Research Highlights

Africa’s AIDS Industry

Fighting stigma, helping orphans, and empowering women are popular areas of funding for AIDS-prevention efforts in Africa, but not because they are the most effective strategies. 


In an article entitled “Working Misunderstandings: Donors, Brokers, and Villagers in Africa’s AIDS Industry,” published by the Population Council in the Population and Development Review, UC Berkeley sociology professor Ann Swidler and her colleague, University of Pennsylvania sociology professor Susan Cotts Watkins, describe how certain HIV/AIDS-prevention approaches  are repeatedly implemented in the course of development aid projects in Africa, even though they are largely ineffective.

This piece was written as a part of Swidler’s larger project, run in collaboration with the Canadian Institute for Advanced Research, to understand the nature of HIV/AIDS programs in Africa and why they often fail, in order to create a model of development projects that function with “institutional vitality and societal competence.”

In their article, Swidler and Watkins focus on the case study of HIV prevention programs, primarily in Malawi and South Africa, to illustrate how different actors frequently come to rely upon certain tropes because they are deemed to be acceptable to donors and locals alike.

“HIV prevention projects generate complex misunderstandings and conflicting motives among the critical actors in the AIDS enterprise: the deep-pocketed altruists who fund the programs, the local brokers who implement them, and the villagers who are the programs’ ultimate targets,” they write. “The donors, large and small, have fantasies about what poor villagers need; the villagers too have their own fantasies and, like the brokers, their own aspirations…. Our account of the roles of local actors can be viewed as a narrative of seduction—and sometimes, of heartache and betrayal—characterizing the fraught embrace between altruists who come from afar and their significant others, the locals.”

“Fighting Stigma” and Other Tropes

As an example of the ineffectual “tropes” they say have come to characterize AIDS-reduction efforts, Swidler and Watkins note that many HIV prevention programs focus on eliminating the “stigma” associated with the disease, which they call the “mom-and-apple-pie of AIDS interventions”.

“We have found no rigorously designed studies that demonstrate empirically that reducing stigma reduces HIV transmission,” they write. “Moreover, if the goal of HIV prevention is behavior change, then persuading people not to condemn behaviors that lead to HIV transmission could be counterproductive.”

Despite the lack of benefits, they argue that the central theme of “fighting stigma” continues to be deployed as it appeals to the sentiments of donors and is also suitable to the existing customs for caring for the ill that exist in local villages. “Stigma…looms large in the imagined arsenal of AIDS prevention interventions because it sounds good to all and offends no one: everyone, from donors and their sponsors, to brokers, to churches and villagers, can get on board,” they explain. “But even though donors, brokers, and villagers have all signed on to the same program, they ‘misunderstand’ each other in the sense that the fight against stigma means something quite different to each group….”

Another focus frequently repeated in AIDS efforts is an emphasis on caring for orphans and vulnerable children, which they say often leads to misallocated support for children who are not the neediest; another is an emphasis on empowering women. “[Local agents] who sit in a meeting making AIDS policies and implementing programs do not speak of women in miniskirts seducing men,” they write. “Rather, they echo the language of the international community in attributing women’s and girls’ vulnerability to HIV to poverty. But in our experience, when they leave the room where formal policy is being deliberated, they spontaneously talk of predatory sex workers and schoolgirl temptresses. From one room to another, the images of women shift shape.”

The authors also call out NGOs and governments for delivering trainings that tend to be both predictable and pointless. “Just as a Catholic mass would not be a mass without wine and wafers, a training is not a ‘training’ without allowances for attending the training, flip charts, and magic markers, a ‘bun’ and a ‘Fanta,’ at mid-morning and mid-afternoon breaks, and an ample lunch,” they write. “Village chiefs and other participants of higher status, such as a schoolteacher or a pastor, are budgeted for a larger per diem and a more expensive lunch than ordinary villagers, and are served first.”

Yet trainings have become an integral part of nearly every initiative, Swidler and Watkins say, as they are easy to execute and allow organizations to tick off a check box that donors can relate to. “For donors, the trainings of village volunteers to teach others are the only practical way that they can imagine transforming the billions of poor people into participating, self-actualizing, empowered individuals,” they note. “The number of people trained provides an easy measure of success to report to funders, at least as long as donors and their funders have faith in the power of training to transform the identities and behaviors of poor villagers.”

New Realities On the Ground

Swidler and Watkins acknowledge that, while these approaches may not have been as successful as they might have been in preventing AIDS, they may have unexpected benefits. “Combating stigma may not be an effective way to reduce HIV transmission; focusing on orphans and vulnerable children may not target the parentless children the altruists imagine; efforts to empower vulnerable women may be foiled by Africans’ views that women are more perpetrators than victims of the AIDS threat,” they write. “But these focal points of the AIDS enterprise have nonetheless created new realities on the ground in Africa.”

For example, they note that the concepts related to  “gender” have found their way into discourse at the local level, and they note that the networks that have been set up to carry out the AIDS-prevention programs have the potential to be employed for other purposes, such as political mobilization. Most ironically, they note, the inflow of development money may finally motivate poor parents to come to value education for their children and limit how many children they have, in part because academic credentials play a role in who earns the highest pay through working with development organizations.

“As the AIDS enterprise, and the NGO presence more generally, have opened up career paths that appear to depend on educational credentials,” they write,” even poor parents may start to see focusing their resources on fewer children as crucial for their own futures and those of their children.”

Photo Credit: UNESCO Africa

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