Politics and Policy of HIV/AIDS

We know, in short, spectacularly little compared to need about the political economies of AIDS. Not economy singular, please note: political economies, plural.

But a much larger part is linked to power, or, in this case, to powerlessness. The powerlessness in question is that of young women who are unable to negotiate or to control their sexual début or their subsequent sexual encounters.

The women brewers were coerced into sex by their customers under the threat that, if they did not submit, then they would be denounced as brewers of bad beer, which had given people stomach aches and thus they would be cut out of the cycle. You can see, therefore, that when such a society falls victim to a sexually-transmitted epidemic such as AIDS, it is structurally vulnerable to the spread of infection. This is what is meant by asymmetric sexual power.

The first is an over-emphasis on treatment of the wrong sort at the wrong time. There is no technical fix to the problem of asymmetric sexual power.

Secondly, the accelerated use of ARVs across the population is an opportunity/cost choice on efforts. My Columbia colleague, Jeffrey Sachs, has called for massive increases in external aid funding as the primary driver for a world effort to combat the pandemic. The Sachs experiment is now, in fact, being conducted and the problem is that it may well exceed the capacity of the administrative and governmental structures of many countries – structures which many frequently have frail legitimacy in any case – to absorb it.

Furthermore, the move to large-scale externally-funded ARV therapies effectively makes whole populations dependent on foreign aid.

But under the strategy of diversification of supply, expectation is that by 2020 Africa will account for about one quarter of America’s oil supplies. And that means that, for the first time since Angola was interesting to Henry Kissinger as a site for a proxy war with the Soviet Union, following the American withdrawal from Viet Nam, the sub-Saharan region begins to take on real strategic importance.

Strategic interest in sub-Saharan Africa is, therefore, assured. Huge increases in non-aid funding look highly likely; a challenge is thereby posed.

The problem is that if the political economy of the first type, which I have described, is not successfully adapted and stabilised before the arrival of the oil royalty bonanza, there is a danger that funding and political interest risk being like petrol poured onto flames. More precisely, what that means is that robust civil society needs to be grounded and nurtured along the West
African littoral and the last of the Big Men of the ‘liberation generation’ (the generation of Mbeki, Mugabe and Nujoma) need by then to have been successfully survived and superseded, for this to occur. Only then can the patrimonial post-colonial state be replaced by something with greater
likelihood of endurance.