DissertationChapter One – IntroductionChapter Two – The Development of AIDS/HIV in AfricaChapter Three – Government policy in UgandaChapter Four – NGO policy in UgandaChapter Five – EvaluationChapter Six – Policies for the hereafter in UgandaChapter Seven – DecisionAIDS/HIV has been a immense wellness issue in Uganda, as it has been across Africa over the past two decennaries. The first AIDS instance was diagnosed in Uganda in 1982 ( www.aidsuganda.
org ) and its Ministry of Health Unit estimates that by the terminal of 2001, 1,050,555 people in the state were populating with HIV/AIDS and there had been over 940,000 HIV/AIDS related deceases since 1982 ( www.aidsuganda.org ) .This thesis will analyze policies that have been put into topographic point by both the Ugandan authorities and non-governmental administrations ( NGOs ) that have worked in the state.
Uganda is one of the few states in Africa where rates of HIV infection have declined and Uganda is frequently held up as an illustration of an African state that has been able to develop successful policies to counter HIV/AIDS.Chapter two looks at the beginnings of the HIV/AIDS epidemic across Africa and so Uganda in peculiar. It is of import to understand the nature of the epidemic across Africa as a whole. Many of the jobs faced across the continent are duplicated in Uganda, yet Uganda is widely seen to be a state that can function as an illustration to its neighbors. There is surely grounds that if policies such as those used in Uganda are implemented in other African states, there may be greater hope for the hereafter.Chapters three and four expression at policy enterprises sole to Uganda and what other states can larn from Uganda’s comparative success. What is interesting about Uganda is that whilst there are a figure of written policies that other states will doubtless look to follow, there are besides a figure of of import unwritten facets to AIDS/HIV policy in Uganda that are alone to the state. At the bosom of policy in Uganda has been a multisectoral attack, through which both governmental and non-governmental organic structures have worked together to develop and implement policies.
Chapter three looks specifically at the function of the authorities and in peculiar the function of President Museveni and his committedness to openness and honesty about HIV/AIDS. The positive attack adopted by the President is widely accepted as a polar factor in Uganda’s successes against HIV/AIDS. Chapter four looks at some of the primary NGOs that have worked in the battle against AIDS in Uganda, both domestic and international. The attempts of TASO, one of Uganda’s most successful NGOs are analysed in this chapter, along with input from more readily recognised administrations such as the United Nations ( UN ) and the World Health Organisation ( WHO ) .
Chapter Five efforts a elaborate rating of the constabularies implemented by both authorities and NGOs in Uganda. Using statistics from a assortment of beginnings, in peculiar the degrees of HIV prevalence over the last 20 old ages, the overall effectivity of policies are analysed. Beginnings of information include the UN, the World Health Organisation and www.avert.org.
Chapter Six looks at the hereafter of the battle against AIDS in Africa. The conflict against AIDS in Uganda is far from over and both the authorities and NGOs must be looking to develop their schemes for the hereafter. There is a possibility that the state of affairs crated by HIV/AIDS could one twenty-four hours lend towards a planetary security menace and this thought is examined here. The possible menaces to Uganda society should the attempts against the disease non be maintained are besides discussed. The increasing function of the American spiritual right is besides analysed as a possible influencing factor in the hereafter of HIV/AIDS policies in Uganda, something that causes concern for protagonists of the successful to day of the month multisectoral attack.Chapter seven provides an overall decision for the thesis.Chapter Two – The Development of AIDS/HIV in AfricaThe effects of HIV/AIDS across Africa as a whole since the early 1980s have been lay waste toing. At the terminal of 2000, over 25 million people in sub-Saharan Africa were populating with HIV/AIDS and more than 80 per cent of the planetary AIDS deceases occurred in the part in 2000.
( Fourie P & A ; Schonteich M, African Security Review, vol 10 no 4, 2001 ) . The graduated table of the epidemic has doubtless taken the remainder of the universe by surprise every bit much as Africa, and with the hapless substructure in topographic point in most African provinces to cover with such a catastrophe, the burden has fallen on the developed universe to take the manner in the battle against the disease. The graduated table of the AIDS crisis in Africa is merely something that the remainder of the universe can non disregard. It is a genuinely planetary crisis. As the WorldWatch Institute summarises: “the HIV epidemic ramping across Africa is a calamity of heroic proportions ; one that is changing the region’s demographic hereafter. It is cut downing life anticipation, raising mortality, take downing birthrate, making an surplus of work forces over adult females, and go forthing 1000000s of orphans in its wake” ( Fourie and Schonteich 2001 ) .The long term effects of the AIDS epidemic across Africa are huge and non merely in footings of loss of human life.
As de Vaal writes “in add-on to killing 1000000s and doing economic contractions, the pandemic threatens structural transmutations in African economic systems, establishments and governance” ( p1 African Affairs 102 ) . The spread of the disease has been identified by both the United Nations Security Council and the US National Intelligence Council as a possible menace to international peace. There can besides be enfeebling mental and societal reverberations. Miller and Stockwell conclude “the psychological consequence of AIDS on communities, households and those infected can be lay waste toing.
Communities confronted by this new, fatal unwellness, which in incompletely understood and carries important societal stigma often develop widespread fright and depression” ( p87 Miller and Rockwell, AIDS in Africa 1998 ) .Demographic alterations can be another consequence of HIV/AIDS. A lessening in big length of service can take to adolescents in some provinces anticipating merely half as much grownup life than that of their parents.
A gender instability can besides happen – the younger mean age of infection in adult females can take to an surplus of grownup work forces over adult females ( p15 African Affairs vol 102 ) . The UN provinces unambiguously that adult females are at greater hazard of the disease, saying that at nowadays there are on mean 13 septic adult females for every 10 work forces in sub-Saharan Africa – this has increased from a ratio of 12:10 in 2002 ( UN AIDS Report 2004 ) . The societal impact of the epidemic can besides weigh more on adult females. The load of attention for illustration normally falls on adult females. Girls will drop out of school to care for ill siblings or parents, and older adult females frequently take on the load of attention for ill grownup kids and subsequently, when they die, take on the parental function for the orphaned grandchildren. The stigma of HIV/AIDS can still be an of import factor in parts of Africa. Older adult females who are caring for orphans or ill kids due to AIDS may be socially ostracised. There is besides a possibility that stigma will intend household support is withheld from adult females if they become HIV positive, or they may hold their belongings seized when their hubby dies.
