Some Self-Criticsm

Last night I read two notes on Facebook, posted comments on them both, and went to sleep. One of them was prompted by a priest that the author respected saying that the Catholic Church is the one true church and that other churches and religions are cult. It was generally about the arrogance of Christians claiming that they have the way to God to the exclusion of every other or most others. I wasn't up for debating the merits of the case that he outlined, so I just zeroed in on a statement he made about the truth:

"It is a touchy subject too; everybody seems to know the truth, and yet the truth itself is so fragmented and gap-toothed that it comes across as little more than an ugly carapace hiding some grotesque crustacean monster. Alright, that was a bit melodramatic, but inescapably true."

My response:

The truth's teeth, like all her other features, are perfectly beautiful. Unfortunately, like many of her other parts, it isn't easy for us to see them, and when we see them we often don't properly perceive what we see. We're rather like Flatlanders perceiving solids, or maybe hypercubes.

I think I still stand by what I said about Flatlanders, but I don't think I'm right about the truth being perfectly beautiful. Maybe she's perfectly whole, but I don't have any reason to believe that there aren't some parts of the truth that are ugly even for s/he who sees the truth in its entirety.

The other note was rather long. It was about some things the author was thinking about relationships. Unlike the previous note, my response was not targeted at any particular line, but at a few ideas he expressed. My comment went:

You mentioned two particularly interesting things: people trying to wield a special power over others who like (or love or have affection for) them, and people trying to change the people they like (or love or have affection for) and who return that like (or love or affection). There are good and bad forms of both these things. I think you've highlighted the bad forms.

For the first, you spoke of a sort of selfish 'love' that relishes in controlling another person primarily because of the power and feelings of control it gives. This seems to be a perversion of important parts about love, parts that involve putting oneself at the mercy of another/others through things like trust and just caring what the other person thinks. A good form of this, I think, is in using love to positively influence the beloved to do good and to be a better person. That's probably one of the best things about true love: it beautifies the beloved. If I love someone and she loves me back, I should use my special influence on her to help her overcome her weaknesses, capitalise on her strengths, and be the best person that she can be. She should become a stronger, more confident person. If she's a whore (and I can manage loving and being with a whore), she should become less of one until, ideally, she stops being a whore altogether. If she's the gullible, naive type, I should help her be wiser about what she says and who she trusts. My love should make her better, and likewise with her love for me.

The second bad form you talked about is a fake sort of love that loves who it wants someone to be without loving who the person really is. The good, 'true' form loves BOTH the person for who s/he is and for who s/he can and should be (and, I guess, who the lover *wants* him/her to be). This ties in with the first bad/good form pair. People can (and perhaps should) validly love both who a person is and the even more lovable person s/he is becoming.

The part on sex and monogamy is interesting. I often wonder to what extent humans are 'naturally' monogamous, and to what extent these monogamous behaviours and attitudes like the ones you mentioned are culturally conditioned. Our society's prevailing Christian ethic definitely promotes monogamy, but it seems that pride and competition have a large part to play in our view of monogamy. And as for the sex thing, can you imagine living in a society that attached almost no emotional significance to sex? Is that even possible?

I love the bit on being truthful in relationships.

I'm not going to reread that now, but my thoughts last night were that I didn't check to make sure that my use of s/he and him/her instead of just she and he was consistent, and that the comment was sloppy and imprecise in the use of the word love (and uh, why that bit in the first paragraph about like/love/have affection for???) and about whether it's the lover's love for the beloved or the reciprocation of that love that has certain effects.

I was so critical of my contributions that I kinda dreaded reading the responses. Perhaps unsurprisingly, though, no one has said anything along the lines of the withering criticisms I've had for my writing. The first person responded saying that my comment was well said (I suppose it was, but I still don't think the first part was true) and the second person hasn't responded to my comment on his note as yet.

Many times, I think I'm too harsh on myself.

A Grammar Rant

Kendall El 04 de agosto a las 19:06 · Comentar · Me gusta
Liverpool accept Alonso bid

Kamal El 04 de agosto a las 19:28 · Eliminar
"Liverpool ACCEPTS Alonso bid"

In this context, Liverpool is either a plain singular noun (the Liverpool Football Club) or a collective noun(the Liverpool football team). I think the first is more likely; in that case, the verb is obviously in the singular. If it is, indeed, the second case, then the noun should take a singular verb since we're dealing with a collective noun whose individual members are inconsequential to the meaning of the sentence.

I'm sure they taught you all this in Prep School. Don't let the silly British media and the ape-ish West Indian, Australian, New Zealandic, South African and Irish media ruin your grammatical sense. For once the Americans and the Canadians (perhaps by virtue of some Canadian ape-ishness) have it right.

Campbell's Summary of the SVG Constitution 2009

So the government† has finally taken the initiative and included the draft new constitution in copies of each of the three weekly papers printed on Friday, 31 July 2009. That's just in time for Emancipation Day (175 years, yay!), but a full two months after the 28 May 2009 date on the cover of the constitution bill. The 48-page newspaper pull-out also includes a four and a half page article titled A brief summary of the main proposals in the St. Vincent and the Grenadines Constitution 2009 by Parnel R. Campbell, QC, Resource Person of the Constitution Drafting Panel, Chairman of the Constitutional Review Steering Committee (CRSC) (2007-2009), and Chairman of the Constitutional Review Commission (CSC) (2003-2006). The document says that it's "A discussion paper presented to a Consultation hosted by the Windward Islands Farmers' Association (WINFA) on Wednesday 8th July 2009". That was just over 3 weeks ago.

So they're late, but better late than never, right?

Mr Campbell's article is especially useful and I expect that much of the commentary in the immediate future will focus on the things the article says, the things it doesn't say, and the man who wrote the article. I have nothing to say about the man and I sincerely wish that people participating in these discussions would try really hard to not spoil their points and arguments with personal attacks. I have some things to say about the document, though. I encourage everyone to read Mr Campbell's article. I'll try to get an electronic copy of it and make it available as soon as I can.

