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Face of AIDS| Connections Between Political Leadership and Effective Approaches to the AIDS Epidemic in Uganda and South Africa

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Face of AIDS| Connections Between Political Leadership and Effective Approaches to the AIDS Epidemic in Uganda and South Africa University of Montana ScholarWorks at University of Montana Graduate Student Theses, Dissertations, & Professional Papers Graduate School 2003 Face of AIDS| Connections between political leadership and effective approaches to the AIDS epidemic in Uganda and South Africa Tasha R. Keathley The University of Montana Follow this and additional works at: https://scholarworks.umt.edu/etd Let us know how access to this document benefits ou.y Recommended Citation Keathley, Tasha R., "Face of AIDS| Connections between political leadership and effective approaches to the AIDS epidemic in Uganda and South Africa" (2003). Graduate Student Theses, Dissertations, & Professional Papers. 2306. https://scholarworks.umt.edu/etd/2306 This Thesis is brought to you for free and open access by the Graduate School at ScholarWorks at University of Montana. It has been accepted for inclusion in Graduate Student Theses, Dissertations, & Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more information, please contact [email protected]. Maureen and Mike MANSFIELD LIBRARY The University of Montana Permission is granted by the author to reproduce this material in its entirety, provided that this material is used for scholarly purposes and is properly cited in published works and reports. **Please check "Yes" or "No" and provide signature** Yes, I grant permission No, I do not grant permission Author's Signature: /L /ti. Date: & 2^ 0? Any copying for commercial purposes or financial gain may be undertaken only with the author's explicit consent. 8/98 THE FACE OF AIDS: CONNECTIONS BETWEEN POLITICAL LEADERSHIP AND EFFECTIVE APPROACHES TO THE AIDS EPIDEMIC IN UGANDA AND SOUTH AFRICA by Tasha R Keathley B. A. University of Kansas Presented in partial fulfillment of the requirements for the degree of Master of Arts The University of Montana June 2003 Approved by: airperson Dean, Graduate School ^ \zQ>lo-2> Date UMI Number: EP34640 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent on the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. UMT DlMirtnttanPUbMina UMI EP34640 Copyright 2012 by ProQuest LLC. All rights reserved. This edition of the work is protected against unauthorized copying under Title 17, United States Code. uesf ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106 -1346 Keathley, Tasha R. M.A., June 2003 Political Science The Face of AIDS: Connections Between Political Leadership and Effective Approaches to the AIDS Epidemic in Uganda and South Africa Director: Peter Koehn The HIV/AIDS epidemic has devastated sub-Saharan Africa. It affects every aspect of society. Two of the most stricken countries are Uganda and South Africa. How their national governments have responded to, and approached, the AIDS epidemic varies. This thesis asks: does presidential leadership make a difference in HIV/AIDS prevalence? The correlation between presidential leadership and HIV/AIDS is analyzed against the historical background from which each administration rose using Rosberg and Jackson's typology of personal-rule coupled with Gordon's characteristics of an effective and creative leader and the World Health Organization's 1986 recommendation for a plan of action in the African region. Uganda is the most successful HIV/AIDS prevention case in Africa. It is the only country in sub-Saharan Africa where the incidence of HIV/AIDS has decreased. Under President Yoweri Museveni, Uganda became the first African country to acknowledge the seriousness and severity of the ADDS epidemic. Uganda's government vowed to focus its efforts on fighting the disease, and responded actively. Through an autocratic style of leadership, Museveni has embodied Gordon's characteristics and has enabled Uganda to ftilfill WHO's recommendations. In addition to a decrease in HIV/AIDS, condom use has increased substantially among young people. There has also been a subsequent rise in the age of first sexual intercourse and in monogamy. South Afiica is home to the largest population of HTV/AIDS victims on earth. Five million people lived with the disease at the end of 2001. Denial, ministerial wrangling, and the misallocation of resources characterize South Africa's governmental response to the AIDS epidemic under President Mbeki. The result is that the HIV/AIDS epidemic in South Africa is escalating and the population is feeling its demographic and social impact. Utilizing an autocratic leadership style, Mbeki failed to realize Gordon's characteristics or lead South Africa to