Download Politics and AIDS in Africa - University of San Diego Home Pages

There is a growing awareness of the importance of
macropolitical and institutional factors in shaping the
dynamics of the AIDS crisis
and governmental responses
to it, but these factors
remain poorly understood.
Taking up the research
challenge can give political
scientists a role in the war
on a disease that is transforming Africa in ways we
have only begun to imagine.
Politics and AIDS in Africa:
Research Agendas in Political Science
and International Relations
Catherine Boone and Jake Batsell
Political Science as an academic discipline has been slow to
grapple with the enormous implications of the AIDS crisis
for much of the developing world. This article argues that
important research agendas link AIDS and politics, and that
more work in these areas could contribute to the struggle to
cope with the pandemic. Research could also yield theoretical advances in the field of political science. Five research
agendas for Africa are: variations in state response to the pandemic; the relationship between governments and NGOs;
the AIDS challenge to neoliberalism; AIDS and North-South
tensions; and connections between AIDS and international
security issues.
Introduction
The spread of Acquired Immunodeficiency Syndrome (AIDS) now represents
a major social and economic crisis in much of the developing world, as
well as a public policy crisis of virtually unprecedented proportions. SubSaharan Africa is the most affected area of the world, with more than
twenty-three million people estimated to be infected with the AIDS virus
(HIV) or to have full-blown AIDS.1 In 1998, AIDS killed 2.2 million people
in Africa, making the disease more than ten times more lethal than wars,
which were responsible for an estimated two hundred thousand deaths in
the same year. Life expectancy in sub-Saharan Africa, which had risen by
fi fteen years in the postcolonial era to a relatively impressive fi fty-nine
years in the early 1990s, was projected to drop to forty-five years by the end
of the decade. In the most severely affected countries, infection rates are up
to twenty to twenty-five percent of the adult population.
AIDS is not a problem confi ned to Africa. It is shared by the rest
of the developing world: eighty-five percent of all cases of AIDS are now
found in the world’s poorer countries. India is home to one of the world’s
largest populations of people living with HIV and AIDS. There are full-
africa TODAY
4
POLITICS AND AIDS IN AFRICA
blown epidemics in other parts of South and Southeast Asia. In Latin
America, infection rates creep up and up among poor populations. Affluent
countries such as the U.S. are in a rather different position: much of the
general public in the U.S. and Western Europe now has a sense that the
AIDS epidemic has been brought under control, thanks to new discoveries
in science (drug therapies), innovation in public policy (regulating the blood
supply), and behavior changes. In the U.S., for example, there is widespread
perception (correct or not) that the worst is past. This contrasts sharply with
the situation in the developing world, where there is a general consensus
among experts that the epidemic is at the early stages and that it is continuing to spread at exponential rates.
HIV-AIDS crystallized as a global political issue in the mid- to late
1990s. It rose to the top of the United Nation’s (UN) agenda, second only to
military interventionism and peacekeeping.2 In the 1990s, the World Bank
redefi ned its paradigm for dealing with this issue: AIDS had been viewed
as a purely medical or social-service delivery problem but in 1999 it was
redefi ned as a major developmental crisis. The Bank has now identified
AIDS as the biggest threat to all gains in health, education, life expectancies,
and standards of living that Africa has made since the 1950s. Losses already
recorded on all these fronts make the HIV-AIDS crisis, as one Zimbabwean
doctor put it, “a catastrophe that is transforming the continent forever. It
will defi ne how economies and society develop over the fi rst half of the new
century in Africa” (Mutetwa 2000). 3 The UN Security Council and the US
National Security Council recently sounded the alarm over the security
implications of the epidemic, arguing that AIDS’ destabilizing impact on
societies, militaries, and economies around the world could have repercussions in countries like the US where most of the population now feels relatively insulated from the devastation that can be wrought by this disease.
Political science as a discipline, including the branch of international
relations, has been slow to grapple with the AIDS crisis. It seems that the
HIV-AIDS issue has been conceived of as too private, too biological, too
microlevel and sociological, too behavioral and too cultural to attract the
attention of many political scientists. Most of the literature has concentrated on microsociological issues that speak directly to the interpersonal
dynamics of the spread and prevention (education, behavior changes) of the
disease. There is a growing microsociological literature that concentrates
on the effects AIDS has on families and communities, and on householdlevel development issues like farming practices. When it comes to the
more political, institutional, and macrocauses and effects of HIV–AIDS,
the literature is very sparse indeed.
Political science must now race to catch up with the AIDS challenge
and with the political debates that it has spawned. It is increasingly obvious
to all major institutional actors that AIDS is as much a political as a
health issue. It seems, however, that the way it connects with the problems
that preoccupy political scientists such as the state, institutional reform
and development, democratization, civil society, globalization and global
africa TODAY
5
CATHERINE BOONE AND JAKE BATSELL
governance is not evident to many people. In spite of the rising clamor
surrounding AIDS in international fora like the UN Security Council and
increasing politicization of the issue as it affects arenas such as human
rights, development, security, and North-South relations, political scientists
have devoted little attention to the subject. “Here is a major global issue
with potential ramifications as great as any war, yet hardly any political
scientist shows scientific interest in it!” Kim Lanegran and Goran Hyden
lamented in 1993 (1993:247). Seven years later, academic work examining
AIDS and politics in Africa remains conspicuously scarce. Throughout the
1990s, most social science work on AIDS in Africa was done in the fields of
anthropology, medical anthropology, and public health, with contributions
from population studies, sociology, family planning and black studies. The
situation today echoes the voices of the editors of the now-defunct journal
AIDS and Society, who asked a decade ago, in November 1990, “Where are
the political scientists interested in AIDS?” (Aids 1990:2).
Why have political scientists shown so little interest in AIDS and
politics, especially in Africa? Lanegran and Hyden suggest that one factor
may be that examining a disease as a key variable in political analysis is
virtually unprecedented. The AIDS crisis may appear like such a straightforward public policy challenge that there is not much left to debate or
explain: after all, government attempts to stem epidemics are usually not
controversial. Another factor contributing to political scientists’ neglect of
the issue may be changes in the discipline itself. Although it is obvious
to most political scientists that the AIDS epidemic raises macrosocial
and political economy questions, substantive political economy issues in
general have gravitated out of the mainstream research in the subfield of
comparative politics. With the demise of developmentalism and the Cold
War, professional incentives have shifted to the study of formal political
institutions and the narrow arenas of electoral politics. A compounding
problem has been the tendency to defi ne AIDS, especially in Africa, as a
“hopeless” problem, one that is beyond the reach of public policy. “What
is the connection between politics and a disease that African governments
cannot cure or prevent?” AIDS has been framed largely as a matter of private
behavior, private suffering, and certain death. For political scientists AIDS
has been, as Lanegran and Hyden write, “silent and largely invisible. The
question of how to get a handle on it, therefore, remains” 4 (Lanegran and
Hyden 1993:247).
In this article we try to address this issue by framing some research
agendas that do indeed cut to the heart of political science.5 Our goal is
to discuss ways in which the challenges of AIDS engage the expertise and
theoretical concerns of scholars in political science and international relations. The challenges intersect directly with the traditional concerns of
political science. Political scientists can contribute toward an understanding
of what the pandemic means for Africa, for the state, and for development.6
We discuss AIDS politics and research agendas under five headings.
The fi rst section of the paper highlights significant variations in state
africa TODAY
6
POLITICS AND AIDS IN AFRICA
responses to the spread of AIDS in Africa. What explains these differences? The answer is not obvious, for the governments that have responded
most effectively and vigorously to this challenge are not the wealthiest,
best institutionalized, or even the most democratic. Comparing national
responses to AIDS could generate more nuanced understandings of the
sources of state capacity, responsiveness, and legitimacy in African contexts.
The second section frames issues that have to do with the relationship between African governments and civil society organizations, often
referred to generically as non-governmental organizations (NGOs). Much
of the political science literature has assumed that civil society in Africa
(and everywhere else) is basically an agent of political liberalism. NGOs
were thus often cast as natural leaders of, or joiners in, the political reform
movements that emerged across the African continent in the 1990s. Contra
such expectations, AIDS-focused NGOs (AIDS NGOs) in some countries
(Zimbabwe is a stark example) have been reluctant to engage in overt political action, even as advocates for better AIDS policy. There is an apparent
paradox here, and it underscores the need for more systematic inquiry into
when, where, and what kind of NGOs are most likely to pressure for policy
reform and political opening by way of confrontation (or engagement) with
the state. Investigating AIDS NGOs in Africa suggests the importance of
factors like NGOs organizational structure, political capacity, ideology, and
positioning vis-à-vis the state. Research in this area could contribute to
better understanding of the conditions under which positive partnerships
between regimes and civil organizations can develop.
The third highlights the role of the AIDS crisis in helping to erode the
1990s “Washington consensus” on neoliberal growth strategies in Africa.
There is growing awareness of the magnitude of the macroeconomic and
long-term effects that AIDS is likely to have on African society. Like the
Asian fi nancial meltdown of 1997, the devastating effect of AIDS on African
societies and economies highlights the need for public goods that only
governments acting unilaterally or multilaterally can provide. In the case
of AIDS, these public goods include education systems, public health infrastructure, and anti-poverty programs that were, in many places, decimated
by budget crises and structural adjustment programs in the 1980s and
1990s. Attempts to chart AIDS’ macrolevel impact in Africa can help social
scientists to engage new developmentalist agendas and to better understand
the forces that are shaping international public investment in the new,
more liberal global order.
Fourth, we point to the role of AIDS in stoking North-South tensions
that defy neoliberal visions of global consensus and smooth-functioning
world order under Western (U.S.) leadership. The stark global divide between
“haves” and “have-nots” leads poor countries to question the legitimacy
and desirability of global regimes, including trade regimes that protect the
profits, property rights, and political prerogatives of the rich. All this has
come to a head in AIDS politics. These tensions erode the efficacy and
CATHERINE BOONE AND JAKE BATSELL
Over the past decade in sub-Saharan Africa, AIDS and politics have become
increasingly intertwined. The capacity of African governments to mobilize
effective responses to the AIDS crisis has been evidenced by the experiences
of Uganda and Senegal, where aggressive public education campaigns are
widely credited with helping to lower HIV infection rates. Conversely, other
African countries such as Zimbabwe and South Africa are often singled
out as examples of governmental failures in the arena of AIDS policy.
