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PaperclipPerfector  5mo ago (text post)   37665 thread views

Culture War Roundup for the week of January 27, 2025

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One of the US Foreign Aid programs that got special attention during the pause was PEPFAR, and I thought the program was interesting enough for a thread top-level comment of its own.

Perhaps others remember this article about it from Asterisk. It's from the "Mistakes" issue, the "mistake" being healthcare economists' prospective criticisms of what was ultimately a very successful program, though I don't think the content of the article justified that framing. The two alleged errors by healthcare economists were premising their cost-benefit analysis on a fixed foreign aid budget, rather than PEPFAR's budget being a new appropriation, and failing to forecast the drop in cost of anti-retroviral therapy; unfortunately, the article doesn't explain what caused the drop in price.

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.

Wollen relies in part on this Center for Global Development blog post, by the same author as the Asterisk article (with very similar content), which claims that demand from PEPFAR for generic ART medication was itself what reduced the cost, but I really want to see proof of this.

Sidenote: The healthcare economist that the Asterisk/CGD contributor use as an example was Emily Oster, who might be familiar to some of you.

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.

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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