Patients, But Not Citizens?: Voting on HIV Policy in African Democracies

Background: We understand very little about how average citizens engage with HIV as a political issue; however, in Africa's emerging democracies where HIV is particularly endemic, citizen engagement on HIV policy issues is essential. While civil society movements have emerged strongly in some areas and have been extensively studied, this research instead focuses on the tendencies of majority voters to consider and vote according to HIV policy appraisal.

Methods: Using Afrobarometer data from 15 African countries, Ordinary Least Squares regression and logistical regression, as well as chi-squared tests, were performed to assess the conditions under which it was most likely that citizens would pay heed to HIV policy issues, and vote accordingly. Economic and social conditions were considered, as was HIV-affectedness (those who have lost friends / family) and state HIV policy.

Results: Preliminary results show overwhelming evidence that economic concerns push HIV policy concerns to the margins among African voters. Surprisingly, those most likely to vote according to HIV policy concerns—who have been affected by the epidemic or live in countries with very poor policies—are much less likely to do so.

Conclusions: This research provides evidence as to why African electorates have not mounted a strong political voice in response to the epidemic. It undermines assumptions that democratic processes are allowing a majoritarian voice on HIV policy to be heard. Future efforts to build political accountability among leaders must also attempt to build more accountability among voters, as they are crucial to providing checks on executive HIV policy decisions.