The social contract
This article which recently appeared in Mail & Guardian reminded me of something I read in Paul Johnson’s History. He notes how the governments of developed nations should have understood from the outset that the spread of AIDS was not primarily their concern, because, and I quote:
Hugely expensive and probably ineffectual government campaigns against drug abuse and AIDS saw the modern state in a characteristic, twentieth-century posture - trying to do collectively what the sensible and morally educated person did individually.
Of course, such opinions sound absurd to the South African ear. But while this view is in complete contrast to every single mainstream opinion, one has to wonder. It seems that nobody has thought of actually holding individuals responsible for their own behavior, instead of expecting government to act as nursemaid to it's citizenry. And although I understand the chorus singing about how government is not doing enough, I can't help thinking that these people are just living on another planet. I mean no matter which backwater village you live in, you must have by now heard of AIDS. And if you had to hear that a deadly disease is making the rounds, one would think it would at least spark the smallest iota of interest - at least enough to finish reading the paragraph or stay listening to the radio. You know, up to the part where it notes that "AIDS is real, incurable and spread mainly through heterosexual sex”. Or if one had to hear about it from a friend, would that not motivate one to do some research on the matter, like asking a nurse in the village clinic, before going out and having unprotected sex again.
People blame Mbeki for not sending a clear enough message, but it appears to me that these people aren't picking up any messages whatsoever. According to the survey noted above, 8% of people in SA still do not believe that AIDS exist. That's 1 in 12.
Haven't they noticed the people dying around them?
3 comments:
I have worked worked with HIV+/AIDS sufferers and my guess is that the 8% hein mentioned find the concept of AIDS incomprehensible. I still remember the blank stares I received when I informed them of their positive HIV tests.
I also remember the AIDS sufferer who's main complaint was impotence even though he died the next day of multi-organ failure.
Here in NZ we don't have much of a problem with AIDS (I think it has to do with its remoteness, because kiwis sleep around as much as any other nation, which is supported by our appalling STI statistics), but increasingly there is a problem with obesity, as in most other 'developed nations', and I think it raises many of the same issues. I've been out of the AIDS loop for too long, so let me talk about something I know more about. Fat: What should the government do?
The liberal response is simply that adults should be able to eat and drink what and how much they like, and that the state has no business interfering with this freedom. If we get fat, then that's our problem. (And of course, it will be our problem, just as the individual who ends up with AIDS does get to suffer the consequences.)
The weakness of this position is that as individuals we do not have as much control over our lives as we might think we have, even in developed nations. For instance, a friend of mine spent 2 years in Texas, and eating what she thought was the same moderate diet she's eaten all her life. She gained 20kgs, which she promptly lost again after returning to NZ. She says the Texans add sugar and fat to everything; you simply cannot avoid it.
So here we have an example of an intelligent, educated person (she has a PhD), who does not suffer from weakness-of -the-will, who finds herself powerless to control her own weight in a developed nation.
The government can, through a few simple regulations, ensure that the fat and sugar content of all food products don't exceed a certain limit, and thus have an enormous effect on the obesity statistics. So, I think it should. Freedom schmeedom. I would still have a wide selection of junk food to choose from, it just won't be as bad for me.
Any nation, whether developed or developing, has and should have paternalistic measures in place, that is, measures that aim to benefit the individual by restricting their freedom to harm themselves. Think of laws requiring us to wear seat-belts and bike helmets, not to take certain drugs, etc.
With AIDS: Probably not quite as simple as fat-control, but perhaps the same holds true in principle. Many individuals simply don't have the freedom or ability to take steps to avoid being infected, so the state cannot leave it up to the individual to do so. I'm not sure what the state can do to halt the spread of AIDS, but I figure they have an obligation to do what they can. For one, try to decrease the number of people who find the concept of AIDS 'incomprehensible'.
A further point: In NZ it is mainly the poor that are fat, and suffering poor health as a result. So why the hell don't they just stop eating shit?, I'm tempted to ask. I think it has to do with priorities: Someone with a cosy, safe, middle-class lifestyle like me cannot comprehend how someone can allow themselves to become obese, given the effect it has on one's health. But if you have 6 children, you're on the dole, your son has just joined the Mongrel Mob, you're fighting off the men who want to rape your daughters, etc. etc., the threats that accompany obesity (or unsafe sex) are just not an issue.
Liezl
I hear what you say, dcm, perhaps a team of fat police will not be as effective as some other measure the government could put into place. If I over-simplify practical matters it is in order to focus on the underlying (moral) principle, which in this case is that any government (whether of a developed or developing nation) ought to do what it can to prevent harm to its members, provided they don't interfere too much with their liberty. (How much is too much? Well, I guess the constituents will start to complain.)
One way to curb the spread of AIDS that does not require interference in people's sex lives, is by reducing mother-to-infant transmission. This can be done by giving anti-retroviral drugs during pregnancy as part of standard pre-natal care. (Yes I know in many areas the standard care in SA is nothing at all, but surely this is an area that deserves to be worked on.)
In a recent M&G article, entitled "SA in denial over AIDS" (sorry, I am old, and don't know how to hyperlink in a blog):
"The CI analysis of the government's plan on the care, management and treatment of HIV/Aids indicates it does not adequately address two key interventions -- reducing HIV infection in adults and the prevention of mother-to-child transmission."
It reminds me of something my 6-yr old son said after his pet lizard died: "I only forgot to two things: food, and water."
Liezl
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