Review of Amy Patterson’s book on AIDS in Africa

I’ve blogged a bit about the book before (see here), but here is my review of Amy Patterson’s book on AIDS in Africa that just appeared in Political Science Quarterly (here is a link to the PDF).

The Politics of AIDS in Africa by Amy S. Patterson. Boulder, CO, Lynne Rienner Publishers, 2006. 226 pp. Cloth, $52.00; paper, $19.95.

Amy Patterson’s book provides an informative look at the AIDS epidemic in Africa that is likely to appeal to both specialists and readers new to the topic. She paints a portrait of indifference among most African leaders and of suffering publics distracted by poverty and other grave problems. Her discussion of the lack of political salience of AIDS in much of Africa is the best part of the book and echoes Alex de Waal’s recent AIDS and Power: Why There Is No Political Crisis—Yet (London: Zed Books, 2006).

Patterson is less successful in explaining the variation among African countries in their responses to the epidemic. She evaluates several hypotheses related to institutional attributes of African states, including state capacity, centralization, corruption, and stability. However, in her case studies of South Africa, Swaziland, Uganda, and Zimbabwe, she finds that no single hypothesis explains the level of effort on AIDS by different governments. She would expect that a poor country like Uganda, with its centralized government, would perform badly, but Uganda’s AIDS prevention program is perhaps the continent’s most well-known success story. South Africa, given its relative wealth, would be expected to have a better AIDS program, but Thabo Mbeki, the President since 1999, has famously undermined his country’s AIDS efforts. Patterson tries to explain why there is no meta-answer for variations in country performance, but there could be a more unified narrative. The closest the book comes to one is a recognition that personal leadership (or its absence) by a state’s top leaders has been critically important in countries like Uganda, South Africa, Swaziland, and Zimbabwe.

Patterson uses the AIDS Programme Effort Index (API) as one of the main measures for evaluating the performance of the different governments in her case studies. The API is a survey instrument that is intended to reflect a country’s level of effort on AIDS on a number of criteria, including political support, policy and planning, organizational structure, legal and regulatory environment, and human rights. Scores are derived from surveys with experts knowledgeable about different components of the country’s AIDS program. Scores are generated on a 100-point scale for individual components as well an aggregate. The experts base their judgments on what would constitute an ideal level of effort. In the 2003 API, the average number of respondents per component was four. This is likely to make aggregate scores troublesome for cross-country comparison. South Africa, for example, scored a 75 on the 2003 API, similar to Uganda (76) and less than Botswana (80) and Rwanda (81). However, as Patterson notes, President Mbeki has undermined South Africa’s AIDS program. Mbeki denied that HIV causes AIDS and resisted the use of anti-retroviral therapy in the treatment of HIV-positive South Africans, although South Africa is the country with the second-highest number of HIV-positive people (India has the highest number). How could South Africa score so high on the API? Patterson is understandably constrained by data availability. In the absence of better indices or metrics, the API is perhaps the only option. An exploration of the API’s limitations could have been helpful.

Patterson’s chapter on donor responses to the epidemic is, like the rest of the book, rich in detail. Her review of the George W. Bush administration’s response to the epidemic is insightful, particularly the discussion of how the politically contested nature of prevention programs has contributed to the increased focus on treatment. This chapter is more descriptive than explanatory. She addresses donor motivations in passing, and because her final chapter is a call for greater political commitment, more discussion of political mobilization dynamics in donor countries would have been useful. For readers trying to get a handle on why African governments have had such difficulty dealing with the epidemic, Patterson’s book is a good introduction.

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One Response to “Review of Amy Patterson’s book on AIDS in Africa”

  1. This looks like a fantastic book. Thank you for pointing it out!

    Robert Nowinski