Cultural obstacles to the rollout of antiretrovirals: language, region and the backlash against AIDS funding
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2009
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University of Cape Town
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This paper employs quantitative analysis to explore the issue of cultural barriers to accessing highly active antiretroviral treatment (HAART) in developing countries. It begins with an econometric analysis of potential socio-economic determinants of HAART coverage, i.e. the number of people on HAART as a percentage of the total number needing it. The analysis suggests that language fractionalisation (a widely used indicator of cultural diversity) acts as a barrier to HAART coverage, whereas ethnic fractionalisation is not significant, although politically salient ethnic divisions may be. The most important drivers of HAART coverage are: region (notably, living in the hyper-epidemic region of the Southern part of the African continent); and access to donor funding. The effect of 'region' may, of course, be proxying for unmeasured 'cultural' variation that is not being picked up by the language and ethnic diversity variables. But it may also be picking up other imperfectly measured variables such as level of economic development and institutional strength or even unmeasured factors such as different variants of HIV. One thus cannot conclude from the fact that regional differences exist, that these have roots in cultural differences. The question of 'cultural barriers' to HAART is usually interrogated at a domestic or local level where understandings of disease aetiology and healing, stigma, conceptions of masculinity etc can be explored (e.g. Ashforth, 2005; Nattrass 2005; Ashforth and Nattrass, 2005; Nattrass, 2008a; Steinberg, 2008). Similarly, country-level research can help shed light on how political factors, such as government leadership on AIDS and civil society mobilisation in favour of HAART, also affect the pace and level of HAART coverage (e.g. Nattrass, 2007; Robbins, 2009). Political factors are crucial in shaping access to HAART (Bor, 2007; de Waal, 2006; Iliffe, 2006; Nattrass, 2008b) but these are not immutable and can be transformed rapidly through domestic and international pressure. The same is true of cultural understandings of HIV and HAART which can change quickly in the presence of civil society mobilisation and in response to the lived experience of successful antiretroviral treatment. This paper, by virtue of its focus on cross-country differences in HAART coverage, does not address the kinds of cultural and political obstacles that are more appropriately addressed through ethnographic research. However, the analysis highlights a potentially important over-arching cultural issue which is easily missed by country-level analysis – namely the role of donor attitudes and beliefs in shaping access to HAART. Donor funding is typically seen as an economic issue. But to understand it merely as a resource flow is to miss the importance of 'donor culture' in shaping and sustaining that resource flow.
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Nattrass, N. (2009). Cultural obstacles to the rollout of antiretrovirals: language, region and the backlash against AIDS funding. Centre for Social Science Research: University of Cape Town.