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Boundary institutions and HIV/AIDS policy in Brazil and South Africa

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Abstract

Why have some national governments acted more aggressively to address the HIV/ AIDS pandemic than others? More specifically, what explains, widely varied responses across Brazil and South Africa—two countries where one might have expected more similarity than difference? We argue thatboundary institutions—those sets of rules and practices that give social and political meaning to group identities—help explain this puzzle. Institutions interact with other pressures to structure the dissemination of information, the construction of risk, and priorities within society. Where institutions divide groups deeply, elites and ordinary citizens are less likely to feel volnerable, and more likely to blame other groups, making aggresive government action far less likely.

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References

  • Alesina, Alberto, Reza Baqir, and William Russell Easterly. 1999. “Public goods and Ethnic Divisions.”Quarterly Journal of Economics 114(4): 1243–1284.

    Article  Google Scholar 

  • Altman, Dennis. 1999. “Globalization, Political Economy, and HIV/AIDS.”Theory and Society 28: 559–584.

    Article  Google Scholar 

  • Associated Press (AP). 1987. “Botha: Terrorists Bring AIDS to South Africa,” via Lexis/Nexis Academic Search, 20 March 1987.

  • Associated Press (AP). 1994. “Newspaper Alleges Police Killed, Spread AIDS” via Lexis/Nexis Academic Search, 2 December 1984.

  • Baldwin, Peter. 1999.Contagion and the State in Europe, 1830–1930. Cambridge; New York: Cambridge University Press.

    Google Scholar 

  • —. 2005.Disease and Democracy: The Industrialized World Faces AIDS. Berkeley; New York: University of California Press: Milbank Memorial Fund.

    Google Scholar 

  • Barnett, Tony, and Alan Whiteside. 2002.AIDS in the Twenty-First Century: Disease and Globalization. Houndmills Basingstoke, Hampshire; New York: Palgrave Macmillian.

    Google Scholar 

  • Barth, Frederik. 1969.Ethnic Groups and Boundaries. Boston: Little Brown.

    Google Scholar 

  • Bennett, Janette. 1990. “AIDS Budget Up, but ‘It’s Not Enough’”Cape Argus, 1 December 1990.

  • Biehl, João. 2004. “The Activist State: Global Pharmaceuticals, AIDS, and Citizenship in Brazil.”Social Text 22(3): 105–132.

    Article  Google Scholar 

  • Boone, Catherine, and Jake Batsell. 2001. “Politics and AIDS in Africa: Research Agendas in Political Science and International Relations.”Africa Today 48.

  • Boyle, Brendon. 1988. “AIDS Cited as Reason to Bar Blacks from South African Resort.” UPI via Lexis/Nexis Academic Search, 10 January 1988.

  • Brooke, James. 1993. “In Deception and Denial, an Epidemic Looms,”New York Times, 25 January 1993, Al.

  • Bulatao, Rodolfo A. and John A. Ross. 2002. “Rating Maternal and Neonatal Health Services in Developing Countries.”Bulletin of the World Health Organization 80: 721–727.

    Google Scholar 

  • Cerqueira Marcelo, and Luiz Mott. 2002. “Interfaces da Violência: AIDS e Homofobia.” InO Outro Como um Semlhante: Direitos Humanos e AIDS, eds. Cristina Câmara et al. Ministério da Saúde.

  • Clarke, Lee, and James F. Short. 1993. “Social Organization and Risk: Some Current Controversies.”Annual Review of Sociology 19: 375–399.

    Article  Google Scholar 

  • Cohen, Cathy J. 1999.The Boundaries of Blackness: AIDS and the Breakdown of Black Politics. Chicago, IL: University of Chicago Press.

    Google Scholar 

  • Crewe, Mary. 1992.AIDS in South Africa: The Myth and the Reality. London, England: Penguin Books.

    Google Scholar 

  • De Waal, Alex. 2003. “How Will HIV/AIDS Transform African Governance?”African Affairs 102: 1–23.

    Google Scholar 

  • Douglas, Mary, and Aaron Wildavsky. 1983.Risk and Culture: An Essay on the Selection of Technical and Environmental Dangers. University of California Press.

  • Easterly, William, and Ross Levine. 1997. “Africa’s Growth Tragedy: Policies and Ethnic Divisions,”The Quarterly Journal of Economics 112(4): 1203–1250.

    Article  Google Scholar 

  • Galvão, Jane. 2000.AIDS No Brasil: A Agenda de Construção de uma Epidemia. São Paulo: ABIA /Editora 34.

    Google Scholar 

  • Garbus, Lisa. 2003.South Africa: Country AIDS Policy Analysis Project. San Francisco: AIDS Policy Research Center, University of California, San Francisco.

