A RESEARCH REPORT SUBMITTED TO THE WITS SCHOOL OF GOVERNANCE IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR A MASTER OF MANAGEMENT DEGREE IN PUBLIC AND DEVELOPMENT MANAGEMENT / HIV and AIDS impact severely on the capacity of the state, its skills base and the efficient use of public funds to render high quality services to the broad populace. Public sector institutions are under immense pressure to implement policies and programmes to mitigate the impact of HIV and AIDS in the workplace (Public Service Commission, 2006). In this context, the purpose of this research is to assess the implementation of HIV and AIDS policy in the Gauteng Department of Roads and Transport to determine if employees are benefiting from this policy. To accomplish this goal, the study employed qualitative interviews and observations to obtain the necessary data from DRT managers, programme officials and employees in June 2014. An examination of the data confirmed that efforts had been made to implement the HIV/AIDS policy in the DRT, although the scope and intensity of these initiatives varied across occupational levels. It was found that an internal policy on HIV and AIDS has been developed; some employees had been informed about the risks of HIV and AIDS; some line managers had been trained on HIV/AIDS management; health screening including HIV counseling and testing takes place regularly; employees have access to 24 hour counseling services; and some units had been supplied with educative messages including pamphlets and brochures. However, the findings also revealed gaps in the current implementation strategy, including limited communications, poor participation in campaigns, lack of leadership commitment, lack of resources and time constraints. In light of this, it was concluded that the current HIV/AIDS management strategy suffers from lack of capacity and coordination

“Strange Bedfellows” examines how the political economy of Medicaid and hospital provision shaped the social, political, and thus material response to the HIV/AIDS epidemic in the United States. By doing so, this study explores the consequences of a decade-plus shift that began in the late 1960s, wherein federal, state, and local policymakers deemphasized epidemic preparedness and acute care in favor of downsized hospitals, increased outpatient services, and more “personal responsibility.” Over the course of seven chapters, the study links the transformation of Medicaid into a welfare medicine program; federal health planning’s shift from the pursuit of equality to cost-cutting; the role that anti-inflation policy played in curtailing subsidies for hospitals and clinics, which reduced access to acute care; the diminution of civil rights protections for quality healthcare; and the effects these developments had on the response to HIV/AIDS. Challenging the notion that the HIV/AIDS epidemic was unforeseen and, thus, impossible to plan for, the study demonstrates how a series of purposeful decisions by presidential administrations, Congress, state legislatures, and city officials led to chronic underinvestment in public and voluntary hospitals that served poor people and people of color. A story of the neoliberal transformation of the Medicaid program and public and voluntary safety net hospitals, this dissertation illustrates how healthcare and welfare politics intertwined from the mid-1960s to the new millennium in ways that confounded the United States’ epidemic preparedness. A healthcare system focused on chronic disease by the 1960s and cost cutting in the 1970s could not cope with an emergent infectious disease like HIV/AIDS.

