\jeff{krimmel}

I saw also that 1 in 3 10 year olds is having sex in South Africa. It can be read here.

This brings up the age old question, what’s the best part about having sex with 28 years olds? There’s 20 of them. Hilarious. Sorry, total inappropriate I know but it just popped into my head and there was nothing I could do.

By Griztown on Jul 12, 2005 at 3:02 pm

“This problem needs to get solved, quickly.”

If you mean “get solved” in the sense that we need to ramp up (dramatically) production of AIDS treatments, then the issue becomes one of scale. I really doubt that we can provide the complex drug cocktails to 6.5 million people without tens or hundreds of billions of dollars in government subsidies. Then there is the issue of administering those treatments. We would need to bolster the African hospital systems, which would take lots of people and lots more money. I just don’t see the problem getting solved quickly in this way.

Now, if by “get solved” you mean, come up with a cure that can be administered cheaply and quickly, I’d say were still at least a few years away from something like that. People are working very hard on the problem right now, but unfortunately science doesn’t work that way. You should know this. You can’t say “we need a cure”, toss scientists at the problem, and expect to get results. Science generally cannot be controlled in that way. There have been some breakthroughs recently in fighting off the HIV virus, but it takes time to take something that works in a petri dish and turn it into something that works in a living human being. I recently saw a comment about this: If you want to kill off HIV in a petri dish, there are lots of things you can do, like run over it with a car, but when you scale it up to the human level, running people over with your car doesn’t really get you anywhere. So, as much as we might want a cure, or need a cure, I’d say we’re doing about as much as we can do right now.

By Adam on Jul 12, 2005 at 3:02 pm

Griz actually points out the most effective solution (without saying it outright). The most effective way of stopping the spread of AIDS in Africa (and elsewhere) is getting the African people to either abstain from sex or to have safe sex (either by using condoms or by having regular testing for HIV, although such tests don’t always work). Unfortunately, this is something that the people have to do for themselves, meaning both the government providing proper education and the people in curbing their urges. Neither is likely. Which is a shame, because it’s pretty much a surefire way to virtually eliminate the problem in the span of a decade.

By Adam on Jul 12, 2005 at 3:08 pm

I remember reading somewhere that several governments had been approached about trying to educate people about safe sex and so forth and that the agencies trying to help out were firmly rebuffed. Yes, we have plenty of money and manpower that we can send to help educate the people on how to avoid HIV/AIDS, but unless the governments are willing to accept such a solution, there’s only so much we can do.

This was a few years ago, if I recall. Perhaps things are different now. But had the governments been willing to allow this kind of help, then my guess is that the number of people infected would be a fraction of what it is now.

By Adam on Jul 12, 2005 at 3:29 pm

I could be totally wrong. I think some NGO have been estimating 1 in 4 to 1 in 5 people in the southern part of Africa have HIV/AIDS. (there are countries much worse than S. Africa) In fact, in some countries, the percentage is levelling off because HIV/AIDS has pretty gotten everyone who is sexually active. I think the biggest problem in Africa is the historical and sociologically background of those places. I mean, education can help. But, some women are extremely vunlerable. They are in no position to ask their husbands to use a condom, while it is a common practice for men to be sleeping around (in fact, I learn the word “promiscuous” when I was researching for a paper in college). Is it going to change through education? Probably. Is it going to be fast enough for it to be active. The success rate could be doubtful. Also, many countries in Africa simply cannot afford the medication that can slow down the epidemic (like administrating a one-time drug to delivering mothers right before they go into labor). Only 6 people in Malawi can afford the medicines. Guess how many people have HIV/AIDS. one million…

By UALboy on Jul 13, 2005 at 2:55 am

But… yes… S. Africa is definitely much richer than other nations in Africa. The next question is… how are they going to get people tested? How are they going to get the drugs and knowledge into remote areas of the country. I could be wrong, but I was under the perception that the division between the rich and porr is quite obvious. I definitely remember seeing my first real slump when I was landing into the Cape Town airport. It was sooo poorly constructed that it scared me. Also, didn’t the South African government not give the proper attention to the whole HIV/AIDS thing until pretty recently. I could be getting it confused with Mugabe who is just insane. If I am right about this, S. Africa is probably playing a lot of catching up but they are probably the first one who is turning around in this HIV/AIDS thing.

By UALboy on Jul 13, 2005 at 3:03 am

Bert, I think you’re right. I think the President of South Africa tried to say that you could link HIV to AIDS or something like that. So yeah, a lot of countries in Southern Africa have really had their heads in the sand.

