Germs and Governments: Politics of HIV/AIDS in Developing Democracies Open Access

Kakietek, Jakub (2011)

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Abstract

Abstract
Germs and Governments: Electoral Market Imperfections and the Politics of HIV/AIDS
in Developing Democracies.
By Jakub Kakietek

Although well established theories in the scholarship on political economy and social
policy suggest a link between democratic regimes and high quality of social policy, a
closer look at the Caribbean suggests otherwise. In particular, it reveals considerable
variation in the way developing democratic nations in the region responded to the
epidemic. My dissertation addresses this puzzle by exploring the reasons similarly
democratic countries can produce dramatically different policy outcomes. It attempts to
answer two questions pertaining to the impact of democratic accountability of
HIV/AIDS policy: 1) under what conditions institutions of democratic representation
improve HIV/AIDS policy outcomes and 2) is the impact of democracy the same for
policies affecting the general population (e.g. providing prophylaxis for the prevention of
mother-to-child transmission (PMTCT) of HIV ) and policies affecting marginalized
groups: men who have sex with men and commercial sex workers.
I argue that imperfections in electoral
markets mediate the impact of democratic institutions on policy, including measures
aimed at fighting HIV/AIDS. More specifically, imperfections in the electoral markets,
defined as: 1) lack of access to information among the citizens, 2) ethnic polarization,
and, 3) limited trust of the citizens in politicians, in particular the lack of trust that
politicians deliver on their electoral promises, suppress the positive impact of democratic
accountability and lead to HIV/AIDS policy failures in democratic countries.
In countries
where electoral market imperfections are more pronounced, policies and institutions
aimed at fighting AIDS take longer to develop, spending on AIDS and the availability of
services for those infected and at risk are low, and the effects of the efforts to fight AIDS,
such as behavioral change in those at risk of infection, are limited.





Germs and Governments: Electoral Market Imperfections and the Politics of HIV/AIDS
in Developing Democracies.
By
Jakub Kakietek
Master of Arts, 2001, Emory University, 2003
Master of Public Health, Rollins School of Public Health, 2009
Advisor: Richard Doner, Ph.d.
A dissertation submitted to the Faculty of the
James T. Laney School of Graduate Studies of Emory University
in partial fulfillment of the requirements for the degree of Doctor of Philosophy in
Political Science
2011


Table of Contents

Table of Contents:
CHAPTER 1: INTRODUCTION ..............................................................................p. 1

CHAPTER 2: QUANTITATIVE ANALSYSIS........................................................p. 36

CHAPTER 3: BARBADOS CASE STUDY .............................................................p. 83

CHAPTER 4: TRINIDAD AND TOBAGO CASE STUDY .................................p. 147


CHAPTER 5: ELECTORAL MARKET IMPERFECTIONS

AND SOCIALLY MARGINALIZED GROUPS - THE

CASE OF THE WALROND REPORT ...................................................p. 201

CHAPTER 6: CONCLUSIONS ..........................................................................p. 223

APPENDIX A: IN-DEPTH INTERVIEW SECTORS AND

DATES....................................p.








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