ABSTRACT
The global crisis of the HIV/AIDS epidemic has been met with an unprecedented level of financial, political and personal commitment to address its spread, help those living with the disease, and address its roots in socioeconomic poverty. This commitment comes with new forms of coordination and cooperation in approaching the dual problem of articulating what works, and how we approach the sensitivities of other people’s sex lives in the context of shifts within the global political economy. The complexities surrounding the spread and impact of HIV/AIDS require a multifaceted approach to address this problem. Central to this approach is a structured form of governance regime that constitutes the global response to HIV/AIDS, and how to make this regime made up of multiple actors with different interests and approaches, accountable to people living with and affected by HIV/AIDS. Commonly associated with effective means of service delivery and the lea-
dership of governments, governance has been increasingly recognised as a central component in effectively realising an end to the impact and spread of HIV/AIDS. With the plethora of actors, regulations, and norms associated with means of responding to the epidemic, notions of governance, who is governing whom and for what purpose, have become blurred. Governments are still of paramount importance to tackling the epidemic in any particular country, and are thus central to any conception of governance in this regard. Yet, the emergence of civil society organisations (CSOs) – from small community groups to international advocacy organisations, private-public partnerships, informal networks, multilateral and bilateral donors, United Nations agencies and regional bodies challenges preconceived notions of governance as influence upon decision-making, agenda-setting and service delivery. Confusion as to who is doing what, who is influencing whom, and who is governing what amid structures of economic and social inequalities exists, at every level of the HIV/AIDS response, undermining any form of cohesion and cooperation in the face of this global crisis. These challenges lead to the crux of the problem within HIV/AIDS governance: participation and accountability. The multiple actors involved within the response to HIV/AIDS suggest that
widespread participation is not a significant issue. What is unclear, however, is
what is meant by participation, who is participating and why they participate, and the outcome of this. Questions remain as to what claims to legitimacy these actors have, how legitimacy is fashioned within HIV/AIDS governance and the impact this is having on the disaggregated forms of alternative participation. Conceptions of legitimacy are bounded within mechanisms of accountability, and whether one infers the other. Accountability and structures of accountability have come to mean different things for different actors within the response. Accountability has become a tool of governance, in regards to who is able to hold whom to account, which actors remain unaccountable and why, and the gaps that exist in measuring accountability. Problems with accountability and participation have been central to the agenda of international organisations, governments, and donors within the HIV/ AIDS response, but in practice these concepts are narrowly understood and thus unequally applied. These bodies demand structures of accountability and participation from those working in the field of HIV/AIDS and those infected with and/or affected by the disease; but they fail to reciprocate such levels of accountability and participation. As such, perceptions of what governance means in regards to HIV/AIDS remains problematic both in theory and, crucially, in practice. This book unravels some of these issues, and confronts what we mean when
we talk about participation, accountability and governance in regards to every aspect of the HIV/AIDS response. It does so by drawing on the work of public health specialists, political scientists, economists, lawyers, those working with community groups and within international organisations, to offer different and revealing perspectives as to what governance means in regards to HIV/AIDS and ‘the response’. The eight central chapters of the book provide a snapshot of the multiplicity of actors involved within the response, problems of accountability and partnership, and empirical evidence as to how these problems unravel in practice. As such, the book addresses four pertinent areas of HIV/AIDS governance:
(i) role of the state and democratic governance; (ii) non-state actors, popular participation and mechanisms of accountable
governance; (iii) partnerships: public-private, formal and informal Networks; and (iv) global governance and multisectoralism.
