Public Law 108-25 (PEPFAR), U.S. foreign policy, and the HIV/AIDS pandemic in Sub-Saharan Africa (SSA)

This qualitative dissertation applies three models of foreign policy analysis (FPA) to explain how U.S. foreign policy is constructed by examining the social, economic, and political motivations of Public Law 108-25 (PEPFAR) of 2003. The theoretical application is laid out followed by a thorough literature review of HIV/AIDS and development in Sub-Saharan Africa (SSA). In order to empirically link the pandemic to U.S. national interests, I highlight the securitization and salience of HIV/AIDS in U.S. foreign policy documents. Three research questions are explored: What are the links between U.S. national interests and the HIV/AIDS pandemic in Africa? How is HIV/AIDS framed and the problem represented in U.S. foreign policy documents at the key decision units (president, Congress, and executive branch agencies), and the role and competing policy preferences of a few selected key interests groups? How can we best explain U.S. HIV/AIDS policy towards Africa using the Rational Actor Model, the Bureaucratic Politics Model, and the Pluralist-Interest Group Politics Model? Both in theory and practice, I find that humanitarianism, national security, and economic self-interest all underline Public Law 108-25. They exist simultaneously or in competition---depending on the decision unit or interest group being analyzed.;By combining documents reviews and content analyses of presidential speeches, memos, directives, and State of the Union Addresses by President George W. Bush, the National Security Strategy of 2002 and 2006, and White House briefings and policy statements, and literature review, I demonstrate using rationality, why it was rational for the president to launch PEPFAR and to frame the HIV/AIDS pandemic through the humanitarian lens rather than the conventional national security lens that is paramount in U.S. national interests. Although HIV/AIDS is of genuine concern to U.S. policy-makers, I provide empirical evidence to demonstrate why framing it through the humanitarian lens serves as the pretext of explicit U.S. national security objectives in SSA.;A content analysis of the Congressional Record and transcripts of committee and sub-committee hearings of the House of Representatives and the Senate during the 106th, 107th, and 108 th Congresses on HIV/AIDS and Africa and literature review are used to demonstrate the issue-frames employed by the congresspersons, their enunciated policy preferences, and the ideological and bureaucratic politics driving Public Law 108-25. At the executive branch agencies level, I provide documentary evidence detailing the importance of organizational culture-competence and bureaucratic politics in the framing, the approach and the ensuing implementation of Public Law 108-25 because each agency has crafted its own foreign policy agenda to further its organizational goals. Against this backdrop and resident in the policy sciences literature are found problems of policy coordination and implementation at the inter-agency level. The study demonstrates through documentary evidence, the frames, the policy preferences, and the roles played by domestic politics and selected interest groups in Public Law 108-25. The study finds that the key beneficiaries of Public Law 108-25 are organized interest groups and the policy making decision units. By drawing insights from the current research, the study provides policy lessons and recommendations to improve U.S. HIV/AIDS policy. It delineates the contours for future research.