By Griztown on Jul 13, 2005 at 8:18 am

Something you have all missed to this point is that the cost of medicines is unnecessarily high, and that is something that can be directly controlled by the United States. It is primarily US patent holders (big pharma) that have prevented the dissemination of cheap aids drugs. The US government has done much of the dirty work in protecting those patents. A few years ago the UN via the WHO passed a resolution that stated developing countries could bypass intellectual property rights in situations of national health crisis. Guess who the only country that didn’t back the resolution was? You got it, the US. Furthermore, the US consistently puts pressure on developing countries to respect US pharmaceutical patent rights by building provisions into unilateral trade agreements. So, even if it is permitted under international law, countries are forced to pay exorbitant amounts for drugs so that the can maintain “most favored nation” trade status with the US. When I say exorbitant, I mean it. The generic AIDs cocktail can be manufactured for a couple of hundred dollars per year per patient. However, the drug companies charge up to $16,000. Now, granted, the amount charged varies widely, but the prices have only come down as international pressure has mounted. One of the best success stories against AIDs is Brazil. They have more than halved the amount of new HIV/AIDs cases and dramatically increased the lifespan of those that carry the disease. How did they do it? They credibly threatened to produce the drugs themselves if they couldn’t secure massive discounts on the drugs. Then, the government gave the drugs away for free and gave condoms away as well. Instead of applauding their success, the US had brought charges against Brazil with the WTO for violating trade laws.

By Bobby on Jul 13, 2005 at 9:28 am

Correction: It was the WTO in an amendment to the TRIPs agreement that allowed developing countries to ignore patent rights in cases of national health emergincies.

For great stats on HIV/AIDs, a good source is
here.

By Bobby on Jul 13, 2005 at 10:45 am

The above link is broken, try this.

By Bobby on Jul 13, 2005 at 10:48 am

I’m not arguing for the abolition of pharmaceutical patents, but more what you said about following the exceptions of the TRIPS agreement. I think when an impoverished country faces an epidemic that can only be solved by cheap drugs (along with other measures), the right of those governments outweighs the intellectual property rights of the pharmaceutical companies.

When I say price are artificially high, I mean the pharmaceutical companies price the drugs according to monopolistic microeconomic principals. A patent is really just another way of saying that a particular person or entity has a monopoly on the sale and production of something. In a perfect free market, marginal cost determines the price of a good. So, if it costs you $10 to manufacture something (including all overhead), the price will be $10. If you price it at $11, a competitor will get all of the business by pricing it at $10. In a monopoly, the price is determined by maximizing profit. So they restrict supply and sell to fewer people at a higher price. This means people that could have afforded the drugs in a competitive market no longer have access to the drugs. This is also why you see different prices in different countries. If a pharmaceutical company thinks they can get $100 per pill in South Africa, but $500 per pill in Egypt, you can be damn sure they will price accordingly. That’s one of the reason’s we pay such high prices in this country; we can afford to (or our insurance can).

So the only way to make these drugs cheaper is to allow others to produce them, either the countries themselves or somewhere like India. That way, if the drugs cost $300 per patient per year to produce, that’s what the countries will pay (by the way, that is about what Brazil pays if I remember correctly). Don’t get me wrong; it doesn’t solve the problem of administration, education, cultural barriers, intentional infections (rape as punishment), corrupt governments, or any other potential contributors to the problem. But it is something we, as the US, can do to actually help.

And the honeymoon was fantastic.

By Bobby on Jul 13, 2005 at 11:59 am

As an aside, although South Africa is richer than many African nations as a whole, inequality still persists. According to this (p.52), the poorest 20% of the population only has 2% of the wealth. And their gini coefficient, which measures inequality, is .593. This number is between 0 and 1 and as a basis for comparison, the best is Hungary at .24 and the worst is Namibia at .707. Interestingly, the US is at .408, which is much higher than most other industrialized nations. For more on the gini coefficient go here.

By Bobby on Jul 13, 2005 at 1:39 pm

This is a fantastic thread! Now you’ve got me wanting to write some longer things, but I’ll leave that for later and say a few quick things:

1) Education and abstinence: Yes, the only way to permanently get rid of AIDS is to stop it spreading. For this people need to change their ways. Problem is, there’s nowhere in the world that has “solved” the promiscuity problem. South Africa (of which I know the most) has tried hard — anywhere you go in the country, there are huge AIDS billboards, leaflets, information centres, and so forth. Government provided condoms are available all over the place. I’m sure it’s helping, but can one immediately stop new infection? I don’t think so — even the USA is seeing rising rates of new infection. And of course the US population is far better educated than large segments of Southern Africa.

