Stigma and policy aggressiveness: A quantitative analysis of country responses to AIDS & TB

AIDS and tuberculosis (TB) are both infectious diseases that primarily affect the poorest and most marginalized members of society, which might suggest a tendency for both to be neglected problems. Yet TB policies have been implemented in over 180 countries with the scale-up of first-line TB drugs reaching 100% coverage in many low-income countries. Meanwhile, antiretroviral drug coverage for AIDS has yet to reach 100% in most places. What makes the success of TB policy even more surprising is that comparatively, AIDS has a greater mortality and morbidity burden, and funding for AIDS programs far exceeds funding for TB – factors that suggest greater policy attention for AIDS. This study investigates why these two diseases have such different domestic policy trajectories using a unique cross-national panel dataset of all countries with per capita GDP less than US$8,000 in 1995 (N=139). I conduct a regression analysis, controlling for factors such as disease prevalence, domestic health spending, donor aid and other measures of a country's ability to address health problems, in order to identify the factors that influence the willingness of governments to act aggressively. Findings indicate that the symbolic stigma of AIDS, defined as the harsh moral judgment of those who are infected, exacerbates pre-existing social inequalities, specifically inequality between ethnic groups, weakening policy responses to AIDS. Variables for pre-existing social inequalities were not significant in the TB models, suggesting an interaction affect between disease-related stigma and social inequalities on policy outcomes.