demonstration that the demand for polygamy is positively related to the value of the women's contribution to family income, see Gary S. Becker, "A Treatise on the Family" 89-104 (enlarged ed. 1991)."

Later, on p. 259, Judge Posner points out that brideprice, as opposed to dowry, was common in traditional African societies, because wives contribute much of the income. He wrote, "The negative effects of polygamy are mitigated in a society in which women are highly productive of goods besides children, as they were in African tribal society (where polygamy flourished and brideprice was common)..."

Abiola willfully misunderstands my point, which is that promiscuity is _not_ a major cause of the rapid spread of HIV in Africa. His argument about prostitution in mining camps is irrelevant because I pointed out that the evidence suggests that promiscuous sex with prostitutes is not the key to understanding the AIDS crisis in South and East Africa (although, no doubt it contributes to some modest extent). (By the way, the reason powerful interests in Africa have so often hauled African men into forced or voluntary labor apart from their families, as in South African mining camps, is because the women and children won't normally starve without their menfolk around working in the fields.)

As I pointed out, Helen Epstein's Feb. 2004 Discover Magazine article that Western AIDS statistical modelers couldn't come up with an accurate computer model of the spread of HIV in Africa simply by assuming Africans followed Western sexual relationship styles -- of which 1982 Castro Street-style promiscuity was one and heavy use of prostitutes was another. No, it was not until Western statisticians became aware of the widespread African phenomenon of people of both sexes having "multiple concurrent relationships" that they could make their models realistic. Obviously, this doesn't apply to every individual and it varies by culture within Africa, but the important point is that the probability distribution in Africa is shifted in that direction. Epstein's article is at: http://www.discover.com/issues/feb-04/features/why-aids-worse-in-africa/?page=3

Polygamy is one example of this African tendency. It's far more common in tropical Africa (and some other tropical cultures) than in more temperate zones, even where the religion and culture endorse it. That's because it's more affordable because much of the tropical agricultural work is hoeing, which women are at least as good at as men are. Further, the population density in much of Africa has traditionally been low (due primarily to the tropical disease burden -- see John Reader's "Africa: Biography of a Continent"), there hasn't generally been the need to work the land as intensively as elsewhere, so long hours from men aren't as necessary to feed the family as in, say, traditional China.

For an amusing anecdotal portrait in the LA Times of a Kenyan gentleman who has been married more than 100 times, see:
http://www.polygamyinfo.com/intnalmedia%20plyg%2014%20latimes.htm
The point is not that African men are "hypersexualized" as Abiola hyperventilates, but that one fairly average man can _afford_ as many wives as, in other parts of the world, only an emperor or sultan could afford.

Megahusbands in tropical Africa don't normally lock their wives up in the harem or employ expensive eunuch harem guards to ensure their fidelity. They send them out to work. Sometimes they are seduced by all the lonely bachelors left over, but since the straying wife can often provide enough food to feed the cuckoo's egg baby, the equatorial polygamist husband tends to be less outraged than in polygamist societies where the husband expects to support his wives and their children.

Thus, as I said, one cause of the rapid spread of AIDS in Africa is the lower degree of male jealousy.

If Abioloa is actually interested in learning as opposed to denouncing, Judge Posner's footnotes recommend the works of anthropologist Jack Goody.

[Paul Gowder]

I have but two comments, both minor but, I think, damaging to your central point:

1. You say: "To the extent that these methods of avoiding the disease are infeasible in certain poor countries because of intractable social and economic problems, providing money for costly AIDS �cocktails� is a band-aid solution which, as I have just suggested, may actually make matters worse by reducing the incentive to avoid contracting the disease in the first place."

Judge Posner, do you really believe that the availability of drugs for a disease that is still incurable -- drugs that merely lengthen the likely lifespan of the patient -- will provide an incentive to engage in risky sex? What thought process does this assume? "Hmm... I could have this unprotected sex with this untested partner. I might get aids, but I can always extend my life ten years by taking an antiretroviral!" I suggest that such a thought process, or its unarticulated equivalent, is so absurd and ridiculous that nobody would engage in it, and nobody would ever negatively modify their behavior as a consequence of the availiabity of the current crop of medications for aids.

2. Is it really all that cheap to distribute condoms? Note I say distribute, as opposed to make available. In many "third world" countries with widely dispersed rural populations, some with unique and insular tribal identities, some nomadic, it seems reasonable to expect that the cost of distributing any good through the population is fairly heavy. Foreign aid might well be necessary to establish that, non?

[Bill]

Sex Costs and Benefits:

RP says: "Unlike an air- or waterborne disease, HIV-AIDS is easily avoidable by an inexpensive change of behavior, namely using condoms in sex, or by a more costly but still feasible change, namely by avoiding promiscuous sex."

