[Chapter 3, page 46]
The Cohens address HIV/AIDS
Here’s another example of developing alternative solutions—this one involving a global rather than a local problem.
Ron and Johanna Cohen are new to philanthropy. Johanna, a former public health nurse, has a particular interest in women’s health issues, and the couple’s recent visit to some rural African villages left them both concerned with the high incidence of AIDS and the effects of unwanted pregnancies on women’s lives. They believe that condoms can ameliorate both, and return from the trip ready to fund an organization that distributes condoms free of charge. They propose to pay for both the condoms and a pilot program in several villages, with the thought of expanding the work if it is successful.
Needing assistance in identifying organizations that could carry out this work, the Cohens hire a consultant who is knowledgeable about development and health issues in Africa. After doing some research, the consultant reports on the pros and cons of various approaches to family planning, including oral and injectable contraceptives and intra-uterine devices; and approaches to dealing with HIV/AIDS, particularly antiretroviral drugs. He also describes methods that address both problems: ABC (abstinence, be faithful, condoms) programs; male and female condoms alone; and programs that encourage girls to stay in school longer, which tends to postpone the onset of sexual activities and hence unwanted pregnancies and disease.
The Cohens, who had not thought about girls’ education in this context, appreciate the point, but feel more comfortable supporting a more direct intervention. The consultant discusses the costs of these approaches, the difficulties of getting pharmaceuticals and contraceptive devices to rural villages, and barriers to their being used regularly and effectively. While condoms are likely to help prevent the transmission of HIV/AIDS, they are most effective when integrated with programs that counsel limiting the number of one’s sex partners—programs that are not prevalent in rural African villages—and they are far from the ideal form of birth control.
Realistic about the uncertain efficacy of condoms but believing that they’re better than nothing, the Cohens end up considering an approach that involves both condoms and injectable contraceptives, which are very popular with African women. But the question remains how they can use their philanthropic dollars to achieve real impact. Obtaining these items is relatively easy and inexpensive—they are subsidized by government agencies—but getting them distributed in rural areas is difficult. One organization, Population Services International (PSI), has been innovative in distributing contraceptives through the same supply chains that provide matches, chewing gum, flour, and Coca-Cola to rural communities. By selling them rather than giving them away, PSI employs local commercial markets in their distribution. And PSI stimulates demand through marketing campaigns.
In addition to providing a possible way of reaching their objectives, PSI’s approach appeals to Ron’s business background. The couple asks the consultant to introduce them to PSI’s executive director.
The little vignette of the Cohens’ philanthropy illustrates some useful points about coming up with possible solutions to problems. The most fundamental of these is: Don’t stop with the first good idea that comes to mind. There may be better ones just ahead. It is often useful to begin by considering solutions of two sorts:
- solutions that maximize the achievement of your most important objective even at the expense of others; and
- solutions that simultaneously satisfy several important objectives, even if they are not optimal for any one of them.
Considering both types of solutions can open up options that you may have overlooked. Sometimes, like the Cohens, you even may be lucky enough to find a solution that furthers all of your major objectives.
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The difference between knowledge in the natural and social sciences surfaced in Ron and Johanna Cohen’s consideration of how to reduce HIV/AIDS and unwanted pregnancies in rural Africa. While there is considerable medical knowledge about methods for reducing the transmission of HIV and avoiding pregnancies, the social determinants of people’s actual use of these methods are far less well understood and vary greatly in different contexts. The effectiveness of so-called ABC programs is reduced when condoms are not available; and the effectiveness of condoms is reduced in the absence of effective messages about abstinence and fidelity. Approaches that are effective for commercial sex workers may be ineffective for the population at large.1
1 See, e.g., Norman Hearst and Sanny Chen, “Condom Promotion for AIDS Prevention in the Developing World: Is it Working,” Studies in Family Planning 39 (2004): 35.