For the first twenty-five years of Ghana’s national response to HIV/AIDS, the government, like most nations in Africa, did not include gay and bisexual—locally known as sasoi—and other men who have sex with men (MSM) as a high-risk group for HIV in its policies. In 2011, Ghana finally addressed this policy blind spot by acknowledging sasoi and other MSM as a key population at-risk for HIV and in need of policy and programmatic interventions—a shift that is occurring in many parts of Africa. Using Ghana as a case study of this policy shift on the continent, my dissertation examined: why sasoi and other MSM were not initially acknowledged in Ghana’s national AIDS policies; why and how the government decided to include MSM as a key population in its national AIDS policies and programs; what cultural, social, and political factors have affected the development, implementation, and reception of these policies and programs; how sasoi and other MSM perceive and experience these policy and programmatic efforts; and how sasoi and other MSM experience life in a country that criminalizes and stigmatizes same-sex sexual activities. Using ethnographic methods, I conducted a 12-month qualitative study in Ghana. I conducted: interviews with 43 state and non-state policymakers and stakeholders, HIV frontline workers, and sasoi and other MSM; focus group interviews with 18 peer educators; participant observations of policy and HIV prevention work, and meetings and other events related to the research scope; and archival research of media coverage of homosexuality. My findings indicate that Ghana’s MSM policy blind spot was due to: 1) the criminalization and stigmatization of same-sex sexualities in the country, 2) a construction of the Ghanaian epidemic as driven by migrant female sex workers, and 3) international AIDS researchers’ categorization of HIV in Africa as heterosexual, which informed donor policies and stipulations. However, in 2011, the government shifted to include MSM as a KP at risk for HIV in light of mounting epidemiological data on MSM HIV prevalence and risk, NGO advocacy efforts, and international donor policy changes that now recognize MSM as a KP in Africa. I conceptualize this change as a paradigm shift in Ghana’s national AIDS policies from a general population paradigm to a key populations paradigm that includes MSM as biomedical citizens at higher risk for HIV. The country’s progress in addressing HIV among sasoi and other MSM using evidence-based policies has earned it status as a model country in Africa in MSM HIV efforts. Stakeholders, however, face significant challenges rooted in the country’s sociocultural context, namely institutionalized homophobia and heterosexism, a dated and underfunded healthcare system, and inadequate HIV funding. Implementation of MSM HIV policies has come into conflict with the country’s legal and sociocultural realities in Ghana, where male same-sex sexual activities are criminalized and socially stigmatized. Moreover, stakeholders are strategically discreet in how they implement MSM HIV policies and programs and are hesitant to publicly push any advocacy efforts that might come across as supporting or promoting homosexuality, in fear of social and political retribution. Despite this strategy, I argue that MSM HIV efforts have attracted public attention and criticism and have constituted, in part, the politicization of homosexuality in Ghana, reshaping public representations and perceptions of homosexuality and presenting challenges to the ongoing efforts to address HIV among MSM. Stakeholders must evaluate these unintended consequences alongside the intended policy objectives and outcomes to strengthen efforts to reduce the burden of HIV among sasoi and other MSM in Ghana.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: This study aims to understand the processes and factors that explain the framing of HIV and AIDS policy in Botswana, South Africa and Swaziland. Africa remains the global epicentre of the HIV and AIDS epidemic with Southern Africa remaining the most affected region in the world. The investigation centres on the HIV and AIDS policymaking discourses and dynamics leading to the securitisation of the epidemic in the three countries. The central focus of the study covers the timeframe of the leadership of President Mogae in Botswana, President Mbeki in South Africa and King Mswati III in Swaziland. This period is important as it characterises the HIV and AIDS epidemic being elevated onto the political agenda of the respective countries. This dissertation relies on two strands of theoretical literature namely, public policy theory and securitisation theory to help explain the framing of policy decision-making that leads to the process of securitisation of the HIV and AIDS epidemic in the three countries. This study is a multiple case study within the qualitative research paradigm. This research is based on three case studies: Botswana, South Africa and Swaziland. As