On a whole, I thought the article was great. It does an effective job of pointing out most of the major changes to the constitution, and it even includes some reasons for some of these changes. It talks about quite a few things (one can suppose this is because the constitution changes quite a few things) but, naturally, spends more time on some things than others (probably because some things are more contentious and important than others). Four major changes occupy more space than all the others: the change of our head of state from the hereditary British monarch to an indigenous President; the change in the electoral and parliamentary system from a strictly first-past-the-post system to a mixed first-past-the-post and proportional representation system; the reductions in the powers of the Prime Minister; and the increases in the powers of the Leader of the Opposition (who the new constitution would renamed the Minority Leader). In talking about these major things Mr Campbell draws on personal experience, talks a bit of history, and makes comparisons with other Commonwealth countries.

The article isn't without its flaws, though. Foremost of these are the things the article notably does not talk about. It does not mention the proposed changes in the amendment process. That is, it does not mention the reduction in the minimum period between the reading of the constitution bills from 90 days to 60 days, and the reduction of the majority required in the referendum from two-thirds to three-fifths. The article also doesn't say that the change of our highest court of appeal from the Judicial Committee of the Privy Council to the Caribbean Court of Justice would not require another referendum. As a summary, one can't expect the article to include everything, but I really don't think that the changes in the amendment process are insignificant omissions.

Still, as I said, it's well worth the read. It's certainly the best composed, most informative and best argued piece on the constitution that I've seen so far. So if you haven't read it yet, go pick up a newspaper, pull out the pull-out, turn to page 43, read the article that begins there, and let us know what you think.

*****

† I should say that I don't know that the government did this; I think it did, but I don't know. The pull-out is included in all three papers and there's a bit on page 43 about the constitution being published under the auspices of the Clerk of the House of Assembly, but I don't think these things confirm that it's the government that did this, and I haven't heard or seen anything else anywhere to confirm or deny it.

9 intriguing things about HIV/AIDS

Here's a list of things about HIV/AIDS that intrigued or surprised me when I first learned of them. I have to admit: in more than one case I refused to believe the claim until I had what I thought was enough evidence to persuade me to believe it. (One generally shouldn't believe a counter-intuitive claim because a good friend of yours said she read it somewhere on the Internet.) So when writing this, I did my best to support each of the nine points with (what I hope is) sufficient reasoning.

I'm sure that when many people see some of these things they'll ask why on earth I chose to put this list together. Wouldn't people be better off not knowing some of these things? Don't some of my statements trivialise the suffering of the hundreds of thousands of people infected with HIV across the region? Don't they undermine the efforts of our public-health sectors and non-governmental organisations? Isn't this just foolish?

Maybe. I sincerely hope not and I honestly don't think so, but maybe.

The thing is, though, none of this is conspiratorial. This isn't anything like evidence that HIV was brewed in a lab. This is stuff from free, public UN, WHO and governmental reports. This is Wikipedia and news stuff. This is Google stuff. This is stuff that's out there in plain sight for anyone who really bothers to look.

1. The risk of transmission of HIV/AIDS is much smaller than you probably think.

What do you think is the chance of you contracting HIV from an unprotected sexual encounter with an HIV-positive person of the other sex? Over 50? Near certain? 110%?

The actual figure is closer to 0.1%.

A person's risk of contracting HIV in an unprotected sexual act depends on the type of sexual act and his/her role in the act. A study published in February reviewed other studies on the per-act risk of contracting HIV in unprotected sex[1]. It reported that studies done in developed countries found that the risk of female-to-male transmission is around 0.04% and the risk of male-to-female transmission is around 0.08%, while studies done in developing countries found a female-to-male transmission risk of 0.38% and a male-to-female risk of 0.30%. (The authors suspect that the difference is due to poorer study quality, greater heterogeneity of risk factors, and under-reporting of high-risk behaviour in low-income countries.) The Joint United Nations Programme on HIV/AIDS (UNAIDS) 2008 report on the global AIDS epidemic cites a study of Ugandan couples which found that the chances of an HIV-negative partner contracting HIV from his/her HIV-positive partner of the opposite sex is about 8%...per year [2]. The study itself nicely provides an average per-act risk of 0.12% with a peak of 0.82% immediately after HIV acquisition and a low of 0.07% between initial acquisition and the late stages of AIDS just before death [3].

These figures are for penile-vaginal sex. What about other types of sex? Oral intercourse is the least risky; there is about a 0.0005% risk for the insertive partner and 0.001% risk for the receptive partner. On the other hand, anal intercourse is the riskiest type of intercourse. Estimates put the risk for the receptive partner at between 0.5% [4] and 1.7% [1], and the risk for the insertive partner at 0.1% [4]. That's between 5 and 21 times riskier than vaginal sex for the receptive partner.

For comparison, the studies cited by the Wikipedia article on HIV list the risks of the non-sexual modes of transportation as follows: Blood transfusion, 90%; Mother to child, 25%; Needle sharing drug use, 0.67%; Percutaneous needle stick, 0.3% [4].

*****

1. Boily M-C, Baggaley RF, Wang L, et al. (2009). "Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies". Lancet Infect Dis 9 (2): 118-129. PMID 19179227.
2. UNAIDS (2008). Report on the global AIDS epidemic. UNAIDS, Geneva. p. 43
3. Wawer MJ et al. (2005). Rates of HIV-1 transmission per coital act by stage of HIV-1 infection, in Rakai, Uganda. Journal of Infectious Diseases, 191:1403–1409. http://www.who.int/hiv/events/artprevention/wawer.pdf
4. Wikipedia article on HIV -- Transmission. Check the table to the right and the studies they cite.

2. Perhaps HIV doesn't discriminate, but it certainly doesn't affect all groups of people equally.

Certain groups are disproportionately[1] affected by HIV. These include prostitutes (or commercial sex workers as they say in HIV/AIDS-speak), injecting drug users and gay men. Knowing what is commonly taught about HIV/AIDS, it isn't hard to figure out why prostitutes and injecting drug users would be disproportionately affected by HIV. It's perhaps less obvious why gay men -- or, as they say in the HIV/AIDS epidemiological community, men who have sex with men (MSMs) -- are disproportionately affected. As a matter of fact, they were the first group known to be affected by the virus.

The virus that would later be termed HIV and the disease that would later be called AIDS were first discovered among gay men in the United States[2]. In some countries, men who have sex with men make up the majority of the male HIV/AIDS cases (despite being estimated to comprise between 5% and 7% of the male population)[3], and in many countries any man who admits ever having had sex with another man on his blood donor form is permanently barred from donating blood[4]. Men who have sex with men are also disproportionately affected in the Caribbean and experts believe that we underestimate how much of our epidemic is a result of sex between men, but they do not believe that our epidemic is significantly driven by sex between men [5]. In all but two countries, the AIDS epidemic is thought to be driven by heterosexual intercourse with roughly equal proportions of men and women having HIV and AIDS. The two exceptions are Dominica and Cuba. In both of those countries the majority of infected persons are men and sex between men is thought to be the main mode of transmission [6].

