Why do countries develop harm reduction programs?: a mixed methods approach

Abstract

This thesis investigates why and how countries develop drug harm reduction programs today. Though they began as a controversial set of ideas challenging global drug policy’s dominant interdiction model, they have evolved over decades of mobilization around HIV and become a global social policy in many ways spearheaded by international organizations in its “medicalized” form. Drawing on understanding of complex multilateralism and the Advocacy Coalition Framework, this thesis uses an ordered probit regression analysis and a structured focused comparison of two countries to investigate harm reduction’s development. Based on the dataset by Harm Reduction International (HRI) noting the presence or absence of seven programs in 165 countries, analysis found measures of participatory and egalitarian governance to be especially important. Kenya and Cameroon were chosen for case study through Mill's Method of Difference, as a deviant, successful case and as a typical, unsuccessful case, with substantial similarity in important factors except for the chosen variable of interest: civil society participation in government. It concludes that international involvement, civil society mobilization, and government cooperation with CSOs are especially important to harm reduction’s development. In addition to being the first quantitative study and the first comparative case study on the specific factors that lead a country to develop harm reduction programs, this paper offers insight into global governance by showing how a global social policy can transcend national laws and be in some ways implemented by international actors.