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Brazilian Political Science Review (Online)

On-line version ISSN 1981-3821

Braz. political sci. rev. (Online) vol.2 Rio de Janeiro Dec. 2007


The securitization of the HIV/AIDS epidemic as a norm: a contribution to constructivist scholarship on the emergence and diffusion of international norms



Marco Antonio Vieira

European School of Management (ESCP-EAP) UK

Replicated from Brazilian Political Science Review (Online), Rio de Janeiro, v.1, n.2, July/Dec. 2007.




This article discusses the emergence in the late 1990s of an innovative conceptualization of security that proclaims the global HIV/AIDS epidemic a threat to international peace and stability. The study provides a framework for understanding the securitization of the HIV/AIDS epidemic as an international norm defined and promoted mainly by multilateral bodies, powerful states in the North and transnational HIV/AIDS advocacy networks. The HIV/AIDS securitization norm (HASN) is an attempt of the present analysis to synthesize under a single analytical concept the myriad of ideas and international prescriptions about HIV/AIDS interventions. The article identifies the actors who developed the main strategic prescriptions of the HASN and the transnational mechanisms that promoted the diffusion of its concepts throughout the state system.

Keywords: Securitization; HIV/AIDS; Southern African states; constructivism; international norms; international security.




his article discusses the emergence and diffusion in the late 1990s of an innovative conceptualization of security that proclaims the global HIV/AIDS epidemic an emergency threat to international peace and stability. The study provides a framework for understanding the securitization of the HIV/AIDS epidemic as an international norm defined and promoted mainly by multilateral bodies, powerful states in the North and transnational HIV/AIDS advocacy networks.1 The HIV/AIDS securitization norm (from now on HASN) is an intellectual attempt of the present article to synthesize under a single analytical concept the myriad of ideas and international prescriptions about HIV/AIDS interventions.2

The HASN is analytically divided here into two integrated parts: 1) one that defines the idea of HIV/AIDS as a security issue, which presupposes rights and obligations (norm); and 2) one that prescribes the right policies to be implemented in the international, regional and national levels to combat the threat posed by the epidemic (rule). In this respect, one can say that the (international) norm is deterministic in terms of defining a supposedly unique and uncontested understanding of what the HIV/AIDS epidemic is and also normative in the sense of knowing what are the good policies to be put in place by states.3

The following discussion explores the theoretical and empirical foundations of the HASN. Specifically, it investigates some analytical advantages for the present study in linking the constructivist literature on the emergence and diffusion of international norms with the securitization framework of Buzan, Waever and De Wilde (1998). It also assesses the empirical contributions of the HASN to the theoretical debate on how pre-existing normative orders, political structures and agents condition the domestic reception of international norms. The article then identifies the conceptual basis of the HASN, its empirical origins, the actors who develop its main strategic prescriptions and the transnational mechanisms that promote the diffusion of its concepts throughout the state system.


Theoretical Perspectives on Norm Formation and the Securitization Debate

This section aims to bring together in a single analytical framework some of the theoretical contributions made by the securitization framework and constructivist scholarship on norm formation and diffusion. It explores the analytical advantages that such a merger could offer to the understanding of the HASN.

Fundamentally, constructivist scholarship on international norms focuses on the mechanisms by which ideas emerge and spread. This school is divided into two interrelated perspectives.4 The first research agenda looks primarily at the system level (Finnemore 1993; Barnett and Finnemore 1999; Finnemore and Sikkink 1998). It focuses on how international norms emerge and the means of their propagation in the international system. This perspective is also interested in the actors who embrace and promote these norms. They focus on the role of transnational social movements, multilateral institutions and states as teachers of norms. 5

The second group stresses the process by which international norms penetrate the domestic structure of states (Cortell and Davis Jr. 1996; Risse 1994; Klotz 1995; Gurowitz 1999; Legro 1997). This perspective confines the analysis to how the particular political, societal and cultural characteristics of states produce distinct outcomes in terms of the domestic absorption of international norms. They describe the levels of convergence between international and domestic understandings about a given issue and how bureaucracies, legal systems, and shared principled beliefs serve as filters of international norms.6

In general, these perspectives are exclusively concerned with universal norms of good " international citizenship" (protection of wildlife, promotion of human rights, protection of women and minority rights, anti-slavery campaigns, transnational movements against land mines etc) and with how they promote normative change (Acharya 2004; Carpenter 2005).7 However, norm formation and diffusion in international politics also involve other types of norms. These authors usually ignore the essential quality and special appeal of some of these international norms that are identified as responding to existential threats to peace and security.8

The present argument claims that, by drawing the line between processes of politicization and securitization, the framework of Buzan, Waever, and Wilde (1998) provides an important contribution to constructivist scholarship on international norms in terms of pinning down the constitutive dynamics of international security norms. In fact, by the examination of the emergence, dissemination and final institutionalization of the HASN, this article aims to go beyond these authors’ typology, arguing that, at its final stage, the securitization process becomes an international norm. In what follows, this section briefly examines some relevant assumptions underlying the securitization framework.

Drawing upon early postulations of speech-act philosophy (Austin 1962; Searle 1969), the so-called " Copenhagen School" (Waever, Jahn, and Lemaitre 1987; Waever, Lemaitre, and Tromer 1989; Buzan, Kelstrup, Lemaitre, Tromer, and Waever 1990; Waever, Buzan, Kelstrup, and Lemaitre 1993; Buzan, Waever, and Wilde 1998) posits that security is not a static concept, as understood by traditional security studies, but an inter-subjective rhetorical practice. In line with this basic premise, Buzan, Waever, and Wilde (1998, 32) claim that, to successfully frame something in terms of security, a securitizing actor has to convince a significant audience that a specific issue constitutes an existential threat. In that sense, the measurement of (in) security is not given only by an objective assessment of the actual nature of the threat but mainly by the analysis of the conditions by which a securitization claim becomes widely accepted and eventually institutionalized. After an issue is successfully securitized, the next step is the institutionalization of the security rhetoric. At this stage, there is no further need to persuade others through the use of discourse. The security argument and the sense of urgency become implicit in the standards of behaviour, principles, policies and bureaucratic procedures that were created to deal with the problem. The securitization is institutionalized only if the threat (either perceived or real) is resilient enough to demand the build-up of standing bureaucracies and procedures.9

Those attempting to institutionalize the securitization of new threats, as in the case of transnational advocacy networks (Greenpeace is a good example, concerning environmental issues), in general have to face resistance from an international political context still dominated by traditional security institutions. The degree of either confrontation or adequacy towards these securitization moves can vary greatly, depending on the characteristics of the political setting (either multilateral, regional or national) in which securitization is attempted (Buzan, Waever, and Wilde 1998, 29).

International norms can assume various forms and most of them fall in the realm of politicization. This means that they are in general part of normal public debate and policy decision-making and do not represent an urgent matter requiring actions outside usual political procedures. However, depending on circumstantial changes, issues can be moved further up the list of policy priorities, requiring a special kind of politics and greater allocation of human and material resources. As shown later, the HIV/AIDS epidemic is an interesting example, whereby an issue has been gradually moved from the politicized to the securitized category. In this sense, one can say that the process of constituting international security norms is analogous to the image of a pendulum that swings from politicization to securitization and vice-versa in terms of the perceived levels of urgency and threat that are allocated to a specific issue. In the case of HIV/AIDS, the pendulum has already swung from politicization to securitization and, as long as the disease is eventually controlled, it can move back to the sphere of politicization.

Given the above considerations, this article proposes that the explanation of the cognitive process by which issues in the transnational system are moved from the category of normality to emergency and back, is the most compelling contribution of the securitization framework to the study of how international security norms emerge and spread. In this respect, securitization theory fills an important gap in the literature on international norms, that is, the lack of interest in the strategic social construction of threats to international security. Consistent with the view put forward by the Copenhagen group, in general, and Buzan, Waever, and Wilde (1998), in particular, this study argues that, through the use of rhetorical practices (speech-act) as well as other forms of persuasion, HASN entrepreneurs promoted change in pre-existing interpretations about the HIV/AIDS global epidemic. As further elaborated in the following section, these actors successfully re-framed the disease from an early bio-medical issue to the current immediate threat to global security.

However, despite its relevance to the present discussion, securitization scholarship has, at least, two very important shortcomings: firstly, while digging deep into the theoretical puzzle, Buzan and his followers neglect the empirical verification of actual processes whereby issues, after being successfully securitized in the realm of discursive practices (speech-act), become widely embedded in transnational institutions and states’ bureaucracies. I empirically address this analytical gap in the forthcoming appraisal of the global securitization of the HIV/AIDS epidemic.

A second related problem concerns these authors’ lack of conceptual tools to understand the impact of externally induced securitization processes on pre-existing regional and domestic systems. This kind of criticism was first raised by authors (Balzacq 2005; Stritzel 2005) who pointed to the need for proper social contextualization in the analysis of processes of securitization. Notwithstanding their emphasis on the role of social power and facilitating conditions (1998, 31-33), Buzan, Waever, and Wilde do not satisfactorily elaborate on the interplay between the autonomous linguistic practices of securitization and the structured social and power contexts in which these practices take place. Instead, they centre the analysis almost exclusively on the subjective practices of discourse, therefore missing the strategic environmental factors that deeply influence them.

This article claims that these conceptual tools are better provided by the abovementioned " second wave" constructivist scholarship on international norms. This literature maintains that states and regional institutions do not react in the same manner to externally induced/imposed normative frameworks. Rather, their particular domestic and regional contexts condition their reception by governments and regional institutions alike. Within this research agenda, a number of important factors have been shown to condition the domestic incorporation of international norms. They have argued that variations in the domestic adaptation of international norms can be explained by the distinctive features of local actors’ principled beliefs and cognitive identities, as well as by the (mis) match between the prescriptions of international norms and states’ political structures.

Peter Gourevitch (1978), for example, has usefully demonstrated, in his influential analysis of the role played by domestic structures in mediating the effects of systemic pressures, that some actors have more access than others to policy discussions due to the particular institutional configurations of the decision-making process. Other authors have explored a number of similar issues. These are the causal link between the ability of international norms to influence state behaviour and the different configurations of state-society relations (Risse 1994), the congruence between international norms and pre-existing political cultures (Checkel 1999), the processes wherein domestic groups instrumentally appeal to international norms to further their own local interests (Cortell and Davis Jr. 1996), and the processes by which international norms reconstitute national interests (Klotz 1995).

While trying to demonstrate causality relations between international norms and domestic policy structures, these scholars have shown that states are not only passive recipients of international norms but also respond to them in distinctive ways. In other words, in understanding norm diffusion in the interstate system, they have demonstrated that the agency role of norm takers do matter a great deal. At the state level, international actors and norms meet particular cultural, social and political contexts that not necessarily fit in their prescribed guiding principles. Regarding the particular set of questions put by this article, it means that, without denying the active role of international HASN entrepreneurs, they impact in very different degrees on the domestic structures of states.

