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Scourge of a Continent:
The Devastation of AIDS, HIV Prevention Policies, and the Relief Effort in Sub-Saharan Africa

(Released February 2006)

  by Matthew Ruben  


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  1. Rural perspectives on HIV/AIDS prevention: a comparative study of Thailand and Ghana

    Denis Worlanyo Aheto and Kwame Prosper Gbesemete.

    Health Policy, Vol. 72, No. 1, April 2005, pp. 25-40.

    The paper compares rural perspectives in Thailand and Ghana on the level of condom acceptance in sexual relations, willingness to test oneself for HIV before and in marriage and sources of information on HIV/AIDS. We also compared the policy approaches to combating HIV/AIDS in both countries. The results indicates that in the villages studied in Thailand, all single men and the majority of the single women were in favour of using condoms in sexual relations. This group also showed a positive attitude to HIV/AIDS test before and in marriage. However, married men in rural Thailand disapproved of the use of condoms with their wives but married women in the sample population were open to the possibility of using condoms. Both married men and women were strongly against HIV/AIDS test in marriage. In contrast to Thailand, most single men in the communities studied in Ghana showed a disapproval to the use of condoms in sexual relations. However, they condoned HIV test before marriage. Married men and women in rural Ghana were against the use of condoms in sexual relations as well as HIV/AIDS test in marriage. In order to mitigate mother-to-child transmission, the Thais applied anti-retroviral drug care for HIV positive pregnant women during pregnancy and after delivery. In Ghana on the other hand, pregnant women were subject to HIV test and counselling. The mode of information acquisition on HIV/AIDS in both countries were through the media, campaigns and village volunteers. Finally, we observed that fighting poverty is a sine qua non for the success of any HIV/AIDS eradication programme.

  2. HIV/AIDS Policy in Africa: What Has Worked in Uganda and What Has Failed in Botswana?

    Tim Allen and Suzette Heald.

    Journal of International Development, Vol. 16, No. 8, November 2004 2004, pp. 1141-1154.

    A comparison of HIV/AIDS policies in Botswana and Uganda is revealing. It helps to highlight the kinds of policies that are necessary to come to terms with the pandemic in Africa, where it is already a public health disaster. It is argued that the promotion of condoms at an early stage proved to be counter-productive in Botswana, whereas the lack of condom promotion during the 1980s and early 1990s contributed to the relative success of behaviour change strategies in Uganda. Other important factors included national and local-level leadership, the engagement (or alienation) of religious groups and local healers and, most controversially, procedures of social compliance. We end with a call for more draconian measures than are currently envisaged.

  3. AIDS and Security

    Dennis Altman.

    International Relations, Vol. 17, No. 4, December 2003, pp. 417-427.

    The war on terrorism has drawn attention to non-conventional threats to security, even as it led to conventional warfare in the case of the attack on Iraq. HIV/AIDS is arguably an even greater threat to security, with the effect of destabilizing the social and economic order to the extent that the very survival of entire nations is at stake. This article examines both the security implications of AIDS, and the various international responses aimed at slowing its spread and mitigating its impact.

  4. Letting Them Die: Why HIV/AIDS Prevention Programmes Fail

    Mary Brydon-Miller.

    Health Education & Behavior, Vol. 32, No. 2, Apr 2005, pp. 279-281.

    Reviews the book "Letting Them Die": Why HIV/AIDS Prevention Programmes Fail, by Catherine Campbell (2003). In the book the tragedy that is the HIV/AIDS crisis in South Africa ceases to be told in terms of impersonal statistics and becomes the compelling story of individuals driven by poverty, desperation, and loneliness- individuals caught within political and economic systems of inequality and oppression. The effort to combat this crisis is told not as a tale of triumph over incredible odds nor as a simplistic exposť of corporate or governmental greed and malfeasance but as a nuanced examination of one attempt to deal with the problem-an account that is sometimes hopeful, often desperately troubling, but always direct and uncompromising in its commitment to providing an honest appraisal of this particular effort to address the HIV/AIDS problem in South Africa. I have criticisms of this volume. The first is that, although providing the opportunity for readers to become acquainted with the sex workers, students, and miners whose stories are at the heart of the project, Campbell does not give us a sense of her own involvement or investment in the Summertown community and its efforts to combat the AIDS/HIV crisis. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

  5. Rethinking the African AIDS Epidemic

    John C. Caldwell.

