Jessica Rich’s book is a premonitory tale about how state actors and social movements deal with a pandemic. Written before the current dystopian times of COVID-19, Rich’s volume is an outstanding analysis of the HIV/AIDS pandemic and how it was efficaciously tackled in Brazil.
The book’s argument is that the successful story of the AIDS movement in Brazil is a result of the alliance between federal bureaucrats and a collection of NGOs and advocacy groups. This was possible because of the contradictory effect the dual transition to political democracy and neoliberal economy produced in undercutting traditional corporatism. Democratization led to the renovation of the bureaucracy with the inclusion of a generation of state officials with a progressive and democratic perspective, the redesign of the state institutions around the principles of participatory democracy, and the emergence of a new “social question” that responded to claims that transcended labor-based grievances. Neoliberalism, in parallel, cut resources to labor-based actors but increased them for NGO-style actors, while it promoted outsourcing of social policies to NGOs to reduce the state apparatus.
In this context, federal bureaucrats expanded a grassroots movement to confront the negative effects of outsourcing and decentralization as part of state reforms that would have left AIDS programs under the sphere of conservative subnational governments. Thus, the main motivation for bureaucrats to support grassroots groups was the need to bypass internal state resistance to AIDS policies to provide an efficient health response to the HIV/AIDS pandemic. In this sense, Rich goes well beyond the narrow co-optation arguments of some social movement literature, which confuse incorporating social actors into the state apparatus with abandoning the ambition of promoting social change. The book makes a strong case for the need to surpass the outsider-insider argument in social movement–state dynamics and instead explores the embeddedness of societal processes and health policies as mutually reinforcing dynamics.
Rich shows the transformations of the AIDS movement in Brazil by means of a careful reconstruction of its main historical events. In the 1980s, the AIDS movement was composed of small and professionalized NGOs that lobbied and protested. In the 1990s, activists penetrated the state apparatus as federal bureaucrats and helped promote AIDS policies that created a series of technocratic NGOs concerned only with service provision, but kept alive the programs that contained the pandemic. In the 2000s, support for the recovery of an activist ethos in the AIDS movement was possible thanks to the legacies of struggle of the 1980s, expanding the movement to include the popular sectors and minority groups. This activist ethos democratized the AIDS movement beyond the urban and white middle and upper classes that had originated it.
In this fascinating story, the book combines the analysis of institutional and contentious tactics performed by the AIDS movement, but lacks a theoretical discussion of this interesting dynamic, which could have dialogued very well with some central debates in social movement studies. As a result, we are not informed how these tactics are interrelated in repertoires of strategies. However, the narrative clearly shows how legacies of struggle are interconnected from the 1980s to the 2000s to reformulate twice the AIDS movement in Brazil.
The result of the process studied in this book was the emergence of a new model of state-society relations. Rich’s empirical argument engages with the central debate of how to define state-society relations in Latin America. She proposes a novel definition of how state actors shape the nature of state-society relations, called civic corporatism. This subtype of neocorporatism is a result of transformations in the constitution of a democratic and neoliberal state-society bond. The theoretical proposal illuminates how the AIDS movement–bureaucracy nexus formed an alliance to put forward a progressive health agenda for the HIV/AIDS pandemic. The question is how much the functional logic dominates the whole range of state-society bonds in Brazil beyond this case. Observing the general political panorama in Brazil, the record seems mixed. In this open debate, Rich’s book offers a possible answer that we need to consider when studying Brazil.
Reflecting from the vantage point of comparison that the COVID-19 disaster in Brazil offers, I found that Rich’s book poses some important lessons for the current and future pandemics. Facing the same opposition from conservative religious groups as it does now, Brazil’s government became during the HIV/AIDS health crisis a worldwide model of how to correctly treat a pandemic. What explains the present devastating consequences of the failure of Brazil’s responses to the COVID19 pandemic?
Three main lessons can be learned from Rich’s book for successful management of the current pandemic. First, it needs a mobilized and coordinated group of social organizations struggling for the right to health treatment. Second, it is crucial to have a state bureaucracy with enough capacity to support social movements and NGOs and the will to confront powerful conservative actors. Third, the confluence of these two elements must include the preference for human life over capital accumulation; therefore, irrespective of pharmaceutical patents.
If we connect past struggles with present ones, we could argue that the current vaccine apartheid might be explained by the triumph of capitalist accumulation over life, but also by the lack of a coordinated societal answer to counterpoise it. In this same sense, looking back to the antecedents of the AIDS movement, could the successful story Rich narrates have been possible without the previous Sanitarista movement, which universalized health access in Brazil? Health policies seem to be interlocked across different movements in Brazilian history. Therefore, why and how things changed 180 degrees in Brazil from the HIV/AIDS pandemic to the COVID-19 pandemic is a crucial question that Rich’s book allows us to start exploring.
