In the first official admission that the universal prevention strategy promoted by the major Aids organizations may have been misdirected, Kevin de Cock, the head of the WHO's department of HIV/Aids said there will be no generalized epidemic of Aids in the heterosexual population outside Africa.This is, to be sure, not good news for homosexuals or Africans; but it is, that sad fact notwithstanding, well past time the epidemiological realities of HIV/Aids risk were acknowledged. Just in case there is an outbreak of candor going on among public officials (yes, I know), perhaps someone could say the same thing about resources misspent through the generalized screening for possible terrorist suspects to avoid profiling.
This is a delicate topic. When the “pink disease” was first detected among a handful of homosexual men in Los Angeles in the early 1980s, this originally named Gay Related Immune Deficiency began to attract serious general public attention in the U.S. only after cases of heterosexuals contracting the disease (e.g., female sexual partners of AIDS patients and blood transfusion recipients) were documented. I speak here purely anecdotally, but my impression in the early to mid 1980s was that the U.S. shifted rapidly from a state of almost complete indifference over the plight of homosexuals and IV drug users to a state of panic over their own risk.
Of course, the medical community was mostly ignorant of the nature of HIV/Aids, itself, in the 1980s. But a decade later we had a much better understanding of the retrovirus and, thankfully, much better available treatments. Most relevant here, however, we also had ample epidemiological evidence leading to an almost overwhelmingly obvious conclusion: white, heterosexual male, non-IV drug users -- in other words, the demographic group who wielded the most power in the U.S. and, indeed, in the world – faced just about the smallest real risk of contracting HIV/Aids possible.
Counter-factual arguments being what they are, there is no way of telling whether public support and, more to the point, public funding for HIV/Aids research would have been nearly as extensive in the past quarter century if the general public had known that claims of the universal risk of contracting HIV/Aids were, although true, highly misleading.
Certainly, however, it is at least not unreasonable to suspect that support and funding would not have been as extensive, and perhaps not nearly as extensive, which raises the following interesting ethical question: Is misinforming or misleading the public ever ethically justified on grounds of public health and safety?
By way of addressing this issue somewhat obliquely, let’s ignore for now concerns about giving undeserved ammunition to homophobes and drug warriors whose worldview continues to include the belief that HIV/Aids is God’s punishment for being gay or using drugs. (In passing, I have yet to hear from those who hold that view how it is that God is so piss-poor at punishing junkies and queers that all He can manage to do is put them in a higher risk category?!?) Let’s consider Africa, instead.
A month or so ago, the Onion ran an almost throw away one-liner in the crawl below one of their Onion News Network videos. It read:
ABC cancels new reality show Who Wants To Save Africa? after second episode.Indeed. (And, yeah, it’s so painfully true that it is funny.)
Of course, you’d be hard pressed to come up with ways in which sub-Saharan Africa isn’t a basket case, and even if you could magically eliminate HIV/Aids from the continent, Africa’s public health record would still be abysmal. But, no doubt about it, HIV/Aids has been epidemic in Africa’s general population to an extent unlike everywhere else. Why?
Dr. de Cock (I know, I know!) says:
It is the question we are asked most often – why is the situation so bad in sub-Saharan Africa? It is a combination of factors – more commercial sex workers, more ulcerative sexually transmitted diseases, a young population and concurrent sexual partnerships.
Sexual behavior is obviously important but it doesn't seem to explain [all] the differences between populations. Even if the total number of sexual partners [in sub-Saharan Africa] is no greater than in the UK, there seems to be a higher frequency of overlapping sexual partnerships creating sexual networks that, from an epidemiological point of view, are more efficient at spreading infection.
Which is to say that there are not only political and economic differences but also social differences in much of African culture which make the spread of HIV/Aids that much more intractable.
Here is the reality, though. As terrible as HIV/Aids is, it is only one of the terrible ways people die needlessly in Africa or, for that matter, around the world. As reason’s Ronald Bailey recently wrote in a report on the 2008 Copenhagen Consensus Conference, “[T]he number 1 priority identified by the experts in the 2004 Copenhagen Consensus was combating HIV/AIDS. That dropped to number 19 in the 2008 ranking."
Ceteris paribus, the same must be said of the U.S., as well.
There are, to be sure, all sorts of objections that can be raised in good faith to that perspective. I wouldn’t be a bit surprised if the medical research focusing on a cure for HIV/Aids didn’t yield important findings for other diseases and disorders. I suspect that the rise of HIV/Aids in the U.S. actually contributed positively to the struggle for gay civil and human rights, ironically enough. Whether disingenuous or not, suggesting that the entire population was similarly at risk for HIV/Aids diminished the stigma unfairly attached to those who, for whatever reason, contracted it. These are certainly collateral benefits to the emphasis in HIV/Aids research and public health policy in the past twenty-five or so years.
But every benefit has a cost, and every tradeoff is susceptible to the reasonable question, was that a good deal? Put differently, only progressives – and not very bright progressives, at that – whine at this point “Well, it shouldn’t be a case of ‘Either / Or.’ We should be able to support HIV/Aids research and treatment and address all those other health and safety problems, too. You’re arguing a false dilemma.”
It may be a false “dilemma,” but it is a very real tradeoff. A dollar spent on X is necessarily not a dollar spent on Y.
So, too, with our most recent insanity, the War On
Yes, there’s a real and vitally important difference between describing someone who has actually committed a crime and targeting people simply because there is a statistically significant correlation between their demographic characteristics and the commission of a potential crime. (And, yes, police engage in the sort of racial profiling that no court can prohibit because, for better or worse, it’s the same sort Jesse Jackson and Chris Rock engage in. And, yes, it’s a bad thing and one of the reasons why, comparatively speaking, being black in America still sucks.)
And there’s “always the possibility,” the ever incompetently vigilant TSA will tell you, that Osama Bin Laden could recruit some Prairie Home Companion grandmother to pack some C-4 up her, well, you know to blow up that puddle jumper from Omaha to Ft. Worth, too. Absolutely true. Here are some other possible occurrences: invasion by space aliens, commercially viable cold fusion energy using ordinary household products, George W. Bush winning the Nobel Peace Prize, my wife finally unpacking and sorting the stuff in the garage (Ouch! Sorry, dear!), a Pauly Shore movie not sucking, and, well, you get the picture.
Exaggerating the risk from or to Group A while discounting the risk from or to Group B always has attendant costs, costs that could otherwise be used to address some of those other perhaps even more important health and safety issues. In some cases, those attendant costs have been unconsciously, obscenely high.
So I return to the original question. Is misinforming or misleading the public ever ethically justified on grounds of public health and safety? When public support for a policy objective, any policy objective depends on deliberately misinforming the public, part of the non-economic attendant costs of that lie must surely be harm to the very core of popular sovereignty.
It remains to be seen whether we will abandon the rewards and risks of genuine popular sovereignty for the promise of health, safety and happiness from our paternalistic nannies. Reality is always a mixed bag, but many recent trends suggest we are well down the road toward making a very bad tradeoff.
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