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  • The Politics of AIDS in Africa
  • Chimaraoke O. Izugbara
Amy S. Patterson . The Politics of AIDS in Africa. Boulder. Colo.: Lynne Rienner Publishers, 2006. xii + 226 pp. Maps. Charts. Bibliography. Index. $52.00. Cloth. $19.95. Paper.

Africa currently bears the brunt of HIV and AIDS. While twenty-five million Africans were living with HIV at the end of 2005, three million new infections and two million AIDS-related deaths occurred in the continent during that year. The disease has also killed ten times more Africans than any war and has orphaned more than twelve million African children. In The Politics of AIDS in Africa, Amy Patterson interrogates how key aspects of African politics—the state, democratic transitions, civil society, and donors—affect AIDS policymaking. Patterson's book opens with the customary sobering statistics on the magnitude and implications of the pandemic for Africa. But she admits that the pandemic does not affect all people equally because of the character of African political institutions and the resource differences and inequities in policymaking in the politics of AIDS both within African countries and between wealthy and poor countries.

Four aspects of the African state—centralization, neopatrimonialism, state capacity, and security—provide the grid upon which the second chapter of this slender book engages AIDS policies in four African states: Uganda, South Africa, Zimbabwe, and Swaziland. The author uncovers [End Page 201] mixed results. High state centralization and neopatrimonialism mar AIDS policymaking in Zimbabwe and Swaziland, but not in Uganda. High state capacity helps South Africa but plays little role in Uganda. Insecurity facilitated initial Ugandan AIDS efforts but frustrates them in Zimbabwe. Despite South Africa's high state capacity, relative stability, low neopatrimonialism, and low centralization, Uganda, which lacks those state characteristics, appears to have achieved more in the AIDS fight. Patterson also suggests personal leadership as key to successful AIDS efforts in Africa. Museveni's longstanding forthrightness on AIDS set the tone for Uganda's successful AIDS fight. In Swaziland, the playboy life style of King Mswati, who recently married his twelfth wife, continues to deliver unfavorable outcomes. Mbeki's private views about the pandemic foster policy uncertainties in South Africa, while Mugabe's repressive and survivalist tendencies sway attention from AIDS in Zimbabwe.

Contrary to what pundits anticipate about democracy and citizens' health, chapter 3 shows that the impact of democratic transitions on AIDS policymaking in Africa is at best chaotic. While AIDS has made it into the manifestoes of a few politicians in Africa, the generally immature nature of most African democratic structures impedes accountability and representation. As a result, the ballot box is not yet a reliable instrument for holding African governments accountable for AIDS policies, even as public opinion in Africa has yet fully to prioritize AIDS. Exploring the influence of civil society on the politics of AIDS in Africa in chapter 4, Patterson contends that excepting the Treatment Action Campaign (TAC) in South Africa, civil society's influence on Africa's struggles against AIDS is at best minimal. Patterson's thick description of the many challenges facing organizations that try to affect AIDS policy in Africa shows that these challenges include the dominance of the state in state–civil relations, weak financial and resources outlay of the organizations, authoritarian governments, hostile political cultures and milieus, and state capture.

AIDS-related donor efforts and strategies for institutionalizing the AIDS fight in Africa receive attention in the last two chapters of the book. The donor programs evaluated are GFTAM (the Global Fund to Fight Tuberculosis, AIDS, and Malaria) and PEPFAR (the President's Emergency Plan for AIDS Relief, USA). Patterson's interest in these programs is to examine their potential to foster political commitment to AIDS, not to contest their reported gains. Neither of the two programs escapes unscathed. As she argues, neither GFATM's participatory and inclusive approach and careful controls on accountability, nor PEPFAR's emergency and result-oriented tactics help matters. The two programs have yet to mainstream AIDS programs into long-term development efforts. Although Patterson makes little attempt to engage the critical political ends which these programs serve for the global North, she nevertheless successfully underlines how such institutions are...

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