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Why do some African states commit more effectively than others to the fight against AIDS? How do power inequalities and decision-making institutions shape Africa's ability to combat the disease? Within the context of debates about the nature of the African state, its relations with civil society, and its reliance on external donors, Amy Patterson presents a systematic study of African state efforts to battle the AIDS epidemic. Patterson directly tackles the topics of power, representation, accountability, and leadership. She closely examines the impact of formal and informal institutions, transitions to democratic governance, and pressures from the international community. Her focus on the politics of state actions brings to the forefront the crucial need for a new, constructive, and sustainable politicization of the struggle against AIDS.