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Between 2002 and 2013 bilateral donors spent over $64 billion on AIDS intervention in low- and middle-income countries. During the same period, nearly 25 million people died of AIDS and more than 32 million were newly infected with HIV. In this book for students of political economy and public policy in Africa, as well as of global health, Kim Yi Dionne tries to understand why AIDS interventions in Africa often fail. The fight against AIDS requires the coordination of multiple actors across borders and levels of governance in highly affected countries, and these actors can be the primary sources of the problem. -- From inside cover.

In this book, France's leading medical anthropologist takes on one of the most tragic stories of the global AIDS crisis—the failure of the ANC government to stem the tide of the AIDS epidemic in South Africa. Didier Fassin traces the deep roots of the AIDS crisis to apartheid and, before that, to the colonial period.

Critics of liberalism in Europe and North America argue that a stress on 'rights talk' and identity politics has led to fragmentation, individualisation and depoliticisation. But are these developments really signs of 'the end of politics'? In the post-colonial, post-apartheid, neo-liberal new South Africa poor and marginalised citizens continue to struggle for land, housing and health care. They must respond to uncertainty and radical contingencies on a daily basis. This requires multiple strategies, an engaged, practised citizenship, one that links the daily struggle to well organised mobilisation around claiming rights. Robins argues for the continued importance of NGOs, social movements and other 'civil society' actors in creating new forms of citizenship and democracy. He goes beyond the sanitised prescriptions of 'good governance' so often touted by development agencies. Instead he argues for a complex, hybrid and ambiguous relationship between civil society and the state, where new negotiations around citizenship emerge. Steven L. Robins is Professor of Social Anthropology in the University of Stellenbosch and editor of Limits to Liberation after Apartheid (James Currey).

In the years since the end of apartheid, South Africans have enjoyed a progressive constitution, considerable access to social services for the poor and sick, and a booming economy that has made their nation into one of the wealthiest on the continent. At the same time, South Africa experiences extremely unequal income distribution, and its citizens suffer the highest prevalence of HIV in the world. As Archbishop Desmond Tutu has noted, \"AIDS is South Africa's new apartheid.\" In Ancestors and Antiretrovirals, Claire Laurier Decoteau backs up Tutu's assertion with powerful arguments about how this came to pass. Decoteau traces the historical shifts in health policy after apartheid and describes their effects, detailing, in particular, the changing relationship between biomedical and indigenous health care, both at the national and the local level. Decoteau tells this story from the perspective of those living with and dying from AIDS in Johannesburg's squatter camps. At the same time, she exposes the complex and often contradictory ways that the South African government has failed to balance the demands of neoliberal capital with the considerable health needs of its population.

How resources are being used to fund the community response to human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) is of considerable interest to the donor community and governments. In the past decade, international funding for the HIV and AIDS response provided by governments rose from about US

This groundbreaking work, with its unique anthropological approach, sheds new light on a central conundrum surrounding AIDS in Africa. Robert J. Thornton explores why HIV prevalence fell during the 1990s in Uganda despite that country's having one of Africa's highest fertility rates, while during the same period HIV prevalence rose in South Africa, the country with Africa's lowest fertility rate. Thornton finds that culturally and socially determined differences in the structure of sexual networks—rather than changes in individual behavior—were responsible for these radical differences in HIV prevalence. Incorporating such factors as property, mobility, social status, and political authority into our understanding of AIDS transmission, Thornton's analysis also suggests new avenues for fighting the disease worldwide.

AIDS epidemics continue to threaten the livelihoods of millions of people in sub-Saharan Africa. Three decades after the disease was first recognized, the annual death toll from AIDS exceeds that from wars, famine and floods combined. Yet despite millions of dollars of aid and research, there has previously been little detailed on-the-ground analysis of the multifaceted impacts on rural people. Filling that gap, this book brings together recent evidence of AIDS impacts on rural households, livelihoods, and agricultural practice in sub-Saharan Africa. There is particular emphasis on the role of women in affected households, and on the situation of children. The book is unique in presenting micro-level information collected by original empirical research in a range of African countries, and showing how well-grounded conclusions on trends, impacts and local responses can be applied to the design of HIV-responsive policies and programmes. AIDS impacts are more diverse than we previously thought, and local responses more varied - sometimes innovative, sometimes desperate. The book represents a major contribution to our understanding of the impacts of AIDS in the epidemic's heartland, and how these can be managed at different levels.

