Personal responsibility & compassion – finding a balance.
Whilst visiting the International Aids Conference’s Global Village back in July, I was given a pamphlet advising media about correct and incorrect language to use when discussing and reporting on issues related to HIV/AIDS. Prepared by AFAO, the pamphlet contains a great checklist to help communicators avoid using terms that are derogatory, or that perpetuate myths or stereotypes about HIV. These were some of its suggestions:
“USE person living with HIV; DON’T use HIV sufferer”.
“USE street-based sex worker; DON’T use street walker.”
“USE person who uses drugs; DON’T use junkie, drug addict.”
“USE affected communities; DON’T use high risk group.”
“USE children with HIV; DON’T use innocent victims.”
Innocent victims. Such an odd term. The AFAO caution against using it, as its use contributes to the stigma around and discrimination against people living with HIV. Let us, for the sake of the discussion in this post, entertain the notion that such a category does exist. If there is such a class, what are we to refer to other victims as … “guilty victims”?
These binary judgments sound ridiculous, and arguably are. Nonetheless, a significant percentage of the world’s population believe in the existence of such categories. Implicit within the terms above is the perception that some victims of – well, anything, really – have taken some action or done something wrong, to deserve (or at least facilitate) whatever it is that has happened (or is happening) to them.
From this point of view, the predicaments people experience in life are a consequence of the choices they make and actions they take. In the case of HIV, adults who contract it from voluntary unprotected sex with someone likely living with the virus, are said to have brought it upon themselves. A child who contracts HIV from their parent, in contrast, is absolved of any “guilt” in the creation of their life predicament – they had no choice. They are innocent.
You might expect someone to the right of the political spectrum to endorse such a karmic view of the world – one in which adults are responsible, and reap what they sow. Not too long ago, social psychologist Jonathan Haidt, who studies the intuitive foundations of morality, conducted a study in which Americans were asked questions to ascertain their moral values. Over 350,000 people were surveyed, and the sample group were asked to endorse or reject the following two statements, among others:
1) “Compassion is the most important virtue.”
2) “The world would be a better place if we let unsuccessful people fail and suffer the consequences.”
Haidt’s research found that conservatives endorsed both statements mildly, and equally. It is a predictable finding. People who lean right tend to emphasise the idea of “personal responsibility”. Beyond cleaning up the fallout of ones own errors, this seems to involve encouraging (sometimes forcing) people into what could be described as conservative lifestyles. Setting aside religion-based notions of propriety and worthiness, these lifestyles are seen to afford the individual a measure of protection against all manner of undesirable things.
In contrast, the response of liberals to those same statements above was stronger – the liberals in the sample group strongly endorsed the compassion statement, and strongly rejected the failure statement. They wanted compassion to be the foundational virtue of their society (evidence of bleeding hearts). Haidt said the liberals surveyed were more likely to give people further chances – and more likely to endorse the idea that mercy is better than revenge.
Of course, many liberals also espouse notions of moral “personal responsibility” and “natural” karmic law. I recall dissident feminist Camille Paglia’s (controversial) assertion that the AIDS crisis that killed so many gay men in the 1980s, was directly connected to out-of-balance promiscuous excesses – although she attached no moral judgment to this assertion. In contrast, sex positive advice columnist/activist Dan Savage scolded some men in his community living with HIV, for endangering the lives of others through what he saw as wilfully irresponsible behaviour.
It is easy to see how both the “karmic” and “compassion” perspectives could be wrong – and how they could be right. On the one hand, many of us have a choice as to how we live our lives – we can mitigate risks to ourselves, and others, through these choices. Whilst apportioning blame to HIV-positive people is both cruel and unconstructive, providing people with resources, reliable information, and encouraging everyone (through incentives and disincentives) to responsibly self-care can be empowering for both individuals and communities.
On the other hand, we are inherently flawed beings; we make mistakes. We must navigate complex environments with familial, social, cultural, economic, legal, political and psychological pressures, using whatever knowledge and resources we’ve been able to accumulate at any point in time. We have different levels of access to information, different life experiences, different temperaments and abilities, different inner and outer struggles. We are not always able to foresee the consequences of the choices we make. A large number of us do not have many choices at all.
