A Global Disease and Its Governance: HIV/AIDS in Sub-Saharan Africa and the Agency of NGOs

Abstract

This article provides a theoretical assessment of the agency attributed to nongovernmental organizations (NGOs) within the emerging international governance of HIV/AIDS. The analysis, which focuses on the pandemic in sub-Saharan Africa, responds to the question of how effectively NGOs are able to function in policy interventions in the long term. It looks at the nature of the emerging governance system and the role it attributes to NGOs, then raises questions for this system by looking at the operational characteristics of NGOs in context. In conclusion, it suggests that although NGOs have been important actors in this field, they do not have the sort of agency required for sustainable long-term policy interventions in the HIV/AIDS context. KEYWORDS: HIV/AIDS, Africa, agency, NGOs, governmentality. ********** The HIV/AIDS epidemic is a catastrophic phenomenon--one of the most devastating ever--that has and will continue to impact people's lives in sub-Saharan Africa. In 2005, approximately 29 million people are living with the disease in the region. In 2002, 3.5 million people contracted HIV. (1) The epidemic, generalized largely in eastern and southern Africa, influences all aspects of society. The problem has been given importance in international development and aid policy agendas for most of the last ten years. Although international policymakers believe that the intervention mechanisms in place are providing correct channels for policy interventions, they have recognized lack of funding as one of the most important challenges they are facing in scaling up these existing mechanisms to deal with the more generalized disease. In this, taken as a part of the existing intervention mechanisms, civil society organizations--nongovernmental organizations (NGOs)--have been at the center of the international policy interventions for the HIV/AIDS pandemic in the region. Therefore, it is timely at this juncture, when many countries are pledging new HIV/AIDS-targeted funds, most of which will be channeled through the existing mechanisms, to ask the following questions: how efficient is the role played by these organizational forms, (2) and do they have the agency to bring about long-term sustainable change to deal with the HIV/AIDS pandemic? It opens up an important problem in the field, namely the agency required to positively address people's needs. By examining this problem, the distinction between claimed and actual agency of NGOs can be scrutinized. In this article, I argue that this international system, or governance system, not only manages but also constitutes the agency of certain actors and relevant domains of policy. This is done according to a particular domain of governance whereby people with the disease are constructed in a manner independent of their everyday lives, allowing them to be governed in a particular domain, that of international HIV/AIDS policy produced by certain languages and technologies. The overall analysis is based on the outcomes of my ongoing research on the impact of international policy on HIV/AIDS in sub-Saharan Africa conducted in the last three years in Uganda, Zambia, Botswana, and Rwanda. The article is a theoretical look at the issues; the empirical claims related to this debate are analyzed in depth elsewhere. The first part articulates the conceptual concerns of the present study by looking at the idea of agency and governance. The second part examines the context of governance and articulates the peculiarities of the system in relation to the international policy environment on HIV/AIDS. This section points out those issues that exacerbate the disjuncture between the policy context and the needs expressed by the infected and affected. This is followed by a section that locates NGOs within this system whereby they have become the main actors in the implementation of policies on the ground. The following part looks at the characteristics of NGOs as civil society actors. …