Emily's Worldview

I've been on vacation for almost two weeks, and just let everything go. I've been following the example of our black and white cat--sleeping in, eating when I feel like it, lazing around the house, letting my whole body go as limp as a noodle. I've relaxed in some other ways too--driving everywhere, buying things at regular stores, only reading the Washington Post. Who knew it would be so easy to take a vacation from my principles?

I spent a lot of time with one of my friends from way back, which reminded me that the good thing about having friends from forever ago is that you don't have to be 'on' to be with them, you don't have to be anything but yourself. And with my family even more so--I can unselfconsciously be the same dorky kid I've always been. It's great to meet new people and to be surrounded by unfamiliar faces, but it's also pretty great to be home and to remember what I'm like when I'm totally comfortable.

In this week's NYTimes, Paul Theroux reveals that he finds Bono "annoying" because the rock star is always pushing the "big money platform", that increased aid, fairer trade relations and debt relief are crucial to real development in Africa. Theroux thinks this results in perverse outcomes, and that self-sufficiency must come from African governments and African people cleaning up their acts.

By the way, this man's credentials are that he wrote a prize-winning novel and did a few years in Peace Corps in the 70s. He's basically the literary-rock-star version of Bono, except without a real plan. I mean, what is his alternative? Encouraging young local professionals to stay and work. Great, except for, um, AIDS, which kills exactly those people at faster rates than those countries graduate them. When you have HIV epidemics of 10-40% in the general population, you can't rely on the piecemeal stuff that he supports; "humanitarian aid, disaster relief, AIDS education or affordable drugs". You have to make it possible for governments to have enough money to do those AIDS treatment programs, forever. And the infrastructure issues he talks about at the end are exactly the types of projects that foreign aid is pretty good at doing and should be doing more of.

Of course, he's right that money has been wasted in the past, often by the governments it was going through. Remind me again why the poorest people in the world are being asked to pay for bad deals between their corrupt rulers and misguided international lending institutions? And what about all the well-designed, transparent, high-level HIV, malaria, and TB projects that the Global Fund has approved and that are just stagnating while they wait for funding?

Here's the thing; even if debt relief and aid do not always lead to improved welfare, there is just no scenario where a heavily impoverished and indebted nation can turn itself around within the current world system. Development is not the necessary result of more aid; but aid and trade and debt relief are all sine qua non for development.

Obviously, there's a lot that's indefensible that goes on in the aid world, and I agree a lot with the critiques like the one I discussed in my previous post. But those critiques are made analytically and descriptively and they aren't used to undermine the fundamental principle that rich people have an obligation to use their wealth in service to the poor. A principle that Bono has a big role in bringing to the international table. Now that's a real rock star.

I'm in the middle of finals so not much time to post. I wanted to point out a great article on Malawi in the Times this week. It nicely summarizes the contradictions in the "aid industry" in Africa. I think it's actually a little gentle--for example, CARE in Malawi gets to explain away its part in exacerbating poverty in Malawi by its limited geographic scope. As a matter of fact, CARE is currently working in 60 countries around the world. Perhaps they would be more effective if they were less concerned about lifting their own profile and sucking up as much donor money as possible, and more concerned about actually dealing with entrenched poverty in the countries they are in.

Many of the international NGOs are the same, of course. Which is a problem for someone who feels like she is being groomed to join just that kind of organization; who wants a job in Africa, but not at the expense of the destitute poor who live there.

Buenos Aires' World AIDS Day celebration. As my friend Amanda said, "I just can't picture them doing that to the Washington Monument". I'll save the comparison of Brazil's enlightened AIDS policy with America's non-policy for another day, and just let the picture speak for itself.

Today is World AIDS Day. In the Washington Post, an interesting pair of op-eds from Jim Yong Kim, now of WHO, and Richard Holbrooke, former US ambassador. Kim looks at the latest statistics and finds some reason for hope: the vastly expanded access to treatment with antiretroviral therapy for people living with the disease. Holbrooke acknowledges the importance of treatment but urges the international community to scale up prevention, particularly through expanded testing programs.

But what Holbrooke doesn't address is the fact that there is little incentive for people to get tested in the absence of treatment. You have to do both. From a human rights perspective: you can't force people to get tested, and the state does have an obligation to provide life-saving therapy. Antiretrovirals are not optional, they have to be a part of any strategy. Of course testing is crucial, but in the US, where 1/3rd of people who are HIV positive do not know their status, we haven't put treatment on hold until they all get tested. Why should any other government have to make that choice.

It's World AIDS Day, but I don't feel hopeless because even in the last 5 years, so much has changed in the global pandemic. Treatment is more doable and cheaper all the time, there are extremely cheap and effective interventions to prevent mother to child transmission, and microbicides are in human trials. Of course there are so many more people infected and epidemics taking off in new places, and so many young lives lost, and all of this is sobering. But not hopeless.