The Role of Governments in the Fight Against HIV/AIDS

On the cluster map illustrating the electronic network surrounding HIV/AIDS (posted below on September 14), six different government websites show up: Sweden, Australia, the United States, the UK, Norway, and Switzerland. Three of these, Switzerland, Sweden, and the United States have all been host countries for the 12th, 4th, and 1st/3rd/6th International AIDS Conference, respectively. Australia hosted the 4th Annual IAS Conference on HIV Pathogenesis, Treatment and Prevention. Recently, Sweden has also hosted the 2007 International Workshop on HIV/AIDS with a focus on preventative work and led by two ministers from the Swedish government. 

The United States identifies itself as "a world leader in responding to the global pandemic of AIDS," the USAID website noting that:

The U.S. government has made the fight against HIV/AIDS a top priority, not only for humanitarian reasons, but because the HIV/AIDS crisis threatens the prosperity, stability, and development of nations around the world. USAID has funded almost $6 billion since inception of its international HIV/AIDS program in 1986, more than any other public or private organization. USAID currently has HIV/AIDS programs in nearly 100 countries worldwide.

In addition to USAID, the US launched the President's Emergency Plan for AIDS Relief (PEPFAR), which was recently resigned to continue for another five years. This plan increased US financial contribution for HIV/AIDS, malaria and tuberculosis by $48 billion.  Interestingly, on the PEPFAR website they make explicit their partnerships with civil society organizations, noting that "PEPFAR’s success is rooted in support for country-owned strategies and national programs with commitment of resources and dedication to results, achieved through the power of partnerships with governments, non-governmental, faith- and community-based organizations, the private sector, and groups of people living with HIV/AIDS. In 2007, 87 percent of PEPFAR partners were indigenous organizations, and nearly a quarter were faith-based."

The UK government's Department of International Development (DFID) has made a commitment to work on the UN's Millenium Development Goals, one of which is the eradication of HIV/AIDS, malaria, and tuberculosis. The Swedish International Development Cooperation Agency (SIDA) has pledged their support to UNAIDS, civil society organizations working on prevention and treatment. These exemplify a common pattern of AIDS being picked up by government offices of international development once it had been successully reframed as such an issue. As mentioned in my previous post, a major player in the reframing of AIDS as a global development issue was the UN, not only in its formation of an alliance between development-related agencies under UNAIDS, but also in their inclusion of HIV/AIDS eradication as one of the six Millenium Development Goals. The impact of this inclusion on the movement of governmental bodies on the issue is made explicit in an Evaluation Report released by the Norwegian government in which they note that "in the year 2000, the HIV/AIDS challenge was made a priority for Norwegian Development Cooperation; the time coincided with the period that HIV/AIDS was given growing political attention with the adoption of Millennium Development Goals (MDGs) by World Leaders."

The UN and HIV/AIDS Agenda Setting

The issue of HIV/AIDS has a long history of being taken up by various UN agencies. Coinciding with the reframing of HIV/AIDS as a issue of poverty and development – and arguably a major factor contributing to this reframing process – the United Nations Development Fund (UNDP) partnered with the World Health Organization (WHO; also a UN agency) in 1987 in the formation of the WHO/UNDP Alliance to Combat AIDS (Ingenkamp 2008).

1996 marked the founding of UNAIDS as a fully operational UN agency specifically dedicated to responding to global AIDS epidemic. As Nina Ingenkamp notes, “the starting point for the idea of UNAIDS was an external study of the GPA in 1992, which concluded that improved collaboration among UN agencies was needed” (2008: 37). Many of the agencies at the table agreed that the WHO was not the best organization to be addressing the AIDS epidemic giving the multidimensional nature of the problem as it was now being framed; that is, primarily as an issue of development. In replacement of the UNDP/WHO Alliance, a new alliance under the banner of UNAIDS was formed, and was composed of ten other co-sponsoring UN agencies: UN Children’s Fund (UNICEF), UN Development Programme (UNDP), UN Population Fund (UNPF), UN Educational, Scientific and Cultural Organization (UNESCO), World Health Organization (WHO), the World Bank, UN Office on Drugs and Crime (UNODCD), the International Labor Organiation (ILO), and the Office of the UN High Commissioner for Refugees (UNHCR).

UNAIDS thus plays a pivotal role in the ways in which AIDS is placed on the global agenda. The governing body of the agency – the Programme Coordinating Board – brings diverse UN agencies, governments, civil society organzations, and People Living With HIV/AIDS (PLWHA) Associations together twice a year, maintaining network ties and facilitating a space where ideas can be shared and agendas can be set. UNAIDS also maintains a network made up of major governmental donors called “Friends of UNAIDS,” composed of representatives from Australia, Belgium, Canada, Denmark, Finland, France, Germany, Italy, Ireland, Japan, Norway, Sweden, Switzerland, Netherlands, the US, and the UK. As Ingenkamp notes, “these strong interorganizational ties are a good basis for discursive, strategic and contested processes leading to global frame development and moreover build a favourable contextual factor regarding frame dissemination and consequent establishment” (2008: 26).

