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United States Foreign Policy Toward HIV/AIDS in Africa Loyola University Chicago Loyola eCommons Dissertations Theses and Dissertations 2016 United States Foreign Policy Toward HIV/AIDS in Africa: The Role of Pharmaceutical Companies in the Formulation and Implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR) 2003-2008 Toussaint Kafarhire Murhula Loyola University Chicago Follow this and additional works at: https://ecommons.luc.edu/luc_diss Part of the International Relations Commons Recommended Citation Kafarhire Murhula, Toussaint, "United States Foreign Policy Toward HIV/AIDS in Africa: The Role of Pharmaceutical Companies in the Formulation and Implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR) 2003-2008" (2016). Dissertations. 1948. https://ecommons.luc.edu/luc_diss/1948 This Dissertation is brought to you for free and open access by the Theses and Dissertations at Loyola eCommons. It has been accepted for inclusion in Dissertations by an authorized administrator of Loyola eCommons. For more information, please contact [email protected]. This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. Copyright © 2015 Toussaint Kafarhire Murhula LOYOLA UNIVERSITY CHICAGO UNITED STATES FOREIGN POLICY TOWARD HIV/AIDS IN AFRICA: THE ROLE OF PHARMACEUTICAL COMPANIES IN THE FORMULATION AND IMPLEMENTATION OF THE PRESIDENT’S EMERGENCY PLAN FOR AIDS RELIEF (PEPFAR) 2003-2008 A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL IN CANDIDACY FOR THE DEGREE OF DOCTOR OF PHILOSOPHY PROGRAM IN POLITICAL SCIENCE BY TOUSSAINT KAFARHIRE MURHULA, S.J. CHICAGO, IL MAY 2016 Copyright by Toussaint Kafarhire Murhula, S.J., 2016 All rights reserved ACKNOWLEDGEMENTS I am grateful primarily to God and to my Ancestors because throughout my entire life they have supported, encouraged, and challenged me to always strive to understand that which should matter most about our human condition. HIV/AIDS, as a matter of life and death, is such an issue. It requires undivided attention, focused knowledge, and our deepest understanding in order to produce the best policies that will help promote the dignity and welfare of all those who are vulnerable to the pandemic. I was blessed to work with terrific scholars whose insights and rigor challenged me and benefited my work tremendously. Throughout the entire process of my research and writing, all three professors who made up my dissertation committee – Prof. Vincent Mahler, Prof. Peter Sanchez, and Prof. Peter Schraeder – contributed constructively and significantly to the final product of my research project. Prof. Vincent Mahler was very thorough in reading my drafts and proposing how to refine my ideas. While he provided me with similar cases to compare and contrast my own research, Prof. Peter Sanchez was keen to discuss the substance of my arguments and broaden my perspectives. And Prof. Schraeder, my dissertation supervisor has been the very model of mentorship. He simply embodies what it means to be an educator; that is, a guide and leader who seeks to produce the best out of you. Selfless, insightful, challenging, such guidance, undivided attention, encouragements, and support led me through the writing process. To all three professors who saw me through moments of self-doubt in the process of completing the writing, I owe an inestimable debt of gratitude. iii Of course, I would not have come to this program in the first place without the financial support that my Order secured for me. To the Society of Jesus and to all my fellow Jesuit brothers both in my Central Africa Province (ACE) and in the Chicago- Detroit Province (CDT), to the US Jesuit Conference, and to my Loyola University Chicago Jesuit community, I say a deep thank you. In a special way, I would like to acknowledge here that my religious superiors took the time and the trouble to travel long distances every year – from the Democratic Republic of the Congo to Chicago – to bring me the needed “cura personalis.” Although naming names incurs the danger of forgetting some very important people, I will mention a few of the other Jesuits who were instrumental in the completion of my work. These include Brian Paulson and Jim Hayes, Kevin Flaherty; Si Smith, Tom Worcester, Bob Birely and all the Jesuit Scholastics with whom I shared the community life at Gonzaga. I am particularly grateful for the blessing that my family has always been to me. My father Heliodore Kafarhire and my mother Alice Bazalake and all my siblings have simply given me what any human being expects from his own: love, trust, and support. My late Aunt Dr. Pelagie Selemani is not here to celebrate the joy of my crossing the finish line but my gratitude will find its way to wherever she is. My faith has expanded during my studies in