1. China’s evolving AIDS policy: the influence of global norms and transnational NGOs Joan Kaufman, Sc.D Heller School, Brandeis University Harvard Medical School and Harvard Kennedy School of Government Conference on Civil Society and Nonprofits in China Harvard University, January 22, 2011

2. Transnational civil society movements – the “Third Force” Relevant Perspectives soft power - legitimacy of messages about social justice, moral authority and claim to represent public interest and common good (Florini 2000) “boomerang effect” – civil society groups bypass the state and appeal to trans national networks and institutions as well as foreign governments (Keck and Sikkink 1998) However True transnational civil society activism in China limited by the political space allowed it by the party/state (Beja, 2008) (e.g. AIDS versus reproductive rights)

3. China’s AIDS response: 1985 (first case) versus now Then Denial Stigma and victim blaming Criminalization – arrest and punish drug users Foreigners disease Now State Council leadership (SCAWCO) and multi sectoral collaboration NGO community involved in AIDS response (174 in Yunnan alone) but mostly MSM and PLWHA Strong pragmatic policy response and free treatment program Many international partners “Harm reduction” programs with police (sometimes) Acceptance of stigmatized groups: MSM and PLWHA

4. Innovations in global governance for HIV/AIDS (Sidibe, Tanaka, Buse, Global Health Governance, IV:1 Fall, 2010) Political commitment/accountability for a health issue (UNGASS, etc) Expanded political space for affected persons Use of a human rights discourse (right to health, access to essential medicines) Novel arrangements in the global health architecture (creation of a Global Fund; UNITAID)

5. Global Norms for an effective AIDS response at country level (promoted by UNAIDS and global institutions) Participation of HIV positive persons (PLWHA) – the “GIPA Principle – Greater Involvement of Persons Living with HIV/AIDS” Peer approaches to service provision – NGOs that represent at-risk groups Multi sectoral government collaboration – especially police Harm reduction – public health over law enforcement goal – approaches reduce transmission of HIV for illegal groups like drug users and sex workers Treatment Access

6. Many transnational NGOs engaged in global organizing and advocacy on HIV/AIDS Access to Essential Medicines - International Treatment Preparedness Coalition, Treatment Action Campaign, MSF Participation of stakeholders – GNP+, Global Alliance of Sex Workers NGO place at the table for governance - Global Fund and its “Country Coordinating Mechanism (CCM)” Business Responsibility - Global Business Council on HIV/AIDS, Product Red Sustainable Financing– UNITAID, Advance Market Commitments

7. Mechanisms for Introducing Global Norms UN system – UNGASS and UNAIDS (e.g. mandated reporting on civil society) Funding Mechanisms - Global Fund for AIDS, TB, Malaria (CCM – the mandated governance requirement) Donor programs (e.g. AIDS Public Policy Training Project, Asia Pacific Leadership Forum) Networking at International and Regional AIDS Conferences Global organizing over the internet

8. China - Transnational Civil Society connections Global Network of People Living with HIV/AIDS (GPN+ ) – China “branch” established with FF funding Sex Workers – Global Network of Sex Worker Projects and China Sex Worker Network – red umbrella campaign used in Vienna then repeated in Wuhan (8/3/10) calling for legalization of sex work China Global Fund Watch linked to Global Fund Observer China AIDS NGO-Action list serve (internet) closely linked to offline activism International NGO list serves (SEA-AIDS, Human Rights List serves)

9. Example - Yirenping Online Hepatitis B campaign against labor discrimination Protected in policy documents but hard to enforce Extended to HIV

10. Global Fund for AIDS, TB, Malaria Global Fund ( $424 million over 6 rounds) round 3 initially rejected and comments on IDUs/China led to acknowledgement of central China blood scandal CCM requirement and election process 20% of funds set aside for NGOs NGO work committee

11. Insights from the AIDS NGO scene – How does this relate to philanthropic practices in China? Big movement possible for “allowable issues” (Beja)– (AIDS versus reproductive rights) (progress pre and post SARS) Limiting factor on real social movements is the limit on branch organizations except through GONGOs (e.g. China GNP+ could provide mechanism for PLWHA to sue government for blood related infections) Local governments don’t want to give $ to NGOs (national contracting mechanisms?) Social welfare orgs – charitable and humanitarian – okay for service but stricter limits on rights advocacy (e.g. Wan Yanhai, Ye Haisen, Asia Catalyst, etc)

12. Summary of the China AIDS epidemic in 2009 People living with HIV740,000 Number of AIDS 105,000 New HIV infections 48,000 Deaths due to AIDS 26,000 HIV prevalence 0.057% 45% increase in incidence in recent years