AIDS in Africa: a perspective on the epidemic

Issues surrounding the spread of acquired immunodeficiency syndrome (AIDS) in Africa are summarized. Subjects considered include the disease's origins, proportion of the population infected with the human immunodeficiency virus (HIV) and AIDS, the problems in caring for children orphaned by the disease, innovations in drug treatments discovered by African scientists, the spread among women, and the difficulties inherent in incorporating Western-based policy and aid provisions into the African context.     

AIDS,speech and silence in South Africa (Respond to this article at http://www.therai.org.uk/at/debate)

Confessional technologies are frequently deployed to deal with the HIV/AIDS pandemic. In South Africa, these are most eagerly embraced by activists of the urban‐based Treatment Action Campaign, who use speech such as public confession and testimony to overcome pathos. However, fieldwork in the Bushbuckridge area of the South African lowveld shows wide resistance to direct speech about AIDS. In this article I explore reasons for such resistance. In addition to the stigma of labelling and poor treatment options, I argue that villagers feared the innate power of words such as ‘HIV’ and ‘AIDS’ to crystalize sickness, and bring fears of death into consciousness. In conclusion, I suggest that rather than insist upon confession, health providers could use speech and silence as alternative modes of dealing with AIDS.     

In from the margins? The changing place of Africa in International Relations

This article surveys recent literature on Africa and International Relations (IR) and reviews the current place of Africa within the discipline. It notes that critical debates continue around claims of a mismatch between Africa and ‘mainstream’ IR theories and concepts. However, alongside this set of issues, there is in fact a burgeoning literature on many aspects of Africa's international relations. While some of these studies utilize existing IR theories, and others explore empirical cases that could deliver important lessons for the wider discipline, much of this promise goes unfulfilled. The article reviews literature on China's role and on HIV/AIDS governance in Africa to illustrate how the study of African international relations, the wider IR discipline and international policy could all benefit from a closer engagement between Africa and IR. The article concludes by setting out three challenges for a renewed agenda: a need to address the problematic relationship between universal analytical concepts and regional particularities; a need to give recognition to, and analyse, African agency in international politics; and a need to address inequalities in knowledge production in the field of Africa's international relations.     

South Africa's Transition in a Globalizing World: HIV/AIDS as a Window and a Mirror

South Africa's peaceful transition is evolving during a period in which spectacular twentieth-century achievements have greatly improved life for one-fifth of the world's population. These are being gradually eclipsed, however, by the impact of social and economic forces that relegate four-fifths of the world's population to increasingly insecure, miserable and impoverished lives. South Africa's negotiated revolution, which has allowed it to move from the pariah status of apartheid to that of a fledgling democracy, exemplifies the paradigm shift required for global progress towards a more just and peaceful world. The HIV/AIDS pandemic, a major threat to South Africa, the African continent and many others around the world, is used in this article as a window through which to view the prospects for the long-term social success of South Africa's transition. It is also used as a mirror to reflect the world in which such a disease could emerge and spread pervasively. The explanatory links between exploitative global economic forces and the emergence of threats to lives are considered, in order to illuminate new pathways towards global progress in which respect for human rights will be further consolidated through promotion of solidarity, interdependence and social justice.     

South Africa,the world and AIDS (Respond to this article at http://www.therai.org.uk/at/debate)

South Africa has been at the centre of world history for over a century and it is now the focus of all eyes for the World Cup. The country has been a by‐word for racial inequality and more recently for crime and violence. But it is also notable for social progress and cultural vitality. The HIV/AIDS epidemic has claimed more victims there than anywhere else, a tragic sequel to apartheid. Successive political leaders highlight the contradictions of this historical moment in poignant, even Shakespearean ways. The author briefly reviews three books by anthropologists on AIDS there and suggests that South Africa is likely to remain a source of innovation for the discipline. But we need to take a broader view of world history than at present.     

