PRIVATE AUTHORITY AND GLOBAL HEALTH GOVERNANCE: PUBLIC-PRIVATE PARTNERSHIPS AND ACCESS TO HIV AND AIDS MEDICINES IN THE GLOBAL SOUTH

Abstract

<p>The global HIV/AIDS pandemic has emerged alongside a changing world order marked by the growing power and authority of business, new constraints on public authority and policy autonomy, and new global hierarchies, inequalities, and contradictory tendencies. These conditions have helped midwife new configurations of public and private power, authority, and relations and shaped normative and operating environments for global health governance. In these contexts, public-private partnerships emerged as an institutional experiment, ostensibly to address health governance gaps and failures, including access to HIV and AIDS medicines in the global South. This study investigates the growth and roles of private authority in health governance through the lens of four case studies of public-private partnerships intended to enhance access to HIV and AIDS medicines in the global South. The study reveals that public-private partnerships in health emerged from this history as institutional experiments, yet not convincingly as functionalist responses to governance gaps and failures. The history demonstrates that private business actors opted to engage in partnerships in the contexts of a convergence of social, political, and commercial pressures, and normative and structural transformations in the world order. The case study partnerships emerged as accommodation or <em>trasformismo </em>strategies which offered concessions in an attempt to neutralise and co-opt social contestation around treatment access, without succumbing to demands for deeper structural and legislative reforms. These strategies offer bilateral, narrow, and tactical contributions in a framework of poor design, governance, accountability, and equity considerations and obligations, and are ultimately unconvincing in their commitment or capacity to expand access to HIV and AIDS medicines. Ultimately, public-private partnerships in health present practical, strategic, and normative consequences that necessitate new approaches to reform and/or serious reconsideration of their role and prospects in global health governance.</p>