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Public-private partnerships as a strategy against HIV/AIDS in South Africa: the influence of historical legacies Viviane Brunne

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Population Unit, United Nations Economic Commission for Europe, Palais des Nations , 1211, Geneva 10, Switzerland 1 Published online: 08 Apr 2010.

To cite this article: Viviane Brunne (2009) Public-private partnerships as a strategy against HIV/AIDS in South Africa: the influence of historical legacies, African Journal of AIDS Research, 8:3, 339-348, DOI: 10.2989/AJAR.2009.8.3.10.931 To link to this article: http://dx.doi.org/10.2989/AJAR.2009.8.3.10.931

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African Journal of AIDS Research 2009, 8(3): 339–348 Printed in South Africa — All rights reserved

AJAR

ISSN 1608–5906 EISSN 1727–9445 doi: 10.2989/AJAR.2009.8.3.10.931

Public-private partnerships as a strategy against HIV/AIDS in South Africa: the influence of historical legacies Viviane Brunne

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Population Unit, United Nations Economic Commission for Europe, Palais des Nations, 1211 Geneva 10, Switzerland1 Author’s e-mail: [email protected] In the face of the extreme challenges posed by the South African HIV/AIDS epidemic, collaboration between public and private partners is often called for in an attempt to mobilise additional resources and generate synergies. This paper shows that the ability to successfully use public-private partnerships to address complex challenges, such as an HIV/AIDS epidemic, is influenced by the fabric of society, one important aspect being historical legacies. The first part of the article shows how South Africa’s apartheid past affects the ability of public and private partners to collaborate in a response to HIV and AIDS today. It also takes into account how reconciliation and nation-building policies in the immediate post-transformation period have affected the ability to form and sustain partnerships concerning HIV/AIDS issues. The second part of the article analyses more recent developments regarding the information that these hold as to the feasibility of public-private partnerships and whether these continue to be affected by the legacies of the past. Two events with symbolic political value in South Africa, namely the 2010 FIFA World Cup soccer event and the recent changes in government, are systematically examined on the basis of three analytical queries, regarding: the impact of the event on nation-building and transcending cleavages in society; the event’s impact on the ability to form public-private partnerships in general; and the role of HIV/AIDS in connection with the event. Conclusions are drawn a propos the influence of historic factors on the ability of South African society to effectively use public-private partnerships in the response to HIV and AIDS, and the continued dynamics and likely future directions of these partnerships. Keywords: government policy, history, nation-building, reconciliation, transformation, 2010 FIFA World Cup

Introduction South Africa is one of the countries most affected by the HIV/AIDS pandemic, with an estimated 5.7 million people living with HIV/AIDS (UNAIDS, 2008). The epidemic affects all areas: families and households, the health system, the workplace, and the national economy. As no single actor is able to end the epidemic and its impacts, partnerships, especially between public and private sectors, seem promising. In a previous study examining the potential effectiveness of the public-private partnership (PPP) approach as a strategy against HIV and AIDS in South Africa (Brunne, 2008), factors potentially affecting the feasibility of PPPs were identified on three levels: the international, the national (macro) and the project (micro) level.2 On the international level, the enhanced discussion of PPPs in international policy-making bodies can make it more likely that partnering is considered as a viable option by public and private actors on the country level. Whether or not international incentives materialise in an increased use of the concept in a country (on the macro level) depends on the fabric of society, characterised by cultural, socio-economic and historical factors. For example, if public and private actors have historically used collaborative approaches to solving societal problems, then individual actors on the ground have likely developed a routine of successful collaboration. They

have built trust in the process and learnt to have confidence in their ability to achieve a common objective jointly. The macro-framework affects the way individuals interact in concrete projects on the micro level, for example in terms of the intensity of interaction. From the comprehensive catalogue of factors on all three levels examined in the previous study (i.e. Brunne, 2008), those proving most important for the success of HIV-related PPPs in South Africa were largely determined by conditions related to the macro level — that is, the fabric of society. Among these, historical factors (in particular, the apartheid legacy), played a prominent role warranting further enquiry. This paper is therefore dedicated to a more in-depth examination of how historical factors on the macro level influence the interaction between public and private sectors and how those factors affect the feasibility of PPPs designed to address the HIV/AIDS epidemic in South Africa. The analysis is presented in two parts. The first part looks at how the ability of private and public actors to work in partnership is influenced by their historical relations in the pre- and immediate post-transformation situation. This part of the analysis is inspired by findings of a previous study (i.e. Brunne, 2008), which was based on 87 semi-structured interviews with experts who were either themselves directly involved in or closely observing PPPs in South Africa. In the second part of the article, the findings of the first part are re-evaluated against more recent developments.

