1. Rachel Sullivan Robinson Assistant Professor School of International Service American University, Washington DC robinson@american.edu

2. 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 messages 2)Often advocate for their members and those at risk 3)Serve as a conduit for donor funds

4. Distribution of Organizations for PLWHAs, 2004

5. HIV/AIDS NGOs vs. HIV Prevalence, 2003

6. New NGOs and Foreign Aid, Nigeria, 1980-2003

7. 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

8. 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 survive Through 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?

9. 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

10.  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 message o Very challenging