    Population and Development Review, Vol. 26, No. 1, Mar 2000, pp. 117-135.

    Some 50% of the AIDS (acquired immune deficiency syndrome) victims in the world are in eastern & southern Africa, where adult HIV (human immunodeficiency virus) seroprevalence was 11.4% by the end of 1997 & reached 25% in two countries. HIV/AIDS infection is not the result of ignorance, as nearly everyone has sufficient knowledge about AIDS & how it is transmitted. The high levels of AIDS arise from the failure of African political & religious leaders to recognize social & sexual reality. The means for containing & conquering the epidemic are already known & could prove effective if the leadership could be induced to adopt them. The lack of individual behavioral change & of implementation of effective government policy has roots in attitudes toward death & a silence about the epidemic arising from beliefs about its nature & the timing of death. International responsibility may have to be taken before the needed policies are put in place. 77 References. Adapted from the source document.

  6. AIDS-Induced Orphanhood as a Systemic Shock: Magnitude, Impact, and Program Interventions in Africa

    Klaus Deininger, Marito Garcia and K. Subbarao.

    World Development, Vol. 31, No. 7, July 2003, pp. 1201-1220.

    According to many descriptive accounts, the orphan crisis in Africa has assumed alarming proportions, largely due to AIDS-related deaths. Using household panel data from Uganda to confirm this & assess the impact on affected households & children, we find that (a) receiving a foster child leads to a significant reduction of investment; (b) initial disadvantages in foster children's access to education were largely eliminated by the introduction of a program of Universal Primary Education; & (c) new inequalities have emerged in foster children's access to health services. Even though this suggests that specific programs could help to alleviate some of the negative impacts of orphanhood, the policy response in many African countries has remained piecemeal. We use data from existing programs to estimate the cost of a concerted policy response & highlight implications for further research. 11 Tables, 2 Figures, 21 References. [Copyright 2003 Elsevier Ltd.].

  7. HIV/AIDS and the changing landscape of war in Africa

    Stefan Elbe.

    International Security, Vol. 27, No. 2, Fall 2002, pp. 159-177.

    Explains how armed forces in Africa have become a high-risk group for transmission of HIV/AIDS, illustrates how the virus has been used as a weapon of war in some regions of the continent, and argues that the conflicts have led to a significant increase in the number of AIDS-related war casualties; includes policy recommendations.

  8. Condom use in African adolescents: The role of individual and group factors

    Melanie Giles, C. Liddell and M. Bydawell.

    AIDS Care, Vol. 17, No. 6, Aug 2005, pp. 729-739.

    This study set out to assess the ability of the Theory of Planned Behaviour (TPB) to predict and explain condom use in a traditional African context and in particular to assess the relative contributions of individual and normative constructs. A questionnaire survey was administered to 152 young adults (48% male, 52% female) at two points in time. Key constructs contained within the TPB were measured at Time 1. A short follow-up set of items was administered one week later at Time 2, thereby allowing for the measurement of actual behaviour. The results not only provide strong support for the predictive power of the TPB, since 67% of the variance in intention was explained, but also highlight the extent to which sexual behaviour in a rural location is governed by family/social influences. Subjective norm not only proved to be one of the most significant elements of the TPB model, together with self-efficacy (neither attitude nor perceived control were significantly involved), but 'my family' emerged as the most significant other. As such, the findings offer empirical evidence to support interventions that penetrate community networks. (PsycINFO Database Record (c) 2005 APA, all rights reserved) (journal abstract)

  9. Capitalising on Global HIV/AIDS Funding: The Challenge for Civil Society and Government

    Caroline Halmshaw and Kate Hawkins.

