viernes, 26 de octubre de 2007

Let them eat Kafka

Oct 25th 2007 | SANTIAGO
From The Economist print edition

The president enlists the literary critics

ASK Chileans what they are reading and the answer will probably be Isabel Allende's “La Suma de los Días”, a memoir by their country's best-known living writer. If, that is, they read anything at all: in a recent survey, 45% said they never read books and 34% did so only occasionally.

Michelle Bachelet, Chile's president, wants to change that. To do so, she has come up with a scheme to give 400,000 of the poorest families a maletín literario or box of up to nine books each. After much pencil-chewing, a jury of literati this month selected a list of 49 works, from which officials will then choose those books they think appropriate for each family (each will get an encyclopaedia and/or a dictionary).

The list comprises fiction and poetry for both adults and children. It ranges from Chile's Ms Allende and Pablo Neruda to J.D. Salinger's “The Catcher in the Rye” and Franz Kafka's “Metamorphosis”. This is unexceptionable fare. But is the book box the best way to achieve Ms Bachelet's laudable aim?

It could help. While some older Chileans lack functional literacy or were alienated by a rigid school syllabus, younger ones may be deterred from buying books by their price. This averages $14, higher than the Latin American average and the equivalent of two weeks of bus fares to and from work in Santiago. If books were cheaper, more Chileans would read them: pirated copies sell on pavements, while a lending library that operates on the Santiago metro has been a big success. With massive orders, the government could force big discounts from publishers.

But critics see the book box as a populist gesture. “It's like dropping bank notes out of the sky,” complains Verónica Abud of La Fuente, a charity that promotes reading. “Who says that a plumber in a poor district of Santiago will actually want to read Kafka?” For less than the estimated $11m cost of the book box, La Fuente has set up 60 libraries in schools and neighbourhoods. Since only 7% of Chileans belong to a library, there is scope for plenty more.

Commerce between friends and foes

From The Economist print edition

The United States may finally ratify a trade deal with Peru. But pan-American trade diplomacy remains a mess

IN HIS first term as Peru's president, in the 1980s, Alan García was a firm believer in protectionism, banning the import of foreign cars and even of Chilean wine. But since coming to office again last year he has embraced free trade with a passion bordering on mania. “More trade and more investment [means] less migration, less poverty and less environmental destruction,” he told a meeting in Lima last month convened by the World Trade Organisation (WTO). “You might resign yourself to just having a free-trade agreement with the United States, but for me it's not enough,” he told his audience, ordering his harried trade minister to secure similar deals with a score of other countries.

That Mr García was so pumped up was perhaps because at long last Peru's trade deal with the United States, negotiated 18 months ago, looks close to ratification by a hitherto reluctant American Congress. On September 27th the administration sent a bill to Congress after a majority of the House Ways and Means Committee and the Senate Finance Committee indicated they would back it. Though upsets are still possible, supporters reckon the bill will be approved within weeks. But for free-traders, that is cause for only the faintest cheer.

The benefits to Peru seem clear. Mr García, who when a candidate was sceptical of the deal, now says that it could add an additional percentage point to economic growth (which reached 8% last year). That is mainly because it provides investors with greater security. Peru's industrialists' association reckons that it could prompt an extra $9 billion in industrial investment in 2008 and 2009 alone.

Opponents worry that farmers, especially of maize, cotton and wheat, will struggle to compete with their subsidised counterparts in the United States. They also fret that American companies will try to take out patents on Amazonian plants.

Free-traders have other worries. A decade ago, the United States and 33 countries in Latin America and the Caribbean hoped to negotiate an all-embracing Free Trade Area of the Americas (FTAA). But the mood has changed. The Democrats, who won control of the American Congress last November, are mistrustful of trade agreements, reflecting widespread fears that globalisation has made jobs more insecure in the United States. Mercosur, the trade block led by Brazil, backed away from an FTAA in favour of the Doha round of WTO talks, but these have stalled too. All this comes as some governments in Latin America, led by Venezuela's Hugo Chávez, are turning their backs on open trade.

