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PaperclipPerfector  26d ago (text post)   36908 thread views

Culture War Roundup for the week of January 27, 2025

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Effective Altruist Amos Wollen published a defense of PEPFAR on the 29th, which doesn't steelman the programs' current critics, but does address the current politics of the programs.

Man, that's pretty charitable to just say it "doesn't steelman". To wit:

In response to a tweet by right-wing PEPFAR advocate Richard Hanania, many of his followers expressed their grievance at the country with the largest share of the world’s GDP shelling out a small sliver in foreign aid to do something unambiguously good:

As for whether the US has reason to set aside a skimpy sliver of its budget for a programme that has saved easily more than 20x the lives that the Iraq War stole, the most important justification for PEPFAR funding is that saving that many lives is straightforwardly morally good, and failing to engage in a baseline, easily-affordable level of Christian charity when that many lives are at stake is Satanic.

OK, well, I'm not Christian, so that line of defense isn't really going to work for me. More importantly though, this doesn't actually meet the argument head on, it just insists that you have to agree that it's morally good because it's such an eensy-weensy-teeny-tiny expense that does so much good. Without arguing about just how eensy-weensy the program is or how much good it does, this prompts a couple immediate thoughts:

  • If it's so tiny, why is it critical for American taxpayers to cover it? Things that are so tiny and so good should be pretty easy to convince people to participate in voluntarily rather than via confiscation.

  • In the event that there's really a coordination problem, that it can't be done via charity for some unclear reason, why isn't it an internationally shared expense? It's super-duper tiny, barely costs anything at all, and does so much good, so it should pretty easy to get the UN to fund this instead of it just being a responsibility for the United States.

  • This argument is fully general for anything that you just think is good in the federal budget. It precludes ever cutting anything if its advocates say that it's really important and doesn't cost that much anyway. If it's true that nothing that supporters think is good and costs less than eleventy bajillion dollars can ever be cut, fine, I'm probably just going to oppose more or less all new programs since they can apparently never be ended or shifted to the private sector.

At the end of the day, my real question is why the hell HIV spreads so well in Africa. I've read the explanations and they just don't really make much sense to me. In the United States, Europe, and Asia, HIV just spreads really poorly among heterosexual populations that don't use intravenous drugs.

People have mentioned extremely high rates of promiscuity in Africa - cheating, prostitution, men with multiple families, etc. - and dry sex, which is overrated because of its surprising nature. The main reason for high heterosexual HIV transmission rates is both more pedestrian and more unpleasant. Few African women, particularly in urban slums and to some extent in rural areas, have access to appropriate feminine hygiene stuff (period products, vaginal healthcare, etc.), and as a result many develop long-running vaginal infections, UTIs, or other issues. Because HIV is blood-borne, women with infections or open wounds in their vagina are much more likely to pick it up from sex, and similarly for men having sex with HIV-positive women and contacting their blood. Unfortunately, this is a more difficult problem to solve than anti-retrovirals, and I don't really foresee a similar program to PEPFAR creating much improvement in that respect.

In the event that there's really a coordination problem, that it can't be done via charity for some unclear reason, why isn't it an internationally shared expense?

This could certainly be done, but cutting funding effective immediately and leaving the doctors and administrators of the existing program in the lurch doesn't seem like a particularly sensible way to initiate such a transition.

At the end of the day, my real question is why the hell HIV spreads so well in Africa. I've read the explanations and they just don't really make much sense to me. In the United States, Europe, and Asia, HIV just spreads really poorly among heterosexual populations that don't use intravenous drugs.

Because Sub-Saharan Africans are more sexually active with more partners and with worse hygiene than their counterparts in other parts of the world. Transmission of HIV from women to men can occur when both have open cuts or sores and are engaging in some of the practices others downthread have referenced, particulary for men who frequent brothels where everyone else is infected. This lack of hygiene is also why circumcision reduces the risk of getting HIV for men in Africa but not nearly as much in other parts of the world, or so I've been told.

Isn't HIV in Africa a different strain from in western countries?

why the hell HIV spreads so well in Africa

There's a 'cultural practice' that may promote transmission.

https://pubmed.ncbi.nlm.nih.gov/9788473/

Heterosexuals in the US, Europe and Asia in my experience prefer cunnus umidus.

Though the same may not be true on Endor

Dry and furry seems a particular poor combination.

Sleepy stripper Cardi B makes her argumemt for WAP in her commercially successfull song WAP. It's success suggest it's a message that resonates with many. (This is not an attempt at consensus building.)

I was convinced of the merits of WAP the year Cardi B was born. Though working summers with my uncle I'd been hearing of the many advantages for several years before.

I was supprised how much had been written and money spent in an effort to describe and dissuade this cultural practice.

