NYTimes Home Page: Starbucks and PRODUCT(RED) Advertisement
Today is World AIDS Day. Twitter went red. Even Google had a link under its main search box today that featured links where you could learn more and act against AIDS.
I’m always confused about how to commemorate the day: it’s not really meant to be a celebration, and worse yet, all the solicitation one sees from PRODUCT(RED) and the like in the week leading up to World AIDS Day makes me feel it’s been commercialized (much like that other big day in December). In fact, the image here is a screenshot of the NYT home page last week.
I’m sad to see that Shashank Bengali, the Nairobi-based McClatchy correspondent, will be leaving Africa to move back to the US. Shashank’s reporting has been unlike other journalists with a stint on the continent; he is the one major-paper reporter whose work has never made me roll my eyes back and wonder whether they ever left the capital. Shashank kept a blog of his journeys in Africa, but as he ends his time in Nairobi, so too comes the end of the blog. McClatchy has no plans of replacing him in Nairobi, but as he says in his send off post:
So our Africa bureau is going dark. Other American newspapers, too, are closing bureaus on the continent or leaving postings unfilled. It is the unfortunate reality of the moment. But while nothing can quite replace independent, unbiased reporting by professional journalists, we must be honest that there’s no shortage of news out of Africa. Just glance at the blogroll to the right, or head over to Twitter, where a vibrant community of Africans and foreigners are reporting and debating everything from economics to soccer results to ICC cases.
On a lighter note, I wonder what will become of Shashank’s Obamarama catalog? I hope that he’ll continue to post any photos folks send his way.
“Why?” asked Mark Daku. I just don’t know what to make of changes in estimates of HIV prevalence over time — especially since methods of estimation and data collection have also changed over time. This particularly bothered me when I sat and listened to an “epidemiologist” discuss trends in Malawi at the 2008 National AIDS Conference; I asked, but how can you compare these estimates if you are now using different data, collected from more sites? Needless to say, the answer was not convincing (actually, he didn’t even answer the question).
UNAIDS is clear on its current estimation methods in the new report:
The epidemiological estimates summarized in this report are the result of a systematic process used by UNAIDS and WHO. Estimates for 2008 build on recent improvements in HIV surveillance and estimation methods.
HIV surveillance has historically focused on anonymous epidemiological monitoring in designated sites (‘sentinel surveillance’). The number of sentinel surveillance sites has significantly increased in recent years. In a growing number of countries, sentinel surveillance has been complemented by national population-based surveys that include HIV testing. Since 2001, national HIV surveys have been conducted in 31 countries in sub-Saharan Africa, two countries in Asia, one province in each of two other countries in Asia and two Caribbean countries. In eight African countries and one Caribbean nation, more than one population-based HIV survey has been conducted since 2001, permitting an assessment of trends over time. The notable growth in the magnitude and quality of HIV epidemiological data has significantly strengthened the reliability of HIV estimates.
Of course, in the best situation, we’d have gotten great data from the start and then this large shift in the methods wouldn’t have us worried about whether we’re comparing apples to apples or to oranges. If only the intertemporal difference in data collection and estimation were the single concern…
A colleague wrote an article published not that long ago that showed that even the holy grail of HIV estimation used by UNAIDS — population-based testing — suffers from a refusal bias: HIV-positive respondents are four times more likely to refuse an HIV test in the future after learning their HIV-positive status. In fact, in writing a dissertation chapter that tried to separate the policy preferences of HIV-positive respondents, I had to use earlier wave data from our longitudinal study to figure out if any of our respondents in 2008 that refused HIV testing had learned in a previous round that they were positive (and then impute their status).
All of this is to say that I’m no longer convinced that population-based testing will provide us HIV prevalence estimates we can be confident about.