    Reproductive health matters, Vol. 12, No. 24, Nov 2004, pp. 35-41.

    After years of passionate advocacy informed by solid policy work on the ground, the global response to HIV/AIDS is better resourced. Poor countries can absorb considerably higher levels of aid than they currently receive, but recent increases in funding have generated a number of concerns. This paper analyses the capacity of NGOs, community-based organisations & governments to ensure that the influx of funds has a significant effect on the HIV epidemic & people's lives. Limited absorptive capacity may be an obstacle to the uptake of funding. To avoid community-based organisations being over-stretched by AIDS & to ensure capacity is maintained, HIV-positive staff must be enabled to continue their work through access to antiretroviral therapy & related services. Equally challenging, given that donors are increasingly using governments as intermediaries to fund civil society organisations, is increasing the capacity of developing country governments to disburse funds effectively. If donors do not accept that governments & civil society organisations need technical support in order to accept, distribute & account for increases in funding, there is a danger that home-grown responses will be replaced with imported solutions. The community sector is the glue that holds responses to HIV/AIDS together; now it needs to adapt to new partnerships with government & other emerging HIV/AIDS service providers. 7 References. [Copyright 2004 Reproductive Health Matters; published by Elsevier B.V.].

  10. Facing a Merciless Enemy: 1W/AIDS and the South African Armed Forces

    Lindy Heinecken.

    Armed Forces & Society, Vol. 29, No. 2, April 2003, pp. 281-300.

    The impact of HIV/AIDS on health, development, and security is nowhere more daunting than in southern Africa, where many claim that it has the potential to destabilize the entire region. In this article, the impact of HIV/AIDS on southern Africa, the factors contributing to the rapid spread of the disease, and how it is affecting the armed forces are highlighted. As an important regional economic and military power, how South Africa and more specifically, the South African armed forces manage the impact of the disease is of national and regional, if not global, concern. The various policy, human rights, human resources, health, and educational challenges facing the South African National Defence Force (SANDF) are discussed with specific reference to its impact on operational capacity and capability. Should the SANDF be unable to manage the disease efficiently, there may be a profound effect on peace and stability in the entire region.

  11. Protection and Participation: An Interactive Programme Introducing the Female Condom to Migrant Sex Workers in Cambodia

    Joanna Jusza and S. Baker.

    AIDS Care, Vol. 16, No. 4, May 2004, pp. 507-518.

    The female condom has received much attention for its potential to empower users in negotiating safer sex. Studies demonstrate that the process used to introduce the method can influence subsequent use rates, resulting in calls for comprehensive documentation of introduction activities. This paper details an intervention study introducing the female condom to Vietnamese sex workers in Cambodia. Part of a wider community mobilization approach to reducing HIV/AIDS transmission, the intervention emphasized informed debate, group skills building & collective support. Research methods included both quantitative & qualitative data collection to evaluate the introduction's effect on sex workers' negotiation skills & social support networks. The findings show that approximately 16% of sex workers tried the female condom. Ever-use was significantly associated with participation in intervention workshops, & with indicators of both individual & community empowerment. Sex workers who incorporated the female condom into their work were also more likely to feel a sense of community identity. Introduced through an appropriate process, the female condom can serve as an 'entry point' to building community capacity. It can support sex workers in achieving protected sex & developing cooperative relationships, even in severely restrictive settings. 4 Tables, 22 References. Adapted from the source document.

  12. Moral Panic and Cultural Mobilization: Responses to Transition, Crime and HIV/AIDS in KwaZulu-Natal

    Preben Kaarsholm.

    Development and Change, Vol. 36, No. 1, January 2005, pp. 133-156.

