White Coat Underground

World AIDS Day—the good, the bad, and the horrific

Posted by PalMD on December 1, 2009
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Today, the 21st annual World AIDS day, comes at a time when AIDS has become an everyday fact of life. Conservative estimates have over 33 million people living with HIV world-wide with an adult prevalence of 0.8%. This is a common disease, but its distribution is unequal. Due in part to economic, cultural, political, and genetic differences, Sub-Saharan African has been hit particularly hard, although comparisons can be difficult. It is widely believed that some large countries, including China and Russia, significantly under-report HIV disease.

Coming to terms with HIV has been hard for the global community. Lack of resources drives some nations to deny the problem, while hate drives patients underground. In the US, the stigma of HIV disease has decreased (yes, it really has). In South Africa, where the former president was an HIV denialist, the new president has announced sweeping new HIV initiatives.  

In Uganda, pending legislation will criminalize homosexuality and make homosexual contact among the HIV-infected a capital offense. They have not proposed similar legislation for heterosexuals who make up the majority of African HIV cases. (Of note, American evangelicals have tossed Ugandans under the bus on this one.  They can interfere with foreign affairs for fetuses, but not for living people who might have “the gay”).

The scientific progress on HIV has been remarkable.  A vaccine may or may not be in the future, but treatment has become very successful.  Prevention has not been as good.  Puritanical regimes both here in North American and overseas have blocked effective prevention programs.  It’s hard to over-estimate potential American influence here.  We provide an enormous amount of foreign aid to fight HIV. If we were to make real prevention a priority and free recipients from ridiculous abstinence-focused policies, this could have a real, tangible impact both at home and abroad.  

Nearly thirty years ago, doctors began noticing clusters of an unusual pneumonia in gay men in Los Angeles.  Since that time, HIV has rapidly become one of the world’s most important diseases both socially, medically, and scientifically.  This is unlikely to change, but it can be mitigated with compassionate, science-based policies.

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  1. #1 James Sweet
    December 1, 2009

    There was a recent UK debate series that Christopher Hitchens and a bunch of other folks debating the question, “Is the Catholic church a force for good in the world?” Being a bit of an anti-theist, I would tend to answer in the negative, but given all of the charity work the Vatican finances, I could see it being an interesting question… were it not for the Vatican’s stance on condom use in Africa. I don’t think it would be too hyperbolic to suggest the Catholic church bears at least partial responsibility for hundreds of thousands of deaths over the past decade. Takes a helluva lot of charity to make up for that one….

  2. #2 catgirl
    December 1, 2009

    It’s so frustrating when sex-shaming gets so mixed in with a terrible disease. I wish that certain groups would care more about saving lives than punishing those they deem sinners. It just seems so backwards.

  3. #3 Donna B.
    December 2, 2009

    I have an unhealthy love/hate relationship with the Catholic Church. I admire wholeheartedly some of the charity work they do — Holy Angels in Shreveport is one — and yet, I cringe when I see the signs in the local Catholic hospital saying they do not participate in the Medicaid program. (I wonder why, but I’ve never asked.)

    There’s a huge difference in attitude between the employees of the Catholic hospital and the other major hospitals in town. Individual employees are friendlier, more personally caring, and are very happy employees. It’s obvious they love their jobs. Yet, the system is disorganized, the equipment lower end in some cases (ER cots, for example.)

    The other major hospital “chain” in town is completely computerized, well-organized, but seems to try to squeeze every last bit of caring out of each staff member without refilling it. This hospital utilizes staffing agencies for nurses and the lack of attachment or loyalty or whatever quality is frequently notable.

    (The other hospital in town is LSUMC, which I hope I never have to use, as my only reason for doing so would mean I was severely injured and needed their trauma expertise, or ill with rare or obscure disease, or destitute. This charity hospital provides free (or fee based on income) services to any Louisiana resident.)

    Back OT, sort of. I cannot understand why the Catholic Church places more value on a life not yet conceived than it does on one already existing. The Church’s stance on birth control is untenable. This is especially true where condom use is concerned. To not realize, or not care, that the use of condoms protects existing lives is willful blindness to human suffering.

  4. #4 Igor
    December 2, 2009

    “I cannot understand why the Catholic Church places more value on a life not yet conceived than it does on one already existing.”

    I’m sure you understand perfectly well Donna. It is because the majority of its policies are completely arbitrary and based on the Church’s current interpretation of the scripture. When the majority of an organization’s policies are based on fantasy it is hard to be morally consistent.

  5. #5 James Sweet
    December 2, 2009

    There’s a huge difference in attitude between the employees of the Catholic hospital and the other major hospitals in town. Individual employees are friendlier, more personally caring, and are very happy employees. It’s obvious they love their jobs

    I always wonder how much of this sort of thing is because of the religion aspect, and how much of it is that the people who are naturally inclined to caring and friendliness tend to be drawn to the largest charity organizations (regardless of their shadowy bigoted leadership). It’s a really important question, because if it’s the former then the focus should be on either reforming existing religious institutions, or replacing them with a more naturally benign dogma; while if it’s the latter then the priority should be on cultivating large secular charities, leaving dogmatic religion as something solely for eccentric kooks. I think the answer is far from clear…

  6. #6 Calli Arcale
    December 2, 2009

    I don’t think the Catholic Church actually does place more value on lives not yet conceived than on lives already living. The problem is that many in the hierarchy are so fixated on teaching people to be more “moral” that they fail to see the logical outcome of their actions. This is compounded by a tendency (not unique to Catholics, nor even to religious folks in general) to feel that if someone does something naughty and gets sick or hurt, it’s kind of their fault. This leads to two places: seeing the consequences as just, and feeling that since the person could’ve avoided the consequences by not being naughty, there is no responsibility for giving them another way of avoiding the consequences.