This is why it is important to balance an understanding of personality responsibility with an understanding of – and compassion for – the complexity of the human experience. We are all frequently victims of human frailty, both our own and others. Simultaneously, we contend with larger social forces in an unconscious world that powerfully shape our behaviour. Given this volatile, uneven and unfair world we all have been born into, compassion seems to be the only reasonable response.
Strolling around the International Aids Conference Global Village, visiting information stalls from over 30 countries representing all demographics affected by HIV, I was once again reminded of the necessity of that compassion – and just how (unnecessarily) complicated the world we have created is. How societies shame people living with the virus, whilst enacting policies and enforcing social mores that unintentionally raise the likelihood of high-risk behaviour, and prevent people from seeking, or even having access to, medical care.
In many societies today, the tension between a conservative “karmic” view of those affected by HIV, and those advocating a “compassion” response – with a greater emphasis on removing the burden and barrier of stigma – rages on. Stigmatisation inevitably accompanies the conservative view of morality, of cause and effect. Not only does this adversely affect HIV-positive people – babies, children, teenagers, adults, the elderly – but the stigmatisation can actually put a society as a whole at risk.
Consider the advent of “AIDS denialism” in South Africa, famously propagated by its former president Thabo Mbeki, under the influence of maverick (pseudo) scientists. The country faces hugely complex problems surrounding containment/treatment of sexually transmitted diseases. Whilst sexuality is very much a part of being human, our species historically has had a profoundly tortured relationship with its own – in many cultures and religious traditions, sexuality has been stigmatised, and attributed to mankind’s lower “animal” nature. Such notions accompanied Christian-European settlement of South Africa.
Adding to this deep, toxic shaming of a basic human impulse, Black South Africans contended with a history of racist characterisation regarding their sexual behaviour – they were regarded by many whites as rampantly promiscuous, and thus less moral or worthy. In a country where these interrelated, shame-inducing bad ideas about sexuality and race were long embedded, the susceptibility of some towards wanting to believe that a disease spreading quickly in a majority black population was not transmitted through sexual contact, was foreseeable.
The consequences, sadly, were utterly devastating. By the late 1990s, Thabo Mbeki had started to question the scientific consensus on AIDS, that the syndrome is caused by a viral infection that can be treated (not cured) with life saving/extending medical drugs. In 2000, Mbeki publicly rejected that consensus, declaring AIDS was not brought about by a virus, but by the collapse of the immune system – which he said was caused by poverty, bad nourishment and general ill-health. Alleviation of poverty was thus the answer – not expensive medications.
The ensuing policies enacted by his government were responsible for the avoidable deaths of more than a third of a million people, according to Pride Chigwedere and colleagues from the Harvard school of public health in Boston. They estimated that more than 330,000 people died unnecessarily over the period 2000-2005, and that 35,000 HIV-positive babies were born who could have been protected from the virus. Culturally embedded stigma, shame, and denial thus contributed significantly to the massive spread of HIV not just at a community level, but also at the highest, legislative level.
There is clearly much to be said for taking responsibility for ones actions – for enacting policies that encourage people to do so, and guide social behaviour in order to protect both individuals and a whole population. But the unfortunate example of South Africa under Mbeki shows that rigid moral judgments – particularly when unexamined – coupled with a denial of human nature, can cause as much needless suffering, if not more, than individual poor choices. In that case, moral judgments (and the fear of them) actually prevented policies that would have facilitated healthier behaviour and saved lives.
And so, when it comes to assisting people living with HIV, a virus that does not discriminate, morality-based notions of “innocent” and “guilty” victimhood are entirely redundant and unhelpful. But we do need to get the balance right. Coming up with policies that encourage and empower people to make wise choices in regards to their lives and health, whilst working zealously to eliminate stigma as something that is both inhumane and dangerous for society as a whole, is the middle way forward.
Yes, that was another epic absence from here. I meant to post this back in July but, ya know, life.
Posted on October 13, 2014, in Health, Humanity, Uncategorized and tagged AIDS conference, compassion, harm reduction policies, HIV positive, karma, reducing stigma. Bookmark the permalink. 2 Comments.