February 27, 2019 / Kyle Shantz
An often spun yarn among social innovation types is that of the emerging HIV/AIDS crisis in the 1990s and the modern miracle that was Brazil’s response.
It goes something like this: South Africa and Brazil were both early victims of the HIV/AIDS epidemic, and in the 1990s HIV diagnoses in both countries were growing exponentially. Development experts and social scientists like to compare these two countries in particular due to their similarities in levels of human and economic development, recent transitions to democracy, decentralised government structures, complex racial histories, and levels of inequality. In 1988, Brazil had the second highest number of reported HIV/AIDS cases in the world after the USA, and almost twice as many cases as South Africa, who had themselves just hit an alarming milestone: 1% of their total population was infected. The World Bank advised Brazil to focus on prevention rather than treatment, as the epidemic would likely claim everyone already suffering. Circumstances were dire and not expected to improve.
By 2012 the infection rate in South Africa had exploded to 18%, or 5.6 million South Africans living with HIV – at that time the largest number in any country in the world. But in Brazil something incredible had happened: the infection rate was flat at 0.6%. That’s not far off Canada’s 0.4%. The Brazilian response to the HIV/AIDS is an incredible success story in the face of seemingly impossible odds. Decentralized and emergent, it found resources in unlikely people and places. So what are the key lessons that the climate movement can learn from, and use, in our struggle to avoid the looming climate catastrophe?
They Harnessed the Church
At the time, 65% of Brazil’s population was Catholic and the Catholic Church officially opposed condom use, meaning alignment was not guaranteed and the Church could easily have been a natural enemy to prevention efforts, but it wasn’t. Catholic Ecclesiastical Base Communities, small distributed groups of Catholic adherents practiced something called Liberation theology, a progressive version of Catholicism which believes the poor are the core of Christ’s message. These groups were practically the only legitimate focus of resistance and defense of basic human rights during military rule. Liberation theology had earned great legitimacy with Brazilians and its emphasis on grassroots involvement, individual self-esteem building, emancipation, and the people’s ownership of social problems and solutions meant that Catholics everywhere took up the call to serve. Locally, these practicing religious groups were instrumental in supporting diagnosis and treatment efforts, especially in rural areas and places the new government did not have a presence.
Today the Pew Research Centre estimates that nearly six of the Earth’s seven billion people are affiliated with a major religion. However, liberal, progressive circles where climate change is an accepted fact are largely secular spaces made up of academics and leftists easily accused of elitism. The climate movement continues to make compelling, well researched, documented, peer reviewed and necessary scientific arguments for action, but how well are we engaging with God’s people by using God’s directives to care for the vulnerable? Are the secular and religious communities more misaligned than they were in Brazil? They are not. Are there no faithful among us who can bridge the gaps? There are. How might we unlock and better harness the massive energy and resources of what was once the most powerful motivating force in our history? How do we “rouse” this “sleeping giant” and more importantly when we do, make sure they’re on our team?
When the Math Didn’t Work, They Changed the Numbers
How do you treat people with HIV/AIDS when the per capita income of Brazil is roughly US$5.000/year, and the cost of antiretroviral treatment is US$12,000? Brazil started questioning the question: why were the drugs so expensive? The answer was not that the ingredients or manufacturing processes were prohibitively expensive, it was that that drug companies’ patents protected their intellectual property, and less expensive generic treatments were therefore unavailable. Brazil argued that the HIV/AIDS epidemic was a national emergency and used a clause in the World Trade Organization charter to break patent laws. Then they made their own drugs and gave them away for free.
When it comes to climate, maybe the math needs another look. A holistic examination of costs makes fossil fuels more expensive, yet in practice we contain our financial arguments to an arena featuring utility bills vs. carbon taxes. Is extinction not a national emergency? What would it take to radically change the numbers in the equation? In Getting to Maybe the authors posit that solutions to well defined problems are finite: they are clear and precise and lead to follow-up actions. Complex solutions lead to more questions; they continue to open up the space for inquiry and for solutions to emerge.
Once Brazil had the drugs they needed, a new challenge emerged. The treatment regime was difficult to administer: there were many pills that needed to be taken at many specific times of the day, some with food and some without. Additionally in 1980 25% of Brazilian adults were illiterate. The answer this time was full mobilization: information centres and treatment centres were installed across the country, not just in government spaces and HIV/AIDS charities, but in all charities, churches, NGOS and private homes. Everyone became part of the solution. Volunteers drew pictures of the sun, moon, and food on the labels. They connected sufferers with local groups to get the food they needed, when they needed it, to time eating with their medicine. In the end the adherence rate was the equal to that of Canada and the United States.
