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AIDS Policy in Uganda : Evidence, Ideology, and the Making of an African Success Story - John Kinsman

AIDS Policy in Uganda

Evidence, Ideology, and the Making of an African Success Story

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Published: 18th October 2010
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This book presents a comprehensive history of Africa's best-known AIDS "success story," from the start of the epidemic in the early 1980s up until 2005. It focuses on the various ways in which evidence and ideology have contributed to AIDS policy in Uganda, and it places the development of the country's innovative prevention and treatment strategies into the context of international, national, and local processes. Through this, John Kinsman shows how the country became an important influence in defining global AIDS control strategies.

'Groundbreaking. Intrigued by what could actually have guided AIDS control in Uganda, the author investigated a flagship research which was set up in the early days of the epidemic to guide policy. The lesson the book teaches us all is that for a socially and sexually determined epidemic such as HIV/AIDS, the linkages in collaboration, cooperation and investment of resources must be multilevel: at global, institutional, patient-doctor and individual patient levels.' Sam Agatre Okuonzi, The Independent



'AIDS Policy in Uganda is well written, about an important topic, and contains observations and criticisms that deserve broad discussion.' American Anthropologist



'An accessible and compelling story of evidence and AIDS . . . Beautifully written and argued.' Gill Walt, Professor Emeritus of International Health Policy, London School of Hygiene and Tropical Medicine



'John Kinsman brings a health educator's and anthropologist's perspective to examining the AIDS policy process in Uganda. His unique insights make fascinating reading and suggest how important it is for policy advisers to understand the context, influences, and personalities of decision makers in addition to the scientific factors. This very readable book has much to teach those who advise on health policy issues.' Dr Richard Laing, Department of Essential Medicines and Pharmaceutical Policies, World Health Organization, Geneva, Switzerland



'This book is written with great sensibility to Ugandan culture. Using a political-economy approach, it shows that HIV/AIDS in Uganda is not purely a medical problem, but one that is anchored in multiple economic and structural contexts, globally, nationally and locally. The book will appeal to a wide audience and make an important contribution to the field of medical anthropology, especially as it pertains to international health policy, the social history of AIDS, and social epidemiology.' Professor Charles B. Rwabukwali, Department of Sociology, Makerere University, Kampala, Uganda

List of Figures and Tablesp. xi
Acknowledgmentsp. xiii
Map of Ugandap. xv
Acronyms and Abbreviationsp. xvii
Introductionp. 1
A Call to Armsp. 1
The Primacy of Politics of Science?p. 3
Methodological Issuesp. 7
The Anthropologist as Both Actor and Observer: Conflicting Roles?p. 13
Outline of the Bookp. 15
Key Themes and Conceptsp. 17
Introductionp. 17
(i) The Multilevel Perspectivep. 18
(ii) The Construction, Nature, and Use of Evidencep. 23
(iii) Linking Evidence with Policy and Practicep. 29
Evidence-based policy makingp. 30
A model of the policy processp. 33
Advocacy and policyp. 37
Accepting the Unacceptable: Establishing a National Response to AIDS in Ugandap. 41
Introductionp. 41
Uganda's War against All Diseases-and against Tanzaniap. 42
Kasensero-Epicenter of a Pandemicp. 45
Atypical Kaposi's Sarcoma-The First Scientific Evidence of AIDSp. 48
Reports from Rakai and Confusion over Etiologyp. 50
A Trip to Masaka-Recognition and Denialp. 53
The Tide Turns: Official Acceptance of AIDS, and the Establishment of the National AIDS Control Programmep. 58
Discussionp. 62
Working on a Hunch: A History of HIV Prevention in Ugandap. 67
Introductionp. 67
Three Key Concepts: Abstinence, Faithfulness, and Condom Usep. 69
(i) 1986 to 1992-A Homegrown Approach to HIV Preventionp. 71
An open AIDS policyp. 71
Education-a vaccine for AIDSp. 72
The role of the Catholic Church in Masakap. 75
A change in strategy-quiet condom promotion beginsp. 78
The role of research in developing Uganda's early HIV prevention policyp. 79
(ii) 1992 to 2002-The Rise of the Condomp. 84
Condoms, controversy, and the growth of Uganda's AIDS industryp. 84
Epidemiological developmentsp. 88
Did research contribute to Uganda's falling HIV infection rates?p. 90
(iii) 2002 to 2005-Money, Politics, and Mud PEPFAR and the retrospective birth of ABCp. 93
What really caused the fall in HIV incidence and prevalence?p. 97
A changing condom policy in Uganda: Under pressure from the United States?p. 99
Discussionp. 103
Overcoming Resistance: Big Men and the Scale-Up of Antiretroviral Therapy Provisionp. 109
Introductionp. 109
Toward ART Provision in Uganda (1987-2001)p. 110
Doubts about Global ART Scale-Upp. 116
(i) The risk to HIV preventionp. 118
(ii) The risk of generating drug-resistant virusp. 120
(iii) Doubts over ART program sustainabilityp. 121
Engines of Change: The Big Men of International Politics and Financep. 123
What Was the Role of Research?p. 127
Scale-Up in Ugandap. 129
Uganda Cares-The Birth of an ART Providerp. 132
Discussionp. 138
The Masaka Intervention Trial: A Case Study in the Interpretation of Complex Research Findingsp. 143
Introductionp. 143
"How Can We Reduce New HIV Infections?" The Mwanza, Rakai, and Masaka Trialsp. 144
The Masaka Intervention Trial-Findingsp. 151
The Masaka Intervention Trial-Responses and Interpretationsp. 155
International levelp. 160
National levelp. 160
Local levelp. 162
Discussionp. 167
What Has Guided AIDS Control Policy in Uganda?p. 173
Introductionp. 173
The Myth of Evidence-Based Policy Makingp. 174
Ideological Context and Pragmatic Choicesp. 180
Appendix: Multilevel Timeline of Key Eventsp. 187
Notesp. 195
Referencesp. 205
Indexp. 227
Table of Contents provided by Ingram. All Rights Reserved.

ISBN: 9780230104280
ISBN-10: 0230104282
Audience: Professional
Format: Hardcover
Language: English
Number Of Pages: 240
Published: 18th October 2010
Publisher: Palgrave Macmillan
Country of Publication: GB
Dimensions (cm): 21.59 x 13.97  x 1.91
Weight (kg): 0.39
Edition Number: 1