Understanding the politics of national HIV policies: the roles of institutions, interests and ideas

Clare Dickinson and Kent Buse, October 2008

HIV has been highly politicised from the outset. In many contexts politics, ideology and ignorance have proven more influential on policy than epidemiology or technical best practice. Despite this, there has been limited analysis of the political determinants of HIV policy formulation and implementation. Based on an analysis of peer-reviewed literature, this paper attempts to answer the following questions:

• Which institutions, interests and ideas account for HIV policy change?
• Which actors are typically involved in policy development?
• What incentives underpin policy positions?
• What political strategies and tactics have been employed to drive policy change?

Key findings:

• In many contexts, politics, ideology and ignorance have greater influence on HIV policy than evidence and best practice
• No single determinant can explain HIV policy - this emerges from a unique interaction and configuration of institutions, ideas and interests
• Analysis which identifies the political obstacles and opportunities to evidence-informed policy should constitute a core feature of every national HIV response

This work was supported by the Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu Natal, South Africa:
www.heard.org.za