The primary objective of this thesis is to explore the role of chronic political instability on the response to the HIV/AIDS epidemic in Guinea-Bissau. The first sub-objective was to understand to which extent political instability and its manifestations have been considered in research conducted during this period on the country’s HIV/AIDS epidemic. The second sub-objective was to understand local stakeholders’ perceptions of the effects of instability on the HIV/AIDS response during the MDG period. We hypothesize that chronic political instability has served as a major barrier to an effective HIV/AIDS response in Guinea-Bissau.

Results – The Viewpoint article reminds the global health community that political and social environments count in the design and implementation of public health programs. As the case of Guinea-Bissau showed, our systematic review identified 122 published journal articles about HIV/AIDS in Guinea-Bissau, and we found six articles containing a specific reference to the country’s political instability. The literature on the HIV/AIDS epidemic is largely biomedical in nature with limited research conducted to date situating the country’s higher HIV/AIDS disease burden in the context of its history of political instability. Our qualitative health research fills this gap and suggests that key stakeholders perceive that the country’s political instability has served as a substantial barrier to the country’s efforts to mount a successful response to HIV/AIDS. Various themes emerged from key informant interviews, such as, the phenomenon of “starting over,” the effects of instability rippling from central level throughout the health pyramid, vulnerable populations becoming more vulnerable, and the emergence of grassroots coping mechanisms at community level.

Conclusion – Building on the themes of the Viewpoint article, the two articles on Guinea-Bissau are the first research to explicitly examine the effects of chronic political instability on the HIV/AIDS disease response in Guinea-Bissau. The systematic review found a heavily biomedical literature on the HIV/AIDS epidemic in this country. Yet the qualitative health study suggests that key informants are eager to discuss the effects of chronic political instability on the HIV/AIDS disease response. It is critical for researchers, funders, and other global health practitioners to account for countries’ overarching political contexts when designing and implementing public health programs.