Chicago to see beyond what I believed during my childhood. And while this wonderful yet adventitious family was too far away, unable to soothe my Chicago winters’ anguishes, God gave me another family: Stacy Fifer and John Conour and their daughters. I am equally grateful to my brother Tom and his wife Cher; and to iv my other American family Terry Johnson and Lunell Anderson whose families I consider my own. I cannot fail to mention the friendship of my many other friends. I count you all among my Chicago blessings. They helped dampen the scourges of the doctoral studies nightmares and the “dépaysement” of living in a different culture. I won’t be able to name them all. Yet, they all contributed to my growth process while my doctoral studies lasted. I think particularly of Emmanuel Bueya, Charlotte Stroumza, and Bemnet Yigzaw to whom I owe them a huge debt of memory. Last but not least, my special gratitude goes to Fr. Jerry Overbeck (Pono), a man I will live to always love and respect. He taught me the wisdom of patience, authenticity, and the mantra from Helen Steiner Rice’s verses that “This Too Shall Pass!” v TABLE OF CONTENTS ACKNOWLEDGEMENTS .............................................................................................. iii LIST OF TABLES .......................................................................................................... viii LIST OF ABBREVIATIONS ............................................................................................ ix ABSTRACT .................................................................................................................... xiii CHAPTER ONE: HIV/AIDS IN AFRICA AND US FOREIGN POLICY ........................ 1 Introduction ...................................................................................................................... 1 Understanding the Context of the HIV/AIDS Pandemic ................................................. 4 Overview of the PEPFAR Initiative ................................................................................. 8 Context of the Bush Administration’s Decision to Launch PEPFAR ............................ 13 Research Questions and Rationale of the Study ............................................................. 16 Chapter Summaries and Organization ............................................................................ 20 CHAPTER TWO: COMPETING THEORIES AND THE ROLE OF US PHARMACEUTICAL COMPANIES IN THE MAKING OF PEPFAR ...................... 23 Introduction .................................................................................................................... 23 Classical Explanations of PEPFAR ................................................................................ 25 President Bush’s adherence to compassionate conservatism ...................................... 25 The presidential politics argument .............................................................................. 39 The domestic politics and the Christian evangelical right ........................................... 50 A Brief Overview of US Foreign Policy Toward Africa ............................................... 57 Neoliberalism and Privatization in US Foreign Policy .................................................. 67 The Private Corporations’ Influence on US Foreign Policy Toward HIV/AIDS .................................................................................................................... 76 PEPFAR as a Paradigm of Neoliberal Welfare Privatization ........................................ 90 Research Methodology ................................................................................................... 95 CHAPTER THREE: HISTORICAL CONTEXT AND EVOLUTION OF US HIV/AIDS FOREIGN POLICY FROM REAGAN TO CLINTON 1981-2001 .......... 106 Introduction .................................................................................................................. 106 The Reagan Administration 1981-1989 ....................................................................... 107 Origins and evolution of the HIV/AIDS pandemic ................................................... 107 The Reagan administration response to the HIV/AIDS problem .............................. 111 The Clinton Administration 1993-2001 ....................................................................... 131 Evolution of the US response to the HIV/AIDS problem ......................................... 131 Conclusion .................................................................................................................... 156 CHAPTER FOUR: CONTRIBUTION OF US PRIVATE PHARMACEUTICAL COMPANIES TO THE MAKING OF US HIV/AIDS FOREIGN POLICY TOWARD AFRICA UNDER THE BUSH ADMINISTRATION
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