Counselling Citizens and Producing Patronage: AIDS Treatment in South African and Ugandan Clinics

Global health interventions to provide antiretroviral (ARV) drug treatment for people living with HIV/AIDS in developing countries have linked global and local actors in unprecedented ways. These uneven relationships have been described as creating new forms of citizenship that challenge the liberal understanding of rights and responsibilities bestowed by the state. A comparative case study based on fieldwork from South Africa and Uganda suggests different theoretical understandings of the link between technologies of AIDS treatment and relationships of belonging. Yet, ethnographic data from local clinics in both countries point to similarities that exist across AIDS interventions, and to the importance of counsellors in negotiating the rules of ARVs. Neither patients living with HIV nor the local providers of their AIDS treatment are ‘bare life’ subjects to be acted upon by a global development intervention. As ARV technologies are increasingly prescribed in developing country clinics, diverse social relationships are taught and negotiated as part of the pedagogy of biopolitics. The following discussion demonstrates how local counsellors and clients negotiate the rules of AIDS treatment together for mutual benefit. The article concludes that AIDS treatment creates relationships of therapeutic citizenship and clientship in ways that constrain the possibilities of citizenship and development.     

Africa's population and family planning dynamics

The historical and current demography of Africa in this discussion focuses on the context of population policy, contraceptive use, reproductive behavior, polygamy, and economic impacts. Sub-Saharan Africa countries have the highest rate of population growth in the world. 50% are aged under 20 years, and 20% are aged under five years. Urban areas are growing at the fastest rates in the world (5-6% annually). Population density remains low, except for areas where there is high soil fertility. Many African countries recognize the need for population policies. The most important donor to Africa, the World Bank, has pressured African governments to adopt family planning (FP) programs. A major World Bank study has shown that more FP services are desired by African women. Family expenditures for the 1980s for FP were estimated at $100 million annually, of which $53 million was provided by donors. Further expansion in the program is needed. The World Bank targeted contraceptive use at 25% of African married couples. Except for Egypt and North African countries, contraceptive use is around 3-4%. Another perspective on population reduction is to expand programs for child spacing and postnatal nutrition of mothers and infants. There has been a failure to turn health systems around to low-cost preventive health, particularly in rural areas. Infant mortality must be reduced before fertility will decline. Population growth can be slowed by changing the status of African women (high social status and recognition are associated with high fertility), age of marriage, child spacing, agricultural productivity, and nutrition. Demographic data on Africa have only become available during the past 25 years. African demographers are in short supply and require training abroad. Demographic data gaps and reliability problems are offset by the recent availability and quantity of survey data. Historical demography has produced conflicting results. Although some investigators, such as Ester Boserup, argue that population pressure results in agricultural innovations, Africa has yet to experience this phenomena. The youthful composition of the population guarantees continued population momentum. Fertility is enhanced by the cultural emphasis on perpetuating lineage and high fertility. Changes in reproductive behavior will depend on major social changes for women.     

Poverty, debt and Africa's HIV/AIDS crisis

As Africa enters its third decade of structural adjustment pressures, the promised advantages of economic restructuring—as hailed by the various lending bodies— have not been forthcoming. The indelible picture emanating from the continent is one of a people relegated to a position of extreme poverty as state managers and the international community either fail to, or seem unable to, pursue policies that will secure the basic needs of its citizens. To compound matters, HIV and AIDS are threatening to erode the continent's already fragile development capacity. Predicated on the continent's limited economic capabilities, this article charts the relationship between poverty, debt relief and the politics of effective response to HIV/AIDS in Africa. The article begins with an assessment of the societal causes and consequences of the epidemic, moving on to contextualize the case for debts cancellation. It concludes by examining the crucial relationship between debt relief and the successful implementation of effective strategies against the pandemic in Africa.     

Privileging prevention,gendering responsibility: an analysis of the Ghanaian campaign against HIV/AIDS

This article focuses on the discourses around HIV/AIDS in the national Ghanaian ‘Stop AIDS Love Life!’ public health campaign, within non-governmental HIV/AIDS publications, and the Ghanaian national print media. I have used critical discourse analysis to interpret and deconstruct a range of these social texts collected between June and September of 2001 and 2003 in and around Greater Accra, Ghana. I argue, firstly, that these discourses are shaped by an international politics of funding for HIV/AIDS that privileges prevention through behaviour change over treatment action under the premise that prevention is a more cost-effective option for the Global South. I critique this stance, highlighting the emerging possibilities for integrated prevention–treatment efforts in resource-poor settings such as Ghana. Secondly, I argue that the discourses around HIV/AIDS presented in prevention campaign materials powerfully construct normative and gendered subjectivities with assigned roles and responsibilities. The fight against HIV/AIDS is constructed as a national project in which an idealized, and often very young, female citizen is positioned as educator, volunteer, carer and protector of herself and society. This discursive coding of responsibility places the many burdens of HIV upon some of the most vulnerable in society, ignoring the structural constraints of gender, generational and economic inequality. I conclude my paper by arguing that efforts to reduce transmission rates, stigma, and the burden of care for those living with HIV/AIDS in Ghana must integrate both preventative efforts and treatment action. Where prevention campaigns are utilized I suggest that these must recognize the limitations of behaviour change initiatives that primarily target women and acknowledge the gendered constraints faced by those very subjects identified as responsible for the protection and education of the nation.     

