Since it was first identified in the early 1980's, HIV/AIDS has become one of the world's most devastating epidemics, disproportionately affecting people in developing countries, particularly in Africa. A number of domestic and international efforts emerged to address the epidemic, including the creation of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) in 2003, which brought a huge surge in U.S. funding for global HIV/AIDS programs. Given the historical, political and public opposition to increasing funding for foreign assistance programs, this sudden spike in U.S. spending on global HIV/AIDS raises questions over how the policy process resulted in broad bipartisan political support for the creation of PEPFAR. While some previous literature focuses on various components of the politics surrounding the creation of PEPFAR, there has been little academic research which attempts to provide a complete picture of the policy making process that led to PEPFAR. In particular, previous research has not adequately addressed certain aspects of the policy making process, or provided a comprehensive explanation of the interests and events that shaped the policy process. In addition, previous research has not utilized existing theories of policy making or agenda setting.
This dissertation used punctuated equilibrium theory and the advocacy coalition framework as complementary lenses to explore the political processes and identify the key factors that generated and reinforced the emergence of PEPFAR. This research utilized a detailed case history, which drew on a range of primary and secondary sources, and was supplemented by analysis of quantitative data. The overarching research question, which guided this dissertation, was: how did the politics of global HIV/AIDS and the process of policy formation result in the creation of PEPFAR? Additionally, this dissertation examined the interests and events that shaped the policy process leading up to PEPFAR; issue framing as well as public and congressional attention to the global HIV/AIDS epidemic leading up to PEPFAR; and the political agreements that were negotiated to satisfy the competing interests of various stakeholders.
My findings highlight a number of key elements of the policy process which enabled PEPFAR, including the importance of: both congressional and presidential leadership on global HIV/AIDS leading up to PEPFAR; the formation of broad coalitions resulting from activism among a range of interest groups; successful use of humanitarian rationales by Congress and the President to justify the program; and the evolution in the framing of global HIV/AIDS away from prevention and sexual behavior toward treatment and innocent victims. This dissertation builds on previous literature on the influences on decision-making around U.S. foreign assistance programs and contributes to research on policy change. By better understanding the process that led to a major change in one particular area of foreign assistance, academics, policymakers, and advocates can gain greater insight into how such factors can be employed to build potential political support for future large-scale humanitarian endeavors.
|Advisor:||Balla, Steven J.|
|Commitee:||Deering, Christopher J., Levi, Jeffrey, Newcomer, Katherine, Stoker, Robert|
|School:||The George Washington University|
|Department:||Public Policy and Public Administration|
|School Location:||United States -- District of Columbia|
|Source:||DAI-A 76/11(E), Dissertation Abstracts International|
|Subjects:||Public administration, Public policy, Epidemiology|
|Keywords:||AIDS, Agenda setting, HIV, PEPFAR, Policy making, Punctuated equilibrium theory|
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