Civil Society Leadership in the Struggle for Aids Treatment in South Africa and Uganda

Abstract

This thesis is an attempt to theorise and operationalise empirically the notion of ‘civil society leadership’ in Sub-Saharan Africa. ‘AIDS leadership,’ which is associated with the intergovernmental institutions charged with coordinating the global response to HIV/AIDS, is both undertheorised and highly context-specific. In this study I therefore opt for an inclusive framework that draws on a range of approaches, including the literature on ‘leadership’, institutions, social movements and the ‘network’ perspective on civil society mobilisation.This framework is employed in rich and detailed empirical descriptions (‘thick description’) of civil society mobilisation around AIDS, including contentious AIDS activism, in the key case studies of South Africa and Uganda. South Africa and Uganda are widely considered key examples of poor and good leadership (from national political leaders) respectively, while the Treatment Action Cam- paign (TAC) and The AIDS Support Organisation (TASO) are both seen as highly effective civil society movements. These descriptions emphasise ‘transnational net- works of influence’ in which civil society leaders participated (and at times actively constructed) in order to mobilise both symbolic and material resources aimed at exerting influence at the transnational, national and local levels. They endeav- oured to influence both AIDS policy and the course of the epidemic directly. I conclude that these networks played a key role in the effectiveness of both TAC and TASO.These qualitative case studies are complemented by econometric analyses. At the continental level, I attempt to measure the impact of civil society mobilisation on the performance of national governments through a cross-country regression analysis applied to 42 Sub-Saharan African states. This analysis fails to show a strong relationship between the presence of AIDS NGOs and HAART and PMTCT coverage (controlling for a range of factors) — potentially supporting my hypothesis that civil society mobilisation is only effective in certain circumstances. At the local level, a second set of regression models using household survey data investigates whether TAC’s mobilisation in Cape Town impacted appreciably on HIV prevention efforts. They show a significant relationship between contact with TAC and not endorsing false conspiracy beliefs about AIDS as well as condom use, indicating that TAC’s impact is not restricted to the national policy level.