    Google Scholar 

  • Gauri, Varun, Chris Beyrer, and Denise Vaillancourt, 2006. “From Human Rights Principles to Public Health Practice: HIV/AIDS Policy in Brazil.” InPublic Health and Human Rights, ed. Chris Beyrer. Baltimore, MD: Johns Hopkins University Press, forthcoming.

    Google Scholar 

  • Gauri, Varun, and Peyvand Khaleghian. 2002. “Immunization in Developing Countries: Its Political and Institutional Determinants.”World Development 30(12): 2109–2132.

    Article  Google Scholar 

  • Gibson, James L. 2003. “The Legacy of Apartheid.”Comparative Political Studies 36(7): 772–800.

    Article  Google Scholar 

  • Grindle, Merilee Serrill, and John W. Thomas. 1991.Public Choices and Policy Change: The Political Economy of Reform in Developing Countries. Baltimore, MD: Johns Hopkins University Press.

    Google Scholar 

  • Grundligh, Louis. 2001. “Government Responses to HIV/AIDS in South Africa as Reported in the Media, 1983–1994.”South African Historical Journal 45: 124–153.

    Google Scholar 

  • Gumede, William M. 2005.Thabo Mbeki and the Battle for the Soul of the ANC. Cape Town: Zebra Press.

    Google Scholar 

  • Hamilton, Robin. 1991. Special Issue on HIV/AIDS. Johannesburg, South Africa: South African Institute of Race Relations.

    Google Scholar 

  • Heller, Patrick. 2001. “The Politics of Democratic Decentralization in Kerala, South Africa, and Porto Alegre.”Politics and Society 29(1): 131–163.

    Article  Google Scholar 

  • Hickey, Allison. 2004. “New Allocations for ARV Treatment: An Analysis of 2004/5 National Budget from an HIV/AIDS Perspective.” InOccasional Papers: Idasa-Budget Information Services.

  • Human Sciences Research Council. 2005.South African National HIV, Prevalence, HIV Incidence, Behaviour and Communication Survey, 2005. Nelson Mandela Foundation/HSRC.

  • Hyden, Goran, and Kim Lanegran. 1993. “AIDS, Policy, and Politics: East Africa in Comparative Perspective.”Policy Studies Review 12(1/2): 46–65.

    Google Scholar 

  • Inglehart, Ronald, et al. 2004. World Values Surveys and European Values Surveys. 1981–4, 1990–3, 1995–7, 2000–1,” [Computer file]. ICPSR version. Ann Arbor, MI: Institute for Social Research [producer], 2004. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor].

    Google Scholar 

  • Jacobs, Sean, and Richard Calland. 2002.Thabo Mbeki’s World: The Politics and Ideology of the South African President. Pietermaritzburg; London; New York: University of Natal; Zeb Books.

    Google Scholar 

  • Jamal L.F., Romera S., Santos, N.J., Bueno S.M., Monteiro A.L., Nascimento C.M., Rodrigues N.M., Ruiz E.A. 2002. Ethnicity in HIV/AIDS Patients of the São Paulo State STD/AIDS Referral and Training Center. Paper read at International AIDS Conference, 7–12 July 2002, at Barcelona, Spain.

  • King, Gary, Robert Keohane, and Sidney Verba. 1994.Designing Social Inquiry: Scientific Inference in Qualitative Research. Princeton, NJ: Princeton University Press.

    Google Scholar 

  • Knight, Jack. 2002. Informal Institutions and the Microfoundations of Politics, Prepared for the conference, Informal Institutions and Politics in the Developing World. Weatherhead Center for International Afrairs, Harvard University, 5–6 April. (unpublished manuscript).

  • Kohli, Atul. 2004.State-Directed Development: Political Power and Industrialization in the Global Periphery. Cambridge, UK; New York: Cambridge University Press.

    Google Scholar 

  • Lamont, Michèle, and Virág Molnár. 2002. “The Study of Boundaries in the Social Sciences.”Annual Review of Sociology 28: 167–195.

    Article  Google Scholar 

  • “Lekota: ‘No AIDS Alarm in SA’,” Mail and Guardian online 2003. Accessed 8 October 2003, 〈www. mg.co.za〉.

  • Levi, Margaret. 1988.Of Rule and Revenue. Berkeley, CA: University of California Press.

    Google Scholar 

  • —. 1997.Consent, Dissent, and Patriotism. New York: Cambridge University Press.

    Google Scholar 

  • Levy, Tania. 1990. “All Must Become Involved in Fight to Control AIDS”.Business Day, August 27, 1990.

  • Lieberman, Evan S. 2003.Race and Regionalism in the Politics of Taxation in Brazil and South Africa. Cambridge Studies in Comparative Politics. Cambridge, UK; New York: Cambridge University Press.

