Principled actors or strategic players? The puzzling practice of international HIV/AIDS resource allocation in Sub-Saharan Africa

Melissa Jean Buehler, Purdue University

Abstract

Globally, over 40 million people were living with HIV/AIDS in 2005, with more than 64 percent living in Sub-Saharan Africa (WHO 2004–2005). Sub-Saharan governments have proven incapable of adequately responding to a crisis of this magnitude due to limited preventative and diagnostic resources, ineffective domestic infrastructures, corruption, and civil unrest. This failure has given rise to greater involvement by international organizations (IOs) in the domestic affairs of states. However, IOs such as the World Health Organization (WHO) and UNAIDS are not allocating HIV/AIDS resources as one might expect. Instead of distributing resources based on need, these principled organizations frequently give more resources to countries with less severe HIV/AIDS problems. Through the application of a mixed methods approach, three logics: geostrategic, civil society, and state capacity, provide the theoretical framework for demonstrating that IOs are, in fact, employing a type of systemized approach that is not based on overall need even though they claim this to be their primary motivation. Ultimately, the three logics present themselves at different times and play a role in WHO and UNAIDS resource allocation process. Understanding how and when these logics appear to be important is key to understanding IO behavior and will provide insight into the conditions that influence HIV/AIDS resource allocation. Overall, the regression analyses support the tenet of the state capacity logic concerning the importance of political, economic, and social stability. The analyses also demonstrate that improvement in human deprivation values is associated with higher target achievement rates. While it is understandable that IOs want to allocate resources to stable states, economic deprivation can often lead to risky sexual behavior (Kalipeni et al 2004). Then why are states with low levels of development not prioritized? After employing statistical and comparative analyses, it is clear that the overall patterns of HIV/AIDS resource distribution do not mirror the ideals. While states such as Botswana and Uganda exceeded national goals, the international community must be mindful of possible "sandbagging" or "beating up" of the data, as well as apparent claims of "success" and criticisms levied against states that fail to meet expectations. Without a clear understanding of UNAIDS decision-making and evaluation processes, including how national plans are devised, judgments should not be made. More importantly, if UNAIDS truly has the best interests of those states battling unimaginable levels of devastation and disease at heart, then transparent mechanisms and methodologies should be promptly implemented. This will not only further our understanding of the effectiveness of HIV/AIDS initiatives, it will simplify the resource allocation and assessment processes. In the end, the establishment of transparent IO mechanisms may even contribute to resource conservation efforts. Given the scarcity of HIV/AIDS resources, this should provide the necessary motivation for IOs to undertake these measures. Failure to do so will only result in further spread of the disease, human suffering and subsequent death.

Degree

Ph.D.

Advisors

Moghadam, Purdue University.

Subject Area

Public health|Political science|Public policy

COinS