The Distribution and Impacts of HIV/AIDS NGOs in Sub-Saharan Africa Rachel Sullivan RobinsonAssistant ProfessorSchool of International ServiceAmerican University, Washington DCrobinson@american.edu

Introduction

Current Questions: What makes some countries organizationally

“richer” than others? What makes some countries more effective

than others at addressing HIV/AIDS? How do NGOs impact responses to the

HIV/AIDS epidemic?

NGOs have high potential for positive impact because they:1)Provide local legitimacy for prevention messages2)Often advocate for their members and those at

risk3)Serve as a conduit for donor funds

Distribution of HIV/AIDS NGOs, 2003

.00 .01-.09 .10-.19 .20-.29 .30-.39 .40-.49 .50-.59 .60-.69 .70-.79 .80-.890

2

4

6

8

10

12

Proportion of Country's NGOs that Target HIV/AIDSSource: UN 2003

Num

ber

of

Countr

ies

CARComorosDjiboutiGuinea BissauSao Tome et PrincipeSomalia

Burkina FasoSouth Africa

BurundiCape Verde

CongoGuineaLesothoMadagas-carMaurita-niaTanzaniaZambia

Distribution of Organizations for PLWHAs, 2004

Countries with No Orgs. Countries with 5+ Orgs. Country Country Number

of Orgs. Number of Orgs. per 10,000,000 People

Cape Verde Burkina Faso 8 6 Comoros Cameroon 8 5 Djibouti Central African Republic 10 25 Guinea-Bissau Congo 6 16 Madagascar Ghana 5 2 Rwanda Kenya 16 5 Sao Tome et Principe Mozambique 9 5 Sierra Leone Nigeria 40 3 Somalia Senegal 15 13 Sudan South Africa 8 2 Tanzania 6 2 Togo 7 12 Uganda 55 20 Zambia 5 4 Source: USAID 2004

HIV/AIDS NGOs vs. HIV Prevalence, 2003

0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.900

5

10

15

20

25

30

35

R² = 0.0636251747158186

Proportion of Country's NGOs that Target HIVSource: UN 2003; UNAIDS 2006

HIV

Pre

vale

nce

Rate

Swazi-land

Mozam-bique Malaw

i

Namibia

Zim-babwe

Botswana Lesotho

Zam-bia

South Africa

BurundiBurkina

Congo

Tanzania

Madagas-car

GuineaMaurita-nia

Mean proportion across countries

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

0

1

2

3

4

5

6

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

YearSource: Robinson 2008

*Number of new reproductive health NGOs in a given year, divided by the total number of existing reproductive health NGOs

Aid

Per

Capit

a 2

000 U

S$

Cru

de O

rganiz

ati

onal B

irth

Rate

*

Aid Per Capita

Crude Organiza-tional Birth Rate

New NGOs and Foreign Aid, Nigeria, 1980-2003

Main Findings

Impacts of HIV/AIDS NGOs:Change in HIV Prevalence Proportion of NGOs targeting HIV Date of first HIV/AIDS NGO

Provision of ARVs Date of first HIV/AIDS NGO

Determinants of organizational richness:

All NGOs Foreign aid GDP per capita

HIV/AIDS NGOs Foreign aid

(negatively) HIV prevalence

How Can NGOs Enable Social Capital Mobilization?

By being good NGOs: Need to engage in income-generating

activities Need the support of larger social

movements Need to integrate with the larger community Need to surviveThrough purposeful partnerships with donors:Donors need to fund areas NGOs want to engage, regardless of priorities

Donors need to hold NGOs accountable for use of funds

– Microcredit?– Venture capital model?

Lessons Learned

NGOs can’t solve everything NGOs ≠ civil society (automatically) NGOs are small businesses and prone to

failure NGOs suffer from the whims of donors

NGOs are associated with positive outcomes, but:

Very likely a third, unobserved variable driving the existence of NGOs and the positive outcome

In a multivariate context:– NGOs only explain a portion of the

variance in the change in HIV rates, and GDP explains more

– NGOs don’t explain any of the variance in ARV coverage – GDP is the best predictor

Brainstorm on Behavior Change

Reducing HIV prevalence requires major behavior change

– Green et al. in March 2009 Studies in Family Planning

People act on information when it comes through personal ties, but it does not have to be strong personal ties– Granovetter (1973) “Strength of Weak Ties”

Both ideas and HIV diffuse through social networks

If NGOs can be successful bridges (a.k.a. weak ties) to social networks, they can facilitate behavior change– More than being peer educators

– People who work for NGOs have to capitalize on personal ties to their communities and send the right messageo Very challenging