    This article discusses the micropolitics behind the murder of an ANC councillor in a KwaZulu-Natal slum area in 1999, and the forms of violence which have continued in the aftermath of apartheid. The history of violence is traced back to struggles between the IFP and the ANC in the 1980s which interacted with differences in generational, moral and cultural outlook, as well as with conflicts between Zulu-speaking residents and immigrants from the Transkei. Since apartheid was dismantled, similar patterns of conflict have persisted, but now within a local context in which one political party holds almost total sway. Postapartheid violence is related to rivalries around local state resources in a situation of continued poverty, and to moral and ideological disagreements which, since 1994, have been intensified by the HIV /AIDS epidemic as well as by an escalation of local crime. Strategies for the moral rehabilitation of local society, such as virginity testing, are discussed, as is the controversy around them, rooted in oppositions between youth and elders, and between different cultural styles. Finally, the mismatch between the concentration of political power at municipal ward level and the diversity of positions expressed in local civil society is raised as a reason why disagreements have continued to involve violent conflict.

  13. The African Pandemic Hits Washington

    J. Stephen Morrison.

    Washington Quarterly, Vol. 24, No. 1, winter 2001, pp. 197-209.

    The AIDS tragedy will reshape Africa & inexorably dominate US foreign policy toward the continent. How we engage on the soft global issues stemming from HIV & AIDS in Africa will inevitably shape our future response elsewhere in the world. Adapted from the source document.

  14. United to Fight HIV/AIDS?

    J. Stephen Morrison and Todd Summers.

    The Washington Quarterly, Vol. 26, No. 4, autumn 2003, pp. 177-193.

    Two critical challenges stand in the way of US efforts to lead the international response to HIV/AIDS successfully; the UN is uniquely qualified to help find solutions for each. Adapted from the source document.

  15. Complexities and Challenges: Men's Responses to HIV and AIDS in Winterveld, South Africa

    Kammila Naidoo, Zethu Matebeni and Mariana Pietersen-Snyman.

    Commonwealth Youth and Development, Vol. 2, No. 2, 2004, pp. 45-63.

    Recent literature on HIV/Aids in South Africa acknowledges the failure of programmes & research initiatives to adequately integrate & take detailed account of masculine responses to the Aids pandemic. Although launched on a small scale, primary interventions have mainly targeted women as victims, transmitters & carriers of HIV. This article focuses selectively on findings from field research conducted in Winterveld, in South Africa's North-West Province, which reveal ways in which poverty, gender inequalities & cultural constructions intersect to shape contradictory profiles of men: as 'protagonists' actively spreading the disease, & as a socially isolated group who are falling 'victim' to HIV in increasing numbers. It is argued that despite the evident complexities & the marginal status of the area, there is space for engaging discourses & practices & for driving meaningful social interventions. Efforts in communities such as Winterveld, however, will only bear positive results if the process of mobilising men occurs alongside the implementation of broader socio-economic interventions. The article draws attention to men's recommendations regarding Aids interventions. 30 References. Adapted from the source document.

  16. Global Neoliberalism and AIDS Policy: International Responses to Sub-Saharan Africa's Pandemic

    Colleen O'Manique.

    Studies in Political Economy, Vol. 73, spring-summer 2004, pp. 47-68.

    The evolution of the Western public health system's response to AIDS in the West & then Africa (through the World Health Organization) is examined. The Western biomedical framework, the ideological hegemony of neoliberalism, & the ideas & practices of institutional development in the Third World have informed its policy toward the African AIDS pandemic. Within the Western perspective, structural features of the African economy & societies are mere backgrounds rather than relevant factors, African gender relations are considered fixed rather than interactive, & women's caregiving labor is taken for granted. With its individualist view of humans, the Western policy response sidesteps the role of agricultural restructuring in Africa & the unfair burden of AIDS on women. Policymakers need to have a better understanding of local communities & gendered power dynamics that contribute to the spread of the disease. M. Pflum.

  17. AIDS and global security

    Gwyn Prins.

    International Affairs, Vol. 80, No. 5, Oct 2004, pp.931-952.