South Africa is an interesting case in this regard. Despite the objective threat posed by HIV/AIDS (the virus is spreading faster in South Africa than anywhere else in the world), the South African President Thabo Mbeki and his close advisers, including the country’s Minister of Health, have constantly defied the mainstream international approaches to the epidemic. Mbeki links the epidemic’s spread to poverty and the deep-rooted legacies of the Apartheid regime. He also claims that HIV and AIDS are not related and that Pharmaceutical Companies, backed by powerful states, are exploiting (one could also say securitizing) the epidemic exclusively to achieve financial gains.10

The South African government’s ideological resistance to HASN entrepreneurship in the country clearly illustrates how a cultural mismatch (Checkel 1999) between external and internal understandings about the epidemic’s impact can hamper the process of successfully transmitting the HIV/AIDS securitization norm from the international to the domestic sphere. In South Africa, this conflictive encounter between international normative understandings (securitization) and local belief systems and practices (de-securitization) resulted in sustained domestic resistance to the internationally prescribed securitization of the HIV/AIDS epidemic.11 The remainder of this article seeks to find empirical support for the theoretical assumptions put forward here.


The Origins and Substance of the HIV/AIDS Securitisation Norm (HASN)

a. HIV/AIDS and security: setting the debate

The following analysis focuses on the concept of security and the current understandings of its relationship with the HIV/AIDS epidemic. It describes the ideational changes in the definitions and referent objects of security since the early 1980s and how HIV/AIDS became part of this academic and policy debate.

The notion of security in international relations is a contentious one. It is muddled by a plethora of unresolved debates about its actual meaning. These debates can be divided into two main groups. The first is made up of scholars who interpret security mostly as national or state security, which basically means fear from military threats from states against other states. This school in security studies is deeply rooted in the realist tradition of international relations (e.g., Carr 1939; Morgenthau 1948). The realist understanding of the national security problem is well exemplified by the widely acknowledged idea of the security dilemma (Herz 1950). This is the notion that the security needs of one state will necessarily lead to the insecurity of other states, as each interprets the behaviour of others as potentially dangerous (Buzan 1991, 14). For realists, the international system is anarchic, signifying the lack of a central authority restraining state behaviour. In this rather unstable external environment, states will inevitably develop military capabilities to protect themselves.

This largely pessimistic view of security is shared by contemporary neorealist authors such as Kenneth Waltz (1979) and John Mearsheimer (1990), who envisage balance of power politics as the permanent structural feature of the international system (Baylis 2005, 302).12 Kenneth Waltz, in particular, had a profound impact in the area of security studies. His neorealist theory argues that the structural characteristics of the international state system mould state behaviour. According to Waltz, states are the most important analytical units in international relations. For him, the ultimate goal of states is self-preservation, " since no one can be relied on to do it for them" (Waltz 1979, 109). In this sense, he argues that " the units of an anarchic system are functionally undifferentiated. The units of such an order are then distinguished primarily by their greater or lesser capabilities for performing similar tasks" (p. 97). This means that the structure of a particular system is defined by the distribution of capabilities among like units rather than through differences in their character and functions (p. 98). In Waltz’s formulation, security can only be achieved through balancing the power capabilities of the most important units in the system.

Since the early 1980s, however, the neorealist conceptualisation of inter-state security relations has been challenged by a growing number of writers who argued for an alternative understanding of security (Buzan 1991; Ullman 1983; Wæver, Jahn, and Lemaitre 1987; Tickner 1992; Buzan, Waever, and Wilde 1998). This new research agenda included in the security analysis non-military threats, as well as non-state actors. Richard Ullman (1983), for example, argued that national security can be undermined by events other than military conflict. He articulated an unconventional definition of national security threat in terms of an action or series of events (such as internal rebellions, blockades and boycotts, decimating epidemics, catastrophic floods etc) that drastically threaten the quality life of the inhabitants of a state and/or narrows the policy options available to the government of a state or a non-governmental entity (1983, 133). Following the same trend, Barry Buzan (1991) made analytically clear the distinction between economic, political, environmental, social and military security threats that could affect states and non-state actors alike. He also delineated the security dynamics at three inter-related levels: the individual, the state and the system.13

The introduction of this new security agenda in academic works was accompanied by a strong tendency in the wake of the end of the Cold War to shift the referent object of security from states to individuals. The United Nations was at the forefront of these developments. In 1992, following a request from the Security Council, the UN Secretary-General, Boutros Boutros-Ghali produced the first of a series of influential documents aiming to address the changing international security order. Boutros-Ghali’s An Agenda for Peace outlined the rationale and methods for moving away from the Cold War’s conceptualisation of state security towards a closer focus on the security of individuals. The subsequent emergence of the human security perspective is intrinsically linked with the principles and themes initially developed in An Agenda for Peace. It focuses on a broad understanding of security that encompasses not only the security of states against external or internal armed threats, but also the security of people living within states against non-military threats, such as disease, environmental degradation, economic and social instability etc. While breaking down state security into many subcategories, this perspective shifted the levels of analysis from states and the inter-state system to societies and individuals within and across states.14

The United Nations Development Program (UNDP) was the first organisation to officially champion the human security perspective. The UNDP launched the concept of human security in 1994 through its Human Development Report. It lists several categories in which human security can be at risk, such as food security, economic security, personal security, community security and political security. Subsequently, the UNDP proposed a series of measures to institutionalise the concept, such as the formulation of a world social charter, the creation of a global human security fund, the recommendation of global taxes for resource mobilisation and the establishment of an Economic Security Council (UNDP 1994, 24-25). Following the lead of the UNDP, other international bodies such as the International Monetary Fund (IMF) and the World Bank have adopted the concept of human security in their policy frameworks. In addition, a number of governments have also embraced the concept when defining their national security policies — Canada and Norway being pioneers in this regard.15

HIV/AIDS clearly falls into this latter categorisation of security, which led to the adoption of this broad perspective by a wide range of governments, multilateral agencies and academics. This group has raised questions concerning the economic impact of the disease at the community and family levels, how the epidemic is creating millions of orphans, whether it can become a threat to food security, how it contributes to crime and the implications of the epidemic to governance and economic development (Kristofferson 2000; Elbe 2001; Piot 2001; Fourie and Schonteich 2001; Chen 2003; Leen 2004). There have also been a number of academic studies and policy reports addressing the epidemic within the more traditional framework of security. Generally, this literature explores the indirect impact that HIV/AIDS could have on the territorial security and integrity of (mostly Western) states. The issues examined in this regard include, for example, whether high prevalence rates can constitute a threat to the national security of regimes friendly to the West, therefore requiring external intervention. They also assess whether economic and social burdens associated with HIV/AIDS could cause further domestic and regional instability in areas already characterised by entrenched conflict, and whether new strands of the HIV virus could penetrate Western societies (Heinecken 2000; National Intelligence Council (NIC) 2000; Price-Smith 2001, 2002; Singer 2002; Elbe 2003; Fidler 2003; De Waal 2003; Prins 2004; Garrett 2005; Ostergard 2002).16 Some of these scholarly studies and policy reports explore the implications of HIV/AIDS on the readiness of national armed forces with high HIV prevalence rates (Mills 2000; Elbe 2002),17 and how international peacekeeping operations can serve as an important vector for further spreading HIV in the emergency areas where these forces are deployed (Tripodi and Patel 2002; Elbe 2003).

What this amounts to is a two-tier perception of the security implications of the epidemic. At one level, the referent objects are individuals and societies, whereas in the other, states and the international system are seen as the main analytical focus. The human security approach in general accuses the traditional perspective of focusing exclusively on a narrow state-centric understanding of the security implications of HIV/AIDS that frequently ignores the well-being of people both affected and infected by the epidemic. In turn, traditionalist security theorists charge the human security approach of losing focus and expanding the concept too widely, thus neglecting very important questions about the impact of the epidemic on state institutions and governance (Ostergard 2002; Elbe 2001).18

This article claims that these two tiers are not divorced from each other. It argues that the variations in meaning between human and national security approaches to HIV/AIDS indicate the presence of different mental models or road maps (Goldstein and Keohane 1993, 13) within a common worldview about the existential threat posed by the epidemic. This shared broad notion about the security threat posed by HIV/AIDS is what defines this group as a particular epistemic community (Haas 1992). According to Haas, epistemic communities provide crucial information to policymakers by interpreting problems and offering solutions to these problems (1992, 4). However, they are not a monolithic bloc in which all members agree with one another. Participants of an epistemic community do squabble over issues. What is important for an epistemic community is that members share a general worldview of a problem. With regard to this article’s case, their shared belief that HIV/AIDS is an emergency threat does not necessarily translate into identical interpretations about how to deal with it and who is targeted by the threat (either states or human beings).

Moreover, this broader worldview is often based on feeble empirical evidence. Barnett and Prins (2006), for example, have raised interesting questions about the reliability of the evidence presented in some of the studies about HIV/AIDS and security. They point to serious problems in terms of poor data collection and the pervasiveness in some analysis of " factoids" , meaning " soft opinions that have hardened into fact" (2006, 18). These authors’ analysis shed some light on the social construction of reality concerning the links between HIV/AIDS and security. This means that in the case of HIV/AIDS, the interaction between the various discursive articulations (or speech-acts) about the security impact of the epidemic is what really makes HIV/AIDS a security issue rather than any identifiable objective fact.

In the light of the above, it is argued here that the human and national security perspectives on HIV/AIDS represent two general tendencies that the present study attempts to convey in a single analytical concept, HASN. As shown later, this is done by examining how these intellectual developments around the ideas of national and human security are translated in terms of international norms and practices through the work of states, transnational networks and international organizations, notably the US and the Joint United Nations Program on HIV/AIDS (UNAIDS). The epistemic community of scholars with an interest in the security aspects of HIV/AIDS is just one of the many providers and carriers of knowledge about the epidemic’s security impact. In this respect, the creation of a strong discourse clamouring for the global securitisation of HIV/AIDS is the result of the interaction between powerful players involved in the epidemic’s policy arena. The question of who they are and how they are connected to each other, as well as with their respective audiences, plays a fundamental role in understanding the securitisation of the epidemic. It is important, therefore, to understand the ideational and political process by which those actors have successfully re-conceptualised HIV/AIDS to signify security.

The following demonstrates how those securitising actors/norm leaders used both national and human security arguments to spread the idea that, because HIV/AIDS threatens the security/survival of a referent object (either states or human beings), the epidemic should be treated as a special kind of emergency. As shown next, the new theorising about the security impact of the global HIV/AIDS epidemic, coupled with the growing acknowledgment of its multidimensional and destructive impact, promoted a turn in the way the epidemic would be responded to. At this stage, the aforementioned pendulum started to swing steadily towards the securitisation pole.

b. Translating theory into practice: from a biomedical approach to the institutionalisation of HIV/AIDS as a security issue

This section discerns how the above conceptualisation of the links between HIV/AIDS and security translated into actual political moves to securitize the epidemic. It unfolds the historical process whereby the HASN emerged and, after reaching a " tipping point" (Finnemore and Sikkink 1998), cascaded throughout the international system. The (un) successful internalisation of this international norm by states critically affected by the epidemic is assessed later through an analysis of its incorporation into the domestic structures of Botswana, Mozambique and South Africa.

