For these two reviewers—one a historian who teaches on global health interventions, and the other a recent graduate headed to the Peace Corps—Kim Yi Dionne’s new book, Doomed Interventions: The Failure of Global Responses to AIDS in Africa, provides much to consider about what is right, wrong, misguided, or in desperate need of change in regard to AIDS interventions on the African continent. Dionne is an exemplary researcher with long experience on the continent, first as a volunteer herself; she is currently Assistant Professor of Political Science at UC Riverside. For this book she draws on a rich and diverse data set, including interviews and surveys she herself conducted, public opinion polls, local news sources, and extensive observations. The book offers a critical analysis of why AIDS interventions in Africa often fail, arguing that misaligned priorities between external actors and intended beneficiaries often lead to unsuccessful interventions.
Dionne’s book has seven chapters and is organized thematically. She begins with a broad overview of some of the challenges associated with AIDS development projects, then narrows to focus on Malawi, concluding by suggesting some solutions to the challenges she discusses. Chapter Two’s overview includes a discussion of how AIDS is understood and responded to differently across the continent. Here, she emphasizes that while AIDS has been a top priority among international donors, many Africans have not considered it to be the primary challenge facing their communities. It is an introduction to the profound disconnect between international and local priorities and desired responses to the AIDS challenge. Chapter Three speaks to the inevitable problems stemming from what Dionne terms the “global-to-local supply chain,” where international actors’ priorities and methods for intervention are valued over local interests and considerations. Chapter Four provides an overview of the study site and how responses to AIDS have evolved in Malawi, setting up her discussion for why AIDS interventions have failed and her practical suggestions for how international aid frameworks need to shift.
Chapters Five and Six answer those two key questions, suggesting that prioritizing “powerful donor” interests over those of local citizens ultimately lays the foundation for failed interventions. She argues, based on the Malawian case study, that more generally, the success of AIDS interventions “depends on how they are received by local populations” (101). Dionne argues that without the involvement of local communities in these types of programs, such interventions will struggle to succeed. Within the body chapters, she offers some ways to re-orient global health programs to better represent local interests, including better utilizing village headmen, who are well positioned to represent local interests.
Dionne concludes by calling on global health actors and policy makers to reevaluate their methods for interventions. More specifically, she argues that the priorities of the citizens need to be central, shifting the narrative away from that of a “global-to-local” approach to a more grassroots-oriented framework. Dionne provides some refreshing insight into how to realistically move to more productive and sustainable programming.
Doomed Interventions is appropriate for undergraduate audiences, though some of the language in the early chapters may be unfamiliar to non-political scientists or economists. For those working in global health or international development—or new grads considering careers in these areas—it is an important reminder of the limits of current models and ways of working. A real strength of the book is how Dionne’s arguments are always sensitive to local considerations and how the needs, priorities, and understandings of African community members are reintegrated. Dionne’s work is not only a rich and insightful contribution to the academic literature, but also provides some pragmatic solutions that international aid and global health workers would be wise to consider.