far as data collection is concerned, this study drew on primary sources of data, which consisted of documents obtained during the fieldwork from various stakeholders such as such as official government documents, as well as official documents from international and domestic HIV and AIDS organisations. Twenty semi-structured interviews were also conducted between 2007 and 2008 with various stakeholders including government officials, representatives of domestic and international HIV and AIDS organisations operating in the respective countries, researchers from think tanks and academics. In addition, eleven exploratory interviews were also conducted as part of the fieldwork process. Furthermore this study also relied on various secondary sources of data such as scholarly articles and books, official documents and legislation and newspaper articles. The preliminary results collected and analysed in this study suggest that Botswana, South Africa and Swaziland have all demonstrated a degree of formal commitment to adopting international guidelines to combat the epidemic. The thesis shows that while all three countries may share the burden of the epidemic, each presents a different political, social and cultural identity with different institutional architects (both foreign and domestic) that determined the nature of the response policy to the epidemic. The study shows that each of the three case studies presents an example of differing degrees of securitisation attempts: i) Botswana - successful securitisation; ii) South Africa - unsuccessful securitisation; and iii) Swaziland - partial securitisation because different actors and audiences are positioned at varying points along a spectrum of securitisation. This degree of securitisation can be linked to the acceptance of international ideas and the prevailing global discourse regarding the HIV and AIDS epidemic and the openness to forming collaborative agreements between state and non-state actors in each of the three countries. / AFRIKAANSE OPSOMMING: Hierdie studie poog om ’n begrip te ontwikkel van die prosesse en faktore wat verklaar hoe beleid rondom MIV en VIGS in Botswana, Suid-Afrika en Swaziland geraam word. Die Afrikavasteland is nog steeds die wêreld se MIV en VIGS-episentrum en die Suider-Afrika-streek loop die mees gebuk onder die epidemie. Die ontleding sentreer op die MIV en VIGS beleidsdiskoerse en die dinamieke wat aanleiding gee tot die beveiliging van die epidemie in die drie lande. Die kollig val op die tyd toe President Mogae van Botswana, President Mbeki van Suid-Afrika en Koning Mswati III van Swaziland aan bewind was. Hierdie periode is van belang omdat dit die tyd was toe MIV en VIGS op die drie lande se politieke agendas geplaas is. Die proefskrif gebruik literatuur uit twee teoretiese velde, naamlik openbare beleidsteorie en sekuriteitsteorie, om te verklaar hoe daar op bepaalde beleide besluit word, hoe dit geraam word, en die proses waarvolgens MIV en VIGS gevolglik in die drie lande beveilig word. Die studie is ’n meervuldige gevallestudie binne die kwalitatiewe navorsingsparadigma. Die navorsing is op drie gevallestudies gebaseer, te wete Botswana, Suid-Afrika en Swaziland. Ten opsigte van data-insameling, het die studie van primêre databronne gebruik gemaak bestaande uit bewysstukke wat van verskeie belangegroepe verkry is. Hierdie stukke beslaan amptelike regeringsdokumente en amptelike dokumentasie van internasionale sowel as nasionale MIV en VIGS-organisasies. Daar is ook met verskeie belangegroepe onderhoude gevoer. Die belangegroepe het bestaan uit regeringsamptenare, die verteenwoordigers van nasionale en internasionale MIV en VIGS-organisasies betrokke in die drie lande, akademici, en kundiges by navorsingsinstansies. Twintig semi-gestruktureerde onderhoude is in 2007 en 2008 gevoer. Boonop is daar as deel van die empiriese navorsing 11 verkenningsonderhoude gevoer. Die studie het ook van verskeie sekondêre databronne soos vakwetenskaplike artikels en boeke, amptelike dokumentasie, wetaktes en koerantartikels gebruik gemaak. Die voorlopige bevindinge dui dat Botswana, Suid-Afrika en Swaziland elkeen hulself tot ’n mate formeel tot internasionale riglyne verbind het om die epidemie te beveg. Die proefskrif bewys dat ofskoon al drie lande swaar aan die las van die epidemie dra, daar by elkeen verskillende politieke, maatskaplike en kulturele identiteite, asook institusionele argitekte (plaaslik sowel as buitelands) bestaan wat die aard van die beleidsrespons bepaal het. Die studie dui verskillende grade van beveiliging by elkeen van die gevallestudies: i) Botswana – suksesvolle beveiliging; ii) Suid-Afrika – onsuksesvolle beveiliging; en iii) Swaziland – gedeeltelike beveiliging. Hierdie grade van beveiliging kan verklaar word aan die hand van die mate waartoe daar by elkeen van die lande aanvaarding was van internasionale denke en diskoers oor die MIV en VIGS-epidemie en of samewerking tussen staats- en nie-staatsakteurs bewerkstellig is.