AIDS/HIV can impact the operation of the province. A provinces monopoly on force can besides be lost as the ground forces and constabulary forces are affected by the disease – “soldiers and police officers are amongst the occupational classs with the highest prevalence of HIV” ( p15 African Affairs vol 102 ) .The disease can impact the ability of people in Africa, peculiarly the hapless, to do a life for themselves.
Across Africa, agribusiness provides a support for up to 80 per cent of the population ( Fourie P & A ; Schonteich 2001 ) . As people in rural countries fall ailment, productiveness diminutions dramatically. Forms of cropping displacement from hard currency harvests to subsistence farming that in bend reduces household income and forces households to sell off their land and farm animal to last.
There are few countries of life in Africa that the AIDS/HIV epidemic does non touch.The response across the continent has been hapless for a figure of grounds –As Caldwell concludes, “The African AIDS epidemic is a modern-day wellness crisis of reeling proportions and one with which African society and authoritiess, every bit good as the international wellness system, has signally failed to cope” ( p117, Population and Development Review vol 26 ) . In many African provinces, South Africa included, authoritiess have been slow to respond to the crisis and populations have been loath to alter their behaviors. The epidemic has a immense impact on economic growing, income and poorness degrees across Africa. It besides poses a major menace to development. Many African states rely on a little figure of extremely skilled forces in of import countries of public direction and nucleus societal services. Badly affected states are losing this extremely trained expertness to AIDS, which is hard to replace.Communities are besides extremely threatened by HIV/AIDS.
In the worst affected countries, turning Numberss of human deaths take topographic point against a background of deteriorating public services, hapless employment chances and endemic poorness that can merely be exacerbated by AIDS. In bend, this state of affairs reduces the ability of the community to back up those most affected by AIDS.HIV besides reduces the figure of kids go toing formal instruction. Up to a 3rd of kids infected with HIV are less likely to last to school traveling age ( World Health Organisation Situation Analysis Report 2002 ) and many kids who have lost their parents to AIDS or live in families that have taken in AIDS orphans are forced to drop out of school and get down gaining an income to supply for themselves and their households.Another noteworthy impact of HIV/AIDS is that it can really impact the ability of the continent’s authoritiess to work expeditiously. Social services can neglect to present due to the decimated ranks of decision makers and operational effectivity of establishments such as prosecution services and bench are diminished.
Fourie and Schonteich list a figure of important grounds as to why HIV/AIDS can impede a nation’s efforts to keep a democratic society:
- A future coevals of political and economic leaders is being wiped out
- The magnitude of the orphan crisis poses a long-run menace to stableness and development
- Established household and societal constructions are interrupting down due to their inability to get by
- The projected budgetary demand on authoritiess is doing them to cut down on bringing in other sectors of society
Citizen support for, and engagement in democracy will diminish as more people fall sick and take themselves from the populace sphere. This affects society’s capacity to prosecute in public argument that can interpret into a loss in society’s ability to construct a sense of national coherence ( Fourie & A ; Schonteich 2001 )AIDS besides has the possible to go a security issue across Africa. UN Secretary General Kofi Annan told the Security Council in 2000:“The impact of AIDS in Africa was no less destructive than that of war itself. By overpowering the continent’s wellness and societal services, by making 1000000s of orphans, and by decimating wellness workers and instructors, AIDS is doing societal and economic crises which in bend threaten political stability…In already unstable societies, this cocktail of catastrophes is a certain formula for more struggle. And struggle, in bend, provides fertile land for farther infections” ( Fourie P & A ; Schonteich M, African Security Review, vol 10 no 4, 2001 ) .AIDS, as it foremost emerged in Uganda was referred to as ‘slim’ due to its physically blowing features. It had foremost emerged in the state on the shores of LAKE Victoria in the late seventiess, yet it was 1982 when the first instance was really diagnosed. As was the instance the universe over, there was small understanding ab initio about what lay waste toing consequences the disease could bring.
As in neighboring states, AIDS was ab initio seen in Uganda as holding a minor impact against other jobs faced in the part. In 1986 less than 20 per cent of the population had entree to clean H2O, 25 per cent of kids surveyed were malnourished and less than ten per cent of the nation’s kids were immunised against preventable diseases ( p87 Miller and Rockwell 1998 ) . Established diseases like malaria, TB and respiratory jobs were more of a concern than a new disease about which small was known or understood. Government passing on wellness was negligible in any instance. In 1987 Uganda spent less than $ 2 on wellness per citizen and Government wellness functionaries were holding to do hard picks on apportioning scarce wellness attention resources – picks between looking necessities such as clean H2O, healthful installations, immunizations or commanding the spread of AIDS.AIDS/HIV in Uganda today continues to hold a awful impact, in malice of statistics that show that policies are holding a positive consequence. In many respects, any alleviation that can be taken from grounds of success against HIV/AIDS can be overwhelmed by the sheer size of the job that remains. In add-on to the 1,050,555 people estimated to hold HIV, an estimated 120,00 have developed AIDS ( WHO Situation Report 2002 ) .
Of those infected with HIV, 80 per cent are between the ages of 15 and 45, an age group by and large seen as the most economically productive and likely to be household leaders. Children in peculiar in Uganda have felt the full force of the horror of AIDS. Around 2 million kids under 18 old ages of age are orphans with either one or both parents dead. ( WHO Situation Report 2002 ) . Typically they are being orphaned at an age when parental counsel and socialization is most desirable. Almost necessarily, the attention, instruction and socialization of these kids are hapless.In the face of such force per unit areas, it would hold been easy for the Ugandan authorities and people to merely give into the job and allow the disease run its class.
To its recognition, Uganda, led by its President, has developed a positive response to HIV/AIDS. Such is the outrageousness of the issue that at times jobs must hold appeared unsurmountable, but through a combination of immense attempt and intelligent policy devising, Uganda has shown that there is hope is the battle against such an epidemic.Some background to the overall state of affairs in Uganda is utile before an analysis of its government’s policies on AIDS/HIV. Uganda remains of the world’s least developed states and is resource hapless. Its current population bases at around 24.7 million ( www.unaids.org ) and whilst the serious civil discord of the 1970s and 1980s has subsided, there remains and ongoing insurgence in northern and eastern parts of the state.
