State Response to the Hiv/Aids Epidemic in Russia: Institutional Factors
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STATE RESPONSE TO THE HIV/AIDS EPIDEMIC IN RUSSIA: INSTITUTIONAL FACTORS A Dissertation Submitted to the Temple University Graduate Board In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY by Elena Sokolova May 2016 Examining Committee Members: Hillel Soifer, Department of Political Science Sandra L. Suarez, Department of Political Science Richard Deeg, Department of Political Science Jennifer K. Ibrahim, College of Public Health © Copyright 2016 by Elena Sokolova All Rights Reserved ii ABSTRACT In the second half of the twentieth century, political scientists observed a remarkable increase in policy convergence across disparate issue areas. The literature on policy diffusion suggests that countries are likely to converge around internationally accepted norms of behavior. These include, for example, public health policies designed to deal with epidemics such as polio, tuberculosis, SARS, and HIV/AIDS. Most countries treat these epidemics in similar and in some cases almost identical ways. States where epidemics emerge relatively late are at an extraordinary advantage. They not only have the expertise of a number of international organizations and their technical assistance at their disposal, but also the experience of other states. Once successful policies to address such epidemics are identified, many states choose to adopt these approaches. However, when it comes to the prevention of HIV/AIDS, Russia’s policy is an outlier. While the Russian Federation is facing the fastest growing HIV/AIDS epidemic in Eastern Europe, it remains one of the few states that refuses to implement key interventions. The goal of this dissertation is to examine why this is the case. I investigate the role of domestic factors in shaping HIV/AIDS policies in Russia. Existing literature suggests that the political regime, the development of civil society, and patterns of federalism are some of the factors that might explain variation in state responses to the HIV/AIDS epidemic. In contrast, I demonstrate that path-dependent factors, such as the influence of the medical epistemic community and the politics of morality, account for the absence of HIV/AIDS policy diffusion in Russia. I argue that in the Russian Federation, HIV/AIDS prevention policies are undermined due to lack of state will and centralized authority. Therefore, individual agencies conduct interventions without a specific mandate to prioritize a iii response to the HIV/AIDS epidemic. These agencies design and implement interventions in accordance with their established priorities, norms, and practices, which are strongly path-dependent. In particular, I show that institutionalized influence of the domestic medical epistemic community and the politics of morality on policy-making processes prevent the adoption of best practices in Russia’s response to the HIV/AIDS epidemic. iv ACKNOWLEDGMENTS I am indebted to my friends, teachers, mentors, and family for helping me succeed in graduate school and finish this dissertation. I am grateful to my colleagues who accompanied me through the ups and downs of graduate school life. I am also grateful to those who inspired me to pursue this path in the first places and who believed that I would succeed in my endeavors. My dissertation advisors, Hillel Soifer and Sandra Suarez, guided me through this dissertation project from its very beginning. Hillel Soifer was always willing to discuss potential ideas for the project, provide detailed feedback on all of my drafts, and help with the methodological aspects of the dissertation. He spent many additional hours during a directed reading seminar discussing ideas in comparative politics. He helped me to break this big project into manageable parts and locate new ideas in times when it felt like new ideas or motivation would never come. Hillel also helped me to develop greater discipline in the process of writing by persuading me to set and comply with self-imposed deadlines. I am grateful to Hillel for his patience, support, encouragement, and guidance. Sandra Suarez provided support for the project, encouraged me to pursue fieldwork in Russia, brainstormed ideas with me, helped me to think about the broader theoretical framework and, most importantly, helped to see a bigger picture beyond this dissertation. Her enthusiasm about my project and my development as a scholar has been of a great support while writing this dissertation. Beyond that, Sandra Suarez helped me to improve my teaching and showed me how to construct beautiful sentences in academic writing. I am also very grateful for the useful suggestions from my other committee members, Richard Deeg and Jennifer Ibrahim. I thank Richard Deeg for chairing my v defense and for being a third reader for this dissertation. I am grateful for his questions and comments that helped me think about how to advance this research further. Jennifer Ibrahim, an external examiner of my dissertation committee, gave me insightful feedback and helped