*****

1. A group X is disproportionately affected by HIV if the proportion of Xs in a population differs significantly from the proportion of Xs with HIV in that same population. For example, Xs are disproportionately affected by HIV if they make up 2-5% of the general population but 20-25% of the HIV-positive population.
2. This is fairly well known but many people may not have heard it since there's little reason for the Caribbean's HIV/AIDS campaigns to mention it. Evidence: This BBC article, this link on the US Centers for Disease Control website, and this random blog entry.
3. The USA, Canada and Australia are three such countries. Check here for the US, here for Canada and here for Australia. The 5% to 7% figure is in the link for the US.
4. See National Health Service of the United Kingdom, Exclusion of Men who have Sex with Men from Blood Donation Position Statement: 12th March 2009; National Health Service of the United Kingdom, Summary of International Policies relating to the Exclusion of Men who have Sex with Men from Blood Donation (March 2009); and Medscape Today, Debate Continues Over Blood Donation From Men Who Have Sex With Men 27 Feb 2009. I believe countries in the Caribbean have a similar restriction. In some countries, the person is only barred if he had sex with another man since ~1977. In others countries, the bar is not permanent and it may apply to the female sexual partners of MSMs. For example, the NHS document on international policies says that the bar in Australia is for 1 year since the last sexual encounter and applies both to MSMs and their partners (including women) and the bar in New Zealand is for 5 years since the last encounter.
5. UNAIDS (2008). Report on the global AIDS epidemic. UNAIDS, Geneva. p. 53
6. ibid, p 54

3. Not that many people in the Caribbean have HIV.

You may be accustomed to hearing that the Caribbean has the second highest HIV rate in the world, a rate second only to that of sub-Saharan Africa. Well, that's true. But have you ever wondered what the figures are? Is it that we're really close to them? Are we close but are both figures really that high? And what's our HIV rate?

The Caribbean's adult prevalence rate stands at 1.1%, just over one fifth of Sub-Saharan Africa's 5.0%. The world average is 0.8%. [1] By country, our adult prevalence rates range from a low of 0.1% in Cuba to a high of 3.0% in the Bahamas with notable mentions of Haiti at 2.2%, the Dominican Republic at 1.1%, Jamaica at 1.6% and Trinidad and Tobago at 1.5% [2]. (SVG's rate in the general population is at least 0.4% [3]. Not all countries report their prevalence rates; you can download your country's report here to see if it's given in the report.) Sub-Saharan Africa's rates range from less than 0.1% in the Comoros to 26.1% in Swaziland with notable mentions of Botswana at 23.9%, Lesotho at 23.2% and 4 other countries with rates over 15%. [4]

As you can see, although we're the second worst-hit region, the epidemic in Africa is considerably worse than the epidemic in the Caribbean.

*****

1. UNAIDS (2008). Global facts and figures 2008. UNAIDS, Geneva.
2. UNAIDS (2008). Report on the global AIDS epidemic. UNAIDS, Geneva. p. 230
3. St Vincent and the Grenadines UNGASS report, p 5. Internet link. The prevalence rate was clearly calculated by dividing the 472 reported cases by the 106,253 persons living in the country according to the census so it doesn't take into account those people who have HIV but haven't been tested for it. Since we don't have universal testing for HIV, this means that this figure is certainly too low.
4. UNAIDS (2008). Report on the global AIDS epidemic. UNAIDS, Geneva. pp 39, 215

4. HIV/AIDS prevalence statistics have been revised downwards several times in the past.

The Caribbean's measurement and surveillance are generally poor in almost every area that matters, but it seems that we aren't the only ones with problems when it comes to estimating the impact of HIV and AIDS in populations. Since most (all?) countries in the world do not have universal testing for HIV, statistical techniques are often [1] used to make educated guesses of the HIV prevalence rates of entire populations based on the rates of people who are tested. These techniques aren't always as accurate as we'd like them to be. In November 2007, there were widespread reports of UNAids having to readjust and revise statistics of the prevalence of HIV/AIDS downwards in several places around the world because of significant errors in the statistical models used to estimate national prevalences. (This is probably not usually UNAIDS' fault; the organisation can only go on the data it receives from governments and other partners.) The reports centred on a revision of the Indian estimate by 7 million people and on revised estimates in some African countries, but by looking at the UNAIDS reports over the years, it seems that the Caribbean is also one of the places where figures had to be adjusted.

UNAIDS has issued a global report on the HIV/AIDS epidemic at the beginning of every even year since 1998. The organisation also issues epidemic update reports at the end of every odd year. One only has to look at the figures for the 2003 epidemic update report and the 2005 epidemic update report to see that something is amiss. The 2003 report numbers the Caribbean's general HIV population as somewhere between 350,000 and 590,000 people with an adult prevalence rate between 1.9% and 3.1% [2]. The 2005 report revised these figures for 2003; it gives a general HIV population of between 200,000 and 510,000 with an adult prevalence rate of between 1.1% and 2.7% [3].

One can also see downward revisions of figures in the prevalence rates of some countries. In the Caribbean, the global reports have only consistently reported country statistics for the Bahamas, Barbados, Cuba, the Dominican Republic, Haiti, Jamaica, and Trinidad and Tobago. I'll take three of them to make my point, but you can check the statistical tables at the end of the reports to see the others. The percentage given in normal type is the percentage that was given by that year's report. The italicised rates in parentheses are revised rates given in a 2008 WHO/UNAIDS document on the history of the epidemic from 1990 to 2007 [4].

Haiti: 2001 6.1% [2.2%]; 2003: 5.6% [2.2%]; 2005: 3.8% [2.2%]; 2007: 2.2%.
Bahamas: 2001 3.5% [3.1%]; 2004 3.0% [3.0%]; 2005: 3.3% [3.0%]; 2008: 3%.
Trinidad and Tobago: 2002: 2.5% [1.4%]; 2004: 3.2% [1.4%]; 2006: 2.6% [1.5%]; 2008: 1.5%.

