The model by pengtt


									HIV/AIDS: why prevention campaigns do (not)

                    Gani Aldashev
                CRED, University of Namur

   (based on research joint with Jean-Marie Baland, CRED)

   Puzzle 1: Why so little policy response
    to HIV/AIDS in the developing world,
    even in the countries with very high

   Puzzle 2: reversal in downward incidence
    and prevalence trends in the countries that
    have initially taken active stance against the
Success stories
   Uganda 1986: Museveni takes active stance on public
    awareness program
         “As mortality rises people began to respond, but the hope is that
          there is a way to short circuit this process. Uganda suggests that the
          only way to do this is through leadership creating the environment in
          which society can discuss these issues” (Whiteside et al. 2004)

   Thailand 1980s: no debate because of negative effects on
    tourism, in 1991, the prevention and control of HIV/AIDS became
    the top priority for the government, with massive public
    information program.

   Similar in Brazil, Senegal (with support of religious leaders!), and
Failure stories
   South Africa –Mbeki initially recognized the importance of the
    epidemic, and later on reverted to complete denial of the problem. In
    the elections in 2004, opposition parties campaigned on platforms
    proposing “free ARVs,” yet the ANC still gathered 70% of the vote.
    (Bor 2007)

   Kenya 1996 – Demonstrations orchestrated by religious leaders.
    President Arap Moi called to refrain from sex as the main prevention
    activity, and denied the importance of more active measures such
    as subsidizing condoms:

      “As president, I am shy that I am spending millions of shillings importing
         those things”
Important aspects

   Awareness and Effectiveness of Government Action
         “Southern Africans simply do not list HIV/AIDS as a political
          priority for their governments … it could be that people see the
          responsibility for HIV/AIDS to lie with individuals and
          communities rather than governments, perhaps because they
          do not believe that governments have the ability to deliver in
          this area” (Whiteside et al. 2004)
         “The failure of elected leaders to respond to AIDS may reflect
          a rational response to the demands of their constituents.
          Africans consistently rank HIV/AIDS low among their political
          priorities, preferring government action on unemployment, the
          economy, poverty, water, and crime” (Bor 2007)
Important aspects

   The Role of Discussions and Social Networks in
    creating political support for public action
         90% of Ugandans discussed AIDS with others compared to
          less than 35% of South Africans
         Stoneburner and Low-Beer (Science, 2004) show that the
          success in Uganda is strongly associated with communication
          about AIDS through social networks
Policy and awareness

Policy action affects the extent of public awareness
 and social network discussions
…but awareness in turn provides support for public

   It is important to consider both channels
       From public awareness to policy (via voting / other political
        mechanisms of representation)
       From policy to awareness (directly and via
        intergenerational transmission of knowledge)
The model: awareness

   We have built a simple model in which both the
    disease and awareness about prevention get
    transmitted across generations:
       Individuals are born healthy, but some of them get the
        disease from the older generation via sexual contact
        (« sugar daddies » in Kenya)
       Individuals are bborn unaware, but some of them get the
        information about prevention from the generation of their
The model: awareness

   3 types of individuals:
       Aware: provide political support for massive prevention
       Unaware: consider such campaigns ineffective (« positive
        cost, no benefit »), thus are against
       Conservative: regardless of the cost-benefit calculation, are
        ideologically opposed to campaigns
   The campaigns are conducted only if type-1
    individuals are a majority:

                 Naware > Nunaware + Nconserv
Stationary equilibria

   Two key variables in the model evolve over time:
       Rate of disease prevalence (alpha)
       Rate of awareness among the voting population (q)
   Stationary equilibrium: when these variables settle at
    some constant value
Stationary equilibria
Vicious circle
   First stable equilibrium:
       Low awareness, no campaigns, high prevalence

   « Vicious circle »:
       Relatively few people are aware about the prevention possibilities …
       … therefore, not enough political support for massive prevention
        campaigns …
       … little diffusion of information in social networks
       Consequences:
           High prevalence of the disease
           Few young people who are aware  not enough political support also in the
   This explains puzzle 1: countries like South Africa, Kenya, Nigeria,
    etc., are « caught » in the vicious circle
Virtuous circle
   Second stable equilibrium:
       High awareness, massive campaigns, low prevalence

   « Virtuous circle »:
       A large number of people is aware about the prevention possibilities …
       … therefore, sufficient political support for massive prevention
        campaigns …
       … diffusion of information in social networks increases
       Consequences:
           Low prevalence of the disease
           Many young people who are aware  enough political support to sustain the
            policy also in the future
Short run dynamics
Short run dynamics

   The „good‟ equilibrium is fragile:
       If the disease prevalence falls (temporarily) below
        a certain threshold, the aware citizens give
        political support for a smaller-scale prevention
           This induces a number of aware in the next generation
            which is too small to constitute a majority …
           … and in the future, the policy gets eliminated!
       This explains Puzzle 2:
           “Increase in HIV prevalence in Uganda is being fueled by
            complacency, as well as a decreased intensity of prevention
            programs, funding, and political commitment” (Munaabi 2006)
   How did countries like Uganda, Brazil, and Thailand become
    « success stories »? How did they manage to get out of the vicious
   Role of leadership
     Abdou Diouf (Senegal)

     Museveni (Uganda)

   What to do when leaders do not take active position against the
   Role for NGOs:
       Large concerted campaigns. Should be large enough to push the
        situation out of « vicious circle »
       Combatting complacency to preserve the « virtuous circle » (Uganda,

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