meet WHO's recommendations. Attitudes about HIV, sex, and condoms have been slow to change in South Africa. There, sexual behavior has remained dangerous and condom use low. HIV prevalence in antenatal clinics continues to rise. Where people have not modified their behavior, rates increase. Lack of strong presidential leadership has meant little change in attitudes about HIV/AIDS among South Afiicans. ii To my dreams come true Derek, Ella, and Liliana; my breath, my light, my life. iii Never before has man had such a capacity to control his own destiny, to end thirst and hunger, to conquer poverty and disease, to banish illiteracy and massive human misery. We have the power to make this the best generation of mankind in the history of the world—or make it the last. John F. Kennedy, 1963 iv CONTENTS Chapter 1. INTRODUCTION History of HIV/AIDS in Sub-Saharan Africa Magnitude of HIV/AIDS Effects of HIV/AIDS In Sub-Saharan Africa African Leadership 2. THE CASE OF UGANDA Overview of Uganda's Recent History History of HIV/AIDS in Uganda Magnitude of HIV/AIDS in Uganda PoHtical Leadership in Uganda Type of Personal-Rule Creative and Effective Leadership who's 1986 Recommendation for a Plan of Action in the African Region Connections Between Political Leadership and Effective Approaches to the AIDS Epidemic in Uganda 3. THE CASE OF SOUTH AFRICA Brief History of South Africa History of HIV/AIDS in South Africa Apartheid Origins Magnitude of HIV/AIDS in South Africa Political Leadership in South Africa Type of Personal-Rule Creative and Effective Leadership who's 1986 Recommendation for a Plan of Action in the African Region Connections Between Political Leadership and Effective Approaches to the AIDS Epidemic in South Africa COMPARISON OF POLITICAL LEADERSHIP AND EFFECTIVE APROACHES TO THE AIDS EPIDEMIC IN UGANDA AND SOUTH AFRICA 87 Presidential Leadership in Uganda and South Africa Results of Presidential Leadership in Uganda and South Africa Leadership and National HIV Prevalence-Rates in Uganda and South Africa Conclusion WORKS CITED 102 VI INTRODUCTION Sub-Saharan Africa has more than two times the number of people living with HIV/AIDS than the rest of the world combined. According to the AIDS Epidemic Update, published in December 2002 by the United Nations Programme on HIV/AIDS (UN AIDS), and the World Health Organization (WHO), 29 4 million of the 42 million people currently living with HIV/AIDS are in sub-Saharan Africa. There, the adult- prevalence rate, the proportion of adults 15 to 49 years of age infected with HIV/AIDS, is currently a staggering 8.8 percent, more than 80 times higher than Australia and New Zealand's adult-prevalence rate of 0 1 percent, and more than 7.33 times the average global adult-prevalence rate of 1.2 percent. In more insular terms, three percent of the world's population, located in what is referred to as the "AIDS Belt," has close to 55 percent of the world's HIV/AIDS cases.' The AIDS Beh extends from the Republic of Congo, through the Central African Republic and Southern Sudan, through Uganda, Kenya, and Tanzania to Malawi, Zambia, Zimbabwe, Botswana, South Africa, and Namibia. In the Belt, monitoring agencies classify HIV infection as generalized, which means that the HIV prevalence rate is at least five percent.^ The HIV/AIDS epidemic has devastated Sub-Saharan Africa, and affects every aspect of society Two of the most affected countries are Uganda and South Africa. How their national governments have responded to the AIDS epidemic varies. 1 This thesis asks: does presidential leadership make a difference in HIV/AIDS prevalence? History of HIV/AIDS in Siib-Saharan Africa The story of the disease known as Acquired Immunodeficiency Syndrome (AIDS) begins in 1979 and 1980, when doctors in the United States observed clusters of extremely rare diseases that occurred because of immunosuppression/ Groups of unusual diseases that had previously been extremely rare in young adults in the West characterized the initial syndrome/ Doctors first recognized AIDS in Los Angeles after five young homosexual men were hospitalized with Pneumocystis carinii (PCP), a type of pneumonia carried by birds/ PCP is often fatal and known to occur only in people with weakened immune systems/ The Centers for Disease Control (CDC) published the first official announcement on June 5, 1981, in its weekly bulletin, the Morbidity and Morality Weekly Report (MMWR) ^ One month later it reported a clustering of twenty-six cases of Kaposi's sarcoma (KS) in New York, adding that doctors identified an additional ten cases of PCP in California, bringing the total since September 1979 to fifteen/ Kaposi's sarcoma is a disfiguring cancer that shows up in purplish or brown blotches that usually appear on the arms and legs, but can appear
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