No abstract

Notwithstanding the massive social and economic disruptions caused by HIV/AIDS in many sub-Saharan countries, the epidemic does not pose a serious political threat to African governments. Based on an analysis of today's dominant aetiologic framing of HIV/AIDS in sub-Saharan Africa, this paper argues that the behaviour-centred explanatory approach contributes to the political domestication of the epidemic. The behavioural aetiology suffers from a double reductionism: It concentrates on sexual transmission only and, within sexual transmission, it focuses exclusively on the immediate cause of transmission (unprotected sex), omitting that biological co-factors increase populations' vulnerability to infection. By overlooking these non-behaviour-related determinants of sexual HIV transmission, this explanatory approach implicitly blames individual behaviours for the spread of the virus. Conversely, the likely underestimation (if not the outright denial) of iatrogenic HIV transmission exonerates governments and donor agencies. The variable political resonance of different explanatory approaches is not random and the translation of the available bio-medical and epidemiological evidence into prevention measures is politically mediated.

No abstract

By affecting the lives and survival of numerous people, global health initiatives deeply alter local landscapes of inequality. They tackle some conditions at the origin of ill health while leaving others untouched, and they inevitably generate new inequalities. Yet, despite their inherently conflictual nature, global health players often minimize the political dimension of their interventions. Taking international AIDS control efforts in Tanzania as an example, this contribution discusses some modalities -and political causes -of the structural neglect of conflict in global health discourse and practice. It analyses how African HIV epidemics continue to be framed and managed in ways that obscure both the health inequalities at their origin, and those that result from efforts to control them. AIDS policy makers conceal inequalities by framing the epidemic as a problem of individual sexual behaviour, and by implicitly rationing access to HIV-prevention and -treatment services. Furthermore, the imposition of disease hierarchies set by international fora excludes broader health-related allocation decisions from domestic democratic debate. Drawing on a theoretical consideration of depoliticization as artificial deconflictualization, the article concludes by calling for a more open acknowledgement of conflict in global health policy making, and explores some analytical and practical implications of such a re-politicization of public health.The author would like to thank the anonymous reviewers, as well as Bridget O'Laughlin and Sébastien Le Pipec for their very helpful comments. All remaining flaws are, of course, my responsibility alone. Development and Change 47(4): 798-817.