Utah Valley Global Health Group

A blog about global health for those living in Utah Valley and their friends.

Reconciling Moral Issues with Effective Policy by Aaron Anderson

Posted by benjamincrookston on April 8, 2008

I feel that one of the greatest complications facing public health officials today is reconciling “moral issues” with effective policy. I came to this conclusion while studying the efforts of the Thai government in its fight against HIV/AIDS.

Because of Thailand’s “vibrant” sex industry, HIV/AIDS spread rampantly in the country. Between 1989 and 1991, HIV infections rose from 3.5% to almost 22%. Infections in army conscripts rose six fold. Thailand appeared headed for a health disaster. However, thanks to the heroic, if not controversial, efforts of Thailand’s National AIDS Committee and its “100% Condom Program,” HIV was brought back under control.

Many health leaders in Thailand recognized that it would be impossible to stop people from visiting sex workers, so they sought a more pragmatic approach—they would make sex safe.

The so called “condom czar” of Thailand, Mechai Viravaidya spearheaded the effort. I watched a video of his efforts in which he explained that in order for the program to work, sex had to become less taboo. He explained that comedy had to become part of the campaign. Mr. Viravaidva impressed me with his efforts, however controversial they might have been. I was struck by images of him blowing up condoms like balloons in front of school children, handing out condoms wholesale in bars, and, most strikingly, him giving speeches in between strip shows about safe sex.

Viravaidva was primarily responsible for stopping the AIDS crisis in Thailand, however, I do not believe that such tactics would ever fly in the United States—and many other countries for that matter. Viravaidva created an innovative and successful program for his native Thailand, but replicating his tactics elsewhere probably won’t work. I think Thailand provides an excellent case study not necessarily for HIV prevention, but for demonstrating the importance of local leaders developing their own solutions for their own constituencies.

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5 Responses to “Reconciling Moral Issues with Effective Policy by Aaron Anderson”

  1. Kami Knudson said

    Having served a mission in Thailand I have seen some other side effects of Michai’s ‘fun’ HIV prevention programs: broken homes, a sex addicted nation and a government that endorses it. Sure, it can be argued that a government must choose its battles and that the lives saved by HIV prevention outweigh any other moral consequences. But with the support of the government, those that live have spawned a morally devoid subculture that is growing insatiably and is most destructive. We cannot let AIDS victims simply die, but when stark immorality is condoned, we choose to allow them and those around them suffer in other arguably more painful ways. But until we can quantify and validate heartbreak and sadness, AIDS is all we’ll get the funding for.

  2. chads said

    Kami and Aaron, thanks for your thoughtful post and comment. Very difficult issues! Then again, we’re not going to tackle difficult problems if we don’t address difficult issues. Here are a few quick questions that come to mind when thinking about challenges like AIDS that have so many moral, cultural, health, and political dimensions:

    -What is my current role? My approach might be completely different if I am a government public health official as opposed to a Mormon humanitarian missionary.

    -What does the data support? It seems to me that many have emotional responses to issues like condoms and AIDS. While I think it is reasonable to oppose, say, condom distribution on moral grounds, it seems that scientific data is misrepresented too often (“condoms aren’t effective” or “distributing condoms increases sexual activity”) to support those views. Taking a step back to take a good look at the evidence is crucial, I think.

    -Are my moral stances actually based on cultural tradition or political party positions, or are they actually based on moral principles?

    -How does what I believe and support fit in with everything else that is going on? What am I willing to compromise to implement a project or policy that is effective?

  3. Libby Miller said

    One of the most important things that I have learned from my public health education is that you have to look at health issues in a non-moral light. What is our job as public health educators and promotors – do we decide what is right and wrong and then help, or do we see a need a simply address it? I must say that the more I study I lean towards the latter. Of course if we were in a strictly LDS setting it may be different, but health is not moral. The issues may have a moral basis, but health innately is a state of being; it is due in large part to multi-faceted political, economic and societal problems. Our world is corrupt – people have sex at a younger age, there is more abuse (drugs, physically, emotional etc) and there are more health problems (many caused by man), but what would you do if your 15 year old daughter becomes sexually active with her boyfriend and refuses to change her habits. Do you fiercely punish her knowing those actions will only increase her desire to perfome the prohibited action, or do you educate her on safe sex and encourage her to use condoms for her own safety and well being??

  4. natalie said

    I heard an interesting question asked about what my reponse would be to those people who supported an abstinence only program. (Personally – I feel it’s the way to go.) But I also know that publicly – sex education is much more effective, and so as far as the public is concerned, I feel that sex education does need addressed in the schools more now, as it’s been proven to be a better program. People are more aware of what consequences their choices may or may not lead too. But along with that, is realizing that not everyone believes the way I do (in regards to abstinence only) and they’re going to make their own choices regarding their health – good or bad. I don’t know if I would personally call it a “non-moral light”, because for those who are not of the same faith I am, it wouldn’t make as much sense to them as “abstinence or non-abstinence programs”. But Libby brought up a good point when she brings out the fact that as health educators – it’s our job to take care of the problem or “…address it”. And she’s right, as it isn’t our job to judge morality. Whereas, it is up to us to find out why and what is causing the problem and how it can be fixed and the steps necessary to do that.

  5. Kaitlin said

    I am familiar with Mechai Viravaidya’s efforts in Thailand. There is no doubt that helped contribute to the success Thailand had with the increase of condom use and decrease in HIV that occurred at this time. The results were impressive. However, I disagree that a similar program could not be put into action in other countries. The general idea of the Thailand case was to put someone out there where the problem was occurring who could relate to the people and discuss this very taboo subject openly. The ability to talk about it, educate people, and raise awareness is what made this program so successful. If a person with a similar purpose were to do the same in another country in Southeast Asia or even in the United States, I believe there could be the same remarkable results. While we may not be able to replicate Viravaidya’s humor to help other countries, I do think we could find a similar public figure from that country to help spread the message of the spread of HIV/AIDS and ways to prevent it. This person would adapt his/her message to fit the needs and culture of the audience. Such an advocate and public figure would be beneficial to the fight against AIDS. I do not find moral opposition in the matter since I think the goal is to stop the prevention of HIV/AIDS in any and all methods that are possible. Abstinence should definitely be taught, but if this is not going to happen for everyone, something else must be done.

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