But there’s a more important point. Saying that education and behaviour change is the answer also means that you’re consigning 1 in 7 South Africans to death within perhaps a decade — and the people are young parents, students starting careers, etc., exactly the worst people for a country to lose. It’s more than died in the Holocaust, in South Africa alone. AIDS could have been stopped perhaps a decade ago as a threat, but through the world’s inaction, we HAVE to treat those infected today. (Incidentally, India is at about the point we were about a decade ago, but instead of changing history, there’s again very little in the way of resources going to education and prevention there).

2. Treatment: The drugs available now prolong people’s life essentially indefinitely, and allow them to rejoin the labour force. The lowered virus levels also make the person far, far less infectious. They also save the health system vast sums in not having to treat dying people — which is eating up ever larger amounts of the health budget.

The South African government, after many years of ignoring the problem, are currently rolling out a plan to provide free AIDS drugs to everyone in the country. Some tens of thousands are on the programme already. It’s expensive and really hard, but is (just) affordable. The problem is how long it takes to set the systems up, because you can’t just give out drugs — you need careful monitoring to ensure they’re working, to work around the bad side-effects all the drugs have, and to ensure that the drugs are taken properly so that resistant strains of HIV don’t evolve.

Of course, money and help from overseas would speed things up greatly — and and is surely a good investment. A disaster of this magnitude, if unchecked, will destroy much of the country. For generations, since there are now many more orphans than the existing systems can handle, and many aren’t getting an education.

3. TRIPS and patents: Global patent law allows for governments to apply “compulsory licensing” of drugs in the case of emergencies. This allows them to manufacture the drugs, for strictly local distribution, without paying license fees to the patent holder. The US, for example, could use this in the event of a bio-terror attack. Brazil has used this approach; South Africa was able to convince drug companies to provide drugs at cost price by threatening compulsory licensing. This has cut the cost of the drugs by orders of magnitude. However, as Bobby says, the US has indeed been arguing that the AIDS crisis is not in fact a crisis, and has been using leverage from all sorts of other trade deals to prevent other countries from following Brazil’s example, and fighting it at the WTO.

By paul.za on Jul 13, 2005 at 4:02 pm

Bobby, the problem with allowing for a competitor to come in and start producing a drug that you’ve developed is this: Drug Company A spends $XXX Million on developing a Drug X, and needs to have a certain price per dose in order to recoup the money spent on the R&D in addition to production costs. If you have no patent to prevent Drug Company B from coming along and producing Drug X, then DrugCo B can afford to produce the drug for much less, and thus sell it for less, because they didn’t have $XXX Million in development costs.

Thus patents encourage pharmaceutical companies to develop new drugs, because they will be able to recoup R&D costs (and yes, also marketing costs) and hold a monopoly for a period of time. Without patents, there would be huge incentive to wait for someone to develop a drug and then pounce on it and start selling it for cheap. So, in general, I’ve got to side with the pharmaceutical companies (and the US) in wanting to protect patents.

With that said, HIV/AIDS is a special case, and I think that the drug companies should do things differently. Here’s what I think should happen:

In exchange for dropping the price for AIDS drugs as low as it can go, the pharma companies involved are subsidized for their R&D by the world governments (not just the US). Or perhaps they get a big tax break for the next XX years. Something like that to compensate them for dropping prices. If the companies can meet demand, do not introduce a competitor. If the companies can’t produce drugs quickly enough, individual governments can set up production facilities if they help to chip in with subsidizing the drug companies.

I’m sure there are plenty of holes that you can poke at here, but I think that doing away with drug patents completely is a bad idea, both in this case and in general.

By Adam on Jul 13, 2005 at 4:06 pm

Oh, and a thought on US offers to help with education: it’s a great tragedy that a few years ago USAID, the main channel for US aid, was forced to cut all funding and assistance to non-governmental organisations in Africa which mentioned abortion during any of their family planning programs. This has meant large parts of Africa haven’t been getting the condoms that were once supplied by USAID, as they’ve refused to agree to abide by US requirements not to mention abortion.

A lot of recent funding from the US Congress also requires that the money be spent on “abstinence only” education — which doesn’t provide condoms, even though combined approaches seem to be a lot more effective.

It’s often the case that offers of assistance have strings attached. It’s a pity when domestic issues in donor countries have such a negative effect on the effectiveness of the aid.

Which is not to say that African governments have NOT been at fault — they certainly have. But good, solid economics proves that effective anti-AIDS work is not just a good idea, but that it gives better return on investment than about anything else.

