AIDS policy responsiveness in Africa: Evidence from opinion surveys

Abstract

As a result of massive scale-up efforts in developing countries, millions of people living with HIV are now receiving antiretroviral therapy (ART). However, countries have been uneven in their scale-up efforts with ART coverage rates exceeding expectations in some places and lagging behind expectation in others. This paper develops a model that explains ART scale-up as a function of the responsiveness of political parties to their primary constituents. Specifically, the paper argues that, faced with a perilous ‘threat to the nation’, countries responded in one of two ways, both of which were designed to appeal to their primary constituents – either adopting a ‘Geneva Consensus’ response, or depicting the epidemic as a Western disease and adopting a ‘pan-African’ response. The article tests this theory using Afrobarometer data for eleven countries. The paper finds that HIV/AIDS is generally a non-partisan issue in most countries. However, the analysis does uncover some differences in partisan support for HIV/AIDS responses in both countries that have adopted Geneva Consensus and pan-African responses, though not in the direction hypothesised. The lack of congruence in policy preferences between the public and their governments suggests a democratic deficit in that these governments have acted independently of the preferences of core constituents.

Keywords:

• HIV/AIDS
• public opinion
• Africa
• government responsiveness

Notes

1. ‘Geneva Consensus' refers to best practice, evidence-based responses to HIV as recommended by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), two international health institutions located in Geneva, Switzerland (see Gauri & Lieberman, 2006).

2. Here I use the term ‘pan-African’ to refer to oppositional HIV/AIDS responses adopted by African leaders that explicitly challenge the Western construction of HIV/AIDS with regard to treatment, prevention and behavioural approaches to addressing the epidemic and to explaining its spread. As described more below, this pan-African discourse on HIV/AIDS has taken a variety of forms. Other authors have discussed President Mbeki's use of pan-African rhetoric in crafting South Africa's response to HIV/AIDS and the influence of his notion an African Renaissance in influencing his personal beliefs on the subject (Butler, 2005; Nattrass, 2003).

3. See Inglehart (1997).