Elizabeth Pisani illustrates in her TED talk ‘Sex, Drugs and HIV—let’s get rational’ that rationality takes on a variety of guises. From a junkie’s perspective, it is rational to share needles with other junkies in order to minimize the risk of going to jail. From a policy maker’s perspective, it is rational to imprison drug users who are caught with a needle. This is because each person is trying to achieve a different goal. The end goal of the drug user is to achieve a fix; whereas the end goal of the policy maker is to minimize the circulation of HIV. I am in partial agreement with Pisani on this point. Achieving a fix is an irrational goal for a person because it harms his or her well-being. If rational decision making is fueled by irrational ends, then the means necessary to achieve that end are polluted. Therefore, although the decisions may have the appearance of being rational, they are inherently irrational.
One example of when people might put themselves at risk for rational reasons are clinical trials. Some people volunteer to ingest a particular drug that has yet to be FDA approved in a clinical trial. There is an inherit risk in these trials. Some side effects can be moderate to severe. In a few reported cases, some people have even died in clinical trials. Often, people volunteer for clinical trials in exchange for a sum of money. If a medical student’s goal is to pay off college loans, then participating in a clinical trial may be a rational means to achieve that end.
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"Sex, Drugs and HIV—let’s get rational".
Pisani claims that ‘people do stupid things—that’s what spreads HIV.’ Yet even Pisani admits that this is only a half-truth. This relates back to our discussion regarding means versus ends. If the end goal is to achieve a fix, then there are objectively rational means to achieve that fix. For example, sharing needles increases the risk for HIV. However, owning an individual needle increases the risk of getting caught and going to jail. If the end goal is to avoid jail and achieve a fix, from a rational perspective, sharing needles is an effective means to achieve that goal.
I agree with the statement, “people do stupid things—that’s what spread HIV.’ The actions of drug addicts are fueled by irrational ends. In short, the person’s rationality is polluted. When the entirety of an individual’s well-being is considered—from the physiological to the economical—the means to get high are as irrational as the end. Therefore, actions that are directed towards the end goal of getting high can be regarded as stupid.
Pisani raises the interesting point that treatment for HIV actually increases the need for other preventive measures. Pisani argues this on the grounds that HIV is less threatening, and more maintainable, than AIDS. This being the case, people with HIV are less likely to always wear protection during intercourse had they not been treated. Pisani provides statistics that illustrate rates of HIV are lower in countries where treatment is readily available. She also provides statistics that, within these countries, particular sects in society—such as homosexual males and drug addicts—are more likely to have HIV than other sects who have less intercourse. Given these statistics, it is hard to disagree with Pisani on this point. Other preventive measures for HIV could consist of providing large-scale needle exchange programs. This can prevent drug users from sharing needles and thus, decrease HIV circulation.
Pisani describes what is known as the ‘compassion conundrum’, which states people are more likely to empathize with AIDS victims than with people who are HIV positive. Specifically, people are more likely to view HIV victims with a degree of moral turpitude. This is because HIV is maintainable, whereas AIDS is not. As a result, society spends much more money on expensive drugs for AIDs, rather than on less expensive means to prevent HIV from spreading, such as providing clean needles for junkies. I think the compassion conundrum plays an important role in HIV/AIDS funding. In particular, people can empathize with other people who are suffering, as tends to be the case with AIDS victims. Since HIV is treatable, people are more likely to recognize the severity of AIDS and not the severity of HIV.
The speaker also noted that HIV is not as scary as AIDS as it was at the beginning of the epidemic. My personal perception of HIV is that it is a very serious condition but not a death sentence. Someone living in a country with a generalized epidemic might have a different perception of HIV. People in these populations may be much more fearful of HIV given its prevalence. Given the lack of immediate treatment, people in generalized populations may be more prone to empathize with HIV victims than people in developed countries. Someone living in a concentrated population may be less threatened by HIV. In these countries, people may view the disease as a condition latched to an irresponsible sect of society. This being the case, people may be less likely to empathize with HIV victims in concentrated regions. In addition, HIV victims who are drug addicts in concentrated countries may view not attaining a fix as worse than HIV.