“Dissemination as Intervention”: Building Local HIV Competence through the Report Back of Research Findings to a South African Rural Community

Abstract: What ethical obligations do researchers have to research informants in marginalised communities in serious distress? Our “dissemination as intervention” exercise reported research findings back to a South African rural community—using a dialogical approach which sought to strengthen participants’ confidence and ability to respond more effectively to HIV/AIDS. Nine workshops were conducted with 121 people. Workshops provided opportunities for participants to start developing critical understandings of the possibilities and limitations of their responses to HIV/AIDS, understandings which constitute a necessary (though obviously not sufficient) condition for further action. Workshops alerted participants to the valuable role played by local HIV/AIDS volunteers, facilitating reflection on how local people might better support the volunteers. These discussions served as the impetus for the establishment of a three‐year community‐led intervention to further these goals.     

Is there a distinct African sexuality? A critical response to Caldwell

The author challenges the hypothesis developed by Caldwell and others that sexuality in Africa is inherently permissive, and that prevailing attitudes and behavior are primary reasons for the relative failure of family planning programs to reduce fertility, and thereby will be major factors hindering efforts to control the spread of HIV infections and AIDS. The article is in three parts. "The first is a summary of the thesis as presented by Caldwell et al., including their location of African sexuality and their conceptualisation of change. The second offers a critical response, focusing mainly on the problems of research into sexual behaviour and the christianisation process, with special reference to the case of the Kikuyu people, among whom, recent studies suggest, even where sexual activity may have appeared largely free of moral restraint, there was indeed a moral order.... Part three offers a new way forward." (SUMMARY IN FRE)     

Human security and development in Africa

There has been a recent rise in optimism about Africa's prospects: increased economic growth; renewed regional and national political commitments to good governance; and fewer conflicts. Yet, given current trends and with less than eight years until 2015, Africa is likely to fail to meet every single one of the Millennium Development Goals (MDGs). Home to almost one‐third of the world's poor, Africa's challenges remain as daunting as ever. Despite highly publicized increased growth in some economies, the combined economies of Africa have, on average, actually shrunk and are far from meeting the required 7 per cent growth needed to tackle extreme poverty. A similar picture emerges from the analysis of Africa's performance on the other MDGs. In a world where security and development are inextricably connected in complex and multifaceted ways, Africans are, as a result, among the most insecure. By reviewing a select number of political, security and socio‐economic indicators for the continent, this analysis evaluates the reasons underlying Africa's continuing predicament. It identifies four critical issues: ensuring peace and security; fostering good governance; fighting HIV/ AIDS; and managing the debt crisis. In assessing these developmental security challenges, the article recalls that the MDGs are more than time bound, quantified targets for poverty alleviation–they also represent a commitment by all members of the international community, underwritten by principles of co‐responsibility and partnership, to an enlarged notion of development based on the recognition that human development is key to sustaining social and economic progress. In recent years, and often following failures, especially in Africa, to protect civilian populations from the violence and predation of civil wars, a series of high‐level commissions and expert groups have conducted strategic reviews of the UN system and its function in global politics. The debate has also developed at the theoretical level involving both a recon‐ceptualization of security, from state centred norms to what is referred to as the globalization of security around the human security norm. There has also been a reconceptualization of peacekeeping, where the peacekeeping force has enough robustness to use force not only to protect populations under the emergent responsibility to protect norm, but also enough conflict resolution capacity to facilitate operations across the conflict–development–peacebuilding continuum. This article opens up a discussion of how these ideas might be relevant to security regime building and conflict resolution in African contexts, and suggests how initiatives in Africa might begin to make a contribution to the theory and practice of cosmopolitan peacekeeping.     

