P013


Governing AIDS through aid to civil society: power, responsibilization and resistance 
Convenors:
Maj-Lis Follér (University of Gothenburg)
Håkan Thörn (University of Gothenburg)
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Location:
C2.01
Start time:
27 June, 2013 at 11:30 (UTC+0)
Session slots:
3

Short Abstract:

The aim of this panel is to analyse how civil society in Africa is influenced by the enormous inflow of foreign HIV/AIDS aid and by the various modes of governance that comes with the new funding schemes.

Long Abstract

In the last decade there has been a huge influx of resources to manage the HIV/AIDS epidemic worldwide. Although there are indications that this trend is soon to be reversed due to the global economic downturn the increased availability of funds have so far had profound impact on the landscape of HIV/AIDS work in Africa. One effect has been that substantial amounts of aid money are now being channelled to and through local civil society organisations. Hence, civil society now appears to be recognized by both international donors and African governments as important partners in the HIV/AIDS response, including prevention, impact mitigation and treatment. The aim of this panel is to analyse and critically discuss how local civil society is influenced by the enormous inflow of foreign aid and by the various modes of governance that comes with the new funding schemes. How do these modalities of government affect the rationalities and everyday practices of civil society organizations and to what extent is it possible for the organizations to negotiate or resist them? We are particularly interested in critical papers that discuss how power is articulated, reproduced, resisted and/or transcended in the relationships between international donors and local civil society actors involved in HIV/AIDS work on the African continent.

Accepted papers:

Author:

Maj-Lis Follér (University of Gothenburg)

Paper short abstract:

This paper presents a case study of a broken relationship between a donor and a recipient NGO in Mozambique. The termination of the contract can be looked upon as an act of (de)-responsibilization.

Paper long abstract:

This paper presents a case study of a broken relationship between a donor and a recipient AIDS NGO. The contract was terminated by the donor. Questions that will be explored are: Why was the contract terminated and could it have been handled in another way? What did the donor want to achieve with the termination? The closure of the contract resulted in that the national NGO had to finish most of their activities with the communities, member CBOs and PLWHA. What does 'social responsibility' mean and what does responsibilization and de-responsibilization stand for in this specific case? Mozambique's is a highly aid dependent country and the politics of AIDS is formulated in a policy document (PEN III), created together with the main donors in a Partner Forum (PF). The aid discourse embraces that the recipients require professional guidance from the outside. Most donors emphasize the will to strengthen civil society and stress the importance of responsibility and ownership. They also highlight that partnership relations should be marked by reciprocal respect and trust - so that the receiver feels self-respect. The way the donor in this case, governed the termination of the contract can be looked upon as an act of responsibilization/de-responsibilization.

Author:

Christoph Haug (University of Gothenburg)

Paper short abstract:

By examining the practice of exchanging funds for reports in development cooperation, this paper argues that the technologies of results based management serve to shield the comfort zone of the global north from the stories of suffering and their moral imperative.

Paper long abstract:

Donor agencies legitimize their existence by producing activity reports which show that they are making a difference. Evidence needs to be produced that links the donor to the results achieved by its partner organizations. Such evidence usually comes in the form of reports which the partners are obliged to deliver before they receive the next slice of funding.

The present paper examines this practice of exchanging funds for reports, asking how it affects the relationship between the development partners. The focus of the analysis is on the construction of agency in the interactions between donor and recipient. Given the donor's dependence on reported results, how can the donor claim agency? Given the dependence of local organizations on resources from the donor, how can they claim agency? And to what extent is it possible for both partners to claim agency for the results of their collaboration?

Based on a case study from HIV/AIDS work in South Africa, the analysis finds that the negotiation of agency takes place in two conflicting languages: the language of results and the language of grievances. The paper argues that a significant source of donor power lies in their ability to structure the communication between the partners by defining reporting templates that are result oriented and thereby frustrate attempts of grievances-related storytelling. Given the preposterous scope of human suffering in poor communities, the language and technologies of results based management serve to shield the comfort-zone of the global north from these heartbreaking realities and their moral imperative.

