Enacting “bounded justice” through HIV integrated planning in the United States

Abstract: HIV integrated planning was proposed as a solution to the poorly-coordinated and inequitable US HIV/AIDS epidemic response. However, its ability to achieve justice has been limited by longstanding systemic barriers, such as a lack of universal healthcare and underfunded social services. We argue that HIV integrated planning created what Melissa Creary calls a “bounded justice,” wherein state and local agencies were structurally disempowered from achieving the forms of equity asked of them by the federal integrated planning policy paradigm. HIV integrated planning was implemented as a strategy to support the National HIV/AIDS Strategy (NHAS) released in 2010, the first coordinated federal effort to address the country’s HIV/AIDS epidemic. NHAS’s vision statement used lofty equity-driven rhetoric, promising access to care for all people living with HIV and naming historically marginalized groups. Federal HIV integrated planning guidance released in 2015 required states to create integrated plans aligned with NHAS's vision and goals. We analyzed 19 states’ and Washington DC’s integrated plans using Carol Bacchi’s critical policy analysis approach, which aims to identify how social problems are framed by studying proposed solutions. Our analysis focuses on how plans framed key populations affected by HIV, efforts to integrate HIV programs and their data infrastructures, and jurisdictions’ stakeholder engagement efforts. We describe how integrated planning groups worked within varied constraints to create plans that best advanced the principles of health equity in NHAS. We assert that integrated planning was insufficient for combating historic disenfranchisement and advocate for systemic solutions that address root causes of inequities.

Alec Manning – University of Texas Medical Branch; Justin Edwards – University of Texas Medical Branch; Stephen Molldrem, PhD – University of Texas Medical Branch