Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Political Science


During his 2003 State of the Union Address, President Bush announced his Emergency Plan for AIDS Relief (PEPFAR) and asked Congress, over the next five years, to authorize the appropriation of $15 billion to provide treatment, prevention and care to people infected and affected by HIV/AIDS, mostly in Sub-Saharan Africa. Given the existing pattern of neglect and indifference in U.S.-Africa relations and the Bush campaign’s statement in 2000 dismissing Africa from his foreign policy priorities, what then justifies his administration’s undertaking of this massive foreign policy change?

My dissertation offers insight into the role played by private US pharmaceutical companies in continuity and change in US HIV/AIDS foreign policy toward Africa. As global nonstate actors, these institutions were instrumental in shaping the perception about neoliberal international norms in the practice of the global public health welfare provision. PEPFAR represents a stark contrast to the Clinton Executive Order 13155 that attempted to reinstate the now defunct welfare state model and offers the conservative alternative that establishes the market monopoly over social issues. Hence, the provision of extraordinary resources to fight HIV/AIDS in resource-constrained countries, mostly in Africa, blocked the possibility of implementing two provisos in the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement, namely, the compulsory licensing and the parallel importation. By the same token, it allowed the Bush administration to counter the claim of African governments to sovereignly regulate the antiretroviral patented HIV/AIDS drugs in the global market.

This qualitative case study uses process-tracing methods to uncover the implementation of a privatization agenda in US foreign policy toward Africa. Data for analysis are essentially collected from a thorough examination of primary documents, including presidential speeches, memos, directives, executive orders, and Congressional hearings. Secondly, the literature and secondary documents are reviewed and analyzed, most being reports from governmental agencies and non-governmental organizations. To supplement this process, in-depth interviews were conducted with key policy officials, corporate lobbyists, and human rights activists. The findings are compared with and contrasted to the case of US foreign policy toward HIV/AIDS in Uganda, one key US partner in Africa among other PEPFAR focus countries.

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Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.