In each case, you can see that the current estimates are significantly lower than the estimates before 2008. This is most pronounced for Haiti and least pronounced for the Bahamas. Given Haiti's large population, it seems that the overestimates in Haiti are partly to blame for the bloated regional figures in the earlier reports.

*****

1. Often but not always. For example, it seems that Barbados, Trinidad and Tobago and Jamaica use such techniques, but at least some of the nations of the OECS don't. The calculation of SVG's 'prevalence' rate as note in point 3 of note 3 above suggests that SVG does not use such statistical techniques.
2. UNAIDS (2003). AIDS epidemic update 2003. December. UNAIDS, Geneva. p. 5
3. UNAIDS (2005). AIDS epidemic update 2005. December. UNAIDS, Geneva. p. 53
4. Figures for the normal type rates are from the UNAIDS 2002, 2004, 2006 and 2008 global reports, pages 198, 203, 530 and 230 respectively. Figures for the italicised rates are from Adult (15-49) HIV prevalence percent by country, 1990-2007, a WHO/UNAIDS document.

5. A study found that, genetically, black people tend to be more susceptible to HIV than people of other races.

A study released last year reported that a gene that protects black people from malaria also increases their vulnerability to HIV infection by about 40%. Strangely, this same gene apparently allows those people to live an average of two years longer than HIV-positive people without the gene. About 90% of Africans and 60% of African-Americans possess the gene. I have no idea what proportion of Afro-West Indians or people of other races have the gene.

As far as I know, this is the first and only study that has found anything like that. It hasn't been confirmed by other studies as yet, so it isn't quite scientific fact just yet.

UPDATE: A follow-up study[4] attempting to confirm the results of this first study[5] found evidence contradicting the first study. The second study's researchers found that there was no difference in HIV susceptibility or AIDS progression in people who possessed the supposed gene. While I saw news of the first study in the media, I'm yet to see anything on the second study. Many thanks to Meisha Bynoe for alerting me to this follow-up study.

*****

1. BBC News. "Malaria gene 'increases HIV risk'". 16 July 2008. http://news.bbc.co.uk/2/hi/health/7509210.stm
2. The Washington Post. "Genetic Trait Boosts AIDS Risks in Blacks". 16 July 2008. http://www.washingtonpost.com/wp-dyn/content/article/2008/07/16/AR2008071601539_pf.html
3. MedPage Today. "Anti-Malaria Mutation in Blacks Promotes HIV Infection." 16 July 2008. http://www.medpagetoday.com/HIVAIDS/HIVAIDS/10141
4. Winkler, Cheryl A et al. (2009). "Expression of Duffy Antigen Receptor for Chemokines (DARC) Has No Effect on HIV-1 Acquisition or Progression to AIDS in African Americans." Cell Host Microbe. 2009 May 21; 5(5): 411-413. ScienceDirect Link. You'll need to have an institutional login, connections or money to retrieve it.
5. He, Weijing et al. (2008). "Duffy Antigen Receptor for Chemokines Mediates trans-Infection of HIV-1 from Red Blood Cells to Target Cells and Affects HIV-AIDS Susceptibility." Cell Host Microbe. 2008 July 17; 4(1): 52–62. PubMed Central Link to entire document.

6. There are people who are resistant to HIV, there are people who seem immune to HIV, and there's this one guy whose doctor has apparently cured him of HIV....

Researchers have long observed that some people seem uncommonly resistant or even immune to HIV. It is now believed that certain genetic combinations confer virtual immunity to HIV, other combinations heighten resistance to HIV, and still others prolong the life of HIV-positive individuals by slowing the progression of AIDS. Knowing this, when an American man living in Germany who had been HIV-positive for 10 years needed a bone marrow transplant to treat his leukaemia, his doctor sought and found a compatible person who possessed the immunity gene. (White blood cells are produced in bone marrow.) It has been over two years since the man's transplant and he now seems to be HIV-free.

Unfortunately, this procedure is fairly expensive and rather dangerous. It is only used as something of a last resort to treat leukaemia patients and, even then, it kills up to 30% of the people it is used on.

*****

1. Wired. "Genetic HIV Resistance Deciphered" 7 January 2005 (or is that 1 July 2005?) http://www.wired.com/medtech/health/news/2005/01/66198?currentPage=all
2. The Independent. "Gene therapy offers hope of cure for HIV". 12 February 2009. http://www.independent.co.uk/life-style/health-and-families/health-news/gene-therapy-offers-hope-of-cure-for-hiv-1607227.html
3. The Wall Street Journal. "A Doctor, a Mutation and a Potential Cure for AIDS: A Bone Marrow Transplant to Treat a Leukemia Patient Also Gives Him Virus-Resistant Cells; Many Thanks, Sample 61". 7 November 2008 http://online.wsj.com/article/SB122602394113507555.html

7. Male circumcision significantly reduces the risk of men contracting HIV.

Several studies have found that male circumcision reduces the risk of sexual transmission of HIV from a woman to man in penile-vaginal intercourse by about 60%. As a result, the WHO and UNAIDS now recommend its use as part of the package of HIV-fighting measures [1]. Research is currently unclear on the impact of male circumcision on the sexual transmission of the virus from male to female and on its effect on transmission to the insertive partner in anal intercourse. Studies so far suggest that male circumcision does not significantly reduce HIV transmission in male to male sexual transmission [2].

*****

1 UNAIDS. "Male circumcision." http://www.unaids.org/en/PolicyAndPractice/Prevention/MaleCircumcision/default.asp
2. BBC News. "Circumcision HIV impact doubted". 7 October 2008. http://news.bbc.co.uk/2/hi/health/7656229.stm.

8. There's evidence that condoms may negatively interact with other anti-HIV/AIDS strategies.

This one is a tip back to the entry I made about that controversy the Pope got into in Africa some time ago. This time, though, I'll skip the Pope stuff and go straight into what the scientists on his side said. This is a repeat of what I said in that note.

The Irish Times[1] quotes Dr. Edward Green[2], the director of Harvard's HIV Prevention Research Project, as saying that "there is not a single country in Africa where HIV prevalence has come down primarily because of condoms". He claims that many of the reductions in African HIV/AIDS rates are because of reductions in the number of sexual partners that Africans have. The Catholic news Agency quotes him more extensively and even has him saying -- in some appropriately fancy scientific language, of course -- the same thing that some regular people argue: that condom use may increase risky behaviour[3].