    Google Scholar 

  • Lieberman, Evan S. 2004. The Politics Determinants of HIV/AIDS Prevention Regimes: Preliminary Results from Cross-National Statistical Analysis. Princeton, NJ. (unpublished manuscript)

  • Marx, Anthony. 1998.Making Race and Nation. Cambridge: Cambridge University Press.

    Google Scholar 

  • Miguel, Edward. 2004. “Tribe or Nation? Nation Building and Public Goods in Kenya versus Tanzania.”World Politics 56: 327–362.

    Article  Google Scholar 

  • Ministerio da Saúde. 2005. Personal Communication.

  • Ministerio da Saúde, Coordenação Nacional da DST e AIDS. 2000.Legislação Sobre DST e AIDS no Brasíl.

  • Nathanson, Constance A. 1996. “Disease Prevention as Social Change: Toward a Theory of Public Health.”Population and Development Review 22(4): 609–637.

    Article  Google Scholar 

  • Nattrass, Nicoli. 2004.The Moral Economy of AIDS in South Africa, Cambridge Africa collection. Cambridge, U.K.; New York: Cambridge University Press.

    Google Scholar 

  • Ngwena, Charles. 1998. “Legal Responses to AIDS: South Africa.” InLegal Responses to AIDS in Comparative Perspective, ed. S. Frankowski. The Hague, The Netherlands: Kluwer Law International.

    Google Scholar 

  • Nobles, Melissa. 2000. “History Counts: A Comparative Analysis of Racial/Color Categorization in US and Brazilian Censuses.”American Journal of Public Health 90(11): 1738–1745.

    Google Scholar 

  • Okie, Susan. 2006. “Fighting HIV—Lessons from Brazil.”New England Journal of Medicine 354(19): 1977–1981.

    Article  Google Scholar 

  • Parker, Richard G. 1994a. “Public Policy, Political Activism, and AIDS in Brazil.” InGlobal AIDS Policy, ed. Douglas A. Feldman. London: Bergin and Garvey.

    Google Scholar 

  • — 1994bA AIDS no Brasil, 1982–1992, Coleção História social da AIDS; no. 2. Rio de Janeiro, RJ: ABIA: IMS-UERJ: Relume Dumará.

    Google Scholar 

  • Phillips, Howard. 2001. “AIDS in the Context of South Africa’s Epidemic History: Preliminary Historical Thoughts.”South African Historical Journal 45: 11–26.

    Article  Google Scholar 

  • Posner, Daniel. 2004. “Measuring Ethnic Fractionalization in Africa.”American Journal of Political Science 48(4): 849–863.

    Google Scholar 

  • Ramphele, Mamphela. 2005. HIV/AIDS: The Mirror in South Africa’s Face. Speech delivered at the 2005 South African AIDS Conference, Durban, 7–10 June.

  • Republic of South Africa (RSA). 2000. HIV/AIDS/STD Strategic Plans for South Africa 2000–5.

  • Reuters. 2004. “Brazil: 3 Billion Free Condoms,”New York Times, 12 August 2004.

  • Riding, Alan. 1985. “Fright Grips Brazil as AIDS Cases Suddenly Rise.”New York Times, 25 August 1985, 4.

  • Riding, Alan. 1986. “Brazil Called Lax in AIDS Treatment.”New York Times, 15 December 1986, 11.

  • Schneider, Helen. 2002. “On the Fault-Line: The Politics of AIDS Policy in Contemporary South Africa.”African Studies 61(1): 145–167.

    Article  Google Scholar 

  • Sen, Amartya Kumar. 1999.Development as Freedom. 1st. ed. New York: Knopf.

    Google Scholar 

  • Shisana, Olive, Leickness Chisamu Simbayi, and Human Sciences Research Council. 2002.Nelson Mandela/HSRC Study of HIV/AIDS: South African National HIV Prevalence, Behavioural Risks and Mass Media: Household Survey 2002. Cape Town: Human Sciences Research Council.

    Google Scholar 

  • Skidmore, Thomas E. 1995.Black into White: Race and Nationality in Brazilian Thought.Durham: Duke University Press.

    Google Scholar 

  • Sontag, Susan. 2001.Illness as Metaphor and AIDS and Its Metaphors. New York: Farrar, Straus and Giroux.

    Google Scholar 

  • Steinmo, Sven, Kathleen Thelen, and Frank Longstreth, eds. 1995.Structuring Politics: Historical Institutionalism in Comparative Analysis. New York: Cambridge University Press.

    Google Scholar 

  • Stepan, Nancy. 1991.The Hour of Eugenics: Race, Gender, and Nation in Latin America. Ithaca: Cornell University Press.

