Month / May 2013

by sheilasingapore

Newspaper Column #15: The Viralness of HIV/AIDs – Part II: The Difference Between Working Hard and Working Smart.

As it appeared in the Sunday Standard, Botswana May 19, 2013, edition.

From a systemic perspective, the causality of HIV/AIDs as a phenomenon will be no different from that of one country to another!  Be it that it is happening in India or Europe or China or here in Botswana, South Africa or Namibia.  Despite races or nationalities or professions.

The circle of causality reinforces or feeds itself, negatively, perhaps at different rates (some slower, others faster), but the reasons or causes that appear in the cycle will be the same.

The reason for transmission of the virus however, for an individual may differ from one person to another.  That’s from the perspective of a medical doctor.  That’s what he sees.  But the systemic causality of the phenomenon will be the same across all them.

Systemic thinking is not interested in the former.  It’s focus and attention is on the latter.

And what would you say this means from a systemic perspective for nations that show low levels of the epidemic numbers?  This would mean that the circle of causality is reinforcing positively rather than negatively or we say virtuously in their instances.  It is the same cycle, just reinforcing positively.

Each time the circle of causality reinforces or as we say the causes feed themselves as a cycle, the community or the country experiences increasingly negligent levels of infections despite the levels other nations may be experiencing around the globe.  And most importantly, they achieve those results with little or no effort (and certainly no resources) on their part.

Whether it is good news or bad news, the cycle of causality will be the same.

This series of articles that we have just begun here, seeks to uncover what is the circle of causality in the case of HIV/AIDs as a systemic or national phenomenon.

Please note however, the doctor, needs to continue to treat or advice the patient, nevertheless.  However, treating a patient will not treat (or reverse the effects of this phenomenon) as a nation.  The cycle will continue to run its course until we treat the cycle with a systemic solution.

That’s not a medical perspective.  It requires the perspective of the nation.  The latter cannot absolve itself from being a part of the solution here.

In last week’s article, we explored and uncovered the following:

Prevalence Levels ß New Infections (identified or otherwise) Levels ßLevels of Transmissions ß ?

And then I left you with the question,” what causes the levels of transmissions to go up?”  Notice again, I did not ask, what caused a transmission.  Instead, the question seeks to understand what causes its relentless upward trend.

And then I clarified the question further by asking which one of the above did you (and your circle of family and friends) think was the MAIN REASON? … the 20% that contributes 80% of the causes!

And I offered five options:  Was it unsafe sexual practices?  Would it be mother-to-child transmissions?  Would it be unsafe use of tainted needles?  Or is it accidents and wounds?  Or was there another reason?

I have posed this question each time with various groups for possibly over thousands of participants.  And there is resounded one unequivocal answer.  I am sure you have guessed it too!

Most, quite easily vouch that the answer is, sexual intercourse.  And should we take you the readers of this newspaper and continue to make that count, we are quite sure that we will arrive at the same answer.

Now, to see that ‘sexual intercourse’ as the “main river” that adds to the “ocean of HIV/AIDs prevalence”, was important.  Here’s why.

When I do this activity with a group of medical practitioners who are tasked to advance the prevention of transmission of the disease from mother to child, it begins to dawn on them that while they work hard at preventing the transmission of the virus to the child from its mother, yet that child when it grows up, it did not have a way to control the transmission of the virus to itself through its own sexual practices.  The child (and that is all of us) has not learned to save itself from the virus.  It just happens.  Sometimes, before we reach our teens!  This clarity floors these organizations every time.

What is the implication of understanding this on resources and effort?  It literally means money down the drain for them.

Why do we do that?

While it was a necessary correction, it was still an easier and costlier route. We would choose this way, because, trying to curb transmission through sexual practices, was a more difficult process, and in our minds, and almost impossible task.

Yes, it is impossible.  That is, if we see all solutions as about controls and monitoring others.

When we are faced with such a systemic situation, it requires learning to work with levers that lead to individuals taking actions for themselves.  This way of thinking is perhaps new for us.

In short, it means, we need to learn how the individual would make those decisions.  Whatever, the reason that leads one to take a decision, when the reason is “not there” it would lead one to decide to take a different course of action.  For oneself!

