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Circus monkeys or change agents? Civil society advocacy for HIV/AIDS in adverse policy environments

Author

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  • Spicer, Neil
  • Harmer, Andrew
  • Aleshkina, Julia
  • Bogdan, Daryna
  • Chkhatarashvili, Ketevan
  • Murzalieva, Gulgun
  • Rukhadze, Natia
  • Samiev, Arnol
  • Walt, Gill

Abstract

This paper explores the factors enabling and undermining civil society efforts to advocate for policy reforms relating to HIV/AIDS and illicit drugs in three countries in Eastern Europe and Central Asia: Georgia, Kyrgyzstan and Ukraine. It examines how political contexts and civil society actors’ strengths and weaknesses inhibit or enable advocacy for policy change – issues that are not well understood in relation to specific policy areas such as HIV/AIDS, or particular regions of the world where national policies are believed to be major drivers of the HIV/AIDS epidemic. The study is based on in-depth interviews with representatives of civil society organizations (CSOs) (n = 49) and national level informants including government and development partners (n = 22). Our policy analysis identified a culture of fear derived from concerns for personal safety but also risk of losing donor largesse. Relations between CSOs and government were often acrimonious rather than synergistic, and while we found some evidence of CSO collective action, competition for external funding – in particular for HIV/AIDS grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria was often divisive. Development partners and government tend to construct CSOs as service providers rather than advocates. While some advocacy was tolerated by governments, CSO participation in the policy process was, ultimately, perceived to be tokenistic. This was because there are financial interests in maintaining prohibitionist legislation: efforts to change punitive laws directed at the behaviors of minority groups such as injecting drug users have had limited impact.

Suggested Citation

  • Spicer, Neil & Harmer, Andrew & Aleshkina, Julia & Bogdan, Daryna & Chkhatarashvili, Ketevan & Murzalieva, Gulgun & Rukhadze, Natia & Samiev, Arnol & Walt, Gill, 2011. "Circus monkeys or change agents? Civil society advocacy for HIV/AIDS in adverse policy environments," Social Science & Medicine, Elsevier, vol. 73(12), pages 1748-1755.
  • Handle: RePEc:eee:socmed:v:73:y:2011:i:12:p:1748-1755
    DOI: 10.1016/j.socscimed.2011.08.024
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    References listed on IDEAS

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    1. Doyle, Cathal & Patel, Preeti, 2008. "Civil society organisations and global health initiatives: Problems of legitimacy," Social Science & Medicine, Elsevier, vol. 66(9), pages 1928-1938, May.
    2. Rhodes, Tim & Singer, Merrill & Bourgois, Philippe & Friedman, Samuel R. & Strathdee, Steffanie A., 2005. "The social structural production of HIV risk among injecting drug users," Social Science & Medicine, Elsevier, vol. 61(5), pages 1026-1044, September.
    3. Solava Ibrahim & David Hulme, 2010. "Has civil society helped the poor? - A review of the roles and contributions of civil society to poverty reduction?," Global Development Institute Working Paper Series 11410, GDI, The University of Manchester.
    4. Jeremy Shiffman & Stephanie Smith, 2007. "Generation of Political Priority for Global Health Initiatives: A Framework and Case Study of Maternal Mortality," Working Papers 129, Center for Global Development.
    5. Biradavolu, Monica Rao & Burris, Scott & George, Annie & Jena, Asima & Blankenship, Kim M., 2009. "Can sex workers regulate police? Learning from an HIV prevention project for sex workers in southern India," Social Science & Medicine, Elsevier, vol. 68(8), pages 1541-1547, April.
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    2. Olafsdottir, Sigrun & Bakhtiari, Elyas & Barman, Emily, 2014. "Public or private? The role of the state and civil society in health and health inequalities across nations," Social Science & Medicine, Elsevier, vol. 123(C), pages 174-181.
    3. Leonard, David K. & Bloom, Gerald & Hanson, Kara & O’Farrell, Juan & Spicer, Neil, 2013. "Institutional Solutions to the Asymmetric Information Problem in Health and Development Services for the Poor," World Development, Elsevier, vol. 48(C), pages 71-87.
    4. Akpalu, Wisdom & Dasmani, Isaac & Normanyo, Ametefee K., 2013. "Optimum Fisheries Management Under Climate Variability: Evidence from Artisanal Marine Fishing in Ghana," WIDER Working Paper Series 052, World Institute for Development Economic Research (UNU-WIDER).
    5. Bridget O'Laughlin & Jasmine Gideon & Fenella Porter, 2016. "Forum 2016," Development and Change, International Institute of Social Studies, vol. 47(4), pages 782-797, July.
    6. Owczarzak, Jill & Kazi, Asiya K. & Mazhnaya, Alyona & Alpatova, Polina & Zub, Tatyana & Filippova, Olga & Phillips, Sarah D., 2021. "“You're nobody without a piece of paper:” visibility, the state, and access to services among women who use drugs in Ukraine," Social Science & Medicine, Elsevier, vol. 269(C).

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