And he isn't the only one. In 2003, Norman Hearst, a Professor at the University of California, San Francisco published a study on the effect of condom promotion on AIDS prevention in the developing world[4]. The study's summarised results:

Condoms are about 90% effective for preventing HIV transmission, and condom use has grown rapidly in many countries. Condoms have produced substantial benefit in countries like Thailand, where both transmission and condom promotion are concentrated in commercial sex, but the public health benefit of condom promotion in settings with widespread heterosexual transmission remains unclear. In countries like Uganda that have curbed generalized epidemics, reducing numbers of partners appears to have been more important than condoms. Other countries continue with high HIV transmission despite high condom use. Impact of condoms may be limited by inconsistent use, which provides little protection, low use among those at highest risk, and negative interactions with other strategies, such as partner reduction.

There are, of course, more than two people in the epidemiological community. In the CNA article Dr Green plainly says that his views aren't popular. But that, of itself, doesn't render them without merit.

*****

1. Irishtimes.com. "Harvard director backs pope on condoms". 30 March 2009. http://www.irishtimes.com/newspaper/world/2009/0330/1224243690652.html
2. His profile page on the website of the Harvard AIDS Prevention Research Project.
3. Catholic News Agency. "Harvard Researcher agrees with Pope on condoms in Africa". 21 March 2009. http://catholicnewsagency.com/new.php?n=15445
4. Hearst, Norman and Chen, Sanny. Condom Promotion for AIDS Prevention in the Developing World: Is it Working? 26 March 2003 http://www.usp.br/nepaids/condom.pdf

9. Your 'epidemic' probably isn't your epidemiologist's.

When most people hear the word 'epidemic' they think of a rapidly-spreading, deadly disease that infects a large proportion of the population in a region. They then understand a 'pandemic' as an epidemic that is widely distributed geographically, such as across continents or around the world. This seems to be a good description of the casual, non-scientific use of 'epidemic', but as the issue with H1N1 (swine flu) and raising the world flu pandemic level hinted at [1], it isn't the really the definition of epidemic. In fact, it isn't the definition that health officials mean when they talk about the AIDS epidemic.

One technical definition of an epidemic is "the occurrence in a community or region of cases of an illness, specified health behaviour, or other health-related events clearly in excess of normal expectancy; the community or region, and the time period in which cases occur, are specified precisely" [1]. The article I got that definition from goes on to point out that "the definition does not specify a minimum number of cases. The area covered by an epidemic may be limited to a small area such as a school classroom, or it may extend to include many countries. Epidemics may also last from a few hours to many years." Note also that the definition says nothing of the severity of the disease.

Note also the key phrase "...in excess of normal expectancy..." (emphasis mine). I don't know how it is defined and who defines it, but it seems that 'normal expectancy' -- what is considered a normal incidence rate for a disease -- depends on the disease being described. For a disease with an expected incidence rate of 25%, 50% would exceed normal expectancy; for a disease with an expected incidence rate of 0.1%, 1% would exceed normal expectancy. So while the word 'epidemic' tells us that the incidence of a disease is worryingly high, it doesn't tell us anything about the severity of a disease, nor does it tell us what proportion of the population has it.

I haven't been able to find out for sure what is considered normal expectancy for HIV or AIDS. Google has quite failed me there v_v. The only thing I've found is a reference in the 2004 report on the global aids epidemic to a generalised epidemic being where HIV prevalence is above 1% [3]. Is it still defined as that? If I had to guess I'd guess 'yes', but I really have no idea. Does this mean that a specialised epidemic in, say, women would be where their prevalence is over 1%? Once again, I'd guess 'yes' here, but, once again, I really don't know.

And does this mean that if our prevalence rate were only 0.4% it would be incorrect to say that there's an HIV epidemic in the general population of St Vincent and the Grenadines?

*****

1. I'm referring to the WHO's consideration of a flu pandemic purely in terms of how widespread the disease is without regard for its deadliness. This BBC News article hints to that and also talks about concern for the panic that declaring a flu pandemic might have caused. Check also the WHO's own pandemic scale, which says nothing about deadliness, and talk of devising a flu pandemic severity index in the US.
2. Green, MS et al. When is an Epidemic an Epidemic? Israel Medical Association Journal 2002; 4: 3 - 6. http://www.ima.org.il/imaj/ar02jan-1.pdf. This is a short, easy read on the different ways different people use the word 'epidemic' and the impacts those differences may have.
3. Page 24. The sentence, "By 2002, only 36% of low- and middle-income countries had a fully implemented surveillance system; however, 58% of countries with a generalized epidemic (where HIV prevalence is above 1%) had such a system."

**************

Some UNAIDS publications

AIDS epidemic update report archive
2001 AIDS epidemic update
2002 Report on the global AIDS epidemic
2003 AIDS epidemic update
2004 Report on the global AIDS epidemic
2005 AIDS epidemic update
2006 Report on the global AIDS epidemic
2007 AIDS epidemic update
2008 Report on the global AIDS epidemic

Catholicism and Carnival II

This is a follow-up to my previous entry Catholicism and Carnival. The responses [on Facebook] went a good distance towards helping me answer my questions. I started typing my thoughts on those responses with the intention of posting them as comments to that [Facebook] post, but I think they're long enough to deserve a blog entry of their own.

The main question was why does the Catholic Church not oppose carnival? My objective here isn't to criticise Catholicism, though I do realise that because of my position and the way I phrase my questions it may come across as though I'm doing that. What I want to do is figure out how the Catholic non-opposition and support for Carnival are justified within a Catholic framework. I'm basically wondering why the rationale for the evangelical condemnations of Carnival does not result in a similar Catholic condemnation of the the festivities. I realise that the Catholic church isn't the only one with such a stance, but I've chosen it for a variety of reasons, among which are that I know more about Catholicism than, say, Anglicanism, and because I think Catholicism typifies some of the other, older, established Christian denominations in this regard.

So to the follow up. People said lots of stuff in their comments. I'm using this note to address the points that were made in direct response to my questions. I commented on the other contributions in the comments section of the last note.

The reasons given for the Catholic church's non-opposition/support were:

• It's our culture; it's part of our identity. [Shanique]
• It's tradition. The church has not opposed (or has supported) carnival for years. [Kevon?, Kevyn, Anya]
• It brings in money. Carnival is profitable so it would be difficult for the church to oppose it. [Kevon, Anya]
• You can participate in Carnival without sinning. It isn't necessarily about excess. [Shaun, J'elle, Jomokie]
• We're small, so it isn't something that would've attracted the attention of the Vatican. [Shaun]

I hope I didn't miss or conflate any.

