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ࡱ> #` :bjbj\.\. .>D>D1 &`'''8','tn?2x(("((()n)$*>>>>>>>$@hCN?1*))1*1*?(((?I4I4I41*((>I41*>I4I4V-;@;(l( G'2jm; <>?0n?y;xVC3VC;VC;(1*1*I41*1*1*1*1*??3^1*1*1*n?1*1*1*1*'' 2.4.06 HIV/AIDS on the Campus: Universities and the threat of an epidemic By Bertil Eger, Dept of Sociology, University of Lund The issue In the early 1990s we got a message that we would have to expect rising sickness and death tolls among staff. It turned out to be true. Some of us got very concerned, and we tried to get everyone involved in counselling and supporting our peers. Over time, the engagement faded out. Now we are more complacent: HIV/AIDS is part of everyday life, something we have to live with. To mobilise for action would be very much harder. (Makerere University professor, 2003) The HIV/AIDS pandemic enters its third decade of expansion, leaving an ever-growing trail of premature deaths in its wake. In Sub-Saharan Africa, Southern Africa is extremely hard hit, while West Africa on the whole is better spared. Uganda, the source of the above quote, succeeded in turning an upward trend of HIV transmission down to a seemingly stable 6 8 percent HIV-positive among adults, a level that is heralded as a sign of success while in an Asian perspective it would be regarded as catastrophically high. No single and effective response to the pandemic has yet been found. Predictions are that it will run its course for many decades ahead. With such devastating impacts, the pandemic should long ago have led nations to mobilise all available resources against the epidemic. Universities, the site of intellectual excellence, should stand in the forefront in fighting social taboos, gender inequalities and other barriers against a general social mobilisation for life-saving changes in sexual relations. On the whole, this mobilisation has not taken place. Few if any universities in Sub-Saharan Africa are in the forefront in the struggle against AIDS. Calls for mainstreaming the epidemic into research are yet to be heard. Only when specifically and systematically targeted have university authorities begun to address HIV transmission within campus and its impacts on education, research and management. This paper summarises some initial work to address the question why universities respond the way they do. The answer is sought not in the attitudes or behaviour of individuals in leading positions, but in the actions of universities as organisations or institutions. How an organisation acts is linked to two central factors; its mandate or purpose, and its structure. Individuals act within structures, working to fulfil mandates if they are leaders, pursuing their own objectives if they are not. Makerere University, the prime university in a country whose leadership is known to have responded early and with determination to the AIDS epidemic, is the case used for the study. Summarising Ugandas responses to impacts in the public sector, and regional responses to inactivity by African universities, the paper analyses developments in Makerere during the period from the early 1990s. The answers offered to the question why in fact universities avoid responding are backed up with references to relevant approaches in organisational theory. Data for the study has been collected during intermittent visits over the last three years. Interviews with academics or administrative staff known for some kind of engagement have enabled identification of historical events and other actors in these events. Archival search has added to and sometimes corrected the memories of those interviewed. Based on this reconstruction of its past, systematic interviews with representatives of Makereres central administration, unions, student organisations etc., have provided insights into the situation of today. The method is not fool-proof. However, using the facts-on-the-ground basis has made it possible to revitalise peoples memories while at the same time avoiding to fall victim of (sometimes consciously) biased recording of events. The national context AIDS entered Uganda through the rural South-Western district of Rakai in the early 1980s. It was made visible through the AIDS-related mortality wave building up over the 1980s, making people all over Uganda increasingly aware of the threats of the epidemic. AIDS hit all sectors and all strata, bringing concern and demand for action. Since then most likely through the effects of both the deaths of AIDS sick and behavioural changes prevalence levels have fallen and are today officially given as 6-7 percent. The Uganda Government initially focused on prevention responses reaching broadly to all people. In the late 1990s, it began to address in a systematic way primary and secondary schools, in terms of their role in prevention as well as the impacts of AIDS on their functioning. Tertiary level educational institutions, among them universities, were only addressed in 2004 (MoES 2004). The traditional autonomy of universities, perhaps combined with an expectation that they are capable of handling their own affairs, may contribute to the lack of Government attention during over twenty years of experience of the epidemic. Lately, the in-house effects of the epidemic on the Government departments themselves have moved into focus. A review of trends in AIDS mortality in government departments was undertaken in 2000 (MoPS 2000). Some departments have since adopted active responses to impacts in their particular areas of responsibility, while the government has worked on the formulation of a comprehensive policy covering ARV services, social support etc. These initiatives could be expected to have a bearing on public sector institutions outside of the Government itself, among them universities. Some universities did take early action. Improved information to students, better access to condoms and voluntary counselling were typical responses (to what extent staff was targeted is less clear). However, once the first wave of AIDS morbidity/mortality had passed, it appears that, as indicated in the quote introducing this article things were allowed to slip back to business as usual. Up to 2005, only two Ugandan universities had adopted policies on HIV/AIDS covering prevention, management and mitigation measures most likely out of concern for future impacts of the epidemic, as neither university had any data on either staff or student HIV infections. Thus, in spite of the importance of universities in national development, of the high costs for running them, of the investments made in the education of students reaching tertiary level, literally nothing is known on the human losses and costs resulting from absenteeism, hospitalisation, death and staff replacement. Nor is there any systematic knowledge of the effects on the quality of teaching, on the maintenance of library or other services, or on the administration of university functions. It is sometimes argued that educated people are more aware of the risks of HIV transmission and thus less likely to get infected. This was certainly not true for the early years of HIV transmission, and evidence about substantial change is weak. The cosmopolitan nature of universities increases the likelihood of higher than average risk for students and staff to capture HIV. Academic staff is known to travel, often leaving their spouse behind. Students may spend considerable time elsewhere on fellowships or research work. Student wards offer little of the protection provided by parents in a family. High-risk practices might be more common there than in other communities (Kelly 2001). Universities themselves have no data to offer. A regional workshop for universities in Lusaka in 2001 found that there is lack of substantiated evidence of prevalence rates for [university] staff and students, while it is extremely difficult, for various reasons, to collect relevant statistical data (ACU 2001 p.3). Statistical data cannot be compiled because the basic information required from departments of finance and personnel is not organised to serve that purpose, or it is regarded as classified. This lack of data can be seen as the expression of a deeper resistance, based in the discomfort people feel having to talk about it, let alone approach it in their working life. Work is now underway to tackle the lack of data (see e.g. Chilisa et al. 2001) As shown by universities where AIDS policies are now adopted or underway, good management data is not highest on the list, nor is it required to get the policy process underway, provided other types of pressure are brought to bear on university leaderships. Building pressure on universities As the epidemic unfolded it was gradually realised that, very much like ordinary people, even organisations operating within a culture of rationality found it difficult to relate to the threat and develop counter-measures. Private enterprises needed much time to move, and in many affected countries the public sector is still to take it on board as an in-house issue. The same goes for many universities, in Uganda as well as in other countries in the region. Networks such as the Association of African Universities (AAU) and the Association of Commonwealth Universities (ACU) were important in calling attention to the situation and to the need to get universities to act. An important commissioned study by Kelly (2001), and later meetings of these associations, disclosed that even where a university had adopted a policy, systematic attention to in-house dimensions of the epidemic were often lacking. As is often the case with discourses on AIDS and the need for behaviour change, the meetings appear to have given more attention to what ought to be done than to the question why in fact so little had been done. This is noteworthy, given that the majority of participants in these meetings were scientists who in their daily work engage in identifying and searching for scientific answers to the many why questions of society. The initiatives of AAU and ACU have however been really worthwhile. An internet search informs that a number of universities in the region have policies and/or are expanding preventive services to students and staff. In Uganda, the two universities of Nkumba and Mbarara have developed and adopted AIDS policies. More universities are likely to follow suit. Makerere a typical case? Makerere is one of the oldest universities in the region. Recovering from the hard years of the Amin government, it is the by far most important university in Uganda, whose policies and actions could be, and possibly are, important guidelines for the whole sector of tertiary education. The many new universities in Uganda have, by and large, drawn their top leaders from the senior ranks of Makerere. Finally, Makerere produces teachers, technical and other professionals whose roles in fighting the epidemic are crucial for a sustainable control of prevalence and impact. As an institution, Makerere lacks an official position on the AIDS epidemic and its own role. Nor is there any formal requirement for such institutions to