Paper short abstract:

In policy approaches to HIV in Africa, the choices made by individuals have a dominant role.However such approaches disregard the wide range of structural factors that affect HIV risk, instead suggesting a de-politicized agenda that ignores power and inequality.

Paper long abstract:

Using empirical evidence from a range of studies and disciplines drawn from East and Southern Africa, this paper discusses the way that policy on HIV envisages 'choice'. In public policy approaches to HIV risk in African countries, the choices made by individuals have a dominant role: over the number of partners, over the choice to use condoms. However, the choice-theoretic approaches disregard the wide range of structural factors that affect HIV risk. These have been well-documented in epidemiological and anthropological studies, and range from the factors that determine the political economy of intimacy (following the work of Hunter) and the political economy of affliction (following the work of O'Laughlin). More importantly the choice theoretic approach suggests a de-politicized agenda,where HIV risk is seen as arising from the supposedly aberrant decisions of individuals. Policy makers are increasingly seeing to influence these 'choices' through cash transfer programmes, such as in Malawi, Zambia and South Africa. However, it is not clear that such approaches will have long-run impacts. More generally, there is clear evidence that sexual norms and health risks are deeply affected by wider economic, social and political factors that lie outside a focus on individual choice.