It’s hard to be against the efforts of Doctors Without Borders (aka Medecins Sans Frontieres/MSF): they work in difficult conditions providing excellent care to people who have few if any other options. But recent ad campaigns by MSF have gotten out of hand. Take the latest example, “Girl”:
Perhaps the economic downturn has had a negative impact on giving to MSF, precipitating a need to use such a jarring advert that would compel donors to give in great numbers. I don’t deny the story they tell in the advert could really have happened (in fact, the makers remark the advert uses real audio recorded in an MSF field site). However, after seeing the previous (and related) advert, “Boy”, I commented:
as someone who has spent some time in Tanzania and Malawi, I come back to the US to answer questions from friends about what it’s really like in Africa and if it’s as bad as everyone says it is, or *gulp* worse. i think that viewers might perceive the advert to be about a place in Africa and that it would continue to distort their view of a place that isn’t always tragic (though i understand it is very much so in places where MSF works). i just think the advert furthers this whole “dark continent” nonsense.
All of this is to say you won’t find me recommending students seek jobs with MSF or encouraging rich MBA friends to donate to MSF causes.
Owen abroad discusses the lethal effects of development advocacy. His first example is of earmarked funding for HIV/AIDS in Ethiopia:
…we should also make sure that people have bednets and drugs to stop malaria, provide childhood vaccination to prevent easily preventable diseases, ensure access to contraception and safe abortions, and, above all, enough funding to provide basic health services that would save thousands of lives and suffering. Yet we are not willing to provide enough money to do all of this. It is in this context that it is damaging to earmark 60% of health aid to HIV.
He quotes from the Open Budget Blog a quick-and-dirty “value-of-life” estimate:
Using these estimates, it would cost an additional US$29.7 million to treat all of the 540,000 kids who died from pneumonia/diarrhea in Nigeria and Ethiopia. Were this money to come out of the HIV budget, it would reduce the number of HIV patients that could be provided treatment by about 61,240. So, using these admittedly very rough estimates, our current allocation of resources from the pot of money for disease treatment suggests that we value the life of a person with HIV at 8.8 times the value of the life of a child with pneumonia.
I was just at the University of Tennessee presenting a chapter from my dissertation about the weak demand for HIV/AIDS services in rural Malawi, even among those most affected by HIV/AIDS. The audience of mostly political science faculty and graduate students raised a few good questions:
When I compared the morbidity/mortality and international funding of HIV/AIDS against diarrheal disease, one professor asked, but doesn’t AIDS typically affect adults whereas diarrheal disease has greatest impact on children? (Yes. [Insert here discussion of how children have little if any political power.])
Why does the international community prioritize AIDS over other health problems if the other health problems are actually cheaper to deal with? (That’s a long answer, for which I have little evidence and mostly conjecture.)
What does international prioritization of HIV/AIDS over the concerns most important to local citizens mean for democratic governance? (Well, in the nascent democracies where HIV rates are the highest in the world, I can’t say the path international actors is good or consistent with their contemporary rhetoric about local governance.)
I just read a paper written by a former colleague about the unintended effects of the international outpouring of aid following the 2004 tsunami in the Indian Ocean (earlier, ungated version here). By trying to aid those impacted by the tsunami, international actors gave undue hope to rebel leaders that international aid flows could sustain their governance operations, and thus they’d no longer need a relationship with the state — escalating the violence between the government and the rebel group.
All of this is to say: I’m not anti-humanitarian or anti-aid. But people on the outside need to think about what their compassion does to people on the inside — in broader strokes and in the longer term.
Mead Over at CGDev posts about a recent White House memorandum calling for increased emphasis on program evaluations from the director of the Office of Management and Budget.
One particular line resonated with me: “Attract and retain talented researchers in an office with standing within the agency.” Does this mean the Ph.D.s like me who are on the job market (where things are admittedly bleak) might actually land something — albeit working for the government and not the beautiful ivory towers about which we still dream? Seriously though, much as I think the work I do is important and that my training in how to identify causal relationships is valued, I don’t know that I want every agency in the government to be funded to do the same. Rather, I’d want the great majority of my tax dollars going to actually “doing” something rather than measuring how well something is done. Especially if the folks “doing” and the folks “measuring” are in the same office, we’re setting it up for one employee to blow the whistle on another’s poor performance. That might save us some tax dollars in the end, but I’d hate to play on that department’s softball team. Couldn’t we just have one agency that specialized in evaluating, or hire some external auditors on short term contracts?
UNAIDS announced an eight-year trend shows new 
