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Adopting HIV/AIDS Policy in Russia and South Africa, 1999-2008 Syracuse University SURFACE Maxwell School of Citizenship and Public Political Science - Dissertations Affairs 2011 Treatment as a Common Good: Adopting HIV/AIDS Policy in Russia and South Africa, 1999-2008 Vladislav Kravtsov Syracuse University Follow this and additional works at: https://surface.syr.edu/psc_etd Part of the Political Science Commons Recommended Citation Kravtsov, Vladislav, "Treatment as a Common Good: Adopting HIV/AIDS Policy in Russia and South Africa, 1999-2008" (2011). Political Science - Dissertations. 97. https://surface.syr.edu/psc_etd/97 This Dissertation is brought to you for free and open access by the Maxwell School of Citizenship and Public Affairs at SURFACE. It has been accepted for inclusion in Political Science - Dissertations by an authorized administrator of SURFACE. For more information, please contact [email protected]. ABSTRACT The goal of this dissertation is to increase our understanding of domestic policy responses to initiatives and expertise as provided by international health organizations. Although following international recommendations often improves domestic public health, in certain circumstances resistance to adopting them persists. My core theoretical argument suggests that a strong societal agreement about what constitutes the ―common good‖ served by state (e.g., ―social purpose‖) informs how domestic policy-makers evaluate the benefits of adopting international recommendations. This agreement also affects how governments frame the provision of treatment, decide which subpopulations should benefit from the consumption of public good, and choose their partners in policy implementation. To demonstrate the impact of social purpose I examine how, why and with what consequences Russia and South Africa adopted the external best case practices, guidelines, and recommendations in regard to the HIV/AIDS treatment. In doing so, I investigate how major international health, developmental, and financial organizations formulated the global HIV/AIDS policy, and devise a set of indicators operationalizing this policy. Then, I use these indicators to design a structured, focused comparison of the domestic HIV/AIDS policy responses and empirically demonstrate that governments in both states created policy environments sanctioning a highly selective approach to international policy guidelines and recommendations. Rather than responding to the epidemic as a pressing public health issue Russia‘s ―Sovereign Democracy‖ prompted the government to respond to HIV/AIDS as the issue of demographic survival and criminal drug abuse. This choice subsequently eroded the human rights component from the official policy, overcommitted the government financially, and frustrated the cooperation with private sector and civil society. The imperatives of ―African Renaissance‖ reframed the HIV/AIDS epidemic as a local developmental problem. As a result, the Cabinet supported substandard biomedical treatments and indigenous healing practices, consistently resisted the universal and free rollout of treatment in order to avoid the undesirable governmental expenditures and redistributive strategies. In both countries, these policy choices resulted in the adverse consequences for public health and prompted a protracted contestation among various state and non-state actors around the principles of the desired public health policies. TREATMENT AS A COMMON GOOD: ADOPTING HIV/AIDS POLICY IN RUSSIA AND SOUTH AFRICA, 1999-2008 By Vlad Kravtsov MA, Syracuse University, 2005 BA, Russian State University for the Humanities, 1999 DISSERTATION Submitted in partial fulfillment of the requirements for the Doctor of Philosophy degree in Political Science in the Department of Political Science Maxwell School of Citizenship and Public Affairs Syracuse University, Syracuse, NY 13244 May 2011 Copyright 2011 Vlad Kravtsov CONTENTS Contents ........................................................................................................ vi Acknowledgments......................................................................................... vi List of Acronyms .......................................................................................... vi Chapter 1. Introduction .................................................................................. 1 Argument in brief ....................................................................................... 6 Why HIV/AIDS? ..................................................................................... 12 Social purpose: a brief discussion ............................................................ 19 Social purpose as a concept .................................................................. 19 Social purpose as an explanation .......................................................... 23 Social purpose and constructivism ....................................................... 29 Social purpose and identity .................................................................. 34 A further look at cases and comparisons .................................................. 36 Dissertation structure (The rest of the argument) ..................................... 42 Chapter 2. International policy initiatives against HIV/AIDS: operationalizing the consensus ..................................................................... 50 Treatment ................................................................................................. 52 Indicator 1a: The pandemic as a public health crisis ............................ 53 Indicator 1b: Standardized protocol in treatment ................................. 59 Indicator 1c: Check on prices and the availability of generics ............. 68 Universality .............................................................................................. 73 Indicator 2a: Providing ARVs to key vulnerable groups ...................... 74 Indicator 2b: Scaling up as a proxy for universality ............................. 81 Indicator 2c: Treatment as an integral part of prevention ..................... 85 Partnerships .............................................................................................. 89 Indicator 3a: Public-private partnership ............................................... 90 Indicator 3b: Partnerships with international health organizations ....... 94 Indicator 3c: Partnership with civil society sector ................................ 99 Conclusion ............................................................................................. 104 Chapter 3. Social purpose: a framework of analysis .................................. 106 vi Muddling through the core debates ........................................................ 108 Discourse and oversocialization ......................................................... 109 Agency and intentionality .................................................................. 115 The framework of analysis ..................................................................... 120 Social purpose and elite‘s commitments ............................................ 123 Social purpose and its public legitimacy ............................................ 130 Social purpose and public culture....................................................... 138 The effects of social purpose on public policy ....................................... 147 Conclusion ............................................................................................. 153 Chapter 4. Social purpose in Russia (Sovereign democracy) ..................... 155 Elite‘s commitment to Sovereign Democracy ........................................ 157 Strong state as an ultimate political value .......................................... 163 State-led development ........................................................................ 168 Great power in the multipolar world .................................................. 175 Sovereign Democracy and its public legitimacy .................................... 179 Strong state as an ultimate political value .......................................... 184 State-led development ........................................................................ 190 Great power in the multipolar world .................................................. 195 Sovereign Democracy in collective articulations ................................... 201 Strong state as an ultimate political value .......................................... 206 State-led development ........................................................................ 210 Great power in the multipolar world .................................................. 216 Conclusion: Ranking national purpose ................................................... 218 Chapter 5. Social purpose in South Africa (African Renaissance) ............. 219 Elite‘s commitment to African Renaissance........................................... 222 Indigenousness: return to the roots ..................................................... 227 Marketization as the economic empowerment ................................... 231 Ubuntu in the context of globalization ............................................... 235 African renaissance and its public legitimacy ........................................ 239 Indigenousness: return to the roots ..................................................... 245 Marketization as the economic empowerment ................................... 249 vii Ubuntu in the context of globalization ..............................................
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