The intersection of AIDS and politics was on full display in July 2000 at
the World AIDS Conference in Durban, where participants waved placards
during South African President Thabo Mbeki’s speech urging his government to “Break the Silence” on the pandemic. Archbishop Njongonkulu
Ndungane, head of the Anglican Church in South Africa, recently lambasted
the ANC-led government’s inaction against AIDS as “a serious a crime
against humanity as apartheid” (South Africa 2000).
7
I. Comparative State Responses
africa TODAY
sustainability of international regimes that claim to be “governing the
global commons.” North-South tensions may be just as important in this
regard as factors that have received far more attention from political science
(such as international capital flows).
Fifth, we discuss AIDS as a catalyst for international regime formation and as an international security issue. The challenge of HIV-AIDS has
given rise to a regime-formation process that has been driven mostly by
transnational actors. Gay rights activists, international NGOs, the World
Health Organization (WHO), and the UN itself have been at the vanguard
of forces pushing for coordinated, global initiatives aimed at both problemdefi nition and problem-solving. Strengths and limits of these new processes
are evident in the arena of AIDS politics. Meanwhile, the spread of AIDS
has been intertwined with classic issues in the field of security studies
such as interstate war, civil war, deployment of military forces in interstate
confl icts, and international migration. So far, advocacy groups and the
popular media have paid more attention to the broad international implications of the AIDS pandemic and global responses to it, than mainstream
international relations theory.
The article remains suggestive in its approach; it does not aim to
answer questions so much as it does to raise them. By framing some of the
issues and posing research questions, we highlight deeply political aspects
of the AIDS crisis in Africa. There is a growing awareness of the importance
of macropolitical and institutional factors in shaping the dynamics of the
crisis and governmental responses to the AIDS challenge, but these factors remain very poorly understood. Taking up the research challenge can
give political scientists a constructive role in the war on a disease that is
transforming Africa in ways we have only begun to imagine. The practical
and theoretical justifications for research are very compelling.
africa TODAY
8
POLITICS AND AIDS IN AFRICA
Public health advocates and AIDS sufferers have looked to the state to
take a more active role in confronting the epidemic since the late 1980s. Governments, after all, possess the capacity to mobilize and allocate resources,
to coordinate national education programs, to appeal for international
funding, to supply materials such as condoms and self-destruct syringes to
reduce the spread of the disease, and to supply or subsidize the cost of drug
therapies. As UNAIDS (Joint United Nations Programme on HIV/AIDS)
puts it, “experience shows that when governments commit their political
prestige and fi nancial resources, involve civil society fully, emphasize prevention and care, and support activities in a range of sectors, they are able
to limit the spread of the epidemic and mitigate the impact, and attract
international support. Only then can the rate of new infections be slowed”
(UNAIDS/WHO 2000:25).
All too frequently, however, governments in Africa have been slow
and half-hearted in reacting to AIDS. In the opening segment of his Pulitzer
Prize–winning series on AIDS in Africa for the Village Voice, Mark Schoofs
(1999a) accuses African governments of being “shockingly derelict” in their
responses to the epidemic. Lanegran and Hyden (1993) concurred, observing
that “what is striking about the situation in most African countries is
how little urgency there appears to be in dealing with this war of attrition
or impending catastrophe” (Lanegran and Hyden 1993: 246). Even Nelson
Mandela, by all accounts one of the twentieth century’s most visionary
leaders, waited until the end of his five year term before he fi nally delivered
a major speech on the disease in late 1998. “Why he waited so long to
confront AIDS,” Schoofs contends, “remains one of the most maddening
enigmas of the epidemic” (1999c).
Ignorance is not the excuse: African governments have been keenly
aware of the magnitude of the AIDS epidemic since at least the mid-1980s.
Government sponsored education programs began in Rwanda and Uganda
in 1985 (Waite 1987; Mameli 1998; Eboko 2001). All sub-Saharan African
countries were signatories to the UN Resolution 42/8 of 1987, which stressed
the need for open communications about AIDS and called for nations to
band together in confronting the problem. At a Health and Welfare Conference in Maputo in 1990, more than 250 delegates from Southern Africa
passed a resolution urging the region’s governments to put AIDS squarely
on the public agenda and to consider the disease a top political priority. The
delegates insisted that “any attempt to deal with the HIV epidemic must
be situated within the broader struggle for sociopolitical change” (South
African 1991: 8).
Still, many African governments continued to shun AIDS as a political and policy issue. The Nigerian case was perhaps the worst: an AIDS
program that got off to a vigorous start was allowed to wither under military
dictatorships. Nigeria’s early program, the National AIDS and STD Control
Program, now limps along on about U.S. $500,000 a year in a country of
100 million. In Zimbabwe, probably the worst hit country on the African
CATHERINE BOONE AND JAKE BATSELL
UNAIDS frequently invokes the example of Uganda, along with Senegal
and Thailand, when highlighting positive state responses to AIDS. In all
three countries, AIDS prevention and education programs have lowered
HIV infection rates (UNAIDS/WHO 2000:18). In Uganda where AIDS has
been curbed most dramatically, the infection rate estimated to be near
thirty percent in 1991 is now estimated at around twelve percent. In June
2000, UNAIDS Director Peter Piot called for U.S. $2 billion to provide for
more Uganda-style prevention and awareness campaigns in Africa.7
President Yoweri Museveni adopted a nationwide plan to combat
AIDS in the mid-1980s, when Uganda was facing the most staggering
increase of AIDS cases of any country in the world. Museveni enlisted both
government agencies and NGOs in crafting and delivering public education
and health services programs. The country established the fi rst African
center for anonymous HIV testing and counseling (Caron 1999). But the
most distinguishing feature of Uganda’s AIDS program, a characteristic
which has yet to be matched by any other African country, is sustained
political commitment at the highest levels—even the health minister took
to the streets to distribute condoms. According to Fredland (1989), political
leaders shrewdly realized that the country’s fragmented population could
only be reached through an intense, grassroots, face-to-face educational
campaign because “the incentive to act against AIDS was irresistible”
(1989:5).
Senegal, too, is credited with mounting one the most effective responses
to the crisis in the developing world. It has been based on public education
campaigns, early and systematic programs aimed at controlling sexually
transmitted diseases (STDs) among high-risk groups (such as commercial sex
9
Contrasting Cases: Uganda and Zimbabwe
africa TODAY
continent (infection rates among adults have hit about 25%), AIDS spending
actually declined between 1994 and 1999 (Schoofs 1999c).
Fortunately, some governments in Africa and elsewhere have adopted
vigorous public policy aimed at addressing the AIDS challenge. Mary Caron
of the Worldwatch Institute points out that “where politicians have lifted
their heads from the sand [and become involved in battling HIV-AIDS],
millions of lives have been saved” (1999: 30). Caron notes that governments
that have registered successes in responding to AIDS have adopted the
following set of common policies: early and aggressive action; involving
community groups and other realms of civil society; political leadership
at the top levels; extensive data collection and dissemination; distributing
low-cost, high-quality condoms; and targeting interventions to high-risk
groups such as migrant workers or prostitutes. Caron (1999:34) argues that
these policies “are proven to work, at least at mobilizing communities
to keep HIV in check.” She recommends that every country adopt such
policies. The question is why are they not?
africa TODAY
10
POLITICS AND AIDS IN AFRICA
workers in urban centers, for example) and increasing the responsive capacity
of an already well-developed primary heath care delivery system.
These cases stand in stark contrast to Zimbabwe, where government response has been slow and inadequate. Zimbabwe is now one of the
world’s most severely AIDS-stricken countries. As the government stood by,
HIV–AIDS infection rates soared in the late 1980s and 1990s. Today, more
than twenty-five percent of the adult population is believed to be infected
with HIV (UNAIDS 2000). Urban centers have even higher infection rates.
A child born today in Zimbabwe is expected to live to be thirty-eight; in
the absence of the AIDS epidemic, life expectancy would be seventy years.
The back pages of daily newspapers in Harare and Bulawayo are replete
with death notices, many accompanied by haunting photographs of young
people cut off in their prime. Meanwhile the government daily eschews
responsibility and berates young people “who contract AIDS because they
insist on indulging in risking sexual experimentation” (Herald 2000: 4).
Despite the severity of the catastrophe, AIDS remained a closeted
issue in Zimbabwean politics throughout the 1990s. The prevailing perception among both domestic and international observers is that the Zimbabwean government simply tried to sweep AIDS under the carpet.8 President
Mugabe publicly acknowledged the national epidemic for the fi rst time in
April 1999, when more than 1,200 Zimbabweans were dying each week
from the disease (Los Angeles 1999). “President Mugabe, although he will
occasionally wear an AIDS ribbon, has never taken the sort of leadership
stance that President Museveni in Uganda has, talking openly about the
problem,” an official from the U.S. Embassy in Harare told one of us in
an interview. “The minister of health has, at times, spoken bluntly and
honestly about the problem in productive ways. But his approach was to
downplay it, to try to persuade people that no, it’s not as the West says it
is” (Batsell 2000b).
What Explains Differences in Governmental Response?
What explains these cross-national variations? Political science offers a
repertoire of straightforward hypotheses about why state actions vary across
cases. There are explanations that focus on incentives facing politicians on
levels of institutional and/or economic development, and on regime type,
to name just a few. The cases we have assembled here allow us to conduct
a preliminary analysis of these explanations.
Earlier analysts have focused on politicians’ incentives to explain
why so many African governments have not acted decisively in the face
of the AIDS epidemic. Richard Fredland, one of the few political scientists
who has paid systematic attention to this issue, contends that politicians
do not have much incentive to place AIDS at the forefront of the political
agenda (see also Fassin and Dozon 1988). Given the immense hardships
African countries have endured during severe austerity programs, government officials have been reluctant to draw attention to an incurable disease
africa TODAY
11
CATHERINE BOONE AND JAKE BATSELL
out of concern for their own political survival. Fredland thinks that official
silence on AIDS stems at least in part from pragmatism, since no sensible
political leader would want to spend his or her time scolding people through
public education campaigns about a disease “that can only be prevented
by wholesale behavioral changes” which are “unlikely to reach fruition
during any given leader’s tenure in office” (1998: 562).
