Political will as a means to HIV Prevention in Africa:

Hypocrisy or Concrete Strategy?

At the turn of the new century the primordial home of man has come to define what is becoming increasingly an ‘African disease’. I am talking about HIV. The specter of HIV wherever and whenever mentioned these days, invariably points in the direction of Africa. Part of the reason may be embedded in Africa’s prohibitive, almost unbelievable statistics on HIV. According to UNAIDS, since the epidemic began, 60 million people have been infected with the virus. Worldwide, it is the fourth biggest killer. Currently it estimates 28.1 million infected souls in Africa alone (see table below).

If we belief the figures provided by UNAIDS, the UN organization that has assumed a hegemonic role with regards to HIV/AIDS, then, HIV will impact significantly on socio-economic development and poverty alleviation in Africa than anywhere else in the world. Wherever it takes hold, the AIDS epidemic feeds on existing economic and social problems and unleashes untold misery on millions of lives.

Adults and children living with HIV/ AIDS as of end 2001

 Sub-Saharan Africa			      28.1 million 
 Latin America               		      1.4 million
 Eastern Europe and Central Asia 		1 million
 East Asia and Pacific  			 	1 million
 South and South east Asia 		      6.1 million
 Caribbean 				 420 000 thousand
 North America				 940 000 thousand
 

Source: UNAIDS/WHO

This article looks at the politics of HIV and AIDS in Africa and questions the wisdom of some of the key issues that take center stage.

Introduction

By and large Africa entered the ‘HIV/AIDS war’ late but nevertheless have assumed control of proceedings by the end of the 20th century. When the first AIDS cases were identified amongst homosexuals in the United States in 1981 it was thought of myopically as a ‘Western disease’ and throughout the 1980’s Africa stayed relatively quiet and a mere spectator while the ‘HIV/AIDS war’ waged on. The course of the epidemic took a U-turn in the 1990s when suddenly AIDS became a ‘clear and present danger’ to a majority of African nations south of the Sahara. By the time the 11th International Conference on AIDS and STDs in Africa was launched in 1999 the World Bank was already claiming that “ The damage AIDS has done in the present is incalculable… it threatens millions of futures”. Most of this was blamed on lack of political will on the part of African Governments.

Political will, another of those illusive words that often emanates from western knowledge of development problems has become a buzzword of the 21st century. The Joint United Nations Programme on AIDS (UNAIDS) has as its ‘holy creed’; the imperative of strong political will backed by concerted multi-sectoral effort as representing a panacea for HIV prevention in Africa. Instead, as one commentator asserts, where Africa is concerned:

There has often been a stance of denial or, alternatively, official acknowledgement of the need for an AIDS policy coupled with a persistent failure to accept the depth of the crisis or the urgency of the situation, much less to follow through on construction of a comprehensive policy. It is as if, having officially conceded the presence of AIDS, governments then go about their business-fighting wars

Briefly put, Africa’s response to the HIV/AIDS pandemic has been phlegmatic. Yet as this article argues, one cannot ignore the dynamics of political economy and poverty when addressing the problem of HIV/AIDS in Africa. Whilst there is no shortage of academic texts on the poverty of political will, good and democratic governance in Africa, the question that I pose is, does the failure of political will matter? Would Africa’s problems be less if the ‘anti-AIDS’ slogan had been sounded more loudly? The answer to both questions is yes and no.

Yes, because it is Governments who must formulate National plans, manage large-scale programmes and coordinate efforts of NGOs and CBOs to make responses to HIV effective. There is also the need for Governments to take charge of providing basic needs (food, shelter, education, health amenities, water etc), which ensures a decent standard of living crucial for HIV prevention campaigns.

Yet, this has to be considered in context. Africa entered the 21st century the most financially indebted, technologically backward, poor and the only continent experiencing negative economic growth. Under such distressing climate and the already limited role of the state as a result of Structural Adjustment Policies imposed by the IMF and World Bank it seems almost impossible for African Governments to shoulder the onus of responsibility expected when it comes to HIV and AIDS. This can be likened to the analogy of, ‘the soul is willing but the body is weak’. Thus the validity and efficacy of such an approach is not without its critics.

Political will is but one part of a giant HIV jigsaw puzzle. Most often than not the other parts of the jigsaw puzzle is left out in the analysis of HIV in Africa. They have become ‘sacred cows’ that cannot be slaughtered. Yet in order to fully understand the problem we cannot discount the importance that debt servicing and its attendant problems pose to Governments in Africa. Most of the debt problems have a historical setting and are entrenched in global market forces unleashed by the so-called ‘Washington consensus’. Political will is important but we must also not forget that most countries in Africa who face the threat of AIDS are ill equipped to do much because of poor economies, lack of infrastructure facilities, unemployment, poverty and malnutrition which are deeply embedded in the dynamics of international political economy. In this respect:

The hypocrisy of donors and international organizations must be called into question given their articulation on the one hand of the huge gap in funding measures to combat the AIDS crisis and, on the other, the relatively paucity of their own contributions and beyond this the tendency for what is offered to be bound up in conditionalities which merely exacerbate the situation

Debt is a drain on the ability of African countries to direct resources to health and development needs. Debt servicing in Africa is close to 5% of GDP, 15% of export revenue. If 50% of debt were cancelled it would release funds for preventing, managing and mitigating the effects of HIV. Clearly then, debt relief offers a window of hope to rehabilitate infrastructure for the delivery of both HIV prevention and AIDS mitigation in Africa.

In Africa poverty creates a conducive environment for the large scale spread of HIV. The increasing financial insecurity and vulnerability that poverty breeds and exists in many female-headed households makes transactional sex a ‘rational’ means of making ends meet. There is abundant information confirming how poverty exacerbates HIV risk behaviour and vice versa. Poor women are especially limited in their ability to make healthy choices when it comes to adopting HIV prevention methods. Most prevention campaigns are premised on an equal distribution of power in sexual relationships. Yet the reality on the ground is that low economic and social status of women in most parts of Africa implies that even when women have the intention and self-efficac

to adopt the use of condoms in sexual activities for instance they can not because in the final analysis it is men who hold the power be it economic and/or social as to where, when and in what context sexual activity takes place. Poverty breeds dependency and when it comes to concerns regarding food, shelter and care of their children many women in Africa place a higher priority on meeting these daily needs of their children than worry over the long term consequences of HIV.

Thus there are many facets to the question of HIV/AIDS in Africa. We must therefore alienate ourselves from simple causalities and undertake a more in-depth structural analysis of economic and social arrangements that reinforce HIV risk behaviour.

The way forward

To defeat AIDS all significant actors in the developmental process must become partners. The idea that, Africa must always be ‘talked to, about and not with’, on an equal platform, must be dismantled. There is an urgent need to transform the entire international political economy so that terms can favour Africa to ‘participate’ rather than ‘feed’ the Global market. This will achieve two things. One, it will help ease the burden on African Governments to play their role as ‘public goods providers’. Two, It will enable money to be poured into national poverty reduction strategies so that we can discount poverty as significant in fuelling the HIV pandemic thus paving the way to access whether Governments are really willing to act or prefer to be mere spectators whilst a majority of its populous suffer in silence from HIV.

Ultimately, the test of leadership will be how decisive poverty in all its forms; inequality and inadequate infrastructures that are the enablers of HIV/AIDS are addressed. Building a full-scale response to HIV/AIDS in Africa requires a pooling of energy, creativity and resources from all the stakeholders in Africa’s renaissance. It is the single greatest development challenge of the new millennium, and one that must be met.

(Isaac Tsiboe, Roskilde University, Denmark- Tsiboe@ruc.dk)