By paul.za on Jul 13, 2005 at 4:22 pm

[devil’s advocate]
So, to those who have no qualms about abortion and don’t have issues with sex outside of wedlock, such practices (cutting funding for mentioning abortion, not providing condoms, etc.), seem absurd. However, to those who consider things like abortion and sex outside of wedlock to be wrong, bad, or outright sinful, then attaching strings to foreign aid like this is not just a good idea, it is essential.

The control that we have over where our tax money goes is exerted through voting, and as it stands right now, our elected officials tend to support abstinance and not support abortion. If you don’t like it, then you can either vote for politicians with different views and hope that other people do so as well, or you can make donations to private aid organizations that don’t attach strings like this to their programs.

But the main point I want to make clear is that things that you might be completely okay with, others might find completely and utterly reprihensible. Knowing that their tax money has gone to support abortions and promote safe sex instead of abstinance is, for some people, tantamount to committing such a sin yourself. While others might think such a thing is silly or stupid, that doesn’t change the fact that there are people that hold these viewpoints. And silly as they may be, they are just as entitled to their views as everyone else.
[/devil’s advocate]

By Adam on Jul 13, 2005 at 11:28 pm

However, to those who consider things like abortion and sex outside of wedlock to be wrong, bad, or outright sinful, then attaching strings to foreign aid like this is not just a good idea, it is essential.

This looks like another example of why mixing religion with politics and/or science is a Bad Idea.

By Dixie on Jul 14, 2005 at 8:20 am

In response to Adam’s assertion that profits are necessary to ensure new drug development:

I agree, but only to an extent. As we have both stated, HIV/AIDs is a special case. I tend to agree with Article 7 of the TRIPS agreement:

“The protection and enforcement of intellectual property rights should contribute to the promotion of technological innovation and to the transfer and dissemination of technology, to the mutual advantage of producers and users of technological knowledge and in a manner conducive to social and economic welfare, and to a balance of rights and obligations”

The key for me is the last part, about balancing our rights and obligations against the intellectual property rights of the producers. I think AIDs is a case where the right of a country to save its people outweighs the monetary concerns of the pharmaceutical industry.

Now, with that said, the idea that large profits are necessary for R&D are ill founded. Here are a couple of reasons:

1. Profits are extremely high - Over the last 3 years the ten largest producers of prescription drugs worldwide have had an average net profit margin of 18.4% on average annual sales of $255 billion. As a basis of comparison, in 2002, when net profit margins in the drug industry were 19%, while the average net profit margin for all S&P 500 companies was 7.5%. Keep in mind this is profit, meaning above R&D costs.
2. Large profits are not necessary for high levels of R&D - While this flies directly in the face of the industry’s claim, it is empirically proven by other sectors of the economy. As an example, high levels of R&D with much lower profit margin levels have always characterized the semiconductor industry. For the period from 2001-2003, Intel, exceeded the annual R&D expenditures of the comparably sized GlaxoSmithKline by an average of over $567 million dollars. Additionally, Research and development is an area unlikely to be subject to cost cuts, since its products and discoveries are essential to the future and direction of companies.
3. Private Industry has never spent large amounts of money on developing world diseases. Most new R&D is for drugs that can be marketed in developed countries, because that’s where the money is. So, instead of malaria and HIV medicines, you get a slew of cholesterol lowering and erectile dysfunction drugs. So, government spending is necessary no matter what to subsidize research costs for these medicines.

Another thing to keep in mind: With AIDs and other diseases that plague the developing world we already have drugs. While there may be a potential to improve them, if we only made the drugs already discovered cheaply available, it would save millions of lives.

As for the devil’s advocate “don’t vote for politicians that don’t agree with you, this is a democracy and the people want it post”, see this. Most people don’t believe in abstinence only education and didn’t elect our officials to promote it. Regardless, I agree that everyone is entitled to his or her view, but we simply don’t have to listen to irrational ones.

By Bobby on Jul 14, 2005 at 9:31 am

Adam, aka Devil’s Advocate, you make a point that, to my vast frustration, is probably true in the world’s current formulation of democracy. On the one hand, a small group of American lobbyists is essentially dictating religious practice to people in another country, at pain of death; but on the other it is US taxpayers’ money.

Idealistically speaking, I’d like to see two areas where what I see as the principles of democracy and human rights lead to the rewriting of some of the current practices of (US) democracy:
1) Freedom of religion / religious practice: while this seems to be under threat in the US as well, I would say that one should be able to argue that enforcing a particular moral stance on anyone, never mind on a group of people that don’t even have a vote (ie. foreigners) is wrong.
2) Relaxation of nationalist tendencies, and the extension of the human rights granted within a country, to all people. Over the last centuries government has changed to recognise the obligation that it has to serving its own citizens; I think the next step is to recognise an obligation to people everywhere. This will necessarily entail a change in the nation-state system as currently used.