This argument is taken to its logical extreme in a pessimistic analysis
rooted in rational choice theory by Philipson and Posner (1993). Their book
purports to demonstrate that public education campaigns are unlikely to reduce
AIDS infection rates. Approaching AIDS from an economic perspective, the
authors define risky sexual encounters as economic “trades” that will continue
to occur as long as sex is an activity perceived “as mutually beneficial to the
persons engaged in it” (Philipson and Posner 1993:5). Thus, public education
campaigns conducted by governments are destined to be futile. By this logic,
politicians have absolutely no incentive to tackle the issue.
One problem with these analyses of politicians’ incentives is that
they do not explain the anomalies that may teach us the most about how
government authority can be harnessed to slow the spread of AIDS. Uganda
and Senegal have kept HIV infection rates in check through aggressive,
state-initiated public education campaigns. Why were political officials in
Uganda and Senegal willing to take the political risks that so many of their
counterparts, including those in Kenya and Zimbabwe, were not?10 These
cases force us to move beyond theories that tell us that politicians and
political entrepreneurs, by defi nition, have no incentive to focus on a longterm, difficult-to-address problem.
Levels of economic development and bureaucratic capacity are always
factors in explaining the scope and effectiveness of governmental response
to crisis. In the case of these four countries, however, these explanations are
not immediately satisfying: the two best-endowed states in terms of economic and bureaucratic levels of development (Kenya and Zimbabwe) have
the worst records. How can we explain the fact that one of the continent’s
poorer countries (Senegal), and another country that has known state decay,
civil war, and disorder for much of its postcolonial history (Uganda), have
both been at the forefront of Africa’s fight against AIDS?
If wealth and bureaucratic capacity alone do not account for variation
in state response, what does?11 Comparisons across these four cases seem
to suggest that an explanation may lie in “regime type,” if we can interpret
that term very broadly. Amartya Sen (2000) argues that democracy, for all
its weaknesses, has the advantage of forcing government to be moderately
responsive to the needs of the people. Famines, he observes, do not occur
in democracies. Dictatorships let people starve because they do not fear the
political consequences of doing so. Sen’s logic seems to sidestep many of the
conceptual difficulties that dogged questions about whether, how, and why
democracy produces concrete improvements in poor people’s lives.
Amartya Sen’s take on the political consequences of democracy seems
to provide some leverage in the cases we are examining here. The govern-
africa TODAY
12
POLITICS AND AIDS IN AFRICA
ments that have generally dealt openly with the AIDS challenge in Senegal
and Uganda have tried (albeit with uneven commitment and success) to
cultivate broad legitimacy by encouraging some grassroots participation in
the political process. Zimbabwe and Kenya, by contrast, suffer from some of
the most politically intransigent, closed, and bureaucratically entrenched
regimes on the continent. Both were left far behind by the “democratization
waves” that washed over the African continent in the early and mid-1990s.
These two regimes continue to regulate political competition through
repression and the strategic deployment of state violence. Failing to respond
to the AIDS crisis is clearly part and parcel of a bad governance syndrome
in these two states.
If we accept the Amartya Sen explanation for the differences we
observed above, we have learned something about the politics of AIDS,
but are left with a problem for political science. When political scientists
construct large data sets that typologize developing countries by regime
type, Senegal and Uganda are usually not counted as democracies (Geddes
1999). Senegal’s ruling party dominated the electoral arena from 1952 to
2000, when it lost the presidency for the fi rst time.12 Across the continent
in Uganda, politics has appeared even more uncompetitive. For the last
decade, Uganda has held elections but political parties have been outlawed.
Museveni has made Uganda a “no party state.” The regime is fighting two
guerrilla movements within its borders, often using great force and violence
against civilians to do so. Museveni’s regime receives very low marks
from Human Rights Watch for this violence, and also for harassing and
repressing those who seek to widen the political and constitutional debate
in Uganda.
Yet, given all this, governments in Senegal and Uganda have been
responsive in the area of AIDS policy. Both have been able to forge productive
partnerships with civil society organizations and foreign NGOs to advance
AIDS prevention and education efforts. In Senegal, this is surely partly a
function of political stability and political openness, and the existence of
a credible judiciary, an energetic press, and an increasingly competitive
electoral process. Some of the mechanisms that produce responsiveness in
a democratic society are in place, and the AIDS response may be one area in
which the cumulative and indirect effects of this are clearly manifest.13
Fewer mechanisms of political constraint, check-and-balance, and
regime monitoring are evident in Uganda. The constellation of factors that
help produce government responsiveness in this issue area in Uganda may
include the legitimacy and grassroots connectedness of a regime that rose
to power through guerrilla struggle that liberated Uganda from almost
two decades of violent dictatorship. Museveni enjoyed widespread popular
support in his fi rst decade of rule. He also reached deep into village and
local-level politics via decentralization programs designed to energize local
government councils and mobilize popular participation in civic life at the
local level. The successes of the AIDS programs may owe much to diffuse
popular support for Museveni’s regime, the local government initiatives,
CATHERINE BOONE AND JAKE BATSELL
In the 1980s, many political scientists argued that modern associational
life was flourishing in Africa in spaces left vacant by the decay of the state.
Naomi Chazan and others traced the proliferation of civic associations
and NGOs serving basic needs for education, security, health care, local
infrastructure, and fi nancial services. In the 1980s, proponents of structural
adjustment and state shrinking embraced voluntary associations as “the
thousand points of light” that could help supply the social services and
safety nets the state could no longer afford to provide. Across the continent,
NGO service providers began to solicit and receive direct funding from
official and non-governmental international agencies. “Development funding” bypassed states and went directly into the hands of local, decentralized,
citizen-controlled organizations.
As these changes unfolded, political science concentrated its attention
on a fairly narrow set of questions concerning the role of “civil society
associations” in promoting transitions to democracy. There has not been
13
II. Civil Society and the State
africa TODAY
and the government’s openness to the wide array of international agencies
and NGOs that have rushed forward to actually implement and fund much
of the on-the-ground AIDS-prevention work that has been undertaken in
Uganda.
In both cases, we see evidence of a capacity to supply “good governance” that political science does not defi ne or measure very well. Research
aimed at better understanding where state strength and effectiveness comes
from in these cases could be useful. It could contribute to broader and
more general understandings of what it takes to generate state capacity in
Africa and it could also help identify new political resources that could be
mobilized in efforts to provide public goods, including positive responses
to HIV-AIDS.
Political scientists can make a direct contribution by analyzing the
factors that contribute to constructive public policy responses to AIDS. It is
clear that there is simply no substitute for state action in this domain: governments must be at the center of AIDS-prevention and treatment efforts.
Experiences from the past fi fteen years show that where governments fail
to act, the disease spreads faster, the eventual costs of dealing with it are
higher, and the negative effects on development are more far-reaching and
intractable. Conversely, governments that do respond forcefully to the issue
of AIDS have registered successes in bringing HIV infection rates down,
such as in Uganda and Senegal. As Peter Mameli wrote in his 1998 dissertation examining variations in state response to the AIDS pandemic, “it is
essential that researchers begin to analyze which background conditions,
administrative techniques and organizational forms have worked most
effectively at the national and international levels of political response as
we continue to address this health crisis” (Mameli 1998: 24).
africa TODAY
14
POLITICS AND AIDS IN AFRICA
much work in the discipline that attempts to untangle these different
conceptions of NGOs, their role in restructuring state-society relations,
and their political positioning vis-à-vis the state. Under what conditions
do NGOs advance the different historical mandates assigned to them by
political science? What attributes of civil society, political-institutional
context, and the NGOs themselves affect the likelihood that productive
state-society relations can emerge? Work so far has concentrated on attributes of society in general or on general political structure to answer these
questions. Robert Putnam (2000) pointed to the presence of social capital,
a feature of society at large, as a factor empowering civil society organizations. Crook and Manor (1998), who studied local government in West
Africa, along with democracy theorists since Tocqueville, have explained
variation in civic capacity in terms of broader political context, or regime
type. By contrast, there has not been much work on attributes of NGOs
themselves that may help explain variation in political behavior across
space or time.
These questions have special poignancy in the area of AIDS response.
In this political domain, it is important that NGOs act as they are often
envisioned by political science theory as grassroots activists and promoters
of political and policy reform. In Europe and North America, including
Mexico, bottom-up pressure from NGOs has played a very important role
in moving governmental policy forward in this issue area.
For an effective fight against AIDS, it is also important that NGOs are
in a position to be partners of the state. Academics, public policy makers,
journalists and activists who closely follow AIDS in Africa often stress
the critical role of NGOs in confronting the HIV epidemic. The shrinking
of state health services across the continent, a consequence of increased
privatization, has placed much of the burden upon NGOs to fi ll the gap.
Since NGOs play a major role in the health sector already, it might seem
that African governments would be eager to tap them for their skills and
assistance in confronting AIDS. One central policy prescription of most
work on this topic is that governments need to team up with NGOs,
community groups and other grassroots organizations. “You can’t fight
AIDS without civil society and without community groups,” says Piot, the
UNAIDS director. “You need both the government and civil society—particularly community groups, local government and also business—to really
implement programs at the grassroots level” (Batsell 2000c). There are
indeed positive examples of government-NGO partnership in the fight
against AIDS in Africa. Museveni’s government is often cited as exemplary
in its ability to draw together broad-based coalitions of NGOs and civic
associations in this endeavor.
In many African countries, however, the relationship between government and AIDS NGOs has not followed the evolutionary scenario assumed
by some of the Political Science literature on NGOs and democratization.
This is especially true in places like Zimbabwe, Kenya, and South Africa.
In these countries, civic response in caring for people with AIDS has been
africa TODAY
15
CATHERINE BOONE AND JAKE BATSELL
strong. NGOs have emerged in spaces left vacant by the state, including
where the state has failed or declined to provide basic social services to
citizens. Yet, relations between government and AIDS NGOs in these
countries have been characterized by suspicion and even tension.
In the wake of structural adjustment in Zimbabwe, health-related
NGOs began to proliferate, many with connections to parent agencies
from Western countries. Turshen (1999:35–6) notes that in 1992 there were
267 health-related NGOs operating in Zimbabwe. The private sector and
missions made up a large share of the heath care industry: missions, for
example, provided nearly seventy percent of all hospital beds in the rural
areas in 1999. Outside the formal health-care sector, there has been a
formidable effort by NGOs at the grassroots level to educate and care for
local populations affl icted by AIDS.14
The government’s response to the rise of a vigorous NGO sector
in Zimbabwe has been suspicious, even hostile. In 1995, the government
passed the Private Voluntary Organizations (PVO) Act. The act requires
NGOs to register with the government and gives ministers the power to
“suspend” NGO officials from their administrative duties whenever “it
is necessary to do so in the public interest.” Brian Raftopolous of the
University of Zimbabwe’s Institute for Development Studies contends that
the act “signaled the eagerness of the state to control the growing NGO
sector” (Raftopolous 2000:36). NGOs working in the AIDS area have been
victims of the governments suspicion of NGOs in general, and of its reluctance to deal with the AIDS issue. For most of the 1990s, Mugabe’s regime
denied that an AIDS problem existed. When the government fi nally came
around to admitting the problem, it worked hard to marginalize the NGOS
and prevent them from taking a central role in any coordinated policy
initiative at the national level.