    So it’s not that the Catholic Church explicitly places more value on potential babies than they do on people already living who might be exposed to HIV. After all, they already feel that people who have HIV are committing a terrible sin if they give it to someone else (“thou shalt not kill”, after all). They just feel that proper way to avoid passing HIV is to abstain.

    Note: it is worth mentioning that this view is not universal within the Catholic Church. Some bishops have even expressed the view that using condoms is acceptable as a means of preventing disease transmission, although it would be better to abstain entirely. While still a bit backward, IMHO, this is a step in the right direction. Unfortunately, I have little confidence that this new pope will build on that.

  7. #7 James Sweet
    December 2, 2009

    This is compounded by a tendency (not unique to Catholics, nor even to religious folks in general) to feel that if someone does something naughty and gets sick or hurt, it’s kind of their fault.

    Indeed, I’ve seen this problem manifested in everyone from the most devout to the most atheistic, and all other manner of personality types too.

    A related issue is to conflate justice on a personal level with a big-picture societal view of the issues. Let’s say just for the sake of argument we accept that someone who has unprotected sex outside of marriage does deserve to die a horrible death from HIV. (I would never take such a position, but this is a mental exercise) But what about their spouse who might become infected? Their children? What about the other “adulterers” this person spreads it to, who can then infect their spouse and/or children?

    Even if we have refuse to have pity on an individual who contracts HIV due to sexual promiscuity, the societal issue of hundreds of thousands of preventable deaths remains, and a refusal to address that is just plain wrong. Forest from the trees, as it were.

  8. #8 James Sweet
    December 2, 2009

    Perhaps a better example of what I am talking about can be found in the current banking crisis. On an individual level, I think about a hypothetical banking executive who put his or her short-term financial gain ahead of sound long-term policy, and thereby helped drive the economy into the ground… and I want to kick said CEO in the nads.

    But this righteous anger does absolutely nothing to solve the societal problem of perverse incentives. We must assume there will always be talented, yet either short-sighted or unscrupulous, executives willing to grab the maximum quarterly profit at the cost of long-term solvency. Rather than simply trying to punish those executives and getting all indignant about some undeserved bonuses that, as galling as they are, only represent an insignificant fraction of a percent of the amount of money being thrown around, instead we need to try and craft legislation that incentivizes long-term solvency.

    Individuals may or may not deserve what they get, but when looking at society collectively, we can’t afford to be bogged down by a slavish adherence to ideals of justice.

  9. #9 PalMD
    December 2, 2009

    Viz the Catholic Church, I’d argue that the US’s puritan-driven policies are much more harmful, given our influence.

  10. #10 Calli Arcale
    December 2, 2009

    That is very well put, James.

    Not to digress too much, but I personally think that was one of the things Jesus was trying to do — break us out of that judgmental attitude. Law was so heavily focused on justice, particularly retaliatory justice, that it was preventing society from moving forward in a meaningful way. Productive members of society were marginalized because of a perception that they had done something bad, and nobody wanted to look as if they approved of what those people had done. It would have been like disagreeing with God.

    Ironic, then, that we Christians today do the same thing, happily judging and even rejecting people over it. We think they deserve their fates, and so will not rescue them from them.

    Lately, I’ve been very depressed, watching the response to the ELCA’s decision to allow churches to call homosexual pastors if desired. It very much highlights this sort of attitude.

  11. #11 PalMD
    December 2, 2009

    Of course, Jesus is made in man’s image. Over at Conservapedia, evangelicals argue that the Parable of the Adulteress is really a later liberal edition to the Bible and Jesus woulda stoned the bitch.

  12. #12 Calli Arcale
    December 3, 2009

    Conservapedia argues a lot of things. I wouldn’t put a lot of store by what they say; they’re pretty far out there compared to most Christians. (What worries me is that not a lot of Christians know that; Conservapedia may wind up being to Christianity as Age of Autism is to autism-awareness, and able to do quite a bit of damage until the majority figures out how whacked out they really are. The sort-of-good news is that religions tend to change very slowly, and a volatile medium such as theirs may not have much lasting significance.)

    About which does more harm, US government policies driven by Puritanical politicians, or the Catholic Church’s anti-condom stance…. That’s hard to quantify. It might be a toss up. In some areas, our government has definitely done more damage. In others, the strong influence Catholicism has over the leadership and the hearts and minds of the populations of some countries does more harm. On balance, I think I’d say the Catholic Church is probably ahead of us in South America, but we’re ahead of them in Africa, in terms of how many have died through due to moralizing driving policy decisions. Hard to say, and depends on what all gets included.

    It’s one of the reasons I passionately support a separation of church and state, and why the “faith-based initiatives” pissed me off so much, despite being a Christian myself.