The first notified cases of AIDS in the world occurred in 1981 among young gay men in New York (Hymes, Greene, and Marcus 1981). In the early 1980s in the US, the HIV virus became primarily associated with homosexuals. The early association of the virus with this politically unpopular group led to indifference towards social movements demanding more assertive policy action from the US government.19 This lack of urgency in dealing with the problem was reproduced internationally.

During the 1980s and early 1990s, the responses from multilateral agencies were directed exclusively to the biomedical aspects of the epidemic. These early efforts were fragmented and under-resourced. Nobody identified the new disease as a mounting global threat. The World Health Organization (WHO) was very slow in responding to HIV/AIDS. This was mostly due to the perception among WHO officials that AIDS was a disease of well-off minorities in the richest states in the world. By contrast, the WHO had been created to concentrate its resources on the provision of healthcare to poor populations in Third World countries (Iliffe 2006, 68). In 1986, however, following the publication of alarming reports about growing HIV prevalence in several parts of Africa, the WHO began to address HIV/AIDS as a serious public health problem on a global scale. By this time, the WHO had established its Global Programme on AIDS (GPA) and advised governments to create surveillance systems and HIV/AIDS committees within their Ministries of Health. It also set up an HIV/AIDS department whose primary goal was to assist health ministries and governments to put in place national plans, through the provision of technical expertise, financial support and the centralisation of all the information about HIV/AIDS.

The WHO Global Programme on HIV/AIDS was the first multilateral initiative that was aimed at raising the profile of the epidemic as a public health issue of global importance. It promoted a worldwide mobilisation of institutional and financial resources to deal with the epidemic. In its initial stages, GPA policy initiatives concentrated mainly on the promotion of public awareness, blood screening, condom distribution and prevention efforts. From 1986 to 1990, under the active leadership of the first head of the GPA, Jonathan Mann, the WHO helped devise short- and medium-term plans for more than 150 countries (Illife 2006, 70). However, despite the rising global mobilisation against HIV/AIDS led by the WHO/GPA, the rapid growth of the global epidemic was not yet seen as an emerging security threat. By then, Mann, the most important figure in the WHO Global Programme, propounded a human rights approach to the epidemic based on American gay activism of the early 1980s. His strategy of preventing discrimination against people infected by HIV served well the interests of gay minorities in Western states and somehow reduced the stigma surrounding them. Nevertheless, it was not clear whether Mann’s logic would be applicable to a mass heterosexual epidemic such as that in Africa (Illife 2006, 69).

In the early 1990s, the proportion of people affected by HIV/AIDS in Western Europe and the US was still relatively low. In Africa, on the other hand, prevalence rates were notably higher and growing rapidly. In spite of the already alarming HIV/AIDS situation on the African continent during this period, the US administration of George Bush Senior seemed unaware of the looming crisis. The shift in US foreign policy as a result of the collapse of the Cold War system was not helpful to the cause of HIV/AIDS in Africa (Ostergard 2002, 339). With the end of the bipolar conflict and the disappearance of the Communist threat, the US began to reduce its diplomatic presence in Africa. Social programmes were discontinued or significantly reduced and diplomatic representations were closed (New York Times, July 7, 2000).20

The epidemic’s initial securitising move came in the mid-1990s. As the virus spread at an accelerated pace in Africa, showing the ineffectiveness of the global response, the leadership of the WHO/GPA began to fade. By this time, the international community had begun to realise that HIV/AIDS was not only a medical condition and that all branches of government and more international actors should mobilise against the impact of the epidemic. During this stage of the global epidemic, it became clear that no single United Nations organisation or state could provide the coordinated level of assistance needed to address the many factors driving the spread of HIV/AIDS, or help countries deal with its impact. A growing sense of urgency prompted the creation of special multilateral and national bureaucracies and more comprehensive policies to deal with the impact of the epidemic. Moreover, as a consequence of the end of the Cold War, the very meaning of security had been transformed. As already noted, normative reformulations of the concept of security prompted policy-makers and academics to rethink what the HIV/AIDS epidemic really meant in terms of a reformed security framework. According to the human security approach of the UNDP, for example, the protection of people against a wide range of new threats, including epidemic diseases, should be a primary concern of national governments and multilateral organisations (Axworthy 2001, 19).

As a result of these normative and policy changes, in 1996, the United Nations took an innovative approach by drawing six organisations together in a joint and cosponsored programme, the Joint United Nations Program on HIV/AIDS (UNAIDS). The creation of a separate multilateral HIV/AIDS agency was an unusual development in the history of the UN. In fact, it was the first time that the world organisation had taken this kind of approach to deal with a single disease. UNAIDS is in charge of promoting a particular understanding of what HIV/AIDS is and how it should be dealt with by states and non-state actors alike. UNAIDS embodies a variety of actors and has the institutional capacity to build up wide consensus towards HIV/AIDS policies and practices. The goal of UNAIDS is to catalyse, strengthen and orchestrate the unique expertise, resources and networks of influence that each of these organisations offers. Working together through UNAIDS, the so-called cosponsors expand their outreach through strategic alliances with other United Nations agencies, national governments, corporations, media, religious organisations, community-based groups, regional and country networks of people living with HIV/AIDS, and other non-governmental organisations (UNAIDS 2001). The creation of an organisation such as this was a visible change of direction concerning the multilateral response to the epidemic.

It should be stressed, nonetheless, that the knowledge about the full-scope impact of HIV/AIDS, together with its necessary corollaries, policy and strategy, evolved gradually over time. In the beginning, UNAIDS did not articulate a unified message concerning the security threat posed by the global epidemic. At this early stage, both researchers and high-level political authorities had not yet fully recognised, either through systematic scientific work or international policy debate, the potential impact that the epidemic could have on global security.21 As noted before, the UN system at the beginning of the 1990s was going through a process of normative adaptation to the new post-Cold War international order. The transformation in the meaning of security was an integral part of these changes. The UNDP, not accidentally one of the cosponsors of UNAIDS, took the lead in 1994 by formulating and adopting the idea of human security as a core principle in promoting peace and development after the end of bipolarity. The expanding international acceptance of the concept of human security as a viable alternative to the national security logic of the Cold War resonated with pre-existing interpretations of HIV/AIDS. The human security perspective attracts attention to issues directly related to the impact of the epidemic, such as poverty, famine, social instability etc. The renaming (or reframing) of HIV/AIDS in terms of human security can be partially seen as the result of these broader normative changes in the understandings of security.

The definitive turn in the language used to name, interpret and dramatise HIV/AIDS took place only in the late 1990s. During this period, a growing circle of high-profile politicians, transnational activists and academics began making it consistently clear that the global HIV/AIDS epidemic was indeed a serious threat to security (Prins 2004). From that point onwards, UNAIDS embedded this view and started to take the securitisation of HIV/AIDS as a teaching mission, whereby this organisation would work to supply states and other HIV/AIDS actors with information about the best HIV/AIDS policies and organisational practices at the state level (Finnemore 1993).

Another important step towards the securitisation of HIV/AIDS came in 1999, when the Bill Clinton administration designated the global HIV/AIDS epidemic a threat to the security of the United States. It was the first time that a US President had provided such a designation to a disease. Clinton’s decision followed the release of an influential report produced by the US government’s National Intelligence Council (NIC) on " The Global Infectious Disease Threat and Its Implications for the United States" . This document described in detail the direct and indirect impact that the HIV/AIDS epidemic could have on the US and global security over the following 20 years. Along the same lines, on 10 January 2000, this unconventional thinking on security issues was captured at the UN Security Council (UNSC) when US Vice-President Al Gore presided a historical meeting devoted to the impact of HIV/AIDS on peace and security in Africa (UNSC 2000a). At that occasion, for the first time in the history of this institution, an issue other than a military one was granted the relevance of an international security threat. UNSC resolution 1308 that followed, fully recognised the potential threat posed by HIV/AIDS to stability and security and represented an important step towards achieving broad international conformance with the HASN (UNSC 2000b).

In April 2001, African states met in Nigeria to discuss the special challenges posed by HIV/AIDS. The resulting Abuja Declaration of 27 April 2001 was endorsed by all fifty three members of the Organisation of African Unity (OAU). They jointly declared that HIV/AIDS " [ …] is not only a major health crisis but an exceptional threat to Africa’s development, social cohesion, [ …] as well as the greatest global threat to the survival and life expectancy of African peoples [ …] " (OAU 2001, emphasis mine). Two months later, on 27 June 2001, the Heads of State and representatives of government adopted, at the 26th Special Session of the UN General Assembly (UNGASS) devoted to HIV/AIDS, the Declaration of Commitment on HIV/AIDS. This document was a landmark in the history of the epidemic. It represented an official recognition by all UN member states that the epidemic was a " global emergency" and " one of the most formidable challenges to human life and dignity" , therefore demanding global action and unrestricted commitment by member states. It also recommended that the multilateral response should be coordinated under the leadership of UNAIDS, " [ …] which could assist, as appropriate, member states and relevant civil society actors in the development of HIV/AIDS strategies [ …] " (UNGASS 2001).

Also part of the agreements set up at the UNGASS, the establishment of the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria, which are the most serious epidemics in the world, represented a substantial step towards the actual implementation of the HASN.22 The fund was formally established in 2001 by the UN and the G8 group of industrialised nations as the global war cashbox against these diseases. Most developed and some middle-income states have established bilateral assistance mechanisms for assisting national HIV/AIDS plans in poor countries. Initially, these initiatives were located in classic foreign aid agencies, such as Britain’s Department for International Development (DFID) and the United States Agency for International Development (USAID). With the introduction of the Global Fund, some of these states have now shifted a large share of (in some cases most of) their financial assistance to the Fund (Garrett 2005, 12). The Global Fund is an unprecedented case of comprehensive multilateral action to finance the global fight against the three main global killers, namely malaria, tuberculosis and HIV/AIDS.

The Fund is an innovative wide-reaching mechanism of health financing. It is formed by a board of international partners (donor and recipient states, multilateral agencies, such as UNAIDS and the World Bank, Non-Governamental Organizations (NGOs and representatives from the private sector). The Fund’s secretariat is based in Geneva and deals with the routine activities of the organisation. It links the disbursement of HIV/AIDS grants to the creation of country coordinating mechanisms (CCM). These country-based committees include not only members of the recipient government but also representatives of NGOs and the international community of multilateral and bilateral donors (Global Fund 2005a). Under the " technical assistance" of the international partners, the CCM is responsible for preparing the proposals for the Global Fund. In fact, to be approved, the proposals should embody the principles and guidelines taught to states by the international actors involved with the promotion of the HASN. After grant approval, the CCM is also in charge of overseeing the implementation of the projects. In recipient states, pre-existing institutional structures have to adjust to manage the Global Fund’s money. In general, the CCM nominates a few public or private agencies (in general either the National AIDS Council or the Ministry of Health) that will control the management of the funds (Global Fund 2005a).