It is more difficult process to get there.  No doubt.

Unfortunately, however, it is the reality.

When we face that reality, we also learn to face solutions that work.  And when, we get there, it becomes very simple.

So shall we carry on uncovering the reason in the cycle?

So, the next question is what causes transmissions by sexual practices to go up?

Let me frame this differently.  In my workshops, I would typically ask a question, “Should two individuals, both HIV positive stay sexually fidel to each other, would that lead to increased levels of transmissions to individuals outside of the couple’s relationship.  That is, in spite of unsafe sexual practices with each other?

And the answer would be quite simply …. No!  Yes, you are right!

Except for the pair, there would be zero transmissions beyond them.  Something, a lot of nations easily aspires for it to happen but thinks it is difficult to reach.  Yet, it really isn’t that difficult to figure this one out.

Taking this reasoning beyond the obvious reason, lies in asking the question, what causes or encourages the behaviour of discriminate sexual relation by a couple with each other?

Perhaps you may ask, what is that?  It would be the act of engaging in sexual relationship with one person that lasts beyond evenings to a lifetime of days.  Hard as it may sound, we would otherwise refer to as fidelity.

So the next question is, “what causes sexual fidelity”?  Would it need controls?  What encourages its growth?  What discourages it?

We all seem to know what causes infidelity.

But what causes fidelity?  Where does that begin?  What do you think?  What does your wife (or girlfriend) think?

This will be the subject of the column’s discussion for next week.  Happy discovering!

Does it really matter that we know all of the causes of the viralness or we need to figure the  ONE?  Yes, it matters that we figure the “main river”.

It makes all the difference between working hard and working smart.

Ms Sheila Damodaran works as a systemic strategy development consultant currently developing her practice with national planning commissions in southern Africa.  She welcomes comments and queries for her articles and programmes at https://www.facebook.com/SystemicThinkingColumnist or call DID: 3931518.

by sheilasingapore

Newspaper Column #14: The Viralness of HIV/AIDs – Part I: How Does Viralness Grow?

English: Geographic distribution of Hepatitis ...

Red blood cells on an agar plate are used to d...

As it appeared on The Sunday Standard May 12, 2013 edition.

It has been a while.  As the articles grew, we took the time to consider an appropriate site for the column.  That search is on-going.  However, for now, the column and I is here and we are glad we are back with you!

The column showcases a work that leads by learning to understand persistent issues of systemic or national concern and develop strategies to mitigate them.  These strategies are typically not run-of-the-mill solutions because had they worked in the past, we would not be facing these issues today globally.  When a problem is ‘solved’, it will work not to come back.  Period.

And when it does come back, it is a sign we have yet to understand what’s causing the problem.  It is an indication that the search is not over as yet.

We will use this thought to begin to understand the viral nature of HIV/AIDs that has caused epidemic proportions in its behaviour and consequences around the globe.

How did it grow the way it had done so far?   Both with and without our control?  What is the ‘gaspipe, outside of the medical domain’ that keeps bringing more of these cases back on into the health sector?  And why does it continue to resist our efforts to control it despite works by multi-sectoral efforts.  It seems to behave, almost ubiquitously as in “till deaths, do us part”?

The story today has gone way beyond sex workers or truck drivers, because infections happen regardless.  Had such “acts” not persisted beyond these two sectors, the mere non-action would slow down or even stop the infection in its track.  However, we know this is not the case.  Infections have now gone from beyond one area and one country, to countries across lands and inspite oceans.  It has transcended boundaries, including age, gender, professions, and so on.

Interestingly, this story now also holds keys to learning to grow any kind of phenomenon.  Even how as nations we may learn to grow our economies and businesses.  Why do I say that?  Read on.

While the unintended consequences of HIV/AIDs are not desirable, it is nevertheless exhibiting the nature of growth behaviour ‘at its best’.  Think viruses that started off as one, in very small numbers, and yet today the number has grown to billions in the millions of us.  It has grown to an extent that the question today is no longer, ‘when would we turn the tide around’ but rather ‘can we turn the tide’?  It is no longer a trickle, a brook or a river.  It is turning into an ocean.

