| The goal of this dissertation is to increase our understanding of domestic policy responses to initiatives and expertise as provided by international health organizations. Although following international recommendations often improves domestic public health, in certain circumstances resistance to adopting them persists. My core theoretical argument suggests that a strong societal agreement about what constitutes the "common good" served by state (e.g., "social purpose") informs how domestic policy-makers evaluate the benefits of adopting international recommendations. This agreement also affects how governments frame the provision of treatment, decide which subpopulations should benefit from the consumption of public good, and choose their partners in policy implementation. To demonstrate the impact of social purpose I examine how, why and with what consequences Russia and South Africa adopted the external best case practices, guidelines, and recommendations in regard to the HIV/AIDS treatment. In doing so, I investigate how major international health, developmental, and financial organizations formulated the global HIV/AIDS policy, and devise a set of indicators operationalizing this policy. Then, I use these indicators to design a structured, focused comparison of the domestic HIV/AIDS policy responses and empirically demonstrate that governments in both states created policy environments sanctioning a highly selective approach to international policy guidelines and recommendations. Rather than responding the epidemic as a pressing public health issue Russia's "Sovereign Democracy" prompted the government to respond to HIV/AIDS as the issue of demographic survival and criminal drug abuse. This choice subsequently eroded the human rights component from the official policy, overcommitted the government financially, and frustrated the cooperation with private sector and civil society. The imperatives of "African Renaissance" reframed the HIV/AIDS epidemic as a local developmental problem. As a result, the Cabinet supported substandard biomedical treatments and indigenous healing practices, consistently resisted the universal and free rollout of treatment in order to avoid the undesirable governmental expenditures and redistributive strategies. In both countries, these policy choices resulted in the adverse consequences for public health and prompted a protracted contestation among various state and non-state actors around the principles of the desired public health policies... |
