Conceptual and methodological challenges to measuring political commitment to respond to HIV

Abstract

BackgroundResearchers have long recognized the importance of a central government’s political “commitment” in order to mount an effective response to HIV. The concept of political commitment remains ill-defined, however, and little guidance has been given on how to measure this construct and its relationship with HIV-related outcomes. Several countries have experienced declines in HIV infection rates, but conceptual difficulties arise in linking these declines to political commitment as opposed to underlying social and behavioural factors.MethodsThis paper first presents a critical review of the literature on existing efforts to conceptualize and measure political commitment to respond to HIV and the linkages between political commitment and HIV-related outcomes. Based on the elements identified in this review, the paper then develops and presents a framework to assist researchers in making choices about how to assess a government's level of political commitment to respond to HIV and how to link political commitment to HIV-related outcomes.ResultsThe review of existing studies identifies three components of commitment (expressed, institutional and budgetary commitment) as different dimensions along which commitment can be measured. The review also identifies normative and ideological aspects of commitment and a set of variables that mediate and moderate political commitment that need to be accounted for in order to draw valid inferences about the relationship between political commitment and HIV-related outcomes. The framework summarizes a set of steps that researchers can follow in order to assess a government's level of commitment to respond to HIV and suggests ways to apply the framework to country cases.ConclusionsWhereas existing studies have adopted a limited and often ambiguous conception of political commitment, we argue that conceiving of political commitment along a greater number of dimensions will allow researchers to draw a more complete picture of political commitment to respond to HIV that avoids making invalid inferences about the relationship between political commitment and HIV outcomes.

Building political will for HIV response: an operational model and strategy options

“…Other studies find that the space democracies create for media to report on HIV matters more than voting patterns in explaining political leaders' responses to the epidemic (Bor, 2007). Fox et al (2011) argue that the creation of the bureaucratic infrastructure to develop and manage HIV response is a manifestation of political will in that such actions create organizational mechanisms and procedures that constitute what political scientists call "credible commitments," because they result from political negotiations, agreements and promises that are difficult to undo. Gore et al (2014) extend this analysis in assessing how institutional variables-which include the existence of a national AIDS council, favorable national policy, adequate administrative structures and staff, attention to monitoring and evaluation, and adequate HIV-specific resources-contribute to explaining political commitment for HIV.…”

Institutional Commitment to Community Engagement: A Case Study of Makerere University

“…Fox, Goldberg, Gore and Bärnighausen (2011) categorise commitment into three broad types-expressed commitment, institutional commitment and budgetary commitment-that focus on different aspects. However, this paper will focus on, and utilise, the term 'institutional commitment' to embrace all of the above-mentioned categories of commitment because one cannot capture the full picture of the commitment of a university to CE by focusing on only one aspect of commitment.…”

Indicators of political commitment to respond to HIV

“…For instance, as we describe above, the ‘political support’ category of the API indicators is not the only category that captures a component of political commitment. In table 1, we show whether each of the three sets of indicators cover the three components of political commitment (‘expressed’, ‘institutional’ and ‘budgetary’ commitment) defined by Fox et al 4. Some indicators in the API indicator set are outcomes of political commitment (such as the responses to the question ‘Overall how would you rate the coverage (number of people served) of care and treatment efforts of the HIV/AIDS program?’), whereas others represent the government capacity to implement policies (such as the responses to the question ‘Is there an adequate administrative structure and staff for HIV/AIDS activities either through the national AIDS program or through the Ministry of Health?’),18 a measure of ‘institutional’ commitment.…”

“…For some purposes, this choice may be reasonable given that this category covers aspects of ‘expressed’ political support for HIV policies and programmes,4 such as whether the ‘head of government, and/or other high officials, speak publicly and favorably about AIDS issues at least twice a year’ and whether there is a ‘National AIDS Council or Commission outside the Ministry of Health that coordinates the multi-sectoral AIDS program’ 18. However, several other categories of the index—‘policy and planning’, ‘organisational structure’, ‘programme resources’, ‘legal and regulatory environment’ and ‘human rights’— capture aspects of the ‘institutional’ and ‘budgetary’ components of political support to respond to HIV 4. For example, the ‘organisational structure’ category collects information about the types of laws and regulations put in place to protect anonymity and confidentiality of HIV test results and to prevent discrimination based on HIV status and the category on ‘programme resources’ collects information on the adequacy of available funding for HIV care, treatment and prevention programmes.…”

“…The NCPI captures information about the ‘expressed’, ‘institutional’ and ‘budgetary’ commitment of the government to respond to HIV 4. For example, ‘expressed’ commitment is measured by asking government leaders if, and how often, they have spoken out favourably about HIV and have chaired important AIDS meetings.…”