Transformation From Below?: The Role of Civil Society Organizations in the Global Governance of the Response to HIV/AIDS.

Abstract

This thesis contributes to debates on the role of civil society organizations (CSOs) in global governance by asking if their participation in the global response to HIV/AIDS has been transformative – with transformation conceptualized as change towards a more equitable order. Adopting a critical International Relations approach, and applying qualitative methods, it analyzes how CSOs used the initial failure of biomedical responses to the epidemic to advance a human rights frame, which justified their participation in global governance. This frame complemented conceptions of AIDS exceptionalism, and has recently shifted in response to an increased focus on key populations. CSOs continue to advance the rights frame in global institutions – the focus here being on how they have done so within UNAIDS and the Global Fund to Fight AIDS, Malaria and Tuberculosis. However, rigid bureaucracies and dominant power relationships limit CSOs’ ability to transform these institutions to be more responsive to and representative of those affected by the epidemic. CSOs have further struggled to influence the largest global donors of the HIV/AIDS response – the Global Fund and PEPFAR – to direct greater resources to rights-based initiatives, despite CSO participation in resource mobilization. Though CSO participation has been restricted by donor state power, bureaucratic structures, and changes in the political economy of global health, CSOs have continued to promote potentially transformative alternatives, and so have continued to represent the interests of those most affected by the epidemic. This allows potential for further transformative alternatives.