me to think about the public health aspects of my dissertation more rigorously. I thank other professors with whom I worked at Temple University and who were helpful in developing ideas towards this dissertation and building research and writing skills: Mark Pollack, Orfeo Fioretos, Sean Yum, Meghan Mullin, Ryan Vander Weilen, Kevin Arceneaux, Heath Fogg Davis, Michael Hagen, Robin Kolodny, Gary Mucciaroni, and John Masker. I especially thank Roselyn Hsueh for being an excellent mentor, discussing research ideas with me, showing me how to conduct interviews, sharing with me how to overcome challenges that women face in academia, and for being supportive of my pursuits. Ariadna Alexandrovna Petrova, my undergraduate advisor at St. Petersburg State University, has been an unwavering supporter of my academic pursuits and encouraged me to follow the academic path further. I am grateful for her friendship and encouragement. I am also grateful to have a group of supportive colleagues who made this path a worth-while endeavor. I thank them for their friendship, help, support, and also for discussing ideas, reading drafts, providing feedback, and simply sharing this path. I especially want to thank my theory colleagues, whose ways of teaching, doing research, building human connections, and thinking about justice have been inspirational to me. I am grateful for Alex Melonas, Desiree Melonas, Susan Alunan, Brett Miller, Erin Maher, vi Brinn Cassidy West, and Ashish Vaidya. I also thank Gorana Draguljich, Justin Murphy, Arnold Kim, Heather Bosak, Stefanie Kasparek, Meghan Rubado, John Hebert, Amanda Milena Alvarez, Aja Binette, Arnold Kim, Nick Anspach, Pat Amberg-Blyskal, Everett Vieira, Theresa Cotter, Lauren Farmer, Daniel Scherer, Caroline Tynan, Michael McCarthy, Josh Leon, Krystina Litton, and Merim Baitimbetova. I thank the Political Science department for supporting conference travel and providing me the opportunity to further expand my research skills at the Institute for Qualitative and Multi-Methods Research. I also thank the department and Graduate School for grants that helped me to have uninterrupted time to work on the dissertation manuscript. The Open Society Foundation provided funding to conduct interviews in Russia, which were crucial to the success of this project. I am grateful for the opportunity, provided by the Open Society, to participate in a conference in New York, where I had an opportunity to present my research and connect with other scholars from Eastern Europe and former Soviet States. I thank Vladimir Zolotov for helping with the logistics of my fieldwork in Moscow. I thank the People’s Friendship University of Russia, which provided me with accommodations during my stay in Moscow. My writing greatly improved with the help of tutors at Temple University’s Writing Center. Leslie Allison and Lorraine Savage do an excellent job of making the Writing Center a valuable resource for graduate students and the friendliest place on campus. I thank writing center tutors, Mark Emerick and Deirdre Kellher, for readings drafts of all chapters in this dissertation, for patiently helping me to formulate my ideas, vii and for introducing me to the intricacies of writing in English. I received other invaluable support in writing from Anne Louise Antonoff and Louis O’Neill, who read drafts of my applications and papers. I would also like to thank Ariel Weiss, my Alexander Technique teacher, who made sure that I do all my writing with a proper posture. I also thank Talya Escogido for teaching me wisdom and for her advice, insights, and support. It was only with the love and support of my friends and family that I was able to pursue graduate school and finish this dissertation. They helped me stay focused and cheered me up on the gloomy days—for that reason I believe it takes a village to write a dissertation. I will never be able to adequately return their kindness. I thank Omur Arslan, my greatest champion, for sharing experiences in Philadelphia, reading everything that I write, and being my most supportive friend and partner. I thank Lyuda Dunayeva for being my friend for as long as I can remember, with whom I can confide in pretty much anything. I also am grateful to have met friends in Philadelphia who shared with me many adventures and with whom many memories were created—Arjun Bhgavata, Kseniya Gorbenko, Kevin Gruenfeld, Igor’ Safonov, Andrew Wrigley, Sundeep Kaur, Maria Kozitska, and Suzan Tandojo. I thank Alfonso for his wonderful spirit. My wise friend and mentor Gabor Solano has always been a support and inspiration. My friends in Russia patiently waited for me to finish the dissertation, occasionally visited me in the US, made me feel as if I have never left during my short visits home, and believed that graduate school is a worthwhile endeavor. I am very grateful to have in my life Natasha Somova, Veronika Somova, Andrey Krylov, Lesha Evstafiyev, Dima Matrenko, Lena Petiforova, Nadya Vasilyeva, Alyona Sukhanovskaya, viii Anya Serova, Anton Lyutynskiy, Olya Vorobyeva, Lena Leshko, Lesha Bratakhin, and Artyem Zhirnov.