Association for Public Policy Analysis & Management

In this study, I investigate why HIV positive men are being neglected as a policy target population in South Africa, even though they are less likely to be on treatment and more likely to die from AIDS than women. I investigate this issue applying and modifying the theory of target population social construction to explain gendered patterns of resource allocation for a stigmatized disease in a middle-income country. To examine the influence of target population social construction on policies and resource allocation, I analyze approximately twenty years of South African government speeches, statements, policy documents, budgets, and health system activities using discourse analysis and process-tracing. These methods were used to look at what decisions were made over time, how they were justified internally and externally, how target population social constructions were formed in political discourse, and how these constructions influenced who got what, when, and how. Through this analysis I found that a pervasive government narrative surrounding men as vectors of disease and women and children as victims distorted the provision of resources away from more politically powerful groups to groups more typically considered as dependents. In order to distribute resources for a problem with high symbolic stigma (harsh moral judgment) and instrumental stigma (perceived threat), government needed a group that was not to blame, otherwise it would be giving public resources to negatively constructed target populations, which had unfavorable normative consequences for policymakers. The South African government found it more acceptable to provide resources to “vulnerable” groups than to “responsible” groups, which is one reason why men are neglected in policies and programs. The social construction of target populations theory is useful for understanding this process, particularly the role of power and group valuation, but the process becomes more complicated for issues with high symbolic and instrumental stigma. The theory underestimates the degree to which symbolic stigma and negative constructions diminish benefits for powerful groups, as well as the degree to which resources for dependents are augmented based on their construction as innocent and deserving. One of the key findings is that power is not always beneficial to groups in need of public resources. Additionally, the motivations of policy makers go beyond electoral concerns to include other normative concerns such as avoiding or deflecting stigma to preserve status and esteem, and concerns over legitimacy, credibility, and doing the right thing to alleviate human suffering. This paper then presents a modified theory of target population social construction and directions for future research in low and middle-income countries.