M.A. (Public Management and Governance) / The study deals with the effectiveness of the HIV/AIDS policy in City Power Johannesburg (CPJ). HIV/AIDS is a worldwide pandemic. Sub-Saharan Africa is the worst affected and very little is being done to suppress its destructive nature. All administrative spheres need to implement workplace policies, procedures and programs to curb and eventually eliminate any new infections and the spread of the pandemic. Whilst workplace policies are a statement of intent and are formulated to guide decision making, they are only effective when formulated, implemented, monitored and evaluated, and reviewed strategically. The methodological approach adopted in this study is qualitative by nature and interpretative. For this dissertation to achieve its purpose, the main study objectives were to determine the objectives of the current HIV/AIDS policy in CPJ, to determine how these objectives have been achieved and what measures could be taken if these objectives are not achieved? The dissertation proposed that in order to curb the pandemic in CPJ, the HIV/AIDS policy will only attain policy effectiveness if various interventions are implemented and adhered to.

This study is concerned with corporate policy on IllV/AIDS. This was investigated by speaking to key-informants from fifteen enterprises in KwaZulu Natal. They were asked about their policies and programmes and what they had put in place to combat this epidemic. The rational choice model was used as a framework for analysis ofthe policies. This model is discussed in the first part ofthe study and was chosen as it seems to reflect the dominant policy outlook in South Africa and may shape the way that organisations .respond. The second part of the project is the report and discussion of the findings. It is a presentation ofthe responses given by the key informants regarding their perceptions and understanding of the problem of IllV/AIDS as well as the policies .of their companies regarding the same. Mostofthe companies in the study did not have policies specific to. IDV/AIDS. Some had general guidelines and treated HIV/AIDS as any major illness. There seemed to be denial, especially among the management, of the seriousness of the disease despite evidence ofits significant impact within the various organisations. There were few to no resources set aside formv/AIDS programmes and interventions and this seems important in defining the IllV/AIDS problem as one of the future rather than the present In the third part of this project, the theoretical framework and the findings were linked. There was an attempt to answer the question ofhow rational the policy process is within the companies in the study and .whether the responses of these organisations can be understood in the context ofthe rational choice model. It seems that this model does aid in understanding of the policy process when there is a realisation· that it interacts with other human mctors to create what we observe. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

This dissertation is an examination of presidential communication, focusing primarily on how Mbeki promoted a fringe group of researchers (the Virodene researchers) and a discredited scientific position (the AIDS dissidents). It employs aspects of critical discourse analysis in order to examine Mbeki's speeches, articles, interviews and letters dealing with HIV/AIDS from 1998 to 2003 in order to identify how his views and beliefs on the epidemic changed from the orthodox position that HIV causes AIDS to a dissident view, which led to him asserting that it was impossible for one virus to be the single cause of a wide range of illnesses defined as AIDS. In addition, it examines briefly how civil society, particularly the TAC, responded to Mbeki's unconventional approach to HIV/AIDS, and how Mbeki reacted to criticism of his views on HIV/AIDS. By using the relations of antithesis, entailment and equivalence, this dissertation finds that, although Mbeki moved from an orthodox to a dissident position on HIV/AIDS, there are common threads running through all his discourse. These threads include an intense interest in science and a concern with the plight of the "underdogs", namely those that he feels have been discriminated against by the scientific establishment particularly the pharmaceutical industry. Mbeki's dissident views were not a crude assertion that HIV does not cause AIDS, as has been suggested by other researchers, or those of a sophist seeking excuses for his government's inability to deploy adequate resources to HIV/AIDS. His interest in dissident theory is considered and he has clearly engaged with the scientific arguments of the dissidents. However, this is not the case when Mbeki deals with his critics. It is a matter of concern that Mbeki used the power of the Office of the President to undermine and discredit his opponents by accusing them of being racists or "Uncle Toms" for opposing his dissident views on HIV/AIDS. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2003.

HIV/AIDS is reducing the hard-won returns on investment in education in South Africa.