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This part focuses on how the legacy of the past and the attempts to overcome it affect partnership work in the present. While the analysis of the apartheid period and the strategies of reconciliation in the immediate follow-up of the transition may improve the general understanding of the dynamics between public and private partners, project practitioners may have a need for analysis on an ongoing basis. They should be given analytical tools to make sense of the present. To this end, two symbolically important political events have been selected as a framework of evaluation of current trends in partnering between public and private sectors. These events — namely the FIFA World Cup 2010 and the changes in government after president Thabo Mbeki’s stepping down in September 2008 — have been chosen because of their importance in the public discussion representing a more general state of mind within the nation and because of their relevance to both public and private sectors. Both events are analysed here as to their impact on transcending cleavages within society — in particular between public and private actors — and as to their impact on the ability to partner in relation to HIV/ AIDS issues. Based on this two-part analysis, conclusions are developed regarding the influence of historic factors on the ability of the South African society to use PPPs in the response to HIV and AIDS, their continued dynamics and likely future directions. Public-private partnerships (PPPs) and HIV/AIDS Before introducing the more in-depth analysis of the impact of historical factors on the ability to use PPPs related to HIV/ AIDS, it is necessary to define what is meant by PPPs in connection with HIV and AIDS. Based on an earlier detailed analysis of the PPP phenomenon (Brunne, 2008), a PPP shall be seen as an institutionalised arrangement consisting of at least one public and one private organisation, who decide to make resources available and to act jointly in a project, related to a matter that affects both (or all) contributing parties. Their decision to act jointly is based on their expectation to achieve more together than what they can individually. All involved actors subscribe to a sense of shared responsibility for the provision of services or goods (Brunne, 2008). PPPs in relation to HIV/AIDS can take various forms. Existing PPPs have most often evolved around HIV/ AIDS workplace programmes comprising HIV prevention, treatment and care services targeted towards employees. Such programmes may also begin outreach activities into the communities surrounding the companies where workers live. The government may provide services in addition to those of the employers who may not have genuine expertise in implementing HIV/AIDS programmes. Sometimes, several companies, together with government, may decide to offer external employee assistance programmes jointly, which are located outside of both company premises and governmental offices. Often such PPPs become multi-party partnerships; they integrate other stakeholders (such as community-based organisations or trade unions) that complement public and private

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actors. At times, it is these supplementary actors that work as intermediaries between public and private actors and facilitate their initial encounter. How South Africa’s historic legacy affects its ability to use the public-private partnerships (PPPs) model The macro level: apartheid legacies South Africa has a heterogeneous society, consisting of the descendants of San, Khoikhoi and Bantu-speaking tribes, Europeans and Asians, which have all come to South Africa during different periods of time. Today’s South Africa is therefore a melting pot of different ethnic groups (Hagemann, 2001; Mayer & Boness, 2003). The way in which these groups live together has been conceptualised in different ways. The concept at the root of apartheid was based on the assumption that South Africa was a multinational state, consisting of ten different nations and pre-states of nations, each of which should be living in their own independent homeland. Based on such concepts, the society had been directed towards disintegration for a long period of time. The overwhelming impression gathered from interviews is that this legacy continues to affect the relationship between racial and ethnic groups today, inhibiting their ability to enter multi-ethnic partnerships easily (Brunne, 2008). Research carried out in another context has attributed this reluctance to collaborate with certain partners to the lack of equal contact or friendship across the so-defined racial groups, leading to profound scepticism, fear and prejudice towards ‘the others’ (Gibson, 2004). A study by the Human Sciences Research Council (HSRC) showed that 56% of the black respondents said they mistrusted whites in principle, and 54% of the white respondents said they either mistrusted blacks or were unsure whether to trust them (Gibson, 2004). The study also showed that the majority of blacks did not have any meaningful interaction with whites even to date, indicating the lack of opportunity to replace prejudices with positive collaborative experience (Gibson, 2004). Given the fact that most PPPs would comprise mixed-coloured membership, such data provide some indication as to why these apartheid legacies continue to negatively affect the ability to enter partnerships on an equal footing across previously antagonising groups. The issue of HIV/AIDS seems to reinforce such cleavages, making partnerships across the black/white divide even more difficult. A significant degree of stigma is attached to HIV and AIDS, which has often been ascribed to ‘the others,’ to those who seem different. As lower HIV prevalence has been shown among white South Africans than among black South Africans, responsibility was easily externalised and the problem became localised within the black communities: “Blacks were blamed for spreading the disease through gross sexual licence, the collapse of the family structure, and migration from other countries” (Crewe, 1992, p. 16). Blacks in turn refused to be labelled as scapegoats once more and to be ascribed exclusive responsibility for the epidemic. Among the black communities, the perception about illness is still influenced by memories of targeted research during apartheid to