Access to healthcare across the state remains limited, peculiarly in countries of agitation. The jutting life anticipation in the state is 42. This would be 56 were it non for HIV/AIDS ( www.
unaids.org ) .One of the most noteworthy facets of Ugandan Government policy towards HIV/AIDS has been its openness to admit the disease and its annihilating effects. In other African provinces there has been reluctance in politicians to tie in themselves with the disease whilst others have surely in the early old ages of the pandemic seen HIV/AIDS as a low precedence. A simple involuntariness in politician to speak honestly about sexual issues and a fright that Discussion of HIV/AIDS might impede touristry has prevented Government openness in other states. The Ugandan authorities appears to hold found common land with its people in response to the epidemic.
Whilst other provinces doubtless see their citizens with HIV/AIDS as a hinderance, in Uganda the response has been non to fault the sick for their status but to understand the state of affairs and do bar of farther spread of the disease a national precedence.In Uganda the Government has been notably and systematically unfastened and positive about the causes and effects of HIV/AIDS. From 1986 onwards when the Health Minister foremost acknowledged that HIV existed in the state there has been political honestness and openness about the topic and a willingness to speak about the epidemic, the hazards involved and how it might be avoided. There is evidently some cynicism about the Government’s motivation. De Waal argues that Governments merely act when they perceive a existent menace to their ain power and writes “famously, President Museveni of Uganda responded to the AIDS crisis in his state when he discovered that the officer corps of his ground forces was enduring really high rates of HIV” ( P21 African Affairs vol 102 ) . This position nevertheless is excessively critical of the Ugandan President who, more so than any other leader on the continent, has displayed an consciousness of the issues around HIV/AIDS. Equally early as 1986, Museveni was touring the state, stating the population that they had a loyal responsibility to avoid contact with HIV.
He besides encouraged the engagement of a figure of separate authorities ministries, NGOs and faith groups and it appears that his attempts have been rewarded with alterations in behavior that have allowed prevalence degrees to worsen. Museveni promoted the message that AIDS was a menace to all Ugandans and that they should ‘love carefully’ to protect themselves and their households from the disease ( p75 International Relations 15 ) . He has even encouraged national wireless to air his message of safe sex.
Undoubtedly, Museveni has adopted AIDS/HIV as an of import issue both nationally and internationally and many functionaries both in Uganda and abroad see his support as an of import facet in the government’s conflict against AIDS. In consequence, the outstanding function of the President, openly discoursing the issue, has helped take some of the stigma around the disease, reduced favoritism against sick persons and brings about a civilization in which Ugandans are willing and able to accept that HIV/AIDS is an issue that affects them all.The remotion of stigma around HIV/AIDS can in itself be seen as an of import policy success. Decrease in stigma foremost of all allows people to be more comfy with traveling for proving or reding and it besides allows greater assurance for people to state spouses or ex-partners if they have been infected.
Parkhurst suggests that this is peculiarly likely in the instances of adult females who are frequently ostracised, blamed or beaten by spouses for purportedly conveying HIV into the relationship, despite the fact that research shows that it is more likely to be work forces who have excess matrimonial personal businesss and contract sexually transmitted diseases such as HIV ( p70, International Relations 15 ) .Under the old disposal, the response to HIV/AIDS had been the opposite. There was stigma attached to the disease and the authorities offered little in the manner of policy to undertake the issue.
The rise to power of Museveni with the National Resistance Movement ( NRM ) in 1986 was a turning point in the Ugandan response to AIDS/HIV. The old disposal, whilst cognizant that AIDS was a turning wellness issue had done small to battle the intensifying state of affairs. Parkhurst writes, “the political leading at the clip was besides unwilling to let for any scrutiny of what was go oning in the state. Valuable clip was lost between so and 1986 when the authorities established a formal control programme in the wellness sector” ( Parkhurst, p71, International Relation vol 15 no 6 ) .A multisectoral attack was at the bosom of Uganda’s initial written policies on AIDS/HIV. A National Committee for Prevention of AIDS ( NCPA ) was established including wellness workers, decision makers, political and church leaders to develop precedences and set national precedences ( p92 Miller & A ; Rockwell 1998 ) . An AIDS Control Programme ( ACP ) – one of the first of its sort in Africa was besides established in 1986 with an initial remit to include: epidemiological surveillance, guaranting a safe blood supply, proviso of AIDS Information, Education and Communication ( IEC ) and control of other Sexually Transmitted Diseases ( p73 International Relations 15 ) .
The programme has achieved many of its aims. It has set up a figure of sentinel surveillance sites at prenatal clinics to supervise HIV prevalence, introduced blood showing which reduces HIV transmittal through transfusion, promoted a figure of enterprises in schools and the community to advance AIDS/HIV instruction and consciousness, and been involved in the societal selling of subsidised rubbers to do them low-cost and popular with the Ugandan population.The Uganda AIDS Commission ( UAC ) has been another arm of the multisectoral attack. This administration, under the umbrella of the Office of the President instead than the Minister of Health Acts of the Apostless as a coordinating organic structure for all AIDS/HIV activities in Uganda.
( Again the fact that outstanding organic structures engaged in HIV/AIDS work semen under the umbrella of the Office of the President shows a committedness to the battle against the disease that goes right to the top of authorities ) . In add-on, since 1993, Uganda has besides gone through three national strategic planning exercisings including consensus edifice, and developed a National Strategic Framework ( NSF ) for AIDS which places the epidemic in the broader context of national development ends. De Waal besides suggests that the Ugandan attempt against HIV/AIDS has been linked to the democratization and restructuring of local authorities in the state.
He writes: “the attender rebuilding of societal coherence has been recognised as an of import factor act uponing Uganda’s comparatively successful AIDS policies” ( p22 African Affairs 102 )A farther of import strand of authorities policy, once more linked to the multisectoral attack which has worked so good, is its National Operational Plan which has run in concurrence with a National AIDS Programme and the World Health Organisation’s Global Programme on AIDS ( GPA ) . The first coevals medium term programs for HIV/AIDS bar developed by a figure of national authoritiess were aimed chiefly at the wellness sector – the GPA is now encouraging 2nd coevals medium term actions plans that evolve through a consensus edifice procedure that involves all take parting sectors. The WHO study for 1992-93 provinces: “with NAPs going progressively multisectoral, GPA has responded by developing and polishing a national planning procedure that takes into history the multiple participants in the national effort” ( p101 WHO Global Programme on AIDS – Progress Report 1992-93 ) .In Uganda the National Operational Plan, formulated ab initio in 1993, has involved up to twenty different administrations to garner information on HIV/AIDS and other STDs, sexual behavior and cultural, traditional and other determiners of these behaviors in Uganda. The work culminated in a national consensus conference and planning workshops affecting 175 representatives from 50 different administrations – governmental, non-governmental, private and giver. ( WHO progress Report 1992-93 ) . The ensuing program – the Ugandan National Operational Plan for HIV/AIDS/STD Prevention Care and Support 1994-98 gave a comprehensive lineation of all activities that needed to be varied out at national, territory and local degrees by public and private wellness and non-health sectors. As with any program of its type its success has to be measured by consequences and in this instance the program can be seen to hold been successful – it was endorsed by the Ugandan AIDS Commission in October 1993 and later that twelvemonth was used as the footing for explicating a World Bank undertaking that culminated in $ 73 million in grants and loan being made available for AIDS undertakings.
