Implementing Safer Sex and Needle Exchange Programs:

An Outcome of Grassroots-Driven Policy Formation


This is a proposal to incorporate the study of grassroots-initiated HIV/AIDS policy into Policy Implementation (USP 562/662), a graduate-level course offered in the College of Urban and Public Affairs.

Policy studies are frequently taught from a top-down perspective, by which policy-making is seen to occur as a result of agenda setting by powerful actors in positions of control. A common interpretation, relying on the corporatist model, emphasizes decision-makers from government, business, and other powerful arenas, such as the judiciary, military, or labor unions.

An alternative perspective, best articulated by Richard Elmore in his work regarding "backward mapping," maintains that the standard top-down approach to policy studies misses any type of policy that is grassroots initiated. Examples of policy formation that has occurred from the bottom up include policies directed toward the homeless, civil rights legislation, and, germane to this proposal, HIV/AIDS policy. Typically, bottom-up policy is initiated by actors outside of the corporatist paradigm of power – individuals and groups who are not normally considered to reside at the "center" of policy making, but rather at the "periphery" or "target" (to use Elmore’s terms).

Another alternative to the standard top-down approach to policy analysis is that offered by Sabatier and Jenkins-Smith in their articulation of the "advocacy coalition approach" to policymaking. This framework seeks to identify coalitions of actors at all levels of the public and private sphere who share common goals and work to manipulate government institutions and structures in order to achieve these goals. HIV-infected individuals themselves make up an important component of this coalition, working both outside of and within "the system" to achieve their goal of HIV/AIDS advocacy from the grassroots up.

I propose to build the presentation of bottom-up, or backward mapping, policy studies around HIV/AIDS policy, using local Portland initiatives as case study examples of grassroots-driven policy. Outside In’s condom supply and needle exchange programs (NEP), one of the oldest in the country, are important local programs that students can study. Students will be able to examine the formation and implementation of these programs and the Oregon Revised Statutes that make NEP possible.

The course will include some historical perspective on AIDS activism from the trenches, particularly efforts by grassroots organizations such as Act-UP, to bring HIV/AIDS issues to the policy agenda-setting table. This project will not only provide students with the opportunity to study effective grassroots policymaking within their own community, but will remind them of the importance of connecting pedagogy, theory, and praxis. Students will learn how AIDS activism has informed other grassroots-driven health policy, including breast cancer and child immunization initiatives. They will also have the opportunity to grapple with the ethical issues involved with the idea of condom supply, NEP, and other HIV/AIDS programs that struggle for existence within a contemporary culture characterized by the contradictory themes of freedom and moral righteousness.

My interest in this project is twofold. One is to give urban and public affairs students the opportunity to look at HIV/AIDS as an urban policy issue that their other courses tend either to treat as a public health matter or to ignore altogether because it appears to fall outside of the more common areas of urban institutional and infrastructure inquiry. My other interest is in providing students of policy studies the opportunity to look at a local example of grassroots-driven policy.

I do not expect to change my current syllabus markedly except to incorporate more readings about bottom-up policy formation, particularly with respect to AIDS/HIV activism. Although it is not reflected in my current syllabus, this term I am working with a group of students in this class on a different policy study; we report as a group to the rest of the class about our progress, so that our work can serve as a model for the other students. The students in the group, as well as the rest of the students, find this process – whereby I, as instructor, actually participate with students on a group project – to be very useful to the learning process. I would expect to replicate this process next year, working with a group on this project of studying the implementation of a grassroots-driven policy aimed at HIV/AIDS prevention. My group and I would report back to the other members of the class on a weekly basis. One or two members from my group would present the final paper in a presentation at the end of the course. I would go on to develop the results of our research into an article for presentation at a professional conference and then follow that up with submission to a journal.

Although I will work with a small group of students on this project, as noted above, the entire class will participate by reading selected portions of materials about grassroots-driven policy in general and HIV/AIDS policy in particular. I would expect to have at least one guest speaker, possibly Kathy Oliver from Outside In, address the class about implementing programs such as NEP.

I assess students’ learning through a variety of means, as indicated on my syllabus, and students can choose from among several projects for assessment. The extent to which all students have benefited from being involved in a hands-on, grassroots analysis of this topic will be apparent to me from all of these projects and from class discussions. In addition, I hold mandatory "one-on-one" conferences with each student at least once a term, and during these meetings, I gauge the students’ learning process and progress.

This class is likely to consist of approximately 15 graduate students from masters and doctoral programs within the College of Urban and Public Affairs, as well as doctoral students from other programs, such as OHSU’s Ph.D. in nursing.