Sunday, December 13, 2009

Occam's razor and the debate about condoms in Africa

“Keep your eye on the ball.” A case for the ethical use of condoms to combat the spread of HIV/AIDS
Fire at Samuel Wesley's House

HIV/AIDS is a medical problem.

Occam’s Razor: entia non sunt multiplicanda praeter necessitatem, "entities must not be multiplied beyond necessity." It is also expressed this way: Numquam ponenda est pluralitas sine necessitate, "Plurality ought never be posited without necessity".

Promoting the use of condoms is an ethical and necessary step towards preventing the spread of HIV, and that the conversation about the use of condoms to stem the spread of HIV in Africa has to be kept simple and direct.

Only unencumbered language will allow us to arrive at an effective strategy to stop AIDS. That has to be the goal – reduce the rate of HIV infection among poorer African populations. Considerations from other disciplines, practices, myths, cultures, religions, or magic cloud the thread of the argument.

Here is an analogy that I hope brings home some of the contending impulses that get in the way of thought and action.

Imagine that you are walking along, minding your own business, and suddenly you notice a crowd standing around a huge building that is being engulfed by flames. I think all of us would agree that the most human, immediate response would be to alert the people inside that there’s a fire, to call the fire department, organize a bucket brigade, and help get those in harm’s way to safety as quickly as possible with the least risk to yourself and anyone else close to the flames.

But when you begin to take any action – grab a bucket, ring the fire alarm, shout to people in the building so that they might be able to find a way out – various subgroups among the bystanders try to stop you.

One group says that one floor of the building has been taken over by crack heads and that it’s better to let them burn than possibly influence their kids and turn them towards the path to addiction.

Another group says that there are whores living in a part of the building and they spread venereal disease and, besides, the injunction in their holy books says that prostitution is punishable by death. The fire itself is their god’s wrathful punishment.

Another man says that his wife is on one of the upper floors, but that she has been unfaithful, and is a burden. It makes no difference to him whether she lives or dies. He is cheered on by a larger group of men who do not believe that men should put themselves in danger by trying to rescue any women.

Another group of women say that they will blockade any intervention because their husbands are in the building, each and everyone is HIV infected, and the fire is the hand of god saving them from certain infection.

A group of priests stand by and say that the only possible solution is to avoid fires. They also claim that it is immoral to intervene in a situation where the laws of nature have been violated – they have certain knowledge that the fire was set by an arsonist who is doing the devil’s work. And finally they claim that dousing the flames with water will not work in cases like this anyway.

A group of social workers stands to one side shaking their heads and says that this situation could have been avoided entirely if the basic needs of the folks in the burning building had been meet, if they had been educated, fed, given classes in self esteem.

Meanwhile the fires engulfs floor after floor. More and more people die. The professional firefighters cannot do what they know how to do. They know for certain that fires are extinguished by suppressing the flames with water or chemicals, and they also have also been trained to handle emergency catastrophic fires and reduce the loss of human life. But they cannot do their job.

Each group has very sound reasons for blocking the intervention of the firefighters. The group opposed to drug addicts point to tons of studies that prove that proximity to drug addicts increases the risk of addiction. The group that is content to let prostitutes die shouts age-old taboos about sex and virginity to justify themselves. The man whose unfaithful wife is going to be burned feels justified because his honor will be satisfied. The women whose husbands are HIV infected feel that finally nature has set about to reset the balance of power between the sexes. The priests use myth about being possessed by the devil to justify their claim that water will not put out these flames. The social workers feel that their profession might finally be recognized for the possible benefit for all mankind when finally the fire has taken its toll and they can sift through the ashes.

Here is a modern gloss of Occam’s razor: any good baseball coach teaches young players to keep their eye on the ball. It is that simple – there is only the ball flying through space, only you with a bat, or your glove, can stop its trajectory. When you hear people screaming at you from the stands, “if you catch it, you’ll be no better than the devil, you’ll go to hell, there’s a spell on that ball, it carries drug addiction and disease,” what do you do? Eliminate the noise as best you can.

Entia non sunt multiplicanda praeter necessitatem.
HIV/AIDS is a medical problem. Nothing else.