formulate their role, although such a step would be in line with the seriousness of the epidemic itself. Teaching and research on AIDS is in no way absent from the campus. For instance, the Faculty of Medicine is part of an internationally financed regional network of advanced research, and gives courses on the epidemic to all students. Staff at the Faculty of Social Science is engaged in research as well as in cooperation with Government and other actors. The university hospital has long engaged in activities to support students and staff (see Ennals and Rauan 2002). Providing information on demand, making condoms available, offering counselling and testing are activities that dont require policies as long as resources are made available. Without official support, however, they rarely assume the character of open campaigns that the situation badly requires. The hospital director admits, very few of the staff use the services we offer. Perhaps they feel more safe in the anonymity of a clinic in town (Dr Jane Bosa 2004). This attitude among staff seems to be reflected also in the workings of the administration. No decision has ever been taken, or even contemplated, to make an organised effort to improve AIDS prevention, care and support for staff. On the management side, the implications for the university of loss of staff to AIDS-related mortality, have not been considered. Consequently, no effort has been undertaken to assess the impact of the epidemic on university staff. In this respect, Makerere is no different from other universities in the region. Kelly summarises his findings from seven universities, no one knows exactly what the HIV/AIDS situation is at their respective universities. A thick cloak of ignorance surrounds the presence of the disease on campus. (Kelly 2001, p.iii). Makereres early initiatives: impressive and aborted When AIDS was found to have entered Uganda, Makerere shared the general anxiety in Uganda surrounding the new epidemic and its potential to wreak havoc on society. In the late 1980s, proposals were made for compulsory screening of all new students, aiming at barring students who tested HIV positive from entering the university. It met with immediate resistance and was never implemented. There were however good reasons for concern. A simple undated diagram produced by the Deans office shows a more than four-fold increase in mortality among students from 1983 to 1991. Another graph (drawn by hand) shows that deaths among staff more than doubled from 1989 to 90 and stayed high for the next two years (see Annex for figures retrieved from the graphs). In September 1992, the Uganda AIDS Commission officially raised the question of Makerere University and its role in the fight against AIDS (Lwanga 1992). It was seen as a matter not only of research and knowledge, but also of support to students and of mobilising the university community itself to be bold and take stands, some of which may not be popular (ibid. 36). This action is most likely related to an initiative from within the university. In early 1992, a staff member of the medical faculty, Dr Sam Luboga, approached the University Senate and other bodies within and outside the university, proposing the formation of a university anti-AIDS task force. This was approved, and MUAATF was created at a well attended workshop in August/September the same year. Mortality statistics was presented, a situations analysis debated and a series of recommendations given by important members of the academic community. Despite many task force meetings, the formulation of a five-year plan, the formation of no less than six special committees, and other concrete activities, the initiative gradually faded out. Why? There was no lack of interest in 1993 the task force had more than 30 members. The killing factor appears to be a complete lack of support from responsible university bodies once the workshop had been concluded. There is no record of any meeting of either Senate or Council where the issue was on the agenda. During three years after the workshop, the nucleus of the task force continued its struggle for support, without success. As late as May 1994, the Deputy Vice-Chancellor received a request for some rims of paper for printing the report, and for a seed grant for training seminars and other activities. It was turned down immediately, with reference to the financial constraints faced by the University. The group then turned to the AIDS Control Programme of the Ministry of Health, with the same request. The lack of success is evidenced by a final letter from Dr Luboga directly to the Vice Chancellor in early January 1995, where he once more refers to the workshop and the task force, whose work has led to a substantial workshop report and other documents. Underlining the critical problems caused by the AIDS epidemic, he notes that there are still no funds available to copy the workshop report and circulate it to, among others, the Senate itself. He repeats his requests for seed grant, secretarial services etc. There is no sign that the letter evoked the required response. By this time the students, who had requested active support in their struggle to hold back on HIV transmission, appear to have lost hope in the university leadership. In November 1994 the Makerere Students AIDS Control Association arranged an AIDS Awareness Week. They acted alone, with no cooperation with MUAATF. Dr Luboga was invited in person to attend the event. The university authorities had failed to grasp the opportunity given them by his initiative. A similar fate, though for completely different reasons, was reached by an initiative to create a special social science chair on AIDS-related issues. In the early 1990s UNESCO agreed to finance a chair in the Social Science Faculty, to be held by an Ethiopian ex-UNESCO representative by then based in Johns Hopkins University in USA, provided it was made a twinning arrangement with Johns Hopkins. In the recollection of an involved staff member, the Ethiopian passed away before the project plan was ready, and no money was ever made available to Makerere to replace him. The exact role of Makerere in the UNESCO project still needs sorting out. In the view of the director of the University Hospital when interviewed in 2003, The university authorities agreed to certain actions by the hospital, but for the rest turned their back on AIDS issues. They had decided that beyond that, no special responsibility to care for staff was required. The director should know. The hospital and the Ministry of Health had developed a project, over two years old by the time of the interview and still run only on a small scale. The project aimed to create an ARV treatment centre with testing equipment, counselling and of course access to medicines. Apparently the University leadership had remained reluctant to support the project. Makerere today hope for change? Towards the end of 2003, a change in official attitude seemed to be on the cards. The then Acting Vice-Chancellor had attended a meeting of the AAU in South Africa. He returned with a questionnaire where details of university policies and other AIDS-related activities were to be entered. Consequently, the Hospital Board and the Dean of students were requested to formulate policy proposals. This decision might also have been motivated by the fact that another Ugandan university, Nkumba, had elaborated and published a policy statement on AIDS, finally approved in December 2002. Presumably, Nkumba University was (and is) much more sensitive than Makerere to financial aspects of staff loss, and also concerned to maintain a high quality in its teaching. However, whatever the reasons, Nkumba has done what Makerere should have done a long time ago. There was also internal dissatisfaction with the current state of affairs. During a planning retreat in May 2003, the office of the Academic Registrar decided to request university authorities to prepare a broad policy on AIDS-related issues. There is no doubt that the Council, or at least its Management Committee, was uncomfortable about the situation. Lately, a year-long constraint to change has been removed. The 2001 government act that regulates the appointments of university leadership positions was in December 2002 finally taken on board. The new act gives the Council the role of selecting candidates for the appointment of chancellor, vice-chancellor and deputy vice-chancellors. This gave way for a process of replacing temporary holders of top university positions with permanent staff. In 2004, professor Livingstone Luboobi took up position as vice-chancellor of the university. His record of engagement and activism on AIDS-related issues gave hope for a more dynamic stance by the new university leadership. How it will handle the AIDS impact issue depends on its weight relative to that of other difficult issues not treated by the predecessors, and on what information it has for passing judgement. Today there is a general belief, not checked against evidence, that mortality levels on the campus peaked in the mid-90s, and then stabilised on a lower level. The Dean of students is convinced that his 800 strong support staff is the worst hit on the campus. They work in halls of residence and are believed to mix sexually with students again a belief without clear foundation. All university staff is on the payroll while sick, and persons are removed only if and when they die. So far, no attempt has been made to estimate the financial implications of AIDS. However, the administration is concerned. A sign of this is that the university nowadays is hesitant to employ new support staff in replacement of those who die. To avoid expenses for sick leave and death, it now resorts to recruitment of casual labour on a day-to-day term with no further obligations. The office of the new vice-chancellor still has to prove its dedication to tackle the AIDS epidemic in-house. Little happened in its first year in office. Stimulated by donor pressure, a committee formed most likely during early 2005, headed by the dean of the medical faculty. Its terms of reference, membership etc., are not yet known. Nor has it been possible to extract details about its work so far. The future of this initiative depends not least on the opinion climate and the pressure from other priorities. As remarked a few years back by the current vice-chancellor, AIDS is now very much part of everyday life. A kind of complacency reigns over the place... Indeed, there are many pressing issues on his agenda. Will AIDS remain a second priority? When Muzeweni and NRM took over in the 1980s, Makerere was in a bad state. The university had with difficulty survived the years of the Amin era and needed to be reconstructed. As formulated by Musisi et al. (2003): Makerere's financial resources from both public and external sources declined dramatically in the 'seventies and 'eighties. at the same time that the university was experiencing increasing pressure to expand enrolment. Makerere responded by admitting more students, but with fewer resources than it had