Government Structurs and Behavior Change in the Politics of HIV/AIDS

Abstract

During the past decades, the worldwide spread of the human immuno-deficiency virus (HIV) has created one of the deadliest epidemics in human history. Despite widely available bio-medical knowledge about how to prevent transmission of the virus, and technologies and resources to treat people living with HIV/AIDS, the disease continues to spread, and especially in sub-Saharan Africa. However, despite the general precarious situation in sub-Saharan Africa, there is in fact great variation among African states as regards HIV prevalence. This paper builds a framework for increasing our understanding of the sources of this variation. More specifically, we argue that HIV/AIDS is a different kind of problem than other diseases in the sense that effective prevention demands sacrifices on the behalf of individuals that are costly in both material and non-material terms. The failure to recognize these costs makes standard solutions, such as for example increased access to medication, expanded funds, and health sector reforms, potentially ineffective. With the point of departure in the costs and individual sacrifices demanded for the successful combating of HIV/AIDS, this paper suggests that future research on HIV/AIDS would benefit from exploring the impact of varying institutional arrangements such as for example the degree to which state power is centralized or decentralized on HIV/AIDS outcomes. Institutions have commonly been argued to shape and constrain individual behavior. Yet, their impact on sexual behavior and behavior change remains largely unexplored.