Neoliberalism and AIDS Crisis in Sub-Saharan Africa: Globalization’s Pandemic PDF
Preview Neoliberalism and AIDS Crisis in Sub-Saharan Africa: Globalization’s Pandemic
International Political Economy Series General Editor: Timothy M. Shaw, Professor of Commonwealth Governance and Development, and Director of the Institute of Commonwealth Studies, School of Advanced Study, University of London Titles include: Glenn Adler and Jonny Steinberg (editors) FROM COMRADES TO CITIZENS The South African Civics Movement and the Transition to Democracy Glenn Adler and Eddie Webster (editors) TRADE UNIONS AND DEMOCRATIZATION IN SOUTH AFRICA, 1985–1997 Einar Braathen, Morten Bøås and Gutermund Sæther (editors) ETHNICITY KILLS? The Politics of War, Peace and Ethnicity in Sub-Saharan Africa Deborah Bräutigam CHINESE AID AND AFRICAN DEVELOPMENT Exporting Green Revolution Gavin Cawthra SECURING SOUTH AFRICA’S DEMOCRACY Defence, Development and Security in Transition Jennifer Clapp ADJUSTMENT AND AGRICULTURE IN AFRICA Farmers, the State and the World Bank in Guinea Neta C. Crawford and Audie Klotz (editors) HOW SANCTIONS WORK Lessons from South Africa Staffan Darnolf and Liisa Laakso (editors) TWENTY YEARS OF INDEPENDENCE IN ZIMBABWE From Liberation to Authoritarianism Susan Dicklitch THE ELUSIVE PROMISE OF NGOs IN AFRICA Lessons from Uganda Kevin C. Dunn and Timothy M. Shaw (editors) AFRICA’S CHALLENGE TO INTERNATIONAL RELATIONS THEORY Kenneth Good THE LIBERAL MODEL AND AFRICA Elites Against Democracy Kees Kingma DEMOBILIZATION IN SUBSAHARAN AFRICA The Development and Security Impacts Vijay S. Makhan ECONOMIC RECOVERY IN AFRICA The Paradox of Financial Flows Clever Mumbengegwi (editor) MACROECONOMIC AND STRUCTURAL ADJUSTMENT POLICIES IN ZIMBABWE Colleen O’Manique NEOLIBERALISM AND AIDS CRISIS IN SUB-SAHARAN AFRICA Globalization’s Pandemic Nana Poku REGIONALIZATION AND SECURITY IN SOUTHERN AFRICA Howard Stein, Olu Ajakaiye and Peter Lewis (editors) DEREGULATION AND THE BANKING CRISIS IN NIGERIA A Comparative Study Peter Vale, Larry A. Swatuk and Bertil Oden (editors) THEORY, CHANGE AND SOUTHERN AFRICA’S FUTURE International Political Economy Series Series Standing Order ISBN 0–333–71708–2 hardcover Series Standing Order ISBN 0–333–71110–6 paperback (outside North America only) You can receive future titles in this series as they are published by placing a standing order. Please contact your bookseller or, in case of difficulty, write to us at the address below with your name and address, the title of the series and one of the ISBNs quoted above. Customer Services Department, Macmillan Distribution Ltd, Houndmills, Basingstoke, Hampshire RG21 6XS, England Neoliberalism and AIDS Crisis in Sub-Saharan Africa Globalization’s Pandemic Colleen O’Manique Trent University Canada © Colleen O’Manique 2004 Softcover reprint of the hardcover 1st edition 2004 978-1-4039-2089-8 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The author has asserted her right to be identified as the author of this work in accordance with the Copyright, Designs and Patents Act 1988. First published 2004 by PALGRAVE MACMILLAN Houndmills, Basingstoke, Hampshire RG21 6XS and 175 Fifth Avenue, New York, N.Y. 10010 Companies and representatives throughout the world PALGRAVE MACMILLAN is the global academic imprint of the Palgrave Macmillan division of St. Martin’s Press, LLC and of Palgrave Macmillan Ltd. Macmillan® is a registered trademark in the United States, United Kingdom and other countries. Palgrave is a registered trademark in the European Union and other countries. ISBN 978-1-349-51514-1 ISBN 978-0-230-50408-0 (eBook) DOI 10.1057/9780230504080 This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data O’Manique, Colleen, 1962–. Neoliberalism and AIDS crisis in Sub-Saharan Africa:globalization’s pandemic/Colleen O’Manique. p. cm. — (International political economy series) Includes bibliographical references and index. ISBN 978-1-349-51514-1 1. AIDS (Disease)—Africa, Sub-Saharan. 2. AIDS (Disease)— Uganda. 3. Africa, Sub-Saharan—Economic policy—Health aspects. 4. Globalization—Health aspects. I. Title. II. International political economy series (Palgrave Macmillan (Firm)) RA643.86.A357O46 2004 362.196′9792′00967—dc22 2003067400 10 9 8 7 6 5 4 3 2 1 13 12 11 10 09 08 07 06 05 04 Contents Acknowledgements vi List of Abbreviations vii Introduction: Globalization’s Pandemic 1 1 AIDS Knowledges and Africa’s Pandemic 16 2 Africa in the Global Institutional Response 44 3 The Other ‘War on Drugs’ 78 4 Why Africa? Uganda’s Epidemic in Historical Perspective 99 5 The Uganda ‘Success Story’ 135 Conclusion: AIDS, Human Rights, and Global Inequality 169 Appendix 178 Bibliography 180 Index 198 v Acknowledgements The research for this book dates back almost a decade, and the people who assisted me at the beginning of the project are many – thanks to Patricia Stamp, Robert Albritton, Michael Stevenson, Judith Hellman, Kenna Owoh, Jonathan Barker, Richard Stren, and Nakanyike Musisi. In Uganda, Tom Barton, Mary Ssengo, Arnest Wabwire, Narithius Asinguirre, Abbey Nalwanga-Sebina, Harriet Birungi, and Bonnie Keller offered advice and research support, while Agnes Namusisi- Nabakka, and Annette, Nabuwanuka took great care of