Author:

Bent Steenberg Olsen (Roskilde University)

Paper short abstract:

How and why ordinary Mozambican HIV/AIDS patients are influenced by a shift in the modality of the governance of AIDS treatment through an aggravation of AIDS stigma in local communities.

Paper long abstract:

The dawn of Mozambique's AIDS treatment era came as late as 2002, at which point in time the provision of antiretroviral drugs (ARVs) through national sub-Saharan health sectors was thought of as largely unfeasible. Quasi-autonomous medical organisations thus pioneered in the field of AIDS treatment through so-called Day Hospitals caring solely for the HIV+. In 2008, however, shifts occurred in global health discourse and major international actors are now warm proponents of an on-going health care reform: a decentralisation of AIDS treatment services in which AIDS care is integrated within public health sectors, thus out-phasing medical NGOs previously charged with this task. A decentralisation of AIDS care services, it is assumed, will have several beneficial effects for AIDS patients, chiefly due to a closer proximity of these services to local communities. Contrariwise, however, new ethnographic data from extensive fieldwork following this process in Mozambican AIDS treatment facilities paradoxically suggest that these policies are in fact producing the exact opposite of their alleged beneficial effects due to an inadvertent aggravation of AIDS stigma through public exposure and increased visibility of the HIV+ in local communities. From the point of view of ordinary patients, present paper analyses the significance of an aggravation of AIDS stigma for three specific programme components. I argue that despite the intentions of policymakers, decentralisation and AIDS stigma result in increased transport costs for patients; in decreased patient retention in care; in unpredictable and uncertain patterns of patient uptake; and, consequently, in increased rates of treatment abandonment.

Author:

Håkan Thörn (University of Gothenburg)

Paper short abstract:

This paper discusses three ‘theoretical families’ - global governance, neo-imperialism and governmentality - in relation to a AIDS development cooperation in sub-Saharan Africa. It is argued that the complexity of power relations requires theoretical synthesis.

Paper long abstract:

In the social sciences, the concept of political power has most often, explicitly or implicitly, referred to the nation state as the most important unit of analysis. Responding to the latest phase of economic, cultural and political globalization however, a number of attempts have recently been made to re-conceptualise power as a transnational, or even global, phenomenon. This paper discusses three theoretical families that in different ways represent such attempts: global governance theories, emphasizing the emergence of self-organized policy networks across borders; neo-imperialist theories, which argue that aid politics in the 2000s has implied a return of bilateral aid and that the US, as the dominant state, has used aid to legitimize its foreign policy in a manner resembling 'the civilising mission' of classical cultural imperialism; and theories of global governmentality, arguing that political power is exercised through regulations that emphasize responsibilization through 'self-regulation', market-mechanisms, and civil society participation. These three theories are in the paper 'tested' in relation to a case study of international aid interventions in sub-Saharan Africa; more specifically aid to civil society in Rwanda, Mozambique and South Africa. It is argued that since relations of power in the context of international aid have become increasingly complex, and none of the three theories discussed can grasp this complexity, there is a need for theoretical synthesis

Author:

Andreas Wagner (University of Hildesheim)

Paper short abstract:

This paper argues that external aid increases the workload of civil society groups. This can finally lead to negotiations over ownership between donors and civil society groups, in which the later are especially able to request for specific inputs within the logical frame of the projects.

Paper long abstract:

Civil society organizations play a vital role in the response to HIV and AIDS in sub-Saharan Africa. The focus of this paper is on the effects of foreign aid and resulting negotiation processes in development cooperation. The results are based on a qualitative research and consultancy of a cooperation program between a large international child-welfare organization and local community groups aiming to provide social support to orphans and vulnerable children. The data was collected through participant observation in meetings, 22 key informant interviews and 66 focus group discussions with community initiative members and beneficiaries, NGO staff and government representatives in Ethiopia, Kenya, Mozambique, Uganda and Zambia.

