Article Text

Download PDFPDF

Understanding and comparing HIV-related law and policy environments: cross-national data and accountability for the global AIDS response
  1. Matthew M Kavanagh1,2,
  2. Ellie Graeden3,
  3. Mara Pillinger1,
  4. Renu Singh1,
  5. Stephanie Eaneff3,
  6. Victoria Bendaud4,
  7. Rico Gustav5,
  8. Taavi Erkkola4
  1. 1O'Neill Institute for National & Global Health Law, Georgetown University, Washington, DC, USA
  2. 2Department of International Health, Georgetown University, Washington, DC, USA
  3. 3Talus Analytics, Boulder, CO, USA
  4. 4UNAIDS, Geneva, Switzerland
  5. 5Global Network of People Living with HIV, Amsterdam, The Netherlands
  1. Correspondence to Dr Matthew M Kavanagh; matthew.kavanagh{at}


Law and policy differences help explain why, as HIV-related science has advanced swiftly, some countries have realised remarkable progress on AIDS while others see expanding epidemics. We describe the structure and findings of a new dataset and research platform, the HIV Policy Lab, which fills an important knowledge gap by measuring the HIV-related policy environment across 33 indicators and 194 countries over time, with online access and visualisation. Cross-national indicators can be critical tools in international governance—building social power to monitor state behaviour with the potential to change policy and improve domestic accountability. This new and evolving effort collects data about policy through review of legal documents, official government reports and systematic review of secondary sources. Alignment between national policy environments and global norms is demonstrated through comparison with international public health guidance and agreements. We demonstrate substantial variation in the content of law and policies between countries, regions and policy areas. Given progress in basic and implementation science, it would be tempting to believe most countries have adopted policies aligned with global norms, with a few outliers. Data show this is not the case. Globally, alignment is higher on clinical and treatment policies than on prevention, testing and structural policies. Policy-makers, researchers, civil society, finance agencies and others can use these data to better understand the policy environment within and across countries and support reform. Longitudinal analysis enables evaluation of the impact of laws and policies on HIV outcomes and research about the political drivers of policy choice.

  • HIV
  • health policy
  • AIDS
  • tuberculosis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Supplementary materials

Related Data


  • Handling editor Seye Abimbola

  • Twitter @MMKavanagh, @mplngr

  • Contributors Empirical work was conceptualised by all authors. MK, RS, and EG drafted the paper. All authors edited and approved submitted version. MP and SE led data collection and structuring. VB and TE led work on NCPI survey which makes up part of the data.

  • Funding This study was funded by United States Agency for International Development.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.