From 2001 onwards, the securitisation of HIV/AIDS became permanently infused into the international normative understandings of the epidemic. With the signature of the UNGASS Declaration of Commitment, " a critical mass of states" (Finnemore and Sikkink 1998, 895) embraced the new norm proclaiming the securitisation of HIV/AIDS. In May/June 2006, Heads of State and Government gathered in New York to renew the strong commitments they made back in 2001 and to review progress in implementing the UNGASS Declaration. Despite the political manoeuvring of a few dissident states, this high-level UN meeting was concluded with the adoption of a comprehensive political declaration that reaffirmed national governments’ engagement in the implementation of the policies and principles stated in the first UNGASS (UN General Assembly 2006).23

Yet, in several important respects, the understanding of the HASN as a single and coherent normative framework should be contextualised within broader North-South ideological and political cleavages. The case of the political disputes over treatment with generic antiretroviral drugs (ARVs) is significant in this regard. The hope that ARVs brought to millions of people suffering from AIDS in poor countries encouraged some states in the South, such as Brazil and India, to produce and deliver generic ARVs to their populations.24 The quarrel that followed with pharmaceutical companies over the issue of patent rights was eventually decided in favour of those developing countries’ claims. In November 2001, at the Doha round of trade talks, the World Trade Organisation (WTO) agreed that TRIPS25 should not prevent states from taking measures to protect their societies against epidemic diseases such as HIV/AIDS.

This meant that, in a situation of threat to public health, governments could manufacture, buy and import generic copies of patented medicines. The Doha agreement of 2001 was an unprecedented move towards the securitisation of severe epidemic diseases. It was also perceived as a significant victory of (relatively) small states against the powerful economic interests of the North. For the first time in the history of trade negotiations, states were legally entitled to issue compulsory licences to copy patented drugs in case of health emergencies. These developments had a kind of emulative or cascading impact in the rest of the developing world (Finnemore and Sikkink 1998). Transnational advocacy networks began pressuring donor governments and multilateral agencies to give a renewed relevance to the provision of generic HIV/AIDS drugs as a core priority in the domestic national plans to combat the epidemic.26

The introduction of generic versions of branded AIDS drugs promoted a radical change in the manner global HASN leaders would relate to each other and with their securitising audiences. While the US government strongly backed the patent protection claims of pharmaceutical corporations, the UNAIDS/WHO launched in 2003 an ambitious global initiative for treating 3 million people by 2005, using both generic and branded AIDS medicines.27 It was only in 2005 that Bush’s Global Initiative on HIV/AIDS included a few generic medicines as part of its financial aid for treatment in developing countries. Those global divisions among HASN leaders reflected on treatment policies at the national level of decision-making. For example, South Africa and Mozambique adopted treatment plans based completely on generic drugs. The South African government took a more radical stance, openly accusing the US-backed pharmaceutical companies of exploiting the suffering of impoverished Africans. In contrast, the government of Botswana brokered a deal with the US pharmaceutical giant Merck and the Bill and Melinda Gates Foundation through which it would provide branded AIDS drugs in the public health system.

c. The tri-dimensional character of the HASN

In order to enhance clarity, it is worthwhile at this point to be more specific about the content of the so-called HIV/AIDS securitisation norm. Basically, it has three interconnected dimensions. The first dimension is more subtle than the others and empirical detection is therefore more difficult. It concerns a broad subjective tendency in the international community to gradually move HIV/AIDS away from the area of " business as usual" when dealing with public health issues. This is part of a progressive historical transition that started years before the first actual utterance of HIV/AIDS to mean security in the mid-1990s. This historical move towards the securitisation of HIV/AIDS can be generally identified by some watershed events in the history of the global response. These were, for example, the creation of the WHO Global Programme on HIV/AIDS in the mid-1980s, when HIV/AIDS began to be seen as a very serious issue in some African countries. It was followed by the establishment of UNAIDS ten years later, given the partial failure of the WHO’s biomedical approach to the epidemic, and finally by the formalisation of the links between HIV/AIDS and security with the Security Council meeting of 2000 and the UNGASS Declaration of Commitment one year later.

It is beyond the scope of this study to engage in a comprehensive historical sociology of the HASN. However, the argument here is that the social construction of the HIV/AIDS Securitisation Norm would not be comprehensible without the previous acknowledgment of the historical (social, material and interest-based) conditions that led to its creation. At the ontological level, this means that the HIV/AIDS actors constituted their social world in the same way that the social world they created defined the possibilities of their future interaction (Wendt 1987). This dimension also corresponds to an externalist (Stritzel 2005) understanding of securitisation that is generally neglected by the Copenhagen School. Contrary to its view of the securitisation process, the argument put forward here claims that the semantic articulation of security should be analytically integrated with the larger process of securitisation that involves social/political phenomena other than solely the speech-act. Stephan Elbe’s (2005) exploration of the biopolitical dimension of the securitisation of HIV/AIDS sheds some light on the contextuality problem in most of the securitisation literature. Foucault designates biopower as the power that " brought life and its mechanism into the realm of explicit calculations and made knowledge-power an agent for the transformation of human life" (Foucault quoted in Elbe 2005, 405). In demonstrating the biopolitical dimension of HIV/AIDS, Elbe uses the example of UNAIDS, " as an institutional apparatus for the detailed statistical, monitoring and surveillance of world population in relation to HIV/AIDS" (p. 405). Borrowing from Foucault’s reflections on the concept, he further argues that

The unfolding of the securitization of AIDS follows a net-like deployment of biopower, as it is being simultaneously driven by a plethora of actors [ …] The net of the securitization of AIDS has been widely cast, corroborating Foucault’s view that biopower is never solely the property of one agent; it is always plural, decentralized and capillary in nature. " Power" , he reminded his readers, " is everywhere; not because it embraces everything, but because it comes from everywhere" . (p. 407/408)

What is interesting in Elbe’s transposition of biopower to illuminate the securitisation of HIV/AIDS is that it allows for a holistic understanding of the securitisation process. Rather than being solely the activity of isolated securitising actors performing speech-acts, the securitisation process is seen through these lenses in the form of a chain of events and actors, or something that historically mutates and evolves into something else. In line with Elbe’s biopolitical stance on the securitisation of HIV/AIDS, I argue that the historical and social construction of the disease eventually led to the creation of a hegemonic grammar that portrays the epidemic in terms of a special type of problem, which demands special institutions and policies.

In this sense, the securitisation of HIV/AIDS can be understood as a constitutive element of a larger hegemonic world order that encompasses long-term political, ethical, economic and ideological spheres of activity on a global scale. This is what Gramsci called a historic bloc (Gramsci 1971). According to Robert W. Cox, in the historic bloc " there is an informal structure of influence reflecting the different levels of real political and economic power which underlies the formal procedures for decisions" (Cox 1993, 63). For him, " international institutions perform an ideological role. They help define policy guidelines for states and to legitimate certain institutions and practices at the national level. They reflect orientations favourable to the dominant social and economic forces" (p. 63). I do not use here the concept of historic bloc in precisely the same sense Gramsci (and also Cox, concerning international relations) gave to it. International relations are more diffused and complicated than the big power-centred concept of world order those authors conceived. However, Gramsci’s interpretation of history as a successive movement of powerful hegemonic forms of collective subjectivity is fully applicable to what was called here the first dimension of the HASN. This means that the proposed securitisation of the epidemic is the result of social and political processes that are organically integrated into the current dominant historic bloc.

After the successful institutionalisation of the hegemonic grammar of HIV/AIDS, as seen, for example, by the creation of UNAIDS and later by the adoption of the UNGASS Declaration, the utterance of security becomes less important, or simply epiphenomenal. The next step is the actual application of securitisation principles and policies. This relates to the second and third dimensions of the HASN. The second dimension is narrower than the first in the sense that it provides the actual conceptual framework which defines/frames HIV/AIDS as a special kind of global emergency. It may also be defined in terms of principled beliefs " that mediate between world views and particular policy conclusions" (Goldstein and Keohane 1993, 9). This was demonstrated earlier in this article through the shift of arguments about the ways in which the epidemic threatens security. The formalisation of these principled beliefs about the securitisation of HIV/AIDS appears, for example, in Security Council Resolution 1308/2000. As already noted, this document recognised HIV/AIDS as a threat to all levels of security (human, national and international).

The third and final dimension is more prescriptive/practical than the others and draws from the abovementioned principled beliefs. It sets up the policies, best practices and bureaucratic mechanisms that state and non-state actors should put in place to fight the HIV/AIDS threat. The list of recommendations is extensive, so the following concentrates on two key frameworks created by UNAIDS and the US respectively in collaboration with other HIV/AIDS actors. These are the UNAIDS " The Three Ones Framework" and the principles underlying President Bush’s Emergency Plan for AIDS Relief (PEPFAR). The UNGASS Declaration of commitment also appears in this dimension since it provides a very clear policy base for HIV/AIDS action.

In April 2004, UNAIDS sponsored discussions in Washington between governments of affected countries, key donor states and multilateral organisations, aiming to achieve further international harmonisation of the HIV/AIDS global response. As a result of those talks, the participants agreed on a set of guiding principles that became known as " The Three Ones" . Basically, " The Three Ones" is a blueprint of general policies to be implemented by all governments affected by the HIV/AIDS epidemic. Its strategic message is for donor states, multilateral agencies and governments affected by HIV/AIDS to coordinate their response to the epidemic within a single normative and institutional framework. The policies are:

1. One agreed HIV/AIDS action framework that provides the basis for coordinating the work of all partners;

2. One national AIDS coordinating authority with a broad-based multi-sector mandate;

3. One agreed country-level monitoring and evaluation system (UNAIDS 2004b).

Each of the three basic pillars of the " The Three Ones" is constituted by other principles for national authorities and their partners to follow. These principles are offered to states as a basis for optimising their national responses and improving coordination among all the actors involved (UNAIDS 2004c). Shortly after the 2004 meeting, UNAIDS started to engage with other leading states in building commitment towards the fulfilment and wide adherence to these improved standards for state behaviour. Within the agreement that led to the adoption of " The Three Ones" , UNAIDS was recognised as the main facilitator between stakeholders, as well as the institution with the responsibility for monitoring its implementation by national governments.

