Table Of ContentHIV and East Africa
By traeing the shadow of the epidemie over the last 30 years in Uganda and more
broadly in the region, HIV and EastAfrica investigates the impact ofthe epidemie
on people's lives and livelihoods, plaeing the epidemie within the eontext of the
social, politieal and eeonomie ehanges that have oeeurred over the last three
deeades.
Whilst it inevitably touehes on loss and suffering, the message is also about
managing the impact of an epidemie whieh has had a profound impact on many
lives. When one looks for traees in southern Uganda, onee thought to be the
epieentre ofthe epidemie, it is hard to see any lasting impact at a eommunity-wide
level. Delve deeper and there are sears to be found among families and patterns of
change whieh are a direet result ofthe epidemie.
The book goes on to explore the effeet of improved treatment and eare on
pereeptions of the epidemie and eoncludes by putting HIV into the eontext of
other disease outbreaks, refleeting on what we ean learn from the history of other
epidemies as weH as the last 30 years ofthe HIV epidemie.
Janet Seeley has been aetively engaged in research on HIV and AIDS sinee the
late 1980s, including fouryears withMRC in Uganda (1989-1993) when she was
responsible for setting up social seienee research in the unit, the programme she
returned to Uganda to head in 2008. She is eurrently Professor of International
Development at the U niversity of East Anglia, UK.
Routledge Studies in African Development
Self-Determination and Secession in Africa
The post-colonial state
Edited by Redie Bereketeab
Economic Growth and Development in Africa
Understanding global trends and prospects
Horman Chitonge
African Youth and the Persistence of Marginalization
Employment, politics and prospects for change
Edited by Danielle Resnick and James Thurlow
HIV and East Africa
Thirty years in the shadow of an epidemic
Janet Seeley
HIV and East Africa
Thirty years in the shadow of an epidemie
Janet Seeley
First published 2014
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
Simultaneously published in the USA and Canada
by Routledge
7ll ThirdAvenue, NewYork, NY 10017
Routledge is an imprint ofthe Taylor & Francis Group, an informa business
© 2014 Janet Seeley
The right of Janet Seeley to be identified as author ofthis work has been
asserted by her in aeeordanee with seetions 77 and 78 ofthe Copyright,
Designs and Patents Aet 1988.
All rights reserved. No part of this book may be reprinted or reprodueed or
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without intent to infringe.
British Library Cataloguing in Publication Data
A eatalogue reeord for this book is available from the British Library
Library ofCongress Cataloging-in-Publication Data
Seeley, Janet.
HIV and East Afriea : thirty years in the shadow of an epidemie / Janet Seeley.
p. em. - (Routledge explorations in development studies ; 8)
Includes bibliographieal referenees and index.
1. AIDS (Disease) - Soeial aspeets - Afriea, East. 2. AIDS (Disease) -
Soeial aspeets - Uganda. 3. HIV-positive persons - Afriea, East - Soeial
eonditions. 4. HIV-positive persons - Uganda - Soeial eonditions.
5. Afriea, East - Soeial eonditions. 6. Uganda - Soeial eonditions - 1979-
7. Resilienee (Personality trait) - Afriea, East. 8. Resilienee (Personality
trait) - Uganda. 9. Time - Soeiologieal aspeets. I. Title.
II. Series: Routledge explorations in development studies ; 8.
RA643.86.A353S44 2013
362. 1969792009676-de23 20 130 ll788
ISBN: 978-0-415-52449-0 (hbk)
ISBN: 978-0-203-58997-7 (ebk)
Typeset in Times
by HWA Text and Data Management, London
For Charlotte
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Contents
Preface IX
Acknow ledgements Xl
Abbreviations XV
Map ofEast Africa XVll
1 The shadow of an epidemie: an introduetion 1
2 Leaming to live with HIV: the background to an epidemie 17
3 Loss and grief 39
4 Progress and growth 57
5 Crises and change 75
6 The changing epidemie: treatment and eare 93
7 Managing 10ss and forgetting the pain? 111
Bibliography 121
Index 145
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Preface
International AIDS eonferenees have been held annually or biennially for the
last twenty-eight years. Sinee 1989, and with the exception of one year, eaeh
has been given a theme. In 1989 it was 'the seientifie and social challenge of
AIDS'; in 2004 it was' Aeeess for all'; and in 2012, 'Turning the tide together'.
These themes refleet the evolution of the epidemie in terms of how donors,
seientists, researehers and aetivists have approaehed and responded to it. They
also reveal the changing priorities that HIV and AIDS have presented in the last
three deeades; priorities that initially refleeted extreme pessimism have more
reeently signalled relative optimism ab out managing the eondition. International
AIDS eonferenees are aeeompanied by upbeat declarations or mission statements,
pledging, for example, the 'end of AIDS'. Such energy, exeitement and rhetorie
ean sometimes seem rather remote from the day-to-day lives of those who live
with HIV infeetion.
Many ofthose whom I have known who have lived with or are living with HIV
inhabit a very different world from that of the international eonferenees. My work
in Uganda has taken me to both these worlds of HIY, and the idea for this book
has grown from this experienee.
In the early 1990s my notes and ease studies in Uganda reeorded what then
seemed to be a statie and distressing pieture of bereavement and loss. But the
epidemie did not end then; the trajeetory of an infeetion that seemed to engulf an
entire region has shifted. As time has passed and experienee inereased, treatment,
for some at least, has improved. My assoeiation with Uganda has given me an
understanding ofthe ways in whiehHIVboth slots into and influenees individuals'
lives, why some efforts to prevent the spread of infeetion may be more sueeessful
than others, why eampaigns to get people onto anti-retroviral treatment do not
always sueeeed, and that different groups in soeiety have differing perspeetives
and priorities whieh influenee their responses to poliey. While HIV has an impact
on people's lives, it does so against the broader historieal, soeial and eeonomie
eontext in whieh they live.