In the late 1990s, AIDS NGOs did begin to lobby the state more
aggressively, and they registered some modest victories, including mandatory AIDS education in elementary schools and a law prohibiting employers
from fi ring a worker for being HIV-positive (Batsell 2000a:6). Still, NGOs
were unable to persuade the ruling political party, ZANU-PF, to increase
overall government spending on AIDS. The director of Zimbabwe’s National
AIDS Program admitted in 1999 that state spending on AIDS prevention
had, in real terms, certainly not increased and probably declined since 1995
(Schoofs 1999c). Partly in response to pressure from NGOs, in January
2000, the Zimbabwe government instituted a three percent tax on personal
income and corporate earnings to raise funds for AIDS care and prevention.
Disbursement of these funds created more tensions between the NGOs and
the government. AIDS NGOs in Zimbabwe contend that the government
has shunned their efforts to cooperate in devising a national response to
the epidemic, and that even their efforts to draw attention to the epidemic
have been stifled by the government. Some critics, such as Marvellous
Mhloyi, professor of population studies at the University of Harare, argue
that NGOs themselves “have not really endeavored to put HIV–AIDS on
africa TODAY
16
POLITICS AND AIDS IN AFRICA
the political agenda as an area of debate, to really push on it continuously
and persistently” (Batsell 2000d). As the U.S. embassy official in Harare
put it, “There’s no act-up in Zimbabwe. Nobody’s out there making a big
fuss about it. It’s all very quiet.”
Tensions between government and AIDS NGOs have also emerged in
Kenya, where NGOs and the government clashed over NGO representation
on the National AIDS Committee. Several Kenyan NGO representatives
initially were invited to sit on a subcommittee in charge of developing
an AIDS prevention campaign, but they were eventually dropped because
the government viewed them “as a potential threat to what politicians
perceived as the government’s right to control of the agenda” (Lanegran and
Hyden 1993:251–2). Discord also has characterized the relations between
government and AIDS NGOs in South Africa. One local policy analyst
describes their relationship as “in a word, hostile” (Friedman 2000:27).
Lanegran and Hyden explain that debates over AIDS between African governments and NGOs frequently have been acrimonious in Africa because
“NGOs may feel less concerned about the need to consider what is appropriate from a political point of view to say about the disease in public. Hence,
government officials want to be the sole spokespersons on the subject”
(Lanegran and Hyden 1993:252).
These cases raise questions about state-society relations in contemporary Africa that political science, so far, has not analyzed very systematically. What kinds of NGOs have the political capacity to conduct effective policy advocacy, or to push for broader political reforms and under
what conditions do productive relations between government and NGOs
emerge?
The Zimbabwe case suggests that some NGOs’ capacity for collective
action and political action may be quite low, contrary to political science
scenarios that seem to assume that civil associations are natural catalyzers
of civic action and agents of reform. In the case of AIDS NGOs in Zimbabwe, limited political capacity may be due to their origin and mandates
(such as providing basic services to highly localized clienteles), funding
governmental, church-based, or external sources, or the absence of any
organizational hold on or claim to represent their clients and constituents.
Most of the nongovernmental associations involved in AIDS work in east
and southern Africa are similar to the Zimbabwe NGOs in these respects.
Many emerged in the last two decades, in defensive reaction to the state’s
failings. They tend to be small, localized, and dispersed. Many rely on
funding from Western governments or NGOs. This may force them to
compete amongst themselves for the donors’ largesse and to hamstring
them politically by tying them to the funders’ agendas. In these ways, the
AIDS NGOs may be typical of many of the civil society organizations
funded by international agencies concentrating on local-level development
projects and providing social services.15 NGO political capacity may be
very low in general. Political Science may be overgeneralizing when it
Challenges to Liberalism
The death of Keynesianism killed off developmentalism as an ideology
or public policy agenda. For the last decade or so, the argument that the
downscaled, minimalist state really “is best” for the developing world has
CATHERINE BOONE AND JAKE BATSELL
Since the end of the Cold War, research on International Relations has
been organized around ideas about globalization, convergence, integration,
and economic liberalization. Mainstream political science has been less
interested in wide and deep countercurrents in the international system
that actually constitute very important challenges to the neoliberal world
order. In the AIDS crisis, many of these countercurrents are obvious.
17
III. Liberalism and Developmentalism
africa TODAY
identifies these groups as agents of political reform or democratization. If
that is so, then political science may be missing more particular attributes
of organizations that are effective catalyzers of reform.
African organizations that were at the forefront of political reform and
opposition movements in the 1990s, by contrast, were often labor unions
and professional associations (i.e., farmers associations) that were originally
brought together as corporatist groupings during the era of the old, one-party
states. They operate in economically strategic sectors and have institutional
infrastructures of national scope, constituents or members, and formal
internal governance structures based on some presumption of representativeness and downward accountability. Many have a well-defi ned class base,
and some were originally joined by state action. In Zimbabwe, for example,
the Zimbabwe Congress of Trade Unions (ZCTU) has been at the vanguard
of the pro-democracy movement, and has been the main agent of societal
pressure on the Mugabe regime. Much the same was true in Zambia and
South Africa. In Senegal, too, teachers’ and public sector workers’ unions
were at the forefront of popular (urban) pressure on the long-ruling Parti
Socialist. To be effective agents of political reform, AIDS NGOs may require
some of the attributes of these kinds of organizations (i.e. wider geographic
scope, internal governance structures that provide for some representation,
and accountability).
Comparative research on the political action and positioning of AIDS
NGOs in Africa could produce a better grasp of how the structural, institutional, and material foundations of civil society organizations affect their
political capacity and positioning vis-à-vis the state. And as the discussion
of different governmental responses to the AIDS crisis suggests, crossnational research on AIDS NGOs could also contribute to a more systematic
understanding of how the structuring of the political playing field affects
the strategies and targets of NGO action.
africa TODAY
18
POLITICS AND AIDS IN AFRICA
reigned supreme in policy circles. Political scientists mounted vigorous
critiques of neoliberalism in the 1980s, but much of this impulse was
exhausted by the end of the decade.
Asia’s 1997 fi nancial crisis was the fi rst real shock to this system;
it began to erode the confidence of the neoliberals themselves in the Washington consensus. AIDS is developing into another systemic shock. Just
when neoliberalism was claiming ideological triumph in Africa, the world
has been forced to confront a public policy challenge of unprecedented
proportions. Over the last fi fteen years we have witnessed the loss of much
of Africa’s public health infrastructure, including the public drug sector,
thanks to economic crisis and structural adjustment. In the face of fiscal
crisis and creditors’ demands, African governments slashed health and education budgets ruthlessly. Yet an effective AIDS response requires that governments deliver improved primary health care to all populations, including the most difficult and costly to serve such as those in rural areas and
border regions, the poor and migrant communities. Effective AIDS policy
also presumes that a functioning public educational system is in place.
Some argue that Africa is just one of the fi rst places to pay the costs of
the dismantling of public health and education systems during Western
creditors’ liberal euphoria in the 1980s and 1990s (Garrett 2000a).
The strategy of trying to spur Africa’s transformation primarily
through the introduction of a more market-oriented economy has proven
to be a disappointment in Africa, as it was in Russia, much of the Middle
East, and the peripheral zones of the former Soviet Union. Even the World
Bank now admits that there are limits to market-oriented economic reform
as an instrument of transformation. AIDS has played a significant role
in focusing minds on this issue. Similar to the communist threat of the
1950s, AIDS has come to be defi ned as a security crisis that demands a
developmentalist solution.
A New Developmentalism?
Until very recently, AIDS in Africa and the rest of the developing world was
defi ned as a health problem with a behavioral solution. As Geshekter and
Turshen (2000:15) wrote, the response of the United States and international
fi nancial institutions such as the World Bank “amounts to health education
and condom distribution.” Yet a paradigm shift seems to be underway. In
the last year or two AIDS in Africa has been redefi ned as a development
problem. In 1999, the World Bank redefi ned AIDS as the “foremost threat
to development in the region. AIDS . . . has an unprecedented impact on
economy and society because it kills so many adults in the prime of their
working and parenting lives, it decimates the workforce, impoverishes
families, and shreds communities” (World Bank 2000). In the worst affected
areas, it is reversing the development gains of the last four decades.
Little is known about the quantitative and qualitative effects of the
HIV-AIDS-related illness and death on African economies. It is, however,
africa TODAY
19
CATHERINE BOONE AND JAKE BATSELL
painfully obvious that in the most affected regions of east and southern
Africa, farming, education, manufacturing and services, and the civil service have been hit hard. Investment, productivity, and production seem to
have fallen across the board. The World Bank notes that in the coming
years, “labor productivity is likely to drop, the benefits of education will
be lost, and resources that would have been used for investments will be
used for health care, orphan care, and funerals. Savings rates will decline,
and the loss of human capital will affect production and the quality of life
for years to come” (World Bank 1999:15).16
These effects are surely uneven. They will result in redistributions of
power and advantage between African countries, across regions within the
hardest-hit countries, and perhaps among social classes as privileges born
of family wealth and education are dissipated by illnesses and premature
death. Peasant-centered commercial agriculture will be affected in some
regions, land-labor ratios will change, and in the urban sector, both foreign
and local investors will have to take into account the changing cost of
labor. By some estimates, the disease threatens to eliminate some twenty
percent of the African workforce. Civil service establishments will surely
change in structure and strength. Political science and political economy
need to mobilize their expertise in charting the political effects of economic
change and to generate hypotheses about what the effects of these changes
might be.
Some information from east and southern Africa gives a sense of the
magnitude of the effects at hand. In Zimbabwe, maize production by peasant
farmers and on small commercial farms declined by sixty-one percent in
1999 because of illness and death from AIDS, according to a survey by the
Zimbabwe Farmers Union (World Bank 1999, see also Garrett 1994:478–83).
