The role of the political economy in determining HIV and AIDS policies
S.J. Taleski1,2, A.K. Ahmed2, A. Whiteside2
1University of Toronto, Dalla Lana School of Public Health, Toronto, Canada, 2University of KwaZulu-Natal, South Africa, Health Economics and HIV/AIDS Research Division, Durban, South Africa
Background: Economic evaluations are necessary to make decisions about affordability and assist in the efficient allocation of resources. However, funding constraints are not always the central barrier to the implementation of effective interventions. The political economy can dominate the policy sphere and lead to inefficient implementation of already under-resourced HIV and AIDS prevention, harm-reduction and treatment strategies. We explore the role of the political economy in the facilitation or hindrance of HIV and AIDS policy development at the micro, meso and macro levels.
Methods: A comparative analysis of current and past HIV and AIDS policies by countries experiencing concentrated, but dissimilar, epidemics was conducted. These were; China, Russia and Thailand. This was through the review of literature and policy documents.
Results: Multiple factors, unrelated to funding, were found to have played a deterministic role in the (non)implementation of what might be regarded as ‘standard’ HIV and AIDS policies. Ideology in Russia has influenced decisions to not provide full support for state-led harm-reduction programmes for injection drug users (IDUs), despite available external funding. Russia has, however, responded positively to policies targeted at the prevention of mother to child transmission. In contrast, China and Thailand, recently implemented comprehensive prevention programmes for IDUs, commercial sex workers and men who have sex with men (MSM). This policy shift has been attributed to: positive responses to local research evidence; inter-sectoral government collaboration; and what has been learnt from recent outbreaks of infectious diseases.
Conclusions: Interactions between governance structures, societal norms and religious-cultural beliefs can shape and even determine HIV and AIDS policy decisions. It is recommended that when HIV and AIDS funding or legislative policy is to be influenced, a political economy lens cognisant of the prevailing social, political and economic context be used.