Negotiated Bodies: Institution Building and Participatory Policymaking in Mexico's Public Health Sector

This dissertation examines the relationships between the state and civil society organizations within the context of HIV policy in Mexico. The Mexican context is important in this analysis: Mexico has relatively recently transitioned to a more democratic form of governance, including expanding institutional opportunities for civil society organizations to participate in processes of policy development and implementation. Further, Mexico has an HIV epidemic that is concentrated in the most at-risk communities. These communities typically face political and social exclusion. The extent to which civil society organizations advocating on behalf of these marginalized communities successfully negotiate the creation of new policy interventions and the creation of new public health infrastructure is an important indicator of how deeply democracy has developed in Mexico.;Through direct observation, document analysis, and interviews with government officials and civil society organizations, I find that the relationships between civil society organizations and the state in Mexico, rather than being static, are constantly negotiated. Using a process tracing method of analysis, I further find that civil society organizations wield more power than scholars previously afforded them. The analysis presented in this dissertation is organized around three key areas: identities, rights, and spaces. In negotiating identities, I engage constructivist theories of policy development to explain how the identities of at-risk communities affect both government policy and the relationships among civil society organizations. Because of divergent policy frames and the structure of competitive financing mechanisms, a lack of collaboration among civil society organizations persists. In negotiating rights, I examine the international and national foundations for rights-based claims making in Mexico. As the Mexican government increasingly uses the rhetoric of rights in its public discourse with respect to health and HIV/AIDS, civil society organizations that mirror this discourse have a stronger position in negotiating their relationship to the state, and in advocating for policy changes. Finally, in negotiating spaces, I find that both the metaphorical and physical use of space shapes civil society organizations' repertoire of strategies. This research contributes to the scholarly understandings of state-society relationships, policy development, and democratic inclusion and exclusion in middle-income settings.