Securing Health

HIV and the Limits of Securitization

Suzanne Hindmarch

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317507123
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: Political Freedom
• Index: Politics & International Relations

This book offers a critical inquiry into the framing of health and disease as a security issue.

In particular, the book examines what happens in the United Nations when the ostensibly 'low' politics of global health meet the 'high' politics of security, and when the logic of security comes to shape global health initiatives. It offers a critical re-assessment of efforts in the United Nations system to position HIV as a security threat with the hope that this would attract greater attention and resources for the global HIV response. The book advances securitization theory by presenting a new framework for studying HIV as a policy process, uniting several theoretical strands into a single, powerful model for empirical application. It uses this model to draw attention to important, understudied aspects of HIV securitization, including the role played by discourses about Africa, and the evolution of ideas about HIV and security as actors learned over time. On the basis of this empirically grounded assessment of how securitization works as a theory and a political strategy, the book suggests that securitization is inherently limited, and perhaps dangerous, as a strategy for 'securing' social change.

This book will be of much interest to students of critical security studies, global health, development studies, and IR in general.

1 Introduction

HIV and securitization as a transformative strategy in global health

We live in a world of apparently finite resources and infinite need. Yet decisions about resource allocation are rarely a problem of absolute material constraints; more usually, the greatest challenge is not the total available amount of resources, but how and to whom those resources are distributed. Deliberations about which and whose issues matter most, and therefore have the greatest claim to attention and resources, are intensely political and significantly shape resource distribution. In global health, the distribution of resources including money and medicine, and the inequities produced by unequal access to these resources, are literally a matter of life and death. How, then, to draw attention and resources to a particular global health issue, or to incite particular policy and programmatic action? More fundamentally, how might resource allocation, and the systems that determine how and to whom political attention is given and life-saving resources granted, be transformed to produce a more just world?

This book examines the efficacy and transformative potential of one strategy for attracting attention and resources to global health: securitization, defined as a move in which actors in a position of authority construct an issue as an existential threat, circumventing the deliberative processes of ‘normal politics’ and triggering emergency action in the form of rule-breaking threat response (Buzan, Wæver, & de Wilde, 1998). It is a critical inquiry into what happens to health and disease when they are constructed in security terms in the current, actually existing international system: when the ostensibly ‘low’ politics of global health meet the ‘high’ politics of international security, and when the logic of securitization comes to shape global health initiatives. The book undertakes this inquiry by examining the effort of a small number of elite actors in the United Nations system to position HIV as a security threat and place it on the agenda of the United Nations Security Council (UNSC), with the aim of increasing global HIV funding and treatment access. These actors’ decision to securitize HIV was a departure from the strategies previously employed by activists in the global HIV response, whose calls for urgent action (as will be discussed below) did not rely on the language of security or the logic of securitization. It also represented a departure from previous international security practice, marking the first time the UNSC had ever identified a disease as a security threat. Yet in its assumption that security holds unique power to attract attention and catalyse urgent action, and that securitization can therefore be an effective means of attracting resources and producing political change, the decision reflects a widely-held belief.

Assumptions about the power and political potential of security and securitization significantly shape security studies theory,¹ and the practices of actors seeking resources or, more generally, swift and decisive political action. These assumptions are politically and empirically as well as theoretically consequential: HIV securitization, and the interventions such securitization authorizes or conversely fails to achieve, has profound human consequences for the approximately 36 million people living with HIV (AIDSInfoOnline (UNAIDS-supported data repository), 2015) and the much larger number of people affected by it. In addition to suggesting to policy-makers and community activists alike how we ought to understand and respond to the global HIV pandemic, beliefs about the efficacy and ethics of securitization also have much wider relevance for other advocates seeking strategies to advance redistributive or transformative agendas in support of social justice. They are assumptions that therefore warrant closer scrutiny – as do the UNSC sessions themselves, which remain an oft-cited but sometimes misunderstood instance of securitization. Careful examination of the UNSC’s securitization of HIV can provide an empirically grounded way in to understanding how securitization works as a theory and a political strategy, and in so doing, enables assessment of some widely held beliefs about power, security, securitization, and political change.

