If you are interested in HIV prevention, at some point you are likely to have heard “transactional sex” discussed as one of the issues. However, I find this discussion to usually be awkward and confused, especially among Western audiences: the user is feeling somewhat uncomfortable using the term and the audience is having trouble understanding what it is she exactly means. The frameworks we have in the U.S. are dating on one end and commercial sex work on the other.
To get children to attend school in developing countries, our approach has been primarily to assume that the schooling that is available is worth pursuing, meaning that the problem must be with some barrier to go to school despite a great desire to do so: perhaps the family cannot afford the costs of schooling; perhaps the schools are not good or too far; perhaps the children want to be in school but the parents prefer food today to educated daughter tomorrow; maybe people don’t know the value of schooling, etc.
With funds devoted to HIV/AIDS declining, there has not been a better time, at least in the past decade or so, to optimize the use of the limited resources between treatment and prevention.
Update: As if on cue, the Washington Post published an article (on January 19, 2012, 3:42 PM EST) that says:
For the World AIDS Day, there is a sign at the World Bank that states that taking ARVs reduces rate of HIV transmission by 96%. If this was last year, a sign somewhere may well have read “A cheap microbicidal gel that women can use up to 12 hours before sexual intercourse reduces HIV infection risk by more than half – when used consistently.” Well, sadly, it turns out, so much for that.
Since I reviewed, back in April, the paper by Ashraf, Field, and Lee on the effect of providing vouchers for injectable contraceptives to women in reducing unwanted pregnancies in Lusaka, Zambia, I had been worrying about the use of these modern, convenient, and reliable technologies in those parts of the world in which HIV is highly prevalent.
In this article in the NYT from a few weeks back, there is this quote from Dr. Stefano Bertozzi, director of H.I.V. and tuberculosis for the Bill and Melinda Gates Foundation:
An interesting, recently revised working paper by Duflo, Dupas and Kremer looks at the effects of providing school uniforms, teacher training on HIV education, and the two combined. This paper is useful in a number of dimensions – it gives us some sense of the longer term effects of these programs, the methodology is interesting (and informative), and finally, of course, the results are pretty intriguing and definitely food for thought.
Each year almost 4 million children die within the first four weeks of life, many from preventable or treatable causes. Much programmatic aid is now devoted to devising ways to ensure that simple effective health practices, such as ensuring a more sterile birth environment, are adopted on a wide scale. A number of recent evaluations from South Asia suggest that the active involvement of local women’s groups in problem solving can be among the most cost-effective interventions to prevent deaths.