January 14, 2016
I’m suffering from a head cold right now. Yes, contrary to common sense, the common cold also exists in Africa. This is potentially as surprising as the time I saw a squirrel in my yard chewing on an unripe guava as if it was the most normal thing in the world. Shouldn’t that squirrel have been a monkey? Shouldn’t this cold be malaria? Or dengue fever? I guess I really shouldn’t be complaining. I don’t want malaria. This cold is doing enough damage to my morale and productivity as it is. To make things worse, it hasn’t rained in a while so the cars driving too quickly down the dirt road outside are causing a cloud of dust to continuously roll through the open windows. That cloud of dust, before settling on the furniture and in my sinuses, is mixing with the smoke from the neighbors’ burning trash to create a literal fog in the room that is perfectly aggravating the metaphorical fog in my head. All of this means that writing a blog post - a task that usually comes easily to me - has become difficult. I keep finding myself blankly starting through the fog of dust and smoke, focusing on nothing except the throbbing in my head.
This is not meant to make you feel bad for me. It is actually intended to illustrate the point of this post. I want to champion the power of CARE for AIDS’ holistic approach - namely, the fact that we care “both physically and spiritually” for men and women living with HIV - by discussing how poverty and disease are holistic problems. Let’s do this by moving away from my head cold and taking a more academic approach.
Esther Duflo is a French economist, Co-Founder and Director of the Abdul Latif Jameel Poverty Action Lab, and Professor of Poverty Alleviation and Development Economics at MIT. In 2013, Duflo gave a speech at Standford University titled, “Hope, Aspirations, and the Design of the Fight Against Poverty” in which she discussed the relationship between hope - or lack thereof - and the tendency of poor people to be trapped in a cycle of poverty. Now, this might not immediately seem applicable to the work of CARE for AIDS, because we do not exist, primarily, to alleviate poverty. We do, however, work with people living in poverty. Our program is designed to economically empower people living with HIV as just one aspect in our efforts to equip them with what they need to end the cycle of disease and poverty in their families. Duflo’s speech - and her research - apply to our program even more so because it supports the concept that issues like poverty and disease must be approached holistically. The main point of her research is that a @@lack of hope leads to inaction@@. Basically, even if opportunities to improve your situation exist, you will not take advantage of them if, in general, you have no hope. To state it in the postive, Duflo argues that @@hope functions as a capability that allows people to reach their potential.@@
We see this play out negatively in the context of the global HIV epidemic. According to the World Health Organization, @@59% of people living with HIV are not accessing treatment.@@ In most cases, this is not because treatment isn’t available. It is because there are psycho-social barriers to people taking action to receive treatment.
Duflo explains the relationship between hope and poverty in her speech with two main points. First, she claims with evidence, that stressful conditions, such as those associated with poverty or living with a chronic disease, lead to an increase in cortisol production, which in turn leads to a reduced capacity for rational decision-making. People who are stressed are less likely to make rational decisions to improve their situation. Coritsol acts like my head cold by making people inactive and unable to make good decisions.
Second, she claims that people living in poverty tend to spend less time thinking about the future than those who have brighter prospects. Basically, because the poor face conditions that are difficult, overwhelming, and unlikely to improve, they avoid thinking about ways they could improve their situation or ways they could at least avoid making their situation worse. Not thinking about your situation may decrease your tendency to become depressed and worried, but it also decreases the likelihood that you will take steps to improve your situation.
Taking these two points into consideration, you can see how detrimental it can be to someone who is already living in poverty to find out that they are living with HIV. Think about this example of one of our clients in Kisumu who says that @@when he told his parents that he was HIV-positive, they started digging his grave.@@ If your grave is being dug, what motivation do you have to take your medicine? Or go to work? Although this example is an extreme one, the narrative that exists for people who find out they are HIV-positive is one that tells them there is no hope and they have no future.
In light of Dulfo’s research, it becomes clear that the only effective way to help people improve their situation is to provide solutions that inspire hope. We could provide treatment-adherence counseling, nutrition training, economic training, and all the other things that we provide at CARE for AIDS, but if we didn’t also address this lack of hope, then there would be no motivation for our clients to apply the training they receive and we would see little impact. The reason our program is effective is because we provide people with the skills and knowledge they need to live a long, healthy life with HIV, and we do it in a way that restores people into community, builds their self-confidence, and reminds them that there is reason to hope.
That client in Kisumu registered for our program while his parents were digging his grave. At the end of the nine months, he stood in front of his fellow graduates, and proudly stated, “I will live to see my grand children.” That resolve and confidence means that he will now actively take steps to improve his life and the lives of his children, because he believes that he is no longer just waiting for his grave.
In First Corinthians 13:3 we are reminded that @@we could give all of our possessions to feed the poor, but without love, it would be worthless.@@ So we see that the Bible is in agreement with leading poverty-relief research. People need more than to have their physical needs met. They need to be loved and they need to be reminded of hope. That is why CARE for AIDS exists to care for men and women living with HIV both physically and spiritually.
If you are interested in reading more from Duflo check out the book "Poor Economics: A Radical Rethinking of the Way to Fight Global Poverty" by Abhijit Banerjee and Esther Duflo