The UNGASS Declaration of Commitment of June 2001 is also an important guideline for action for both state and non-state actors. It describes the extent of the epidemic, the effects it has had, and the ways to combat it (UNGASS 2001). It may also be considered part of the second dimension of the HASN, since it establishes the main normative ideas that justify state action. Although the UNGASS Declaration is not a legally binding document, it is a clear statement by governments about what HIV/AIDS represents and what they should do to reverse its impact. The Declaration provides the policy priorities agreed between states. These policies are a basic element for improving coordination across partners and funding mechanisms at the state level. The main tenets of the response, as established in the UNGASS Declaration are: 28

• Leadership: " Strong leadership at all levels of society is essential for an effective response to the epidemic" .

• Prevention: " Prevention must be the mainstay of our response" .

• Care, support and treatment: " Care, support and treatment are fundamental elements of an effective response" .

• HIV/AIDS and human rights: " Realization of human rights and fundamental freedoms for all is essential to reduce vulnerability to HIV/AIDS" .

• Reducing vulnerability: " The vulnerable must be given priority in the response" .

• Children orphaned and made vulnerable by HIV/AIDS: " Children orphaned and affected by HIV/AIDS need special assistance" .

• Alleviating social and economic impact: " To address HIV/AIDS is to invest in sustainable development" .

• Research and development: " With no cure for HIV/AIDS yet found, further research and development is crucial" .

• HIV/AIDS in conflict and disaster-affected regions: " Conflicts and disasters contribute to the spread of HIV/AIDS" .

• Resources: " The HIV/AIDS challenge cannot be met without new, additional and sustained resources" .

The President’s Emergency Plan for AIDS Relief (PEPFAR) was launched in January 2003 by the US President, George W. Bush. It is a unilateral initiative by the US government which had a great impact on the global response to HIV/AIDS. The Plan is the largest global intervention of a single state to fight HIV/AIDS. Its contours were established by the United States Leadership against AIDS, Tuberculosis and Malaria Act of 2003. Among other things, the Plan involves large-scale HIV preventive efforts based on behaviour change that follows the " ABC" model (Abstinence, Be faithful and Condoms, in that order of priority). Although it was not the main focus of the plan, treatment with ARVs was also included as a supplementary way to enhance prevention efforts by motivating patients to be tested (US Department of State 2003). In fact, abstinence-until-marriage programmes are the cornerstone of the Plan, receiving a substantial share (33%) of the HIV prevention funds.29 Despite active US investment in the formulation and adoption of multilateral arrangements, such as " The Three Ones" , the UNGASS and the Global Fund, PEPFAR works mainly through bilateral aid programmes with target states.

It is important to note that the above recommendations and coordinating structures do not form a harmonious and coherent set of policies. As elaborated on later, these policies are on many occasions competing, contradictory or overlapping. The moral logic of PEPFAR and the parallel (normative and bureaucratic) structure it put in place are the main sources of conflict. The myriad of transnational HIV/AIDS actors with their sometimes chameleonic identities and alliances also add complexity to the understanding of the HASN. At the domestic level, these transnational grievances unfold in distinct manners while interacting with local actors and their pre-existing belief systems and political cultures.


The " Norm Leaders" : Institutional Apparatus and Norm Diffusion


In the foreword to the UNAIDS 2004 Report on the Global AIDS Epidemic, Peter Piot assertively affirmed that " as our report indicates, we know what works." 30 Piot’s confidence on the guiding role played by UNAIDS is based on this organization’s unmatched capacity to acquire comprehensive information and technical expertise globally about the evolution of the HIV/AIDS epidemic. This factor alone becomes an important institutional asset in terms of building its legitimacy as a global norm leader or, employing Foucault’s terminology, as an institution of truth.31

In very sensitive and complex issue-areas, in which international policy coordination is needed, policymakers must rely on the advice given by recognized epistemic communities, including here authoritative multilateral institutions, capable of providing and disseminating information globally.32 This dependency upon international sources of expertise is even greater in states lacking the capacity to produce local knowledge about issues, as in the case of many developing states. This type of technical/bureaucratic authority on HIV/AIDS confers to UNAIDS a great deal of symbolic power (Bourdieu 1994) to influence states’ national policies, as well as allowing it to spread that power on a global scale.

Bourdieu, for example, uses the term habitus to explain how human beings are socialized into " a system of durable, transposable dispositions which functions as the generative basis of structured objectively unified practices" (Bourdieu quoted in Dreyfuss and Rabinow 1999, 86). If one transposes his concept to the level of states and other transnational actors, UNAIDS can be seen as a source of habitus in the sense of determining the meaning of organized practices concerning HIV/AIDS. In this respect, Barnett and Finnemore (1999, 700) observed that " even when they lack material resources, IOs exercise power as they constitute and construct the social world" . The authors resorted to Weberian assumptions about how bureaucracies produce and use knowledge to develop a constructivist approach to think the role of IOs as autonomous and powerful non-state actors in world politics. Their claim about the important agency role of IOs offers an alternative approach to traditional perspectives. These conventional views see them exclusively as static structures, which are either an institutionalized representation of the balance of power logic between states (neo-realists) or used by them to maximize the benefits of collective action (neo-liberals).33

The present study argues that IOs, in general, and UNAIDS, in particular, embody elements of agency and structure pointed out by the two schools. It agrees with the constructivist assumption that the power of IOs derives from their capacity to produce autonomous knowledge and promote normative change. Since its creation, UNAIDS has led the global response to HIV/AIDS, defining new concepts and policy priorities that are adopted widely by states and non-state actors alike. In this sense, unlike the (neo) realists hold, UNAIDS’s behaviour cannot be seen simply as the result of a compromise between its powerful member-states. Rather, it produces a kind of autonomous social/scientific interpretation that has been proved strong enough to suppress other competing views about the epidemic.

However, the powerful influence of the US at both the GF and UNAIDS confirms the (neo) realist presumption that the autonomy of IOs is constantly checked by narrow national interests. Since the election of George W. Bush, in 2000, the US government has pursued its own foreign policy agenda to deal with the global epidemic. As this article shows later, the main source of contention between the global HIV/AIDS polity and the US government is George Bush’s President’s Emergency Plan for AIDS Relief (PEPFAR) and the disruptions it has caused to the unified international front led by UNAIDS.

UNAIDS works mainly as a coordinating body as opposed to a direct implementing and funding agency. Its bureaucratic structure is made up of a permanent Secretariat, based in Geneva, Switzerland. It is guided by a Program Coordinating Board (PCB) which comprises 22 delegates of governments, representing all regions of the world, representatives of the 8 UNAIDS Cosponsors (UNICEF, UNDP, UNFPA, UNESCO, WHO, World Bank, UNDOC, ILO) and 5 representatives of NGOs, including associations of people living with HIV/AIDS.34 The PCB serves as the UNAIDS governing body and holds at least one annual working session at its headquarters in Geneva. Only the representatives of governments have voting power at the PCB. The UN Cosponsors and Secretariat meet several times a year as the Committee of Cosponsoring Organizations (CCO) (UNAIDS 2004a, 4).

The largest donor to UNAIDS is the US Government, followed by the Governments of the Netherlands, the United Kingdom, Sweden, Norway and Denmark. Other UNAIDS sponsors, such as the UN agencies and the World Bank, also provide direct financial support for country-based HIV/AIDS plans. Concerning the allocation of money, the Secretariat assesses projects and makes funds available for selected HIV/AIDS initiatives. All UNAIDS activities are discussed and further coordinated every two years through the Unified Budget and Work Plan. It is a very important institutional instrument for controlling overall accountability and structuring the organization’s fundraising initiatives (UNAIDS 2004a, 4-5).

At the state level, UNAIDS operates mainly through the UN Theme Group. It is comprised of the country-based staff of the seven UNAIDS Cosponsors. In it, representatives of the cosponsoring organizations share information, plan and monitor coordinated action between themselves and with other partners, and decide on joint financing of major AIDS activities in support of the country’s government and other national partners. The principal objective of the Theme Group is to support the host country’s efforts to organize an effective and comprehensive response to HIV/AIDS. In most cases, the host government is invited to be part of the Theme Group. Increasingly, other partners such as bilateral development agencies and NGOs are also included.

To date, UNAIDS has established more than 130 UN Theme Groups, covering all regions of the globe. For their day-to-day operations, most Theme Groups have set up special working groups that involve donors, NGOs and groups of people living with HIV/AIDS. In countries with high rates of HIV/AIDS infection, the Theme Group has the support of a UNAIDS staff member, called a Country Program Adviser (CPA). Elsewhere, a staff member of one of the seven Cosponsors serves as the UNAIDS focal point for the country. In addition to supporting the UN system, this staff member is in charge of reinforcing national commitment to HIV/AIDS action and providing information and guidance to a range of host country partners, including government departments and groups and organizations from civil society.

Barnett and Finnemore (1999, p.713) observed that " having established rules and norms, IOs are eager to spread the benefits of their expertise and often act as conveyor belts of norms and models of good political behavior" . It is interesting to note that the UNAIDS case is consistent with this assumption. Considering the diffusion of the HASN as an example, these conveyor belts correspond to the institutional mechanisms described above by which the UNAIDS Secretariat inculcates and enforces its norms globally. By December 2002, around 100 states had already set up National HIV/AIDS plans following recommendations from UNAIDS. Additionally, UNAIDS has helped 85 countries to establish National HIV/AIDS Councils. It has also supported these governments in the actual implementation of their national plans by assisting in many technical areas, such as the drafting of donor proposals, the process of integrating HIV/AIDS in broader development strategies and undertaking reviews that assess the progress of the national responses (UNAIDS 2004a, 5).

What the above suggests is that UNAIDS is a primary source of norm creation and diffusion by virtue of its widely recognized authority to orient and coordinate states and non-state actors towards the best policies to face the HIV/AIDS threat. Nonetheless, the constitution of what is called here HANS is not only the work of an autonomous bureaucracy with knowledge claims about the epidemic. It is also the result of the interaction between powerful Western governments, namely the US government, and transnational networks of HIV/AIDS activists that operate strategically both inside and outside the institutional structure given by UNAIDS. Their political agendas contain both shared understandings about HIV/AIDS and contested ones. This article explores next the role played by some of these actors in the process of HASN formation, as well as the political contexts within which they operate.

b. The US government

As demonstrated in the previous section, UNAIDS is a powerful actor in creating and promoting social knowledge about HIV/AIDS. It is not alone, though. The US government and its associate agencies also play a fundamental role in the process of creating international understandings about the epidemic. In shedding light on the US government’s contribution to the formation of the HASN, one should first set the epidemic within the wider political context of US foreign policy at the beginning of the century.

At the heart of the foreign policy of the Bill Clinton administration was the problem (later resolved by the terrorist attacks of 9/11) of how to use the disproportional power of the United States in the post-Cold War world. The answer back then was to join the EU and the UN in the construction of a kind of cosmopolitan new world order in which the notion of national sovereignty would be downplayed to a holistic conceptualization of humanity. Bill Clinton’s approach to the global HIV/AIDS epidemic should be set against this same background of multilateral engagement.

