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Harm reduction

How conservatives cure your pain

Tom DeLay’s farewell speech to Congress yesterday was rousing:

In any place or any time on any issue, what does liberalism ever seek, Mr. Speaker? More – more government, more taxation, more control over people’s lives and decisions and wallets. If conservatives don’t stand up to liberalism, no one will.

Well, it’s a point of view. Of course, you could turn it around. Adopting the same strategy of wild partisan generalization, you could say, instead:

In any place or any time on any issue, what does conservatism ever seek, Mr. Speaker? More – more funding for the military, more pollution, more control over people’s science education and sexual habits and wombs. If liberals don’t stand up to conservatism, no one will.

But this would just be to get into an unproductive shouting match. Let’s test, instead, one of Mr DeLay’s more interesting claims:

[C]onservatism isn’t about feeling people’s pain, it’s about curing it.

That sounds good. Pity about the ideologically motivated hobbling of stem-cell research in the US, which might seem to put a spanner in the works of curing many people’s pain. Another way in which you might say millions of people all over the world are in “pain” is that they are HIV-positive or already suffer from Aids. Now, the US is the biggest donor to Aids relief efforts in the non-western world, particularly in Africa, and George W Bush should be strongly applauded for his massive increase in funding for Aids over the relatively nugatory amounts approved by the Clinton government.

However, many people have long been worried, as is carefully documented in an excellent new book, Body Count by Peter Gill, that the efficacy of PEPFAR (the President’s Emergency Plan for Aids Relief) is compromised by its moralizing slant. Gill shows that we have the Christian right in America to thank for elevating the global Aids epidemic to its current level of importance in the administration. But we also have the Christian right to thank for imbuing the programme with certain counter-productive ideological biases. Biases, indeed, that appear to want to take “more control over people’s lives and decisions”, in a way that DeLay says is the preserve of liberals.

Last week, for instance, the American government, negotiating over the UN’s new “Declaration of Commitment” on global Aids policy, opposed numerical targets for treatment, and tried unsuccessfully to oppose mention of the term “harm reduction” in the document.

Why should they be against “harm reduction”? Surely everyone can agree that harm should be reduced wherever possible? . . .

The problem, as it turns out, is that “harm reduction” is understood to be, as the Washington Post puts it, “a euphemism for needle exchange programs for addicts”. Well, that is indeed how “harm reduction” has been used by its proponents. As Gill explains:

The International Harm Reduction Association […] was established to promote the success of British, Dutch and Australian needle exchange initiatives at the start of the Aids crisis in the 1980s. […] For a decade or more, the association made steady progress in urging international adoption of the “harm reduction” formula that had succeeded in Europe and Australia. (p 159)

On the face of it, this looks simple. Sharing dirty needles makes intravenous drug users extremely vulnerable to HIV infection. Giving them clean needles eliminates this danger. Harm is thereby reduced.

But there is an argument to be had, naturally, about whether the phrase “harm reduction” is deliberate Unspeak. If you are against the programme, you must be in favour of increasing harm, to which no one will readily admit. The problem is that if you say “harm reduction” is Unspeak, you might be committed to arguing that it does not really reduce harm. If so, you would have to say that people using illegal drugs is a greater harm – harm to the fabric of the nation’s morals, or whatever – than people actually dying of Aids. This is such a patently ridiculous idea that few would say it out loud.

Phrases of Unspeak often come in antinomial pairs, like “pro-life” vs “pro-choice”; “Weapons of Mass Destruction” vs “conventional weapons”, and so on. Even the Republicans’ clever renaming of the estate tax as the “death tax” has been countered by the amusing alternative label of the “Paris Hilton tax”.

But “harm reduction” is such a borderline example – because it can actually be shown empirically to reduce harm – that there is no competing term of Unspeak used by its opponents. Instead, they merely pretend that it is code for what they plainly call “drug legalisation”, calling it “the international harm reduction/drug legalisation movement” (Gill, p 160). Of course, giving addicts clean needles does not imply legalising drugs at all. It’s just a straw man playing on fears of liberalism gone mad.

A second way in which US Aids policy seeks to take “more control over people’s lives and decisions” is in its insistence that the first line of defence against Aids should be sexual-abstinence programmes. This is also the favoured message of the condom-hating Catholic church in Africa. Accordingly, “sexual abstinence” is the first of the “plans and strategies” named in section 35 of the UN declaration. Note that the very term “abstinence”, by comparison with abstinence from alcohol, for example, implies that sex is an evil or poison. Britain’s international development secretary, Hilary Benn, was disappointed:

I wish we could have been a bit more frank in our document about telling the truth. Abstinence is fine for those who are able to abstain, but human beings like to have sex and they should not die because they do have sex.

Quite. But the twin message of US Aids policy is different. Don’t have sex, and don’t use drugs. According to Tom DeLay, it is “liberals” who seek to “take more control over people’s lives”. And yet his party thinks that celibacy is the most desirable behaviour for Africans, and that recreational use of illegal drugs causes more “harm” than dying of Aids. In this sense, “conservatism” as illustrated by the politicized priorities of PEPFAR isn’t about “curing people’s pain”. It’s about telling them that, if they are in pain, it’s no one’s fault but their own. Spiritual harm, it seems, trumps mere sickness and death.

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