AIDS Policy in Uganda Evidence, Ideology, and the Making of an African Success Story

by Kinsman, John

• ISBN13: 9780230104280
• ISBN10: 0230104282
• Format: Hardcover
• Copyright: 2010-08-15
• Publisher: Palgrave Macmillan

Summary

This book presents a history of AIDS control in Uganda, from the start of the epidemic in the early 1980s up until 2005. Uganda is well known internationally as an AIDS 'success story', both for its bringing down HIV incidence and prevalence over the 1990s, and for its innovative approach to scaling up the provision of antiretroviral therapy (ART) for people living with AIDS.

Author Biography

John Kinsman is Research Fellow at the Amsterdam School for Social Science Research, The Netherlands.

Table of Contents

List of Figures and Tables	p. xi
Acknowledgments	p. xiii
Map of Uganda	p. xv
Acronyms and Abbreviations	p. xvii
Introduction	p. 1
A Call to Arms	p. 1
The Primacy of Politics of Science?	p. 3
Methodological Issues	p. 7
The Anthropologist as Both Actor and Observer: Conflicting Roles?	p. 13
Outline of the Book	p. 15
Key Themes and Concepts	p. 17
Introduction	p. 17
(i) The Multilevel Perspective	p. 18
(ii) The Construction, Nature, and Use of Evidence	p. 23
(iii) Linking Evidence with Policy and Practice	p. 29
Evidence-based policy making	p. 30
A model of the policy process	p. 33
Advocacy and policy	p. 37
Accepting the Unacceptable: Establishing a National Response to AIDS in Uganda	p. 41
Introduction	p. 41
Uganda's War against All Diseases-and against Tanzania	p. 42
Kasensero-Epicenter of a Pandemic	p. 45
Atypical Kaposi's Sarcoma-The First Scientific Evidence of AIDS	p. 48
Reports from Rakai and Confusion over Etiology	p. 50
A Trip to Masaka-Recognition and Denial	p. 53
The Tide Turns: Official Acceptance of AIDS, and the Establishment of the National AIDS Control Programme	p. 58
Discussion	p. 62
Working on a Hunch: A History of HIV Prevention in Uganda	p. 67
Introduction	p. 67
Three Key Concepts: Abstinence, Faithfulness, and Condom Use	p. 69
(i) 1986 to 1992-A Homegrown Approach to HIV Prevention	p. 71
An open AIDS policy	p. 71
Education-a vaccine for AIDS	p. 72
The role of the Catholic Church in Masaka	p. 75
A change in strategy-quiet condom promotion begins	p. 78
The role of research in developing Uganda's early HIV prevention policy	p. 79
(ii) 1992 to 2002-The Rise of the Condom	p. 84
Condoms, controversy, and the growth of Uganda's AIDS industry	p. 84
Epidemiological developments	p. 88
Did research contribute to Uganda's falling HIV infection rates?	p. 90
(iii) 2002 to 2005-Money, Politics, and Mud PEPFAR and the retrospective birth of ABC	p. 93
What really caused the fall in HIV incidence and prevalence?	p. 97
A changing condom policy in Uganda: Under pressure from the United States?	p. 99
Discussion	p. 103
Overcoming Resistance: Big Men and the Scale-Up of Antiretroviral Therapy Provision	p. 109
Introduction	p. 109
Toward ART Provision in Uganda (1987-2001)	p. 110
Doubts about Global ART Scale-Up	p. 116
(i) The risk to HIV prevention	p. 118
(ii) The risk of generating drug-resistant virus	p. 120
(iii) Doubts over ART program sustainability	p. 121
Engines of Change: The Big Men of International Politics and Finance	p. 123
What Was the Role of Research?	p. 127
Scale-Up in Uganda	p. 129
Uganda Cares-The Birth of an ART Provider	p. 132
Discussion	p. 138
The Masaka Intervention Trial: A Case Study in the Interpretation of Complex Research Findings	p. 143
Introduction	p. 143
"How Can We Reduce New HIV Infections?" The Mwanza, Rakai, and Masaka Trials	p. 144
The Masaka Intervention Trial-Findings	p. 151
The Masaka Intervention Trial-Responses and Interpretations	p. 155
International level	p. 160
National level	p. 160
Local level	p. 162
Discussion	p. 167
What Has Guided AIDS Control Policy in Uganda?	p. 173
Introduction	p. 173
The Myth of Evidence-Based Policy Making	p. 174
Ideological Context and Pragmatic Choices	p. 180
Appendix: Multilevel Timeline of Key Events	p. 187
Notes	p. 195
References	p. 205
Index	p. 227
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