Table Of ContentHIV/AIDS in Sub-Saharan Africa
Also by Adrian Flint
TRADE, POVERTY AND THE ENVIRONMENT: The EU, Cotonou and the
African-Caribbean-Pacific Bloc
HIV/AIDS in Sub-Saharan
Africa
Politics, Aid and Globalization
Adrian Flint
© Adrian Flint 2011
Softcover reprint of the hardcover 1st edition 2011 978-0-230-22142-0
All rights reserved. No reproduction, copy or transmission of this publication
may be made without written permission.
No portion 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,
Saffron House, 6–10 Kirby Street, London EC1N 8TS.
Any person who does any unauthorized act in relation to this publication
may be liable to criminal prosecution and civil claims for damages.
The author has asserted his right to be identified as the author of this work
in accordance with the Copyright, Designs and Patents Act 1988.
First published 2011 by
PALGRAVE MACMILLAN
Palgrave Macmillan in the UK is an imprint of Macmillan Publishers Limited,
registered in England, company number 785998, of Houndmills, Basingstoke,
HampshireRG21 6XS.
Palgrave Macmillan in the US is a division of St Martin’s Press LLC, 175 Fifth
Avenue, New York, NY 10010.
Palgrave Macmillan is the global academic imprint of the above companies
and has companies and representatives throughout the world.
Palgrave® and Macmillan® are registered trademarks in the United States,
the United Kingdom, Europe and other countries
ISBN 978-1-349-30692-3 ISBN 978-0-230-30205-1 (eBook)
DOI 10.1057/9780230302051
This book is printed on paper suitable for recycling and made from fully
managed and sustained forest sources. Logging, pulping and manufacturing
processes are expected to conform to the environmental regulations of the
country of origin.
A catalogue record for this book is available from the British Library.
A catalogue record for this book is available from the Library of Congress.
10 9 8 7 6 5 4 3 2 1
20 19 18 17 16 15 14 13 12 11
In memory of Victor Flint,
Margaret Tunnell and William Tunnell
This page intentionally left blank
Contents
List of Tables and Maps x
Acknowledgements xi
List of Acronyms and Abbreviations xiii
Introduction 1
Is Africa a special case? 3
Political leadership and HIV/AIDS 8
Too much or too little? International responses 11
Gender and HIV/AIDS 12
Traditional medicine 13
Profiting from misery? 15
The politics of prevention 17
The politics and governance of HIV/AIDS 18
Chapter 1 Sex and Disease: A Historical Perspective 19
Africa’s lack of healthcare infrastructure 20
Communicable diseases become diseases of poverty 22
Communicable disease, paternalism and control 24
The discourse of sex and disease in Africa 26
A precursor to HIV/AIDS discourse: Syphilis in 30
colonial Africa
Conclusion 34
Chapter 2 The Origins of HIV/AIDS 36
A new disease 37
‘Plague’ and the language of HIV/AIDS 39
A ‘gay plague’ 41
Locating the origins of HIV 43
Human agency and the origins of the virus 45
Charting the African pandemic 48
Conclusion 51
Chapter 3 Gender, Violence and the Spread of HIV/AIDS 53
The interface between gender-based violence 55
and HIV/AIDS
Problematizing gender-based violence 58
Politicizing HIV/AIDS and gender 61
vii
viii Contents
Masculinity and the imposition of gender 66
hierarchies
Conclusion 67
Chapter 4 Policymaking, Dissidents and Denialists 69
Questioning scientific ‘dogma’ 70
The dissidents and their views 72
A case for censorship? 77
Thabo Mbeki’s right to dissent 82
The harm principle 83
Conclusion 85
Chapter 5 Traditional Medicine and the Politics of the 87
‘Witchcraft Paradigm’
Engaging with traditional medicine 89
Towards an African view of disease 91
Further social functions of the ‘witchcraft 95
paradigm’
The role of traditional healers 97
Efficacy of traditional medicine 100
Bringing traditional healers and traditional 103
medicine on side
Conclusion 105
Chapter 6 The International Response: Multilateral and 108
Unilateral Approaches
PEPFAR, MAP and the Global Fund 109
Quantifying the efficacy of PEPFAR 113
Framing HIV/AIDS as a security threat: 117
The Clinton administration
Framing HIV/AIDS as a moral crusade: The Bush 120
administration
PEPFAR under the Obama administration 122
HIV/AIDS: A cause célèbre? 123
Conclusion 126
Chapter 7 Morality, Behavioural Change and the Search 128
for a ‘Social Vaccine’
Healthcare provision by faith-based groups 130
Faith-based organizations and the fight against 131
HIV/AIDS
Behavioural change versus risk reduction 133
The ‘Ugandan miracle’ 136
Contents ix
Analysing the extent of behavioural change 139
in Uganda
Gender hierarchies, behavioural change and 141
risk reduction
Conclusion 144
Chapter 8 Governance, the International Trading System 145
and Access to Antiretrovirals
Big Pharma, profits and the poor 147
Drug prices and universal access to ARVs 149
Protecting intellectual property rights 151
Big Pharma’s role in shaping TRIPS 153
The Big Pharma perspective: Innovation and 155
research and development
Making use of loopholes: TRIPS and 159
compulsory licensing
Big Pharma’s role in shaping the US TRIPS-plus 162
agenda
Big Pharma and the US undermine TRIPS 163
flexibilities
The accessibility of second-line therapies 165
Conclusion 167
Conclusion 169
Notes 176
Bibliography 179
Index 206