Man, that's pretty charitable to just say it "doesn't steelman".

I didn't find it very satisfying, but foreign aid opposition is a sea of "I don't want altruistic spending," so I didn't want to condemn his failure, either. To your points:

If it's so tiny, why is it critical for American taxpayers to cover it? Things that are so tiny and so good should be pretty easy to convince people to participate in voluntarily rather than via confiscation.

Wollen has a paragraph addressing this, linking to another post on "taxation is theft." I haven't read his "taxation isn't theft" post, so I don't know whether or not I agree with him about that question, but I think the paragraph in this post includes a good counterargument to opposition directed at PEPFAR: "Still, if you really think taxation is theft (and aren’t like the Republicans who say ‘taxation is theft’ when it comes to Medicaid, but not, for some reason, when it comes to roads, national parks, and hurricane relief), surely it makes sense to do away with the ineffective government programmes first, not the coolest federal programme in history."

In the event that there's really a coordination problem, that it can't be done via charity for some unclear reason, why isn't it an internationally shared expense? It's super-duper tiny, barely costs anything at all, and does so much good, so it should pretty easy to get the UN to fund this instead of it just being a responsibility for the United States.

International coordination would itself be a coordination problem? UN funding would just move "taxation is theft" up one level of abstraction? The absence of other countries having an equivalent program isn't a strong argument that we shouldn't maintain the original.

This argument is fully general for anything that you just think is good in the federal budget. It precludes ever cutting anything if its advocates say that it's really important and doesn't cost that much anyway. If it's true that nothing that supporters think is good and costs less than eleventy bajillion dollars can ever be cut, fine, I'm probably just going to oppose more or less all new programs since they can apparently never be ended or shifted to the private sector.

I think this is a good counterargument.

At the end of the day, my real question is why the hell HIV spreads so well in Africa. I've read the explanations and they just don't really make much sense to me. In the United States, Europe, and Asia, HIV just spreads really poorly among heterosexual populations that don't use intravenous drugs.

I'm curious about this, as well. It seems many infectious diseases spread more easily in Africa than other continents, across various routes of transmission. Two HIV-related challenges I know of are decades of pseudoscientific denial that it was the cause of AIDS in certain countries (South Africa is a good example) and the normalization of men using sex workers while away from home and bringing STIs back to their wives in certain countries (I can't name a specific country, off-hand).

Is men away from home frequenting sex workers really that much more common in Africa? Genuine question: I would bet prevalence of sex work is really high everywhere with a large group of transient men without much education and weak public health. But Africa's HIV rates are far higher (10-50x) than e.g. India's, and Africans aren't having 10x the amount of risky sex as Indians (I think?)

Maybe the graph has more clustering for Indians, which would limit spread, but I don't see how that would cause the rate to be so much lower.

Given the heterogeneity of prevalence even within Africa, I think reaching some bare level of competence in government/public health actually makes a difference here.

Prostitution is extremely common in the American trucking industry; still not much of a problem with heterosexual HIV.

surely it makes sense to do away with the ineffective government programmes first, not the coolest federal programme in history

This is extremely weak, because we can do away with both at the same time. If that guy can name some programs you think are less effective than PEPFAR, let him do it, and we will cancel those in addition to cancelling PEPFAR.

International coordination would itself be a coordination problem?

No. Coordination problem is when individual action is mostly ineffective, and it’s only when everyone agrees on something, you get a benefit. Here, half of spend gets you half of benefit, so you don’t need to get all the countries to agree and coordinate, just make the case for them, and whoever wants to pitch in will be able to.

The absence of other countries having an equivalent program isn't a strong argument that we shouldn't maintain the original.

If you think so, you are very far removed from how normal people think. Why do you think cafes make sure tip jars are made of transparent material, and make sure there is always some change inside?

The absence of other countries having an equivalent program isn't a strong argument that we shouldn't maintain the original.

If you think so, you are very far removed from how normal people think.

This is The Motte...

look up "dry sex"

What percent of infections can be attributed to dry sex?

Wikipedia took me to The Lancet, one of the most prestigious medical journals.

86% of women interviewed in a Zambian study practiced dry sex.

dry sex is most prevalent in KwaZulu-Natal, which has the highest rate of HIV/AIDS.

at least 80% of 150 prostitutes between the ages of 15 and 45 years, working at truck stops in the midlands of KwaZulu-Natal, practiced dry sex.

I also checked some other papers and the results are somewhat more inconclusive, though they're based on self reported data

https://sti.bmj.com/content/75/3/178.short

The younger less educated group were the most likely to practise dry sex. Dry sex practice was associated with an increased prevalence of self reported STDs in men but not in women.

https://sti.bmj.com/content/82/5/392

Both practices were associated with reported symptoms and diagnoses of STI.

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