Saturday, April 26, 2008

Great Moments in Social Engineering

My ability to predict future events might require some fine tuning, but I confidently predict that this will be a miserable failure:
World Bank backs anti-Aids experiment

By Andrew Jack in London

Published: April 25 2008 22:25 | Last updated: April 25 2008 22:25

Thousands of people in Africa will be paid to avoid unsafe sex, under a groundbreaking World Bank-backed experiment aimed at halting the spread of Aids.

The $1.8m trial – to be launched this year – will counsel 3,000 men and women aged 15-30 in southern rural Tanzania over three years, paying them on condition that periodic laboratory test results prove they have not contracted sexually transmitted infections.

The proposed payments of $45 equate to a quarter of annual income for some participants.

The programme, jointly funded by the World Bank, the William and Flora Hewlett Foundation, the Population Reference Bureau and the Spanish Impact Evaluation Fund, marks an important step in the fight to tackle Aids, which claims 2m lives a year.

In spite of billions of dollars spent annually on treatment and prevention worldwide, there were about 2.5m new HIV infections in 2007, predominantly in Africa.

Carol Medlin from the University of California, San Francisco, one of the researchers, said: “We hope this ‘reverse prostitution’ will make people think hard about the long-term consequences of their short-term behaviour.”


How do you encourage long term behavior by delivering short term rewards? You can't bribe someone into personal responsibility. As with most Third World aid initiatives, the infusion of unearned cash will skew the entire economic and social landscape, with many unintended and generally negative consequences. When outside cash flows into an area, graft and criminal rackets are bound to follow.

If you think you'd be helping the school wimp by giving him $100 in lunch money to replace the $1 that the local bully stole from him, you'll just be condemning him to a series of beatings 100 times what he's used to by a veritable swarm of bullies. Might as well dress him in a chum overcoat and throw him into a shark tank.
The designers of the Tanzanian programme believe that payments of $45 when combined with careful counselling could play an important role in reducing HIV infection, especially for vulnerable young women.

If they're vulnerable then their behavior isn't within their control, is it? So a young woman whose husband frequents prostitutes and demands sex from her without a condom is now going to refuse him because she's getting money from outsiders? Do you think he's going to let her keep that money?

Even if this does work as a short term experiment, how do you scale it up? Are we going to pay all Africans up to 1/4 of their annual income to wear condoms?

Who do I call to cancel my subscription to the World Bank?

18 Comments:

Blogger Harry Eagar said...

I can't disagree with what you said, but the behavior of people with annual incomes of $180 can include rather different equations.

I have, for example, read a report of a father sending his barely pubescent daughter down to the lake to get a fish for the family dinner. No money involved.

I don't know how high you'd have to raise income to deter that sort of behavior. Higher than $225, probably.

April 26, 2008 1:25 PM  
Blogger lonbud said...

I am as skeptical of the machinations of the World Bank as the next guy, but there are glaring flaws in the logic of your criticism here, Duck.

Given the enormity of the problem and the relative pittance of the experiment to craft a solution, why not look for reasons and ways to see positive outcomes?

Why would you give $100 to the school wimp to try reducing bullying? Giving it to the bully would seem to be a more promising payout.

Why is the Africans' cash unearned? They are getting the cash in return for producing STD-free check-ups.

This item smacks of knee-jerk 1st-world bigotry: the World Bank is giving money away in Africa? It can't end well...

April 28, 2008 7:26 AM  
Blogger Susan's Husband said...

If you give $100 to the bully, you're encouraging every non-bully to become one. Recidivism would also seem a profitable strategy as well.

And note that even you admit that for Africa, one wouldn't be paying for lack of STDs, but only reports claiming the lack of STDs. Much cheaper and easier to get such reports than avoid STD catching behavior.

"why not look for reasons and ways to see positive outcomes?"

Because when messing about with other people's lives, it's better to be sure you'll improve them?

April 28, 2008 12:32 PM  
Blogger Harry Eagar said...

Man, if my daily income was 50 cents, I'd call $45 cash improvement.

Might not do anything about my sex life, but it could buy enough quinine to save my child's life.

April 28, 2008 2:49 PM  
Blogger Susan's Husband said...

You'd be unlikely to be buying quinine for your child after dieing of AIDS. If the payments encouraged more of that you'd still think it an improvement?

April 28, 2008 6:28 PM  
Blogger Harry Eagar said...