This book, then, has three central aims. The first is to advance securitization theory by proposing a framework to support comprehensive empirical examination of securitization. The book presents a new framework for studying securitization as a policy process, historically produced and organizationally situated, that encompasses discourses, bureaucratic practices, exception and routine, and that is characterized by change as well as continuity over time. Theoretically, the framework unites several strands of securitization theory, levels of analysis and categories of actors in a single framework. Analytically, conceptualising securitization as a series of policy stages enables structured, systematic tracing of the origins, evolution and effects of securitization at multiple levels and points in time, with particular focus on the nature and form of meaning-making contests at each stage. The framework holds potentially wide utility for studying ‘real world’ securitizations, and is intended to contribute to ongoing conversations about securitization theory and its empirical applications. Readers whose primary interest is in the global response to HIV, or in the utility of securitization as a social justice strategy, will also find the framework a useful model with which to investigate instances of securitization; in this respect, the book is an example of what securitization theory can offer to those with an empirical interest in how security is invoked, with what consequences, in ‘real world’ cases.

This leads to the book’s second aim, which is to trace, using this framework, how the UNSC’s HIV securitization unfolded, and what its consequences have been. The overarching argument is that the UNSC sessions were neither the game-changer some participants had hoped they would be, nor were they a failed securitization. Rather, they were at once exceptional and limited, in ways that suggest inherent constraints to the transformative potential of securitization. The book shows that the UNSC sessions and resulting resolutions had significant impact, but in a different form and location than is usually recognized: not in the global HIV response writ large, but in peacekeeping missions, in the UN system itself, and in the epistemic community of HIV and security analysts and practitioners. Additionally, this securitization was not, as is sometimes suggested, simply driven by the US. Rather, there was a distinct international-level move to securitize HIV, and this securitization itself has evolved significantly over time. These arguments are developed by carefully tracing the trajectory of the UNSC’s HIV securitization from its origins in historically-produced discourses, to meaning-making contests in the UNSC’s initial debates in 2000, to the evolution and significant revision of the idea ‘HIV is a security threat’ over the next decade. For security and securitization theorists, the analysis provides granular exploration of the dynamics of securitization as a policy process, showing how discourses and bureaucratic practices work in a specific context and over time to produce securitizations, and how actor learning can produce change in securitizations’ meaning and content. For readers with an interest in the practical politics of HIV and social justice, the analysis usefully illuminates how and why securitization is limited as a strategy for catalysing social change. For both audiences, this empirical analysis provides a critical re-evaluation of the origins, dynamics and consequences of the UNSC’s securitization of HIV.

The third aim of the book is to, from empirical analysis, derive a normative assessment of the ethics and efficacy of securitization as a political strategy. The argument is that securitization holds inherent limitations, largely due to its reliance on threat construction and resulting binary us/Other relations, which create difference, and then hierarchies based on this difference. This produces consistent constraints that shape all subsequent threat response, making securitization an ineffective and dangerous strategy for social change. On this basis, while not claiming to offer definitive answers or solutions, the book proposes that to achieve lasting change in global health resource distribution, we require not securitization strategies, but rather desecuritization efforts that make normal politics itself the site and object of emancipatory praxis. This normative assessment is likely to be of interest to theorists and practitioners with an interest in social justice, emancipation, and strategies and theories of political change.

In sum, this is a book about securitization, and how it works as a theory, policy process and political strategy. It is a book about security-in-use: how security in this instance was understood, operationalized and enacted by people working in and around the UN system in what became, following the UNSC sessions in 2000, the UN’s ‘security response’ to HIV. And it is a book about one facet of the global response to HIV: especially, what happened when much larger claims about HIV as an urgent problem requiring exceptional response were interpreted by, and addressed in and through, the predominantly military-focused international security sector. To situate the arguments that unfold over the rest of the book, the remainder of this chapter briefly outlines the empirical case, locates the UNSC’s treatment of HIV in the larger context of the global HIV response, and establishes the book’s foundational premises and theoretical orientation.

HIV securitization in the UN system

The UNSC’s January 2000 session is often cited as a pivotal moment in which HIV and security concerns were brought together in a novel manner that transformed them both. But this elides that the events of 2000 were not simply a securitization of HIV. The UNSC initially considered HIV as a threat to peace, security and development in Africa, the continent most severely and disproportionately affected by HIV.² Using his prerogative as UNSC president (a position that rotates among UNSC members), US Ambassador Richard Holbrooke declared that January 2000 would be the “month of Africa”, and that the first session would be devoted to a consideration of HIV’s impact on the continent. In this initiative, he was supported and influenced by UNAIDS executive director Peter Piot, who was seeking to draw attention and funding to the global HIV response. The debate was a historic first for the UNSC, garnering considerable political and popular press attention. The session was characterized by far-reaching discussion about the impact of HIV on Africa, calls for improved treatment access on the continent and elsewhere in the global South, and observations about the mutually reinforcing relationship between poverty, underdevelopment, violence and the spread of HIV. It did not however culminate in any action or policy directives.

