Dissertations, Theses, and Capstone Projects

Date of Degree

6-2025

Document Type

Doctoral Dissertation

Degree Name

Doctor of Philosophy

Program

Political Science

Advisor

John H. Mollenkopf

Committee Members

John Krinsky

Keena Lipsitz

Subject Categories

American Politics | Health Policy | Public Policy | Social and Behavioral Sciences | Social Justice

Keywords

Harm Reduction, Social Movements, Punitive Prohibition, Political Coalitions, HIV/AIDS, Social Justice, Narcotic Overdose

Abstract

By the mid-1980s, the HIV/AIDS epidemic breached a longstanding consensus between the political class and its bureaucratic alliances that had relied for decades on attitudes and orientations that championed punitive prohibition toward drugs as a bedrock principle of policy making. This ‘focusing event’ created an opening for HIV/AIDS activists to build a movement that offered an alternative, a more effective and just approach to how government policies and practices can manage illegal drugs and the persons who use drugs.

The dissertation uses several theoretical and methodological tools to address the central research objective that highlights the critical role played by harm reduction activists and how they successfully advanced an anti-prohibition policy alternative that eventually became beneficial to the dominant coalitions of power. Using firsthand observations, in-depth interviews with key actors and archival materials, it examines the evolution of the competing paradigms.

The harm reduction activists used social protest repertoires to change the system first ‘outside’ the system, then whilst ‘inside,’ with the support and following of third-party allies. They thwarted the co-opting that accompanies other social movements by changing the rules-in-use, to further the advance of harm reduction as an effective public health approach. This struggle for power over the prohibitionist ideology and practices that dominated criminal justice and health policy domains leveraged incipient political agendas to the maximum benefit of the activists by expanding the rules of harm reduction outward in what Gramsci would call the war of position. The activists deployed their strategy in three synergistic steps, 1) knowing where to build power; 2) building alliances to create a unity of purpose; and 3) articulating a coherent view of public health from a harm reduction perspective. The core harm reduction principle of, ‘Meeting people where they’re at,’ establishes relationship building as a ground rule for sustaining mobilization without controlling dogmas.

The incremental institutionalization of the harm reduction paradigm into New York’s public health infrastructure effectively reformed and strengthened it, readying it to effectively address future societal threats, e.g., COVID-19, and the epidemic of unintentional narcotics overdose.

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