Somehow, you've leaped from a program that might not be effective to a program that accomplishes the opposite of what its sponsors want.

That's quite a leap and it seems highly speculative.

April 28, 2008 8:15 PM  
Blogger Susan's Husband said...

It's a pretty common leap in real life, particularly for any government program that tries social engineering through incentives.

But you've bait and switched again — lonbud's question was "hy not look for reasons and ways to see positive outcomes?" Unless you're going to state that such perverse outcomes are so unlikely as to be irrelevant, then it's a possibility one needs consider, which is a reason not to just "see positive outcomes".

April 28, 2008 10:02 PM  
Blogger Harry Eagar said...

Oh, you just don't like it because its a government program?

Like private business programs never backfire? Ever hear about Detroit auto discounts?

April 29, 2008 9:24 AM  
Blogger Susan's Husband said...

No.

No.

Yes.

April 29, 2008 10:31 AM  
Blogger Bret said...

A recent and incredibly tragic unintended consequence in Africa:

"In the developed world, we like to think of slavery as a bad memory. But slavery persists to this day, particularly in some parts of Africa, most notably the Sudan. Raiding parties steal children from their home villages and transport them for sale in slave markets many miles away. In the 1990s, when news of this ongoing tragedy came to the developed world, well-intentioned people formed charitable foundations that raised money for slave redemption—that is, buying people out of slavery.

"Did these charitable efforts do any good? Certainly, some people are free now who might otherwise of have lived their whole lives in slavery. But there is strong evidence to suggest that slave redemption made the overall situation worse. As journalist Richard Miniter reported in a 1999 article in the Atlantic Monthly, the high prices offered by relatively rich Americans increased the demand for slaves, turned the slave trade into an even more lucrative business, and thereby gave raiders an incentive to conduct even more slave raids. If not for the activities of Western charitable organizations, many of the redeemed slaves might never have been enslaved in the first place!"


Not that this attempt will end up quite that bad.

April 29, 2008 3:58 PM  
Blogger Harry Eagar said...

This comment has been removed by a blog administrator.

April 29, 2008 7:26 PM  
Blogger Harry Eagar said...

This comment has been removed by a blog administrator.

April 29, 2008 7:26 PM  
Blogger Harry Eagar said...

The history of slavery offers a better example of how to do it.

Once Britain offered a bounty for every Middle Passage concluded without the death of a slave, deaths went down to almost zero.

April 29, 2008 7:26 PM  
Blogger Duck said...

Given the enormity of the problem and the relative pittance of the experiment to craft a solution, why not look for reasons and ways to see positive outcomes?

The pittance of the solution may be minor with regard to the entire continents woes, but it will be a real problem for the small community that this experiment is inflicted upon.

You should look for positive outcomes in places where you should reasonably expect to find them. History has repeatedly shown that social engineering does not lead to those positive outcomes. Africa has borne the brunt of way too many of those well meaning but naive efforts. At what point do you learn from your mistakes?

Why is the Africans' cash unearned? They are getting the cash in return for producing STD-free check-ups.

Because STD-free check-ups should be a basic self-care behavior that any responsible adult would practice out of self interest. The payoff for getting STD-free checkups is good health. Noone should expect to get paid for taking care of themself. Will you pay me if my next dental checkup shows no cavities? If not, why not? Haven't I earned something by taking good care of my teeth?

This item smacks of knee-jerk 1st-world bigotry: the World Bank is giving money away in Africa? It can't end well...

No bigotry at all. Giving money away is corrupting wherever it is practiced, whether in the Third World or the First. Our inner cities are proof of that.

April 30, 2008 11:31 PM  
Blogger Kristin said...

Interesting responses here, but there are a few things missing.

If the FT is representing the protocol proposal adequately, then there is a HUGE problem with the placebo end of the study. That is, one half of the participants get paid, the other doesn't. As someone who spends a lot of time doing research in Africa, I can say that proposing a clinical trial where the researchers create a closed system of **manufactured inequality** on top of the existing inequalities and power differentials that Duck points out, is only asking for trouble.

Moreover, it is not ethical for a university or the World Bank to release aspects of the protocol when in fact the the Institutional Review Board has not authorized researchers to actually include such aspects in the design.

Lastly, there are a gazillion well funded research projects that have shown that poverty and inequality are the overarching structures that contribute to the rapid transmission of HIV and other infections. What will this project tell us that is new? I can already tell you the outcome of such an endeavor and it won't be worth the potential mess that can get created here.