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decimate the black majority. This has led some to think the virus was spread deliberately among the black population, for example by infecting prisoners of the anti-apartheid struggle and then releasing them into their communities (Truth and Reconciliation Commission [TRC], 1998; Barnett & Whiteside, 2002; Purkitt & Burgess, 2002; Fassin, 2003; Brunne, 2008). The known facts regarding the biological and chemical warfare programmes of the apartheid state and further related suspicions as to the origin of the epidemic are reason enough for continued scepticism. In connection with HIV and AIDS, this situation makes work in partnerships particularly difficult, even more so since the majority of the government is black (or at least non-white) while company management is still predominantly white.3 ‘Unresolved issues of race and culture surface there within the AIDS issue,’ one NGO representative confirmed (quoted in Brunne, 2008, p. 323). These dynamics explain why many respondents, when interviewed about their willingness to enter PPPs, seemed hesitant or even reluctant to do so. They referred to scepticism between public and private sectors and to the perceived political nature of the epidemic (Brunne, 2008). Therefore, the ability to make productive use of the PPP approach within society may increase — should it be possible to overcome these legacies of the past and to depoliticise the issue of HIV and AIDS. How these challenges have been dealt with in the immediate aftermath of the formal end of apartheid shall be seen in the next section. The macro level: nation-building, truth and reconciliation After years of deliberate cementation of cleavages in society, the first democratic elections in 1994 were followed by conscious steps to propagate South African nationbuilding. Under the headline of the ‘rainbow nation,’ the different groups in society were encouraged to form a new joint identity (Alexander, 2001; Mayer & Boness, 2003). One important element in this process was the Truth and Reconciliation Commission (TRC), which delivered its report in 2003. Its rationale was to record victims’ accounts and offer the perpetrators amnesty in exchange for the full admission of truth. The procedure was designed to facilitate a South African process of reconciliation that was meant to be less concerned with attributing guilt or reconciliation between individuals, but more with putting society in general in a position to come to terms with its “collective responsibility for a mental and cultural context which makes crimes against humanity possible” (Mischnik, quoted in Krog, 2002, p. 24). An atmosphere was to be created that allowed victims to forgive and the country to concentrate on a new common future (Lodge, 2002; Marx, 2002). Acknowledging that apartheid-era crimes happened on both sides of the racial divide, the reconciliation process was based on the idea of forgiveness and the reintegration of both the victims and perpetrators into society rather than cementing the divide through punishment and retribution (Tutu, 2001; Gibson, 2004). A study by the HSRC confirmed some progress towards reconciliation, albeit with the black population showing considerably more willingness to forgive and look towards a new common future (HSRC, 1996).

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As reconciliation within society progresses and levels of interaction among previously divided groups in society increase, partnerships in heterogeneous and ethnically diverse groups — including those between the public and private sectors — seem to become increasingly possible (Brunne, 2008). According to the authors Adam, Van Zyl Slabbert & Moodley (1997, p. 158), South Africa is now becoming a “pragmatically united rather than a deeply divided society…. Hence, even knowledgeable observers are constantly surprised when their predictions of doom turn out to be overtaken by reluctant cooperation and pragmatic reconciliation.” Therefore, there is hope that the nation-building project can succeed and serve as a basis and framework for more ethnically-inclusive partnerships: “[W]e do argue that there is convincing evidence that a South African nation is not only possible but a distinct probability,” confirm Adam et al. (1997, p. 125). In this context, the transformation process can also be seen as an opportunity for South Africa to progress on this issue while the distribution of roles in society is being renegotiated. While the political process around reconciliation moved on, underlying political conflicts around the issue of HIV and AIDS culminated under the Mbeki presidency in the controversy between those advocating the orthodox view about HIV causing AIDS, and those in favour of the dissident view interpreting the phenomenon as an outcome of wider poverty and malnutrition and doubting the effectiveness of antiretroviral treatment. This debate cemented the dissociation between public and private actors on the issue of HIV and AIDS. In the eyes of many private-sector representatives, the government (at the time) was isolating itself by preventing an effective strategy to HIV rather than promoting a national response. At the same time, company representatives tasked with the responsibility of responding to HIV in the workplace largely consisted of medical staff following an orthodox medical approach. To them, government did not seem an ideal partner (Brunne, 2008). As a consequence, PPPs were driven by the private sector rather than the public sector. This reinforced a trend that has been observed elsewhere: namely, the private sector had a strong agenda-setting function, while the public sector was not sufficiently fulfilling its overall coordinating role. The government did not have a good overview of existing projects, risking parallel systems for delivery of services, while services were lacking in other areas where they were most needed (cf. Buse & Harmer, 2007). The macro level’s impact on the project level When examining the overall impact of these dynamics on the project level, an interesting pattern can be observed. Despite a number of factors pushing PPPs, development around the issue of HIV and AIDS — international, cultural, or the sheer dimension of the epidemic — the numbers of PPPs actually forming around HIV/AIDS have remained relatively low. Public-private cooperation emerges more easily in areas that can fall back upon established networks of solidarity and existing trust-based relationships. Since such relationships can rarely be found between today’s public and private actors, if they decide to partner at all, they prefer to choose light forms of interaction with little risk

