Online Program

Stigma and policy aggressiveness: A quantitative analysis of country responses to AIDS & TB

Tuesday, November 5, 2013 : 11:15 a.m. - 11:30 a.m.

Kathryn Quissell, MPH, MSc, PhD Candidate, School of Public Affairs, Department of Public Administration and Policy, American University, Washington, DC
AIDS and tuberculosis (TB) are both infectious diseases that primarily affect the poorest and most marginalized members of society, which might suggest a tendency for both to be neglected problems. Yet TB policies have been implemented in over 180 countries with the scale-up of first-line TB drugs reaching 100% coverage in many low-income countries. Meanwhile, antiretroviral drug coverage for AIDS has yet to reach 100% in most places. What makes the success of TB policy even more surprising is that comparatively, AIDS has a greater mortality and morbidity burden, and funding for AIDS programs far exceeds funding for TB – factors that suggest greater policy attention for AIDS. This study investigates why these two diseases have such different domestic policy trajectories using a unique cross-national panel dataset of all countries with per capita GDP less than US$8,000 in 1995 (N=139). I conduct a regression analysis, controlling for factors such as disease prevalence, domestic health spending, donor aid and other measures of a country's ability to address health problems, in order to identify the factors that influence the willingness of governments to act aggressively. Findings indicate that the symbolic stigma of AIDS, defined as the harsh moral judgment of those who are infected, exacerbates pre-existing social inequalities, specifically inequality between ethnic groups, weakening policy responses to AIDS. Variables for pre-existing social inequalities were not significant in the TB models, suggesting an interaction affect between disease-related stigma and social inequalities on policy outcomes.

Learning Areas:

Advocacy for health and health education
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Describe important political factors influencing the adoption and implementation of health policies across countries; Explain the role of stigma in the scale-up of health policies; and Compare the role of stigma in the scale-up of treatment for AIDS and TB.

Keyword(s): Politics, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal author of this study which is one chapter of my dissertation project. I have been the primary or co-author on several other studies of the politics of health policy adoption and implementation, including a study of the Global Partnership to Stop TB that was presented at APHA 2012.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.