Fear vs HIV-Prevention

An HIV-positive reader writes:

Here’s another reason you’re right about HIV. Suggesting HIV is a manageable disease may cause some HIV negative guys (very foolish guys I would add) to take safer sex less seriously than before the disease became treatable, but try looking at the situation through the eyes of another population: The untested HIV-positive gay man. In the past several years, I have had the opportunity to be a peer counselor to many newly diagnosed HIV-positive gay men, and I have heard the same story repeated by several of these men. They "kind of had an idea" that they might be positive, but because of fear, stigma, denial or whatever you want to call it (stupidity maybe), they did not get tested because they were afraid of what it would to be labeled "poz".

It is not the healthy, medicated HIV-positive men in America out infecting other men; it is the untreated, untested gay man living in fear of the "gay plague", with viral-loads of several hundred thousand, living in denial that would be responsible for a majority of the new HIV cases among American gay men.

So again, looking at the problem through the eyes of this untested/untreated population, what would be a better picture for them to see: 1) HIV is something you need to fear and will kill you? Or 2) HIV is a manageable disease that is best detected and treated as early as possible? The answer seems obvious to me, and not just because the fact of the matter is that HIV is very manageable, but because letting the highest risk populations know the truth will save lives.

Hollywood’s Middle East Policy

No, not a cover-story in the next Vanity Fair. (When, I wonder, will they merge with the Huffington Post and be done with it?) Just the latest piece of cultural diplomacy:

Visitors to the UAE park will be moved by an animatronic Effie’s emotional delivery of "I’m Telling You I’m Not Going" on Dreamgirls: The Ride.

What Condi can’t do maybe Jennifer will accomplish. More here.

Thatcherism Under Blair

She remains the unsung heroine of recent British history:

Most of the changes implemented by Thatcher (at least up to the time of the poll tax fiasco) remain in place. The big public utilities remain privatised, unions have never really recovered, the rich are a lot richer and so on. Still her term in office now seems to be thought of by both sides of politics, not as a a turning point, but as a period of unpleasant, though probably necessary, shock therapy, best passed over in silence.

Bong Hits For Jesus

Radley Balko airs a libertarian heresy:

This case always seemed to me like an odd one for the drug reform movement to rally around. This was not an essay calling for the legalization of medical marijuana. It was a lame stunt to get noticed.

The fear was that the Bong Hits case would give the Supreme Court the opportunity give its okay for public schools to censor student political speech in favor of legalizing or decriminalizing drugs.  …To that end, you could make a pretty good case that yesterday’s opinion was actually a victory for drug reform advocates, not a setback.

Sicko – A Looming Smash Hit

A lot of people I trust have seen it and said it will be a smash:

I went in expecting to hate it. But I was wowed. His technical abilities have developed amazingly from Roger & Me to this. This might actually be the best film of this sort I’ve ever seen. He’s brilliant at exposing problems in the system. Well, give him credit for that. The problem is that the alternative vision he gives us is laughable – literally.  But there are horrendous inefficiencies with the US system, they need to be bulldogged, and at present nothing’s happening.  Bringing attention to focus on that is a great service.

Another reader writes in defense of government medicine:

You have your own very negative personal experience with Britain’s system. But I feel that the situation as it currently exists in the US requires solutions that, even for a conservative, have to go beyond the hardened orthodoxy of "government = less for more", "private enterprise = more for less". I am no economist; in my own experience, however, this equation just doesn’t cut it. I have little direct experience of government work, but both my parents have worked in state and local government (in a state energy office and a city welfare program) and I saw them working hard, being frugal in their work, making a lot happen with a little, accounting for every expense.

My own brief experience in consulting was, by contrast, one of huge amounts of waste: high-priced plane tickets bought at the last minute for no reason other than laziness, luxury hotel rooms, excessive quantities of staff, lavishly paid for by giant corporations and all to give them messages they wouldn’t act on, but needed to have hired in to check a box or cover their asses.

I don’t want the people involved in those transactions deciding who gets what medical procedure, but they’re exactly the type of person deciding it now. (This also makes me despair at the thought of ever reining in the great damage we’re doing to the environment – corporate culture is just too wasteful and entrenched for individuals on their own to make much difference.) My own experience in university and nonprofit worlds is somewhere in between – in the university I find pockets of extreme frugality and pockets of great inefficiency and waste.

All this suggests to me that much of the difference between efficiency and inefficiency, or smart and dumb decisions, in any given sector is cultural, dependent on local group and individual choices, on access and accountability, rather than a necessary structural effect of the profit status of the enterprise. I think of the $300 wrist splint which cost pennies to make and which I was able to get for $30 because I had insurance. The hospital makes a lot of money, the insurance company passes on the cost to my employer, which has chosen the group health care plan and takes part of the cost out of my paycheck; I have little choice in the matter. It’s one way to manage collectivity (one which, in this case, certainly allows for inefficiency and stupid choices); government is another. I have lots more opinions on this, but I’ll stop here because I really don’t know the economics.

Dammit. I’ll have to see the bloody thing.