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involved. This also explains why some of the partnerships function in a rather ad-hoc manner with no very clear plan or systematic approach (Brunne, 2008). Examples of more sophisticated PPPs can be found in the mining sector, such as for example the Lesedi/Lechabile Project in the Free State Province, providing services to the communities surrounding mining areas, offering treatment for sexually transmitted infections and peer education. A similar project is located in Carletonville, Gauteng Province.4 In the automobile sector, HIV/AIDS workplace programmes of Mercedes-Benz South Africa (formerly Daimler Chrysler) or BMW have followed PPP approaches. These programmes have offered HIV prevention, testing, treatment and other services to their employees and to surrounding communities. In particular when reaching out beyond the immediate workplace context they have aimed to engage the public sector, for example in support of community centres or programmes at school (for more examples, see Brunne, 2008, pp. 373–379; cf. Davis, Samuels & Buse, 2007). Some projects have chosen to avoid excessive public attention in order not to put off the target group. In one instance, media reporting had nearly brought a project to a halt (see Brunne, 2008, p. 160). HIV/AIDS-related activities have therefore become more and more embedded in broader wellness or community health programmes. With regards to the concrete functioning of such PPPs on the project level, a set of 22 factors was examined in Brunne (2008) as to their importance for the success and sustainability of such projects. Some factors were geared towards abstract structural mechanisms of partnership design (for example, decision-making mechanisms), others to the personal characteristics of different actors (for example, as intermediates or leaders) or else were located at the relationship level (for example, a previous positive experience in partnering with the same partners). As could be shown in the study, personal and relationship-oriented factors were more important relative to the structural set-up, given a general scepticism and distrust between public and private actors on the macro level. Due to strong historical and political macrofactors that may inhibit the development of trust-based working relationships, individual relationships become all the more important — as a reassurance in a general context of generalised scepticism. Individual trust has to substitute the missing institutionalised trust. A special intervention by leaders and intermediaries with credibility among all potential partners is needed to bring groups together, eliminate prejudice and replace it with positive joint experience (Brunne, 2008). Where positive relationships are missing between public and private actors, it becomes especially important to invest in long-term collaborative processes where actors can get to know each other and create the experience that collaboration and constructive communication are indeed possible. Beyond the individual and relationship level, certain structural mechanisms can assist the emergence of relationships and reduce the likelihood of misuse of trust. These may be the establishment of representative decision-making or conflict resolution mechanisms, the agreement on contracts, or monitoring and evaluation procedures (Brunne, 2008). Most of these structural factors only proved to have medium to low importance for the projects. Flaws on the relationship level

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cannot be compensated with institutional settings. At the same time, in the absence of a solid institutional framework, projects can still function (albeit maybe in a more ad-hoc manner), as long as the relationship factors are well in place (Brunne, 2008). In summary, the post-transformation situation in South Africa shows an interesting dynamic. The persisting historic cleavages within society make partnerships across certain racial or ethnic groups extremely difficult. Although they have been actively addressed by sophisticated reconciliation policies, this process takes time and is by no means an easy one. It touches upon belief systems that are not easily reframed. However, the transformation process itself has generated a certain openness while renegotiating the redistribution of roles in society. This historically determined framework for partnering is connected with other factors affecting the ability to build partnerships more specific to the topic of HIV and AIDS. The stigma attached to HIV and AIDS and the politicisation of the topic5 have additionally formed strong barriers to collaboration. At the same time, the sheer extent of the epidemic has generated strong pressure for action, which has lead to prejudice being overcome (cf. Brunne, 2008). Symbolic events Processes of reconciliation with the past usually feature prominently during the years immediately following the transformation of a system. However, it is anything but clear how the involved groups will see each other once the focus on reconciliation fades and life normalises. The practice of reconciliation must filter through to other spheres of life beyond conscious debate in order to be effective. Therefore, it is interesting to analyse more recent symbolic events with some significance for the general public debate about signs in favour of or to the detriment of PPP development in the area of HIV and AIDS. For this sake, the 2010 FIFA World CupTM soccer event and the recent changes in the South African government have been selected. They will be analysed based on the following three questions: 1. How does the event impact on nation-building and transcending cleavages in society? 2. How does the event impact on the ability to form publicprivate partnerships (PPPs) in general? 3. What role does the issue of HIV and AIDS play in connection with the event? The first question serves to reach a better appreciation of the cohesion in society as a prerequisite for partnering. The second question shall help to shed some light on the changing conditions related to PPP formation in general. The third examines the evolving nature of the discussions around HIV and AIDS, assuming that more open and constructive discussion is a prerequisite for more collaboration around this topic. These three questions shall now be addressed for the 2010 FIFA World Cup in South Africa. Symbolic events: the 2010 FIFA World Cup and nationbuilding In South Africa, sports have always been symbolically charged. When they were first introduced, “rugby, cricket

