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Die Normalisierung von Aids in Westeuropa: Der Politik-Zyklus am Beispiel einer Infektionskrankheit

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  • Rosenbrock, Rolf
  • Schaeffer, Doris
  • Dubois-Arber, Francoise
  • Moers, Martin
  • Pinell, Patrice
  • Setbon, Michel
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    Abstract

    Das Auftreten von Aids hat in allen westeuropäischen Ländern zu exzeptionellen Innovationen in Prävention, Krankenversorgung, Gesundheitspolitik und Bürgerrechtsfragen geführt. Diese Ausnahmen vom normalen Verlauf der Gesundheitspolitik erklären sich vor allem daraus, daß neben einer gesundheitlichen Katastrophe infolge von Aids auch Zivilisationsbrüche auf dem Gebiet der Bürgerrechte befürchtet wurden. Dies brachte eine trotz großer nationaler Unterschiede im Grundmuster ähnliche „exceptionalist alliance“ aus beteiligten Gesundheitsberufen, sozialen Bewegungen und Betroffenen hervor, die den mangels wirksamer Therapien von der Medizin nicht besetzten Handlungsraum produktiv nutzte. Mit dem Ausbleiben der Katastrophe, Ermüdungserscheinungen der „exceptionalist alliance“ und zunehmenden Therapiemöglichkeiten der Medizin geht der ‘exceptionalism' in Europa jedoch schrittweise zu Ende. In diesem Prozeß werden bei national unterschiedlichen Entwicklungsmustern vier Phasen unterschieden: Circa 1981 - 1986: Entstehung des ‘exceptionalism'. Hierzu werden die Ursachen des ‘exceptionalism' untersucht. Circa 1986 - 1991: Praxis und Konsolidierung des ‘exceptionalism'. Dargestellt werden sowohl das Policy-Modell des ‘exceptionalism' als auch länderspezifische Konfigurationen der Polities und Politics, die zu unterschiedlichen Inhalten der politischen Entscheidungsprozesse (Policies) in bezug auf Aids führten. Circa 1991 - 1996: Auflösung des ‘exceptionalism' und erste Anzeichen der Normalisierung. Untersucht werden die Gründe des Normalisierungsprozesses. Seit 1996: Normalisierung, Normalität. Darstellung des veränderten Umgangs mit HIV und Aids. Dazu werden Beispiele aus den Bereichen Krankenversorgung, Primärprävention und Drogenpolitik betrachtet. Es wird untersucht, welche gesundheitspolitischen Innovationen der ‘Aids-exceptionalism' in Westeuropa hervorbrachte und auf welche Risiken und Chancen diese Innovationen im Zuge der Normalisierung treffen. Es werden drei mögliche Entwicklungspfade identifiziert: Stabilisierung, Generalisierung und Rückwärtsentwicklung. Die Chancen, in Zusammenhang mit Aids entwickelte Innovationen für die Modernisierung der Gesundheitspolitik auch für andere Felder der Prävention und der Krankenversorgung zu nutzen, variieren länderspezifisch. In welchem Umfang ‘Aids-exceptionalism' gesundheitspolitische Innovationen auch in anderen Bereichen anstoßen kann, hängt letztlich vom jeweils erreichten Grad der Institutionalisierung des ‘exceptionalism' und der Entfernung dieser Neuerungen vom konventionellen medizinisch-therapeutischen Geschehen ab. Der Beitrag der europäischen Länder zur Eindämmung der globalen Aids-Krise ist unzureichend. -- In every Western European country the occurrence of Aids has led to exceptional innovations in prevention, patient care, health policy and questions of civil rights. This exception can be explained not only by the fact that a health catastrophe was feared, but also civilizational harm in the field of civil rights. Despite national differences, this brought about similar "exceptionalist alliances" consisting of health professionals, social movements and those affected. With the failure of a catastrophe to arise signs of fatigue in the "exceptionalist alliance" and increasing possibilities of medical treatment, exceptionalism in Europe is drawing to a close. The paper elucidates specific aspects of each of the four roughly distinguishable phases in this process, given nationally different patterns of development: Approx. 1981 - 1986: emergence of exceptionalism. The underlying reasons for exceptionalism are investigated in this paper. Approx. 1986 - 1991: consolidation and performance of exceptionalism. The paper investigates the exceptionalist policy model, more specifically some nationally different factors in the polity and politics that help to explain the different forms of policies. Approx. 1991 - 1996: exceptionalism crumbling, steps toward normalization. The forces driving the process of normalization are investigated. Since 1996: normalization, normality. The changes made in the management of HIV and Aids are elucidated using examples from the fields of health care, primary prevention and drug policies. Aids health-policy innovations, and their risks and opportunities in the course of normalization are investigated. Three possible paths of development are identified: stabilization, generalization and retreat. The chances of utilizing innovations developed in connection with Aids for the modernization of health policy in other fields of prevention and patient care vary from country to country with the degree to which Aids exceptionalism has been institutionalized and the distance of these innovations from medical/therapeutic events. The contribution made by European countries to containing the global Aids crisis is inadequate.

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    Bibliographic Info

    Paper provided by Social Science Research Center Berlin (WZB) in its series Discussion Papers, Research Group Public Health with number P 99-201.

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    Date of creation: 1999
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    Handle: RePEc:zbw:wzbhea:p99201

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    1. Wolfgang HÄRDLE & J. MARRON & L. YANG, 1996. "Discussion," SFB 373 Discussion Papers 1996,65, Humboldt University of Berlin, Interdisciplinary Research Project 373: Quantification and Simulation of Economic Processes.
    2. repec:wop:humbsf:1996-65 is not listed on IDEAS
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