This article examines the political dimensions of Uganda's progress in bringing a generalised HIV/AIDS epidemic under control. The article documents the history of the political processes involved in Uganda's battle against HIV/AIDS and analyses the complexities of presidential action and the relation between action at the level of the state and that taken within societal organisations. By the mid-1980s, Uganda was experiencing a full-blown epidemic, the virulence of which was connected with social dislocation and insecurity related to economic crisis and war. Political authorities faced the same challenge as other regimes experiencing the onslaught of AIDS in Africa. The epidemiological characteristics of HIV and AIDS—transmission through heterosexual activities, with a long gestation period, affecting people in the prime of their productive life—meant that action required wide-reaching changes in sexual behaviour, and the educational activities to achieve this, as well as relatively complex systems to monitor the virus and control medical practices (blood supplies, injection practices, mitigating drug delivery). The centralist character of the Museveni regime was crucial not only to mobilising state organisations and foreign aid resources, but also to ensuring significant involvement from non-state associations and religious authorities. The Ugandan experience demonstrates that there is a tension between the requirements for systematic action that a strong public authority can deliver and the need to disseminate information requiring a degree of democratic openness. The President was able to forge a coalition behind an HIV/AIDS campaign in part because the virus largely ignored the privileges of wealth and political power. With the development of antiretroviral therapy and the access that the wealthy can gain to these drugs, this basis for the broadest possible coalition to fight HIV/AIDS may be weakened in the future.
Public Administration and Development (2004) 24 (1) 19-30 [DOI: 10.1002/pad.306]