International political economy of HIV/AIDS prevention: Lessons from Sierra Leone and Uganda.

摘要

HIV/AIDS continues to devastate Sub-Saharan Africa. An estimated 25 million adults and children are living with HIV in sub-Saharan Africa. An estimated 2.2 million people die from AIDS every year. The epidemic has created some twelve million orphans. Sub-Saharan Africa has been disproportionately affected by the scourge of HIV/AIDS. While industrialized nations have comparatively successfully controlled the spread of the disease, Sub-Saharan African countries with the exception of Uganda and Senegal, are yet to make any significant gains in the fight against the pandemic. Such phenomenon has raised a lot of questions about the spread of the disease and its prevention. In turn, these questions led to a lot of theories; most suggesting sexual behavioral patterns of Africans and lack of governmental response to the pandemic. Others approached the explanation of the spread of the disease from a political economy perspective, linking the World Bank and the International Monetary Fund, the structural adjustment as a contributing factor.;Given the debates that ensued from the above explanations, this study sets out to investigate the relationship between the powers of international financial institutions to influence HIV/AIDS policy implementation two Sub-Saharan countries-Sierra Leone and Uganda. These two countries are important in this investigation due to the fact that both are post-conflict countries; vulnerable to intervention from major powers and one (Uganda) has been largely successful in curbing the spread of the disease. The rational of the study emanates from the fact that I believe to curb the spread of the disease, a country must not only have sound overall health policies, but it should also have the ability to implement those policies.;As a result, this study combines analysis of grand international relations theories (e.g. world systems, regime) with public policy. Theoretically I argue that Sierra Leone and Uganda being part of the World System are in a position that renders them less capable to HIV/AIDS prevention in their countries. I also argue international financial regimes instituted by powerful international financial institutions influence the implementation process of HIV/AIDS policies in the two countries. These regimes make policy recommendations to the governments and these recommendations are to be adhered to most times if the country is to receive any funding for its HIV/AIDS prevention project. As a result of the lack of capacity to implement HIV/AIDS policies in the two countries is also related to loss of agency to identify problems, formulate policies and/or implement those policies. This situation creates constraints in policy implementation in Sierra Leone and Uganda.;The study suggests public policy recommendations to reduce the HIV/AIDS pandemic in Africa need to be inclusive of several levels of analysis, international, national and local. Often, recommendations have been directed only to the central government or mainly, to local private non-governmental organizations. Policy suggestions offered in this study include but not limited to regionalization, allowing global health governance to be handled by the global professional body-the World Health Organization. In addition, Sierra Leone and Uganda are encouraged to seek alternative ways of raising funds for their HIV/AIDS prevention programs. Seeking alternative source of funding may give them the flexibility to operate outside the International Monetary Fund and World Bank's recommended parameters.