One of the successes of Ugandan HIV/AIDS policy has been it ability to procure finance in this mode.Such a multisectoral attack evidently makes sense. Expertness from different countries can unite to first of all develop the right line of policy and so work together to implement the policies devised. Carolyn Baylies argues as such ; “what is required is a multi-pronged attack to guarantee bar, readiness, and shoring up the resources of those non yet badly effected, and – merely as significantly – exigency support and aid for those which are” ( p629 Carolyn Baylies, Development and Change vol 33 ( 4 ) .
Baylies besides makes the of import point that forestalling the spread of AIDS has been linked to poverty relief programmes and justly so. This two-pronged attack would look logical as both aims tie in with the international docket. Baylies concludes: “if authoritiess are pulling up programs in regard of poorness relief, so AIDS and its impact should be included within them” ( p626, Development and Change 33 ) . To make this the authorities has taken stairss to mix HIVAIDS into national poorness obliteration instruments. AIDS has been integrated into four parts of Uganda’s Poverty Eradication Action Plan ( PEAP ) , which implies that authorities will fund a proportion of HIV/AIDS activities at all degrees through its Poverty Action Fund.
These programs and administrations have been at the bosom of Uganda’s formal policy response to the AIDS/HIV epidemic for about two decennaries and can take recognition surely for the high degree of AIDS consciousness across Uganda. More late a national strategic model for HIV/AIDS has been published which reiterates many of the original ACP aims every bit good as naming for better coordination and capacity edifice and more in-depth surveillance and a general baseline study of the population.Another illustration of positive authorities policy has been an attempt to fund sex instruction programmes in schools and on the wireless, concentrating on promoting immature adolescents to wait until they are older before they foremost have sex. A USAID funded strategy to increase the societal selling of rubbers has been in topographic point since 1990 and has managed to increase rubber usage from 7 per cent nationally to over 50 per cent in some rural countries and over 85 per cent in certain urban countries ( www.who.
int ) . Again, such a policy stems from a multisectoral attack – the societal selling strategy involved the subsidized sale or free distribution of rubbers by both authorities and private sector, with input on wellness instruction from some NGOs. Education is perfectly important to forestalling the spread of HIV/AIDS and the Ugandan authorities has systematically remained committed to policies to supply this.Antiretroviral intervention has been an of import component of authorities policy in recent old ages, with Uganda get downing one of the first trial programmes in Africa to administer the life-saving medicine in 1998 ( www.avert.org ) .
This type of intervention can widen the healthy life of person populating with HIV. If other factors remain the same, the intervention can assist people with HIV to last for longer which may really increase prevalence degrees. However, if the debut of the medicine can promote people to be tested, prevalence degrees may cut down, as people who know their HIV position are less likely to prosecute in hazardous behavior.There are few existent unfavorable judgments to be made of government’s policies. The huge bulk of them have been positive attempts to cover with the issue – the government’s inability to fund and implement the degree of action that it would wish is more of an issue than the existent policies.Chapter Four Nongovernmental organization policy in UgandaNGO engagement in Uganda has been important in the successes the state has had in battling the spread of HIV/AIDS. Sanely, the authorities has mostly welcomed NGO support and looked to work in partnership with any administrations that have a part to do.
Again, this differs from the state of affairs in many other African provinces where authoritiess have been less acute to undertake the issue or to tie in themselves with AIDS focussed NGOs. The lone existent policy trouble with NGOs has been the recent efforts by some faith-based groups to try to press home their ain dockets and do some aid reliant on the attachment to their religions based beliefs – an insisting on abstention instead than condom proviso serves as an illustration.The government’s actions in regard of HIV/AIDS reflect merely a little per centum of the work being done in the state. AIDS bar undertakings have been undertaken by a huge figure of administrations from local community groups to spiritual administrations and giver financed international NGOs. A 1997 survey found that more than 1020 groups or bureaus were involved in HIV/AIDS control activities in Uganda, with 60 per cent of these being non-governmental groups ( p7 International Relations 15 ) . This of class is non without possible jobs and clangs of involvements.
As Parkhurst suggests: “with the diverseness of these groups comes besides a broad diverseness of attacks and bar messages that are heard by Ugandans, depending on where they live and who is runing at that place. Indeed, many groups are based at the local degree and orient their messages to specific population groups such as adult females or children” ( p77 International Relations 15 ) .There is of class a great diverseness within the Ugandan population and different groups will accommodate AIDS bar messages to act upon these groups. For a spiritual household adult male for illustration, a message of fidelity from a priest may be the most successful signifier of influence, whilst a successful man of affairs may pay more attending to warnings about personal wellness hazards. What is apparent is that the greater the diverseness in the range of messages being delivered, the greater is the opportunity of cardinal messages making all sectors of the population.
Diversity of attack is clearly one of the most successful elements of both authorities and NGO policy in Uganda.The authorities has worked hard to suit the many NGOs working in the state. Again this is clearly a reasonable line to take – as de Waal concludes: “state imposed control of HIV/AIDS in Africa is hard – province capacity does non be and international givers are non keen….the HIV/AIDS pandemic has unfolded at a clip when the dominant attack to societal action in Africa has been an NGO model” ( p16 African Affairs 102 ) . Uganda’s authorities has created a political environment that is friendlier to NGOs than in other provinces and this in bend has made it easier for NGOs to acquire undertakings underway. Similarly, the authorities has non tried to any great extent to enforce schemes or policies on the NGOs, leting the variegation of attack that has proved successful.
On one manus a group may be speaking of fidelity to spouses and sexual abstention, whilst another NGO is forcing for the societal selling of rubbers. Again, it should be stressed that the broad scope of NGOs allows a battalion of attacks that can be culturally appropriate for different sectors of the population. Equally long as all parties are allowed to be heard, this is all right.The support that comes form NGOs is critical. Finance for AIDS/HIV undertakings can come from a figure of beginnings – bilateral and many-sided givers, international charities and spiritual administrations.