Conversely, the George W. Bush administration’s response to the global epidemic reflected the logic of its own worldview. In this respect, any assessment of Bush’s foreign policy towards HIV/AIDS necessarily has to deal with the subjective issue of how decision-makers see the role of the United States in the world and how the epidemic fits into it. Since the very beginning, the inner circle of Bush’s foreign policy establishment was infused with the realist ideas of an elite of neo-conservative ideologues, on the one hand, and the President’s own moral instincts, on the other. This merge between realism and morality turned into the ideological justification for a wide range of divisive policies (Wallis 2005). 9/11 gave the Bush administration the opportunity to fully develop this new foreign policy thinking and to act on it. The pursuit of national security abroad was framed by the symbolic image of a battle between good and evil. The terrorist attacks re-ignited among foreign policy pundits the long-standing (yet, prior to 9/11, dormant) foreign policy principle of an alleged " American exceptionalism" , i.e., the idea that, given the moral uniqueness and disproportional power of the US, God has delegated to its leaders the divine duty to protect and lead the world. In the words of Michael Cox, this means that

(...) most members of the Washington foreign policy elite do tend to see themselves as masters of a larger universe in which America has a very special part to play by virtue of its unique history, its huge capabilities and accumulated experience of organizing the world for the last 50 years. (2003, 21)

The rise of the United Sates as a " crusader state" (McDougall 1997) is not a totally new development. It is rooted in a long history of idealism in the American foreign policy that goes back to the Founding Fathers (Cox 2003, 8). However, since Ronald Reagan’s use of American ideology as a powerful foreign policy tool against the Soviet Union, the world had not seen anything like the present strong idealist imprint of George Bush’s War on Terror.35 This time, however, the perceived security threat does not come from a communist totalitarian regime but from a rather disperse global network of Islamic extremists backed by a handful of " rogue" states with weapons of mass destruction.

Goldstein and Keohane asserted that ideas " and the principled or causal beliefs they embody" provide " road maps" for political action. According to them, " these conceptions of possibility or world views are embedded in the symbolism of a culture and deeply affect modes of thought and discourse" (1993, 8). Similarly, the present argument claims that the Bush government’s approach to the global HIV/AIDS crisis is deeply embedded in this world view that understands the US as a special nation with global responsibilities.

You know, the world looks at us and says, they’re strong. And we are; we’re strong militarily. But we’ve got a greater strength than that. We’ve got a strength in the universality of human rights and the human condition. It’s in our country’s history. It’s ingrained in our soul. And today we’re going to describe how we’re going to act — not just talk, but act, on the basis of our firm beliefs (US Department of State 2003).

The idea of a practically innate burden to lead the world against HIV/AIDS becomes manifest on this fragment of a speech about the epidemic given by Bush, in 31 January 2003, two days after the announcement of his global HIV/AIDS plan. More than two years after the September 2001 events, the Bush administration publicly acknowledged the devastating impact of the global HIV/AIDS epidemic as a global emergency and seemed to be moving towards its securitization.

Secretary of State Colin Powell stated that " bureaucracy as usual was unacceptable in dealing with this emergency, and we have moved forward urgently" (US Department of State 2004a). He was talking about the launch of PEPFAR. Through this initiative, the President committed US$ 15 billion over 5 years. It is by far the largest pledge to HIV/AIDS international assistance by a single government to date36 The funds will be largely spent on ongoing and new bilateral projects with recipient states. The Plan is run from the State Department by a Global AIDS Coordinator.37

The significant political move of the Bush administration towards the global securitization of the epidemic notwithstanding, the motivations behind the President’s HIV/AIDS Plan are mixed. The securitization of HIV/AIDS as promoted by the US is the result of a complex compromise between various domestic and international interests that are not always related with the security aspects of the epidemic. Within the US establishment, these security aspects are continually interacting with other ideational and material foreign policy interests. Depending on the political circumstances of their interaction, they can either reinforce or contradict each other.

For example, as part of PEPFAR, the United States Agency for International Development (USAID) is working on a complex system to purchase and distribute AIDS drugs to 2 million people until the end of 2008.38 It is the biggest international aid scheme in the USAID’s history, with the release of US$ 7 billion from PEPFAR to be used on AIDS drugs and related services (Graham-Silverman 2005). However, expensive patented drugs, mostly from American pharmaceutical companies, are to be used in this program. Citing concerns over drug safety, the US government is putting extra barriers on buying cheap generic drugs from developing countries, such as India and Brazil.39 Moreover, in the 15 countries included in the PEPFAR,40 development agencies and NGOs fear that the huge parallel structure put in place by the USAID will duplicate pre-existing systems for the management of HIV/AIDS funds and projects, such as the abovementioned " The Three Ones" . The problem is that the PEPFAR’s management strategies have been neglecting these multilateral mechanisms, bypassing National HIV/AIDS Councils and other established country coordinating structures.

The influence of evangelical Christians in the President’s decision to set up an HIV/AIDS global plan should also be added to the equation. Influential evangelical lobby groups are behind the selective way the money is allocated to HIV/AIDS programs in target states.41 At least one third of the PEPFAR’s US$ 15 billion is earmarked for projects that stress abstinence until marriage as the primary preventive measure against the epidemic.42 The other two principles, which stand for the so-called " ABC strategy" , are " be faithful" and " condoms" .

In states financially supported by the US, assistance to HIV/AIDS programs is attached to these moral strings.43 In 2005, for example, Brazil took a strong position against the US administration’s attempt to link US$ 40 million in HIV/AIDS grants to an anti-prostitution pledge by the Brazilian government (Phillips and Moffet 2005). Brazilian authorities rejected the grants and reaffirmed their commitment to the country’s widely praised approach to the epidemic.44 Brazil has been seen by a wide community of HIV/AIDS specialists as a model in terms of best practices to fight HIV/AIDS. This success is in part due to the inclusive way the Brazilians deal with high-risk groups, as well as to the premise that prevention actions should be guided by epidemiological assumptions rather than moralistic ones. This is reflected in the strong investment by the Brazilian government in nationwide educational campaigns to encourage the use of condoms by the public at large (Brazilian Ministry of Health 2000).

This particular case sheds some light on a wider philosophical division among the HASN norm leaders. Brazil clearly follows the line of UNAIDS and other epistemic communities of public health specialists and HIV/AIDS activists. The US administration, on the other hand, has its own (mis) perceptions45 about the best policies to fight the global spread of the epidemic. During the 15th World AIDS Conference, in Bangkok, in 2004, the contrast between these two worldviews came to light in the fears demonstrated by HIV/AIDS activists that the widespread use of condoms had been played down by religious dogmas behind the PEPFAR plan.46

Building on the above analysis, one could understandably argue that these conflicting worldviews between secular pragmatism and religious morality undermine the understanding of the HASN as a single and bounded community of knowledge. However, this article suggests that, rather than falsifying the conceptual relevance of the HASN, this sort of dialectic engagement between the moral and pragmatic understandings of the HASN reveals interesting empirical dynamics of norm formation and socialization at the level of the international system. I return to this issue in the conclusion. As the next section shows, transnational civil society groups are also important channels for the communication of norms from the system to the state level and vice-versa.

c. Transnational networks of NGO47

The widening of the international security agenda in the mid-1990s to include non-military issues gave extra leverage to the international affairs of many non-state actors. A global public space emerged with transnational networks of activists pressuring governments and IOs to fulfil their human security commitments.48 Some of them framed their traditional causes, around areas such as human rights, development and environmental issues, with the language of security to raise the salience of their claims.49 The constant flow of information, further facilitated by technological tools such as fax machines and the internet, brought the language of security to a wide range of non-governmental groups. Through world conferences, web-debates and the circulation of individuals, transnational networks have become acquainted with each other’s activities and developed similar worldviews about the security dimension of their distinct issue areas.

Transnational networks involved with HIV/AIDS issues grew against this backdrop of increasingly global interactions between non-state actors. During the early 1990s, their actions were discursively framed by symbolic categories (such as development, humanitarianism, human rights and, after 1994, human security) that appealed to a moral language familiar to the international community of donors (Carpenter 2005, 297). Since the late 1990s, however, in the context of the growing international securitization of the epidemic, these transnational actors have been increasingly unifying their discursive practices around the concept of security.

The global HIV/AIDS epidemic is a transnational issue par excellence. Its indiscriminate global impact blurs the traditional division between the domestic and the international. Accordingly, the proposed securitization of HIV/AIDS also transcends the conventional practice of state sovereignty. It prescribes normative constraints on the way states behave towards their own citizens. Among the recommendations of the HASN, go-it-alone national policies to tackle the epidemic are not an option.50 In highly affected regions, the global mechanisms for promoting and monitoring the implementation of internationally agreed HIV/AIDS national plans and bureaucracies are transforming the relations between states, their citizens and the international community.

In this respect, transnational HIV/AIDS activists are very important instruments of norm diffusion. Although many times lacking material and economic power to make a difference, networks of activists promote norm change and adaptation by globally disseminating ideas, information and strategies (Florini 1999). As Keck and Sikkink (1998) have noted, they are also important actors in promoting norm implementation at the state level. By their participation in National HIV/AIDS Councils, as well as by linking up with civil society groups at the grass-roots level, transnational advocacy networks engage in discursive practices with local actors. In participating in these social interactions, they ultimately aim to transform domestic behaviour and policies to match international prescriptions.51

However, these networks are not homogeneous structures. As noted before, the international normative framework of the HASN has been fractured by conflicting worldviews about HIV/AIDS. Faith-based organizations are not seen as belonging to the same identity group as other secular international partners.52 Moral reformists, like the protestant and catholic NGOs backed by the US government, emphasize de-securitizing initiatives, such as long-term changes in sexual behaviour and the reinforcement of family and community values. On the other hand, secular international NGOs stress the short-term emergency situation that demands effective and immediate measures against the security threat posed by the epidemic. These conflicting principled beliefs have ideologically divided the international community of HIV/AIDS activists into two main sets of organizations.

The first and wider group supports a pragmatic and secular approach to HIV/AIDS and is aligned closer to UNAIDS and to most UN member-states. The distinctive feature of these HIV/AIDS networks is that they seek to be widely recognized as autonomous and legitimate political spaces for civil action, regardless of either creed or ideological stance. They also stand for the scientific guidelines proposed by UNAIDS and the WHO regarding the promotion of condoms as the best prophylactic available to counter the spread of the epidemic, for example.

The International Council of Aids Services Organizations (ICASO) is one such organization. Since 1991, ICASO has connected and represented HIV/AIDS NGO networks from all five continents. Through its five regional secretariats spread throughout the globe, coordinated by a central bureau in Canada, ICASO brings the voices of community-based organizations from all over the world to the higher levels of decision-making at the state and multilateral levels. Its main arena of negotiation is under the institutional umbrella of the UNAIDS Program Coordinating Board, in which it is one of the NGO sector representatives, and in the United Nations Economic and Social Council (ECOSOC).

