Between 1990 and 2017, 36.9 million people died of acquired immunodeficiency syndrome (AIDS), and 70.8 million people became newly infected with human immunodeficiency virus (HIV), the virus that causes AIDS. Like other states in East and Southern Africa, Kenya has faced a serious AIDS epidemic; analysts estimate nearly 2 million Kenyans have died of AIDS since it was first diagnosed in Kenya in 1984. The Kenyan government largely ignored the AIDS epidemic until the late 1990s, when the prevalence of HIV reached its peak in the country (affecting roughly 1 in every 10 Kenyans) and bilateral and multilateral funders began to make AIDS a priority. Even after this shift, however, the key actors responding to AIDS in Kenya and elsewhere in Africa were nongovernmental and included people living with HIV and their families, friends, communities, and religious congregations, as well as NGOs. Any researcher who has spent much time in East and Southern Africa can attest to the ubiquitous white SUVs emblazoned with NGO logos and red anti-AIDS ribbons zipping around capital cities and along major highways. Before the publication of Megan Hershey’s Whose Agency, however, we knew very little about the many NGOs responding to AIDS in Africa, and especially about how they interact with the state and with citizens and what, if any, real impact they have in stemming the tide of the epidemic.

Whose Agency sets out to teach us not just about the role of NGOs in the fight against AIDS in Africa but also about the challenges faced by NGOs. They are agents navigating the messy middle between two principals: the citizens who are their intended beneficiaries, and the funders and state officials who provide the resources or permission for NGOs to do their work. HIV/AIDS response in Kenya is the substantive focus of Whose Agency, but the book’s ideas about participatory development, state–NGO relations, and faith-based organizations (FBOs) could be applied to other substantive issues in developing countries beyond HIV/AIDS and the health sector, including disaster relief and education (both development sectors in which NGOs, FBOs, funders, and the state play various roles in delivering services to citizens).

The key takeaway of Whose Agency is that NGOs are flexible and adapt to navigate challenges, whether they are posed by the state, funders, or intended beneficiaries. Hershey’s book encourages even skeptics of the AIDS industrial complex to look at the work being done by local NGOs and find success stories in responding to AIDS in Africa. She empirically substantiates this “success” in the fight against AIDS using meaningful measures, including reports on uptake of HIV testing, a critical behavior for stemming the spread of HIV.

Hershey’s analysis is based on a mixed-methods approach. A great strength in Whose Agency is its triangulation of multiple forms of data to support its claims. Hershey draws on data collected through in-depth interviews, participant observation, focus group discussions, and face-to-face survey interviews. She estimates that she conducted 150 interviews with NGO staff, participants in the HIV training programs put on by the NGOs, and government officials. Whose Agency’s most compelling analysis is its close comparison of four NGOs in Nairobi, Kenya, each occupying a cell in a 2 x 2 matrix of location (university setting or high-density informal settlement) and religion (Christian based or not). Hershey conducted more than six weeks of participant observation with each NGO when she collected most of her fieldwork for the book (from November 2007 to October 2008). The original survey data analyzed in Whose Agency (N = 420) included university students and youth in informal settlements and aimed to be representative of the youth populations in the catchment areas of the four NGOs Hershey studied. Through these methods, Hershey aimed to measure and capture a number of phenomena: the NGOs’ success in transmitting HIV-prevention messages that would spur behavior change, the participation of beneficiaries in designing programming and the representation of beneficiaries’ interests in NGO decision making, the challenges NGOs had and how they responded to them, and to what extent religion featured in the NGOs’ culture and programming.

Unlike many works on AIDS in Africa, Whose Agency is not a technical read. Hershey provides an accessible overview of the Kenyan experience with HIV, the state response to the disease, and what NGOs are and how they operate in Kenya. She draws extensively on her qualitative data, making Whose Agency a fast (and pleasurable) read. One of my favorite passages comes from the description of one of her research sites: Hershey shares a friend’s characterization of Kibera—a high-density informal settlement in Nairobi—as a place where “you can buy anything you need here and in any quantity, including a single squirt of toothpaste” (p. 40).

In addition to the introduction and conclusion, Whose Agency consists of seven chapters. Chapter 1 situates the study, giving readers an overview of what NGOs are, what they can achieve, and how Hershey will measure NGO success. Chapter 2 discusses NGOs in the Kenyan context and provides an overview of the HIV epidemic in Kenya, the state response to HIV, and Hershey’s study sites in Kenya’s capital city Nairobi. In chapter 3, Hershey provides a thick description of the four NGOs she studies, background on the survey data collected for the study, and analysis of the survey data to measure the impact of the four NGOs.

In chapter 4 Hershey combines analysis of survey data with analysis of qualitative data collected through participant observation and in-depth interviews to demonstrate the adaptability of NGOs. Chapter 5 provides an overview of participatory development and then assesses the NGOs’ adoption of participatory practices, highlighting the constraints they face in being more fully participatory. Chapter 6 examines the role of religion in the NGOs’ work through an explicit comparison of the religious and secular NGOs. Chapter 7 complements the work done by Jennifer Brass (2016) in Allies or Adversaries and illustrates concretely how NGOs in Kenya coordinate with the state.

Future research could build on the work Hershey has done here to determine whether one can extrapolate more broadly from “Christian” to “faith-based” NGOs. Although the religious NGOs studied in Whose Agency were exclusively Christian, Hershey suggests that the same findings are likely true for “Islamic, Hindu, or Buddhist identities as well” (p. 136). It is possible, however, that people who practice these religions are in the religious minority in Kenya and other African countries where HIV is endemic and that their faith-based NGOs could operate differently than Christian NGOs.