UNAIDS has undisputably done much to keep AIDS on the global agenda and to maintain a particular way of framing the issue that consequently leads to particular modes of action responding to the epidemic. They have done extensive lobbying to ensure that the issue is on the radar of other major international organizations, particularly those dealing with development. As one representative of the organization has noted:

When we noticed that e.g. in the document of the World summit on Aging there is not reference on AIDS we were talking to member states and persuading them that this was the issue, the global issue that should somehow be reflected, and without any problem they were accepting it.

The same informant continued on to note that within a few years “HIV/AIDS was mentioned in all development related UN documents” (2008: 39-40).

Finally, another major contribution of UNAIDS has been the collection and dissemination of country-level statistics. Prior to the founding of the organization, information regarding the epidemic stopped at the regional level, but UNAIDS was able to reveal in a global report that prevalence rates exceeded 25% of the population in some countries and was able to connect these patterns with patterns in UN conceptualizations of economic development. These numbers were widely publicized in the media (often front page) (Ingenkamp 2008).

Ingenkamp, Nina. 2008. How HIV/AIDS Has Made it: An Analysis of Global HIV/AIDS Agenda-setting Between 1981-2002. Saarbruken, Germany: VDM Verlag Dr. Muller

Media Attention to Global AIDS Epidemic

As Wellings and Field note in their book Stopping AIDS: AIDS/HIV Public Education and the Mass Media in Europe (1996), much of the media attention surrounding AIDS has been targeted at general populations, often using fear or humor to inform people about the virus and how to stop its transmission (the image at right represents one way in which two are morbidly combined). However interesting such media might be, analyzing this is perhaps not useful in a discussion regarding agenda setting – these ads arguably are a result of successful agenda setting rather than a catalyst for it. While they get the attention of “average people,” they are traditionally not aimed at organizations or governments who are in a position to create major social and political change.

More important than public service campaigns, then, is story coverage by major newspapers, and more important than either fear or humor, in getting the attention of these major news sources, is the question of expertise/credibility and resources. Miller and Williams (1993) have thus note that media is not a neutral arena. Different groups have different levels of access to media based on the credibility and expertise they are perceived as having, as well as the amount of resources they have available to them. As a result, organizations have to develop media strategies with which “to influence relevant agendas” in their favored direction (127). Government has had success in both these regards, and thus were strong in 1986 and 1987 in launching advertising campaigns intended to educate the public about HIV/AIDS, Other “alternative” groups such as gay activist organizations have had more difficulty in accessing the media, and need to rely heavily on statistics and scientific evidence in order to be seen as legitimate sources. (Miller and Williams 1993).

Regarding one such group that has had success in shaping the agenda through media coverage, Miller and Williams suggest that:

Sources which may be used as experts by the media can use their credibility with journalists to use their own agendas. It is often forgotten that even eminent scientists and doctors sometimes can be their own best publicists. One senior AIDS doctor talked of having used his authority as an ‘expert’ to use the media to ‘exert leverage on the government’. He also said that media interventions in the early 1980s ‘were very effective, not in getting money personally for research or anything, but in getting money put into health education and into services’. (1993: 132)

A Lexis-Nexis search for HIV/AIDS for both the 1980s and the 1990s resulted in over 3000 search results in all news sources, indicating that the issue was being discussed by media sources. Interestingly, however, including search terms to indicate a discussion of AIDS as a global epidemic reveal no results throughout the 1980s, but 897 for the 1990s. During the 2000s, the same search resulted in over 3000 news stories. This indicates a shift in the way the issue was framed from one decade to the next, from a US-based issue to one of global concern. The vast majority of news stories came in the second half of the 1990s and the 2000s. This does not seem to correlate exactly with other events in world government, since the first International AIDS Conference was held in 1987. However, it is interesting to note that coverage of AIDS as a global epidemic picked up substantially in 1995, the same year as the formation of the UN Programme on HIV/AIDS.

In regards to HIV/AIDS, the media appears to both respond to major events in the global agenda setting arena (as the previous example indicates), but also does much work in shaping the global agenda. For example, Human Rights Watch did not pick up HIV/AIDS as a campaign issue until 2001 (discovered using the WayBack Machine, but there were over 100 sources documented throughout the 1990s discussing AIDS as a global human rights issue. Much of the coverage dealt with activist groups advocating for the human rights of people afflicted with AIDS. In this case, one might suspect that media coverage of these actions might have prompted Human Rights Watch to take up the issue (which in turn prompted an increase in human rights framing in media coverage from 2000 to 2005 – 761 pieces in that five-year period alone, many of which were related to HRW news releases). Interestingly, 2001 was also the year that the UN General Assembly adopted a declaration of commitment regarding the relationship between HIV/AIDS and human rights. However, given the limited data available, it is difficult to tease out how much of a role the media played in getting AIDS on the global human rights agenda, and how much that was simply due to the efforts of activists. Most likely, it was a confluence of the two forces that brought attention to that particular way of framing the issue.

Miller and Williams. 1993. Negotiating HIV/AIDS information: Agendas, media strategies and the news. In Elridge (ed.) Getting the Message: News, Truth and Power, Taylor & Francis. 126-144.

Wellings and Field, 1996. Stopping AIDS: AIDS/HIV Public Education and the Mass Media in Europe. London: Lomgman.