Both authorities and NGOs benefit from these contributions and as Parkhurst argues, this input of finance into Uganda is important: “as seen in many developing states, Uganda has non been able to fund or implement a degree of public service which would cover the full population, but in the instance of HIV/AIDS, the province has seized upon the attending the disease has received internationally and has worked to ease a state of affairs whereby a much larger proportion of the public hears messages of HIV bar than the authorities could hold achieved entirely due to capacity constraints” ( p79 International Relations 15 ) .One of the most successful enterprises affecting NGOs has been that of the debut of antiretroviral intervention into the Masaka territory of Uganda by the Uganda Cares enterprise, a partnership made up from the attempts of the Ministry of Health, The Ugandan Business Coalition on HIV/AIDS and the international AIDSs Healthcare foundation Global Immunity. The enterprise, highlighted in the 2004 WHO World Health Report, notes that TASO group for the territory is besides located at the same infirmary premises and has helped with bar, attention and intervention through: initial choice based on in agreement standards, reding and referral of campaigners ; follow up of patients at place and at community degree, therefore understating patient bead out from the intervention programme ; organizing conveyance to clinic assignments for those excessively sick to do their ain agreements and ; nutritionary support for those necessitating such. ( p56, World Health Report 2004 )As a consequence of these attempts – once more the multisectoral attack – , the intervention programme has reported a 97 per cent attachment after one twelvemonth of operation ( p58 World Health Report 2004 ) .TASO has in fact been one of the most effectual NGOs working in Uganda. Formed by Noerine Kaleeba who had seen her hubby become ailment with the disease in the UK in 1986, TASO provides guidance, instruction, nursing and medical attention every bit good as some stuff aid to people with AIDS and their households. The administration tries to utilize people who have HIV or are sick as workers instead than entirely as donees and operates a policy of promoting people to populate positively with AIDS. Kaleeba’s experience in the UK has been critical in the preparation of the TASO’s scheme and whilst it has taken some experimentation to associate the UK experience with Ugandan civilization, it has developed into a critical and well-established grass roots administration.
Barnett and Blaikie write of TASO: “ the of import rules it Teachs are those of populating positively with the disease and its deductions and besides that people with AIDS or who are HIV positive do non therefore become removed from society: they remain an of import portion of it, able to execute their functions as carers and manufacturers. They can and make assist themselves and each other ; they can and make go on as valuable and valued subscribers to their society” ( p158, Barnett and Blaikie 1992 ) .There are a figure of factors that have contributed to TASO’s success including:
- Active support from authorities – politically, financially and morally. Government infirmaries have traditionally hosted and worked with TASO territory offices
- Ongoing support from cardinal givers
- Provision of incorporate bundles of services. This allows TASO to be a convenient one halt Centre for those necessitating services
- A committed and difficult working human resource base –many of these are people who have HIV/AIDS
- Collaboration and networking with other HIV/AIDS service suppliers. For illustration, over 90 per cent of TASO clients have undergone HIV proving with a spouse administration.
TASO itself would be unable to supply the full spectrum of HIV/AIDS services. ( www.tasouganda.
Numerous other NGOs of changing size and degrees of influence have operated within Uganda, once more it should be stressed with the general cooperation of the authorities. UNAIDS, the UN programme on AIDS has worked closely with the authorities on instruction and bar programmes and the World Health Organisation has been involved in a great trade of the aggregation of informations on prevalence degrees. UNAIDS has besides overseen a pilot undertaking on the proviso of antiretroviral medicine, easing the development of the necessary substructure to administrate the drugs. The major hinderance to the distribution of this intervention in Uganda has been the cost of the drugs. National and planetary protagonism for a decrease in the monetary value of these drugs resulted in an addition in the figure of patients on the pilot from 1200 in 1996 to 5000 in 2001 ( UNAIDS Report 2002 ) . The authorities, in cooperation with UNAIDS is go oning to aim capacity development for this intervention at regional degree whilst escalating lobbying attempts for monetary value decrease.
Other international NGOs have campaigned on issues such as women’s rights which can complect with HIV issues – for illustration Human Rights Watch has launched a run associating the issue of domestic force in Uganda with HIV/AIDS.A figure of other smaller private NGOs and faith-based administrations have besides made great parts to the attention of people populating with HIV/AIDS through the proviso of incorporate services for attention and proviso. This can affect intervention, ongoing societal and religious guidance, home-based attention to alleviate the force per unit area of Ugandan infirmaries and proviso of recognition installations and fiscal aid for income generating activities for affected household members, particularly orphaned kids. The AIDS Support Organisation has been involved in the formation of post-HIV trial nines at many of the service Centres and provides a great trade of societal support to people with HIV/AIDS.
It maintains a cardinal function in both bar and support activities in the community and serves as an first-class illustration of an expeditiously working NGO, developing and implementing policies that make a echt difference to the lives of those in Uganda populating with HIV/AIDS and assist towards awareness, instruction and bar.Chapter Five – EvaluationUganda’s policies towards HIV/AIDS are seen as a success and there is a wealth of statistical grounds to back up this. It is seen as one of the few African states where rates of HIV infection have really declined. The United Nations in fact has held up Uganda as an illustration of a state that has dealt aptly with HIV/AIDS saying “Uganda’s history of a strong national committedness to awareness and wellness publicity about HIV/AIDS resulted in an mean 18 per cent diminution in the prevalence rate in the 1980s to its current stagnancy around 6 per cent ( www.unaids.org ) . In add-on, it is of import to understand that one of the major accomplishments of the Ugandan authorities has been in its regular monitoring of the epidemic. It has been Uganda’s ability to supervise the HIV/AIDS state of affairs from early on that has enabled it to develop policies rapidly plenty to stem the flow of the disease in the 1990s.
Its Ministry of Health has been praised for its early constitution of surveillance sites that have kept important records of HIV prevalence amongst adult females go toing prenatal clinics. For illustration, the 1999 study from the Ministry of Health’s AIDS Control Programme has been able to show informations bespeaking a autumn in prevalence rates throughout the 1990s when deriving information on the spread of the disease was important. One of the most noteworthy illustrations of success was at the Mbarara monitoring site, where a HIV prevalence rate of 30.2 per cent in 1992 dropped to 10.
