HIV, gender, and civil society: a Botswana case study

Pulizzi, Scott
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HIV is the most pressing public health and development challenge facing Botswana. Reducing gender-related vulnerability to HIV is one of the top priorities of the government and its development partners. Civil society organisations (CSOs) have been identified as crucial in these efforts. As a result, civil society has grown in Botswana, in both numbers and size, to deliver services such as home-based care, counselling, and testing. Yet to reduce gendered vulnerability to HIV, social and human development goals must be met in several sectors of society. The focus on HIV-related services has implications in practise, policy, and theory that may compromise long-term development aims and co-opt civil society. This research draws on critical theory and uses action research methods to investigate the role of civil society in Botswana for reducing gendered vulnerability to HIV, now and in the future. The case of Botswana is a crucial one, as it has one of the highest HIV prevalence rates, as well as the resources, both domestic and from partners, to mobilise a comprehensive response. The combination of these factors has afforded the opportunity to gain insights to inform civil society theory and development approaches in both policy and practise to improve the HIV response and civil society’s role in it. Through a literature review, interviews with key informants, a survey, and a workshop, this research found that the HIV response in Botswana is addressing many of the issues suggested by global development partners, such as UNAIDS, at the policy level, though implementation is lacking, especially concerning male involvement in gender programming. It found that efforts to meet the immediate needs are in place, but the long-term strategic interests are only incrementally addressed. This suggests that HIV is causing a development deficit. Additionally, the roles that CSOs serve in the response are focussed on serving these immediate needs, making it increasingly difficult for the response to effect broader social change to achieve gender equality and development. Civil society is taking on more responsibility in the public sector, which puts it in a vulnerable position. Its role needs to be reconceptualised in the HIV response and in development more broadly. This research proposes theoretical and policy implications to inform civil society-state relations; approaches to address complicated social development issues, such as genderbased violence; and offers an 18-point analytical framework to address operational and programmatic capacities in civil society. The framework offers a new category for the dynamic analysis of civil society organisations while working with the state called ‘civil agents’. It also describes the bridge function that CSOs serve when working with key populations, such as sexual minorities, in criminalised settings. Together these theoretical and policy implications can contribute to the understanding of civil society in the HIV response, and gender equity in the context of the post-2015 global development agenda. Key words: Civil Society Organisations, Non-governmental Organisations, HIV, Gender, Botswana, Development, Critical Theory, Action Research
A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in the Political Studies Department, Faculty of Humanities, University of Witwatersrand, Johannesburg, South Africa 8 March 2015
Pulizzi, Scott, (2016) HIV, gender and civil society: a Botswana case study, University of Witwatersrand, Johannesburg,<>