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Africans and aid for AIDS: Do we care what they want?

4 June 2009

Last month, I presented a chapter from my dissertation about local demand for AIDS intervention. The findings are somewhat controversial in that there’s a serious misalignment in policy priorities: we in the West have spent a lot on HIV/AIDS, whereas ordinary Africans have stated preferences prioritizing other public policy problems. The discussion was lively to say the least, and I saw it all as a way to move my work forward. From the paper, here’s a look at how 3,843 rural Malawians ranked five important policy preferences:

Rural Malawians' Policy Priorities

One major issue readers had with the chapter was the complete absence of discussion of stigma surrounding HIV and AIDS. They believed that [at least part of] my finding of low prioritization of HIV/AIDS services could be attributed to stigma attached to the disease. I find this argument would likely ring true in places like India and South Africa, where HIV is highly stigmatized and these divided societies (be it class or race) have histories of in/out-group blame. I think Evan Lieberman’s work on ethnicity and HIV makes a good case for this. At the same time, my own work in Malawi leads me to believe that there’s a lot more talk about stigma in Western circles than there is discussion of shame or blame in the places where people are experiencing the AIDS pandemic firsthand.

Another issue some have taken with the paper strikes me as paternalistic: “but don’t we [Western experts] know better?” I suggest the answer to that is no. We do not live the everyday lives of rural Malawians and even technical expertise has its limits. We have a lot to learn about AIDS, a lot to learn about rural Malawians’ experience with AIDS, and a lot to learn about what works in terms of interventions against AIDS and health and development interventions more generally. Most importantly, we have a lot to learn about ourselves: why do we want to intervene against AIDS, rather than say the less sexy health problem, diarrhea? Sure, malaria has of late become the new “it” intervention, but AIDS has been rather exceptional for at least the past decade. What do we [in the West] get out of focusing on AIDS rather than other problems? Why do we think we know the answers for Africans? And, as some documentary filmmakers succinctly put it, what are we doing here [in Africa]? Do the preferences of intended beneficiaries of our good intentions not matter?

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