ABSTRACT
At the centre of the World Bank’s commitment to multi-sectoral interventions into HIV/AIDS is the state. As every HIV/AIDS epidemic around the world has shown, it is impossible to fully address the disease and its impact without the state acknowledging the problem. Similarly, as the Bank’s development orthodoxy has shown, good governance reform cannot work without fully incorporating various parts of the state, most notably the president or prime minister and the Ministry of Finance. Thus, to address HIV/AIDS through a specifi c form of governance reform based on ownership, responsibility, transparency, participation and accountability, interventions must focus a signifi cant amount of funds and initiatives on the infrastructure of state institutions. Within the MAP it is the role of the president, Ministries of Health and the National AIDS Councils (NACs) that are the focus of such reform. These areas of the state in sub-Saharan Africa carry out the following functions in regard to the MAP: co-ordinating the national response, providing leadership and direction in articulating national strategic plans and breaking stigma, and, crucially, engaging with civil society groups. For the Bank, interventions are based on helping states develop their capacity to fully acknowledge and respond to the impact HIV/AIDS is having upon its population. However, as this chapter will show, these state-based interventions have mixed rates of success. The state response is often fraught with problems of capacity, bureaucracy, corruption, confusion and institutional rivalry. Although some of these problems are endemic within specifi c states, the application of multi-sectoralism and the Bank’s governance reform agenda has exacerbated and in some cases created them. The state structures established as part of the MAP and the problems associated with them reveal the contradictions inherent to the application of the Bank’s governance reform agenda and the problem of enacting change and ownership through economic incentive.