9 per cent in 1998 ( p70 International Affairs 15 ) .In measuring the statistics coming out of Uganda, it is of import first of all to understand some of the basic nomenclature used. Many of the figures quoted refer to either HIV prevalence or HIV incidence and there is an of import differentiation between the two. Incidence is fundamentally the figure of new instances of HIV in a population over a certain period of clip. Peoples who were already infected before that clip are non included in the incidence figure, even if they remain alive.
HIV prevalence on the other manus is a figure given as a per centum of a population – by and large assessed against one peculiar group of population. A prevalence of over 10 per cent is by and large seen to bespeak an highly serious job ( www.avert.org ) Incidence is by and large understood to be the more relevant of the two figures – a society demoing regular worsening incidence figures is one which will be sing less and less new infections, something that is desirable and that suggests that the disease is being brought under control.Health statistics for Uganda in the 1980s were of concern, even disregarding the AIDS/HIV epidemic.
For illustration in 1989 for every 1000 unrecorded births, 101 died in the first twelvemonth and another 88 did non populate to the age of five ( p13, Barnett and Blaikie, AIDS in Africa 1992 ) The first national study in Uganda to measure the impact of AIDS was carried out in 1988 and discovered that the mean prevalence rate across the state was 9 per cent.By 1991, prevalence rates peaked, making 15 per cent for the population as a whole and, harmonizing to UNAIDS estimations, making 21 per cent for pregnant adult females between the ages of 15 and 24 ( www.avert.
org ) . This figure was peculiarly distressing, foremost due to the infections probably in kids born and, as mentioned antecedently, the effects that such rates could hold in making a gender instability.Uganda was heading towards an unmanageable crisis in the late eightiess but this appears to hold been averted. Government policies can be linked to the downward spiral in prevalence following the degrees reached in 1991. The multisectoral attack to both turn toing the epidemic and organizing a response to it saw a lessening in prevalence between adult females in the same age group between 1991 and 1993. A battalion of Government sections – agribusiness, Justice, Internal Affairs worked together to set up AIDS Control Programme Units and borrowed $ 50 million from the World Bank which, with $ 25 million from other givers was ploughed into the constitution of the Sexually Transmitted Diseases Project.
Another successful attack has been multisectoral attempts to increase rubber use amongst adolescents carried out by the authorities with fiscal aid from USAID. As a consequence of these attempts, more adolescent misss reported rubber usage than any other age group ; a fact reflected in falling infection rates among 13-19 twelvemonth old misss in Masaka. Another encouraging statistic from the wellness instruction programmes carried out within the same undertaking was the fact that amongst 15 twelvemonth old male childs and misss, the proportion who had yet to gave sex rose from 20 per cent to 50 per cent between 1989 and 1955 ( www.who.inf )The World Health Organisation ( WHO ) has praised the policies that have been implemented in Uganda and provided grounds to back up claims of success. Noting that whilst the rate of new infections continues to lift in many parts of Sub-Saharan Africa, WHO figures show that since 1993, HIV infection rates amongst pregnant adult females, a cardinal index in tracking the epidemic have been more than halved in some parts of Uganda and infection rates among work forces seeking intervention for sexually transmitted diseases dropped by over a 3rd ( www.
who.inf ) . Besides in Kampala, the Ugandan capital, HIV infection among pregnant adult females go toing prenatal clinic from 31 per cent to 14 per cent between 1993 and 1998 whilst outside of the capital, infection rates for adult females under the age of 20 reduced from 21 per cent in 1990 to 8 per cent in 1998. The WHO makes small secret of its thoughts as to where the recognition for these impressive figures is due:“Success in cut downing the prevalence of HIV in Uganda is the consequence of a broad-based national attempt backed up by steadfast political committedness, including the personal engagement of the caput of province, President Yoweri Museveni. From the beginning, the authorities involved spiritual and traditional leaders, community groups, NGOs, and all sectors, hammering a consensus around the demand to incorporate the intensifying spread of HIV and supply attention and support for those affected ( www.who.inf ) .There are a figure of more general grounds as to why Uganda’s response to HIV/AIDS has been mostly effectual.
The ABC attack has been a major component of policy – foremost promoting sexual Abstinence until matrimony ; reding people who are sexually active to Be faithful to spouses and avoid multiple spouses ; and ever utilizing a Condom. The Abstinence/Be faithful/Condom attack has been helped by a figure of other factors.First of all is communicating.
From President Museveni downwards, there has been a honestness and openness about HIV/AIDS since 1986. The cardinal messages have been communicated by the authorities, by NGOs and by word of oral cavity by the population. Avert.org right states “Ugandan people have themselves to thank, in portion, for the decrease in HIV prevalence” ( www.avert.
org ) . A great trade of bar work in Uganda has been done at grass roots degree, people who have HIV have actively contributed to community instruction and bar programmes, there has been a great trade of successful work done in interrupting down the stigma around HIV/AIDS and as a consequence, there is now a high degree of AIDS consciousness among the people.Fear of AIDS, every bit much as consciousness has been a factor in commanding the disease. A 1995 survey showed that 91.5 per cent of Ugandan work forces and 86.4 per cent of adult females knew person who was HIV positive and that word of oral cavity was the primary manner of go throughing on information about bar ( www.
avert.org ) . The graduated table of decease as the epidemic reached its extremum has been a factor in altering behaviour – many small towns were sing several deceases a month, houses were being left empty and grandparents were being left to look after orphaned kids.
However, whilst abstention and fidelity have been one of the cardinal points of policy in Uganda, and whilst there is some grounds of a alteration in behavior there remains much to be done. The most common agencies of transmittal remains unprotected sex ( 84 per centum ) with an septic individual ( World Health Authority, Situation Analysis Document 2002 ) . Married work forces in peculiar remain far more likely to hold excess matrimonial personal businesss than their spouses. In 12 months prior to a 2002 study, 12 per cent of married work forces had one or more spouse other than their partner or cohabiting spouse, with 20 per cent of work forces between 15 and 30 in urban countries being involved in adulterous partnerships. ( p34 STD/HIV/AIDS Surveillance Report, Ugandan Ministry of Health 2002 ) .A figure of other cardinal policies in Uganda from all countries have besides shown pleasing consequences. A UAC study in 2002 praised the impact of the mass information and instruction programs that had been in topographic point since 1986 to give the population cardinal messages on exposure and bar of transmittal to let informed decision-making.
