Economic Woman

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Posts Tagged ‘HIV/AIDS

Paying for it

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An experimental World Bank-backed program in southern Tanzania will pay people to avoid unsafe sex. Hat tip to Marginal Revolution. I’ll repeat a few things said by commenters, but since some of it was said in horrifying context (“in a country like Africa”) I think it’s worth discussing at length.

The assumption is that the problem in Africa is that too many people choose to have unsafe sex. I’m sceptical. We already know that women all over the world, perhaps especially in rural Tanzania, aren’t always empowered to make decisions about sex and protection, especially within marriage. But for a few minutes, let’s go with this premise. How can we convince people to choose safer sex?

Is raising the monetary cost of unsafe sex the answer? Surely HIV/AIDS is already expensive. As one MR commenter points out, this paper suggests that people who already face high mortality might take the comparatively distant possibility of AIDS infection less seriously. Even if this is true, will $45 fundamentally change the equation?

Even if it appears to, we’ll have a lot of conceivable explanations to fight over.
Maybe the value of a program like this is purely cultural. If your partner is going to argue with you over condom use, “I’m getting paid a lot of money to use this” might be just the excuse you need. Unless your partner is willing to pay more – now there’s a whole other issue.

Even more likely, maybe the pilot will work because it includes education. I’ve argued in the past that meaningful sex ed is a human right, and we already know that it works. I’m all for throwing money at this problem, but imagine how many more people could be involved in projects like these if they focused on one-on-one education instead of income support? There’s a control group that won’t get paid, so that will help us answer these questions. (You could argue that the money is just a way of getting people to go to class, but a 25 per cent raise is probably more than is required for that.)

Let’s get back to the Oster paper linked above. Here’s the end of the abstract:

…the magnitude of behavioral response in Africa is of a similar order of magnitude to that among gay men in the United States, once differences in income and life expectancy are taken into account.

If safer sex is a function of income, won’t paying people period – for anything, without conditions – reduce their risky behaviour? Why bother paying for the monitoring? Why don’t we just write the whole continent a cheque?

Because that’s not how you raise income, in the long run. That’s a cheap solution. It’s cheaper than maintaining a meaningful foreign aid budget. It’s cheaper than working to empower women. It’s cheaper than promoting real economic development. But we’re talking about an epidemic, tragedy on an unimaginable scale – the destruction of a continent, perhaps. Stephen Lewis has been arguing for a while now that we know how to fix this problem, but we’ve kept casting around for cheaper solutions. If anyone on earth knows that they’re talking about, it’s him. I can’t help but wonder if it’s time to stop messing around with pilot projects.

Written by Allison

29 April 2008 at 1:45 am