Despite global malaria programmes already operating within resource constraints, 2025 saw a significant decrease in funding following the US government’s termination of most of its global health programmes, as well as the decline in development aid spending by the UK, France, Germany, Canada, Switzerland, and other countries. The disruption of funding was sudden, with most African countries lacking adequate contingency plans. This, despite most of the malaria burden being in Africa (94% of 263 million cases in 2023), accounting for a reduction in gross domestic product of up to 1.3% annually, and half a billion lost workdays. Key malaria control programme activities have been severely impacted, including insecticide-treated bed net distribution, seasonal malaria chemoprevention campaigns, and malaria indicator surveys. In the wake of the funding cuts, some African governments have committed to increasing efforts to raise funds for malaria programmes from the private sector. The Africa Centres for Disease Control and Prevention (CDC) has developed a strategy for governments to increase health budgets while seeking additional funding from the private sector, all while maintaining transparency and accountability. If recent malaria control gains are to be sustained and to prevent resurgence across the continent, African governments will need to increase domestic funding and build robust public–private partnerships for their malaria programmes. Lessons can be learnt from countries where these partnerships have succeeded or failed. Leadership by the African Union, the Africa CDC, the African Leaders Malaria Alliance, and other regional bodies is crucial to support countries in taking immediate, substantive steps and benchmarking progress.

In the face of the world's disorders, moral concerns have provided a powerful ground for developing international as well as local policies. Didier Fassin draws on case materials from France, South Africa, Venezuela, and Palestine to explore the meaning of humanitarianism in the contexts of immigration and asylum, disease and poverty, disaster and war. He traces and analyzes recent shifts in moral and political discourse and practices — what he terms \"humanitarian reason\"— and shows in vivid examples how humanitarianism is confronted by inequality and violence. Deftly illuminating the tensions and contradictions in humanitarian government, he reveals the ambiguities confronting states and organizations as they struggle to deal with the intolerable. His critique of humanitarian reason, respectful of the participants involved but lucid about the stakes they disregard, offers theoretical and empirical foundations for a political and moral anthropology.

Background Since the advent of democracy, the South African government has been putting charters, policies, strategies and plans in place in an effort to strengthen public health system performance and enhance service delivery. However, public health programme performance and outcomes remained poor while the burden of disease increased. This was also the case in the Free State Province, where major public health system challenges occurred around 2012. Assessment was necessary in order to inform health system strengthening. Methods The study entailed a multi-method situation appraisal utilising information collated in 44 reports generated in 2013 through presentations by unit managers, subdistrict assessments by district clinical specialist teams, and group discussions with district managers, clinic supervisors, primary health care managers and chief executive and clinical officers of hospitals. These data were validated through community and provincial health indabas including non-governmental organisations, councils and academics, as well as unannounced facility visits involving discussions with a wide range of functionaries and patients. The reports were reviewed using the World Health Organization health system building blocks as a priori themes with subsequent identification of emerging subthemes. Data from the different methods employed were triangulated in a causal loop diagram showing the complex interactions between the components of an (in) effective health system. Results The major subthemes or challenges that emerged under each a priori theme included: firstly, under the ‘ service delivery ’ a priori theme, ‘ fragmentation of health services ’ (42 reports); secondly, under the ‘ health workforce ’ a priori theme, ‘ staff shortages ’ (39 reports); thirdly, under the ‘ health financing ’ a priori theme, ‘ financial/cash-flow problems ’ (39 reports); fourthly, under the ‘ leadership and governance ’ a priori theme, ‘ risk to patient care ’ (38 reports); fifthly, under the ‘ medical products/technologies ’ a priori theme, ‘ dysfunctional communication technology ’ (27 reports); and, sixthly, under the ‘ information ’ a priori theme, ‘ poor information management ’ (26 reports). Conclusion The major overall public health system challenges reported by stakeholders involved fragmentation of services, staff shortages and financial/cash-flow problems. In order to effect health systems strengthening there was particularly a need to improve integration and address human and financial deficiencies in this setting.