had previously for smaller numbers. The most obvious consequence of the decline in financial resources in the 1970s and 1980s was a sharp deterioration in the quality of teaching and learning. Makerere became a place of bare laboratories, empty library shelves, chronic shortages of scholastic materials and overcrowded halls of residence. Sawyerr (undated 2004?, p.3) adds: Among the critical factors behind this sad tale was the chronic under-funding of the university resulting from dramatic declines in government subvention, upon which it was totally reliant. To redress the situation, the university undertook a number of measures aimed principally at generating income independent of government sources. Key among these was the establishment of a quota for fee-paying students over and above the number supported by the government subvention. This involved the running of extra classes and the use of otherwise under-utilised facilities, and special payments to lecturers who taught those courses. /..../ Throughout the 1990s the student enrolment picture was undergoing developments that can only be described as bizarre, especially for a public university. In 1992 government allowed the university to charge fees for evening courses and special programmes. Taking advantage of this, the Faculties of Law and of Commerce started evening classes exclusively for paying students. In 1995 the University Council allowed Faculties to admit fee-paying students to fill quotas not taken up by government-sponsored students. The result was that, from a 1993/94 enrolment of 3,361, made up of 2,299 government sponsored and 1062 private students, the situation metamorphosed to a total enrolment of 14,239, made up of 1,923 government-sponsored and 12,316 private students within six years - with no significant increases in the resources available to the university. This was the situation of Makerere during the early years of the AIDS epidemic. Heavy priorities of a completely different nature most likely explain why both Council and Senate turned their attention away from the threats of the epidemic, leaving initiatives such as the Task Force totally without support. Obviously, they also gave university authorities a kind of justification for not engaging in the sensitive and complex issue of handling HIV/AIDS on the campus. The challenges on staff and administration have in no way been reduced since the early 1990s. According to its web site, today Makerere has around 30000 students and 3 000 post-graduates. Low wages, better alternatives offered by the state or other universities, plus the staff losses caused by AIDS, add to the burdens of staff remaining on campus while being compelled to take other jobs in town to top up their incomes. If staff and administration had their hands full of other problems, the AIDS threat ought to have alerted trade unions on campus into action. Why has this not happened? Some data from meetings with the academic staff association MUASA gives a background. Barred from action by earlier governments, the new political winds brought by Museweni gave trade unions space for rehabilitation and the expectations that relations to the new government would be positive. MUASA staff soon found that its work to improve the material conditions of staff would be an uphill struggle. Even resorting to strikes did not necessarily give results. For instance, the government responded to a strike in the late 1980s by promising to bring salaries up to average levels in the region. Five years later nothing had materialised. When a new strike was called, it appears that it made things worse. One response of the Government was to weaken MUASA by offering important members better-paid government jobs. Those who did not accept still felt they had to keep a lower profile, thus reducing the strength of MUASA. As for salaries, a recent study shows that the salary structure still remains pathetically low a fraction of the levels paid by other universities in the region (MUASA 2003). MUASA has on its agenda a series of issues related to the AIDS epidemic. However, to improve the wage levels is number one, and to win that struggle MUASA has to build itself up to force again. Given the economic situation in Uganda today, it will be a long time before MUASA can expect to leave the salary issue for other pressing issues. In practice, some prevention work but no attention to impacts The University practice that has evolved over the years includes some elements of value. Firstly, in principle all new students undergo a Freshers orientation week, where information about HIV/AIDS is given. There is no general follow-up on this, only for the lucky students the occasional chance to get more information in course inputs at the discretion of the individual teacher. Medical students belong to the lucky: All medical students get training in AIDS issues, and a course in core counselling is offered. So far, more than 800 students have been trained. They should be an asset not only for their peers, but at least potentially for all students in the university irrespective of faculty. Secondly, the University hospital ensures that condom supplies are available. It offers individual counselling to students and staff alike (said to be little used by the latter), and has a good supply of information and other material for those who would like to contribute to information sharing. Testing is not done when this was offered in the 90s, it met with resistance based on the fear that students who would score positive would be dismissed from the university. The fear was not without grounds; as seen from the already mentioned proposal in that direction that was aired and defeated in the late 1980s. Over the years, AIDS has hit not only at students but at staff as well, leaving losses that had to be filled by new recruits. The size of the losses is not known, nor the effects on teaching and administration. Why is this not an issue? Two different factors seem to explain this. Firstly, the weight of demands caused by an exploding student intake combined with unliveable salary levels forcing teaching staff to overburden themselves in work on or outside the campus, makes the running of everyday affairs an overwhelming task even without AIDS losses. Personnel and finance sections work under pressure anyhow, and the planning department cannot carry out any estimates without their collaboration. Nor have any signals to that effect been received from the central administration. As it turns out, when interviewed this dimension had not surged in the thinking of the administration. To some extent this might reflect the prevention only focus dominating two decades of international and national efforts to address the epidemic. A meeting with the Management Committee, composed of the top senior leadership of Makerere, disclosed that prevention condoms and information remained at the top of everyones head. How to handle inevitable staff losses and their financial implications impact mediation was not a task that had engaged the Management Committee. Mainstreaming seemed to be a new term whose meaning escaped members of the Committee. The lack of any data on trends in staff losses and expenses due to AIDS is both indicative of, and a real obstacle to change in, the perception of what the issues are. Explaining the work of institutions The AIDS epidemic is a special type of threat to the functioning of an organisation. Virus transmission through sexual exchange relates to behaviour that normally is protected by the respect for a persons integrity, while also a target for moral norms. Most secular organisations prefer not to touch such dimensions in their dealings with members or employees. The social problems of communicating about sex and risks would make any senior staff hesitate to engage in dialogues with its members or employees on prophylactic behaviour restrictions. In addition, a policy with such orientation has to embrace everyone in the organisation. The typical practice of differentiation in policy and regulations between executive and other levels would render the whole effort meaningless it would simply erode whatever confidence or cooperativeness was there. As an organisation, a university has a number of particular features that provide structural obstacles to rational responses to threat. A private company is distinctly hierarchical, has a clear line of command, needs to fulfil production plans and serve its clients, and is motivated by profits to achieve high productivity. By contrast, a university has a horizontal structure, with an administrative leadership whose main role is to facilitate the work of all semi-autonomous entities (departments, institutes etc.) over whose internal life it has little control. Output measurements are not always clear-cut, and the integrity claims of heads of entities often stand in the way of constructive criticism and policies intended to improve production (i.e. research; education). In his widely accepted categorisation of organisations, Henry Minzberg (1993) ranks universities among so-called professional bureaucracies, whose main purpose (in his terminology standardization of skills) is best achieved by specialists (senior academic staff) exercising considerable control over their work in a highly decentralised organisation. In addition, the specialists also seek various ways to exercise collective control over their work and over the decisions taken by administrative offices, by serving on committees or other bodies. The administrators in turn tend to rely mainly on coordination through mutual adjustments, rather than confronting the professionals where their opinions about matters differ. This all means that the control and intervention power at central levels is weak. Unless heads of department, faculty deans etc themselves want to see AIDS impacts as a high-level priority, interventions require strong justification, backed by (currently non-existing) hard data and/or external support to stand a chance of succeeding. A university is not only a formal organisation, it is also a complex web of network relations and group dynamics. The typology of group/member relations elaborated by Mary Douglas (1982) offers an interesting theoretical approach to the study of this aspect of a university community. It builds on two dimensions: group allegiance or commitment demanded from or given by each member; and the extent of regulation extended over the individual. A university normally gives its academic staff a great deal of freedom to pursue their (scientific) interests, as long as they contribute their part of teaching, supervision etc. Their commitment or allegiance to the university, its continued life and fulfilment of its tasks, is linked to the freedom and autonomy it offers them. Theirs is a kind of contractual relation built on voluntarism and at least in principle judged in terms of its pros/cons. The administrative staff has less freedom and more regulation, and its compliance is likely to be motivated more by considerations over labour market options and the value of staying on in