How do we achieve full mobilization when it comes to climate change? We no longer sort our recycling, which is close to the bear minimum we can do for conservation, centralized super robots do for us. Perhaps asking less of people isn’t the answer, maybe we need to ask more. Charitable sector legend Dan Pallotta is widely recognized as the innovator behind the grueling charitable event. Demands such as long-distance AIDS bike rides and three-day walks for breast cancer. He once said, “People are tired of being asked to do the least they can do, they are hungering to do the most they can, but they have to be asked to do that.”
They Flipped the Script
The desire for sex is nearly universal, chemical, and existential; preaching abstinence doesn’t work. As expected, young people in Brazil weren’t willing to fight the spread of HIV/AIDS by practicing abstinence, so the Brazilian response flipped the script. They made prevention sexy. One popular billboard featured three women at at condom shaped table saying “Si, Si, Si” provocatively implying that condoms might actually lead to increased sex. They used clowns in condom costumes for distribution to make condoms an object of fun, not embarrassment, or stigma, or as a sickness and death prevention tactic. The result: condom use in first sexual intercourse increased from 4% in 1986 to 48% in 1999 and to 55% by 2003.
There are many theories about why death is not a particularly effective motivator when it comes to human behaviour change. From Faust to french fries, smoking to sunbathing, the fact that people will trade cheap, short, immediate gratification for terrible, potentially long-term suffering in the future is as terrifying as it is well documented. Yet as climate activists, our central call to action is essentially a global prisoner’s dilemma: “Okay gang, you’re all going to have to give up your car, having children, and wearing jeans. Now I’d like you to move into high-density housing in a high-density urban area, and shlep your vegan groceries home on the e-bus. Here’s some photos of Paris, a place you’ll never see. Also if you do this but everyone else doesn’t we’ll all still die.” “Sign me up!” said no one while the earth caught fire. We’re as noble as we are misguided, and it’s no wonder that it isn’t working. Even Al Gore wears jeans sometimes. So How do we make fighting climate change fun and sexy? Bless Tesla for making an electric supercar when everyone else was hawking bubble-dome golf carts (there is of course a place for golf carts, and abstinence, in a well rounded plan too). A Green New Deal might actually put money in our pockets. These are the ideas gaining traction with people and we need more of them.
The Ugly Lesson: The Cost of Denial
South Africa is infamous for its poor leadership related to HIV/ AIDS response, and importantly AIDS denialism by President Mbeki and other political leaders had a significant impact on public health policy from 1999 to 2008. Shortly after being elected, Mbeki criticized the scientific consensus that HIV does cause AIDS. Shortly after that, he organized a Presidential Advisory Panel on HIV/AIDS and included scientists who denied that HIV causes AIDS. During the next eight years, Mbeki continued to express sympathy for denialism while instituting policies that denied antiretroviral drugs to AIDS patients describing them as “poisons”. Mbeki’s appointed health minister acquired the nickname “Dr. Beetroot” because she promoted the use of unproven herbal remedies such as ubhejane, garlic, beetroot, and lemon juice to treat AIDS. In 2002 Nelson Mandela said in an interview that, “This [AIDS] is a war. It has killed more people than has been the case in all previous wars and in all previous natural disasters. We must not continue to be debating, to be arguing, when people are dying.” These policies have been blamed for the preventable deaths of between 343,000 and 365,000 people from AIDS. And possibly most frustrating of all, as Karl Kruszelnicki noted, South Africa, unlike many of its fellow sub-Saharan African countries, “…has both the medical personnel and wealth to meet the HIV/AIDS challenge head-on.”
Does this all sound familiar? The parallels with climate are obvious. Denialism, destain of science, incompetent or willfully obstructionist governments. Deaths on an unprecedented scale. And all this in nations that were among the few to possess the resources required to take meaningful action and make meaningful change. It is of little comfort to today’s victims or the climate movement that history will see its villains, but maybe it could be motivating to today’s villains that that history assuredly will make their names synonymous with suffering that has the potential to, by orders of magnitude, exceed anything that humans have suffered before.
So stand up, leaders, there is great opportunity in great stakes. You could be the next savior of humankind, peerless for two millennia. Or history’s final villain, the end of our remarkably short Anthropocene age, proof our big brains that didn’t get big enough, fast enough, proved to be a colossal evolutionary mistake. There is only one way to be remembered.
Kyle Shantz is the National Communications Lead for Social Innovation Canada. You can follow him on Twitter @KyleShantz