Others have negotiated bilateral free-trade agreements (FTAs) with the United States. But George Bush's administration has struggled to persuade Congress to ratify them: even before the Democrats took control, the Central American Free Trade Agreement (known as CAFTA-DR) passed by just two votes; as well as Peru, deals with Panama and Colombia (and South Korea) still await approval.

So Latin American politicians, such as Mr García, who see trade as an engine of growth, find themselves caught between American indifference and a resurgent, anti-trade left at home. When they negotiate bilateral FTAs, they are in a much weaker position than they would have been when gathered together in an FTAA.

Even so, the Democrats have insisted on changing the agreements. In May they struck a deal with the administration under which the FTAs would have to include clauses to strengthen labour rights and the environment (see article), while slightly loosening intellectual-property protection (giving more flexibility for generic medicines). The Democrats say this was the only way to restore bipartisan consensus on trade. Some economists note that since countries such as Peru already subscribe to many of these standards, in theory at least, their formal incorporation is no big deal.

Even so, only a minority of Democrats are likely to vote for any of the FTAs. Peter Hakim of the Inter-American Dialogue, a think-tank in Washington DC, reckons that at most about 70 of the 232 Democrats in the House of Representatives might vote for the Peru FTA. The agreement with Panama was supposed to be next in line. But the Bush administration has balked over the recent choice to head Panama's parliament of a politician whom it accuses of killing an American in 1992.

The FTA with Colombia faces even bigger obstacles. The Democratic leadership in the House has refused to back it, arguing that Colombia's government needs to do more to prevent the killing of trade unionists and to punish officials linked to right-wing paramilitaries. That was a slap in the face for Álvaro Uribe, Colombia's president, who has been Mr Bush's most loyal ally in Latin America. Colombian officials argue that their efforts to strengthen the rule of law in the face of violence from drug traffickers, guerrillas and former paramilitaries will be undermined by failure to approve an FTA.

This is a powerful point and an objection to the whole structure of trade agreements that is now evolving in Latin America. If the agreements with Peru and Panama are approved, the effect would be to divert trade and investment from Colombia. A recent study by EAFIT, a university in Medellín, and the University of Antioquia found that if the Colombia FTA is not approved and the others are, Colombia's GDP would be 2.2% smaller and 400,000 jobs would be lost.

Some Democrats, at least, recognise that this would be a perverse outcome. Mr Hakim reckons there is a chance the Colombia agreement could be ratified next year—but only if Mr Uribe's government takes further steps to protect trade unionists, and these are seen to be working.

The United States' hard-nosed approach to trade is winning few friends in Latin America. That may become apparent in Costa Rica, which is holding a referendum on October 7th on whether to ratify CAFTA-DR. Polls suggest the result will be close, but opponents appear to have momentum. They recently assembled more than 100,000 protestors in San José, the capital. Although Oscar Arias, the president, insists the accord is vital to his country's future, his government may have overplayed its hand. Last month one of his vice-presidents resigned after the leaking of a memo in which he advocated scare tactics such as painting opponents as allies of Mr Chávez. Some are—but others merely think CAFTA-DR a bad deal, especially in its intellectual-property clauses.

If the American Congress does ratify the pending FTAs, turning its back on CAFTA-DR could cause Costa Rica to lose jobs—a fate that may also await Bolivia and Ecuador. This whole mess underlines that bilateral deals are a third-best option after the Doha Round or the FTAA. But for those Latin American countries that are ambitious to expand their share of the biggest market for manufactured exports, they are the only game in town.

viernes, 12 de octubre de 2007

AIDS: Time to grow up

From The Economist print edition (see article)

“Abstinence only” education does not slow the spread of AIDS

THERE can be no surer way of averting a sexually transmitted infection such as AIDS than avoiding sex. That much is obvious. And it is also convenient for religious lobbyists who believe that premarital sex is a sin. But is it realistic? Those lobbyists argue that a popular alternative—known in the jargon as “abstinence-plus”—which recommends chastity but also explains how to use condoms, is likely to make things worse by encouraging earlier intercourse. “Abstinence-only” teaching, they reckon, should be more effective.