this particular bureaucracy. The same would go for other support staff, whose links to the intellectual world of academia are even weaker than those of administrative staff. A special case is that of academicians who move into high positions in the university administration (VC, DVC, Dean etc), and who are likely to maintain their identification with the academic staff and its rules of conduct. The character and influence of policy-making bodies, the structure of decision-making etc. are important factors for the way universities respond to threats. Already the identification of a threat and the perception of its seriousness are linked to the specific type of social system the university is. Therefore, the interpretations given by staff, even senior staff, of the degree of threat posed by the epidemic and the need for countermeasures, are not necessarily at par with their professional understanding of the epidemic. Minzbergs and Douglas approaches support the contention that a university consists of sub-structures that differ in important ways, yet remain closely linked to each other in their everyday work. The relevance of such differences needs to be closely studied in research supporting the development of AIDS-related policies and actions by university authorities. Concluding comments Scientific rationality is not the only, perhaps not even the prime, guide to universities in their management of internal affairs. In the case of HIV/AIDS, all the subjective factors influencing societys responses are at work even here. It could indeed be argued that the type of organisation and the high value attached to individual freedom of academic staff, make universities particularly poor in dealing with the AIDS threats. Where universities actually fail to respond, as we have seen from the Ugandan scene, research on causes and contexts of failures such as those proposed in this article might be effective in getting them out of the stalemate. After all, scientific discourses are central to dialogue among academic staff. A research programme has both a direct and an indirect agenda. It is a necessary prerequisite to any action in that it clarifies obstacles and can offer insights into ways to tackle them. Further, in a community such as a university, research on its internal functioning is a social action that inevitably influences the community itself. The questions raised in interviews etc. are likely to generate talk in informal contexts, stimulating some to face up to the challenge of AIDS while others might offer the opposite response. The results produced by research cannot be socially neutral, and could provoke talks even in official foras such as senate and council. Student groups and trade unions are likely to take the opportunity to act. The sensitivity of the matter makes it different from most issues raised to research. Any researcher investigating his or her colleagues is likely to run into problems; in this case they could well be insurmountable. Ethics and methodology point in the same direction research might best be carried out by scientists who are alien to a particular university. A key contribution to constructive responses, and a scientifically important issue, is to get the impact of the epidemic clarified in statistical terms. Information on (estimated) AID-related staff absence and staff losses, and calculated financial implications of these losses, are a type of objective data that would propel university authorities into action, as well as add to the neglected field of studies of impact and adjustment. Methods to estimate such impacts remain to be developed. Personnel records and financial data are not organised to enable analysis of this kind. Nor has any substantial work been done to estimate the contribution of AIDS, relative to other causes, to staff absenteeism and loss to death. To tackle these issues is important work whose results can be applied to any organisation. The gravity of the AIDS epidemic for seriously affected countries is indeed an argument for governments to demand from research bodies that they develop scientific programmes directed to the different challenges caused by the epidemic. Concretely, a university could request each individual faculty to develop a research profile reflecting its specific competence in tackling AIDS-related problems. Priorities of this kind would undoubtedly affect the overall university climate in relation to the epidemic, opening also for in-house policies and action. References ACU 2001, HIV/AIDS: Towards a Strategy for Commonwealth Universities; Report of the Lusaka Workshop 7-10 November 2001, available through the ACU website. Chilisa, B., Bennell P. and Hyde K., The Impact of HIV/AIDS on the University of Botswana: Developing a Comprehensive Strategic Response, Univ. of Botswana and DFID, April 2001 Douglas, Mary, Essays in the Sociology of Perception. Routledge & Kegan Paul 1982 Ennals, Alice M., and Rauan, Estrellita C., Status and Impacts of HIV/AIDS in Agricultural Universities and Colleges in Africa. Noragric Report No. 6, February 2002 HIV/AIDS: Towards a Strategy for Commonwealth Universities. Report of the Lusaka Workshop, 7-10 November 2001. Association of Commonwealth Universities and the University of Zambia Katjavivi, Peter, and Barnabas Otaala, African Higher Education Institutions Responding to the HIV/AIDS Pandemic. Paper presented at the AAU Conference in Mauritius March 17-21, 2003 Kelly, M. J., Challenging the Challenger Understanding and Expanding the Response of Universities in Africa to HIV/AIDS. A Synthesis Report for WGHE and ADEA, University of Zambia January 2001 Kirumira, Edward, and Fred Bateganya, Where has all the education gone in Uganda?, IDS Sussex 2003 Lwanga, Stephen K., The Role of Makerere University Senate in the Fight against AIDS: Policy Issues in Management of AIDS with Special Reference to Institutions of Higher Learning. Uganda AID Commission, 1 September 1992 Minzberg, Henry, Structure in Fives; Designing Effective Organisations. Prentice Hall Inc. 1993 MoES 2004, Education and Sports Sector Policy and Guidelines on HIV/AIDS, Ministry of Education and Sports, Kampala, Draft September 2004 MoPS 2000, Baseline Survey of the trends and Impact of HIV/AIDS on the Public Service in Uganda. Final report, Ministry of Public Service, Kampala December 2000 MUASA 2003, Recommendations on revised salary structure for Makerere University academic staff members, MUASA 20.9.03 Musisi, Nakanyike B., and Nansozi Muwanga (2003), Makerere University in Transition, 1993-2000 Oxford: James Currey; Kampala: Fountain Publishers Nkumba University HIV/AIDS Policy, Approved by the 37th Senate of Nkumba University on 13.12.02. Kampala/Entebbe Sawyerr, Akilagpa (undated 2004?), Challenges Facing African Universities, Selected Issues. Association of African Universities,  HYPERLINK "http://www.aau.org/english/documents/asa-challengesfigs.pdf" http://www.aau.org/english/documents/asa-challengesfigs.pdf Annex Evidence on mortality trends from scattered sources Some indirect evidence on the loss of staff is given by interview comments such as that of the University Secretary, that only 50% of positions are filled, or by evidence that for instance masters students have to wait for months to start their thesis work for lack of supervision capacity. More systematic data is not easily available. The few data found so far are summarised below. Deaths among staff and students respectively, selected years, Makerere university 1983198419851986198719881989199019911992Staff deathsn.a.n.a.n.a.n.a.n.a.n.a.27576153Student deaths388991619192210Mortality rates among students0.060.170.230.210.160.420.330.390.38n.a. Sources: Absolute number of deaths; two handdrawn diagrams with numbers entered, probably produced at the time of the University Task Force, author unknown. Mortality rates; graph from Deans office (numbers estimated from points in graph). Definition of mortality rate unknown. Estimated mortality rates for ex-students are found in a study of the professional careers of former Makerere students: Mortality up to end 2001 among ex-students of Makerere University Graduation yearMales (%)Females (%)Total (%)Annualised mortality19803338331.419881513141.119943030.419992021.0 Source: Kirumira and Bateganya 2003  Prof Livingstone S. Luboobi, interview 3.11.03  Prevalence levels give the proportion HIV-infected including the AIDS-sick among sexually active adult populations, i.e. in ages from 15 to 49 years. The estimates are usually based on tests of pregnant women visiting ante-natal clinics.  This does not exclude verbal attention to the AIDS epidemic by academicians, nor does it preclude research on the epidemic and its dynamics in society at large.  The account that follows in this and the next section is based mainly on interviews, supplemented by the limited documentation found so far. Much more work is needed to add substance and detail to the account.  Sources: MUAATF documentation kept by Dr Luboga.  Prof. James Sengendo, Dept of Social Work, interview 31.10.03.  Interview with the director, Dr. Jane Bosa 4.11.03.  Information from University Secretary Sam Byanagwa, October 2003.  The situation is known internationally. A recent review by Katjavivi and Otaala (2003) makes no mention of Makerere University but states that Nkumba University has completed the publication of its policy statement on AIDS, approved by Senate in December 2002.  Interview with dep. reg.. J. Okello 31.10.04. The office had by then not yet decided how to approach the authorities.  The Universities and Other Tertiary Institutions Act No. 7 of 2001.  Interview with Vice-Chancellor Ssebuwufu, 7.4.02;  Interview Dean of students, John Eduru, 7.4.02  Swedish Sida raised the issue of an AIDS policy in negotiating a new cooperation programme starting July 2005. Other donors might have added their weight.  Interview with prof. Livingstone Luboobi 3.11.03  In November 2005 calls for his resignation were published in Ugandan dailies. Following student protests of radical changes in price tags for re-doing exams. The calls were based on impressions that the university administration was not running very smoothly.  Interviews with ex-chair prof. Moses Mubiiki, and with current vice-chair Dr. Kerali, early November 2003.  Firm evidence on the frequency of such initiatives is lacking.  Dr Sam Luboga informed me that he had presented this potential to the Dean of students. After a series of meetings, he had to give up the Deans office was more creative in formulating problems than in searching for solutions. Thus the work remains limited to the Faculty. Some students in mass communication have now found their way to the Faculty and attended a course.  Interviews with former administration up to 2004, new administration during 2005.  In a sense, it reminds of the situation of governments. An official request that universities develop and implement policies on AIDS would be hampered by the traditional autonomy universities enjoy in relation to government.  Research in this direction is in preparation.     