Political repression, civil society and the politics of responding to AIDS in the BRICS nations

Abstract

The policy responses to human immunodeficiency virus/acquired immune deficiency syndrome (AIDS) in the Brazil, Russia, India, China and South Africa (BRICS) nations have played out amid radically different political environments that have shaped state-civil society relations in critical ways. In contrasting these different environments, this article offers the first comparison of the policy response to AIDS in the BRICS nations and seeks to understand the way in which political context matters for conditioning the response to a major epidemic. Using a comparative historical approach, we find that while collaborative state-civil society relations have produced an aggressive response and successful outcomes in Brazil, democratic openness and state-civil society engagement has not necessarily correlated with an aggressive response or better outcomes in the other cases. Response to the epidemic has been worst by far in democratic South Africa, followed by Russia, where in the former, denialism and antagonistic state-civil society relations fuelled a delayed response and proved extremely costly in terms of human lives. In Russia, a lack of civil societal opportunity for mobilization and non-governmental organization (NGO) growth, political centralization and the state's unwillingness to work with NGOs led to an ineffective government response. Top-down bureaucratic rule and a reluctance to fully engage civil society in democratic India substantially delayed the state's efforts to engage in a successful partnership with NGOs. Nevertheless, China has done surprisingly well, in spite of its repressive approach and narrow engagement with civil society. And in all cases, we find the relationship between state and civil society to be evolving over time in important ways. These findings suggest the need for more research on the links between democratic openness, political repression and policy responses to epidemics.

Opioid Use in the Twenty First Century: Similarities and Differences Across National Borders

“…Yet, there are considerable differences in the scope and focus of these policies, with existing evidence revealing a complex picture about the way political contexts shape prevention and intervention policies and influence their implementation in different countries. Our understanding of the role of political repression on state responses to epidemics and health outcomes remains limited, as there is still very little scholarly work on this topic [30]. A recent comparative historical review [30] examining how different political contexts shape the way in which relations between the state and civil society determine prevention and intervention efforts of different nations reveals a complex picture, where democracies do not necessarily fare better in response to health epidemics such as opioid addiction and HIV/AIDS.…”

“…Our understanding of the role of political repression on state responses to epidemics and health outcomes remains limited, as there is still very little scholarly work on this topic [30]. A recent comparative historical review [30] examining how different political contexts shape the way in which relations between the state and civil society determine prevention and intervention efforts of different nations reveals a complex picture, where democracies do not necessarily fare better in response to health epidemics such as opioid addiction and HIV/AIDS. Contrary to expectations, states like China have achieved some relatively good health outcomes such as controlling the HIV epidemic among IDUs, despite authoritarian policies and minimal engagement of civil societal structures like NGOs.…”

“…This has resulted in the adoption of a new Russian Anti-Drug strategy for 2010–2020 [29]; however, it further restricts harm reduction programs and continues the ban on opioid substitution therapy until 2020, often implicated as one of the main driving engines of the HIV epidemic in Russia [25]. The role of civil society, exemplified by non-governmental organizations (NGOs) engaging in harm reduction activities is severely restricted most notably since 2012, when the Russian government implemented a systematic crackdown of NGOs, which severely constrains their activities and threatens their existence [30]. In contrast, China, which has a similarly large number of heroin users (1.32 million registered users in 2013) and even higher IDU-related HIV infection rates than Russia (42% of new infections in 2013) [31] also adopted a new anti-drug law in 2008; but unlike Russia, it changed its philosophy from punitive to assistance-oriented [32].…”

Confronting Health Inequalities in the BRICS: Political Institutions, Foreign Policy Aspirations and State‐civil Societal Relationships

“…In the past two decades, a myriad of health NGOs, especially focused on diseases such as HIV/AIDS and TB, have emerged to form a closer partnership with the Department of Health for prevention and treatment programs (Williams et al., n.d.). NGOs are now perceived by health officials as key allies in policy making, helping provide information on health sector needs and a response to the ongoing HIV/AIDS and TB epidemics (Gómez and Harris, ).…”

Mobilizing civil society for the HIV treatment cascade: a global analysis on democracy and its association with people living with HIV who know their status

“…Scholars have attributed these findings to how democratic political conditions enable active non‐governmental and citizen participation in healthcare, while according them greater civil liberties , which hold true as in the context of HIV organizational leadership . Nevertheless, several scholars find that regardless of regime type, contextual and historical precedence may impede or facilitate such responses to the epidemic .…”