By Gordon Nary
Gordon: When did you join Church of the Ascension and how has Church of the Ascension helped enhanced your spirituality?
Steven: I have been going to Church of the Ascension for the last 9 years. Church of the Ascension in Fountain Hills provides me with a sense of calm about my spiritual life, combining both traditional approaches to the mass and more modern approaches, including having an excellent chorus.
Gordon: What interested you in studying economics, where did you receive your education, and what was the most challenging course that you took?
Steven: I began studying economics when I went to DePauw University in Greencastle Indiana. I entered university with an expectation that I would study political science and then would go on to law school. However, after my first class in economics, I felt that the topic more clearly explained the actions of policymakers than political science. I then went on to study microeconomics, macroeconomics, international economics and even communist economic systems. Reading about Karl Marx taught me a lot about economic philosophy and how it gets applied in the real world.
After DePauw I went on to study marketing and finance at the University of Chicago where I received my MBA. I quickly realized that I was very different from the other MBA students, many of whom wanted to work for financial investment firms. Instead I wanted to apply the liberal arts education I had earned at DePauw, along with the Methodist approach to religion that I learned there, in order to take a more holistic and humanitarian approach to my career.
From there I got a job working in occupational safety and health and environmental economics in Washington DC. While I enjoyed the work, my heart was very much dedicated to international development. There were many areas that interested me, but HIV/AIDS was not one of them.
I only entered the field of HIV/AIDS so that I could work in international development. However, once I began in this field, I learned that many of the challenges that we face in understanding the economics of HIV/AIDS are fascinating and deal with the most intimate and complex parts of human life.
Despite my initial reticence to become involved in the topic (as a dedicated Catholic who was very shy about talking about anything that had to do with sexuality), I could not have chosen a better career.
I do remember a nun speaking to me once about a Catholic retreat I was leading. Her advice was to choose a topic to speak on that would most me feel uncomfortable. She told me, “there is a reason why it is uncomfortable”. I applied this lesson to my career, as HIV/AIDS encouraged me to discuss topics that I wasn’t necessarily comfortable discussing.
Gordon: What initially interested you in the global economic challenges of HIV/AIDS?
Steven: I first became interested in working internationally when I was in college, doing missionary work in Colombia and Peru. These experiences very much changed my life and taught me the extent to which I could influence the world and allow me to be influenced by the world. Peru taught me a great deal about issues like housing and health, even giving me the chance to work as a dentist on children in Peru.
As for HIV/AIDS, this topic was not my initial passion. Only when I was offered a job in this field did I become passionate about it. Reading the book, “And the Band Played On” by Randy Shilts really moved me to care about the topic and to realize what a devastating epidemic HIV/AIDS had really become. I would say that one book, more than another other, convinced me that HIV/AIDS was the right field for me to pursue. As time has gone by, I very much realized that this pandemic is the most important issue of our generation, as it deals with life and death in a way that no other disease seems to have ever done.
Gordon: When were you appointed Deputy Director of Economics and Finance at Avenir Health and what are your primary responsibilities?
Steven: I have been working for Avenir Health for the last 10 years. It is an organization that is full of geeks, which to be honest makes it a perfect home for me. I think the best advice I have ever heard is that you should always work for people who are smarter than you. At Avenir Health, that is definitely the case.
In my job as Deputy Director of Economics and Finance, I work on a number of projects that assess the economics of HIV/AIDS. Currently, for example, I am assessing the potential costs and effectiveness of offering pre-exposure prophylaxis (PrEP) to key populations in Africa. I am working in Kenya, where I recently travelled, to better understand how best to measure costs and benefits to populations that are at very high risk of infection. In South Africa, I recently completed and published a study that looked at the costs and effectiveness of male circumcision, which was a fascinating opportunity for me not only to understand the economics of the procedure, but also to understand the factors that influence boys and young men to make the decision to be circumcised, either through medical or traditional approaches. One of my newest clients was working with Gilead Sciences, the largest manufacturer of antiretroviral for the treatment of AIDS. Using epidemiologic and economic models developed by Avenir Health, we assessed how different the world would look if these medications had not become available and had been widely distributed. Looking all the way back to 1995, we assessed the demographic, epidemiologic and economic changes that have occurred as a result of these lifesaving medications. We also assessed how these medications are likely to evolve in the future, hopefully producing an end to the pandemic globally. Together with Gilead, we hope to publish a paper in Lancet HIV that will be used to convince policymakers that more still needs to be accomplished, but that the end of AIDS remains both a feasible goal and a worthwhile investment.
Steven: I am the founder of the International AIDS Economics Network. I began this network in 1993, at a time when probably fewer than a dozen people in the world were calling themselves “AIDS economists”. The reason I created the network was because the few people involved in this topic didn’t know what the other was doing. As a small group of economists who were based all over the world, we didn’t have the opportunity to meet and to work together to identify cutting edge topics. Therefore I invited everyone I knew who had written anything on the topic and we met in Washington DC.
