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Politics in the Corridor of Dying: AIDS Activism and Global Health Governance. By Jennifer Chan. Baltimore: Johns Hopkins University Press, 2015. 344p. $39.95.

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Politics in the Corridor of Dying: AIDS Activism and Global Health Governance. By Jennifer Chan. Baltimore: Johns Hopkins University Press, 2015. 344p. $39.95.

Published online by Cambridge University Press:  21 March 2016

Sara E. Davies*
Affiliation:
Griffith University
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Abstract

Type
Book Reviews: International Relations
Copyright
Copyright © American Political Science Association 2016 

In September 2015, the United Nations General Assembly adopted 17 Sustainable Development Goals (SDGs) for the next 15 years. The SDGs serve as an addendum to the 2000 Millennium Development Goals (MDGs), whose targets “ended” this year. Among the SDGs is Goal 3: ensure healthy lives and promote well-being for all at all ages. Under Goal 3 are 13 listed targets, one of which, is Target 3.3: “By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.” Essential to meeting this target, of course, are further targets that must be met, including 3.7: “By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes,” and Target 3.8: “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” These goals were adopted by all member states in the 70th UN General Assembly, and from now until the early part of 2016, there will be consultations to discuss the development of milestones to measure, inform, and advocate the achievement of all 17 goals with their attached 169 targets.

An important question that arose during the MDGs project and now carries over to the SDGs is how we measure (and address) the social, economic, and political forms of discrimination that delay development on account of gender, ethnicity, and social position. In other words, to what extent are human rights supported in each country, and are these sufficient to ensure equal access and opportunity to the SDGs? This issue was raised just prior to the adoption of the SDGs by the UN Special Rapporteur on Right to Health, who argued that in the case of Target 3.7, for example, the failure to articulate sexual and reproductive services as rights ignores the social, education, and service barriers to women and girls (in particular). In other cases, unless the criminalization of sexual and reproductive services in certain countries is addressed, the targets simply will not be met.

The initial absence of human rights language, the tension and silences this absence creates, and the job of advocates to bring the language back in would come as no surprise to Jennifer Chan and highlights the prescience of the research in Politics in the Corridor of Dying. This is a beautifully written book that explores the local, national, regional, and international networks of AIDS advocacy told through the eyes of multiple actors in multiple locations interviewed by the author. This is a tour de force for international relations scholars, but would also appeal to all social science scholars who are interested in presenting students with a rich case study on the complex governance of material power, production of knowledge, and social justice. In fact, this book is a must-read for public health, medical science, and virology students as well.

Three things mark out this book. First, it takes a topic—HIV/AIDs—that has had a lot of academic coverage and finds a new terrain—the international interconnectedness of AIDS advocacy: from the local patterns of engagement and refinement in Thailand to suit political, economic, social, and cultural terrain to the international scene of intellectual property disputes and public—private partnerships in Doha and New York. Chan is particularly interested in the ways in which local actors take international agendas and program funding and make them their own, the selective use of human rights language in politically tense environments, and the effect of these local adaptations on the international system that is churning out the science, drugs, governance, and funding response to this disease.

Second, Chan explores the human rights dimensions of global health governance through the case of AIDS and builds a solid case in defense of the power of human rights in shaping global health governance, contra the securitization or realpolitik explanations and concepts that, it can be noted, are rarely mentioned in this book. This is an exciting exploration in the field of global health governance and is reminiscent of the work of Paul Farmer, Jonathan Mann, and Sophia Gruskin, as Chan acknowledges in her Conclusion.

Finally, there is something for everyone in this work. While the introductory chapter explains the metatheory that informs the chapters that follow—the power of knowledge, regimes of knowledge, and counterpower—the remainder of the book is a solid empirical exploration of discourse and its effects. As such, there is much here to explore for those less inclined to Michel Foucault but want a deep interrogation into the political economy of HIV, the legal regulation of disease, the governance of multiple private and public philanthropies, international organizations, and bilateral donor funding. The chapter on the science of HIV (Chapter 2) should be hard reading for epidemiologists and public health officials who unreflexively use “at risk” categories in environments where there are few social, economic, and civil rights afforded to those at-risk categories (and sometimes perpetuate risk). For those grappling with twenty-first-century network governance models, Chapter 4 (governance sector) is a (complex) must-read.

