Saturday, April 01, 2006

Plumbing the Mysteries of Bushland

There has been a significant drop in new HIV infections in Southern India among young men following a period of intensive public education and condom distribution, particularly among prostitutes and their male customers, which in turn reduced transmission to female spouses. This is amazing news as India has the world's second highest number of HIV infections, only behind South Africa.

I applaud these efforts while sadly acknowledging that my own more advanced nation would never approve such an intervention because Prostitution is Wrong and Breaking the Holy Bonds of Matrimony is Wrong. More likely we would see a crackdown on prostitution and some Just Say No program urging men to please keep it in their pants. But they don't call it the oldest profession for nothing.

Again, a battle between How People Ought to Behave versus How People Really Behave, a battle we revisit often. Though data have never supported abstinence-only programs, nevermind the serious concerns over separation of church and state issues it raises, or that the availability of needle exchange programs causes anyone who was otherwise not planning to do so to start mainlining drugs, we hang on tenaciously to the Shoulds.

Generally public health folks recognize some behaviors will be practiced regardless of whether they are legal or not, personally repellant to you, against God's Law, etc. and advocate for a reality based approach to improving the health of a nation's citizens. Nuts, I know.

Try to think of something not so charged. Perfect example: seat belts. Ideally, we would never change lanes without signaling, never speed, never operate motor vehicles under the influence of alcohol, drugs, or while asleep. Because all these things are Wrong and Against the Law. And yet, we do all of these things ... all the time. So rather than investing in more mops with which to swab the brains off the highway, we have seat belts which we are required to wear by law. If we think of this as a public health intervention why then public health seems so ... obvious. A no-brainer, really.

When it comes to more charged issues like drug use or certain sexual practices we think are deviant (except for the time we paid a prostitute for it and have been trying to get partner to do the same but s/he always refuses), we balk. Common sense flies through the windshield like an untethered passenger and we're Should-ing all over the place once again.

I know better than to appeal to a moral imperative to protect people from preventable illness no matter how they might have contracted it. Instead I appeal to the cold bottom line: really sick people make health insurance more expensive and tend not to shop for new houses, cars or plasma televisions--which as we know means the terrorists have won.

There. I said it, and I feel gross but I would think this argument would fly in Bushland--I think. So far I can make no claims to understand Bushland. If I have been paying attention, the moral imperative is for war, people can sicken and die of preventable illnesses because we don't agree with their behavior, but shooting elderly friends in the face is perfectly acceptable. Someday I'll understand. I'm sure of it.

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