    Google Scholar 

  • Surratt, HL, and JA Inciardi. 1998. “Unraveling the Concept of Race in Brazil: Issues for the Rio de Janeiro Cooperative Agreement Site.”J Psychoactive Drugs 30(3): 255–260.

    Google Scholar 

  • Tajfel, Henri, and John C. Turner. 1986. “The Social Identity Theory of Intergroup Behavior.” InPsychology of Intergroup Relations, ed. S. Worchel and W.G. Austin.

  • Teixeira, Paulo Roberto. 1997. Políticas Públicas in AIDS.” InPolíticas, Instituições, AIDS: Enfrentando a Epidemia no Brasil, ed. Richard Parker. Jorge Zahar Editores: ABIA, 1997.

  • Telles, Edward Eric. 2004.Race in Another America: The Significance of Skin Color in Brazil. Princeton, NJ: Princeton University Press.

    Google Scholar 

  • Thelen, Kathleen, and Sven Steinmo. 1992. “Historical Institutionalism in Comparative Politics.” InStructuring Politics: Historical Institutionalism in Comparative Analysis, eds. S. Steinmo, K. Thelen, and F. Longstreth. New York: Cambridge University Press.

    Google Scholar 

  • Turra, Cleusa, and Gustavo Venturi, eds. 1995.Racismo Cordial. São Paulo: Editora Ática.

    Google Scholar 

  • UNAIDS. 2004.A Global View of HIV Infection. (Map) Geneva, Switzerland: UNAIDS.

    Google Scholar 

  • Van der Vliet, Virginia. 2001. “AIDS: Losing ‘The New Struggle?’”Daedalus 130(1):151–184.

    Google Scholar 

  • Varshney, Ashutosh. 2002.Ethnic Conflict and Civic Life: Hindus and Muslims in India. New Haven, CT: Yale University Press.

    Google Scholar 

  • Weingast, Barry. 2002. “Rational-Choice Institutionalism.” InPolitical Science: The State of the Discipline, eds. I. Katznelson and H. V. Milner. New York; Washington, DC:Norton; American Political Science Association.

    Google Scholar 

  • Weyland, Kurt. 1995. “Social Movements and the State: The Politics of Health Reform in Brazil.”World Development 23(10): 1699–1712.

    Article  Google Scholar 

  • Whiteside, Alan, and Clem Sunter. 2000.AIDS: The Challenge for South Africa. 1st ed. Cape Town: Human and Rousseau: Tafelberg.

    Google Scholar 

  • Whiteside, Alan, Robert B. Mattes, Samantha Willan, and Ryann Manning. 2004. “What People Really Believe about HIV/AIDS in Southern Africa.” InThe Political Economy of AIDS in Africa, eds. N. Poku and A. Whiteside. Aldershot, Hants, England; Burlington, VT: Ashgate.

    Google Scholar 

  • World Bank. 1993.Staff Appraisal Report: Brazil AIDS and STD Control Project. Report No. 11734 BR.

  • World Bank. 2003.Brazil: AIDS and STD Control III Project, Project Appraisal Document, June 4, 2003, Report 5759-BR

  • World Bank. 2004. Operations Evaluation Department.Brazil: First and Second AIDS and STD Control Projects: Project Performance Assessment, April 2004.

  • World Bank. 2005. World Development Indicators (on-line database).

  • World Health Organization. 2005Progress on Global Access to HIV Antiretroviral Therapy: An Update on 3 by 5. Geneva: World Health Organization.

    Google Scholar 

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Varun Gauri is senior economist in the Development Research Group at the World Bank.

We gratefully acknowledge fine research assistance from Christina Shim and Nalini Gupta, and helpful comments from Catherine Boone, Chris Beyrer, John Gerring, Denise Vaillancourt, Martha Ainsworth, Nancy Bermeo, Deborah Yashar; attendees of presentations at Princeton, Berkeley, Stanford, Harvard, Georgetown, Brown, the University of Pennsylvania, and at the World Bank; and the editors ofSCID and the anonymous reviewers. We also thank the dozens of South Africans and Brazilians who shared valuable information and their professional insights in interviews conducted by the authors. This paper was originally presented at the Annual Meetings of the American Political Science Association, Chicago, IL, 2–5 September 2004. Evan Lieberman gratefully acknowledges financial support for his research from the Robert Wood Johnson Foundation and the Yale University’s Center for Interdisciplinary Research on AIDS (CIRA). The views expressed in this paper do not necessarily reflect those of the World Bank or its executive directors.

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Gauri, V., Lieberman, E.S. Boundary institutions and HIV/AIDS policy in Brazil and South Africa. St Comp Int Dev 41, 47–73 (2006). https://doi.org/10.1007/BF02686236

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