Medical Research Council Programme on AIDS in Uganda – the first 10 years

Abstract

The Medical Research Council (MRC) Programme on AIDS in Uganda is based at the Uganda Virus Research Institute of the Ugandan Ministry of Health in Entebbe on the shores of Lake Victoria. The programme was established following a request in 1988 from the Ugandan Government to the UK Government for assistance with AIDS, which had recently been discovered to be a large and growing health problem in the country. At that time Uganda had the worst published rates of HIV infection in the world. Over the past 10 years, Uganda has to some extent controlled its AIDS problem while other countries have been overtaken by even worse epidemics. From the outset of the epidemic Ugandan political leaders have discussed the dangers that HIV infection presented to the country and looked for support from community and opinion leaders, including religious groups. They have used available human resources in a relevant manner to trigger important social changes. Sex education is becoming integrated into the school curriculum, programmes have been established to improve the treatment of sexually transmitted diseases throughout the country, and the use of condoms has been actively and widely promoted through free distribution and social marketing. In Uganda today, experts estimate that 10–25% of the urban population and 4–10% of the rural population are infected with HIV.     

South Africa: a legacy of family disruption

This article draws together unusual characteristics of the legacy of apartheid in South Africa: the state-orchestrated destruction of family life, high rates of unemployment and a high prevalence of HIV/AIDS. The disruption of family life has resulted in a situation in which many women have to fulfil the role of both breadwinner and care giver in a context of high unemployment and very limited economic opportunities. The question that follows is: given this crisis of care, to what extent can or will social protection and employment-related social policies provide the support women and children need?     

Syncretism and subversion in AIDS governance: how locals cope with global demands

This article raises a set of theoretical questions about culture and governance in organizational responses to AIDS in sub-Saharan Africa. It draws on material from two visits to sub-Saharan Africa (Botswana in July 2003 and Malawi in June and July of 2004): interviews with government officials, international organization representatives and staff from AIDS NGOs across a variety of settings in sub-Saharan governance. The article examines the relation of AIDS governance to existing patterns of African governance and argues that while 'institutional isomorphism' can be imposed by international funders, such efforts often produce paradoxical outcomes on the ground. It seeks to understand why the intersection between the organizational models proffered by AIDS NGOs and existing patterns of authority and cooperation produce either syncretism, subversion, or simply a standoff.     

建设以非洲地理研究为特色的非洲学——南京大学非洲地理研究成果回顾与展望

论文全面回顾了南京大学非洲地理研究发展的历史,从自然地理、能源地理、农业地理、矿产地理、工业地理、人口与城市地理等方面总结了南京大学非洲地理的重要领域。指出了当前研究的困境与不足,并探讨了今后南京大学非洲地理研究应关注的重点。     

Hidden Child Workers: Young Carers in Zimbabwe

Drawing on an interview‐based case study of young people caring for dependent adult members of their households in Harare, this paper connects the experiences of young carers in Zimbabwe to global forces—namely the HIV/AIDS pandemic and economic liberalisation. It is argued, firstly, that care‐giving by young people is a largely hidden and unappreciated aspect of national economies which is growing as an outcome of conservative macroeconomic policies and the HIV/AIDS explosion. Secondly, that young people have a right to recognition of their work as work. Thirdly, while acknowledging that conceptualising childhood is problematic, there needs to be less emphasis on northern myths of childhood as a time of play and innocence and more attention on defending children's rights to work as well as to be supported in their work under appropriate circumstances. The articulation between global processes and the localised experiences of individual children as providers of care within the home contributes to efforts to re‐introduce social reproduction as an important (but often missing) aspect of debates around globalisation. In addition, this article adds to the growing literature on the geographies of childhood while tackling the imbalance within that literature, whereby working young people and those of the global South are relatively neglected. Suggestions are offered in the conclusions for policy recommendations to recognise and support young carers in Africa, while calling for further research.     

Towards a jus in bello of Guerrilla Warfare

Abstract

Pentecostalism is the fastest growing form of Christianity in developing countries. Paralleling Pentecostalism's growth has been the HIV/AIDS pandemic. This paper examines how post-apartheid South Africans are responding to the conflicts born of the HIV/AIDS crisis. Fieldwork conducted in 2005 shows that Pentecostals who were not involved in efforts to address HIV/AIDS saw the church's mission as almost exclusively spiritual in nature. Pentecostals who were engaged in HIV/AIDS-related work were more likely to have an integrated worldview and to see the church's mission as relevant to the physical world. Beliefs about removing racism from the church and sin as structural as well as individual were also associated with this integrated worldview. These insights lay the foundation for constructing a Pentecostal social ethic for addressing HIV/AIDS.