Cotton, vegetable, groundnut, and sunflower crops were cut nearly in half,
and cattle farming declined by almost a third, according to the same source.
Overall, agricultural output dropped nearly twenty percent in 1999 as a
result of AIDS. In one hard-hit locality, farmers report that business at the
neighborhood convenience store has declined dramatically in the last few
years. “People just don’t have money to spend anymore,” said the owner
(Jeter 2000).
Manufacturing and extractive industries also register huge costs.
According to a December 1998 release issued by the Africa Policy Information Center, life insurance premiums in Zimbabwe quadrupled between
1996 and 1998 because of AIDS deaths. The country’s largest insurance
company says that AIDS accounts for sixty percent of the claims it receives.
Some Zimbabwe companies say that their health bills have doubled over
the last decade: several report that AIDS costs absorb as much as one-fi fth
of their earnings. In Tanzania and Zambia, some large companies have
reported that AIDS illness and death are now costing more than their total
yearly profits (APIC 1998). One South African insurer estimated that the
cost of a standard package of benefits would triple by 2010 (Economist
2000). One U.S. source reported in January 2000 that the Barclay’s Bank of
africa TODAY
20
POLITICS AND AIDS IN AFRICA
Zambia has lost more than a quarter of its senior managers to AIDS (Jeter
2000). In Zimbabwe, managers at the Vitafoam Mattress Company train
three new hires for every job. “We expect to lose two of them within a
year’s time,” said Taanda Marongwe, the plant supervisor in the industrial
center of Bulawayo. “It’s a difficult way to run a factory, but it’s the best
way under these circumstances” (Jeter 2000). At Zambia’s largest cement
factory, absenteeism has increased fi fteen-fold since 1992, and during the
same period, Uganda’s railroad company lost fi fteen percent of its workforce
every year (Economist 2000).17
It seems particularly cruel that AIDS has taken such a heavy toll
on public educational systems in Africa, which stand as one of the great
achievements of the independence era and, along with roads, a prime tool of
“nation building.” Some thirty percent of teachers in Malawi and Zambia
are infected with HIV (World 1999:15). Don Bundy, the World Bank’s West
Africa Regional AIDS prevention coordinator, says that “HIV–AIDS has
devastated educational systems in East Africa.” In the small country of
Botswana, three public school teachers die every week; in Zambia, the
number is higher. West Africa has not been spared either; Côte d’Ivoire loses
one schoolteacher to the AIDS epidemic every day (Economist 2000).
Poverty is surely one consequence of the AIDS epidemic. Unfortunately, poverty and its offspring—illiteracy, joblessness, homelessness, lack
of medical care, and despair—are also major factors in the spread of AIDS.
As Waite wrote, the fragile nature of African economies, “compounded
by poverty, seriously compromises the ability of even well-intentioned
governments to meet the public threat posed by the spread of AIDS” (Waite
1987:156). Structural Adjustment Politics (SAPs) played a role, as we have
seen, because they decimated Africa’s public health infrastructure just at
the moment when the epidemic was gaining momentum.
The international fi nancial institutions (IFIs) and U.S. government
agencies that have been leading the neoliberal charge in Africa since the
1980s are gradually backpedaling. They are beginning to admit that dealing
with AIDS will require a vigorous, developmentalist response on the part
of the African state. The idea that some kind of new developmentalism is
required also appears to be gaining wider currency. In recent documents
and public pronouncements, the World Bank (e.g., World Bank:1999) has
backed away from its doctrinaire neoliberalism of the 1980s and 1990s and
admitted the need for rebuilding economic infrastructure, social service
delivery systems such as health and education, and state institutions. Poverty reduction is now identified as a goal to be achieved through measures
that will permit increases in consumption. With the structural adjustment
orthodoxy of the 1980s now appearing inadequate and outmoded, even in
World Bank discourse, the door is open to new initiatives.
In this connection, debt forgiveness has been placed on the political
agenda as a far more credible proposition than it ever was in the 1980s.
In the U.S. Congress, for example, Republican leaders who have long been
resistant to the idea of canceling third world debt have now agreed to
Reactions against Western Hegemonism
There is extensive literature on anti-Western and antiliberal political currents in the Middle East (often focused on variants of Islamism), and on
how these currents have evolved from older anti-imperialisms. In Africa, a
version of the same situation occurs in many places. Attempts to grapple
with the AIDS epidemic have evoked expressions of intensified hostility
toward the U.S. and Europe that have not been seen in at least a generation.
The argument that the West is, in general, a threat to African interests
and sovereignty, is not new; it is fi rmly rooted in concrete experience
and historical fact. Bilateral and multilateral relations have often been
CATHERINE BOONE AND JAKE BATSELL
It is increasingly clear that the neoliberal growth model offers very dim
prospects for much of the world’s population. We see in many international
arenas a creeping politicization of North-South issues that threatens to
destabilize the entire process of globalization and integration. Huntington
(1996) raised doubts about globalization with his “clash of civilizations”
argument. He identified cultural identities as a source of global tensions,
confl ict, and even disintegration. While Huntington may have identified
the problem, he misdiagnosed its source. Surely the fault lines that divide
“haves” and “have-nots” are a more certain and perhaps even less manageable source of instability and discord in the international system. How
these tensions might affect the legitimacy of international organizations,
the pace of economic liberalization, patterns of alliance and rivalry, and
struggles over the meaning of an open world economy are important questions for political science.
21
IV. North-South Conflicts and Neoliberal Visions of Global Order
africa TODAY
allot $435 million for a worldwide debt relief initiative (Kahn 2000). A
bill proposing “A Marshall Plan For Africa” is circulating in Congress as
well. Meanwhile, the call for “development” as a response to AIDS received
attention at major public settings in the year 2000—by South Africa’s
Mbeki at the World AIDS Conference in Durban and by protesters at the
World Bank’s Year 2000 meetings in Prague. The neoliberal wave may have
peaked, at least in Africa.
For political science, AIDS resurrects a host of traditional questions.
What are the possibilities and parameters that will shape the West’s willingness to promote “development” in Africa?; What factors will determine
where those parameters are set?; What interests are at play in the West
that concern those of international institutions, corporations, governments,
constituencies?; and Will they (or how will they) shape process and outcomes? Questions, theories, and arguments that informed rounds of academic debate about developmentalism and foreign aid in the 1970s and
1980s are ripe for reexamination in this context.
africa TODAY
22
POLITICS AND AIDS IN AFRICA
interpreted through the paradigm of imperialism and enforced dependency.
These ideas may be out of fashion in political science in the United States,
but the opposite is true in much of the world. In the Middle East and in
Russia, Western advice and solutions have often been seen by many as
malevolent attempts to weaken countries already struggling with huge
economic and social problems. Animosity toward the West and toward the
new forms of imperialism that “globalization” promotes is a factor shaping
a new world order. International relations theory has not had much to say
about this so far.
The politics of AIDS interventions in Africa has been influenced by
African reactions to foreign strong-arming and Western attempts to commandeer the policy-making process.18 Fredland (1998:547,566) registered
some of these concerns when he argued that international responses to
AIDS in Africa have sometimes taken forms that “undermine African
autonomy and impede future development, particularly politically and
psychologically,” and deepen the suspicion that the world’s industrialized
countries view Africa as a laboratory for Western research and pharmaceutical companies. This mistrust of Western domination, rooted in Africa’s
colonial experience, was embodied by the famous Nigerian singer Fela
Anikulapo-Kuti, who died of AIDS in 1997. Fela, whose immense popularity
gave him the potential “to do for AIDS in Nigeria what Rock Hudson, Magic
Johnson, and Arthur Ashe accomplished in America,” instead repeatedly
claimed that AIDS was a fabrication by doctors and regarded condoms as a
“white plot to reduce the black birthrate” (Schoofs 1999b). The South African and Zimbabwean presidents, Mbeki and Mugabe respectively, worked
hard to convince their countrymen and women that AIDS is not the problem
that the West claims it to be and have argued that AIDS propaganda serves
to divert attention away from Africa’s more pressing issues.
In AIDS politics, as in other arenas, there is a backlash against Western leadership and bullying, neoliberal economic solutions, and neoliberal
political ideology. These localizing and protective reactions to international
pressure shape country-level responses to global problems, such as the AIDS
epidemic, and to global initiatives. The dynamic is not confi ned to a few
rogue regimes, pariah states, or Islamist political movements. In Africa,
some countries, and not necessarily the poorest, harbor diffuse resentment of Western initiative and arm-twisting. Their political leaders fi nd
it advantageous to stoke and exploit these negative reactions for domestic
political gain. Diffuse anti-Westernism has not figured systematically into
globalization studies that suggest convergence toward a world without boundaries and governed by open and liberal economic and political regimes.
Inequality and the Meaning of “One-World Economy”
AIDS is one of the manifestations of these growing or persistent NorthSouth inequities and also a source of growing North-South tension. There
are massive global inequities in the distribution of AIDS because more than
africa TODAY
23
CATHERINE BOONE AND JAKE BATSELL
eighty-five percent of all cases are found in the developing world. There are
also massive global inequities in the distribution of treatment.
For the fi rst decade of the epidemic, AIDS was defi ned as a disease
with no cure. The development of new antiretroviral (ARV) drug therapies
has changed everything: combination therapies now allow sero-positive
people to “live with AIDS.” Access to medicine, rather than sero-status per
se, is what determines whether a person will live or die. ARV and other
combination therapies cost about U.S. $12,000 a year. In Africa, during
1993, the average person had only fourteen cents to spend on health care
(Geshekter and Turshen 2000:15). Now that these drugs are widely available in the West, the case for prevention-only strategies in Africa has been
reduced to the argument that “this is all that the Africans can afford.”
This is very different from the argument that there is no treatment or that
treatment is futile.
Success of new drug therapies transforms the discussion about politics
and AIDS into an old-fashioned debate about unequal access to resources
and technology. A growing number of AIDS activists and governments
in poor countries are defi ning the issue in precisely these terms. AIDS
becomes an impetus to protest against an international system that protects
the profits and patents of the West at the expense of the lives and living
standards of the world’s poor (Booker and Minter 2001).
These tensions have crystallized in the African countries’ fight to
import cheaper ARV drugs from the world’s cheapest suppliers or to produce
these drugs themselves. The most visible fight was South Africa’s confrontation with drug multinationals and rules of the World Trade Organization
(WTO).
