This thesis contributes to debates on the role of civil society organizations (CSOs) in global governance by asking if their participation in the global response to HIV/AIDS has been transformative – with transformation conceptualized as change towards a more equitable order. Adopting a critical International Relations approach, and applying qualitative methods, it analyzes how CSOs used the initial failure of biomedical responses to the epidemic to advance a human rights frame, which justified their participation in global governance. This frame complemented conceptions of AIDS exceptionalism, and has recently shifted in response to an increased focus on key populations. CSOs continue to advance the rights frame in global institutions – the focus here being on how they have done so within UNAIDS and the Global Fund to Fight AIDS, Malaria and Tuberculosis. However, rigid bureaucracies and dominant power relationships limit CSOs’ ability to transform these institutions to be more responsive to and representative of those affected by the epidemic. CSOs have further struggled to influence the largest global donors of the HIV/AIDS response – the Global Fund and PEPFAR – to direct greater resources to rights-based initiatives, despite CSO participation in resource mobilization. Though CSO participation has been restricted by donor state power, bureaucratic structures, and changes in the political economy of global health, CSOs have continued to promote potentially transformative alternatives, and so have continued to represent the interests of those most affected by the epidemic. This allows potential for further transformative alternatives.

Barriers to reaching human immunodeficiency virus (HIV) testing prevent Canada from achieving The Joint United Nations Programme on HIV and AIDS (UNAIDS) target of 90 percent of undiagnosed people living with HIV knowing their HIV status by 2020 and receive treatment.(1) Fourteen percent (9,090 of 63,100) of Canadians living with HIV were unaware of their status by the end of 2016.(1)(p.9)Individuals exposed to HIV through heterosexual contact are overrepresented (28%) among the undiagnosed people living with HIV in Canada compared to other groups, such as men who have sex with men (18%) and people who inject drugs (20%).(2)(par.15)The reasons preventing this population to present themselves for testing in Ottawa, Ontario, remain poorly understood in the literature. Most of the literature on barriers to accessing HIV testing focuses on the traditional key groups who are likely to test, and limits analysis of these barriers on one or two levels. Equally, health service providers rarely understand challenges behind HIV testing for particularly young heterosexual African migrant men. These challenges may be contributing key barriers to HIV testing. On other hand, late presentation to treatment remains a global issue. Psychosocial outcomes especially after a new positive diagnosis can delay reaching early treatment and prevention services. Indeed, all test results negative or positive have consequences. Even those with a new negative test can return to risk taking behaviour if they delay accessing prevention education. Yet no systematic study exists in this area essential for quality improvement. Programming more equitable HIV testing services will require more comprehensive evidence about challenges and barriers behind accessing HIV testing and treatment to achieve UNAIDS target of 90 percent of undiagnosed people living with HIV knowing their status and receive treatment. This research aimed to contribute to this evidence through two phases. Phase 1 used the Joanna Briggs Institute methods to implement a scoping review on psychosocial outcomes and their measurements immediately following a new HIV diagnosis. This review considered all participants who tested for HIV – whether their results were positive or negative, as any test results have consequences, and regardless of age, sex, or setting – reported in published articles between 2007 -to the present date. Paper 1 presents the scoping review. Phase 2 relied on a qualitative methodology using Grounded Theory informed by a socio-ecological framework and a framework of access to healthcare to understand experiences of accessing HIV testing services in two parts: 1) to examine barriers to reaching HIV testing among young heterosexual African migrants, focusing on young men, in Ottawa (Paper 2); and 2) to identify challenges experienced by health service providers who make accessible HIV testing services to this population in Ottawa (Paper 3). There is some ambiguity in the use of the terms “first generation immigrants” and “second generation immigrants” (or children of first immigrants). In this study, the term migrants referred to both. Selecting participants from both groups (first and second generation) was important to include a wide variety of experiences and interpretations that reflect the study population. Furthermore, the term “health service providers” was used to refer to both healthcare providers and frontline service providers. Healthcare providers referred to those who conduct HIV testing in health facilities, whereas frontline service providers referred to those who provide care and support services needed by members in their communities before and after testing within AIDS organizations and community-based organizations.

HIV/AIDS continues to pose some of the most significant social, political and legislative challenges globally. This project explicates the text-mediated processes by which many HIV-related laws are becoming created transnationally though the use of omnibus HIV model laws. A model law is a particular kind of regulatory text with a set of relations of use. Model laws are designed to be taken, modified and used by stakeholders in the creation of state laws. Because they are already framed in legislative language, model laws are worded in ways that can be expeditiously activated and translated into state law. The problematic of this inquiry arises from the activities of a constellation of legislative actors including human rights lawyers, policy analysts, academics and activists who have worked to critique aspects of the United States Agency for International Development/Action for West Africa Region (USAID/AWARE) Model Law (2004) and subsequent state laws this text has inspired across West and Central Africa. I argue that mapping the origin and uptake of this omnibus guidance text is optimally achieved through a sustained analytic commentary on the institutional genre of “best practice”. Explicating the coordinating function of this textual genre is central to understanding the rapid spread of HIV/AIDS laws across at least 15 countries in West and Central African between 2005-2010. The work processes of legislative creation, challenge and reform under investigation demand an interrogation of complex ruling apparatuses regulated by text, talk and capital relations. The USAID/AWARE Model Law is rife with contestation: from its name, scope, funding source and process of development, dissemination and domestication to its legislative content and role in protecting or violating women’s rights and public health objectives. Many of the policy actors critiquing this USAID-funded initiative have been engaged in the development of alternative HIV-related model laws and the shaping of a global anti-criminalization discourse to respond to the increasing use of criminal law governance strategies to prosecute HIV-related sexual offenses and the rise in new HIV-specific criminal laws in and beyond sub-Saharan Africa. This study maps relations that rule, and makes processes of power understandable in terms of everyday transnational work activities organized by the language of law. My research method is informed by the critical research strategy of institutional ethnography. This complex legislative process was made visible through participant observation, archival research, textual analysis and informant interviews with national and international stakeholders. This has involved research in Canada, the United States, Switzerland, Austria, South Africa and Senegal (2010-2011). / Graduate