The Politics of AIDS in Africa (review)

Patterson's book is published in the series "Challenge and Change in African Politics." Patterson claims that the fight against HIV/AIDS has not received the attention it deserves in African politics. Political centralization, neopatrimonialism, low capacity, and instability have slowed down the fight. Central to the study, which analyzes AIDS and politics in South Africa, Swaziland, Uganda, and Zimbabwe, is the idea that the magnitude of the problem, the growing inequality on the continent, and cultivation of open responsible institutions by African states and all groups in the international community, would go a long way toward implementing a solution. Patterson structures the first two chapters on discourses on the decline of the African state and unsuccessful democratic transitions and analyzes approaches to combating HIV/AIDS—approaches that include an open dialogue and campaign against the disease by President Museveni of Uganda; centralization in the case of Zimbabwe; the right discourse, but contradictory actions by the King of Swaziland; and Thabo Mbeki's pronouncements that have questioned whether HIV causes AIDS and have raised doubts about generic drugs. Despite the fact that South Africa is an open society, in which activists have taken up the cause, South Africa has achieved little because the ruling party, the African National Congress, has centralized the fight against the disease. Patterson uses the available literature on political thought and HIV/AIDS to provide insights into the political behavior and operations in the selected countries, and the result is an insightful book, which demonstrates that the fight against AIDS ought to involve all sectors of the political community, and political leaders at the highest level ought to take charge in creating and implementing policies that would strengthen the fight.

In chapter 3, Patterson works with the postulate that democratic states promote health. She examines this idea through several themes, namely that citizens in African countries want their governments to prioritize AIDS and have organized through civil society to have governments take action in fighting it. It is thought that governments often to respond to such demands because they fear that if they do not respond, they would see an adverse effect during elections. Furthermore, democratic institutions are avenues for promoting the fight against AIDS, and democratic governments respond to citizens' views. The critical analysis of political action in the four countries demonstrates that contrary to these political assumptions, AIDS has not been a major issue in elections, and governments have not taken the risk of budgeting money to fight the disease. Most of the money actually used to fight the disease has come from outside donors. Patterson argues, "with the exception of South Africa, democratic institutions such as legislators, judiciaries, and local governments have played a minor role in AIDS policy development" (p. 91).

In chapter 4, Patterson analyzes the role played by civil society groups in the fight against AIDS, and highlights why some AIDS organizations are strong and some influence policy. What emerges in this chapter is careful description and analysis of well-known AIDS organizations, like the Treatment Action Campaign (TAC) in South Africa, and other organizations in Ghana and Zimbabwe. The strength of an organization depends on adequate financial resources, the capacity of its members, its leaders, and its internal structures. By all four of these criteria, TAC in South Africa is probably a strong AIDS organization, one of the few on the continent. The influence an organization can have in the fight against AIDS depends on several factors, including the political system, which is democratic in the organizations studied, except the Zimbabwean AIDS organization, which is autocratic because of Robert Mugabe's domination. The other factors are the political culture in the country that supports AIDS activism, the building of national and international coalitions, and the relationship the organization has with the state. Here, some organizations, like the AIDS organization in Zimbabwe, have been captured by the state, while some cooperate with and confront the state.

In chapter 5, Patterson analyzes...