In Brazil and India, governments have supported manufacture of lowcost, generic AIDS drugs. The necessary technology is defi ned as a public
good (Rosenberg 2001). Other countries in Africa and Asia, including South
Africa and Thailand, have been forced to negotiate over this issue with
drug multinationals. WTO rule-keepers, the IFIs, and the U.S. government
have spent the last few years lobbying for the generic manufacture of the
drugs widely used in combination therapy in order to force down prices.
Drug companies continued to argue that any generic versions of these
drugs infringe upon US patent laws and WTO rules protecting intellectual
property rights (Rosenberg 2001).19
Between 1998 and April 2001, leading pharmaceutical multinationals
were engaged in an all-out effort to prevent the South African government
from authorizing the mandatory licensing of some of the medications
thereby permitting local production of generics, and from “parallel importing” others from low-cost suppliers in India.20 Although WTO law permits
countries to authorize the “emergency” manufacture of drugs without the
patent owner’s permission—as long as the owner is paid a royalty—the
major drug companies fought hard to prevent South Africa from invoking
these provisions. The U.S. government, voiced by former vice president Al
Gore, sided with the pharmaceutical companies in 1998, bringing heavy
africa TODAY
24
POLITICS AND AIDS IN AFRICA
political and economic pressure, including the threat of trade sanctions,
on South Africa to rescind its proposed cost-reduction measures (Judis
1999).21
Eventually the U.S. government was embarrassed into modifying its
position. It has now embraced initiatives aimed at reducing the cost of
essential AIDS drugs in African countries via price subsidies, but it has
not relented on the issue of protecting the drug companies’ intellectual
property rights. In May 2000, the companies themselves conceded to the
principle of selling AIDS medicines at cut-rate prices in some developing
countries, but they have been slow to deliver on their promises. Critics brand
these measures as a grossly inadequate response to the problem at hand;
the cost of the drugs still exceeds most Africans’ and African governments’
ability to pay.22 They charge that price subsidies protect private patents on
what should be “public goods,” and that they do little to disguise AIDS
profiteering on the part of the multinational corporations.
Is this technology private property, or a public good? If it is a public
good, who pays for it? As is clear when considering other “global commons”
issues (such as the need for global initiatives to control nuclear weapons
proliferation, control hothouse emissions, limit deforestation, and protect
wildlife diversity), mobilizing the resources and creating the institutions
to supply global public goods is a genuine challenge in a “world society”
that has no government, and that also lacks a hegemony that sees a clear
profit in providing the needed resources and leadership.
This particular case can be viewed as a fight for redistribution, with
the potential losers threatening to defect from a global regime, the WTO, if
they are not satisfied. Can international regimes governing global capitalism respond as national-level regimes sometimes have, by buying off a few
powerful interests (in this case, the drug multinationals) in order to protect
the legitimacy of the system at large?23 How much cost will sovereign states
and private capital be willing to bear to make this possible? The capacity
of international regimes to address and manage North-South tensions is
being sorely tested in the AIDS issue area.
V. New International Regimes? New Security Threats?
AIDS politics engages issues that lie at the core of the subfield of international relations. One such issue is international regime formation. We
could surely use an international regime to deal with the AIDS epidemic,
coordinate and amplify national-level responses, overcome collective action
problems, and supply the needed public goods. Will we get one?
Liberal internationalists have argued that international regimes are
likely to emerge where they are needed, for they disseminate information,
lower the transaction costs of cooperation, and can help promote collective
solutions to collective problems. Realists insist that no regime will emerge
unless the most powerful nations believe that their interests are perpetuated
africa TODAY
25
CATHERINE BOONE AND JAKE BATSELL
by making that happen.24 What is happening in the area of AIDS response
provides much grist for this debate.
As liberal internationalists would have predicted, a global regime to
coordinate AIDS response is in fact emerging. The impetus to make this
happen, however, has come largely from transnational actors, rather than
the sovereign states that are the leading players in international relations
theory. Much of the early impetus was provided by gay rights activist groups,
not only in the U.S., but also in countries like Brazil and Mexico that were
later joined by prominent NGOs in the health sector, including Medicins
sans Frontiers.25 In the mid-1990s the UN became the main institutional
actor in this domain. Mameli (1998) cites analysts who argue that the
“emergent international AIDS regime” that has taken shape under UN
auspices may be the most effective case of transnational cooperation the
world has yet seen (see also Will 1991). At the global level, UNAIDS is supposed to coordinate the activities of its six co-sponsors: four UN agencies
(UNDP, UNESCO, UNICEF, and the UN Population Fund), the WHO, and
the World Bank.26 Within countries, it coordinates country-level programs
with bilateral agencies, NGOs, political leaders, and local government
ministries. Mameli (1998:16) notes the “remarkable fi nding” that “a wide
array of political actors . . . ha[s] exhibited an unusual level of cooperation
in the management of the disease.”
Yet UNAIDS is an agency with very limited resources of its own. It is
an annual budget of U.S. $60 million and a staff of about 130, most of whom
are based at the secretariat in Geneva. Money for fi nancing projects, buying
drugs, and advancing research is in the hands of the sponsoring agencies,
the bilaterals, and the country governments. UN Secretary General Kofi
Annan is now campaigning to raise the U.S. $7 to $10 billion that is needed
to fi nance the new Global Fund for AIDS. The US government acts as
though the US has little to gain from supporting an international regime
to coordinate and help implement AIDS strategies. When and where will
governments see a national interest in contributing to building an international regime in this issue area? What forms of sovereignty would be at
stake? Who would govern an international AIDS regime, and how would
its priorities reflect the circumstances of its origin?
Global AIDS initiatives now under UN sponsorship are in fact moving
forward faster than the responses most member governments have been
able to mobilize. What are the ingredients of success in this case? Are they
replicable in other issue areas? What are the pitfalls? Analysis of this case
may help specify the conditions under which liberal internationalists can be
correct. If the UN enters the battle to socialize intellectual property rights
that the WTO has been invoked to defend, then international relations
scholars may have a test case with even wider theoretical and political
repercussions.
AIDS also intersects with issues that are of classic concern to international relations scholars: international migration and war. International
and rural-urban migration has carried AIDS to new communities and new
africa TODAY
26
POLITICS AND AIDS IN AFRICA
populations in Africa, but the phenomenon is global. Labor migration and
the spread of HIV–AIDS are intimately intertwined in China, Central
Europe, and in North and Central America.27 Uneven development drives
this process, but there are a host of ramifications for day-to-day matters in
which interstate relations, including international conventions on trade,
commerce, health, and human rights must deal.
War and AIDS are also fellow travelers. The growth of refugee populations, war, and political instability have been factors in the rapid spread
of AIDS in central Africa (as in the Congo River Basin and Great Lakes
Region, including Uganda) and in Sierra Leone (Hooper 1999). AIDS itself
may also contribute to political instability. The World Bank has sponsored
research projects in which demographers and political scientists collaborate
to study the effects of shortened life expectancies on the business of warlordism (Richards 1999). Prospects of premature death and economic destitution
may combine to shorten people’s time horizons, fray the social rules and
relationships that would keep them in line under better circumstances, and
discourage them from making long-term investments in farming, education, and intergenerational social ties (Richards 1999).
AIDS becomes a security issue because it eats away at political
and military establishments, frays the social fabric, and can so debilitate
national economies that political order is undermined.28 The powers that
be seem sufficiently compelled by the disaster scenarios to have named
AIDS an “international security issue” at UN Security Council and U.S.
Security Council meetings in 2000. The Council on Foreign Relations
recently mounted a research project on “International Health and the U.S.
Foreign Policy Agenda.” Conceptions of the national interest evolve over
time and may eventually add momentum to processes of international
regime formation in the AIDS issue area.
Conclusion
Nearly two decades into a pandemic that poses one of the gravest threats
to public health and development that sub-Saharan Africa has ever faced,
political science can no longer afford to ignore the political implications of
AIDS in Africa. A rich array of research agendas linking AIDS and politics
is worthy of systematic attention, including the explanation of variations in
state responses to the pandemic; the relationship between African governments and NGOs; the challenges AIDS creates for neoliberalism; AIDS
in the context of North-South tensions; and international security issues.
Equally important are issues that we have not addressed here; including the
human rights concerns in connection with HIV testing, drug experiments,
workplace rights, and access to therapies. Also included are the role of
intensified exploitation of Africa’s mining and forest resources and the
spread (and perhaps management) of AIDS and other infectious diseases
(Hardin 2000), gender politics issues (including new legal struggles over
and Visiting Professor in the Division des Estudios Internationales of the Centro de Investigacion y
Docencia Economicas (CIDE), in Mexico City, and Jake Batsell was in the graduate program in the
Department of Government at University of Texas at Austin. We thank Ms. Aimee Garduno Nestor
of CIDE for her research assistance, and CIDE’s Division of International Studies for institutional
support. Comments on earlier drafts were provided by CIDE faculty, especially Farid Kahhat, Adam
Jones, and Jesus Velasco. Peter Trubowitz, Crawford Young, Amy Patterson, Brett O’Bannon, Joshua
Forrest, and Daniel Bach also offered helpful comments. Earlier versions were presented at CIDE (16
October 2000); at the 43rd annual meetings of the African Studies Association in Nashville, Tennessee,
USA (16–19 November 2000); and at the UCLA James S. Coleman African Studies Center conference
on “The HIV/AIDS Pandemic in Africa and World Response” (23 February 2001).
NOTES
1.
The cumulative death toll is about 14 million, on a continent of 500 million. Life expectancy across sub-Saharan Africa has dropped from about 65 to less than 40 years. See
UNAIDS/WHO 2000.
2.
US Ambassador to the United Nations, Richard Holbrooke, in a television interview in
summer 2000, said that “AIDS is the number one issue in the world today, the number one
issue. The level of the AIDS crisis, its potential to destroy economic achievement, undermine
social stability, and create more political uncertainty . . . is so enormous. It’s the worst health
crisis in at least six, seven centuries. And it isn’t only a health crisis” (Garrett 2000b:63).
3.
Mutetwa is a lecturer at the Zimbabwe Medical School, Dept. of Medical Microbiology.
4.
Lanegran and Hyden (1993: 247) noted that funding for AIDS research in the early 1990s was
heavily geared toward biomedical projects, and grants can be hard to come by for behavioral
research “other than that which is directly related to how AIDS can be prevented.” The
Fulbright program in sub-Saharan Africa now offers Regional Research Awards earmarked
for AIDS-related topics.