So, condoms are "costly" and avoiding promiscuous sex is "more costly but still feasible". Do these statements reveal information about Prof. Posner's own "possibility frontiers"? More likely they tell us what he thinks about the choices confronting Africans (or "everybody, in particular Africans").

But is it obvious that using a condom is less costly than avoiding promiscuous sex? Not to me. If I were really into having sex with one or a small group of people who I know are "clean", then I might be really put out if they made me use condoms but not at all bothered by being restricted to them.

I wouldn't make an argument that it is more costly to use condoms in general. But I do think the point is controversial and that there is hardly an "average man" to refer to. (I'm just considering men, for the moment.)

[Anonymous]

On the topic of possibly divergent American and African sex practices: Further inquiry has revealed a number of American women prefer "dry sex" ("that's one more reason its nice to smoke up before", etc.).

[Disclaimer: I do not smoke marajuana or use other illegal drugs. I am not promiscuous.]

This was a surprise to me.

[Alina]

Governments will never be able to control human sexual behavior. The most effective form of social control thus far has been that instantiated by the "holy sacrament" of marriage in Judeo-Christian religious institutions. By controlling the definition and role of marriage in human relations, religious institutions managed to limit sexual intercourse to monogamous pairs.

It's no wonder that governments decided to offer their own form of "marriage" via civil marriage. However, with the rise of no-fault divorce laws and the decreasing moral and legal relevance of "adultery", even the attempt to regulate or sanitize sexual relations through marriage can be deemed a failure.

Would offering free condoms to the poor decrease the incidence of STDs? In the lovely folly of my high school years, I certainly thought so, as I campaigned to install condom machines in the public restrooms. However, having friends who suffer from STDS has forced me to rethink my prior condom idealism.

Many men hate using condoms; and many women are only sleeping with a man in the hopes of pleasing him and thereby winning a longer-term version of his favor. The women who sleep with men for the purpose of pleasing the man (and not themselves, the "fakers", so to speak) are not likely to resist when a man says, "Aww, come on. You don't need that. I'm clean, I swear.."

In the oneupmanship of sexual courtships, there is little room for self-control or rational deliberation. Will men in Africa use condoms if we FedEx large free supplies to them? Tis doubtful. Today the view in some parts of Africa is that condoms CAUSE HIV; tommorow this view might morph into something like the unadulterated sexual irresponsibility of current American youth culture.

Maybe the best way to reduce incidence of STD infection would be to restrict prescrption of birth control to those in monogamous relationships. For everyone else, condoms would be the only choice. (Many girls take birth control and then don't use condoms because they believe the worst thing that could happen to them would be pregnancy. They don't believe that the truly lamentable would be infection with a lifelong disease that could prevent them from having children and seriously restrict their sexual lives.)

I agree with Abiola that "dry sex" theories are frankly uninteresting and incapable of withstanding any rigorous analysis. As long as males are awarded social prestige for their ability to sleep with a large number of women, they will continue to make this, and the accompanying m.o. of recklessness, their secret ambition.

[Oikopolis]

This is a fine discussion of population and policy, and would be appropriate if the assumptions behind CO2/global warming and HIV/AIDS could be so readily accepted. It's disconcerting to see two individuals who care so deeply about resource allocation accept pipular dogma so readily.

First, the Shi article correlates population growth and CO2 emissions...not pop g and global warming. Our understanding of global warming is far too incomplete to identify its causes, predict its effects, or conclude that CO2 is its primary cause. Thus any current allocation of resources to CO2 diminishment is likely to be far from optimal.

Second, HIV and AIDS are two completely different things, one a retrovirus, the other a multifactorial symptom complex, and they do not always coincide (the disease class 'AIDS' was created to separate those cases of severe immune dysfunction where HIV infection was detected, from the many cases where HIV is absent). HIV may not even be a "new" retrovirus. If "jump" theories are correct, it's still uncertain when the jump occurred, and the possible window could be 70,000 years wide. Like CO2 emissions, creating incentives to reduce HIV infection given our current understanding of AIDS would produce a suboptimal allocation of resources.

For now, the focus in developing nations should be on dismantling confiscatory tax systems, improving faulty monetary regimes, and fostering private resource ownership. Good things happen when you get the fundamentals right.

[Igor Taam]

You said:
"All the problems that foreign aid seeks to alleviate are within the power of the recipient countries to solve if they adopt sensible policies. If they do not adopt such policies, then foreign aid is likely to be stolen by the ruling elite, strengthening its hold over the country, or otherwise squandered."
I have to agree with you because I live in Brazil (where corruption has spread). Take the money from the poor americans and give to the rich politics of the Third World doesn't solve anything. But I believe there are other ways to help the development of these countries; in the spirit of charity you can export ideas, studies, thoughts, intellectual instruments... I believe (at least in Brazilian case) people must be introduced to all that.

[Anonymous]

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[Anonymous]

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