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and football were seen as a means to socialise the locals into a British way of life” (Van der Merwe, 2007b, p. 70). The preferences for either one of these sports soon became an issue of race or ethnicity. The “elitist and gentlemanly image” of cricket was mostly associated with the British (Stoddard & Sandiford, 1998, cited in Van der Merwe, 2007b, p. 70). Rugby found the greatest support among the Afrikaans-speaking community, and football (soccer), given its working-class image in England, became the sport of the black masses (Van der Merwe, 2007b). However, football in South Africa meant racial divide even within the discipline. Institutionally-separate football associations catered for the white, Indian, bantu and coloured clienteles before the South African Football Association (SAFA) was established as a new overarching body based on non-racial principles in 1991 (Department of Sport and Recreation, 2007). Given its colonial and apartheid legacy, sports in South Africa continue to be political. Could a mega-event as the World Cup be used to bring people together, to enhance cohesion in society — as a basis for collaboration between previously antagonising groups? As Black (2007, p. 261) confirms, “[S]port mega-events provide unique opportunities for the pursuit of symbolic politics — a chance to signal important changes of direction, reframe dominant narratives about the host, and/or reinforce key messages of change. These signals or narratives are critical vehicles of…mobilisation of societal support for certain dominant ‘ideas of the state.’” Interestingly, shortly after the first democratic elections in South Africa in 1994, international competitions where held in the former white minority disciplines, namely rugby and cricket, which held a certain symbolic value: “The 1995 Rugby World Cup proved cathartic for South Africa at a time when the nation was galvanised through the ‘one team, one nation’ slogan…. The event appeared to capture the imagination of the nation and provided a poignant focal point for the country’s multi-racial aspirations” (Van der Merwe, 2007b, p. 72). Even more than cricket and rugby, football has a wide support base among the black population in South Africa and is seen as having the ability to “transcend historic divisions and build a new, pluralistic, democratic, and multiracial (‘rainbow nation’) identity” (Black, 2007, p. 267). The 2010 FIFA World Cup in particular has lent itself to reinvigorating a message of nation-building: “Rallying the country behind this monumental effort…has the potential to send a powerful signal of change in the historic racial order of South African society — even if the country’s racial conditions on the ground remain stubbornly resilient,” suggests Black (2007, pp. 267–268). A strong indicator of this reconciliation agenda is the fact that the South African personalities most strongly connected to the nation-building and reconciliation project have actively supported the application process for the World Cup. When travelling to FIFA’s final voting rounds in Zurich, Switzerland, the official bid committee was accompanied by South Africa’s president and deputy-president, by former presidents Nelson Mandela and F.W. De Klerk, as well as Archbishop Desmond Tutu (Cornelissen, 2004). FIFA president Joseph Blatter directly acknowledged the need to include the nation-building component into the World Cup narrative after the event was

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awarded to South Africa: “[W]hat greater testimony to what South Africa had achieved with its peaceful transition than the presence of three Nobel Laureates for peace” (quoted in Cornelissen, 2004, p. 1306). Previously, the FIFA Inspection Report had asserted that “awarding the tournament to South Africa would assist the unity process in the country” (Black, 2007, p. 267). However, while the world was looking at the nationbuilding project in South Africa, the focus within the country under Thabo Mbeki’s presidency had shifted towards integration into the international realm (Van der Merwe, 2007b). The 1995 Rugby World Cup event under president Mandela was more inward-looking and focused on multiracialism, while Mbeki had given preparations for the 2010 FIFA World Cup a more pan-Africanist imprint, using the slogan ‘It’s Africa’s Turn!’ (Van der Merwe, 2007a; Cornelissen, 2007). South Africa wanted to demonstrate that it belonged to the international elite of those capable of hosting an event of this scale (Black, 2007; Van der Merwe, 2007b). In the course of the preparations, criticisms have appeared that, while the games are sure to attract international visitors, the ordinary South African can hardly afford the tickets and money is being spent on building stadiums while neglecting the basic needs of large parts of the population. Some have said that people have been evicted from their homes to make room for stadium construction, and cases of corruption have surfaced. While jobs related to stadium construction remain at best temporary, there seems to be a general perception that only some selected large businesses are to actually profit. Such developments work to the detriment of nation-building because they manifest divide instead of inclusiveness and cohesion in society (Duval Smith, 2009a; Smith, 2009). The 2010 FIFA World Cup and public-private interaction With the international discussion on whether or not South Africa would be able to host an event of the scale of a World Cup, a lot of attention has been directed to the construction of stadiums, and the development of transport, accommodation and tourism infrastructure. These activities hold considerable potential for public-private interaction. The national government has undertaken to spend more than R400 billion between 2006 and 2010 on upgrading road, air and other transport infrastructure. During the 2007–2008 financial year, R8.4 billion was made available from public budgets for constructing or refurbishing venues (Cornelissen, 2007; Maenning & Du Plessis, 2007). Finance Minister Trevor Manuel explained in his 2006 budget address: “Infrastructure investment and skills development are the main frontier ahead. These are journeys that have just begun, and they promise…unprecedented opportunities for initiative and partnership” (quoted in Hensley & Behrens, 2006). The South African government therefore appears open to internationally popular PPP approaches. The upcoming World Cup seems to have inspired additional activity and scope for using PPP approaches based on the Treasury’s concept in areas such as entertainment, sporting, tourism, conventions and the film industry. A prominent example is the Gautrain, an 80-km high-speed rail system linking Johannesburg and Tshwane (Pretoria)

