Boundaries of Contagion: How Ethnic Politics Have Shaped Government Responses to AIDS

by Evan Lieberman

Overview

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.

Product Details

ISBN-13:	9780691140193
Publisher:	Princeton University Press
Publication date:	04/12/2009
Edition description:	New Edition
Pages:	368
Product dimensions:	6.00(w) x 9.10(h) x 1.00(d)

About the Author

Evan S. Lieberman is associate professor of politics at Princeton University.

Table of Contents

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

What People are Saying About This

From the Publisher

"In this stunning work, Lieberman traces the divergent responses of governments to the varying salience of ethnic boundaries across polities. Where ethnic boundary institutions are strong, he shows that political leaders are reluctant to address HIV, whether or not their own ethnic community runs a relatively higher risk than other groups. This book should be read and taught by scholars of comparative politics and public health specialists for its substantive argument and multilevel, multimethod research design."—Elisabeth Jean Wood, Yale University

"In this book, Lieberman seeks to explain why countries or states have different public policies and public expenditures towards HIV/AIDS prevention and treatment. His argument relies heavily on the ethnic configuration of nation-states. Brazil does well, South Africa does badly, and India's performance is found to be closer to South Africa. Because of the lower racial consciousness of decision makers and lower salience of race in Brazilian politics, argues Lieberman, governments are able to define HIV as a national, not an ethnic or racial, problem. In South Africa and India, race and caste dominate politics, the politics of blame and shame takes over, and the decision makers are unable to demonstrate the resoluteness that comes with viewing the problem as a national one. A fascinating argument."—Ashutosh Varshney, Brown University

"Why are some countries so callous toward AIDS victims? This book is the first to account systematically for national differences in AIDS policies. The greater the racial fragmentation in society, the comparative analysis shows, the more each racial group will use the tactics of shame and blame to avoid supporting public investment in AIDS treatment. While Evan Lieberman's evidence is distressing, his book is revealing."—David D. Laitin, Stanford University

"There has been a lack of meaningful work on the politics of HIV/AIDS, which is surprising given the prominence of the pandemic as a global issue and policy challenge. This book fills a real void and there is no question that it makes an important contribution to the field."—Richard Parker, Columbia University

"There is a great thirst for research on the social and political dynamics of the HIV/AIDS epidemic, and Lieberman's book makes a decisive contribution to this literature. Boundaries of Contagion reframes the discussion of good policy in far-reaching and startling ways. It represents a heroic effort at developing a theory of how social boundaries shape the provision of public goods, and makes the most humane and compelling argument for nation-building that I have ever encountered."—Catherine Boone, University of Texas, Austin

"Boundaries of Contagion usefully separates the public health issue of which HIV/AIDS policies work best from the political science issue of which political forces are involved in shaping and constraining such policies. The analysis focuses rigorously on the political science issue without neglecting the public health issue."—James McGuire, Wesleyan University

Editorial Reviews

"Lieberman's methodologically eclectic study constitutes the most thorough cross-national examination of the politics of AIDS to date. It should be essential reading for people interested in the politics of AIDS, public health, and public policy making more generally."

Choice

Winner of the 2010 Giovanni Sartori Book Award, Qualitative Methods Section of the American Political Science Association

One of Choice's Outstanding Academic Titles for 2010

From the Publisher

Lieberman's book has the great merit of casting peremptory conclusions about HIV/AIDS implementation in national contexts, and, as such, it constitutes a landmark in the political analysis of epidemic response. Though being a scholarly book, it appeals to wider audience interested in major international social and development policy . . . since it proposes thoroughly argued explanations for specific policy behaviors.

CEU Political Science Journal - Ricardo Pereira

Lieberman's book has the great merit of casting peremptory conclusions about HIV/AIDS implementation in national contexts, and, as such, it constitutes a landmark in the political analysis of epidemic response. Though being a scholarly book, it appeals to wider audience interested in major international social and development policy . . . since it proposes thoroughly argued explanations for specific policy behaviors.
— Ricardo Pereira

CEU Political Science Journal