Humanitarians across the world are trying their best to solve the HIV puzzle, but their methods have not had success. Humanitarian aid is failing! Epstein uses an anecdote about the “disappearance” of 54 MILLION dollars to make it clear:
Foreign Aid Is An ATM
The Global Fund gave the money to the country of Uganda as part of an HIV “package” that included HIV treatment, condoms, and counseling and testing. However, an auditing firm determined that no one knew where the money was! Similar scandals erupted in Kenya and Nigeria. In Zambia, a permanent secretary of health diverted funds to buy a “cure” for HIV from a businessman in Bulgaria. As a result of widespread corruption, not only have vast amounts of money been squandered, but a sense of good will has been demeaned. Epstein implies that the repercussions are dire for the image of Africans in general, but more importantly, that when the money is there, it isn’t achieving its goals. She writes,
As AIDS spending skyrocketed between 2000 and 2005, the HIV rate did not decline at all…
WHY isn’t the money helping? It’s true that HIV/AIDS funding is needed, and the package isn’t a bad idea! In the book, a young man thanks Epstein when he finds out she’s American because he is taking antiretroviral drugs paid for by PEPFAR. In other words, treatment for those infected is expensive and greatly appreciated. But something is going wrong. Many of the Ugandans worry that the HIV/AIDS money has helped to encourage what they call a “Pajero” culture, referencing the many big white SUVs that have appeared along with the NGOs. This culture represents how HIV/AIDS has become an industry for those in need of careers instead of a horrible disease. This is very clear to me as a student in the school of public health. Many of the students are focused on how they can help build capacity of local networks in Africa to stop the spread of HIV, and some are looking for paid travel experiences that are legitimized as humanitarian work.
However, Epstein believes that the disturbing trend of corruption in Africa is due to “many factors,” and neither the aid industry nor Africans should be blamed. She suggests that people have “grown indifferent” to the spread of AIDS, and that the money has created a “crisis of modernity” in which Africans struggle to transition to a modern bureaucratic state. Though they are transitioning, they still participate in the tribal kinship links that have always comprised their community networks. The kinship networks allow people to rely on each other, and oblige those who have money to help those without. When aid organizations like the Global Fund give money to officials in charge of HIV organizations, they may be contributing to the bureaucratization of the epidemic, thereby losing the human side of the disease. The campaigns that have decreased the incidence and prevalence of HIV were campaigns that counted on a lot of solidarity, support and empathy. The loss of humanity combined with those extensive kinship networks may have encouraged politicians, leaders, programmers, and ministers to use the funds for themselves and their personal friends. I think William Easterly says it best when he writes in White Man’s Burden that the programs create “perverse incentives” that “electrify the power grid” of those kinship links.
It is hard not to place blame on someone, though. I would rather like to blame poorly designed foreign aid programs and the officials that have not found a way to help their families by using their own money. Some believe that the answer lies in seeing the poorest people in the world as marketable; they believe in the private sector as a development actor. The private sector’s role would include encouraging entrepreneurship which would allow people to take care of themselves instead of relying on aid. I think this is a good idea for development, (micro credit is not a panacea,)but it hasn’t done much good yet. Yes, it’s empowering for people to control their means of production. Yes, women are better off when they don’t have to engage in risky behaviors to “keep a man” who will support them. But what I believe is truly needed is an approach that builds on positive networks already established that people trust. There should be participation on the part of the host country nationals at all stages of any program that is started: needs assessments, implementation, monitoring, and evaluation. Most importantly, any approach in the fight against AIDS needs to be something that the people themselves can relate to, (such as ABC in Uganda,) with options for reduction of risk all types of behaviors. People need to see, hear, and feel the message from the government, television, their doctor, the private sector, the state, and NGOs. This is not a battle that can be fought by the ATM alone.
