Colbrook, Stephen; (2023) Patchwork Pandemic: American Governance, State Politics, and the Fractured US Response to HIV/AIDS. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis provides the first state-level history of the U.S. AIDS crisis. It is well-known that the federal government’s response to HIV was painstakingly slow, partly because the disease disproportionately affected stigmatized minorities – especially gay men and IV drug users. Rebuffed at the national level, AIDS activists and policy elites turned to state legislatures to address a host of concerns stemming from the pandemic, including the high cost of drug therapies, the rampant discrimination experienced by those suspected of infection, and the housing and healthcare needs of people living with HIV. Anchored in case studies of California, Illinois, and Texas, Patchwork Pandemic argues that the states were at the vanguard of the political and policy response to the epidemic in the 1980s and early 1990s. Faced with a common threat, America’s fifty states nonetheless adopted widely divergent strategies to stem the spread of the new contagion, creating a disjointed approach to a crisis that was national and global in scope. By examining AIDS policymaking at the state level, this dissertation complicates existing scholarship on the American government’s approach to the disease. Much of the rich and voluminous literature on the epidemic assumes, because of the Reagan administration’s inaction and indifference, that all tiers of the U.S. government failed to respond to the crisis. For the most part, state governments are absent from major works on the history of AIDS, and historians have yet to explain how federalism shaped the contours of early AIDS policymaking. Patchwork Pandemic addresses these gaps by showing that the states enacted a flurry of AIDS-related statutes in the 1980s. On one issue after another, ranging from the politics of antibody testing to the funding of prevention education, states became policy incubators during the epidemic’s early years

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