my daughter. The Makerere Institute of Social Research gave me institutional support, and the International Development Research Centre (Canada) provided me with funding. Juliet O’Manique’s support at the beginning of my research was invaluable. Various parts of the book were generously reviewed by Teresa Healy, Katherine Scott, Margaret Barker, Christopher Gombay, John O’Manique, and Erin O’Manique. Small parts of this book appear in an earlier paper, ‘Global Neoliber- alism and AIDS Policy: Institutional Responses to Africa’s Pandemic’, published in Studies in Political Economy, May 2004. At Trent University thanks go to my new colleagues, among them Charmaine Eddy, Judy Pinto, and Erica No1. The greatest debt is to my mother Patricia O’Manique, my father John O’Manique, to my sisters, and to my daughters Sophie and Claire and my husband Christie, for their constant support along the way. vi List of Abbreviations ACP AIDS Control Programme AIDS Acquired Immune Deficiency Syndrome AMREF African Medical and Research Foundation ARV Antiretroviral CHIPS Community Health Intervention Project against STDs CBO Community-based Organization CHDC Child Health and Development Centre CSO Civil Society Organization CPT Consumer Project on Technology DANIDA Danish International Development Agency DMO District Medical Officer FAO United Nations Food and Agriculture Organization FIDA Uganda Women Lawyer’s Association GOU Government of Uganda GPPPs Global Public–Private Partnerships GTZ Deutsche Gesellschaft fuer Technische Zusammenarbeit HIPC Heavily Indebted Poor Countries HIV Human Immunodeficiency Virus IEC Information, Education, Communication IFIs International Financial Institutions ILO International Labour Organization IMF International Monetary Fund IPAA International Partnership against AIDS in Africa KAP Knowledge, Attitude and Practice LC Local Council MAP World Bank Multi-country HIV/AIDS Project for Africa and the Caribbean MFPED Ministry of Finance, Planning and Economic Development (Uganda) MOH Ministry of Health MRC Medical Research Council (UK) MSF Médecins Sans Frontières NGO Non-governmental Organization vii viii List of Abbreviations NRA National Resistance Army NRM National Resistance Movement ODA Overseas Development Agency (UK) PHC Primary Health Care RAIN Rakai AIDS Information Network RC Resistance Council SAPs Structural Adjustment Policies SSA Sub-Saharan Africa STD Sexually Transmitted Disease STI Sexually Transmitted infection SYFA Safeguarding Youth from AIDS TAC Treatment Action Campaign (South Africa) TAG Treatment Action Group TASO The AIDS Support Organization TB Tuberculosis TNCs Transnational Corporations TRIPs Trade-Related Aspects of Intellectual Property Rights UAC Uganda AIDS Commission UNAIDS Joint United Nations Programme on HIV/AIDS UNCTAD United Nations Conference on Trade and Development UNDP United Nations Development Programme UNDCP United Nations Drug Control Programme UNFPA United Nations Fund for Population Activities UNICEF United Nations Children’s Fund USAID United States Agency for International Development USTR United States Trade Representative UVRI Uganda Virus Research Institute UWESO Ugandan Women’s Effort to Save the Orphans WB World Bank WBDR World Bank Development Report WHO World Health Organization WHO/GPA World Health Organization/Global Programme on AIDS WID Women in Development WTO World Trade Organization Introduction: Globalization’s Pandemic Acquired Immune Deficiency Syndrome (AIDS) is a collection of seventy or more conditions, which result from damage caused by a retrovirus to the immune system – the Human Immunodeficiency Virus (HIV). The virus can remain in the body for years before any visible symptoms of the disease appear. The virus chips away at the body’s immune system and its host becomes susceptible to other viruses and cancers, until it eventually dies. It is spread from human to human through sex, blood, and from mother to foetus or infant. Extensive spread began in the mid-1970s and AIDS has since become a global pandemic. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) Epidemic Update of December 2002, 29.4 million out of the 42 million people globally living with HIV infection are in Sub-Saharan Africa (SSA). As of 2000 the continent had buried more than 75 per cent of more than 20 million people who had died of AIDS. In the region, women are infected young, and show a higher prevalence of the disease. And they also shoulder the main burden of the epidemic. The small trading centre of Lyantonde is located in the southwest of Uganda, on the transnational African highway that begins in Mombasa and runs through Kenya and Uganda to Rwanda. At the height of Uganda’s AIDS epidemic, the late 1980s, it was a transient community of approximately 5000 people. Cultivators, mostly women, worked on small plots near their homes. Some women worked in the rest stops and kiosks along the main road, while others sold produce and prepared food in weekly markets in the local area. Traders and long-distance drivers would stop here for rest from their travels. This 1 C. O’Manique, Neoliberalism and AIDS Crisis in Sub-Saharan Africa © Colleen O’Manique 2004
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