From the above, I'd first strike out the money one. It may be a pragmatic concern for some Catholics and maybe even some leaders in the Caribbean's Catholic Church, but I don't think it's an ideological one. I don't think it addresses how Carnival fits into the Catholic worldview or ethic. If anything, I think that such a reason would be outrightly and soundly rejected on ideological Catholic grounds.

On the matter of culture/identity, the only way I could see a Catholic cogently arguing from that angle is if s/he says it's part of his/her Catholic culture and identity. I say this because I don't see how any Christian could seriously argue that something tolerated, accepted or promoted just because it is part of a society's culture or identity. The "It's our culture!" cry simply doesn't interact with the kind of universal, objective moral arguments that Christians usually make. One can imagine or read about a hundred and one cultural practices (honour killings, female circumcision...) that would not hold up to a second's scrutiny in any discussion set in a Christian moral framework. Perhaps one could argue something like:

1. Since something is cultural and
2. Given another reason
3. We should do Ex or we shouldn't do Zed

But I don't see how one could just say "It's our culture!" alone and expect that to stand.

Now if someone argues that it's part of his/her Catholic culture and identity (and it seems that a case can be made there given Carnival's origin as a pre-Lenten festival), that quite naturally raises the question of why. Why is it part of Catholic culture? Why has it become a Catholic tradition? If we phrase the question in terms similar to the ones I initially asked we'd see that we're back to the start. Saying it's part of our Catholic culture and identity doesn't answer the question.

From there we could go nicely into the "It's tradition" reason, but I'll put that off for a bit because I think there's really something there. So before I get to that, I want to talk about the last reason that I find insubstantial. That reason runs something like "we're too small for the Vatican to pronounce on it". That sounds reasonable. But not everything is left up to the Pope or the Vatican to decide, right? Surely if there's an issue in a region then the priests, bishops and cardinal(s) of that region can come together and decide something, can they not? Plus, I gather that Brazil's carnival is rather like ours in the respects that I've outlined. I think Brazil has the world's largest Catholic population, so it is anything but insignificant.

So now to the "It's tradition!" reason. I can see how that would be compelling to Catholics. Whereas Protestants champion (or claim to champion) sola scriptura, Catholics are unapologetic about the role that 'Holy Tradition' plays in their faith. As most Catholics should know, though, in Catholicism there's a difference between common-t 'tradition' and capital-t "Holy Tradition". Whereas one is considered fallible and not truly an indispensable part of the Catholic faith, Catholics consider the other as authoritative as Protestants take the Bible. Granted that Holy Tradition is usually used to mean the teachings and practices handed down from the Apostles, the early Christian community and prominent later Christians, I don't think that any Catholic would seriously argue that the Caribbean carnivals are part of Holy Tradition.

So if it's a tradition it's definitely a common-t tradition. We're familiar with the history of Carnival, so we have an idea as to why that tradition has developed. It seems that good question can be raised as to why it was allowed to develop in the first place (see Jo-Ann's comment in the last note), but let's leave that aside for now and ask another question: why has it persisted after its initial development when, by almost everyone's assessment, the Caribbean's Carnivals have changed?

I think the Catholic answer to that question might be in the final reason: that Carnival isn't necessarily about excess and sin. A person can participate in and enjoy Carnival without sinning, without participating in its excesses, and without condoning the wrongdoing by his/her mere participation.

This seems like a very slim line to use as a route of escape, especially given the strict and largely consistent Catholic sexual and larger moral ethic. So far I don't think it works, but, as I said, the responses have moved me some way along understanding the Catholic position here, so I guess I'll work with this new-found understanding for now.

Catholicism and Carnival

I don't get the (official?) Catholic non-opposition and outright support for Carnival. I really don't. Does anyone know a sound rationale for it? How can a church with such a strong and apparently consistent sexual ethic not condemn the hypersexualised carnivals of the Caribbean? Perhaps it will help if I sketch the evangelical opposition to the practice. Maybe someone can identify where a Catholic worldview would identify a failure in our reasoning and show me why it differs on this. But before I do that, I'll try to outline my understanding of the supporters' position. (Maybe someone can also point out where I'm wrong in this.)

As any apologist who enjoys Carnival will tell you, Carnival is about culture and fun. It's about cultural expression that fuses the region's Christian and European traditions with its African and tribal traditions. It's about creativity. It's about having a good time. It's about social commentary -- airing the societies' problems in songs about poverty, gender inequalities, abuses and politics in creative ways. It's about showcasing women's beauty, talent and (lack of) knowledge.

But it's also a festival of and to the flesh. In the 'original' form that we still see in Trinidad and Tobago and Dominica, it's about a farewell to the flesh before the 40-day Lenten period. It's the time you free up and forget your inhibitions. It's the time we bend the rules of fidelity and make exceptions to our codes of integrity and decency.

And we can go further. As the Christian and other prudential opponents to Carnival say, it's also about excess. It's about sex, sex and more sex -- sex with (barely any) clothes on, protected sex, unprotected sex, sex between people who don't know each other, sex between unmarried people, and sex between a married woman and a man she isn't married to (yuh woman butting me!). It's about alcohol (the only thing better than rum is more rum!). And it's not about alcohol in moderation. It's about getting so drunk that you're brave enough to wind on that woman or sleep with that man. It's about those nights you hope you'll never remember with the friends you may very well forget.

With all this in mind, it's hard for me to imagine a coherent Catholic (or Anglican or Methodist or any other orthodoxish Christian) apology for Carnival. So, what's the reason? What're the arguments? What's excuse? Does anyone know?

And oh, I'm talking about the official (or semi-official or de-facto official) reasoned and/or revealed position of the church or the majority of its clergy here. We all know that in every denomination of Christianity the practice of the laity (and even the clergy) can differ widely from the church's official doctrine or accepted norm. This isn't about the hypocrisy of the young evangelical pastors who preach about abstinence and preach against carnival and end up drunk and wasted J'Ouvert morning. (Yes, that's a major issue, but it isn't the issue I want to deal with here.) This is about the pastors and priests and deacons and churches that don't see anything intrinsically or otherwise wrong with Carnival.