And we have tried turning it around by all means possible.  Genuinely.  For decades.

We have poured and continue to do so billions of dollars around the globe to ‘fight the war’ of HIV.  And that trend has grown relentlessly year on year as organizations around the world jump on the bandwagon to save the numbers of lives increasingly affected by it.

Tongue-in-cheek, it even feels the more money we pour in to fight it, the more we seem to be sucked in by it both as those who are infected and those who need to react to the infected either as medical and research personnel, medical service providers or fund coordinators and not forgetting the rest who are caregivers in the family.

These are the hands and feet that would otherwise have worked hard at growing the country’s economic productivity and sit on the revenue side of the equation of an economy.

Today, rather these resources sit on the side of the cost equation.  And this adds up to the cost (hidden and worse blind ones) sometimes more than just of the investments we make.  They would need to be added in.

Yet the prevalence (of old + new infections) is not abating downwards at the rate investments are scaling — upwards.  The catching up game does not appear to stop.

Is it a stubborn problem?  Yes, it is!  Is there a vicious cycle causing the persistence?  You bet there is!

If the problem has not turned around consistent with the effort we have applied to it, then it is an indication that we have not quite understood what is causing its vicious nature.  Understanding this causality is the first step to solving the problem.

We know that when a virus transmits from one individual to another, it can cause an (new) infection.

That’s a medical side of the story of the disease.  In systemic thinking, however, we want to understand what is causing the recurrence of the transmission that is pushing prevalence upwards, despite differences in time, location and people?  And inspite of different programmes, initiatives and endeavours.

We also want to know the consequences of such prevalence rates and importantly to understand ways they (re-)feed(-back) or reinforce the cycle.  These questions are keys to developing strategies that help turn stubborn issues around.  For good.

Yes, we know it is sex (-ual) transmission.  Yet, not all sexual activities lead to a transmission of the virus.  Yes?  (More later.  Food for thought for now.)

So we have for now explored the topic around a few issues, let’s begin to answer the question.  What causes the relentless persistence of  HIV/AIDs as a phenomena that feeds (grows) the prevalence figures of nations?

So, let’s start with the question, what causes the prevalence to go up?

The first answer I usually get, hands down, is “sex”!  Well, it’s true.  We will get there but let’s stay with the question.  Prevalence is caused by new infections.  When numbers of new infections go up, prevalence goes up.  When infections go down, prevalence goes down too.

The next question is, ‘what causes infections to go up’?  Again, I get the response, well, the answer is obvious!  “Sex”!  Smile.  It’s true.  But as I would say, stay with the question.  Infections are caused by transmission.  If there are no transmissions, there are no new infections.  But when numbers of instances of transmissions go up, so does infection.

The next question?  You know it, now.  What causes transmissions to go up?  Notice, I did not ask, what caused a transmission.  Well, stepping back, we might say, well there are many ways these may happen.  It can be sexual behaviour (such as unsafe sexual practices), mother-to-child transmissions, unsafe use of tainted needles, accidents and wounds, and there could be more.

Here’s a tip.

In a stubborn or a recurring problem, we do not include all of them as causalities.  And here’s why.

By the time, circle of causality becomes vicious 0r recurring, one of these factors have become the reason for its persistence.  It is that ‘main river’ that brings the cycle back and reinforces itself continuing to push the upward tide with each cycle of causality.  We say it is now exists as a self-seeking (helps itself) cycle of growth.  It is not a cause with multiple factors.

So which one of the above do you think is the MAIN REASON? … the 20% that contributes 80% of the causes!

I am sure you know which one it is.  Still, do feel free to check out the question with your family and friends.   What do they think?

Would it be unsafe sexual practices?  Would it be mother-to-child transmissions?  Would it be unsafe use with tainted needles?  Or is it accidents and wounds?  Or is there another reason?

This will be the subject of the column’s discussion for next week.  Happy discovering!

Ms Sheila Damodaran works as a national strategy development consultant currently focussed on working with national planning commissions in southern Africa.  She welcomes comments and queries for her programmes at DID: 3931518 or at sheila@loatwork.com.