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Back | Programme Area: Social Policy and Development (2000 - 2009)

Mozambique's HIV/AIDS Pandemic: Grappling with Apartheid's Legacy



This study focuses on how apartheid, through its economic structures and wars of destabilization to preserve white minority rule, helped shape and deepen Mozambique’s HIV/AID pandemic, and how this tragic legacy continues to this day.

Formal apartheid, and its efforts to destabilize black majority–ruled neighbours via proxy rebel movements, ended in Southern Africa in the early 1990s. Following the peace agreement in 1992, Mozambique achieved significant progress in economic and social reconstruction. But this progress is being undercut by a deepening HIV/AIDS pandemic significantly shaped and accelerated by the legacies of apartheid, and by the economic structures of colonial and white minority rule that continue to operate in the present.

This study analyses how Mozambique’s HIV/AIDS pandemic was shaped by the complex interplay between multiple factors, all of which boosted the risk factors for HIV infection, in particular:
  • the legacy of Portuguese colonialism (including the region-wide, low-wage migrant labour system and the paucity of public health services at independence);
  • the violence and social chaos wrought by the apartheid-sponsored war from 1980 to 1992, which, through its massive disruption of family life, displacement of close to 40 per cent of all Mozambicans and destruction of transport and health infrastructure, crucially determined the geographic pattern and timing of the spread of HIV/AIDS across the country and undermined governmental capacity to respond to it;
  • the necessity of relying on high HIV–prevalent neighbouring states to help defend Mozambique’s infrastructure and for refuge from the chaos of war;
  • the failure or inability to institute effective HIV prevention programmes among returning refugees; and
  • the imposition of economic and other policies, under donor pressure, which have served to limit the access to basic health care that is fundamental to countering such a pandemic.


This study analyses how war-induced dependency on outside donors undermined the Mozambique government’s autonomy in setting national health policy as well as its capacity to implement an effective national strategy. It also looks at how externally imposed structural adjustment conditions undercut Mozambique’s response to the HIV/AIDS pandemic in various ways.

Mozambique’s experience demonstrates the urgent need to initiate HIV/AIDS prevention programmes for refugees, internally displaced persons and soldiers before as well as following armed conflicts—or risk seeing recovery efforts undermined by a worsening HIV/AIDS pandemic. A high cost has been paid by Mozambicans for donor unwillingness to seriously redress, on the scale needed, the apartheid-wrought damage to Mozambique’s health infrastructure.

But if donors and African governments are really serious about wanting to stem the rising tide of HIV/AIDS, they must begin to develop long-term alternatives to the region-wide low-wage migrant labour system, which continues to fragment family life and boost risk factors for HIV, and to the dominant export-led development model on which this system is premised.
  • Publication and ordering details
  • Pub. Date: 1 Feb 2006
    Pub. Place: Geneva
    ISSN: 1020-8208
    From: UNRISD