That, of course, is a possibility. But it is a testable possibility. And Kristen Underhill and her colleagues at the University of Oxford have, over the past few months, been testing it. Their conclusion is that it is wrong. Abstinence-only does not work. Abstinence-plus probably does.

Last month Dr Underhill published a review of 13 trials involving 16,000 young people in America. The trials compared the sexual behaviour of those given an abstinence-only education with that of those who were provided with no information at all or with whatever their schools normally taught. Pregnancies were as numerous in both groups. Sexually transmitted diseases were as widespread. The number of sexual partners was equally high and unprotected sex just as common.

Having thus discredited abstinence-only teaching, Dr Underhill and her colleagues decided to evaluate the slightly more complicated message of “abstinence-plus” using 39 trials that involved 38,000-odd young people from the United States, Canada and the Bahamas. Their results are published in the current issue of Public Library of Science Medicine.

This tuition—compared, as before, with whatever biology classes and playgrounds provide—reduced the number of pregnancies in three out of seven trials (the remaining four recorded no difference). Four out of 13 trials found that abstinence-plus-educated teenagers had fewer sexual partners, while the remainder showed no change. Fourteen studies reported that it increased condom use; 12 others reported no difference. Furthermore, in the vast majority of cases, abstinence-plus participants knew more about AIDS and HIV (the virus that causes the disease) than their peers did. And the tuition often reduced the frequency of anal sex (which brings a greater chance of passing on HIV than the vaginal option). In contrast to the fears of the protagonists of abstinence-only education, not one of the trials found that teenagers behaved in a riskier fashion in either the long or the short term after receiving abstinence-plus instruction.

Unfortunately (and surprisingly) only two of the studies addressed the question of disease transmission directly, and the numbers involved were too small to find a statistically significant difference between groups. Nevertheless, Dr Underhill's pair of reviews should make informative reading for policymakers. America's government earmarks money for abstinence-only teaching, which is matched by individual states. It should review that policy—which is clearly no better than the alternatives, and is probably worse. Its generosity to needy foreigners is similarly prescriptive. Of the $15 billion promised over five years by PEPFAR, President George Bush's personal anti-AIDS initiative, $1 billion is reserved for groups that intend to fight AIDS without mentioning condoms. Though Dr Underhill's results apply only to North America, they do suggest a need to investigate what happens elsewhere, in case PEPFAR's policy, too, needs to be reviewed.
A dose of prevention

Teaching people about what they might wear during intercourse is an important way of reducing the chance of them catching HIV. But teaching them, in addition, about what drugs they could take to reduce that risk may be added to the syllabus in the future. A vaccine is still a long way off, but four clinical trials—in Peru and Ecuador, Thailand, Botswana and also America—are assessing how well daily anti-retroviral pills, which are normally prescribed to control established HIV infections, prevent the virus infecting healthy people who do dangerous things. The results of these trials will be plugged into epidemiological computer models to assess the likely effect of various drug-distribution policies.

One model intended to do exactly that has already been built, by Ume Abbas and John Mellors of the University of Pittsburgh. It is designed to mimic a mature HIV epidemic in sub-Saharan Africa—which it did rather well when the researchers tested its output against data from Zambia, a country in which the epidemic has remained stable for a decade.

Writing in PLoS Medicine's sister journal, PLoS ONE, Dr Abbas and Dr Mellors describe what happened when they added prophylactic anti-retroviral drugs to the model. They experimented with different measures of drug efficacy and with different groups of people taking the pills.

Assuming that anti-retrovirals work 90% of the time and are taken by three-quarters of sexually active people, their model suggests that new HIV infections in sub-Saharan Africa would be cut by 74% over 10 years. Unfortunately, the idea of providing and delivering so many drugs to so many people is logistically implausible. And even if it could be done, it would cost about $6,000 per HIV infection averted—a lot of money in Africa.

However, giving the drug to the 16% of Africans who behave most riskily would be easier and could lead to a 29% reduction over a decade at only a tenth of that cost. A harsh calculation, but a realistic one—unlike expecting teenagers to give up sex because you tell them to.