AIDS as a Long-Term Phenomenon

A second explanation for why political normality persists is that we have not seen the worst. AIDS is a long-term phenomenon. Just as the peak of AIDS deaths occurs eight or ten years after the steepest increase in HIV prevalence, so too does the impact of AIDS on the social fabric lag behind even further.

Nonetheless, AIDS is causing a number of visible problems for African governments, both authoritarian and democratic. Kondwani Chirambo has been studying many of the problems facing functioning democracies in an ongoing research project at the University of Cape Town. These problems include the needs to update voters’ rolls more regularly, to ensure that deceased voters are removed, and to construct special voting facilities for the sick and their caretakers. An increased number of by-elections due to more MP deaths puts financial strains on first-past-the-post electoral systems. In African political systems, such strains advantage the incumbent because the ruling party is more capable of finding the resources necessary to mount by-election campaigns. But these are manageable problems, not an overwhelming crisis. It is possible, however, that AIDS-related political problems may get worse. But arguing that no prediction of doom is yet refuted (or indeed refutable) fails to do justice to the intriguing complexity of what is actually going on.

African Government Political Engineering

More significant is the third part of the explanation, which is that African governments are experts at managing multiple crises and even turning them to their advantage. There is rich literature on how regimes of all political complexions have thrived despite famine, crime, unemployment, and all manner of social disasters that would have destroyed the legitimacy of a Western government. Even democratically-elected rulers have little to fear from AIDS. Governments in Zambia and Kenya may be voted out of office, but political crises brought on by AIDS, or by their mishandling of the epidemic, will have little to do with it.

The devastation caused by AIDS—the number of people lost, the trauma, and the impoverishment—is, in some ways, little different from the impacts of misgovernment over the years. Africa’s leaders have learned that disorder can be a political instrument—that where the social and political infrastructure is limited, opposition cannot sustain sufficient organization to unseat a ruler who floats above the turmoil and deprivation. Why should HIV/AIDS be any different?

Uganda’s President Yoweri Museveni has been particularly masterful. He has not only presided over Africa’s first national generalized AIDS epidemic, but also has turned it to his political advantage. Just how and why Uganda managed to turn the corner in reducing HIV prevalence some 10 years before any other country in sub-Saharan Africa remains a mystery. Perhaps it was the unique trajectory of this early and atypical epidemic, which began in the rural areas and spread to the cities, just as a return to peace meant that many urban dwellers were returning to the newly prosperous countryside as schools reopened and agriculture boomed. Quite likely, the national struggle against HIV/AIDS has been strengthened by the efforts of Uganda’s civil leaders, notably singer Philly Lutaaya, who in an act of conspicuous personal courage played his last tour while visibly sick with AIDS, enjoining his audiences to stand together to fight the disease. Newly installed in power at the head of a revolutionary government, professor-turned-guerrilla-turned-president Museveni also led a remarkably energetic administration in his first few years—a characteristic of a liberation movement in power, before it becomes mired in the limitations of a centralist ruling style.

Whatever finally emerges from a full examination of the social epidemiology of AIDS in Uganda (a topic about which the Ugandan government discourages independent analysis), two things are clear; the first is that the Ugandan response and its success pre-dated any significant foreign spending on AIDS in the country. Incidence was reduced while national AIDS expenditures were less than US$10 million in total. Second, Museveni took the credit. Aid donors and public health activists needed an African “success story,” and Uganda was not only Africa’s first one, but for a long time, it was the only one. Cases such as Senegal where public policies had helped prevent an epidemic were, of course, much less visible. The AIDS-response industry needed Uganda, and Museveni needed their money and political endorsement, especially as he had no intention of relinquishing power. Speaking to foreign audiences, the Ugandan president is ready to credit his country’s success in reducing HIV to whatever a particular donor is most interested in promoting. To evangelical Christians, he emphasizes abstinence and fidelity, to AIDS activists, he jokes about the number of condoms his country needs, and to European ministers of development cooperation, he stresses the integrated national AIDS program established by his administration. In return, the world has paid little attention to his government’s single-party rule, military adventurism, and corruption.

Uganda’s AIDS program is, in fact, an expression of Museveni’s left-wing militarism. Like his fresh and radical plans for restructuring provincial governance to help his country emerge from the trauma of genocidal violence under his predecessors, Museveni’s approach to AIDS was refreshingly frank and energetic. As with international audiences, his different policies targeted different groups. In the capital city, he provided a circumscribed liberal space of uncensored newspapers and resurgent university life—and also encouraged condoms. In the rural areas, there was an exercise in tight administration through implementation of a hierarchy of “resistance councils” and puritan moral standards, exemplified in the anti-condom campaigns, some of which were enforced with coercion. The centralized control of the national program in the presidency is less a vision of a comprehensive and coordinated program—Museveni has never in fact signed the most important pieces of legislation developed by his talented health administrators—than a determination to keep personal control of a crucial national asset. The Ugandan AIDS program has as much to do with the president’s ambition to stay in power for life as with “best practice.” AIDS has served Museveni extremely well in his quest for regime stability. Whether his regime in fact warrants the “success story” label is another matter: the last two years of HIV surveillance show that after fifteen years of decline, the incidence of the disease is sharply rising.