Need vs. Need

Many of you know that I work in the HIV/AIDS community in Oklahoma, a state that has developed a reputation for not being particularly embracing to people of alternative lifestyles or perspectives. I spend much of my time designing programs to improve access to treatment and care, enhance education and prevention measures, and perhaps most of all - how to garner increased funding for our programs. As is the case with most non-profits and governmental entities, I am often faced with the reality that the need is great while the resources are few. So, I set out to do what you always do when requesting more funding: Demonstrate the level of our need.

That's where things get sticky. Oklahoma's economy is closely tied to its tangible resources, namely oil, natural gas, and wheat. While it initially seemed that the global economic crisis might not have a substantial impact this state, Monday's announcement that Oklahoma City Public Schools will be eliminating 131 teachers and administrators and closing three elementary schools in an effort to trim the district's budget by $17 million cast a decidedly pessimistic light on the state's ability to weather this storm unscathed. Along with the Department of Education, most state agencies are looking for ways to cut program spending, including programs that directly affect our clientèle. The response from all levels of the Oklahoma HIV/AIDS community has been "No way! We need this money! HIV/AIDS is still a big deal!"

This is true. Every nine-and-a-half minutes someone in the US is infected with HIV [Video]. Here in Oklahoma, there are an estimated 4,605 people living with HIV/AIDS, nearly half of which live in the Oklahoma City metropolitan statistical area. Yes indeed, this is still a big deal.

According to UNAIDS, Sub-Saharan Africa has around 25 million people living with HIV/AIDS. They've had 2 million new cases reported in just one year - that's more than the total number of cases in the US. And in some African countries, close to 30% of the population is HIV-positive. Infection rates in southeast Asia continue to climb, especially in places like Pakistan, Afghanistan, India, China, and Thailand. So, that's obviously a big deal as well. One could argue that the situation in Africa is worse than the situation in Oklahoma. But how much worse?

I find myself struggling with this issue on a regular basis. How do we determine where to direct our resources? Should we develop a global Level of Need rating system and apply it to all countries? (Hans Rosling has already collected that data; even on a logarithmic scale the United States' need pales in comparison to Sub-Saharan Africa.) How do we decide how much funding should go to prevention and how much should go to treatment? Or, would we be better off to fund something else altogether, like HIV testing, access to fresh produce or iodized salt, mosquito nets, needle exchange programs, education, housing, economic development, etc.? (Watch this video for a much more academic conversation on this question.)

The answer, I suppose, is simply "Yes." Yes, we should support efforts to prevent, identify, and treat HIV both domestically and overseas. Yes, we should support efforts to reduce poverty and increase education and protect people from malaria-carrying mosquitoes. Yes, this is a big deal, and we should fight it. Fight it in lots of places, with lots of tools.