    AIDS has been medically visible for 30 years; but only in the last five have the security implications of the pandemic begun to be discussed seriously. This debate has been in many ways unsatisfactory to date. The purpose of this article is to begin to rectify this at the moment when the first major efforts to combat the pandemic are beginning to take effect. It records therefore the history of that debate and ascertains in what useful and defensible senses AIDS can be described and managed as a security issue. It argues that there are, indeed, several that meet these criteria. The article describes the first three engagements with the disease from the time of its discovery and then suggests three newer ones and, it argues, more fruitful approaches that have advanced since 2000 of which the security dimension is one. The others are the geo-politics of the human immune system and analysis through the prism of political economy. The scope of the next waves of AIDS after the southern African one, is depicted. Its coming intersection with oil and Great Power politics is noted. (Original abstract)

  18. The politics of action on AIDS: a case study of Uganda

    James Putzel.

    Public Administration and Development, Vol. 24, No. 1, Feb 2004, pp.19-30.

    This article examines the political dimensions of Uganda's progress in bringing a generalised HIV/AIDS epidemic under control. The article documents the history of the political processes involved in Uganda's battle against HIV/AIDS and analyses the complexities of presidential action and the relation between action at the level of the state and that taken within societal organisations. By the mid-1980s, Uganda was experiencing a full-blown epidemic, the virulence of which was connected with social dislocation and insecurity related to economic crisis and war. Political authorities faced the same challenge as other regimes experiencing the onslaught of AIDS in Africa. The epidemiological characteristics of HIV and AIDS - transmission through heterosexual activities, with a long gestation period, affecting people in the prime of their productive life - meant that action required wide-reaching changes in sexual behaviour, and the educational activities to achieve this, as well as relatively complex systems to monitor the virus and control medical practices (blood supplies, injection practices, mitigating drug delivery). The centralist character of the Museveni regime was crucial not only to mobilising state organisations and foreign aid resources, but also to ensuring significant involvement from non-state associations and religious authorities. The Ugandan experience demonstrates that there is a tension between the requirements for systematic action that a strong public authority can deliver and the need to disseminate information requiring a degree of democratic openness. The President was able to forge a coalition behind an HIV/AIDS campaign in part because the virus largely ignored the privileges of wealth and political power. With the development of antiretroviral therapy and the access that the wealthy can gain to these drugs, this basis for the broadest possible coalition to fight HIV/AIDS may be weakened in the future. (Original abstract)

  19. The Global Fight against AIDS: How Adequate Are the National Commissions?

    James Putzel.

    Journal of International Development, Vol. 16, No. 8, November 2004 2004, pp. 1129-1140.

    This article examines the response of the international community to the HIV/AIDS crisis, focusing on efforts to promote a "multisectoral" approach to fighting the epidemic. It critically assesses the evolution of an "organizational template", which requires developing country governments to establish stand-alone National AIDS Commissions in order to receive funding for HIV/AIDS programmes. While the World Bank, based on interpretations generated by the United Nations Joint Programme on HIV/AIDS (UNAIDS) and bilateral donors, claims that the model is derived from successful experience, an examination of evidence particularly from Uganda, Senegal and Malawi, suggests that National Commissions have not worked well and may, in fact, have contributed to weakening health sectors attempting to cope with the crisis.

  20. Shifting the burden: the private sector's response to the AIDS epidemic in Africa

    Sydney Rosen and Jonathon L. Simon.

    Bulletin of the World Health Organization, Vol. 81, No. 2, 2003, pp. 131-137.

    Examines strategies and practices to reduce the size of economic burden; based on data primarily from South Africa. Summaries in French and Spanish.

  21. Who Can Help People with HIV/AIDS in Africa? Governance of HIV/AIDS and Civil Society

    Hakan Seckinelgin.

    Voluntas: International Journal of Voluntary and Nonprofit Organizations, Vol. 15, No. 3, Sept 2004, pp. 287-304.