The Kite, or the Fall of Pride

The Kite, or the Fall of Pride
John Newton

My waking dreams are best concealed,
Much folly, little good they yield.
But now and then I gain when sleeping
A friendly hint that’s worth the keeping.

Lately I dreamt of one who cried
“Beware of self, beware of pride;
When you are prone to build a Babel
Recall to mind this little fable.”

Once upon a time a paper kite
Was mounted to a wondrous height,
Where, giddy with its elevation,
It thus expressed self-admiration:

"See how yon crowds of gazing people
Admire my flight above the steeple;
How would they wonder if they knew
All that a kite like me can do!

Were I but free, I'd take a flight,
And pierce the clouds beyond their sight,
But, ah! like a poor pris'ner bound,
My string confines me near the ground;

I'd brave the eagle's towering wing,
Might I but fly without a string."
It tugged and pull, while thus it spoke,
To break the string--at last it broke.

Deprived at once of all its stay,
In vain it tried to soar away;
Unable its own weight to bear,
It fluttered downward through the air;

Unable its own course to guide,
The winds soon plunged it in the tide.
Ah! foolish kite, thou hadst no wing,
How could'st thou fly without a string!

My heart replied, “O Lord, I see
How much this kite resembles me!
Forgetful that by thee I stand,
Impatient of thy ruling hand;

“How oft I’ve wished to break the lines
Thy wisdom for my lot assigns?
How oft indulged a vain desire
For something more or something higher.
And but for grace or love divine,
A fall thus dreadful had been mine.”

*****

The author, John Newton, wrote the lyrics to Amazing Grace.

With what before the Lord?

⁶"With what shall I come before the LORD,
and bow myself before God on high?
Shall I come before him with burnt offerings,
with calves a year old?
⁷Will the LORD be pleased with thousands of rams,
with ten thousands of rivers of oil?
Shall I give my firstborn for my transgression,
the fruit of my body for the sin of my soul?"
⁸He has told you, O man, what is good;
and what does the LORD require of you
but to do justice, and to love kindness,
and to walk humbly with your God?
~ Micah 6: 6 - 8 (ESV)

Hating Reason?

I told a good Internet friend of mine the other day that I hate moralising. I had just reasoned, fairly cogently, I think, in defence of the people who did not condemn outright the murder of one of three or so prominent American abortion doctors. And I hated it. I hated that I could come up with that reason; I hated that I could see a light under which I found that reasoning compelling. I hated my empathy. I hated, I think, reason itself. But I couldn't find a good reason to justify my hatred.

And that wasn't the first time I hated reason. I generally love reasoning and thinking about all sorts of things largely because the rudimentaries come easy to me and I think I am fairly good at it. In my teens I relished the chance to go online, read things, and spar with others. Back then, my biggest concern was thinking through my beliefs, trying to find ways to defend them, and trying to make corrections where needed. I'd pretend that human justifications are stricly rational, even if some of the premisses are hidden or something. I'd argue strongly for objectivity and absolutism, and against subjectivity and relativism. I'd think that finding a single, apparently irrefutable argument against a system should've been enough for someone to drop that system right there.

It's very different today. I still generally believe in objective truth and that the subjectivity is in experience, but I've been almost compelled to focus, it feels, more on the subjectivity of experience than the objectivity of the truth. I still enjoy reasoning to conclusions from premisses and discovering wonderful new things I didn't know. And I still learn sobering things that contradict what I believe and force me to change. But right now, I'm really, really preoccupied with some frustrating things about reason.

I sometimes hate the finality of reason. I hate how unavoidable some conclusions are because of certain premisses. At the same time, I hate the uncertainty of the finality of reason. There's always this thought near the back of my head that I could just be missing that piece of information or two that would drastically change the picture. Just because I've been checking and rechecking my working several times a month for the last seven years doesn't mean that I'm right. Maybe I'm forgetting something. Maybe I never knew it.

And perhaps most of all, I really hate what these things mean for my personal morality. When I was younger, I understood and accepted many of the moral teachings of my faith. But it was a sort of distant understanding. These things are plain, I thought. I get them and they're easy. I know people are different -- different people are tempted in different ways; but why do people still repeatedly do such wrong things when the moral imperative against them is so obvious and undeniable?

Well, today, I don't think I understand those things much less than I did then, but there are new pieces of things to consider. Hahaha. I now know firsthand why people do wrong things even when all their powers of reason tell them they're wrong. And it's exceedingly frustrating how good I've become at making excuses and crafting explanations. Although I find the existence of an objective ethic compelling, I find it hard to condemn people for almost anything. It's as though I think people's weakness is excuse enough to not demand good of them.

But, as you can imagine, I don't really think that.

And I feel as though this entry was crap.

Defining Marriage in our Constitution -- A Response to William and Paula

Following is a response to this post on a blog that I follow. I'm saving it for posterity.

*****

This is quite an interesting post, William. I think our society is a strange one. When I read Paula's letter, I didn't make much of it. There'd be responses, I wagered -- there always are. But I didn't expect anything like what you described on the panel.

I see at least three broad issues in your post. The first two -- protecting marriage and same-sex marraige -- are related and are as difficult to distinguish in your post as they are in the contentious clause. I suspect they'll be similarly difficult to distinguish in this response, but I'll try to set them apart where I can. The third is on the issue of separation of church and state. I'll start with protecting marriage in general.

It's worth noting, firstly, the entirety of section 17.

17. (1) The State acknowledges the family as the natural basic group unit of society. Consequently, the State accords the family recognition, respect, protection and support; asserting that men and women of the age of civil legal and societal responsibility have the right to marry and establish a family.

(2) The State shall protect marriage, which shall be a legal union only between a person who is biologically male at birth and a person who is biologically female at birth

The note in the left-hand column reads "The family". This isn't (just) about 'discriminating' against people who want to marry another person of the same sex. This is about making it clear that families are important to society. From this -- if, indeed, this clause matters as much as we're making it out to -- the government is mandated to continue supporting families, to protect everyone's right to marry, and to protect marriage.

Yes, and to protect marriage. The climate we're in makes it seem like this is purely an anti-same-sex (too many hyphens there?) marriage amendment. It is, of course, largely an anti same-sex marriage amendment. But it isn't entirely one. It sets out the norm for marriage and, in so doing, excludes many things, including same-sex marriage. Marriage is to be an exclusive union between two people -- one male and one female. This not only prohibits same-sex marriage, but it also prohibits polygamy (which is right around the corner) and other less-heard of things that some people call marriage, such as unions with animals, trees and inanimate objects. (I can provide links to news stories on people doing or wanting to do all of these if you wish.)

