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 email@example.com.
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