    This paper locates NGOs dealing with HIV/AIDS problems in sub-Saharan Africa into the larger governance context within which they function. This aims at a theoretical shift to assess the aspirational characteristics for the agency of NGOs that are used to legitimate contracting out implementation of internationally designed HIV/AIDS policies to these organizations. The paper interrogates the nature & impact of the governance structure on NGOs & then looks at the implications of this for HIV/AIDS. The questioning is based on a juxtaposition of the perspective of international policy fora in relation to civil society organizations with the way NGO work is perceived by the people at the receiving end of the policies. The paper suggests that as part of the international governance structure, NGOs are limited within the policy frameworks created by this structure. Furthermore, due to their organizational characteristics, NGOs lack capacity to establish sustainable long-term interventions relevant for sociocultural change as perceived by people themselves. 16 References. Adapted from the source document.

  22. Facing the future together: report of the Secretary General's Task Force on Women, Girls and HIV/AIDS in Southern Africa

    UNAIDS (Joint United Nations Programme on HIV/AIDS).


    2004Addresses gender inequality issues that play a factor in the spread of HIV/AIDS, and presents six areas where intervention is most urgently needed; based on 2003 consultations in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe. Also available in print (ISBN 92-9173-380-6).

  23. Children on the brink, 2004: a joint report of new orphan estimates and a framework for action

    UNAIDS (Joint United Nations Programme on HIV/AIDS).

    New York: United Nations Children's Fund.

    2004Contains statistics on children under 18 orphaned by HIV/AIDS and other causes, analysis of the trends found in those statistics, and strategies and principles for helping the children. Published jointly by the US Agency for International Development, UN Children's Fund, and Joint UN Programme on HIV/AIDS. Also available in print.

  24. Joint United Nations programme on human immunodeficiency virus/acquired immunodeficiency syndrome (UNAIDS)-note by the secretary-general-background information

    United Nations Economic and Social Council.

    United Nations Economic and Social Council, 36 pp.

    2005Assesses the progress made in the UN system's coordinated response to the HIV/AIDS pandemic. The report provides an update of the status of the epidemic and summarizes steps taken by UNAIDS to promote the implementation of the Declaration of Commitment on HIV/AIDS adopted by the special session of the United Nations General Assembly on HIV/AIDS in June 2001. The report further provides recommendations in advancing a more effective and coordinated UN system response to the epidemic.

  25. Navigating the AIDS Epidemic in Rural Malawi

    Susan Cotts Watkins.

    Population and Development Review, Vol. 30, No. 4, Dec 2004, pp. 673-705.

    This article provides a perspective on rural Malawi during the unsettled times following the recognition by village residents that AIDS is a profound danger. The primary data are observational field journals in which local ethnographers wrote their recollections of conversations about AIDS that they overheard or participated in during the course of their daily lives. In their networks of friends, relatives, & neighbors, rural Malawians are publicly discussing a range of strategies of prevention. These strategies range from the abstinence, fidelity, & consistent condom use prescribed by international & national experts to innovative strategies of partner selection, divorce, & renewed religious commitment. The article also considers the effectiveness of these strategies & speculates about the applicability of the findings to other populations. 2 Tables, 87 References. Adapted from the source document.

  26. Briefing: Recent Changes in the South African Government's HIV/AIDS Policy and Its Implementation

    Samantha Willan.

    African Affairs, Vol. 103, No. 410, Jan 2004, pp. 109-117.

    Since 2002 there has been a shift in the South African government's policy response to HIV/AIDS, culminating in a commitment by the Cabinet in Aug 2003 to develop a plan to provide antiretroviral (ARV) drugs. While this shift in policy was greeted warmly, if cautiously, by most analysts & activists, we need to understand why it has occurred, in order to assess its sustainability & whether it will translate into meaningful change on the ground. As a civil society submission to the government noted: 'The success & sustainability of an ARV roll-out program depends on a number of interlocking social, medical, & political factors'. This briefing provides an outline of the government's AIDS policies, recent policy shifts, the social & political factors at play, & some explanations for these shifts. Adapted from the source document.

  27. 2004 report on the global AIDS epidemic: 4th global report

    Sandra (ed ). Woods and UNAIDS (Joint United Nations Programme on HIV/AIDS).