The significant research contribution made by Chan comes with her demonstration of the power of advocacy, but what she finds is that the strength of advocacy is not in rigid adherence to one message, one truth, one “pure” policy response to AIDs. The power of advocacy in HIV has been its challenge to the dominant discourses put forward by the other “regimes of power”: science, market, and governance (covered, respectively, in Chapters 2, 3, and 4), as well as advocacy itself. Science tells us who the at-risk groups are without explaining why they are at risk and continue to be at risk. Market forces encourage acceptance of intellectual property patents and controls on generic drugs; and governance models persistently trend to vertical health program delivery, primarily the result of donor preferences and international organization “turf wars.” Advocacy movements have challenged each of these “truths” in order to expose their fallibility and inability to progress the rights of those infected with HIV. International human rights law and language have been essential in articulating activism, but the community of activists have their own regimes of power that Chan sensitively explores in Chapter 5. There is the inevitable tension between international advocacy agencies and local civil society with competing and sometimes just different agendas. There is the tension of danger and dependence—dependence on international advocates in environments where it is politically dangerous to be an independent local nongovernmental, but the need to situate advocacy in local norms and behaviors requires local knowledge and understanding of the political environment, which may not fit international advocates’ “branding.”

The book also raises some significant tensions evident in the people, situations, and institutions explored by the author. First is the amount of political energy and financial resources devoted to AIDS compared to diseases that are equally rooted in gender, social, and political inequalities (i.e., diarrheal disease and tuberculosis). Chan appears to argue, at least in Chapter 3, where the funding gap question is explored, that even AIDS has not received the funding promised and that the global effort will fail to deliver on key targets and goals in both prevention and treatment. However, if this is the case for AIDS, which has been relatively well funded, how much worse is the situation for other diseases? Second, because of the power of advocacy, I was interested in the relationship between advocates and international institutions. While Chan and those she interviewed queried the efficacy of the United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization, and the Global Fund, others in the same book point to their involvement with pride. This indicates that any dismantling of institutions like UNAIDS, for example, could reveal significant tension within the activist community. This is something Chan raises but leaves unanswered. Third, given the influence of Foucault, I wondered whether the distinct success of AIDS activism is unique to its particular history and location in the Western conscience in the 1980s which inform what made AIDS activism successful and “legitimate” (Chan’s argument). It would be interesting to repeat the study for tuberculosis and malaria—the two diseases “attached” to AIDS in the Global Fund—in order to explore the cross-utilization of the four legitimacy benchmarks suggested by Chan (see next paragraph). Finally, I was struck by the fact that while human rights discourse is important for advocates, Chan argues that the language continues to appear rarely in the funding models, the governance models and the institutions set up to advocate AIDS treatment and prevention, that is, UNAIDS and the Global Fund.

In the concluding chapter, Chan argues that “what AIDS activism has achieved is more than inclusion in clinical trials, increased funding, treatment access, and a foot inside the United Nations. More fundamentally, it has revealed the deep legitimation crises of four contemporary regimes of power—scientific monopoly, market fundamentalism, statist governance, and community control—and, in very concrete ways, challenged their power by imposing rights-based rules of legitimation” (p. 260). She goes on to suggest four benchmarks of legitimacy that she identifies as having been pivotal for AIDS activists: credibility, democratic principles and processes, moral acceptability, and human rights (p. 260). In the next 15 years of the SDGs, the individual goals and their targets will be subject to much scrutiny, and this book’s case study on AIDS activism reveals the importance of continuing to question whose voice is being heard, whose targets are being met, and whose information is informing the policy. In this regard, this is an exceptional book that will guide further study for scholars, students, and activists.