CATHERINE BOONE AND JAKE BATSELL
This paper was written during the 2000–2001 academic year while Catherine Boone was Researcher
27
ACKNOWLEDGEMENTS
africa TODAY
inheritance laws and norms), and issues about citizenship and popular
conceptions of state responsibility and state power that are revealed in
public assessments of governments’ response, or lack thereof, to AIDS.
These topics deserve attention from political science because they are
real-world problems of critical importance. Researchers can make contributions by generating data, helping to frame and theorize issues, sorting out
the conditions under which “best practices” are most likely to emerge,
and getting a better handle on the institutional and macropolitical factors
that shape governmental and societal responses. Such research also offers
prospects for considerable theoretical innovation in political science. AIDS
politics is largely unploughed territory.
5.
We follow and hope to extend the efforts of Lanegran and Hyden 1993; Mameli 1998;
Fredland 1998; Geshekter and Turshen 2000 inter alia; Review of African Political Economy
2000; Eboko 2001.
6.
There are issues related to biomedical ethics, and especially US foreign aid policy, that are
close to the traditional concerns of political science, but we will not address them here. On
ethics, see Marshall 2000; Bekele, 2000; Specter 1998.
7.
New York Times Magazine 2000. Most of this sum should be shouldered by Western countries,
africa TODAY
Piot argues. “The great moral test of our time is how the rich countries respond to the AIDS
crisis,” he said.
8.
Laurie Garrett, a Pulitzer Prize-winning medical and science writer, said in her presentation
to the Thirteenth International AIDS Conference in Durban, South Africa, in July 2000: “In
June, I was in Zimbabwe inquiring about AIDS in a rural area just before the national elections. As I was doing so, a group of ZANU thugs threatened to kill me, simply because I was
28
asking about government failures to stem the tide of HIV. . . . I hightailed it out of town.
Had I been a local reporter, I wouldn’t have had that option” (Garrett 2000b:63). She said
POLITICS AND AIDS IN AFRICA
that in an earlier presentation, she had saluted a Kenyan journalist for his courageous AIDS
reporting. Later that day, she said, the journalist was arrested in Nairobi.
9.
However there is some evidence that HIV/AIDS infection rates are increasing rapidly in the
10.
Fredland (1998: 550) argues that Kenyan and Zimbabwean officials’ interest in protecting
rural areas of Uganda.
the tourist industry goes far in explaining their reticence to address the AIDS issue. Yet
Senegal also has an important tourist industry, and government there dealt earlier and
more directly with AIDS.
11.
Steven Friedman, Director of South Africa’s Institute for Policy Studies, stresses that there
are aspects of governmental response that transcend issues of program funding and state
spending. Friedman observes that in countries with effective AIDS prevention programs,
such as Uganda or Thailand, “the head of government was fully and publicly committed to
treating AIDS as a national priority” (Mail and Guardian (Johannesburg) 2000).
12.
The Diouf regime also used illegal force against civilians and political dissidents in its strug-
13.
Senegal also had the advantage of not being at the geographic center of the AIDS epidemic.
gle to squelch a guerrilla movement in Casamance.
The HIV strain prevalent there (HIV-2) also seems to be less virulent (slower-spreading) than
the central and east Africa variants.
14.
One example is the Insiza Godlwayo AIDS Council (IGAC), which operates in a rural pocket
of southern Zimbabwe. The IGAC has 500 active volunteers, as well as another 500 who
assist as needed. For a comparative perspective, Schoofs points out that the largest AIDS
organization in New York City, the Gay Men’s Health Crisis, had 500 home-care volunteers
in 1994, the year before new drugs began to lower the AIDS death rate in the United States
(Schoofs 1999c). See also Barnett and Blaikie 1992:157–8.
15.
See also Patterson 1998; Ndegwa 1996; Hearn 1998. Mamdani (2000) argues that “[o]ver
the past ten years, a total overhaul of civil society organizations has taken place. Before
that, we [Africans] had a more popular and democratic tradition; the cooperative, the trade
union, and the welfare union were the proto-type. . . . The new NGO culture operates on
an opposed principle: they operate . . . as charitable institutions [without members or
downwardly accountable leadership].” There are exceptions, however. On The AIDS Support
Organization (TASO) in Uganda, see Barnett and Blaikie 1992:157–8.
16.
17.
See also Collins and Rau 2000.
The Botswana Institute for Development Policy estimates that over the next decade, the
economy will be one-third smaller than it would have been without the effects of AIDS
(Africa Confidential 2001).
18.
See Lanegran and Hyden 1993: 254; Eboko 1996; Eboko 2001. See also Bastos’s (1999:53–62)
20.
See also International Herald Tribune 2000 and Washington Post 2000.
Parallel importing occurs when products made under license in one country are purchased
by another.
21.
As the International Herald Tribune (13 March 2001: B9) put it, in 1998, “White House trade
negotiators were backing American pharmaceutical companies to the hilt to stop poor
See the APIC website (www.africapolicy.org) and Medicins sans Frontiers’ website (www.
23.
In March 2001, U.S. Trade Envoy Robert Zoellick came out in support of giving South Africa
more leeway to make or import cheaper AIDS medicine. As he put it, “a backlash is building against the drug industry for aggressively asserting its patent rights in the face of a
monumental health crisis. . . . If they [the drug companies] don’t get ahead of this issue,
the hostility that generates could put at risk the whole intellectual property rights system”
(International Herald Tribune 2001).
24.
On this debate, see Mearshimer 1994/5 and Keohane 1995.
25.
On transnational civil society, see Keck and Sikkink 2000. On gay rights activism in Brazil,
see Rosenberg 2001, and in Mexico see Dr. Jorge Saavedra, ex-director of the Coordinacion
del CONASIDA, the HIV-AIDS arm of Mexico’s Ministry of Health and current Director of La
Clínica de SIDA del DF. 2000. Interview with the authors, 19 October. Mexico City, Mexico.
On a “new social movement” centered on AIDS activism, see Bastos 1999.
26.
UNAIDS was formed in 1996. Its six original co-sponsors are: United Nations Children’s Fund,
the UN Development Programme, the United Nations Population Fund (UNFPA), the UN
Educational, Scientific, and Cultural Organization, the World Health Organization, and the
World Bank. UNAIDS mandate is to do advocacy (keep this issue at the top of the global
agenda), to carry out policy research and development (including assisting local officials
with country-level strategic planning), and to provide in-country technical support. Critics
contend that UNAIDS is too far from the grassroots and from the front lines of struggle, and
that it spends too much time meeting in order to plan meetings.
27.
On Mexico, see Magis-Rodrigues et al. 1995 and 1998. See also UNAIDS 1998; Collins and
Rau 2000.
28.
Military forces are at the forefront of those spreading the disease; some surveys in Uganda
have reported that 40% of the military force is HIV positive (Jeter 2000: F10; see also Hooper
1999).
CATHERINE BOONE AND JAKE BATSELL
accessmed-msf.org). On Mexico, see Murillo 1997.
29
countries from their efforts to obtain cheaper generic [anti-AIDS] drugs.”
22.
africa TODAY
positive assessment of WHO.
19.
REFERENCES CITED
Africa Confidential. 2001. Pointers 41(25):5.
Africa Policy Information Center. 1998. HIV/AIDS Update. Electronic document [1 December], www.
africapolicy.org. Accessed 15 November 2000.
Barker, Carol and Meredeth Turshen. 1986. AIDS in Africa. Review of African Political Economy 36:
51–4.
africa TODAY
Barnett, Tony, and Piers Blaikie. 1992. AIDS in Africa: Its Present and Future Impact. London: Belhaven
Press.
Bastos, Christiana. 1999. Global Responses to AIDS: Science in Emergency. Bloomington: Indiana University Press.
Batsell, Jake. 2000a. AIDS, Politics, and NGOs in Zimbabwe. Paper presented at the annual conference
of the African Studies Association, 16 November, Nashville, Tennessee.
30
. 2000b. Interview by author. 29 June. Harare, Zimbabwe.
. 2000c. Interview by author. 4 June. New York, Council on Foreign Relations.
POLITICS AND AIDS IN AFRICA
. 2000d. Interview by author. 5 July. Harare, Zimbabwe.
Bekele, Yodit. 2000. Maternal-Fetal HIV Trials in Africa: Were the Sponsors Really Concerned about
African’s Children? ACAS [Association of Concerned Africa Scholars] Bulletin 57/58: 35–40.
Booker, Salih, and William Minter. 2001.Global Apartheid. Electronic document [The Nation, 9 July],
www.thenation.com. Accessed 9 July 2001.
Caron, Mary. 1999. The Politics of Life and Death: Global Responses to HIV and AIDS. World Watch
12(3):30–38.
Collins, Joe and Bill Rau. 2000. HIV/AIDS and Failed Development. Electronic document [A paper
prepared for UNRISD, distributed by APIC, 31 October], www.africapolicy.org/docs. or www.
unrisd.org/engindex. Accessed 9 November 2001.
Crook, Richard C. and James Manor. 1998. Democracy and Decentralization in South Asia and West
Africa. Cambridge: Cambridge University Press.
Crosette, Barbara. 2000. Nurse in Malawi Wages War on AIDS and Apathy. New York Times, 7 November: A12.
Eboko, Fred. 1996. L’Etat Camerounais et les Cadets Sociaux Face à la Pandémie du SIDA. Politique
Africaine 64:135–45.
. 2001. SIDA, Société et Politique en Afrique: un Nouveau Défi pour la Science Politique. Paper
presented at the 13th bi-annual meetings of the Association Africaine de Science Politique,
Yaounde, Cameroun, 19–21 June.
Economist. 2000. South Africa’s President and the Plague. 27 May, 45–46.
Fassin, Didier, and Jean-Pierre Dozon. 1988. Les Etats Africains à l’Épreuve du SIDA. Politique Africaine
32:79–85.
Farmer, Paul. 1992. AIDS and Accusation: Haiti and the Geography of Blame. Berkeley: University of
California Press.
Eeldman, Douglas A., ed. 1994. Global AIDS Policy. Westport, CT: Bergin and Garvey.
Fortin, Alfred J. 1987. The Politics of AIDS in Kenya. Third World Quarterly 9(3):906–19.
Fredland, Richard A. 1989. AIDS in Africa: A Political Overview. University Field Staff International
Report 8, Africa/Middle East (November), Indianapolis: University Field Staff International.
