Fighting an epidemic in political context: Thirty-five years of HIV/AIDS policy making in the United States

Abstract

The history of US government action on HIV/AIDS offers important lessons concerning the limits and possibilities of US public health policy. Yet only the first decade of this history has previously been well-documented. This article updates the history by constructing a macro-level account of policies that have been considered and implemented, along with the discourses and debates that have shaped them. This account is generated through systematic study of many dozens of policy making moments, drawing on >70 original interviews, >20,000 daily news reports and hundreds of contemporaneous policy documents. The paper chronicles HIV/AIDS policy from the initial years when the federal government resisted addressing the crisis; through subsequent periods shaped by alternating Republican and Democratic administrations; to contemporary policy making in an era when broader health policy transitions offer hope of normalized treatment and coverage for people with HIV, and scientific innovations offer the possibility of ending HIV/AIDS itself. It also illuminates how national HIV/AIDS policy is not only a series of responses to the concrete challenges of a health crisis, but also a malleable political product and a resource used to wage broader social and ideological battles.