The UNSC’s first HIV-related resolution was passed in July 2000, and it reflected a crucial reframing of the problem: from an initial focus on HIV’s impact on Africa, the July 2000 session was far more narrowly focused on the impact of HIV on peacekeeping. The outcome, Resolution 1308, called for HIV prevention programmes for peacekeepers as a means of addressing the putative threat posed by HIV. The provision of condoms to peacekeepers was a very limited response when compared to the policy problem as originally stated: that is, HIV’s impact on security and development in Africa. It certainly did nothing to address the significant, complex health and development issues that had been raised in the January UNSC sessions. However, having been given a mandate to address HIV in peacekeeping, UN actors tasked with implementing this ‘security response to HIV’ developed programming that, as this book shows, has come to constitute exceptional reach into territories and peacekeepers’ bodies – even as it has done little to reach those most vulnerable to HIV.

There followed two sessions in 2001 and 2005 to update the UNSC on progress in implementing Resolution 1308, after which HIV was not discussed again until June 2011, when a second resolution addressing HIV was passed. Resolution 1983 linked HIV to conflict, post-conflict and peacebuilding, foregrounded the relationship between HIV, gender and sexual violence, and repositioned peacekeepers from vectors of HIV transmission to HIV educators, but made no mention of the especially severe impact of HIV on African states and communities. It expressed a very different understanding of how, why and to whom HIV was a security threat than had been articulated in the initial securitizing moves of 2000, and endorsed a far more expansive set of UN-led programming activities with uniformed services and humanitarian populations, and in conflict and post-conflict states.

From the outset, then, HIV securitization efforts reflected two quite different concerns: the health of Africa and Africans living with HIV on the one hand, and the integrity and effectiveness of peacekeeping missions on the other. The sessions began with evident confusion about the meaning of ‘security’ and ‘threat’, and how each of these concepts related to HIV – that is, whether HIV was a threat to states or to people, and whether it was threatening to African or non-African states or people or both. Additionally, once the focus shifted to peacekeepers, UNSC session participants showed no consensus about whether by ‘peacekeepers’ they meant troops from African states, troops serving in African missions, or all peacekeepers. Peacekeepers were mainly discussed as threatening vectors of HIV transmission in 2000, but by 2011 they were reconstructed as HIV educators. Iterations of HIV securitization in 2000 and 2011 also expressed quite different understandings of the HIV-security relationship and its connection to, variously, Africa, peacekeeping, gender, and sexual violence, indicating the significant evolution of this securitization over time.

This points to the contentious, contested and perpetually unstable meaning of ‘HIV is a security threat’, suggesting that HIV securitization has been a dynamic, ongoing meaning-making process. At the same time, securitizing actors’ almost immediate empirical slippage from positioning HIV as a security problem to locating that problem in the security sector, specifically in peacekeeping, suggests that securitizing moves, although theorized as entailing the radical construction of security (Buzan et al., 1998), are in practice limited by and reflective of security-in-use; that is, the prior norms and understandings that work in a given context to define what security means, which populations and sectors fall within the boundaries of security, and who has the authority to act on security matters.

HIV securitization in the UN system of course took place against the backdrop of much larger political shifts. In particular, a vocal, well-organized transnational HIV/AIDS activist movement, calling for greater political action and financial investments to address HIV, had gained significant momentum over the mid- to late 1990s. By 2000 this movement had contributed to a widespread general sense that HIV was an exceptional global problem (Ingram, 2013), if not specifically a security threat, and this general sense of urgency undoubtedly contributed to the impetus for the UNSC sessions. Activist mobilization in support of universal treatment access would ev...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of illustrations
• Acknowledgements
• List of abbreviations
• 1 Introduction: HIV and securitization as a transformative strategy in global health
• 2 Securitization as a policy process
• 3 Africa, HIV and security: the discursive context of threat construction in securitization
• 4 Speech acts, framing contests and strategic action in HIV securitization
• 5 When urgency meets bureaucracy: boundary work in HIV and security policy implementation
• 6 Through the looking glass: the production of HIV and security knowledge
• 7 The limits of ‘securing’ health through securitization
• 8 Conclusion
• Appendix
• Index