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with the international airport in Johannesburg. Scheduled for completion in time for the 2010 World Cup, the Gautrain project represents a transport PPP, with the private sector providing the design, construction, operation and maintenance components, and with joint public-private financing of over US$1 billion (Hensley & Behrens, 2006). Another example is the National Communication Partnership, established in 2006. That PPP was initiated by the South African Government Communication and Information System and the International Marketing Council and includes 250 leaders in communication, marketing, advertising, public relations, creative industries and tourism in the public and private sectors. The aim of the partnership is to develop an overarching communication strategy across various disciplines for the 2010 event (Department of Sport and Recreation, 2007; National Communication Partnership [NCP], 2008; South African Government Information, 2008). While the World Cup preparations seem to have inspired some PPP activity — does this also apply to HIV and AIDS issues? The 2010 FIFA World Cup and HIV/AIDS When looking at communication strategies related to the World Cup, although the link is made occasionally,6 HIV and AIDS is not very visible. Early on, during the bidding process, there was a loveLife billboard campaign with the motto ‘Love to be there 2010,’ suggesting ‘if you want to be around to watch the matches, practise safe sex and avoid HIV’ (Carroll, 2004; Cornelissen, 2004, p. 1301). Recently, some small-scale campaigns, such as ‘Footballers for life’ or ‘Show me your number,’ have targeted footballers with HIV-prevention messages, aiming to help them handle the temptations that come with being famous (Bodibe, 2008; Health-e, 2009). In the meantime, health-related activities around the event focus on general health and emergency services only.7 The opportunity to use the event to build positive awareness in the sense of taking responsibility for one’s own best health remains unused. The international press has warned that there was no HIV-prevention plan in place targeting the expected 450 000 supporters from around the world. Fears have been expressed that in the euphoria of the games and in connection with high levels of alcohol consumption, visitors may become more vulnerable to higher-risk behaviours (Duval Smith, 2009b). More initiative has come from the international football community. The Grassroot Soccer initiative was founded by former professional football players aiming to use the positive image of the game to address HIV and AIDS. The organisation teaches local stars, including professional players, techniques to build awareness about HIV and AIDS among younger players who are encouraged to take this knowledge into their communities. More than 100 people have been trained as coaches, targeting several thousand school children (Oliver, 2006).8 In summary, the 2010 FIFA World Cup preparations have been symbolic for the state of the nation on different levels. First, it appears that attempts to use the games to enhance national unity and identification have been less successful than during the rugby and cricket cups under President Mandela. Economically, the games have been accompa-

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nied by business opportunities in infrastructure development and construction works, as well as in communications, which has involved the formation of PPPs. However, while the event may provide concrete opportunities for public and private actors to come together in joint projects, none of these have focused specifically on HIV and AIDS. Attempts to sell the World Cup as a positive event are evident and there seems to be no place in the communication strategy for a topic as unpleasant as HIV and AIDS. Activities to use soccer as a vehicle for communicating HIV/AIDS issues have originated on the international level, rather than on the national level where tensions around the topic do not seem to have subsided. While preparations for the World Cup move on, they have been overshadowed by another — equally symbolic — political event on the governmental level, which shall be the focus of the next section. The same three questions relating to the impact of the event on nationbuilding, on PPP formation, and the handling of the issue of HIV and AIDS will again be considered. Symbolic events: changes in government and nationbuilding In September 2008 President Mbeki bowed to pressures from his party and announced his resignation, in reaction to allegations that he interfered in a corruption case against former deputy president Jacob Zuma.9 The cleavages within the African National Congress (ANC) had become more and more visible since Zuma had taken over the ANC leadership in December 2007. Meanwhile, after Mbeki’s resignation, Kgalema Motlanthe was installed as president before Zuma was formally elected in April 2009. How have these changes affected nation-building? These political events hold the potential to develop in two different directions. On one hand, they could support nationbuilding in the sense that they could enhance citizens’ identification with the nation as such. The possibility of change is inherent to democracy. “Democracy flourishes where there is vigorous debate,” Desmond Tutu reiterated.10 The ANC as the undisputed strongest political party has been criticised before for not allowing enough political debate (Brunne, 2008). One can argue that the changes in party leadership in December 2007 and the emergence of the break-away party COPE (the Congress of the People) have strengthened the democratic system by providing different camps a new forum for dispute and an exchange of views. This may therefore enhance identification and nation-building. On the other hand, the changes may lead to further turbulences at a time when the country needs stability to come to terms with its past and define its way into the future. The unifying and integrative personalities of Nelson Mandela and Desmond Tutu have successfully prevented unrest in the immediate aftermath of the political transition. Thabo Mbeki, to an extent, was able to carry such stability-oriented policies further. He was able to build a strong economy and, with the help of Finance Minister Travor Manuel, a solid macro-economic policy framework. The gains in popularity for Jacob Zuma are now an expression of the disillusioned masses who feel that not enough has been done for them to feel tangible improvements in their lives after so many years post-liberation. President

