United against HIV/AIDS? : the politics of local governance in the case of Lusikisiki, South Africa

When the former leaders of the anti-apartheid movement became the new political leadership of the country, many believed that ‘the adversarial social struggle’ with the state had ended. However, within a few years of democracy, new social struggles emerged between the state and civil society. An example of the new struggles that emerged came due to increasing discontent regarding the government’s lack of effective HIV/AIDS action. The Lusikisiki programme is one of the first rural treatment programmes for HIV/AIDS implemented in South Africa. Despite national conflicts between the state and civil society over treatment policies, this is a case where the principal actors on each side, the Department of Health and the Treatment Action Campaign, seem to have put aside previous conflicts and engaged in local treatment collaboration in partnership with an external actor and NGO, Médecins Sans Frontières. The Lusikisiki programme has recently undergone a transition from being an NGO driven pilot project to a public sector programme. The withdrawal of the external actor created a number of challenges for the programme. For instance, Lusikisiki experienced a loss of both technical and financial support and bottlenecks for sustaining the original model have appeared at the policy level. Spaces and opportunities that were opened up by the external actor have to a certain extent been closed again. These experiences point to the fact that local governance is inherently political and inscribed in political structures and processes that far exceeds a particular locality. The thesis studies the political dynamics of local governance of HIV/AIDS in the case of Lusikisiki. It is based upon a qualitative case study of a rural HIV/AIDS programme and employs a theoretical framework concerned with the politics of governance