May 06, 2008 5:54 PM  
Blogger Duck said...

Hi Kristin
You make some good points. I do take issue with one, though:
Lastly, there are a gazillion well funded research projects that have shown that poverty and inequality are the overarching structures that contribute to the rapid transmission of HIV and other infections.
I'm wondering if these research projects are well funded mainly by organizations that have an ideological bias toward finding that poverty and inequality are the culprits.

And which manner of inequalites are we talking about? Inequalities in wealth between the haves and have nots, or inequalities in social power between men and women? If its the latter I might find some ground for agreement. One study that I read said that one of the main vectors for transmission in Africa was long haul truckers, who pick up the disease from prostitutes along their route and then give it to their wives and girlfriends.
And the poverty and inequality explanation doesn't sit well with me because it ignores social and cultural factors. How much does the lack of a scientific mindset and the persistence of religious superstitions contribute to the decisions that people make to engage in risky sexual behavior? Many Africans continue to think that AIDS only afflicts homosexuals. International organizations are loath to pass any cultural judgments on the peoples that they minister to. On the contrary, it seems like they are often on a mission to sanctify traditional cultural ways, and to hermetically seal then in against the affects of globalizing influences.

May 06, 2008 10:11 PM  
Blogger Kristin said...

For years now, a chunk (likes hundreds of millions of dollars) of NIH funded studies and indeed much World Bank and development organizations, not to mention national governments have funded a lot of research that asks questions about health disparities. The answers are almost always fairly predictable and almost always the same: inequality produces differential access to health care.

When I refer to inequality it includes all those that you list and more. But the thing that needs to be understood here is that there are relationships between overarching political/ economic structures and social/cultural structures. These are not mutually exclusive as social relations do tend (but not always) to get built around economic determinants. So, what may be cast as "cultural" may in fact be a form of economic, or even political strategy that leads to either attempts to survive or attempts to gain status (in order to access more money), etc etc. Culture is never an island, where things just happen and people just do things because it's their "culture." We need to move beyond these National Geographic stereotypes of people and pay more attention to the entire context of their actions.

I would be careful with the "lack of scientific mindset" and "persistence of religious superstitions" analysis for several reasons. The money that has gone to fund NGOs and not public health care systems over the last fifteen years in Africa means that there is now a highly AIDS-literate population in most countries - not a 100% but still fairly literate. I can safely say that poor people in some of these countries have a better understanding of HIV transmission than nearly all my US undergraduate students - in any class I teach on this, maybe two percent have some knowledge of HIV coming into the class.

In terms of religious superstition - I'm not sure which religions you are referring to, but Christianity and Islam are the predominant religions throughout Africa. There are more churches and mosques on the continent that do AIDS education than in the US - mostly due to the religious-based funding that is available internationally. Indeed we can extend any problem of religious superstition to the Bush administration because his emergency AIDS program has created an international controversy (and law suits) - the policy itself is driven by the "superstitution" of U.S. fundamentalist Christian values (which are *very* different from the "superstition" of African fundamentalist Christian values).

In the last ten years of doing research on AIDS in different African countries, I have to completely disagree that most Africans think that HIV only afflicts homosexuals. This simply does not reflect most people's reality in Africa- never has - as HIV infection has always occurred via heterosexual transmission for the most part. Homosexual transmission is hardly ever even discussed in Africa - a problem in and of itself. But this certainly is a stereotype found in the US, despite the fact that the majority transmissions are heterosexual at this point.

So all of this is to say that the stereotypes that you use, including the long distance truck drivers (which yes, provided some of the primary vectors during the 1980s and 1990s but that's no longer the case) still persist despite the many changes that have taken place.

May 09, 2008 8:28 AM  
Blogger Kristin said...

Also, in terms of the "determinism" of international aid agencies - I have my problems with them, but what usually happens is the opposite of what you suggest: their values are imposed on local NGOs more so than this idea that they bend or cave to some notion of "backwardness". I've never seen this and I do research on this area. I'd be interested to see what research suggests this pattern. Watch this short video, which will show how people living with HIV in Nigeria are taking action on their lives. This is the kind of activity I am accustomed to seeing - I hope it helps to clear up some of the stereotypes: http://youtube.com/watch?v=ZCqEzwBP85k

May 09, 2008 8:46 AM  

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