The study findings indicate that inputs of the international NGO have various impacts on CBOs, including an additional workload through monitoring and reporting requirements. These additional tasks might not directly benefit the cause of the CBOs and result in a low feeling of ownership of the projects, which can be illustrated by passive resistance, e.g. through slowing down processes, or even retreat from the common project by reducing their own inputs and requests for payment. Since the NGO wants the CBOs to continue with their work, this can lead to negotiations over project ownership, in which the CBOs can demand an adjustment of reporting requirements to make them more suitable to their way of support. CBOs can further refer to and demand promised support or even request additional inputs from the NGO, as long as the requested resources fulfill the donor's internal project logic.

Author:

Beniamin Knutsson (University of Gothenburg)

Paper short abstract:

This paper critically scrutinizes the rationalities and the political economy that permeate - externally supported - government initiatives promoting the establishment of cooperatives for people living with HIV/AIDS in Rwanda.

Paper long abstract:

Impact mitigation is, alongside prevention and treatment, a prioritized area in Rwanda's National Strategic Plan for HIV/AIDS (NSP). Recognizing that people living with HIV/AIDS (PLWHA) suffers from discrimination and that improved access to ARV treatment will enable them to lead longer and economically productive lives the NSP sets out to 'foster a culture of entrepreneurship' among this vulnerable group. Accordingly the Government of Rwanda, backed up by financial assistance from the Global Fund, has launched an ambitious program supporting the establishment of cooperatives for PLWHA. Once established the members of the cooperative are provided with business training and access to credit. The aim of this paper is to critically scrutinize the rationalities of government and political economy that permeates these government interventions. Two lines of argument will be explored. First, it will be argued that the Rwandan context illustrates how small-scale cooperatives, commonly associated with grass-root initiatives in civil society, have largely become a product of government intervention. Moreover, that the notion of 'the cooperative' has been appropriated only to reemerge in its neoliberal form. Second, the paper will argue that the government of cooperatives for PLWHA entails a strong element of responsibilization. Provided with ARV treatment, training, and credit, PLWHA are rendered responsible to lead economically productive lives and to rise out of poverty by exposing themselves to economic risk. Hence, somewhat paradoxically, government of HIV/AIDS in Rwanda simultaneously discourages and encourages vulnerable people to expose themselves to risk.

Author:

Deborah Johnston (SOAS)

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.

Author:

Louise Mubanda Rasmussen (Roskilde University)

Paper short abstract:

Based on ethnographic research with organisations providing help to “Orphans and Vulnerable Children” in Malawi, this paper discusses how donors, international and local NGOs, and CBOs all participate in keeping alive "the fiction of sustainability’, each for their different reasons.

Paper long abstract:

International funding for HIV/AIDS interventions has played a major role in the massive NGO growth Malawi has experienced since its democratic transition in the mid-1990s (Morfit 2010). Foreign funders channel funding towards 'civil society organisations' based on a neo-liberal logic that 'empowering' communities will ensure that initiatives 'really take root' and therefore eventually can continue without donor funding. But what if these organisations are primarily formed for the purpose of accessing donor funds? And what if the organisations that are most 'successful' are those who are best at maintaining and attracting new donor funding? Despite this contradiction, various actors in the HIV/AIDS field continuously invoke the doctrine of sustainability (Swidler & Watkins) as the remedy for problems such as 'donor dependency' and 'high turn-over' among volunteers.

Based on five months ethnographic research with organisations providing help to "Orphans and Vulnerable Children" in Malawi, this paper discusses how donors, international and local NGOs, and CBOs all participate in keeping alive 'the fiction of sustainability', each for their different reasons. Rather than overt resistance to the power of international donors, the processes I discuss reflect how actors from their different positions become skilled in using established policy models and available resources for their own ends.

Author:

Cynthia Bailly (Université Alassane Ouattara Côte d'Ivoire)

Paper short abstract:

This research looks at the governance in the fight against AIDS in the Northern Côte d'Ivoire as a political terrain where state , and non state actors struggle for legitimacy and positioning.