The study found that consciousness is now at 99.7 per cent and cognition at 78 per cent of the general population. In add-on, there has been an addition in the figure of sexually active people utilizing rubbers in the recent yesteryear, a decrease in the figure of sexual spouses and a little addition in the average scope of first sex.
There has besides been an impressive overall betterment in the direction of STDs across Uganda. ( UAC study, HIV and AIDS in Uganda, The Epidemic and the Response 2002 ) .The personalizing the hazard of infection through voluntary guidance and testing has besides proved a utile method of conveying about alterations in behavior, attitudes and purposes that would be necessary to extinguish or cut down single hazard of exposure to HIV. Such voluntary guidance services have been successfully pioneered by one of Uganda’s primary NGOs, the AIDS Information Centre since 1990. Up to half a million people have attended such guidance and there are programs to spread out the programme to all countries of the state.
The impact of antiretroviral intervention besides appears to be positive from consequences to day of the month. A survey on the bar of female parent to child transmittal utilizing this type of medicine revealed positive consequences to the extent of a decrease of 30-50 per cent transmittal ( UAC Report 2002 ) . Although limited ab initio to some of the major infirmaries, there are now programs to spread out this across the state. Whilst the cost of the intervention is falling, it is still prohibitory for developing states. The UN has reported that around six million people in developing states will decease in the following two old ages if they do non have antiretroviral intervention ( UN study 2004 ) .
Uganda needs to guarantee that its advancement to day of the month is non hampered by a failure to supply the intervention that is turn outing the most effectual.There should besides be a note of cautiousness around the statistics that come out of Uganda. The broad scope of administrations runing within the state and the troubles that can halter research – for illustration the jobs garnering informations in countries of struggle – mean that information may non ever be wholly accurate. For illustration, in 2004 the NGO National Guidance and Empowerment Network issues a study claiming that HIV prevalence in Uganda was really 17 per cent, more than three times the official rate recorded ( www.avert.
org ) . Whilst most experts agree that this peculiar survey was inaccurate, many admitted that the HIV job in Uganda might really be worse than the official statistics convey. It is besides of import non to take all talk of the success in Uganda at face value. The state of affairs remains terrible and non every policy can be seen as a success. Parkhurst argues that “the belief that ‘Uganda has seen diminutions in HIV rates from 30 per cent to 10 per cent’ is a statement wholly excessively common, both in the media every bit good as wellness policy literature” ( p70 International Affairs 15 ) and this is true.
Painting excessively positive a image of the state of affairs in Uganda is non merely inaccurate but leaves future authoritiess prone to complacence or a misplaced belief that the disease has been defeated.Much of the statistical information quoted about the success of policies in Uganda is from prevalence rates, frequently of pregnant adult females at urban sites. This is a less revealing step than that of incidence rates that give a more realistic image of new infections and how the disease is distributing over a period of clip.
Unfortunately because of the logistical troubles of garnering incidence informations, there is really small of this information available in Uganda.Parkhurst besides suggests that there may be a important clip component to the informations on Ugandan HIV prevalence that may present prejudice. Much of the information focuses on younger adult females who tend to be more sexually active, more likely to go septic and more likely to go pregnant. Prenatal surveillance so, is more likely to overrate infection in the early old ages of the epidemic while immature adult females with HIV are still healthy and sexually active ( p71 International Affairs 15 ) . In ulterior old ages in contrast, infection rates may be underestimated as the unwellness progresses and these adult females are less likely to fall pregnant. A lifting HIV prevalence, so falling rates at a ulterior day of the month could both be exaggerated due to this prejudice.
UNAIDS has stated “this switching prejudice could in portion explain ascertained decreases in Ugandan HIV prevalence” ( p71 International Affairs 15 ) .Uganda can surely take recognition for policies that have seen a diminution in prevalence rates. There may stay some difference over the truth of some figures but at the terminal of 2003, both the authorities and the UN province that merely 4.1 per cent of grownups had the virus ( www.avert.
org ) . The state is seen by the remainder of the universe as holding implemented a timely and successful instruction run, something that has been a success in its ain right and has besides seen Uganda set up itself as a donee of the assistance that the US is plowing into Africa to contend AIDS.An overall rating of HIV/AIDS policies in Uganda would propose that many of the policies have been thoughtfully designed and efficaciously implemented. There are of class a figure of lessons that that have been learnt. First of all, political support and committedness from the highest degrees of leading are indispensable for strong and sustainable action. This has been the instance in Uganda and President Musenevi and his authorities must be given recognition for this.
Policy shapers need to understand that different communities have different values and must plan schemes applicable to the local and/or spiritual values that different groups of people may hold. This has been done for the most portion in Uganda, with many instruction programmes being targeted at groups with different life styles. It is of import nevertheless that the turning influence of religion based groups do non develop into a state of affairs where spiritual beliefs are ordering policy and NGOs are trying to present a message or a life style that the certain groups of the population will reject.The value of the engagement of the general population, of religion based groups and of people populating with HIV in bar and consciousness undertakings nevertheless remains priceless.
Their direct engagement with the community is one of the elements that make policy in Uganda work. The mobilization of all available attempts and resources has been important in contending the epidemic before it became unwieldy. Again, this is an country where Uganda has fared better than many other provinces.
Finally, the two cardinal facets of policy, and once more two countries in which Uganda can function as an illustration to others. HIV/AIDS can non be beaten or even controlled by one sector entirely. The conjunct attempt of authorities, NGOs and other sectors are an absolute necessity for policies to win.
Uganda has mostly managed this. HIV/AIDS besides has no regard of national boundary lines. Uganda, with its unfastened attack to the job has non been excessively proud to seek aid from elsewhere. Successful execution of policy can merely be achieved through combined attempts at national, regional and planetary degrees.Chapter Six – The Future for UgandaUganda’s greatest challenge is to keep the downward tendency in HIV infection rates that it has managed since the 1980s extremum. Future alterations in authorities or renewed struggle are conjectural dangers to the advancement made but there are other challenges that face Uganda along with every other African state, and so states across the Earth.
The UN planetary study on AIDS produced in 2004 inside informations a figure of issues that will be relevant to Uganda in the old ages in front. One of the most relevant points is that AIDS remains a planetary epidemic. It does non esteem national boundaries and the planetary community must go on to work together. The study provinces: “Today we are faced with life and decease picks. Without major action, the planetary epidemic will go on to surpass the response.