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ࡱ> #` :bjbj\.\. .>D>D1 &`'''8','tn?2x(("((()n)$*>>>>>>>$@hCN?1*))1*1*?(((?I4I4I41*((>I41*>I4I4V-;@;(l( G'2jm; <>?0n?y;xVC3VC;VC;(1*1*I41*1*1*1*1*??3^1*1*1*n?1*1*1*1*'' 2.4.06 HIV/AIDS on the Campus: Universities and the threat of an epidemic By Bertil Eger, Dept of Sociology, University of Lund The issue In the early 1990s we got a message that we would have to expect rising sickness and death tolls among staff. It turned out to be true. Some of us got very concerned, and we tried to get everyone involved in counselling and supporting our peers. Over time, the engagement faded out. Now we are more complacent: HIV/AIDS is part of everyday life, something we have to live with. To mobilise for action would be very much harder. (Makerere University professor, 2003) The HIV/AIDS pandemic enters its third decade of expansion, leaving an ever-growing trail of premature deaths in its wake. In Sub-Saharan Africa, Southern Africa is extremely hard hit, while West Africa on the whole is better spared. Uganda, the source of the above quote, succeeded in turning an upward trend of HIV transmission down to a seemingly stable 6 8 percent HIV-positive among adults, a level that is heralded as a sign of success while in an Asian perspective it would be regarded as catastrophically high. No single and effective response to the pandemic has yet been found. Predictions are that it will run its course for many decades ahead. With such devastating impacts, the pandemic should long ago have led nations to mobilise all available resources against the epidemic. Universities, the site of intellectual excellence, should stand in the forefront in fighting social taboos, gender inequalities and other barriers against a general social mobilisation for life-saving changes in sexual relations. On the whole, this mobilisation has not taken place. Few if any universities in Sub-Saharan Africa are in the forefront in the struggle against AIDS. Calls for mainstreaming the epidemic into research are yet to be heard. Only when specifically and systematically targeted have university authorities begun to address HIV transmission within campus and its impacts on education, research and management. This paper summarises some initial work to address the question why universities respond the way they do. The answer is sought not in the attitudes or behaviour of individuals in leading positions, but in the actions of universities as organisations or institutions. How an organisation acts is linked to two central factors; its mandate or purpose, and its structure. Individuals act within structures, working to fulfil mandates if they are leaders, pursuing their own objectives if they are not. Makerere University, the prime university in a country whose leadership is known to have responded early and with determination to the AIDS epidemic, is the case used for the study. Summarising Ugandas responses to impacts in the public sector, and regional responses to inactivity by African universities, the paper analyses developments in Makerere during the period from the early 1990s. The answers offered to the question why in fact universities avoid responding are backed up with references to relevant approaches in organisational theory. Data for the study has been collected during intermittent visits over the last three years. Interviews with academics or administrative staff known for some kind of engagement have enabled identification of historical events and other actors in these events. Archival search has added to and sometimes corrected the memories of those interviewed. Based on this reconstruction of its past, systematic interviews with representatives of Makereres central administration, unions, student organisations etc., have provided insights into the situation of today. The method is not fool-proof. However, using the facts-on-the-ground basis has made it possible to revitalise peoples memories while at the same time avoiding to fall victim of (sometimes consciously) biased recording of events. The national context AIDS entered Uganda through the rural South-Western district of Rakai in the early 1980s. It was made visible through the AIDS-related mortality wave building up over the 1980s, making people all over Uganda increasingly aware of the threats of the epidemic. AIDS hit all sectors and all strata, bringing concern and demand for action. Since then most likely through the effects of both the deaths of AIDS sick and behavioural changes prevalence levels have fallen and are today officially given as 6-7 percent. The Uganda Government initially focused on prevention responses reaching broadly to all people. In the late 1990s, it began to address in a systematic way primary and secondary schools, in terms of their role in prevention as well as the impacts of AIDS on their functioning. Tertiary level educational institutions, among them universities, were only addressed in 2004 (MoES 2004). The traditional autonomy of universities, perhaps combined with an expectation that they are capable of handling their own affairs, may contribute to the lack of Government attention during over twenty years of experience of the epidemic. Lately, the in-house effects of the epidemic on the Government departments themselves have moved into focus. A review of trends in AIDS mortality in government departments was undertaken in 2000 (MoPS 2000). Some departments have since adopted active responses to impacts in their particular areas of responsibility, while the government has worked on the formulation of a comprehensive policy covering ARV services, social support etc. These initiatives could be expected to have a bearing on public sector institutions outside of the Government itself, among them universities. Some universities did take early action. Improved information to students, better access to condoms and voluntary counselling were typical responses (to what extent staff was targeted is less clear). However, once the first wave of AIDS morbidity/mortality had passed, it appears that, as indicated in the quote introducing this article things were allowed to slip back to business as usual. Up to 2005, only two Ugandan universities had adopted policies on HIV/AIDS covering prevention, management and mitigation measures most likely out of concern for future impacts of the epidemic, as neither university had any data on either staff or student HIV infections. Thus, in spite of the importance of universities in national development, of the high costs for running them, of the investments made in the education of students reaching tertiary level, literally nothing is known on the human losses and costs resulting from absenteeism, hospitalisation, death and staff replacement. Nor is there any systematic knowledge of the effects on the quality of teaching, on the maintenance of library or other services, or on the administration of university functions. It is sometimes argued that educated people are more aware of the risks of HIV transmission and thus less likely to get infected. This was certainly not true for the early years of HIV transmission, and evidence about substantial change is weak. The cosmopolitan nature of universities increases the likelihood of higher than average risk for students and staff to capture HIV. Academic staff is known to travel, often leaving their spouse behind. Students may spend considerable time elsewhere on fellowships or research work. Student wards offer little of the protection provided by parents in a family. High-risk practices might be more common there than in other communities (Kelly 2001). Universities themselves have no data to offer. A regional workshop for universities in Lusaka in 2001 found that there is lack of substantiated evidence of prevalence rates for [university] staff and students, while it is extremely difficult, for various reasons, to collect relevant statistical data (ACU 2001 p.3). Statistical data cannot be compiled because the basic information required from departments of finance and personnel is not organised to serve that purpose, or it is regarded as classified. This lack of data can be seen as the expression of a deeper resistance, based in the discomfort people feel having to talk about it, let alone approach it in their working life. Work is now underway to tackle the lack of data (see e.g. Chilisa et al. 2001) As shown by universities where AIDS policies are now adopted or underway, good management data is not highest on the list, nor is it required to get the policy process underway, provided other types of pressure are brought to bear on university leaderships. Building pressure on universities As the epidemic unfolded it was gradually realised that, very much like ordinary people, even organisations operating within a culture of rationality found it difficult to relate to the threat and develop counter-measures. Private enterprises needed much time to move, and in many affected countries the public sector is still to take it on board as an in-house issue. The same goes for many universities, in Uganda as well as in other countries in the region. Networks such as the Association of African Universities (AAU) and the Association of Commonwealth Universities (ACU) were important in calling attention to the situation and to the need to get universities to act. An important commissioned study by Kelly (2001), and later meetings of these associations, disclosed that even where a university had adopted a policy, systematic attention to in-house dimensions of the epidemic were often lacking. As is often the case with discourses on AIDS and the need for behaviour change, the meetings appear to have given more attention to what ought to be done than to the question why in fact so little had been done. This is noteworthy, given that the majority of participants in these meetings were scientists who in their daily work engage in identifying and searching for scientific answers to the many why questions of society. The initiatives of AAU and ACU have however been really worthwhile. An internet search informs that a number of universities in the region have policies and/or are expanding preventive services to students and staff. In Uganda, the two universities of Nkumba and Mbarara have developed and adopted AIDS policies. More universities are likely to follow suit. Makerere a typical case? Makerere is one of the oldest universities in the region. Recovering from the hard years of the Amin government, it is the by far most important university in Uganda, whose policies and actions could be, and possibly are, important guidelines for the whole sector of tertiary education. The many new universities in Uganda have, by and large, drawn their top leaders from the senior ranks of Makerere. Finally, Makerere produces teachers, technical and other professionals whose roles in fighting the epidemic are crucial for a sustainable control of prevalence and impact. As an institution, Makerere lacks an official position on the AIDS epidemic and its own role. Nor is there any formal requirement for such institutions to formulate their role, although