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Zuma’s mobilisation around this dissatisfaction encourages divide rather than unity. Fears have been voiced that the recent events may reinforce existing cleavages in society and lead to civil unrest, following the example of other African countries that have faltered due to power struggles about political succession. Some fear an upsurge of stagnation and corruption, in particular in light of Zuma’s narrow escape from corruption charges, fraud and tax evasion (Knaup, 2008; The Economist, 2008b; cf. Los Angeles Times, 14 October 2008). Overall, the situation does not seem conducive to greater openness and trust-building between public and private actors. The next section looks at how this affects the development of concrete PPPs. Governmental changes and public-private interaction South Africa continues to have a strong economy: both the manufacturing and mining sectors show double-digit growth, as do investments (Knaup, 2008). President Mbeki had a reputation as a business-friendly president. While his immediate successor Motlanthe announced that he wants to carry on working in the general policy spirit of Mbeki, the mere fact of the premature end of Mbeki’s term served as a strong sign of instability to the business sector. It showed immediate effects on the Rand and on the stock market as well as on the confidence of investors (Günsche, 2008).11 The Economist Intelligence Unit (EIU) reported a drop in business confidence to its lowest level in five years (EIU, 7 October 2008). Meanwhile, President Zuma, having taken over from Motlanthe, has also promised investors he will not change Mbeki’s free-market policies. Early on he embarked on establishing good relations with business representatives, for example while attending the World Economic Forum in Davos. At the same time, his support base within the ANC consists of a trade union and a South African Communist Party clientele. This constituency accuses Mbeki of having done too little to reach the poor; by supporting Zuma they hope to see tangible improvements in their lives, and the business community already fears that it may be at their expense (Knaup, 2008; Los Angeles Times, 14 October 2008; Corporate Africa, 2008). Generally, before business decides to collaborate with the new government, it wants to be sure about its profile (The Economist, 2008a; Mathe, 2009). Before deciding upon their stance towards partnering on HIV and AIDS, in particular, they will want to see in which direction HIV/AIDS-related policies are developing. Governmental changes and HIV/AIDS Zuma himself stands for an ideal of masculinity where entertaining several wives is perceived positively. In 2006 he was tried and acquitted of rape charges, as the court found the intercourse had been consensual. Allegedly, he was aware of the HIV-infection of his female partner with whom he had had unprotected intercourse. What increased the scandal was that Zuma was heading the South African National AIDS Council at the time. Thus, initially it could be considered unlikely that he could take the leadership needed to create a more conducive environment to responding to HIV and AIDS and creating HIV/AIDS-related

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public-private partnerships. At the same time, the replacement of the controversial Health Minister Manto Tshabalala Msimang with Barbara Hogan as interim Health Minister had to be interpreted as an encouraging sign, given her record of speaking out against AIDS denialism as a Member of Parliament under Mbeki. Once in office, she handled HIV and AIDS as a top priority (Cullinan, 2008; cf. The Economist, 2008a; Harrison, 2008). The newly appointed Health Minister Aaron Mtsoaledi has promised to make prevention of mother-to-child HIV transmission a priority and to tackle the issue of overspending of health budgets in some of the provinces. His record in responding to the HIV/AIDS epidemic is less well known than that of Barbara Hogan when she took office, so potential private partners will wait and see about his actual policies. In summary, the sense of instability in government in South Africa set a difficult framework for the formation of partnerships in a response to HIV and AIDS. Partnerships require trust-building, which is clearly impeded by frequent changes in the government and fluctuations in staff. At some point, business may not even want to make an effort to establish relationships with new representatives anymore, not knowing how long they will be in place. Given the short time of her mandate, Minister of Health Barbara Hogan’s ability to establish new partnerships was limited, although she did succeed in instilling HIV/AIDS-related policies with a new momentum (Omarjee, 2008). The new Minister of Health Mtsoaledi has to first establish the general political tone. The current dynamics may lead to an interesting situation: while before, company managers have welcomed the ‘business-friendly’ reputation of the president in principle, but found it difficult to handle working with the government on HIV/AIDS issues, now the situation may be reversed. Business may find it difficult to partner with a president whom they fear will attempt to tap into the economic foundation of the country in order to fulfil election promises to the wider black poor majority. At the same time, business may find it easier to partner with government on HIV/AIDS-related issues, in particular through a new Minister of Health. Despite the reversal of the situation, for the moment, it will most probably mean that nothing much changes. The major signal for business to undertake joint activities with government about HIV/AIDS issues is still missing and they will likely prefer to rely on their own capacities instead of partnering with government in order to avoid disappointments and disruptions when the next major policy changes occur. Conclusions Partnering around a response to HIV and AIDS in South Africa is influenced by several factors, an in-depth analysis of which can be found in Brunne (2008). The aim of this article has been to look at one aspect in more detail, namely the role of historical factors. They may have an important influence on whether or not a society is adept in working in a PPP-format, in particular when using it to tackle the challenges of HIV and AIDS. Societies in which partnerships between potent actors — such as government and business — are easily formed in order to achieve a common goal