It discusses internationally and tries to apply nationally the outcomes of its debates by lobbying governments at the domestic level and by disseminating information to other networks of NGOs. ICASO is an interesting example of a transnational channel for the transmission of the HASN that works in both directions, bringing ideas and experiences from the grassroots level to the international system and also promoting policy outcomes emanating from HASN decision-making centres back to recipient states.

Through widely exposing actual or potential violations of the HASN, ICASO also operates as a sort of watchdog of donor states’ commitment to the fight against HIV/AIDS. In July 2005, for example, ICASO and Aidspan, another influential global HIV/AIDS network, launched with other NGOs from Europe, the US and Japan a worldwide advocacy campaign, called GF+. It sought to persuade governments of donor countries to increase their financial commitments to the GF. The advocacy groups forming the GF+ claimed that with the pledges already made by donors, the GF would not be able to launch new grants for the financial year 2006/7. This means that insufficient funds from developed states will probably hamper the G8’s promise to get close to the goal of universal access to AIDS drugs by 2010 (ICASOa 2005). In the months preceding a donor conference to discuss the replenishment of the GF, held in London, in September 2005, ICASO and its allies disseminated this politically important information (largely through the internet) in order to persuade a worldwide audience to sign a petition urging developed states to fulfil their HIV/AIDS commitments to the GF (ICASOb 2005).53 Despite their coordinating efforts, in 6 September, 2005, soon after the end of the conference, the GF+ released a communiqué stating that the final pledges of money (US$ 3.7 billion) by donor states fell short of what the GF needed to sustain and scale up the global fight against HIV/AIDS, Tuberculosis and Malaria (GF+, 2005).

Another very proactive HIV/AIDS global network is the US based Health Global Access Project (GAP). GAP’s stated mission is to " campaign for drug access and the resources necessary to sustain access for people with HIV/AIDS across the globe" (GAP 2005). The organization’s structure is made up of a core " national steering committee" of 20-25 people drawn from the fields of human rights, people living with HIV/AIDS, fair trade and public health. It has three national program coordinators leading national activities in the areas of advocacy, mobilization and campaigns. Internationally, it is also represented at the UNAIDS PCB and has staff members actively participating in international meetings at multilateral organizations and target countries. GAP also pressures governments, IOs and multinational corporations by globally disseminating information with potential for political impact upon public opinion. For example, GAP exposed the profits of pharmaceutical companies in rich states and how they sabotage developing countries’ efforts to produce cheaper generic drugs. They also use symbolic politics by framing situations with sensitive symbols that will make sense to a wider audience (GAP 2005).54

The second group is formed by HIV/AIDS activists pursuing a different normative agenda. Either for instrumental or ideational reasons, these networks of NGOs associated themselves to the US government’s global HIV/AIDS policies. Although holding the status of " non-governmental" , most of these organizations get money from the Bush administration’s PEPFAR plan and either directly or indirectly work to achieve its goals. In most cases, instead of using its own embassies and international assistance agencies, the US government takes on these networks to actually implement its HIV/AIDS policies abroad.55 The funds are allocated to them either directly by US government agencies, such as the USAID, or indirectly by multilateral agencies and other international partners.

Transnational networks linked to evangelical and right-wing religious sects are the most active advocacy groups promoting compliance with the HIV/AIDS principles of the US government. World Relief, World View, HOPE, Samaritan’s Purse, Catholic Relief Services and Opportunity International are some of the American-based international Christian organizations that are very active in HIV/AIDS-related projects. Each of them will receive around US$ 100 million from the PEPFAR to develop HIV/AIDS projects in target countries.56

World Relief, for example, is subordinated to the US National Association of Evangelicals, which is formed by something like 50 member-denominations and hundreds of evangelical churches all over the US. World Relief’s stated mission is " to work with, for and from the Church to relieve human suffering, poverty and hunger worldwide in the name of Jesus Christ" (World Relief 2005). The organization’s Mobilizing for Life project supports a moral/religious approach to HIV prevention (abstinence until marriage and fidelity within marriage) in Haiti, Kenya, Mozambique and Rwanda. Although they are not systematically promoted, pastors sometimes supply condoms to people who request them (Avert-PEPFAR partners 2005).

Additionally, there is a wide range of smaller international NGOs moving between the two groups. As the securitization of HIV/AIDS went into motion, they were attracted by the new funding mechanisms put in place by the GF and the PEPFAR. These organizations saw in the massive influx of cash to HIV/AIDS programs an opportunity to " stay in business" and expand their activities.57 Whatever humanitarian motives may have caused their creation, these NGOs have to generate surpluses to stay active. This means that their financial needs sometimes precede any prior commitments to certain policy principles, as in the case of NGOs that are reducing their condom distribution programs to qualify for PEPFAR money.58

Going beyond the idea that " transnational civil society actors matter" in international politics, what the particular phenomenon of HIV/AIDS transnational activism shows is that these actors are not always autonomous sources of normative change in international relations. They can also be instrumentally co-opted by powerful states interested in using them to advance their foreign policy objectives. Therefore, the puzzle here has been to differentiate empirically between the political agendas and policy processes of HIV/AIDS transnational NGOs from the ones of states and multilateral institutions. The above evidence suggests, however, that these boundaries are far from being unambiguous.59


Conclusions: The Argument Summarized

This article has proposed a new conceptual framework to help in the understanding of the international responses to the HIV/AIDS global epidemic. By combining insights from the scholarship on international norms and the securitization debate, this framework defined a single concept, namely the HIV/AIDS Securitization Norm (HASN). It is aimed at analytically embracing the myriad of implicit and explicit principles, rules and ideas underlying international action towards HIV/AIDS.

Regarding the historical constitution of the HASN, the analysis has claimed that the securitization of the HIV/AIDS global epidemic in the late 1990s followed the steps described before, from politicization, in the early stages of the epidemic, to a securitizing move, through the emergence of a security discourse, in the early 1990s, and finally to the institutionalization of the securitization process towards the end of the decade. This later period was marked by the creation of a specialized multilateral bureaucracy, namely the Joint United Nations Program on HIV/AIDS (UNAIDS), designed to respond to the global threat posed by the epidemic. Subsequently, as a result of the United Nations General Assembly Special Meeting on HIV/AIDS (UNGASS), UN member-states adopted unanimously the Declaration of Commitment on HIV/AIDS. By this time, the securitization of the epidemic became a recognized international norm. This norm held a series of understandings, policy prescriptions and recommendations about the epidemic, which were internationally promoted as the panacea for efficient HIV/AIDS interventions.

The article then turned to the analysis of the agents or " norm leaders" that promoted the worldwide diffusion of the HASN. It described the fundamental role of UNAIDS as a recognized global authority about HIV/AIDS. It was demonstrated that, by constituting understandings and giving normative value to the epidemic, this organization deeply influences the behaviour of states and non-state actors alike. Similarly, networks of HIV/AIDS activists are powerful transnational mechanisms of norm creation and diffusion. As in a conveyor belt, they promote normative change by transmitting norms from the international system to states and vice-versa.

The study also focused on the role of the United States as a powerful actor in undergoing international normative change. It was shown that material and ideational motivations, derived from deep-rooted worldviews and interests, shaped the particular way the US administration interpreted and reacted to the global epidemic. The US administration’s approach to HIV/AIDS suggested that the limits between the process of politicization and securitization are not easy to assess. As already noted, the move towards securitization taken by the Bush administration was counterbalanced by the de-securitization bias of evangelical groups. These religious organizations lobbied against polices that supported some important HASN recommendations, such as condom education and promotion, for example.

Buzan, Waever, and Wilde affirmed that for an issue to be successfully securitized, a " significant audience" should be persuaded to be afraid of the threat. However, what the above suggests is that securitization initiatives, as in the case of the PEPFAR, do not necessarily depend on people being convinced about the emergency security threat posed by the epidemic. As noted previously, the President’s HIV/AIDS plan was mainly justified on the grounds of religious compassion and of an allegedly moral mission in the foreign policy of the United States.

In the same way, the relatively recent creation of special HIV/AIDS bureaucracies and policies at the system, regional and state levels indicates that the aforementioned pendulum has moved towards the institutionalization of the security threat. Nevertheless, it does not mean that a significant world audience was convinced about the emergency threat posed by the epidemic. Contrasting with the more present danger of international terrorism, for example, the insidious character of HIV/AIDS has disguised the actual magnitude and emergency of the security threat. This particular feature of the securitization of the HIV/AIDS epidemic challenges previous understandings about the determinants of successful securitization claims.

Lastly, this article has demonstrated the important role played by transnational networks of NGOs as instruments of HASN diffusion. It has also exposed some central ambiguities in the institutional mission of those organizations. Reflecting broader structural contradictions in the global securitization of HIV/AIDS, transnational NGOs of HIV/AIDS activists and service providers have been divided by their distinct moralistic, pragmatic and occasionally opportunistic motivations. While more systematic research is needed to unveil the evolution and effects of the transnational phenomena underlying the emergence and global propagation of the HASN, the argument presented here aimed to devise the theoretical and empirical basis for this further endeavour.



1 The concept of transnational advocacy networks is from Keck and Sikkink (1998).

2 At a first glance, the concept of international regime would sound analytically more comprehensive than the concept of international norm. For example, Stephen Krasner provides a definition of international regime which encompasses a " set of implicit or explicit principles, norms, rules, and decision-making procedures around which actors’ expectations converge in a given-area of international relations" (1982:186). However, in Krasner’s formulation, regime is not a single concept but a set of blurry terms, consisting of norms, principles, beliefs, rules and procedures that are really hard to cope with when applied to specific empirical cases. Therefore, to avoid intangible definitional complexities, the present study opted for a minimalist conceptualisation of the HASN in terms of an internationally agreed normative/prescriptive framework promoted with the help of states, IOs and transnational advocacy networks.

3 Consistent with scholarship on the field of international relations, this article accepts Krasner’s definition of norms as " standards of behaviour defined in terms of rights and obligations" (1982:186). It is different from rules that comprise the application of norms to particular situations (Cortell and Davis Jr., 1996:452). For the purposes of this study, the subsequent discussion conveys in a single definition the above understandings of norms and rules.

4 Cortell and Davis Jr. (2000) pointed to " two waves" in the scholarship on international norms. Amitav Acharya (2004) also acknowledged this division in the literature.

5 The idea of international organizations working as " teachers of norms" is from Finnemore (1993). There are a number of other concepts to define the role played by transnational actors in promoting norms, such as " norm entrepreneurs" , " norm leaders" , " norm maker/norm taker" etc. For examples, see Keck and Sikkink (1998), Checkel (1998) and Naldeman (1990).