Over time, we realized that we needed to reach out beyond Washington DC and especially to talk to those developing country economists who were new to the field. We therefore became a virtual network of economists at a time when the internet was first being used to manage discussions on topics of interest.
Despite the success of these virtual meetings, we also missed the opportunity to meet face to face. Many of the international AIDS conferences had a paucity of data on economics, so we decided starting in 2000 at the Durban AIDS conference to initiate IAEN preconferences. These preconferences have occurred every 2 years since, which allows us to have both an online presence and to meet in person.
We have realized that the number of people who define themselves as “AIDS economists” has grown tremendously. Today the IAEN Linkedin group has over 7,300 members, most of whom are from Africa. We post articles that we discuss, as well as jobs and information about conferences. Our membership has expanded beyond those who formally studied economics, to include a broader array of professionals who are simply interested to know what economics has to say about critical HIV/AIDS issues.
Gordon: What are some of the primary economic challenge that impact developed counties that address HIV/AIDS?
Steven: In terms of domestic HIV/AIDS programs, I believe developed countries need to assure that those who are infected with this virus are able to openly receive services, without any kind of stigma or discrimination. The populations most affected by HIV/AIDS in the United States are often times the hardest to reach. The U.S. has assumed that if we build services, then the clients will come (sort of a “Field of Dreams” strategy). This has generally not happened. However, where there is social cohesion (e.g., the gay population in San Francisco, for example), people are willing to get tested and get treated. They also adopt strategies to protect themselves, including PrEP.
As for international assistance, I believe that the U.S. needs to begin by acknowledging how much has been achieved. What shocks me is that Americans are still surprised when I mention what a great job our country is doing, especially in Africa. Without PEPFAR and the Global Fund, there would have been millions more deaths and millions more orphans, particularly in Africa. The American taxpayer has contributed to these two programs and have made a tremendous difference. It is hard to imagine that anything could have been done with those resources that would have had such a large impact on health globally. The American taxpayer deserves a lot of credit.
Gordon: What are some of the primary economic challenge that impact poorer counties that try to address HIV/AIDS?
Steven: Ultimately I think the most important challenge that countries face is that of sustainability. However, sustainability is not merely an economic or financial issue. Sustainability includes how NGOs manage to continue to expand their services to those most in need. Sustainability includes assuring that the politicians who were once very enthused to address HIV/AIDS, don’t become exhausted by the topic and give up. Sustainability is also about delivering interventions efficiently, including key biomedical interventions such as AIDS treatment and male circumcision. Sustainability also means working with international donors to assure that when those donors do reduce their commitment (and we know they eventually will), that there is not a discontinuation of services.
Today, for the first time, half of those living with HIV in the world are receiving treatment. This is an amazing accomplishment that has been achieved by doubling coverage roughly every four years. A final doubling of coverage would mean that everyone could receive treatment in the world, which in turn would tremendously reduce new HIV infections by reducing the viral load of those with the virus. However, we face economic constraints, donor fatigue, inefficiency and a lack of political focus. For the world to sustain the response, and get to full coverage over the next 3 years, it is necessary to guarantee the financial and political momentum we have achieved over the last 15 years. This will require a tremendous sacrifice by developing countries, but they cannot achieve this alone. It will also require development partners and the private sector, working with these countries, to get to this final milestone.
Gordon: What can the all religions do to inspire their members to be more compassionate to these with HIV/AIDS?
Steven: Religion already plays a critical role throughout the world in terms of changing the lives of people living with HIV. I have personally visited orphan programs in Ethiopia and Botswana, observing how children who have lost their parents to HIV/AIDS are thriving as a result of the Catholic church. I have been to health centers in places like South Africa and Namibia, where various Christian churches are dedicated to treating patients with HIV/AIDS. I have tremendous optimism about Christian and Moslem religions who have dedicated themselves to improving the lives of people with HIV.
Yet the role of religion has not always been positive and has not always been enough. There is still so much more that can be done to reduce stigma among church members, and to assure that there is a compassionate response. Religion gives meaning to life for people who often feel that life is meaningless and that death is inevitable.
I will end by noting that recently in the U.S., we observed a full eclipse. The newspapers were full of stories about how “awesome” this celestial event was. It made me realize that many people, without a faith in God, can find “awe” in the mere fact that a moon happens to block out the sun for a few minutes. Yet many people who have a religion find “awe” in so many other event in life, and find it “awesome” when there is real change in the world. In my mind, solar eclipses are nice, but for people of religion, we could see something that is truly awesome if we are able to eliminate AIDS, a disease that appeared ready to wipe out a large portion of the world’s population only a decade ago.
Gordon: Thank you for helping our readers better understand the continuing challenges of this global pandemic. You are an extraordinary example of what true love is when Christ asks us to love our neighbor as ourselves and who our neighbor s are