Wednesday, July 03, 2002

Steven Den Beste has written a new article that uses an interesting argument to come to an old (and disturbing) conclusion. He uses the concept of "triage" (the idea that army doctors differentiate between those patients they think they can save vs. those who are lost causes), in order to justify, well, this:

The triage tough-love possibility is that denying treatment to those who are already infected, and letting them die sooner, will decrease the number of new cases by diminishing the pool of infected individuals who can spread the disease.
Now, I'm sure that any reader with a sense of history has heard this argument before: it's the "gay apartheid" argument- the idea that those who are infected or those who may be infected (homosexuals at the time this argument was popular, although obviously not in the case of sub-saharan Africa today.)

Steven adopts the logical basis of this belief, and argues that giving the U.N. money to save the Africans is at best futile and at worst muderous, because it "means that you've increased the number of HIV-positive people who will continue the sexual practices responsible for the disastrous spread so far. In some of these nations there's good reason to believe that providing them with retroviral drugs will increase the long term death-toll." It's a disturbing argument, because it treats humans like automatons (something that Den Beste seems to be in the habit of doing), completely unable to change their behavior despite little evidence that that is actually the case. The problem with his argument, however, goes far deeper than this.

First, there is a growing belief that anti-virals could make HIV a managable condition, similar to diabetes, herpes, or strong food allergies. All three of these conditions could be "weeded out" by the same technique of "benign" neglect that Den Beste advocates for Africa. The fact that we don't do this is an obvious flaw in Den Beste's argument, because they raise the question of "why"? The reason, of course, is because these are human beings we're weeding out, and we aren't in anything near the sort of desperately shorthanded battlefield conditions that make triage necessary.

Second, there is a disturbing amount of eugencism in this argument. After all, the only difference between HIV and a genetically transmitted disease is the time frame- both are the results of sexual behavior, and both are (in many cases) uncurable. Any argument that we should simply "let the AIDs patients all die off" can and will be extended to the argument that we should let people with, say, cystic fibrosis die off, so there's no chance that they could pass it on to their children.

"But wait", some are no doubt saying right now. "Cystic Fibrosis is a recessive gene!" That is true, of course, but that leads into my third point: HIV is a "recessive" disease. Killing off each and every AIDs patient right now will do practically nothing to stop the spread of the disease, because it can be transmitted between those who not only don't show signs of AIDS, but who don't even test positive for HIV yet. Letting those who show symptoms or even merely test positive die off would mean absolutely nothing, because the virus would still be spreading no matter what we do. (This was the stake through the heart of the "apartheid argument" back in the day, and remains as true in Africa as it did in North America).

Because of that, we get to my fourth point: That education isn't useless. At one point it was almost as hard to get people to use condoms in the West as it is in Africa now, but it has become pretty damned common at this point (although the gay community has been guilty of some backsliding). Yes, there's the problem of those idiotic superstitions about having sex with virgins curing AIDs and the like, but that doesn't require "triage"... that requires no-nonsense eradication of such idiotic notions and promotion of safe sex as the only real way to staunch the spread of AIDS.

My fifth and final point, actually, is about the end point of DenBeste's argument. He isn't arguing in favour of "tough love" or "triage" or anything like that. He is talking in favour of mass death on a scale that dwarfs anything we've ever seen. The whole "triage" argument is a smokescreen, because Den Beste himself doesn't seem to think that there are any healthy soldiers, and therefore has basically thrown up his hands and said "let them all die horribly". The problem is that he's arguing that we should "save as many people as possible", but in the same breath arguing that it shouldn't happen at all. If this epidemic is inevitable, then cutting off the flow of Antivirals wouldn't "save the healthy soldiers"... it would simply doom most of Africa to a painful death, instead of merely being utterly dependent on expensive drugs. Indeed, assuming that he's including the drug that prevent transmission to children about 90% of the time or so, he's arguing in favor of genocide, because that is basically what it would amount to.

Steven, I can understand the impulse to "let the bad cells die so the rest are stronger". As tempting as organic conceptions of society are, though, human beings are not cells, and what you are advocating will not work. In this case, the best we can do is do our damndest to mitigate the worst of it, and mix that with as much real sexual education and social change as we possibly can. To do otherwise is to doom most of the continent to extinction.

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