Association for Public Policy Analysis & Management

Background. The global HIV treatment access movement is considered one of the most successful transnational social movements in recent history. Prior to treatment scale-up, the prevailing consensus among global health elites was that behavioral prevention efforts were the only feasible policy solution for resource-poor countries with rapidly increasing HIV infection rates. This study explores the reasons for the success of the global treatment access movement at garnering global attention and investments where behavioral prevention efforts, once believed to be the only viable solution for resource-poor settings, have been increasingly marginalized.  Methods: Through literature review and key informant interviews, this study draws on social movement and agenda setting theories to analyze the problem, policy and political factors that enabled the success of the global treatment access movement, and hindered the advancement of behavioral prevention initiatives (e.g., reduction in partner concurrency, condom use, structural interventions to change gender norms). Results: Analysis of the factors that led to the success of the treatment access movement include its strategic use of frames that resonated with audiences shared cultural understandings around global social justice; the movement’s exploitation of political opportunity structures to advance rights-based legal claims; its strategic identification of a clear villain (e.g, TRIPS and big Phrma), and set of concrete policy demands.  By contrast, although efforts to reduce multiple sexual partnerships and increase condom use through social marketing had important early successes in Uganda and Thailand, identity politics and a lack of scientific consensus over the efficacy of such interventions led these approaches to be marginalized, and at times even demonized as undermining wider efforts to expand treatment access and stigmatizing to vulnerable populations. Conclusions:  These results have broader implications for global health policy. The success of the AIDS treatment access movement has spurred a massive push to develop new drugs for neglected diseases prevalent in resource-poor countries. However, HIV rates continue to increase in many countries and questions remain as to whether “treatment as prevention” on its own will be sufficient to reverse HIV infection rates. A reconsideration of social, behavioral and structural interventions to address HIV and other intractable diseases could produce more sizable impacts on new infections.