This research was conducted with the aim to evaluate the policy interventions on HIV and AIDS in pregnant women in the Lukhanji sub district of Chris Hani District Municipality. The study would also propose policy improvement strategies towards curbing the spread of HIV and AIDS in pregnant women. In realizing these goals, the entire research process was guided by the research objectives and questions which sought to evaluate policies and strategies relevant to HIV prevalence in pregnant women. The secondary research objectives were accomplished through the review and analysis of the relevant literature and theories. Qualitative research approach was used in determining the findings and conclusions from the study. Data was collected using qualitative research methods and in this case a structured questionnaire was developed and distributed to the study participants. The Questionnaires were handed and discussed with each participant. Demographics, socioeconomic and cultural factors were considered in designing the data collection tool. These factors are known to have an impact on the prevalence of HIV. It has been shown through the study that demographic variables have an effect on HIV prevalence. Hence when considering policy interventions these should be taken into account. All the respondents were given enough time and they provided clear and comprehensive responses to the questionnaire and follow up discussions. The evaluation of the responses showed that various HIV prevention related policies are being implemented within the Lukhanji sub-district. Numerous programmes relating to HIV and AIDS, also specifically covering pregnant women are being rolled out across the sub-district. HIV prevalence in the study population is rated as average to low when comparing with the district, provincial and national statistics. Current data obtained from the study indicates that HIV prevalence stands at 17%. This finding demonstrates the heterogeneity of HIV prevalence when comparing this result with current provincial and national statistics. Evaluation of the different HIV and AIDS programmes that are aligned to provincial and national policy somehow explain the positive outcomes observed in the Lukhanji sub-district The study recommends that more work be done in reaching out to the communities using various communication channels and strategies. This could address the challenges associated with the lack of cooperation with local traditional leaders, because this has been found to have a negative impact on implementation of some programmes such as circumcision. One of the positive findings from the study is the accessibility of health care facilities to the local rural communities. Further research on the subject should be undertaken to ensure continuous evaluation as this topic is viewed as a continuous global issue.

The complex problems of the twenty-first century cannot be effectively addressed with twentieth century top-down bureaucratic governance alone because of limited stakeholder participation in collective decision making and/or implementation. The somewhat limited stakeholder participation in the policy process, especially, that of target populations, can impact generating viable solutions to complex problems. Collaborative governance has emerged as a promising alternative to traditional management in addressing contemporary complex problems. Collaborative governance is thus a type of governance that promotes joint participation of state and non-state stakeholders in decision making and/or implementation by using agreed upon processes of engagement to collectively address problems. Such governance is especially beneficial for addressing the challenges posed by the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). This dissertation uses the collaborative governance concept to explicate the efforts of HIV Health Services Planning Councils in Broward County and Palm Beach County of South Florida with the purpose of accentuating how collaborative governance works in providing various categories of services to meet the needs of people with AIDS (PWAs), as part of the implementation of the Ryan White CARE Act. The study focuses on critical variables of collaborative governance such as facilitative leadership and institutional design, the collaborative process variables such as trust building, commitment to the process and shared understanding, and outputs such as allocation priorities of the Councils. This study employed mixed methods in collecting data from various relevant sources. / The combined findings from surveys, interviews, observations and document reviews were essential to knowledge and understanding of collaborative governance of the respective Councils. The results revealed more similarities than differences between the Councils in their efforts towards addressing the HIV/AIDS problem. The Councils are similar in all variables of collaborative governance with few exceptions relative to facilitative leadership and institutional design. The differences were relative to membership, number of committees, amount allocated for various service categories and number of clients served. Furthermore, the Councils were slightly different in reaching consensus on subjects of deliberation. On the average, Palm Beach County's Council make decisions by consensus relatively easily when compared with the Broward County's Council. Nonetheless, both Councils are consensus-oriented and strive to make decision by consensus as evidenced by unanimous votes or simple majority votes on various subjects of deliberation. In addition, representation and participation of target populations in collaborative governance have contributed to the empowerment of those target populations. The study contributes to the literature by developing a conceptual model for HIV/AIDS collaborative governance for producing outputs to help meet needs of target populations. Also, the study contributes to collaborative governance theorizing by drawing a nexus between variables of collaborative governance and by complementing the existing non-linear perspective of collaborative process for collective problem solving. Collaborative governance involving state and non-state stakeholders thereby enhances efforts of public managers by harnessing resources to effectively manage and/or address complex problems for the benefit of society. / by James K. Agbodzakey. / Vita. / Thesis (Ph.D.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.