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How is HIV prevention policy made in Tanzania and why do structural interventions lose out?
Roger Pebody, 2012-03-28 07:50:00
Far from being primarily driven by scientific evidence, decisions about spending priorities for HIV prevention programmes emerge from an imperfect, politicised process, Moritz Hunsmann argues in an article published online ahead of print in Social Science and Medicine.
Drawing on observations of Tanzanian national policy meetings and interviews with policy makers, he says that cost, political constituencies, the vertical nature of the response to AIDS, the expected timeline of interventions’ political returns, and the perceived feasibility of different approaches all influence the formulation of HIV prevention policies.
The researcher was particularly interested in why policies which aim to change individuals’ sexual behaviour tend to be supported, whereas policies to change ‘structural factors’ are rarely implemented. Structural interventions try to address the broader legal, political and socio-economic contexts in which individuals make behavioural decisions.
The research was conducted in Tanzania in 2007 to 2009, a period of relative plenty in terms of international aid. In-depth interviews were conducted with 92 HIV prevention policy makers, including representatives from government agencies, bilateral and multilateral donor agencies, international and Tanzanian non-governmental organizations, researchers and consultants.
In addition, the researcher observed eight national-level policy discussions, including Prevention Technical Working Group meetings, donor-government policy reviews and a Global Fund stakeholder meeting.
Tanzania is heavily dependent on international aid, primarily via PEPFAR and the Global Fund. Therefore one limitation of the study is that it examined decision making processes taking place at the national level, rather than within the international institutions.
The researcher identified five key aspects of the decision making processes which go some way to explain the barriers to implementation of structural HIV prevention approaches.
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