such a step would be in line with the seriousness of the epidemic itself. Teaching and research on AIDS is in no way absent from the campus. For instance, the Faculty of Medicine is part of an internationally financed regional network of advanced research, and gives courses on the epidemic to all students. Staff at the Faculty of Social Science is engaged in research as well as in cooperation with Government and other actors. The university hospital has long engaged in activities to support students and staff (see Ennals and Rauan 2002). Providing information on demand, making condoms available, offering counselling and testing are activities that dont require policies as long as resources are made available. Without official support, however, they rarely assume the character of open campaigns that the situation badly requires. The hospital director admits, very few of the staff use the services we offer. Perhaps they feel more safe in the anonymity of a clinic in town (Dr Jane Bosa 2004). This attitude among staff seems to be reflected also in the workings of the administration. No decision has ever been taken, or even contemplated, to make an organised effort to improve AIDS prevention, care and support for staff. On the management side, the implications for the university of loss of staff to AIDS-related mortality, have not been considered. Consequently, no effort has been undertaken to assess the impact of the epidemic on university staff. In this respect, Makerere is no different from other universities in the region. Kelly summarises his findings from seven universities, no one knows exactly what the HIV/AIDS situation is at their respective universities. A thick cloak of ignorance surrounds the presence of the disease on campus. (Kelly 2001, p.iii). Makereres early initiatives: impressive and aborted When AIDS was found to have entered Uganda, Makerere shared the general anxiety in Uganda surrounding the new epidemic and its potential to wreak havoc on society. In the late 1980s, proposals were made for compulsory screening of all new students, aiming at barring students who tested HIV positive from entering the university. It met with immediate resistance and was never implemented. There were however good reasons for concern. A simple undated diagram produced by the Deans office shows a more than four-fold increase in mortality among students from 1983 to 1991. Another graph (drawn by hand) shows that deaths among staff more than doubled from 1989 to 90 and stayed high for the next two years (see Annex for figures retrieved from the graphs). In September 1992, the Uganda AIDS Commission officially raised the question of Makerere University and its role in the fight against AIDS (Lwanga 1992). It was seen as a matter not only of research and knowledge, but also of support to students and of mobilising the university community itself to be bold and take stands, some of which may not be popular (ibid. 36). This action is most likely related to an initiative from within the university. In early 1992, a staff member of the medical faculty, Dr Sam Luboga, approached the University Senate and other bodies within and outside the university, proposing the formation of a university anti-AIDS task force. This was approved, and MUAATF was created at a well attended workshop in August/September the same year. Mortality statistics was presented, a situations analysis debated and a series of recommendations given by important members of the academic community. Despite many task force meetings, the formulation of a five-year plan, the formation of no less than six special committees, and other concrete activities, the initiative gradually faded out. Why? There was no lack of interest in 1993 the task force had more than 30 members. The killing factor appears to be a complete lack of support from responsible university bodies once the workshop had been concluded. There is no record of any meeting of either Senate or Council where the issue was on the agenda. During three years after the workshop, the nucleus of the task force continued its struggle for support, without success. As late as May 1994, the Deputy Vice-Chancellor received a request for some rims of paper for printing the report, and for a seed grant for training seminars and other activities. It was turned down immediately, with reference to the financial constraints faced by the University. The group then turned to the AIDS Control Programme of the Ministry of Health, with the same request. The lack of success is evidenced by a final letter from Dr Luboga directly to the Vice Chancellor in early January 1995, where he once more refers to the workshop and the task force, whose work has led to a substantial workshop report and other documents. Underlining the critical problems caused by the AIDS epidemic, he notes that there are still no funds available to copy the workshop report and circulate it to, among others, the Senate itself. He repeats his requests for seed grant, secretarial services etc. There is no sign that the letter evoked the required response. By this time the students, who had requested active support in their struggle to hold back on HIV transmission, appear to have lost hope in the university leadership. In November 1994 the Makerere Students AIDS Control Association arranged an AIDS Awareness Week. They acted alone, with no cooperation with MUAATF. Dr Luboga was invited in person to attend the event. The university authorities had failed to grasp the opportunity given them by his initiative. A similar fate, though for completely different reasons, was reached by an initiative to create a special social science chair on AIDS-related issues. In the early 1990s UNESCO agreed to finance a chair in the Social Science Faculty, to be held by an Ethiopian ex-UNESCO representative by then based in Johns Hopkins University in USA, provided it was made a twinning arrangement with Johns Hopkins. In the recollection of an involved staff member, the Ethiopian passed away before the project plan was ready, and no money was ever made available to Makerere to replace him. The exact role of Makerere in the UNESCO project still needs sorting out. In the view of the director of the University Hospital when interviewed in 2003, The university authorities agreed to certain actions by the hospital, but for the rest turned their back on AIDS issues. They had decided that beyond that, no special responsibility to care for staff was required. The director should know. The hospital and the Ministry of Health had developed a project, over two years old by the time of the interview and still run only on a small scale. The project aimed to create an ARV treatment centre with testing equipment, counselling and of course access to medicines. Apparently the University leadership had remained reluctant to support the project. Makerere today hope for change? Towards the end of 2003, a change in official attitude seemed to be on the cards. The then Acting Vice-Chancellor had attended a meeting of the AAU in South Africa. He returned with a questionnaire where details of university policies and other AIDS-related activities were to be entered. Consequently, the Hospital Board and the Dean of students were requested to formulate policy proposals. This decision might also have been motivated by the fact that another Ugandan university, Nkumba, had elaborated and published a policy statement on AIDS, finally approved in December 2002. Presumably, Nkumba University was (and is) much more sensitive than Makerere to financial aspects of staff loss, and also concerned to maintain a high quality in its teaching. However, whatever the reasons, Nkumba has done what Makerere should have done a long time ago. There was also internal dissatisfaction with the current state of affairs. During a planning retreat in May 2003, the office of the Academic Registrar decided to request university authorities to prepare a broad policy on AIDS-related issues. There is no doubt that the Council, or at least its Management Committee, was uncomfortable about the situation. Lately, a year-long constraint to change has been removed. The 2001 government act that regulates the appointments of university leadership positions was in December 2002 finally taken on board. The new act gives the Council the role of selecting candidates for the appointment of chancellor, vice-chancellor and deputy vice-chancellors. This gave way for a process of replacing temporary holders of top university positions with permanent staff. In 2004, professor Livingstone Luboobi took up position as vice-chancellor of the university. His record of engagement and activism on AIDS-related issues gave hope for a more dynamic stance by the new university leadership. How it will handle the AIDS impact issue depends on its weight relative to that of other difficult issues not treated by the predecessors, and on what information it has for passing judgement. Today there is a general belief, not checked against evidence, that mortality levels on the campus peaked in the mid-90s, and then stabilised on a lower level. The Dean of students is convinced that his 800 strong support staff is the worst hit on the campus. They work in halls of residence and are believed to mix sexually with students again a belief without clear foundation. All university staff is on the payroll while sick, and persons are removed only if and when they die. So far, no attempt has been made to estimate the financial implications of AIDS. However, the administration is concerned. A sign of this is that the university nowadays is hesitant to employ new support staff in replacement of those who die. To avoid expenses for sick leave and death, it now resorts to recruitment of casual labour on a day-to-day term with no further obligations. The office of the new vice-chancellor still has to prove its dedication to tackle the AIDS epidemic in-house. Little happened in its first year in office. Stimulated by donor pressure, a committee formed most likely during early 2005, headed by the dean of the medical faculty. Its terms of reference, membership etc., are not yet known. Nor has it been possible to extract details about its work so far. The future of this initiative depends not least on the opinion climate and the pressure from other priorities. As remarked a few years back by the current vice-chancellor, AIDS is now very much part of everyday life. A kind of complacency reigns over the place... Indeed, there are many pressing issues on his agenda. Will AIDS remain a second priority? When Muzeweni and NRM took over in the 1980s, Makerere was in a bad state. The university had with difficulty survived the years of the Amin era and needed to be reconstructed. As formulated by Musisi et al. (2003): Makerere's financial resources from both public and external sources declined dramatically in the 'seventies and 'eighties. at the same time that the university was experiencing increasing pressure to expand enrolment. Makerere responded by admitting more students, but with fewer resources than it had had previously for smaller