The next thing to note here is that the people who support this amendment aren't the only ones giving exclusive definitions on what marriage is. Perhaps they wouldn't want to put this definition into the constitution, but you can see from the language of the provision's opponents that most of them still think that marriage should be monogamous, that children shouldn't have the right to marry, and that marriage is something between two humans. It's really just a fairly modest modification of the Christian norm of marriage.

We may then note the context in which this definition of marriage occurs. You'll see that it comes on the heels of talk of the family and its importance, and on the right of everyone to marry. This strongly hints at something else -- the purpose of marriage. What is it? Well, Paula wasn't clear on what she thinks it is. She just seems to think that preventing consenting adults people from marrying someone of the same sex is discriminating against adults who want to marry someone of the same sex. That position is typical of people who think that a (or the?) purpose of marriage is for the state (or a religion) to recognise, formalise and 'bless' a union between two people who are in love with each other. That is, no doubt, part and parcel with the current understanding of marriage, but it isn't all. From the context, we can see that marriage is being linked to forming a family. 17(1) reads "men and women of the age of civil legal and societal responsibility have the right to marry and establish a family." This link between marriage and family is common sense. It is not universal (though one could argue that it should be normative), but it's common sense. It also parallels the first part of Article 16 of the Universal Declaration of Human Rights (http://www.un.org/en/documents/udhr/index.shtml), and it is quite clear from the fact that gays and lesbians fight for the right to adopt children and even for access to technology to have their own biological children.

The final thing to note here is that the mandate to protect marriage is broad. With this mandate, the provided definition of marriage, and the context of subsection 17(1) that links it to the family, a reasonable legislature and a reasonable judiciary can use this mandate to do some of the things that are mentioned, including to fight divorce and criminalise adultery (though I don't see that happening).

That just about covers the protecting marriage and same-sex marriage issue. There are some other things that you and Paula said that I should probably address, though.

I really can't say what the motivation of the drafters was, but I doubt it was to make BBC Caribbean. As you said, there is overwhelming support for this provision. If this were to be put to the ballot alone, I don't think any of us doubt it would comfortably pass the 66% threshold required. I think there may be less support among the 'young people' than the 'old people', but I doubt it would be significantly less. The origin of the amendment is apparently from the people, not drafters seeking additional airtime. The CRC's Revised Final Report of 2006 says that this amendment was proposed by many respondents. I quote from item 14 under A. General Comments (it's on page 6 of the paper version of the document that was on the government's website, page 13 in that same pdf):

The seriously contentious issues in Human Rights have been the question of capital punishment and the question of same-sex marriages. The respondents have been overwhelmingly in favour of the retention of capital punishment, and virtually unanimous against the notion of same-sex marriages. Many respondents told us that they had attended consultations for the sole purpose of stating their views on those two issues.

The issue is also mentioned in comment 350: Protection from Discrimination, where it is recommended (or it is noted that people recommended?) that the constitution make clear the definition of marriage as between a biological male and a biological female, and that, "in light of overwhelming public aversion to homosexuality", no further recommendations were being made. (I take it that this explains why the constitution does not add sexual orientation as a basis for claiming discrimination.) In light of this -- and the fact that every amendment like this eventually passed in every single US state where it was put to the ballot -- I think the Victorian-era origination of the law criminalising sodomy is of nearly no significance here.

I'm not sure what to make of what she says about married homosexuals. The things she describes are lamentable, but she can't really expect people who think that marriage should be between a man and a woman and that homosexual activity is wrong to agree with her that a way to fix this is to leave open the way legalise same-sex unions. Clearly, the truly homophobic won't care to address those issues. I'm not homophobic. I think that those things would be addressed if homosexual actions were treated like the more popular fornications, but I no more think that we should fail to establish a norm for marriage that excludes same-sex marriages than I think that, because of adultery and pre-marital sex, we should do away with marriage altogether.

For me, this isn't about beating up homosexuals.

She says that the issue is utterly insignificant in the grand scheme things. Obviously, none of us think it is. She wouldn't write the letter if she thought it were, and the seriousness of the orthodox Christian position on fornication is well-known.

I really, really don't see how prohibiting same-sex marriage amounts to according homosexuals second-class citizenship. Like every other usable word, 'marriage' has to be defined if it is to have any meaning, and it is in the nature of a definition to exclude some things when it carves out space for itself. Is she saying that her definition of marriage accords second-class citizenship to the people whose relationships it doesn't legitimise?

The issue of the intersexed is an interesting one. Firstly, though, it should be noted that the constitutional definition clearly deals with someone's sex and not his/her gender. The clear intention is to prevent those who undergo gender reassignment from marrying someone based on their reassigned gender. As far as I know, the biological definition of sex is concrete and immutable. The same isn't the case for gender. That being said though, the case of the intersexed must be considered, but that asks for a more fundamental redefinition of our understandings of sex. My preliminary statement would be that the intersexed are legally assigned a sex based on biological characteristics and would therefore be able to marry someone of the other sex.

I think that addresses most of the points in her letter. Now for the other ones in your post.

The law proscribes the behaviour of consenting adults all the time. But this isn't even about that. This provision doesn't outlaw sodomy; it outlaws same-sex marriage. Marriage is obviously more than a religious convention -- that's why (almost?) every country in the world recognises it and accords married couples special benefits. The human rights angle is interesting, but there are some people's rights that are often ignored -- the children's. It seems that France is, for the moment, holding out on legalising same-sex marriage and on granting same-sex couples adoption rights on the basis of the rights of the child. And I'm fairly certain that Sabrina's views on this issue do not represent the younger generation.

Finally, the matter of separation of church and state. Nothing happened to it because it never existed in St Vincent. In fact, I think it's only constitutionally required in three countries -- France, Turkey and the USA. Despite that, it's true that most developed countries have a de facto separation of church and state in most matters, and that even in the cases where they have state churches. Consider the case of the UK, where the Church of England holds seats in the House of Commons. I'm not sure what you mean by a 'morality bias', and even with my best guess as to your meaning, I don't know the point you wish to make with it.

Yeah, this can lead us down the path to theocracy. And secularism can lead us down the path to Stalin-like communism.