Divergent campaigns towards global health governance: Canadian and U.S. approaches to the global HIV/AIDS pandemic Jeffrey Ayres Patricia Siplon.

I. INTRODUCTION

In June 2001, delegates representing countries from around the world met in New York City for a United Nations (UN) General Assembly Special Session on HIV/ AIDS. This meeting took place at the start of a new millennium in an international environment where states had grudgingly begun to recognize the huge geographic scale and enormous human toll that the disease had inflicted on developing countries around the world. However, a noticeable division had emerged between delegations over the wording of the draft declaration of the Special Session. The United States (US), siding with the Vatican and Islamic states, struggled to expunge any mention in the draft declaration of groups at particularly high risk of HIV infection. Meanwhile, Canada, along with Australia and various Latin American and European countries, had urged a much more explicit declaration with the stated goal of reducing incidence among those at high risk of infection. Civil society organizations that had earlier that spring contributed to the wording of this draft declaration, but which had been excluded since that time as negotiations took place between delegations in secret, decried these divisions. The non-governmental organization (NGO) Human Rights Watch noted that "at a conference devoted to fighting AIDS, governments must not replicate the silence and denial that have driven the spread of the disease." (1)

It is hard to overstate the dimensions and consequences of infectious disease, particularly HIV/AIDS, which are crippling sub-Sahara Africa, and increasingly threatening other developing areas of the world as well. However, the response of developed countries to this crisis has been uniformly underwhelming relative to what is needed. As suggested by this division over the wording of the UN draft declaration, the response has revealed radically different approaches to global health concerns between two geographic neighbors and historic allies, Canada and the US. Beyond what have become commonplace rhetorical divisions in international conferences, we can identify other contrasts in the approach each country takes to affordable medications and financial aid provided to some of the hardest hit areas.

Canada has passed legislation facilitating developing countries' access to affordable generic medications at the same time that the US has aggressively pursued multilateral and bilateral trade agreement protections for the brand-name pharmaceutical industry. Canada has also put most its financial contributions into multilateral vehicles such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Health Organization's (WHO) "3 x 5" (3 million in treatment by 2005) initiative. The US meanwhile has placed the vast majority of its resources into its bilateral President's Emergency Plan for AIDS Relief (PEPFAR) targeting fifteen countries. Though less obvious, the two countries have also pursued very different policies regarding prevention, in terms of funding priorities and the above noted ideological positions at international meetings, as well as overall development goals in vulnerable countries as well. How might we account for these differences in ideological, financial and policy approaches between Canada and the US to the HIV/AIDS pandemic?

II. FRAMING DIVERGENT STATE APPROACHES TO THE HIV/AIDS PANDEMIC

The global HIV/AIDS pandemic and the international response have major implications for both the study of international relations and the practice of global governance. In addition to the moral imperative of preventing the deaths of untold millions of people worldwide who are either now HIV positive or soon will be, the global pandemic has exposed further gaps in so-called have and have not countries, exacerbating global inequity, gender discrimination and the growing roster of weakening or failing states. Our approach to this issue begins with one of the more enduring analytical and systematic approaches for developing explanations for foreign policy and international relations outcomes: levels of analysis.

Obviously, there are many other analytic frameworks available for this analysis. Social scientists have examined HIV/AIDS using a variety of policy perspectives and approaches for topics ranging from comparative blood policy (2) to the development of care and support policies for HIV positive persons (3) to the highly controversial issue of supervised injection facilities for controlling HIV spread. (4) Another common set of theoretical frameworks has been furnished by social movement theories, including the political ...

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