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In this article, we develop the argument that the primary reason to why HIV continues to spread in sub-Saharan Africa despite extensive resources is that the actors involved are to a considerable extent misinformed as regards what kind of problem HIV is. As such, in the first part of this article, we critically survey the statue of current research and ask what the research community has to say when it comes to the question of what kind of problem HIV/AIDS is and how it can best be combated. In the second part of the article, we then explore how international donors define the problem and what they actually do to combat the disease. In order to be able to assess the extent to which HIV prevention strategies are in fact supported by rigorous scientific evidence, we will analyze policy and financial documents of the largest donors involved in HIV prevention, i.e. UNAIDS, Global Fund for AIDS, tuberculosis and malaria, the World Bank's Global AIDS Programme and the US President's Emergency Plan for AIDS Relief (PEPFAR). The larger the mismatch between how the problem of HIV is conceptualized in the research community and how it is conceptualized in the international donor community, the larger is the reason for international donors to reassess their policy on HIV/AIDS. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

On the most fundamental level health is wealth. As a consequence, health is seen as one of the key ultimate goals of development, and as a dimension of poverty in its own right. Yet, despite heavy investments and a number of global initiatives, widespread disease continues to severely hamper the prospects for development, human well-being, as well as security, in many countries. Especially HIV/AIDS is, apart from causing great human suffering, also seen as inhibiting development in general. Governments have the ultimate responsibility for health services. An institutional framework promoting affordability, accessibility and quality of health services is crucial for positive health outcomes. Yet, the question remains under what circumstances such an institutional framework and ultimately; positive health outcomes, can develop. In an attempt to increase the knowledge about under what circumstances positive health outcomes can develop, this study explores the relation between different types of government structures and HIV/AIDS outcomes in a comparative sub-Saharan African perspective. Two broad questions are in focus. First, how does decentralization of the health sector perform in comparison to non-decentralized systems? Secondly, how do different types of decentralization affect the prevalence of HIV/AIDS? ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]