Vlad Kravtsov, Norm Diffusion and HIV/AIDS Governance in Putin’s Russia and Mbeki’s South Africa (London: The University of Georgia Press, 2015), pp. 259.

Reviewed by: Alla Baranovsky (Harvard University)

Why do some countries rely on local, subpar health policy solutions when tackling enormously important health crises, like HIV? This is especially puzzling in the cases where we have well-established, effective international norms for health governance. To find an answer to this question, Vlad Kravtsov, a graduate of Syracuse University and a current co-investigator on a study of international cooperation in response to HIV/AIDS, examines two cases of norm diffusion and HIV/AIDS governance in Putin’s Russia and Mbeki’s South Africa. Immediately rejecting the all-too-familiar explanations focused on domestic governance and distrust of the outside world and its norms, Kravtsov examines a variable which he calls a state’s “social purpose,” or a set of ideas that justify its raison d’être.

Summit on HIV/AIDS Adopts Political Declaration to intensify efforts to eliminate HIV/AIDS. photo credit: UN Photo/JC McIlwaine.

The book finds that where international health governance norms, which for HIV/AIDS are invariably Western in origin and liberal in nature, impinge on the state’s “social purpose”, the former will be abandoned, not the latter. For example, one well-established international principle for handling HIV/AIDS relies on making the issue into a public health priority and devoting sufficient resources to suppress the virus’ replication. When this principle meets an aspect of the Russian “social purpose” that deals with improving demographics, the state’s response deviates from the international norm. In this particular case, the Russian state apparatus – represented by law enforcement agents together with the conservative Orthodox Church – takes over the policy debate and twists it to emphasize the war on heroin consumption. This, coupled with a general dislike of the human rights concept, results in a failure by the Kremlin to provide preventive services, such as needle exchanges to the vulnerable populations, that may help to slow the spread of the disease.

Kravtsov’s writing style is mostly clear. He is a skilled writer, and he lays out a careful, well-organized argument. The cases are explored in depth, which provides rich details and makes it an interesting read. But a few aspects of the book leave the reader unsatisfied. For instance, I wonder if Kravtsov is, in fact, contributing something new to the discussion by simply creating this new variable, which he calls “social purpose.” Kravtsov defines a state’s social purpose as “ideas [that] are treated as justifications for the existence of the state,” (10).  This sounds a lot like a definition of ideology. For Russia, Kravtsov identifies the social purpose as “sovereign democracy;” for South Africa he calls it “African Renaissance.” Kravtsov argues that social purpose and ideology are two distinct concepts, but this argument is not convincing. He notes that ideology both precedes and outlasts political actors, however that may not be the case. For example, Napoleon Bonaparte brought the liberal ideology to European states that he conquered, while the Stalinist ideology died with the man. Once you relax these definitional wrinkles, the differences between the two concepts fade. Even if we allow the book some conceptual gymnastics, it seems that a state’s social purpose can become ideology over time, or might become a subset of ideology. If the variable of “social purpose” is a new name slapped hastily on an old, and well-explored concept, then this book needs to do more justice to reviewing the existing literature within the topic.

President of South Africa Addresses Opening of HIV/AIDS Summit. photo credit: UN Photo/Paulo Filgueiras.

This volume is a constructivist work within the field of international relations. The constructivist approach implies an emphasis on ideas, “identities and interests of purposive actors” (Wendt 1999, 1).  Broadly, within the discipline of International Relations (IR), I think the choice of the theoretical framework is appropriate. Since the main causal variable is ideology, the author justifiably examines ideas in his work. On the other hand, being a piece of an IR scholarship, this book completely ignores the contributions of comparative politics that might be helpful here. For instance, the literature on state capacity might be useful in explaining states’ priorities in handling health crises. Kravtsov does mention the Russian state’s “limited administrative capacity of the state machinery” (41), but does not elaborate on how this might either support or undermine his argument. Another sub-field of comparative politics that might be helpful in explaining the behavior of both Russia and South Africa is found in literature on “domestic structure”. In this strand of literature, the nature of a state’s “political institutions, state-society relations, and the values and norms [are] embedded in its political culture.” (Risse-Kappen 1994, 185-214). States’ domestic structures help to explain why ideas that seem to be floating ubiquitously around policymakers do not translate into actual policy. To be fair, the book does contain a handful of alternative explanations (role of the individual, pre-modern collective beliefs etc.), but all of them are non-rigorous. Thus, they become a straw-man of sorts. In other words, the book’s alternative explanations are not the ones that first come to mind when I think about possible explanations why neither Russia nor South Africa will utilize modern international health insights in tackling the HIV crisis.

Case selection in this book is another problematic area. The reasoning seems to follow Mill’s method of agreement (although Kravtsov does not acknowledge that), where a single identical variable that is shared across cases explains the same causal outcome in two very dissimilar cases. Kravtsov notes that there are no overt similarities between Russia and South Africa as they are different in “history, regional features, […] sensibilities, or […] cultures.” (14). Then he postulates that the social purpose variable, which is similarly strong in both cases as the countries recently underwent changes in identity, is the cause of the outcome that we observe. My concern with this strategy is that there is considerably more similarities between the two countries than this book admits.

Health Minister of Russian Federation Addresses High-level Meeting on HIV/AIDS. photo credit: UN Photo/Rick Bajornas.

According to Kravtsov, the reason why this variable is so pronounced in the two countries, is that these ideas were formed as a response to Russia’s and South Africa’s need to restructure its domestic political identity following a dramatic regime change. In other words, what underpins this variable is a massive amount of similarities between the two cases. Beyond that, both countries have weak states in terms of their infrastructural capacity, with similar hybrid, personalistic political regimes, and academic arguments have been made to suggest a cultural similarity (Jackson 2015). If these cases are more similar than dissimilar, the case for causality becomes more difficult to make.

The book’s external validity is also limited. Kravtsov suggests that even though he examines how the causal mechanism works within each of the two cases, this does not overturn his conclusions for other states that have recently undergone a restructuring of identity. I am not certain that this is the case. The contribution of this book is not in the causal chain it lays out, nor in its applicability to other countries. In my opinion, it fits better within the literature focused on constraints to global diffusion. If we replace, for example, the HIV governance norms with other ideas, such as those about democratization, the theory still has (limited) explanatory power. Thus, the book’s external validity lies not in the theory’s application to other countries, but to other ideas, norms, and governance principles.

General Assembly Reviews Progress since HIV/AIDS Declaration. photo credit: UN Photo/Eskinder Debebe.

The book is appropriate for international relations and health policy scholars, as well as graduate students with a deep interest in the subject. I struggle to think of a practical application for this text, considering its pessimistic conclusion for practitioners as it shows that no matter how good the health norms you intend to propagate are, these will fall on deaf ears in countries like Russia and South Africa because of rigid domestic factors. Perhaps a follow up work might suggest ways out of this conundrum.



Jackson, Jeanne-Marie, South African Literature’s Russian Soul: Narrative Forms of Global Isolation, London: Bloomsbury, 2015.

Risse-Kappen, Thomas “Ideas Do Not Float Freely: Transnational Coalitions, Domestic Structures, and the End of the Cold War,” International Organization 48 (2), 1994.

Wendt, Alexander, Social Theory of International Politics. (Cambridge: Cambridge University Press, 1999).