Global agenda-setting in multilateral AIDS governance : testing the Vanwesenbeeck model

Fineide, Line Viktoria (2014-04)

Thesis (MA)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Globally as well as nationally, AIDS is politically contested. Since AIDS was first identified in 1981 there have been several responses to the pandemic, reflecting AIDS’ biomedical, political and social nature and implications. Although there are many ways to frame and approach AIDS, no single approach appears to be universally superior to any other, especially as these various approaches are essential for a comprehensive global response to the pandemic. However, these several responses can also represent contested constructs of how AIDS is inter-subjectively problematised based on different ontological understandings and epistemological preferences. The existence of such contested constructs suggests that multilateral AIDS governance is shaped by binaries and zero-sum games where the overall approach ought to be holistic. As such, some scholars claim that HIV is increasingly treated as something medical, and outside the context of overall development issues, sexual and reproductive health, human rights and structural violence. Recently, Vanwesenbeeck (2011) offered a simplified model of ‘high-road’ and ‘low-road’ solutions to the pandemic, problematising specifically the global policy/political response. Vanwesenbeeck’s model suggests that biomedical, vertically distributed and asexual high-road approaches are prioritised at the expense of the more community oriented, sexual and rights-based low-road approaches. This, Vanwesenbeeck argues, is because current ideas and norms of the market, moralism and medicalisation are more aligned with the de-contextual, de-sexual and quantifiable characteristics of high-road approaches. This study tests the analytical utility of Vanwesenbeeck’s model with a case study of the policy and political narratives emerging from the International AIDS Society’s nine International AIDS Conferences from 1996 until 2012. The research question this study investigates is thus: Can Vanwesenbeeck’s (2011) model of high-road and low-road solutions be identified in and illuminate the policy ideas, problem definitions and political binaries that play out in the discourse surrounding the biennial International AIDS Conferences between 1996 and 2012? This main research question is complemented by three sub-questions concerning 1) the strengths and limitations of Vanwesenbeeck’s model, 2) the general trends and developments in global AIDS policy/political responses during, before and after the biennial International AIDS Conferences and 3) the impact of the Global Financial Crisis on the global AIDS response. Applying a qualitative methodology, the study finds that Vanwesenbeeck’s model can both be identified in and elucidate the political discourses, policy implementations and binaries surrounding the International AIDS Conferences between 1996 and 2012, albeit not all. The analytical utility of Vanwesenbeeck’s model is limited by oversimplification of the highroad/ low-road binary and the exclusion of alternative ideas for high-road prioritisation, such as humanitarianism, securitisation/sensationalism and the neoliberal ideological link between medicalisation and the market, as well as negligence of the impact of the Global Financial Crisis.

AFRIKAANSE OPSOMMING: Vigs is internasionaal sowel as nasionaal polities omstrede. Sedert Vigs die eerste keer in 1981 geïdentifiseer is, was daar al verskeie reaksies op die pandemie wat die biomediese, politieke en maatskaplike aard en implikasies van die siekte weerspieël. Hoewel daar verskillende maniere is om Vigs te beskou en te benader, blyk geen enkele benadering universeel superieur te wees nie, veral aangesien al hierdie verskillende benaderinge noodsaaklik is vir ’n omvattende globale reaksie op die pandemie. Tog kan hierdie verskillende reaksies ook as betwiste konstrukte beskou word van hoe Vigs intersubjektief op grond van verskillende ontologiese begrippe en epistemologiese voorkeure geproblematiseer word. Die bestaan van sulke betwiste konstrukte gee te kenne dat multilaterale Vigsbestuur deur binêre en nulsombenaderinge gekenmerk word, terwyl die algehele benadering veronderstel is om holisties te wees. Sommige vakkundiges beweer dan ook dat MIV al hoe meer as ’n mediese probleem hanteer word, buite die konteks van oorkoepelende ontwikkelingskwessies, seksuele en voortplantingsgesondheid, menseregte en strukturele geweld. Vanwesenbeeck (2011) het onlangs ’n vereenvoudigde model van sogenaamde ‘grootpad-’ en ‘smalpadoplossings’ vir die pandemie aan die hand gedoen wat spesifiek die algehele beleids-/politieke reaksie problematiseer. Vanwesenbeeck se model voer aan dat biomediese, vertikaal verspreide en aseksuele grootpadbenaderinge dikwels ten koste van die meer gemeenskapsgerigte, seksuele en regtegebaseerde smalpadbenaderinge gekies word. Dít, reken Vanwesenbeeck, is omdat huidige denke en norme met betrekking tot die mark, moraliteit en medikalisasie eerder met die kontekslose, geslaglose en kwantifiseerbare kenmerke van grootpadbenaderinge strook. Hierdie studie het die analitiese nut van Vanwesenbeeck se model getoets met behulp van ’n gevallestudie van die beleids- en politieke narratiewe uit die Internasionale Vigsvereniging se nege internasionale vigskonferensies vanaf 1996 tot 2012. Die navorsingsvraag van hierdie studie was dus: Kan Vanwesenbeeck (2011) se model van grootpaden smalpadoplossings geïdentifiseer word in, en lig werp op, die beleidsidees, probleemomskrywings en politieke teenpole wat uit die diskoers by die tweejaarlikse internasionale vigskonferensies vanaf 1996 tot 2012 gespruit het? Hierdie hoofnavorsingsvraag is aangevul deur drie verdere vrae oor (i) die sterkpunte en beperkinge van Vanwesenbeeck se model, (ii) die algemene tendense en ontwikkelings in wêreldwye beleids-/politieke reaksies op Vigs gedurende, voor en na die tweejaarlikse internasionale Vigskonferensies, en (iii) die impak van die wêreldwye finansiële krisis op die wêreldwye Vigsreaksie. Met behulp van ’n kwalitatiewe metodologie het hierdie studie bevind dat Vanwesenbeeck se model wél geïdentifiseer kan word in, en lig werp op, sommige van die politieke diskoerse, beleidsinwerkingstelling en teenpole waartoe die internasionale vigskonferensies tussen 1996 en 2012 gelei het. Die analitiese nut van Vanwesenbeeck se model word egter beperk deur die oorvereenvoudiging van die grootpad-/smalpad-teenpole en die uitsluiting van alternatiewe idees oor die prioritisering van grootpadoplossings, soos filantropie, sekuritasie/sensasionalisme en die neoliberale ideologiese verband tussen medikalisasie en die mark, sowel as die verontagsaming van die impak van die wêreldwye finansiële krisis.

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