More practically, irrespective of one’s opinions on abortion, I’d love to see some pragmatism amongst the lobbyists: for the sake of a few thousand abortions, hundreds of thousands more (at least) will die, and their families will be smashed. Admittedly, the former is something that is done, while the latter results from a lack of action, but my Christian faith cannot count a sin of omission as somehow less sinful than a sin of commission. Indeed, Jesus “worked” on the Sabbath to heal the sick (hey, it’s a loose analogy, but it’s the best I’ve got right now :)).

(As an aside: I think volumes could be written on the huge failings of governments and countries everywhere, and particularly in Africa, which let AIDS get to where it is today. The US is in the mixed position of being able, in principle, to make the largest single difference across the world to almost any problem, so gets the most scrutiny. It’s also what most other commentors know the most about, I suppose. So I’m not just trying to pick on the US)

By paul.za on Jul 14, 2005 at 5:39 pm

So, here’s the thing Paul, there are times when protecting one group’s religious beliefs can mean infringing on another group’s. The US Government is in the awkward position of needing to appease fundamentalist (and other) Christians, while still providing aid. (And I don’t consider restricting *aid* based on moral issues to be quite the same as imposing the moral issues directly on the people. Yes, I know that it’s a rather fine line.) There are three ways to approach the US funding of aid that we’ve been talking about.

First, provide money with no strings attached. While this would certainly be best for the African people, there are those that, as mentioned, have moral objections attached to the specifics of the aid program.

Second, provide money with strings attached. This reduces the aid to Africans, but also doesn’t violate the beliefs of many US citizens.

Third, provide no aid whatsoever.

You and I both see the first option as being best. However, with my Devil’s Advocate hat on, there are people that are fundamentally, morally, and religiously against it. The use of government tax money in a way that is fundamentally against the views of a large subset of taxpayers is not religious freedom.

If there were a way for a taxpayer to fill out a form saying that their tax money cannot be used for certain things, then you could have portions of aid with strings and without strings. Rice University, being a wet campus (both figuratively and literally), had a form that everyone could fill out saying whether or not their fees could be applied toward the purchase of alcohol. Something like this for taxes would be nice, but impossible to implement. However, we do have the opposite. For those who feel that the US (or whichever government) isn’t doing enough, then they can donate to organizations like the Red Cross, organizations that are here for the express purpose of filling in the gaps when governments miss the mark in helping our fellow man.

But I certainly think that religious freedom is more complicated than it seems (and that you’re making it out to be). There is often a fine line between protecting a group’s beliefs and imposing the result of those beliefs on another group or outright violating another group’s beliefs. (You can also substitute the word “rights” for “beliefs”.) Is any of this making sense? I’m not asking if you agree, but whether you can see the logic of my argument.

By Adam on Jul 15, 2005 at 12:59 am

Oh, I’d also like to respond briefly to Dixie who said, “This looks like another example of why mixing religion with politics and/or science is a Bad Idea.”

As long as a some of the substituents of a democracy value religion, it is inevitable that religion and politics will be mixed on some level (and science will be impacted when the support for said science is provided through politicians). As soon as politicians start to completely ignore the religious views of their substituents, then we have lost our religious freedom, and in fact our democracy. Instead, we must strive to keep religion and politics (and religion and science, and even politics and science) as separate as possible, without completely disconnecting them.

By Adam on Jul 15, 2005 at 1:09 am

Adam, my moral perspective: As a Christian, I find it deeply morally reprehensible that societies are being shredded and millions of people are dying, many of them through no possible fault of their own by any definition, in a world that could easily have prevented this from happening, and could right now be saving their lives. I find it repugnant that in the midst of this crisis, family planning centres are closing down rather than opening up — people are losing the chance they might have had to get good education about these issues. And worst of all, the money that could be solving this and many other problems is being spent on warfare. If I were an American citizen, I’d have to say that the government’s use of its budget completely violates my fundamental moral beliefs. By your standards, then, I would not have freedom of religion.

In anything under than a fundamentalist theocracy, living in the same country as others necessarily entails compromise. I have to accept that my country will do things and spend money on things that I find morally unacceptable; but in return I should be able to trust that all parties are making compromises in the interests of the most effective final outcomes. What we have here is a small group of fundamentalists of a particular flavour compromising the effectiveness of the life-saving aid that the majority believes is morally correct. That’s not democracy, that’s an oligarchy.

By Paul.za on Jul 15, 2005 at 12:46 pm