This volume analyzes the cost of HIV/AIDS from a fiscal perspective in Botswana, South Africa, Uganda, and Swaziland.

HIV/AIDS continues to take a tremendous toll on the populations of many countries, especially in sub-Saharan Africa. In some countries with high HIV prevalence rates, life expectancy has declined by more than a decade and in a few cases by more than two decades. Even in countries with HIV prevalence of around 5 percent (close to the average for sub-Saharan Africa), the epidemic can reverse gains in life expectancy and other health outcomes achieved over one or two decades. This volume highlights work conducted under the umbrella of a World Bank work program on “The Fiscal Dimension of HIV/AIDS,” including country studies on Botswana, South Africa, Swaziland, and Uganda. It covers four aspects of the fiscal dimensions of HIV/AIDS: First, it aims for a comprehensive analysis of the fiscal costs of HIV/AIDS, with a wider scope than a costing analysis focusing on only the policy response to HIV/AIDS. Second, it embeds the analysis of HIV/AIDS costs in a discussion of the fiscal context, and interprets these costs as a quasi-liability, not a debt de jure, but a political and fiscal commitment that binds fiscal resources in the future and cannot easily be changed, and very similar to a pension obligation or certain social grants or services. Third, it develops tools to assess the (fiscal dimensions of) trade-offs between HIV/AIDS policies and measures that take into account the persistence of these spending commitments. Fourth, most of the fiscal costs of HIV/AIDS are ultimately caused by new infections, and this study estimates the fiscal resources committed (or saved) by an additional (or prevented) HIV infection. Building on these estimates, the analysis here is able to assess the evolving fiscal burden of HIV/AIDS over time.

This volume brings together the most up to date analyses of civil society in Africa from the best scholars and researchers working on the subject. Being the first of its kind, it casts a panoramic look at the African continent, drawing out persisting, if often under-communicated, variations in regional discourses. In a majority of notionally ‘global’ studies, Africa has received marginal attention, a marginality often highlighted by the usual token chapter. Filling a critical hiatus, theHandbook of Civil Society in Africa takes Africa, African developments, and African perspectives very seriously and worthy of academic interrogation in their own right. It offers a critical, clear-sighted perspective on civil society in Africa, and positions African discourses within the framework of important regional and global debates. It promises to be an invaluable reference work for researchers and practitioners working in the fields of civil society, nonprofit studies, development studies, volunteerism, civic service, and African studies. Endorsements: "This volume signposts a critical turning point in the renewed engagement with the theory and practice of civil society in Africa. Moving from traditional concerns with disquisitions on the appropriateness and possibility of the existence and vibrancy of the idea of civil society on the continent, the volume approaches the forms, contents, and features of the actually existing civil society in Africa from thematic, regional, and national angles. It demonstrates clearly the extent to which core intellectual work on civil society in Africa has largely moved from concerns with cultural reductionism to a nuanced examination of the complexities of (formal, non-formal, organizational, non-organizational, traditional, newer, usual, unusual) engagements, detailing the extent to which, over time, civil society as a concept has been indigenized, appropriated and adapted in the terrains of politics, society, economy, culture and new technologies on the continent. In all this, the book accomplishes the near-impossible. Without sacrificing the vigour, rigor and freshness of the often unpredictable fruits of up-to-date research into regional and national differences that crop up in the documentation of Africa's multiple realities and discourses, the volume weaves together a rich tapestry of the historical, theoretical and practical dimensions of an expanding civil society sector, and accompanying growth in popular discourse, advocacy, and academic literature, in such a diverse continent as Africa, into a meaningful whole of insightful themes. Written and edited by a very distinguished cross-continental and multi-disciplinary collection of researchers, research students, practitioners and activists, the volume provides cutting-edge evidence and makes a definitive case for a new lease of life for civil society research in Africa." -Adigun Agbaje, Professor of Political Science, University of Ibadan, Nigeria. "Throughout Africa, forms of civic engagement and political participation have seen dynamic change in recent decades, yet conceptions of civil society have rarely accounted for this evolution. This volume is an essential source of new thinking about political association and collective action in Africa. The authors offer a wealth of analysis on changing organizations and social movements, new forms of interaction and communication, emerging strategies and issues, diverse social foundations, and the theoretical implications of a shifting associational landscape. The contributors provide an invaluable addition to the comparative literature on political change, democratic development, and social movements in Africa." Peter Lewis, Johns Hopkins University School of Advanced international Studies

Much of the time, when confronted with a crisis of national dimensions, businesses do exactly what we expect them to do: they look to their own survival. Occasionally, however, firms in some contexts go beyond this. Based on qualitative, country-based fieldwork in Eastern and Southern Africa, Antoinette Handley examines how African businesses can be key responders to wider social and political crises, often responding well in advance of the state. She reveals the surprising ways in which business responses can be focused, not on short-term profits, but instead on ways that assist society in resolving that crisis in the long term. Taking African businesses in Kenya, Uganda, Botswana and South Africa as case studies, this detailed exploration of the private sector response to crises, including HIV/AIDS and political violence crises, introduces the concept of relative business autonomy, exploring the conditions under which it can emerge and develop, when and how it may decline, and how it might contribute to a higher level of overall societal resilience.

The global response to HIV/AIDS has been a major aspect of global health and development policy over the last three decades. The book illustrates the devastating health impacts of the epidemic, with life expectancy in some countries falling to the lowest levels observed anywhere, and the remarkable success of the global HIV/AIDS response in reversing such extreme outcomes. Concerns about the implications of HIV/AIDS for economic development have played a role in motivating the global HIV/AIDS response. However, evidence on the impacts of HIV/AIDS on economic growth or poverty is weak, and the magnitude and relevance of such economic effects appears trivial compared to the consequences for life and health. Because of the success in extending access to treatment globally, HIV/AIDS has effectively transitioned into a chronic disease. This means that HIV/AIDS absorbs not only a substantial chunk of current global and national financial resources, but that these spending needs are projected to persist over decades. The costs of the HIV/AIDS response thus resemble a long-term financial liability, shaped by past and current policies. Relatedly, the calculus of cost-effectiveness of HIV/AIDS interventions has changed. People who become infected with HIV can now expect to not die because of AIDS; at the same time, each HIV infection results in medical needs and expenditures extending over decades. The book presents a framework for integrating these financial consequences and the transmission dynamics of HIV in the analysis of cost-effectiveness of HIV/AIDS interventions and in the design of HIV/AIDS programs.

The global expansion of HIV programming (HIV "scale-up") and the growth of global health in the past decade reshaped politics, power, civic relations, and citizen subjectivities in countries across the globe. This book draws on interdisciplinary research from numerous sites in the Global South to examine the political dimensions of HIV and global health programming. The chapters reflect extensive methodological diversity and geographic range, yet exhibit striking resonance with the book’s core themes. Collectively, the authors paint a complex global portrait of a unique period in the social history of HIV, as the pandemic enters its fourth decade, and the global response reaches its peak. The book contemplates "scale-up" (and, subsequently, "scale-down") as an object of analysis and an historical shift in the politics of response to global crisis. Ultimately, HIV/AIDS campaigns provide a template for the broader expansion of global health projects and institutions. These transnational shifts and expansions necessitate further critical evaluations across social science and public health disciplines. By collecting diverse perspectives on the political legacies of HIV and global health, this book provides a unique history of the present, cataloguing emerging practices and policies that will have long-term social impacts. This book was originally published as a special issue of Global Public Health.