6 For a useful review of this literature see Cortell and Davis Jr (2000).

7 Acharya (2004:242), for example, called " moral cosmopolitanism" the process whereby international norms are promoted as " universal" and not subjected to resistance or contestation.

8 They are also blamed for failing to grasp the forms by which norm entrepreneurs sometimes manipulate international norms to serve their own particularistic interests (Barnett, 1999; Joachim, 2003; Carpenter, 2005).

9 Buzan, Waever, and Wilde (1998:27-28) note that this process is clearest in the military sector, where the enduring perception of threats, such as internal strife and external invasion, demand the build-up of strong bureaucracies.

10 For more on this, see, for example, " Stop denying the killer bug" , The Economist, 21 February 2002.

11 A comprehensive examination of the domestic incorporation of the HASN in South Africa is beyond the scope of this article. In his doctoral thesis, however, the author developed an extensive analysis of the impact of the HASN on the domestic structure of three Southern African states (South Africa, Mozambique and Botswana), as well as on the regional structure of the Southern African Development Community (SADC).

12 Some neorealist authors are more optimistic about the prospects for cooperation among states. They reject the assumption that states find themselves in a condition of perennial conflict, arguing that there are certain situations in which states seek cooperation rather than competition. See, for example, Glaser (1994/95). Authors linked with the neo-liberal school in international relations have also questioned some neorealist assumptions about international security. Contrary to the neo-realist view, these writers believe that international institutions can provide the regulatory means for improved security cooperation between states. For more on this literature, see Keohane and Nye (1977), Keohane (1984) and Keohane and Martin (1995).

13 According to Buzan, however, international security studies should focus on the latter two levels because security means the protection of human collectivities rather than individual human beings (Buzan, 1991: 50-51).

14 Theoretically, the human security approach is connected with social constructivist literature in international relations. This school of thought posits that ideas rather than power shape the relations between states (Wendt, 1992). Social constructivists, such as Alexander Wendt, for example, would focus their analyses on the ideational move away from traditional narrow understandings of national security to a more comprehensive notion of human security. For them, this move illustrates the power of ideas in shaping international relations.

15 In 1999, a group of states with human security policies launched The Human Security Network. It is currently made up of Austria, Canada, Chile, Costa Rica, Greece, Ireland, Jordan, Mali, the Netherlands, Norway, Slovenia, Switzerland, Thailand and South Africa. For more on this, see:

16 Writers from a plethora of disciplines, such as economics, social policy, anthropology and development studies have also addressed the special and multifaceted impact of the HIV/AIDS epidemic on the social, political, economic and cultural structures of societies, states and regions. See, for example, Bloom and Godwin (1997); Barnett and Whiteside (2002); Campbell (2003); Hunter (2003); Holden (2003); Kauffman and Lindauer (2004).

17 In some African countries, HIV prevalence among armed personnel is estimated to be as high as 40% to 60% (Elbe, 2002, 2006).

18 Stefan Elbe (2001) first acknowledged this division on the security interpretations of HIV/AIDS.

19 The political climate in the US during the 1980s took a conservative turn with the election of Ronald Reagan. Family and religious values were strongly emphasised as indispensable components of society’s cohesion (Ostergard, 2002:338).

20 In the years after the fall of the Berlin Wall, the State Department’s Bureau of African Affairs laid off staff in 70 positions. Consulates in important African states were closed, as in the case of Kenya, Cameroon and Nigeria. The US Agency for International Development (USAID) reduced the staff in its African wing by 30% (Michaels, 1992).

21 These questions started being asked systematically in the academic literature as well as in political circles only about 6 or 7 years ago.

22 On 26 April 2001, at the African Summit on HIV/AIDS, Secretary-General Kofi Annan called for the creation of a Fund to channel money to affected countries. Two months later, at the UNGASS, representatives of states committed themselves to the creation of such a fund. The Fund’s Secretariat was established in Geneva in January 2002, and the first money allocations were approved to 36 countries three months later.

23 For more on this, see " Final Declaration of Commitment on HIV/AIDS Adopted – Disagreement over Strengths and Weaknesses Persist" , Aidsmap, 5 June 2006. Available at: (accessed on 01.08.2006).

24 Brazil, for example, was the first state in the world to provide the cocktail of AIDS drugs to all the patients in need of them through its public health system (Brazilian Ministry of Health, 2000).

25 TRIPS stands for Trade-Related Aspects of Intellectual Property Rights. It is an agreement drawn up by the World Trade Organisation (WTO) between 1986 and 1994 to ensure that intellectual property rights are respected within international trade. It came into force on 1 January 1995, although implementation dates vary from country to country.

26 In this respect, article 6 explores the important role played by the HIV/AIDS advocacy NGO, Treatment Action Campaign (TAC) in South Africa.

27 The WHO has its own qualifying system for AIDS drugs that by December 2005, had approved 70 ARVs, of which 36 from generic companies and 34 from branded manufacturers (WHO, 2005: internet source).

28 All the quotations were taken from the original UNGASS Declaration of Commitment on HIV/AIDS (UNGASS, 2001).

29 In 2004, programmes that focused on sexual abstinence received US$ 50,545,000 from PEPFAR’s total prevention budget of US$ 91,630,000 (US Department of State, 2004b).

30 Every two years, UNAIDS publishes an HIV/AIDS Global Report to update the state of the epidemic worldwide. This study is considered the most reliable HIV/AIDS statistical reference by almost all institutes, NGOs, governments and individuals interested in tracking the progress of the epidemic worldwide.

31 Foucault (1980:115) describes a normative collection of rules, or " discursive knowledge" , which are produced in the service of modern institutions and have the character of truth. For more on this, see also Clegg (1994).

32 This author’s understanding of epistemic community resembles Peter M. Haas’ (1996:3) insightful notion of a " network of professionals with recognised expertise and competence in a particular domain and an authoritative claim to policy-relevant knowledge within that domain or issue-area" .

33 For an interesting review of the different theoretical positions with regards to the autonomous role of IOs in world politics, see Reinalda and Verbeek (1998). See also Baldwin (1993).

34 Curiously, UNAIDS is the first United Nations programme to include NGOs in its governing body.

35 Some authors believe that George W. Bush’s foreign policy is a revision of Ronald Reagan’s idealism. See, for example, Wallinson (2004).

36 Assistance from all developed nations to the Global Fund, for example, amounted to US$ 6 billion in 2004. The Global Fund believes that US$ 38 billion per year will be needed by 2015 to close the gap in health in the world’s poorest countries (Global Fund, 2005b).

37 George Bush named Randall Tobias for this position on 2 July 2003.

38 This program was launched in October 2005.

39 Notwithstanding the widely supported approval system run by the World Health Organisation (WHO), the USAID requires that a US agency, the Food and Drug Administration (FDA), approve AIDS generics.

40 These are Botswana, Namibia, South Africa, Zambia, Ethiopia, Kenya, Rwanda, Tanzania, Uganda, Ivory Coast, Nigeria, Guyana, Haiti and Vietnam. It is interesting to note that, with the exception of Vietnam, every country benefiting from PEPFAR is predominantly Christian.

41 Religious conservatives, including not only Protestants but also traditionalist Catholics and Jews, are the most loyal supporting base of President Bush’s Republican Party. The powerful influence of religious right-wingers goes deep into the US Congress, as well as into the Judiciary and the Executive. For additional information on this, see " The Triumph of the Religious Right" , The Economist, 11 November 2004.

42 Bush himself is a devoted evangelical Christian, who had risked a lot of his domestic political capital working against very sensitive moral issues such as gay marriage and abortion. In June 2005, for example, he addressed the Southern Baptist Convention, promising to work hard in the promotion of their common family values. For more on this, see also " You Ain’t Seen Nothing Yet" , The Economist, 23 June 2005.

43 Financial aid to HIV/AIDS projects is also linked to political support from recipient states to American strategic interests in multilateral institutions, which in many cases are not even slightly related with the HIV/AIDS humanitarian crisis. Human rights activists from Botswana, for example, accused the Bush government of linking financial aid from PEPFAR to Botswana’s support for US interests regarding the International Criminal Court (Ditshwanelo - Botswana Centre for Human Rights, 2003).

44 Prostitution is not considered a crime in Brazil and prostitutes are a very organised group with many associations throughout the country. Brazilian public health officials work in coordination with prostitutes’ associations in condom education and promotion (Phillips, M. M. and Moffet, 2005).

45 Robert Jervis (1976) addressed the problem of misperceptions as a major psychological factor in foreign policy decision-making.

46 " The End of the Beginning?" The Economist, 15 July 2004.

47 Several notions have been employed to define transnational civil society actors. For some useful distinctions, see, for example, Florini (1999), Khagram, Riker and Sikkink (2002). It refers here to " self-organized advocacy groups that undertake voluntary collective action across state borders in pursuit of what they deem the wider public interest" (Price, 2003:580).

48 For a comprehensive review of international relations scholarship on the emergence of transnational advocacy in world politics, see Price (2003).

49 Drawing upon David Snow’s concept of " frame alignment" , Keck and Sikkink noted that to influence broad audiences " network members actively seek ways to bring issues to the public agenda by framing them in innovative ways ... sometimes they create issues by framing old problems in new ways; occasionally they help transform other actors’ understandings of their identities and their interests" (1998:17).

50 Except for the special case of the global superpower.

51 Keck and Sikkink (1998), for example, usefully explore the impact of transnational civil society groups in world politics. The authors set up a list of goals these actors pursue and the strategies they deploy to achieve them.

52 In this regard, Goldstein and Keohane assert that both the world’s great religions and the scientific rationality of modernity provide world views that are " entwined with people’s conceptions of their identities, evoking deep emotions and loyalties" (1993:8).

53 This case is illustrative of one of the tactics specified by Keck and Sikkink in which HIV/AIDS networks generate credible information and quickly move it " to where it will have the most impact" (1998:16).

54 For example, GAP uses human rights claims to challenge multinational corporations to provide free AIDS drugs to their workers. The notion of symbolic politics is from Keck and Sikkink (1998).

55 Joseph Hanlon, for example, called this process " the privatisation of foreign policy implementation" (1991:204).

56 Besides those faith-based organisations, there are hundreds of other North America-based NGOs, Academic Institutions and private companies receiving money from PEPFAR.

57 The opportunities created by the " aid boom" towards HIV/AIDS-related projects favoured the emergence of a number of organisations that established themselves in developing countries without a proper knowledge of the local conditions. They were staffed by young professionals and volunteers who frequently engaged in activities outside the grasp of the established state agencies and coordinating mechanisms. These " side-effects" of HASN are further analysed in this author’s doctoral thesis.

58 " Too Much Morality, Too Little Sense" , The Economist, 28 July 2005.

59 Theoretically, these contentions bring back to light neorealist and neo-liberal assumptions about the predominance of states in international politics as well as Gramscian perspectives that emphasise the underlying logics of global capitalism in shaping actors’ preferences.



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Submitted in June, 2006.
Accepted in April, 2007