SAR, Vol 12 No 2, February 1997
AIDS IN SOUTHERN AFRICA:
5 January 1997
As always, it was with great anticipation that I received your July 1996 issue of SAR [Vol.11, No.4] and found your editorial insightful and your articles challenging. I read with interest the article by Colleen O'Manique ["Liberalizing AIDS in Africa: The World Bank Role"] in which she revealed the increasing influence of the World Bank in shaping the global response to AIDS, a response firmly situated in "the neo-liberal canon, which valorizes the individual, privatization, neo-charity, and cost-recovery, all the while ignoring the social and political contexts fuelling the particular epidemics in Africa."
Although SAR has not carried as many articles on the response to HIV/AIDS in southern Africa as I would like, I have noted that most of the past articles dealt with grassroots education around prevention, community responses, etc. O'Manique's argument casts such approaches in a new light. After considering her critique of the emphasis of HIV/AIDS prevention programmes toward income generation - such that families and individuals become "empowered," so they can "do it for themselves" - we can never again hear about such schemes without hearing a chorus of neo-liberal discourse ringing in our ears: empowerment! self-reliance! fend for yourselves!
And then to read in your editorial that "we hope to specify further with case studies of AIDS in southern African in future issues"! I looked forward to receiving my next issue of SAR and the opportunity to see this discussion evolve further.
When the November 1996 issue of SAR arrived I was immediately pleased to note the inclusion of the aforementioned "case study" as presented by Richard Lee ["AIDS: Conspiracy of Silence"]. But nowhere in this article did I find mention of O'Manique's critique, or even a nod to her arguments. Instead I felt the article slipping back into all too familiar territory.
While Lee does make an important point with regard to the intense stigma still attached to AIDS in southern Africa and "the complicity in levels of government in this conspiracy of silence," I found his understanding of what might constitute a more effective response to the AIDS epidemic lacking ... particularly in light of O'Manique's insights. Lee's conclusion that governments would be better off putting resources into community-based AIDS hospices, housing and job creation, are questionable when one considers O'Manique's point that such actions do not take into account "[s]uch factors as increased labour migration and the separation of households, the high demand for family labour in the face of declining incomes, the growing vulnerability of women ...." As O'Manique notes, empowerment and self-reliance are terms which are steeped in the neo-liberal discourse of "communities fending for themselves." Indeed, Lee does not seem to acknowledge that - in this battle with disease - governments' "resources" are not often theirs to give. The government's function is in overseeing the activities of other donors; the decision about where such funds are to be distributed is not necessarily theirs to make.
I have always welcomed the quality of debate found between the covers of SAR. But on the issue of AIDS/HIV, I believe the debate must evolve somewhat. The arguments made in O'Manique's article must not be lost. I encourage future contributors to challenge their assumptions and to respond to her critique. If there is an alternative, it will only be revealed by grappling with other perspectives.
Myles Sterritt, Vancouver
Myles Sterritt casts me in the role of accomplice because in his view I do not take seriously enough Colleen O'Manique's critique ( SAR July 1996) of the World Bank as villain in exacerbating the African AIDS crisis. I would agree that the World Bank's role in Africa as a whole is an invidious one, but then what? The problem of AIDS remains and Sterritt's critique offers few specifics. Yes, Structural Adjustment Policies have the effect of separating families and driving women further into poverty. Should all existing AIDS programs be put on hold until the World Bank sees the error of its ways?. If the international financial cartel forgave the African debt burden tomorrow would that solve the AIDS problem? Eventually it might, but AIDS workers do not have the luxury of waiting a decade for recovery of African economies from the ravages of SAPs. The issues raised in my article offer more immediate points of purchase for tackling AIDS by addressing policies and behaviours over which the peoples of the region do have some control.
What is most disturbing about Sterritt's view is his dismissal of local empowerment as serving a neo-liberal agenda. By what convoluted logic does one conclude that communities seeking to take their destiny into their own hands are playing into the hands of the oppressors? States in Africa have by-and-large ill-served the needs of their citizens, and disengagement from the state by local communities is a widespread phenomenon. In the absence of strong government programs to meet human needs, self-reliance, local empowerment, and NGO supports are not neo-liberal copouts, they are essential tools of survival. Such local projects offer life-supports to the very women and children made vulnerable by the World Bank policies Sterritt deplores.
I share O'Manique's and Sterritt's conviction that SAPs are a malevolent force in contemporary Africa. But the arguments of Mr. Sterritt seem to come from the rarefied atmosphere of the theorist. Short of the millennium bringing about the transformation of the global system, it would be useful to spell out the practical implications of this insight for the battle against AIDS in southern Africa today.
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