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are more likely to be in a position to address such complex challenges. For the feasibility of PPPs as a strategy, much depends on how the public and private sectors relate to each other and how the society is able to come to terms with the past, reinvent itself, leave conflict behind and focus constructively on issues of the present and the future (cf. Brunne, 2008). As could be shown in Brunne (2008), for South Africa, the country’s apartheid past poses a particular challenge for public-private interaction. Representatives of the public sector are largely black, and business is still a white stronghold. Informal relationships between the two are slow to develop, if at all. Public-private partnerships therefore emerge where individual representatives of the public and private sectors have already established personal relationships that have proven their value. In general, however, more direct interaction between people from different racial or ethnic groups is needed so that they can become acquainted with one another, build trust, and learn to understand each other. Evidence from HSRC data and qualitative interviews suggests that activities of reconciliation and nation-building have indeed helped public and private actors move towards each other, as has the general openness of the transformation situation. At the same time, many actors still feel discouraged from collaborating around this issue, due to a high risk of political complications, and only the sheer dimension of the epidemic itself has encouraged some actors to overcome their initial scepticism (Brunne, 2008). When looking at recent developments in the dynamics of public-private collaboration, symbolic events on a national scale, such as the 2010 FIFA World Cup and the recent changes in government, hold important information. If interpreted systematically, such events can help understand how the framework for PPPs changes over time. The analysis showed attempts to use the upcoming soccer World Cup to enhance national unity and nation-building across previously divided groups. The narrative around the games and the personalities who committed themselves to winning the bid all stand symbolically for reconciliation and national unity. However, the identification currently seems not as strong as it was during the sportive competitions of the Mandela presidency. At the same time, preparations for the cup have generated scope for new government-business partnerships to develop. However, these PPPs appear to be commercially oriented rather than concerned with social problems such as HIV and AIDS (cf. Cornelissen, 2007). Still, they may generate positive joint experiences on less emotional issues than HIV and AIDS and may provide the basis for more partnerships to take place after the games. When looking at the role that HIV and AIDS in the country has been playing during the preparation of the games, it becomes apparent that the handling of the topic is still uneasy. The chance of making it an issue of ‘coming together and seeking to win the battle as a team’ remains unused. Due to sensitivities around HIV and AIDS, PPPs are also in future more likely to be established around other issues. It remains to be desired that the games, once successfully carried out, will raise the self-confidence of all main actors, enabling them to address other challenges more constructively, including the HIV/AIDS epidemic.

Brunne

In light of the political turbulence resulting from Thabo Mbeki’s resignation and the following changes in government, the 2010 FIFA World Cup becomes even more important as an event that bridges apparent cleavages. Heterogeneous actors can all identify with this event as jointly South African. Staying on track in preparing for the games has never been questioned and the political level has issued statements that the current political turmoil should not affect the implementation of the FIFA World Cup (Government Communication and Information System, 2008; Omarjee, 2008). In that sense, the event does actually instil some overarching unity in preparing the games, which bridges the racial divides within society. At the same time, if the newly instated government has a prosperous future for South Africa in mind, it will need to make a major effort towards calming and stabilising the political situation as well as towards trust-building with the private sector. To ensure this, it may prove important to keep a certain level of continuity among operational staff by being in direct contact with private sector representatives. The biggest hope will be that addressing HIV/AIDS-related problems head-on will help de-emotionalise and de-politicise the epidemic, thus facilitating a more objective interaction between actors engaged in all aspects of the epidemic. Then, indeed, the political turmoil and change at the top of the government would have been a major step towards more public-private interaction around HIV/AIDS issues. As the outcome remains to be seen, its assessment will certainly require close observation and an interpretation of the symbolic policy events due to take place in the near future. Notes 1

2

3

4

5

6

7 8

9

Please note that the article solely reflects the personal views of the author and is in no way related to her duties at the United Nations Economic Commission for Europe (UNECE). Factors on the three levels (international, macro and micro) were developed from the theoretical and conceptual approaches of network theory, rational-choice based PPP-discussion and organisational development (see Brunne, 2008, pp. 62–157). This issue was raised by one respondent from the government, one from the private sector, one from the scientific community, and one NGO representative (see Brunne, 2008, p. 323). An insightful analysis of the community aspect of this project type can be found in Campbell (2003). The politicization of the HIV/AIDS issue largely refers to the public discourse and emotional debate between defenders of an orthodox, medical Western-science-based view of HIV and AIDS and those advocating the so-called dissident view, which partly denies that HIV is a virus-driven disease leading to AIDS and partly refuses to accept that HIV or AIDS even exist. Questioning the roots of the HIV/AIDS epidemic has had important implications for strategy-making. A detailed analysis of the issues at stake can be found in Brunne, 2008, pp. 220–234. See . See . See ; ; and . See .

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See . The risk of instability is increased given the current international turbulence of financial systems. Both trends taken together, the instability of the international financial order and instability in South Africa, may mutually reinforce each other to the disadvantage of the situation in the country. See .

The author — Between 2001 and 2004 the author worked as a research fellow at the Institute of Development Research and Development Policy (Germany) where she started her research on public-private partnerships as a strategy against HIV and AIDS in South Africa. Results of this study have recently been published by Nomos (September 2008) and were presented at the World AIDS Conference in Mexico City (August 2008). Between 2004 and 2007 the author worked as the Executive Director of the German AIDS Society, before joining the Population Unit of the United Nations Economic Commission for Europe (UNECE). The author is a member of the board for social science and public health of the Competence Network HIV/AIDS and a member of the board of the German NGO Gesundheitstraining HIV/AIDS e.V. (Health training for people living with HIV/AIDS).

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