numbers. The most obvious consequence of the decline in financial resources in the 1970s and 1980s was a sharp deterioration in the quality of teaching and learning. Makerere became a place of bare laboratories, empty library shelves, chronic shortages of scholastic materials and overcrowded halls of residence. Sawyerr (undated 2004?, p.3) adds: Among the critical factors behind this sad tale was the chronic under-funding of the university resulting from dramatic declines in government subvention, upon which it was totally reliant. To redress the situation, the university undertook a number of measures aimed principally at generating income independent of government sources. Key among these was the establishment of a quota for fee-paying students over and above the number supported by the government subvention. This involved the running of extra classes and the use of otherwise under-utilised facilities, and special payments to lecturers who taught those courses. /..../ Throughout the 1990s the student enrolment picture was undergoing developments that can only be described as bizarre, especially for a public university. In 1992 government allowed the university to charge fees for evening courses and special programmes. Taking advantage of this, the Faculties of Law and of Commerce started evening classes exclusively for paying students. In 1995 the University Council allowed Faculties to admit fee-paying students to fill quotas not taken up by government-sponsored students. The result was that, from a 1993/94 enrolment of 3,361, made up of 2,299 government sponsored and 1062 private students, the situation metamorphosed to a total enrolment of 14,239, made up of 1,923 government-sponsored and 12,316 private students within six years - with no significant increases in the resources available to the university. This was the situation of Makerere during the early years of the AIDS epidemic. Heavy priorities of a completely different nature most likely explain why both Council and Senate turned their attention away from the threats of the epidemic, leaving initiatives such as the Task Force totally without support. Obviously, they also gave university authorities a kind of justification for not engaging in the sensitive and complex issue of handling HIV/AIDS on the campus. The challenges on staff and administration have in no way been reduced since the early 1990s. According to its web site, today Makerere has around 30000 students and 3 000 post-graduates. Low wages, better alternatives offered by the state or other universities, plus the staff losses caused by AIDS, add to the burdens of staff remaining on campus while being compelled to take other jobs in town to top up their incomes. If staff and administration had their hands full of other problems, the AIDS threat ought to have alerted trade unions on campus into action. Why has this not happened? Some data from meetings with the academic staff association MUASA gives a background. Barred from action by earlier governments, the new political winds brought by Museweni gave trade unions space for rehabilitation and the expectations that relations to the new government would be positive. MUASA staff soon found that its work to improve the material conditions of staff would be an uphill struggle. Even resorting to strikes did not necessarily give results. For instance, the government responded to a strike in the late 1980s by promising to bring salaries up to average levels in the region. Five years later nothing had materialised. When a new strike was called, it appears that it made things worse. One response of the Government was to weaken MUASA by offering important members better-paid government jobs. Those who did not accept still felt they had to keep a lower profile, thus reducing the strength of MUASA. As for salaries, a recent study shows that the salary structure still remains pathetically low a fraction of the levels paid by other universities in the region (MUASA 2003). MUASA has on its agenda a series of issues related to the AIDS epidemic. However, to improve the wage levels is number one, and to win that struggle MUASA has to build itself up to force again. Given the economic situation in Uganda today, it will be a long time before MUASA can expect to leave the salary issue for other pressing issues. In practice, some prevention work but no attention to impacts The University practice that has evolved over the years includes some elements of value. Firstly, in principle all new students undergo a Freshers orientation week, where information about HIV/AIDS is given. There is no general follow-up on this, only for the lucky students the occasional chance to get more information in course inputs at the discretion of the individual teacher. Medical students belong to the lucky: All medical students get training in AIDS issues, and a course in core counselling is offered. So far, more than 800 students have been trained. They should be an asset not only for their peers, but at least potentially for all students in the university irrespective of faculty. Secondly, the University hospital ensures that condom supplies are available. It offers individual counselling to students and staff alike (said to be little used by the latter), and has a good supply of information and other material for those who would like to contribute to information sharing. Testing is not done when this was offered in the 90s, it met with resistance based on the fear that students who would score positive would be dismissed from the university. The fear was not without grounds; as seen from the already mentioned proposal in that direction that was aired and defeated in the late 1980s. Over the years, AIDS has hit not only at students but at staff as well, leaving losses that had to be filled by new recruits. The size of the losses is not known, nor the effects on teaching and administration. Why is this not an issue? Two different factors seem to explain this. Firstly, the weight of demands caused by an exploding student intake combined with unliveable salary levels forcing teaching staff to overburden themselves in work on or outside the campus, makes the running of everyday affairs an overwhelming task even without AIDS losses. Personnel and finance sections work under pressure anyhow, and the planning department cannot carry out any estimates without their collaboration. Nor have any signals to that effect been received from the central administration. As it turns out, when interviewed this dimension had not surged in the thinking of the administration. To some extent this might reflect the prevention only focus dominating two decades of international and national efforts to address the epidemic. A meeting with the Management Committee, composed of the top senior leadership of Makerere, disclosed that prevention condoms and information remained at the top of everyones head. How to handle inevitable staff losses and their financial implications impact mediation was not a task that had engaged the Management Committee. Mainstreaming seemed to be a new term whose meaning escaped members of the Committee. The lack of any data on trends in staff losses and expenses due to AIDS is both indicative of, and a real obstacle to change in, the perception of what the issues are. Explaining the work of institutions The AIDS epidemic is a special type of threat to the functioning of an organisation. Virus transmission through sexual exchange relates to behaviour that normally is protected by the respect for a persons integrity, while also a target for moral norms. Most secular organisations prefer not to touch such dimensions in their dealings with members or employees. The social problems of communicating about sex and risks would make any senior staff hesitate to engage in dialogues with its members or employees on prophylactic behaviour restrictions. In addition, a policy with such orientation has to embrace everyone in the organisation. The typical practice of differentiation in policy and regulations between executive and other levels would render the whole effort meaningless it would simply erode whatever confidence or cooperativeness was there. As an organisation, a university has a number of particular features that provide structural obstacles to rational responses to threat. A private company is distinctly hierarchical, has a clear line of command, needs to fulfil production plans and serve its clients, and is motivated by profits to achieve high productivity. By contrast, a university has a horizontal structure, with an administrative leadership whose main role is to facilitate the work of all semi-autonomous entities (departments, institutes etc.) over whose internal life it has little control. Output measurements are not always clear-cut, and the integrity claims of heads of entities often stand in the way of constructive criticism and policies intended to improve production (i.e. research; education). In his widely accepted categorisation of organisations, Henry Minzberg (1993) ranks universities among so-called professional bureaucracies, whose main purpose (in his terminology standardization of skills) is best achieved by specialists (senior academic staff) exercising considerable control over their work in a highly decentralised organisation. In addition, the specialists also seek various ways to exercise collective control over their work and over the decisions taken by administrative offices, by serving on committees or other bodies. The administrators in turn tend to rely mainly on coordination through mutual adjustments, rather than confronting the professionals where their opinions about matters differ. This all means that the control and intervention power at central levels is weak. Unless heads of department, faculty deans etc themselves want to see AIDS impacts as a high-level priority, interventions require strong justification, backed by (currently non-existing) hard data and/or external support to stand a chance of succeeding. A university is not only a formal organisation, it is also a complex web of network relations and group dynamics. The typology of group/member relations elaborated by Mary Douglas (1982) offers an interesting theoretical approach to the study of this aspect of a university community. It builds on two dimensions: group allegiance or commitment demanded from or given by each member; and the extent of regulation extended over the individual. A university normally gives its academic staff a great deal of freedom to pursue their (scientific) interests, as long as they contribute their part of teaching, supervision etc. Their commitment or allegiance to the university, its continued life and fulfilment of its tasks, is linked to the freedom and autonomy it offers them. Theirs is a kind of contractual relation built on voluntarism and at least in principle judged in terms of its pros/cons. The administrative staff has less freedom and more regulation, and its compliance is likely to be motivated more by considerations over labour market options and the value of staying on in this particular bureaucracy. The