Why have governments responded to the HIV/AIDS pandemic in such different ways? During the past quarter century, international agencies and donors have disseminated vast resources and a set of best practice recommendations to policymakers around the globe. Yet the governments of developing countries in sub-Saharan Africa, Asia, Latin America, and the Caribbean continue to implement widely varying policies. Boundaries of Contagion is the first systematic, comparative analysis of the politics of HIV/AIDS. The book explores the political challenges of responding to a stigmatized condition, and identifies ethnic boundaries--the formal and informal institutions that divide societies--as a central influence on politics and policymaking. Evan Lieberman examines the ways in which risk and social competition get mapped onto well-institutionalized patterns of ethnic politics. Where strong ethnic boundaries fragment societies into groups, the politics of AIDS are more likely to involve blame and shame-avoidance tactics against segments of the population. In turn, government leaders of such countries respond far less aggressively to the epidemic.
Lieberman's case studies of Brazil, South Africa, and India--three developing countries that face significant AIDS epidemics--are complemented by statistical analyses of the policy responses of Indian states and over seventy developing countries. The studies conclude that varied patterns of ethnic competition shape how governments respond to this devastating problem. The author considers the implications for governments and donors, and the increasing tendency to identify social problems in ethnic terms.
Evan S. Lieberman is associate professor of politics at Princeton University.
Illustrations ix Abbreviations xi Preface xiii Chapter One: Introduction 1 The Puzzle Of Explaining Government Policy 5 AIDS as a Laboratory for Comparison: Politics in Really Hard Times 10 Outline of the Book 18 Chapter Two: A Theory of Boundary Politics and Alternative Explanations 25 Ethnic Boundaries 28 The Effect of Boundaries on Policymaking 35 Implications for AIDS Policy 42 Additional and Alternative Explanations 50 Conclusion 59 Chapter Three: Globalization and Global Governance of AIDS: The Geneva Consensus 61 The Rise of Asymmetric Global Health Governance 65 The Emergence of the Global Response to AIDS 72 The Content of the Geneva Consensus 86 The Limits of Consensus 106 Conclusion 107 Chapter Four: Partial and Alternative Explanations of Policy Divergence 125 The Effect of Boundary Institutions 142 Conclusion 171 Chapter Five: A Model-Testing Case Study of Strong Ethnic Boundaries and AIDS Policy in India 173 India's AIDS Epidemic 177 The Government's Response: Weak and Delayed 181 Explanation: The Role of Boundary Politics 193 Explaining Policy Variation across Indian States 220 Conclusions and Alternative Explanations 234 Chapter Six: Ethnic Boundaries and AIDS Policies around the World 239 The Data 240 Analysis and Discussion: Estimates of the Effect of Boundaries on AIDS Policy 261 Conclusion 288 Chapter Seven: Conclusion: Ethnic Boundaries or Cosmopolitanism? 292 Implications 295 Future Research 303 References 307 Index 331