. 1998. AIDS and Development: An Inverse Correlation? Journal of Modern African Studies
36(4):547–568.
. 1992. The Politics of AIDS; A Comparative Perspective: South Africa and Other Africa. Proteus
9:35–40.
Friedman, Steven. 2000. Getting the AIDS Politics Wrong. Mail and Guardian (Johannesburg), 15 June.
Garrett, Laurie. 1994. The Coming Plague: Newly Emergent Diseases in a World Out of Balance. New
York: Penguin.
. 2000a. Betrayal of Trust: The Collapse of Global Public Health. New York: Hyperion.
. 2000b. You Just Signed His Death Warrant: AIDS Politics and the Journalist’s Role. Columbia
of Political Science 2:115–144.
Geshekter, Charles, and Meredeth Turshen. 2000. Health, Drugs, and AIDS Background Paper: Deconstructing the Health/AIDS/Drugs Debates. ACAS [Association of Concerned Africa Scholars]
Bulletin 57/58.
to African Family Planning Activity. In AIDS in Africa: The Social and Policy Impact, edited by
Hardin, Rebecca. 2000. Territorial and Political Aspects of AIDS and Emergent Disease in Africa,
Paper presented at the 43rd annual meetings of the African Studies Association, Nashville,
Tenn., 16 November.
The Herald (Harare). 2000. Editorial: Behavioral Change Best Way to Fight AIDS, 4 July.
Hearn, Julie. 1998. The ‘NGO-isation’ of Kenyan Society: USAID and the Restructuring of Health Care.
Review of African Political Economy 75:89–100.
Hooper, Edward. 1999. The River: A journey to the source of HIV and AIDS. Boston: Little, Brown and Co.
Huntington, Samuel. 1996. The Clash of Civilizations and the Remaking of World Order. New York:
Simon and Schuster.
International Herald Tribune. 2000. Africans Plead in Vain for AIDS Treatment, 28 December: A1.
. 2001. US Trade Envoy Signals a New Approach to Tough Issues, 13 March, B9.
Jeter, Jon. 2000. AIDS in Africa: Bitter Harvest. Austin American-Statesman, 2 January, H1, H6.
Judis, John B. 1999. K Street Gore. The American Prospect (July–Aug):18–21.
Kahn, Joseph. 2000. Congressional Leadership Agrees to Debt Relief For Poor Nations. The New York
Times 18 October: A1, A10.
Keck, Margaret and Kathryn Sikkink. 1998. Activists Beyond Borders: Advocacy Networks in International
Politics. Ithaca: Cornell.
Keohane, Robert. 1995. The promise of Institutional Theory. International Security 20(1).
Lanegran, Kim, and Goran Hyden. 1993. Mapping the Politics of AIDS: Illustrations from East Africa.
Population and Environment 14(3): 245–263.
Los Angeles Times. 1999. Zimbabwe President Admits AIDS Epidemic, 19 April, A-4.
Magis-Rodríquez, Carlos et al. 1995. Casos de SIDA en el área rural en México. Salud Pública de México
37(6):615–23.
Magis-Rodríquez, Carlos et al. 1998. La situación del SIDA en México a finales de 1998. Enfermedades
Infecciosas y Microbiológicas 18(6):236–244.
Mail and Guardian (Johannesburg). 2000. Getting the AIDS Politics Wrong, 15 June, 27.
Mamdani, Mahmood. 2000. Respondent Remarks: Democracy and Human Rights. Electronic document [Presented on the APIC/ECA Electronic Roundtable on International Policies, African
Realities, 18 February], www.africapolicy.org/rtable. Accessed 25 June 2000.
CATHERINE BOONE AND JAKE BATSELL
N. Miller and R.C. Rockwell. Lewiston: Edwin Mellen.
31
Greeley, Edward H. 1988. The Role of Non-Governmental Organizations in AIDS Prevention: Parallels
africa TODAY
Journalism Review (November–December):62–3.
Geddes, Barbara. 1999. What Do We Know about Democratization after Twenty Years? Annual Review
Mameli, Peter Angelo. 1998. Sparks and Embers: The HIV/AIDS Pandemic, Public Administration, and
International Relations in the Twenty-first Century. Ph.D dissertation, Syracuse University.
Marshall, Wende. 2000. Discourses of Power, Discourses of Disease: AIDS and the African Diaspora.
A paper presented in the Department of Anthropology, University of Texas at Austin, 21
April.
Mearsheimer, John J. 1994/5. The False Promise of International Institutions. International Security
19(3):5–49.
africa TODAY
Miller, Norman and Richard C. Rockwell, eds. AIDS in Africa: The Social and Policy Impact. Lewiston:
The Edwin Mellen Press.
Murillo, David Alberto. 1997. SIDA y socieded civil. Revista SIDA-ETS 3(3):46–50.
Mutetwa, Solomon. 2000. The Costly Impact of HIV/AIDS. Electronic document [Financial Gazette
(Harare), 5 October], http://www.allafrica.com/stories. Accessed 14 October 2000.
Ndegwa, Stephen. 1996. The Two Faces of Civil Society: NGOS and Politics in Africa. West Hartford, CT:
32
Kumarian Press.
New York Times Magazine. 2000. Epidemic Proportions: Questions for Peter Piot. June 4, 27.
POLITICS AND AIDS IN AFRICA
Patterson, Amy. 1998. Democracy in Civil Society: Evidence from Rural Senegal. Journal of Modern
African Studies 36(3): 423–42.
Philipson, Thomas J. and Richard A. Posner. 1993. Private Choices and Public Health: The AIDS Epidemic
in an Economic Perspective. Cambridge, MA: Harvard University Press.
Putnam, Robert. 2000. Bowling Alone: The Collapse and Revival of American Community. NY: Simon
and Schuster.
Raftopolous, Brian. 2000. The State, NGOs and Democratisation. In NGOs, the State and Politics in
Zimbabwe edited by Sam Moyo, John Makumbe and Brian Raftopolous. Harare: SAPES
Books.
Renaud, Michelle Lewis. 1997. Women at the Crossroads: A prostitute community’s response to AIDS in
urban Senegal. The Netherlands: Gordon and Breach Publishers.
Review of African Political Economy. 2000. Special Issue on AIDS. Vol. 27/4.
Richards, Paul. 1999. Hurry, We Are All Dying of AIDS: Linking cultural and agro-technological responses
to the challenge of living with HIV/AIDS in Africa. Electronic document [A paper presented
at the Conference “AIDS, Livelihood, and Social Change in Africa,” Wageningen Agricultural
University, The Netherlands, April], http://www.kit.nl/ibd/html/abc_wageningen. Accessed
5 April 2000.
Rosenberg, Tina. 2001. How to solve the world’s AIDS crisis: Look at Brazil. The New York Times
Magazine, 28 January: 26–31.
Schoofs, Mark. 1999a. AIDS—The Agony of Africa, Part One: The Virus Creates a Generation of
Orphans. Electronic document [Village Voice, 3 November], www.villagevoice.com/specials/
africa. Accessed 10 October 2000.
. 1999b. AIDS—The Agony of Africa, Part Two: A Tale of Two Brothers. Electronic document
[The Village Voice 10 November] www.villagevoice.com/specials/africa. Accessed 10 October
2000.
. 1999c. AIDS—The Agony of Africa, Part Three: Africa Responds. Electronic document [The
Village Voice 17 November], www.villagevoice.com/specials/africa. Accessed 10 October
2000.
. 1999d. AIDS—The Agony of Africa, Part Seven: South Africa Acts Up. Electronic document
[The Village Voice, 22 December], www.villagevoice.com/specials/africa. Accessed 10 October 2000.
Sen, Amartya. 2000. Development as Freedom. New York: Alfred A. Knopf.
Setel, Philip W., Milton Lewis, and Maryinez Lyons, eds. 1999. Histories of Sexually Transmitted Diseases
and HIV/AIDS in sub-Saharan Africa. Westport: Greenwood Press.
Singer, Merrill, ed. 1998. The Political Economy of AIDS. Amityville, NY: Baywood Press.
South Africa: Government Accused on AIDS. 2000. The New York Times World Briefing. 21 September,
A4.
South African History Archive. 1991. HIV and AIDS in Southern Africa. History in the Making 1(5):
Times, 1 October, A1, A6.
Turshen, Meredeth. 1998. The Political Ecology of AIDS in Africa. In The Political Economy of AIDS,
edited by Merrill Baywood. Amityville, NY: Baywood.
. 1999. Privatizing Health Services in Africa. New Brunswick: Rutgers University Press.
. 2000. Zimbabwe: Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Infec1 September 2000.
UNAIDS/WHO [World Health Organization]. 2000. Briefing Pack: Epidemiological Summary. A document provided for “Panel to Discuss AIDS–A New Priority For International Security,” Council
on Foreign Relations, New York, 5 June.
Waite, Gloria. 1987. The Politics of Disease: The AIDS Virus and Africa. In AIDS in Africa: The Social and
Policy Impact, edited by N. Miller and R.C. Rockwell. Lewiston: Edwin Mellen.
Washington Office on Africa. 1999–2000. Electronic document, [Advocacy to Confront AIDS in Africa.
Washington Notes on Africa 26/1], www.woaafrica.org. Accessed 15 July 2000.
Washington Post. 2000. Death Watch: AIDS, Drugs, and Africa. Electronic document [A seven-part
series, 27, 28, 29 December], http://www.washingtonpost.com/wp-dyn/world/issues/
aidsinafrica. Accessed 1 December 2000.
Webb, Douglas, ed. 1997. HIV and AIDS in Africa. London and Chicago: Pluto Press.
Will, Kurt Dieter. 1991. The Global Politics of AIDS: The World Health Organization and the International
Regime of AIDS. Ph.D. dissertation, University of South Carolina.
World Bank. 1999. Intensifying Action Against HIV/AIDS in Africa: Responding to a Development Crisis.
Washington, DC: The World Bank.
. 2000. Press release on fighting AIDS in Guinea. October.
CATHERINE BOONE AND JAKE BATSELL
tions. Electronic document [June], http://www.unaids.org/hivaidsinfo/statistics. Accessed
33
UNAIDS. 1998. Migration and HIV/AIDS. UNAIDS/PCB (7)98.5, 28 October.
africa TODAY
8–12.
Specter, Michael. 1998. Urgency Tempers Ethics Concerns in Uganda Trial of AIDS Vaccine. New York