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Sick Cure

Mark Weston at Global Dashboard has a plan to reduce the spread of AIDS, based on a proposed World Bank scheme to fight sexually transmitted diseases in Tanzania. It’s simple: give cash rewards to those who test negative, The Bank will pay 3,000 Tanzanians $45 – good money in Tanzania – if they regularly test […]

Mark Weston at Global Dashboard has a plan to reduce the spread of AIDS, based on a proposed World Bank scheme to fight sexually transmitted diseases in Tanzania. It’s simple: give cash rewards to those who test negative,

The Bank will pay 3,000 Tanzanians $45 – good money in Tanzania – if they regularly test negative for sexually transmitted infections (though not HIV, which is more expensive to test for but for which diseases like gonorrhoea are a good proxy).

Weston thinks the initiative should be expanded to deal with AIDS. He writes,

You might think that not dying of AIDS would be reward enough for practising safe sex. In an environment where people have little to hope for, however, and thus no reason to make plans, you’d be wrong.

Weston means well, of course. But this is surely a wrongheaded and very dangerous idea. They may call it “reverse prostitution” at the World Bank, but it’s more like reverse charity: give alms to the healthy, turn away the sick. (Weston does not mention what happens to the poor African who tests positive, but he or she must be punished for the scheme to work). Surely it is in fact AIDS sufferers who need financial help the most? Would the money not be better spent on anti-retroviral drugs for people who are actually dying?

There is, moreover, something deeply sinister about this particular brainwave. The notion of rewarding the fit and punishing the diseased carries a strong whiff of the Third Reich. Indeed the idea amounts to a sort of monetary eugenics. It’s just like recent plots in the UK to punish smokers who refuse to quit by banning them from treatment, or turning fatties away from hospitals because they won’t stop being obese. Only it’s worse.

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