Sometimes we’re just like the rest of us

Not quite true?

As submitted to Daily Maverick

We’ve read plenty of opinion in Daily Maverick on Premier Zille and HIV in recent weeks. And while encouraging thinking and debate on HIV and Aids is crucial, emotive topics such as this lend themselves quite easily to caricature – perhaps especially when protagonists in the discussion describe opposing views using hyperbolic labels such as “fascist”.

In Sipho Hlongwane’s column linked above, he asks whether Zille’s followers agree with her views on criminalising HIV and if not, why their opposition is mostly silent. While I reject the implicit association of a political party and its policies with one individual’s views (even if that individual is the party’s leader), I’ve expressed my opposition to those views in a previous column.

A broader issue raised by both the idea of criminalising HIV transmission as well as something like the Get Tested campaign is the extent to which scientific knowledge should inform policy. To put the issue that baldly might lead to some shaking of heads, in the sense that it might seem obvious and unworthy of debate that our scientific knowledge should inform policy.

But judgements often need to be made, and regardless of what the facts might be, we know that many – perhaps the majority – of votes are cast on the basis of perception. This is part of the reason that it becomes plausible to accuse a leader of populism, as some critics of Zille have done in this instance, or for her to accuse critics of fascism or “slacktivism” (itself often a grossly unfair charge, in that the only voice most of us have comes from behind our computer monitors, from where we are typically not able to control the budgets of state organs).

What I mean is this: On the one hand, the issue of whether criminalising HIV is a good idea or not could be regarded as a simple one, answerable though data telling us whether doing so results in fewer cases of transmission. With Get Tested, we could ask whether the campaign results in more people knowing their status, thereby potentially entering the treatment and counselling net. (Briefly, on the topic of Get Tested, I must regretfully withdraw some of my previously expressed support for the campaign, now that we know that baseline figures for testing rates pre-Get Tested are not available – meaning that we have no way of knowing how effective the campaign has been.)

On the other hand, the issues can never be this simple, because even if we all agree that control of the HIV epidemic is our most pressing concern, other values can nevertheless limit our pursuit of that goal. But what if the data did show that criminalising HIV transmission actually worked, or that Get Tested resulted in a 10% increase in the number of people who were tested for HIV? Would opposition to these measures cease?

My suspicion is that they will not, because we seem reluctant to trust the data to inform policy above all else, and because we’re unwilling to regard ourselves as one trivial data point in the aggregate. We’re of course not trivial to ourselves, and justifiably fear (for example) the imposition on our time that mandatory HIV testing would entail. At the same time, we might be perfectly happy for our sexual partners to engage in such testing, and to hypocritically insist that they do so.

In other words, we assign individual agency a greater value than we do the collective good. Which is as it should be much or even perhaps most of the time, at least if you subscribe to broadly liberal principles. But liberal-minded folk are still part of that collective, and can sometimes benefit more as individuals by focusing on the good of that collective, seeing as there are so many more of them (capable of doing you harm or good) than there are of you.

One particularly interesting test-case involving this conflict between perceived impositions on individual liberty versus the good of the collective is blood donation; and in particular the question of whether the South African National Blood Service and their international equivalents should accept donations of blood from homosexual men.

Gay men who have had oral or anal sex with another man in the last six months (whether protected sex or not) cannot donate blood in South Africa. In the UK, the deferral period for this category of donor was recently reduced to one year, while a lifetime restriction still applies in the USA for men who have had any sexual encounter with another man since 1977.

The phrase ‘category of donor’ is key to the issue I am raising here: We don’t easily think of ourselves as belonging to a category, no matter how clearly the data shows that people of type X, or who engage in behaviour Y, on aggregate merit treatment Z. This is the curse that actuaries have to bear: Their models that price our insurance premiums or motivate for medical interventions such as those mentioned above are in constant competition with the Pythonesque reality of all of us insisting in unison that “We’re all individuals”.

But laws or insurance premiums can’t be tailored to individuals. As much as we are individuals to ourselves, interventions intended to work on aggregate have to treat us as belonging to a category – and the question then becomes how those categories are defined. And here, we need to start thinking about the least wrong way of doing this, and perhaps being more willing to tolerate principled ways of treating us simply as a number.

Legislation based on one person’s moral viewpoint, in opposition to the available evidence, is far closer to most wrong than to least wrong. And science utterly divorced from morality offers its own nightmares, as a Twitter friend reminded me in a conversation on this topic. I’ll return to the specific case of blood deferrals for homosexual men – and other “categories” of human – in a future column.

For now, though, the concern is this: Seeing as most of us know little about science beyond misleading headlines, and our understanding of morality is largely subjective, perhaps more of us should be willing to respond as that lone voice in the crowd did in Monty Python’s Life of Brian. When Brian told the crowd “You’re all different!”, and they responded “Yes, we are all different!”, his muted response was simply “I’m not”. And neither, most of the time, are the rest of us.

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