Discusses factors emerging from research into the management and organizational processes involved in developing services for HIV/AIDS which affected the speed and character of the response made by health authorities. An early response was promoted by perceived high local prevalence, an existing service infrastructure, and high status individuals “championing” the issue and helping to foster a mobilizing sense of crisis. Responses were shaped by the diverse interests and perspectives of those developing services; the lack of established guidelines for treatment and service delivery, and ring‐fenced funding. The idiosyncratic nature of initial service development has sometimes made later strategic choices difficult. If the momentum of service development is to be sustained, HIV/AIDS needs to be integrated into mainstream service provision and managers need improved information about local prevalence and evaluation of service initiatives.
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