same would go for other support staff, whose links to the intellectual world of academia are even weaker than those of administrative staff. A special case is that of academicians who move into high positions in the university administration (VC, DVC, Dean etc), and who are likely to maintain their identification with the academic staff and its rules of conduct. The character and influence of policy-making bodies, the structure of decision-making etc. are important factors for the way universities respond to threats. Already the identification of a threat and the perception of its seriousness are linked to the specific type of social system the university is. Therefore, the interpretations given by staff, even senior staff, of the degree of threat posed by the epidemic and the need for countermeasures, are not necessarily at par with their professional understanding of the epidemic. Minzbergs and Douglas approaches support the contention that a university consists of sub-structures that differ in important ways, yet remain closely linked to each other in their everyday work. The relevance of such differences needs to be closely studied in research supporting the development of AIDS-related policies and actions by university authorities. Concluding comments Scientific rationality is not the only, perhaps not even the prime, guide to universities in their management of internal affairs. In the case of HIV/AIDS, all the subjective factors influencing societys responses are at work even here. It could indeed be argued that the type of organisation and the high value attached to individual freedom of academic staff, make universities particularly poor in dealing with the AIDS threats. Where universities actually fail to respond, as we have seen from the Ugandan scene, research on causes and contexts of failures such as those proposed in this article might be effective in getting them out of the stalemate. After all, scientific discourses are central to dialogue among academic staff. A research programme has both a direct and an indirect agenda. It is a necessary prerequisite to any action in that it clarifies obstacles and can offer insights into ways to tackle them. Further, in a community such as a university, research on its internal functioning is a social action that inevitably influences the community itself. The questions raised in interviews etc. are likely to generate talk in informal contexts, stimulating some to face up to the challenge of AIDS while others might offer the opposite response. The results produced by research cannot be socially neutral, and could provoke talks even in official foras such as senate and council. Student groups and trade unions are likely to take the opportunity to act. The sensitivity of the matter makes it different from most issues raised to research. Any researcher investigating his or her colleagues is likely to run into problems; in this case they could well be insurmountable. Ethics and methodology point in the same direction research might best be carried out by scientists who are alien to a particular university. A key contribution to constructive responses, and a scientifically important issue, is to get the impact of the epidemic clarified in statistical terms. Information on (estimated) AID-related staff absence and staff losses, and calculated financial implications of these losses, are a type of objective data that would propel university authorities into action, as well as add to the neglected field of studies of impact and adjustment. Methods to estimate such impacts remain to be developed. Personnel records and financial data are not organised to enable analysis of this kind. Nor has any substantial work been done to estimate the contribution of AIDS, relative to other causes, to staff absenteeism and loss to death. To tackle these issues is important work whose results can be applied to any organisation. The gravity of the AIDS epidemic for seriously affected countries is indeed an argument for governments to demand from research bodies that they develop scientific programmes directed to the different challenges caused by the epidemic. Concretely, a university could request each individual faculty to develop a research profile reflecting its specific competence in tackling AIDS-related problems. Priorities of this kind would undoubtedly affect the overall university climate in relation to the epidemic, opening also for in-house policies and action. References ACU 2001, HIV/AIDS: Towards a Strategy for Commonwealth Universities; Report of the Lusaka Workshop 7-10 November 2001, available through the ACU website. Chilisa, B., Bennell P. and Hyde K., The Impact of HIV/AIDS on the University of Botswana: Developing a Comprehensive Strategic Response, Univ. of Botswana and DFID, April 2001 Douglas, Mary, Essays in the Sociology of Perception. Routledge & Kegan Paul 1982 Ennals, Alice M., and Rauan, Estrellita C., Status and Impacts of HIV/AIDS in Agricultural Universities and Colleges in Africa. Noragric Report No. 6, February 2002 HIV/AIDS: Towards a Strategy for Commonwealth Universities. Report of the Lusaka Workshop, 7-10 November 2001. Association of Commonwealth Universities and the University of Zambia Katjavivi, Peter, and Barnabas Otaala, African Higher Education Institutions Responding to the HIV/AIDS Pandemic. Paper presented at the AAU Conference in Mauritius March 17-21, 2003 Kelly, M. J., Challenging the Challenger Understanding and Expanding the Response of Universities in Africa to HIV/AIDS. A Synthesis Report for WGHE and ADEA, University of Zambia January 2001 Kirumira, Edward, and Fred Bateganya, Where has all the education gone in Uganda?, IDS Sussex 2003 Lwanga, Stephen K., The Role of Makerere University Senate in the Fight against AIDS: Policy Issues in Management of AIDS with Special Reference to Institutions of Higher Learning. Uganda AID Commission, 1 September 1992 Minzberg, Henry, Structure in Fives; Designing Effective Organisations. Prentice Hall Inc. 1993 MoES 2004, Education and Sports Sector Policy and Guidelines on HIV/AIDS, Ministry of Education and Sports, Kampala, Draft September 2004 MoPS 2000, Baseline Survey of the trends and Impact of HIV/AIDS on the Public Service in Uganda. Final report, Ministry of Public Service, Kampala December 2000 MUASA 2003, Recommendations on revised salary structure for Makerere University academic staff members, MUASA 20.9.03 Musisi, Nakanyike B., and Nansozi Muwanga (2003), Makerere University in Transition, 1993-2000 Oxford: James Currey; Kampala: Fountain Publishers Nkumba University HIV/AIDS Policy, Approved by the 37th Senate of Nkumba University on 13.12.02. Kampala/Entebbe Sawyerr, Akilagpa (undated 2004?), Challenges Facing African Universities, Selected Issues. Association of African Universities,  HYPERLINK "http://www.aau.org/english/documents/asa-challengesfigs.pdf" http://www.aau.org/english/documents/asa-challengesfigs.pdf Annex Evidence on mortality trends from scattered sources Some indirect evidence on the loss of staff is given by interview comments such as that of the University Secretary, that only 50% of positions are filled, or by evidence that for instance masters students have to wait for months to start their thesis work for lack of supervision capacity. More systematic data is not easily available. The few data found so far are summarised below. Deaths among staff and students respectively, selected years, Makerere university 1983198419851986198719881989199019911992Staff deathsn.a.n.a.n.a.n.a.n.a.n.a.27576153Student deaths388991619192210Mortality rates among students0.060.170.230.210.160.420.330.390.38n.a. Sources: Absolute number of deaths; two handdrawn diagrams with numbers entered, probably produced at the time of the University Task Force, author unknown. Mortality rates; graph from Deans office (numbers estimated from points in graph). Definition of mortality rate unknown. Estimated mortality rates for ex-students are found in a study of the professional careers of former Makerere students: Mortality up to end 2001 among ex-students of Makerere University Graduation yearMales (%)Females (%)Total (%)Annualised mortality19803338331.419881513141.119943030.419992021.0 Source: Kirumira and Bateganya 2003  Prof Livingstone S. Luboobi, interview 3.11.03  Prevalence levels give the proportion HIV-infected including the AIDS-sick among sexually active adult populations, i.e. in ages from 15 to 49 years. The estimates are usually based on tests of pregnant women visiting ante-natal clinics.  This does not exclude verbal attention to the AIDS epidemic by academicians, nor does it preclude research on the epidemic and its dynamics in society at large.  The account that follows in this and the next section is based mainly on interviews, supplemented by the limited documentation found so far. Much more work is needed to add substance and detail to the account.  Sources: MUAATF documentation kept by Dr Luboga.  Prof. James Sengendo, Dept of Social Work, interview 31.10.03.  Interview with the director, Dr. Jane Bosa 4.11.03.  Information from University Secretary Sam Byanagwa, October 2003.  The situation is known internationally. A recent review by Katjavivi and Otaala (2003) makes no mention of Makerere University but states that Nkumba University has completed the publication of its policy statement on AIDS, approved by Senate in December 2002.  Interview with dep. reg.. J. Okello 31.10.04. The office had by then not yet decided how to approach the authorities.  The Universities and Other Tertiary Institutions Act No. 7 of 2001.  Interview with Vice-Chancellor Ssebuwufu, 7.4.02;  Interview Dean of students, John Eduru, 7.4.02  Swedish Sida raised the issue of an AIDS policy in negotiating a new cooperation programme starting July 2005. Other donors might have added their weight.  Interview with prof. Livingstone Luboobi 3.11.03  In November 2005 calls for his resignation were published in Ugandan dailies. Following student protests of radical changes in price tags for re-doing exams. The calls were based on impressions that the university administration was not running very smoothly.  Interviews with ex-chair prof. Moses Mubiiki, and with current vice-chair Dr. Kerali, early November 2003.  Firm evidence on the frequency of such initiatives is lacking.  Dr Sam Luboga informed me that he had presented this potential to the Dean of students. After a series of meetings, he had to give up the Deans office was more creative in formulating problems than in searching for solutions. Thus the work remains limited to the Faculty. Some students in mass communication have now found their way to the Faculty and attended a course.  Interviews with former administration up to 2004, new administration during 2005.  In a sense, it reminds of the situation of governments. An official request that universities develop and implement policies on AIDS would be hampered by the traditional autonomy universities enjoy in relation to government.  Research in this direction is in preparation.     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