But there is an alternate: ’ together we can hammer the policies grounded in scientific discipline, non in political rhetoric, and embark boldly on the ‘Next Agenda’ – an docket for future action based on advanced approaches” ( p3 UN Report on the planetary AIDS epidemic 2004 ) .One of the great dangers to the continued success of the battle against AIDS in Uganda would look to be the dislocation of the diverse attack as peculiar groups, most probably spiritual, effort to monopolize the bar messages being communicated. During the summer of 2005 the Ugandan authorities stood accused of blockading the distribution of 1000000s of rubbers whilst prophesying a more difficult line attack that abstention is the best attack for bar ( Uganda’s AIDS programme faces crisis, The Guardian August 29, 2005 ) . This type of stance would look to be influenced by USAid, the US Development Agency that is acute to advance the virtuousnesss of matrimony and fidelity. Jodi Jacobson, the executive manager of the US force per unit area group Centre for Health and Gender Equity has criticised the US led line, saying “the crisis in Uganda has been created by the actions – and inaction – of the authorities of Uganda and the Bush disposal, the primary giver for HIV/AIDS programmes in Uganda, and a major force in sabotaging effectual HIV bar programmes throughout sub-Saharan Africa and cardinal America” ( The Guardian, August 29, 2005 ) .There is farther grounds that spiritual conservativists are establishing a conjunct onslaught on rubber publicity – at the Asian and Pacific Population Conference in 2002 “US functionaries demanded the omission of a mention to ‘consistent rubber use’ to contend HIV/AIDS and other STDs and issues an official statement that because ‘condoms are merely non 100 per cent effectual ( the United States Government ) promotes abstention for the single and fidelity for those who are married as its primary STD strategy” ( p555 Schoepf, Uganda: lessons for AIDS control in Africa, Review of African Political Economy 2003 ) . Other statements against rubber usage have been used to send on a conservative docket. Edward Green, a adviser to USAid has argued that rubbers are disliked by Ugandans and are a western, technological solution, unsuitably exported to Africa that will be of small benefit.
There is small concrete grounds to back up these claims nevertheless and a more sound statement about the values of abstention can be found with Sophie Wacase-Monico, a former manager of TASO: “I am profoundly concerned when I hear people taking a individual component of our successful national plan – for case abstention – out of context and impute all our accomplishments to that one component. They must all be implemented together in order for bar to work” ( p555, African Review of Political Economy 2003 ) .Surely, the publicity of rubber usage in Uganda has been important in salvaging lives and must go on to be a cardinal dogma of policy. Marriage and fidelity may good be cardinal to some spiritual religions, but simple human failing combined with other worlds of life such as harlotry, the subservience of adult females in Ugandan society and the on-going troubles in altering sexual behavior mean that rubbers are a necessity in Uganda.
Another possible trouble for the Ugandan authorities would be any loss of assurance in its ability to pull off the fundss of HIV/AIDS programmes. Again in 2005, a figure of funding administrations have pulled out support from programmes in Uganda because of such concerns and the Global Fund for AIDS has called for the Ugandan ministry of wellness that manages the support to be disbanded. ( The Guardian, August 29, 2005 ) .The on-going struggle in parts of Uganda with the Godheads Resistance Army ( LRA ) is another issue that may go on to impact on Uganda’s effort to command HIV/AIDS in the hereafter. The Joint UN Programme on AIDS ( UNAIDS ) has warned that military struggle necessarily brings economic and societal break including “the forced motion of refugees and internally displaced individuals, and ensuing in a loss of supports, separation of households, prostration of wellness services and dramatically increased instances of colza and harlotry. All this creates conditions for the rapid spread of HIV and other infective diseases” ( Fourie & A ; Schonteich 2001 ) . HIV has an immediate impact on civilian populations during struggle due to the high degrees of sexual interaction between military and civilian populations, either through commercial sex or colza as an instrument of war.
Refugee populations in peculiar – many of who are individual adult females or unaccompanied kids – are peculiarly at hazard of being pressured into holding sex or being raped. Exchanging sex for nutrient or money can be commonplace in cantonments and adult females are six times more likely to contract HIV in a refugee cantonment than adult females outside in the general population ( Fourie & A ; Schonteich 2001 ) .In Uganda itself, LRA Rebels have abducted up to 20,000 kids at the bosom of the struggle in Northern Uganda – about 20 per cent of these are misss who will be forced into matrimonies or given to senior commanding officers as a signifier of wages. Of kids who successfully escape from this type of state of affairs, around 50 per cent have HIV. Among kids who have been held for longer, this figure rises to 85 per cent ( www.
avert.org ) .The rates of infection amongst Rebels themselves and those still held confined are unknown – something that may falsify national figures. HIV prevalence amongst the LRA military personnel is though to be high and this in bend causes concern as there have been many studies of mass-rapes and consider HIV infection against civilian populations.The volatile state of affairs in the North of Uganda makes consciousness and bar work really hard and as a consequence the Gulu state in the North has perchance the highest prevalence of AIDS, with rates of those in the LRA, the ground forces and displaced people higher than those really recorded. Again instruction suffers because of the struggle and with merely around a 3rd of immature people inscribing in school, many do non have equal sexual instruction. There is besides an acute deficiency of rubbers and healthcare proviso in the countries of struggle.
As a consequence, alleviation administrations in the country do non hold the resources to concentrate on HIV/AIDS bar – they are concentrating on covering with the immediate effects of the struggle and supplying exigency medical assistance and nutrient. Making advancement into HIV/AIDS consciousness and bar in countries of struggle must be one of the precedences for future policy devising in Uganda.HIV/AIDS besides has the possible to act upon the long-run political stableness of Uganda. A US national Intelligence Council Report concluded that there is a definite nexus between epidemics on the graduated table of HIV/AIDS and political instability. Some of the report’s cardinal determination can surely be applied to Uganda:
- The impact of HIV/AIDS is likely to worsen and even provoke societal atomization and political polarization in the hardest hit states in the underdeveloped universe.
( The ongoing struggle in Uganda gives some grounds of this )
- The relationship between disease and political instability is indirect but existent. Infant mortality, which is likely to more than double in a figure of African provinces before 2010, correlates strongly with political instability, peculiarly in states that have achieved a degree of democratization
- The terrible societal and economic impact of HIV/AIDS along with the spread of the epidemic into governing political and military elites and in-between categories of developing states are likely to escalate the battle for power in order to procure control of scarce resources. This hampers the development of a civil society and other elements of democracy and will increase force per unit area on democratic passages across Africa ( Fourie & A ; Schonteich 2001 ) .
AIDS may besides go a Se