Paper long abstract:

In the governance of public policies, the socio-political crisis in September 2002 contributed to reduced functional capacity of state structures due to the closure of some structures and the departure of much of the State staff on one hand. On the other hand, the crisis has led to multiple opportunities. In the fight against AIDS, the socio-political crisis has led many opportunities because of the increased funding and other resources, and thus encouraged the emergence of non-state actors interacting in large numbers. Indeed, these actors from diverse origins compete within projects and deploy a number of strategies to capture the available resources. The research looks at the local governance in the fight against AIDS in the Northern Côte d'Ivoire as a political terrain where state, and non state actors struggle for power, legitimacy and positioning. The purpose of this paper is to present the different stakeholders interacting in the arena of fight against AIDS, and analyze the power relationship existing between them. This analysis will be done by identifying the strategies and the resources the actors use for their own positioning.

Author:

Noemi Steuer (University of Basel, Switzerland)

Paper short abstract:

The influx of international funds to fight AIDS in Mali created a situation of harsh claiming practices between diverse civil society actors. Drawing on Bourdieus concept of social fields and based on an exemplary case the presentation analyses different methods of local governance and power articulation.

Paper long abstract:

With beginning of 2004 enormous amounts of international funds, mainly from the primary donor Global Fund, were spent to fight HIV/AIDS in Mali. Since the sums of foreign aid were regularly communicated through the media, they did not only create a strong link between the disease and money in the local perceptions, but they also generate an incentive for all kind of civil society actors to claim a share in this domain. Everywhere in the country, but especially in Bamako, newly funded associations sprang up competing with already established ones for the available resources. Those organizations which could incorporate people living with HIV/AIDS had the best chances for grants. To wide extent AIDS gained the reputation of a very lucrative and flourishing market: "It feeds more people than it kills", was a common saying in Bamako.

During a long-term ethnographic field research (2003-2010), I could observe the high dynamics characterizing the rapidly expanding AIDS sector. Drawing on Bourdieus concept of social fields where diverse actors struggle for their interests, my presentation will elaborate and analyse different but intertwined media-staged conflicts between one of the principal beneficiary of the Global Fund and two rivalling associations of HIV-positive people. The results deliver revealing insights in local modes of governance and power articulation. Moreover, the exemplary case points to political practices which fuelled the recent military coup in Mali and led finally to the present-day crisis.

Author:

Carolina De Rosis (EHESS-CEAf)

Paper short abstract:

This paper critically discusses the dynamics of participation of some Ethiopian traditional self-help associations and the resistance of others to the project Home and Community Palliative Care for HIV-Positive People in Gondar, under the sponsorship of Family Health International (FHI).

Paper long abstract:

Since the beginning of 2000s we have observed a significant increase in global funding for health and new forms of partnership between civil society, international organizations and private foundations - transcending in a first instance the nation-state. Such financial support is basically due to the inflow of aid for vertical programs fighting against infectious diseases like tuberculosis, malaria and more particularly HIV/AIDS. However, the level of financial aid and other resources that have been invested in HIV/AIDS mass treatment programs have stirred debate among scholars (England 2007; 2008; Forman 2011; Moatti 2011). This paper argues that the implementation of epidemic management policies have strongly contributed to the formation of the state (Berman & Lonsdale 1992) in terms of "governmentality" (Foucault 1978). The fighting strategies against HIV/AIDS have triggered the formation of a public and social sphere of action in which different actors articulated the functions and powers of the state in different ways.

We analyze the project set up by a coalition of different self-help associations under the sponsorship of FHI in Gondar by taking into consideration the complex context of various local and international actors involved in the fight against HIV/AIDS. We highlight particularly how the participation of some self-help associations (əddər, sänbäte), and the resistance of others (ǧäm'əya) to the project, are subjected to their links and forms of cooperation already existing within the city's administrative structure.