June 13, 2005

It's The Culture, Stupid

What a breath of fresh air David Brooks continues to be for the New York Times. How sad that the paper is about to begin charging an annual subscription ($50?) to read their prose online, effectively cutting themselves off from millions of readers, reducing their currency and thus their relevance. As much as we conservatives bitch about bias, most of us acknowledge that it's a great paper in lots of ways. But soon I guess I'll have to go all the way to Free Republic to read Brooks for free.

Brooks is traveling in Africa and reporting on the fight against AIDS on the continent. He sounds depressed. And why not?

The problem is that while treatment is a technical problem, prevention is not. Prevention is about changing behavior. It is getting into the hearts of people in their vulnerable moments - when they are drinking, when they are in the throes of passion - and influencing them to change the behavior that they have not so far changed under the threat of death.

This is a mysterious task. In Mozambique's Gaza province, thousands of kids nursed their parents as they died. And yet, according to those who now care for the orphans, the children are exactly replicating the behaviors that led to their parents' demise. If that experience doesn't change people, what will?

(As is my practice with soon-to-be-archived Times articles, you can read the whole thing at the link below)

The New York Times

June 12, 2005

The Wisdom We Need to Fight AIDS

By DAVID BROOKS

Xai-Xai, Mozambique

There's a church in southern Mozambique that is about 10 yards long, with a tin roof and walls made of sticks. Women gather there to sing and pray and look after the orphans of AIDS victims. When you ask those women and their pastor what they tell people to prevent the spread of AIDS, the first thing they say is that it's important to use condoms.

They also talk about the consequences of unsafe sex. But after a while they slip out of the language of safety and into a different language. They say, "It is easier for those who have been touched by God to accept when a woman says no." They talk about praying for the man who beats his H.I.V.-positive wife, and trying to bring him into the congregation. They have polygamists in their church but say God loves monogamy best.

In the week I've spent traveling around southern Africa, I've been struck by how much technical knowledge we have brought to bear combating AIDS. You give us a problem that can be solved technically - like creating the medicines to treat the disease - and we can perform mighty feats.

The problem is that while treatment is a technical problem, prevention is not. Prevention is about changing behavior. It is getting into the hearts of people in their vulnerable moments - when they are drinking, when they are in the throes of passion - and influencing them to change the behavior that they have not so far changed under the threat of death.

This is a mysterious task. In Mozambique's Gaza province, thousands of kids nursed their parents as they died. And yet, according to those who now care for the orphans, the children are exactly replicating the behaviors that led to their parents' demise. If that experience doesn't change people, what will?

We have tried to change behavior, but we have mostly tried technical means to prevent the spread of AIDS, and these techniques have proved necessary but insufficient.

We have tried awareness, but awareness alone is insufficient. Surveys show that vast majorities understand, at least intellectually, the dangers of H.I.V. They behave in risky ways anyway.

We have issued condoms, but condoms alone are insufficient. Surveys also show that a vast majority know where they can get condoms. But that doesn't mean they actually use them, as rising or stable infection rates demonstrate.

We have tried economic development, but that too is necessary but insufficient. The most aggressive spreaders of the disease are relatively well off. They are miners who have sex with prostitutes and bring the disease home to their wives. They are teachers who trade grades for sex. They are sugar daddies who have sex with 14-year-old girls in exchange for cellphone time.

If this were about offering people the right incentives, we would have solved this problem. But the AIDS crisis has another element, which can be addressed only by some other language - the language those people in church slipped into.

The AIDS crisis is about evil. It's about the small gangs of predatory men who knowingly infect women by the score without a second thought in the world.

The AIDS crisis is about the sanctity of life. It's about people who have come to so undervalue their own life that ruinous behavior seems unimportant and death is accepted fatalistically.

It's about disproportionate suffering. It's about people who commit minor transgressions, or even no transgressions, and suffer consequences too horrible to contemplate. In America we read in the Book of Job; in sub-Saharan Africa they have 10 Jobs per acre.

It's about these and a dozen other things - trust, fear, weakness, traditions, temptation - none of which can be fully addressed by externals. They can be addressed only by the language of ought, by fixing behavior into some relevant set of transcendent ideals and faiths.

That's a language governments and N.G.O.'s rarely speak. It's a language that has to be spoken by people who connect words like "faithful" and "abstinent" to some larger creed. It has to be spoken, in Africa, by people who understand local beliefs about ancestors and the supernatural. It's a language that has to be spoken by an elder, a neighbor, a person who knows your name.

This week in Africa, I've been impressed by the level of medical expertise and depressed by the lack of moral, sociological, psychological and cultural expertise. The most subtle analysis of human nature I heard came in that church made of sticks.

E-mail: dabrooks@nytimes.com

Posted by dan at June 13, 2005 12:58 AM