Portal de Periódicos da CAPES

United Against HIV/AIDS? Politics Of Local Governance In HIV/AIDS Treatment In Lusikisiki, South Africa

2010; Taylor & Francis; Volume: 36; Issue: 1 Linguagem: Inglês

10.1080/03057071003607402

1465-3893

Jane Vogt Evensen, Kristian Stokke,

HIV/AIDS Impact and Responses

Abstract South Africa is currently moving from a polarised politicisation of the right to treatment, towards contentions over the implementation of treatment programmes for people living with HIV/AIDS. This article examines the politics of local governance in the Lusikisiki HIV/AIDS programme in the Eastern Cape Province. This is a case where the principal state and civil society actors, the Department of Health (DoH) and the Treatment Action Campaign (TAC), seem to have transcended previous conflicts and entered into partnership facilitated by the international NGO Médecins Sans Frontières (MSF). This article examines the political dynamics associated with the initiation of the Lusikisiki programme, the mobilisation of local communities, and the transition from pilot project to public sector programme for HIV/AIDS treatment. We observe that the programme has been characterised by both co-operation and conflict between the DoH, the TAC and MSF, and that local politics in the Lusikisiki programme are inscribed in a broader multi-scale politics of defining and implementing policies for HIV/AIDS treatment in South Africa. This complex and contentious politics of treatment have produced numerous hurdles for initiating, operating and mainstreaming participatory local governance for HIV/AIDS treatment in Lusikisiki. The sustainability of the Lusikisiki programme seems to depend upon national level policies and directives, especially regarding task shifting and adherence counsellors. Bottlenecks emanating from the national level of government demonstrate the multi-scale character of local governance of HIV/AIDS treatment. Although the politics of local governance is highly contextual, the importance of non-local political dynamics implies that the Lusikisiki programme also provides general lessons for future HIV/AIDS treatment programmes in other localities in South Africa. Notes 1 R. Ballard, A. Habib, I. Valodia and E. Zuern, ‘Introduction: From Anti-Apartheid to Post-Apartheid Social Movements’, in R. Ballard, A. Habib and I. Valodia (eds), Voices of Protest: Social Movements in Post-Apartheid South Africa (Scottsville, University of KwaZulu-Natal Press, 2006), pp. 1–22. P. Jones and K. Stokke (eds.), Democratising Development: The Politics of Socio-Economic Rights in South Africa (Leiden, Martinus Nijhoff, 2005). 2 P. Fourie, The Political Management of HIV and AIDS in South Africa. One Burden too Many? (New York, Palgrave Macmillan, 2006); V. Van der Vliet, ‘South Africa Divided Against AIDS: A Crisis of Leadership’ in K. Kauffman and D. Lindauer (eds), Aids and South Africa: The Social Expression of a Pandemic (New York, Palgrave Macmillan, 2004), pp. 48–96. 3 M. Mbali, ‘HIV/AIDS Policy-Making in Post-Apartheid South Africa’, in J. Daniel, A. Habib and R. Southall (eds), State of the Nation. South Africa 2003–2004 (Cape Town, HSRC Press, 2003), pp. 312–29; N. Nattrass, The Moral Economy of AIDS in South Africa (Cambridge, Cambridge University Press, 2004); P.S. Jones, ‘A Test of Governance: Rights-Based Struggles and the Politics of HIV/AIDS Policy in South Africa’ (2004), available at http://www.humanrights.uio.no/forskning/publ/rn/2004/0104.pdf, retrieved on 14 November 2007; Van der Vliet, ‘South Africa Divided Against AIDS’. 4 P.S. 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Van Blerk, ‘Joining the Conspiracy? Negotiating Ethics and Emotions in Researching (around) AIDS in Southern Africa’, Ethics Place and Environment, 8, 1 (2005), pp. 61–82. 31 A third source of information consisted of various programme documents. Prior to fieldwork, available articles and reports about the programme were examined, and during fieldwork additional documents were requested from the partners of the programme. 32 B. Beresford, ‘Pioneering Treatment Access in a Rural Area of South Africa’, Development Update, 5, 3 (2004), pp. 277–91; S. Robins, ‘ARVs Bring Hope to Pondoland’ (2004), available at http://www.health-e.org.za/news/article.php?uid = 20030948, retrieved on 26 October 2007. 33 Head of MSF in South Africa quoted in IRIN Plus News, ‘South Africa: Lusikisiki – A New Model for ARV Delivery. 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Migdal, ‘State in Society: Studying How States and Societies Transform and Constitute One Another’ (Cambridge, Cambridge University Press, 2001). 45 Interview with adherence counsellor, 5 March 2007. 46 Informal talk with a local woman, 25 January 2007. 47 Habib and Kotzé, ‘Civil Society, Governance and Development’. 48 Interview with a local TAC representative, 24 March 2007. 50 Interview with a TAC representative, 19 March 2007. 49 Robins, ‘Long live Zackie, Long Live: AIDS Activism, Science and Citizenship after Apartheid’. 51 M. Heywood, ‘The Price of Denial’ (2005), available at http://www.tac.org.za/Documents/PriceOfDenial.doc, retrieved on 1 October 2007; Friedman and Mottiar, ‘Seeking the High Ground’. 52 MSF and DoH, ‘Achieving and Sustaining Universal Access to Antiretrovirals in Rural Areas’. 53 S. Robins, ‘ARVs Bring Hope to Pondoland’ (2004), available at http://www.health-e.org.za/news/article.php?uid = 20030948, retrieved on 26 October 2007. 54 H. 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Revision April 2003’ (unpublished, 2003).