| 摘要: | 全球防疫體系之健全與否，影響全人類生命安全、社會穩定與資源永續發展甚鉅。愛滋病疫情在二十世紀末期對全人類的健康與社經議題帶來了相當的震撼，並引發聯合國體系與大多數國家政府的普遍重視。由於傳染性疾病的防治在全球化趨勢下，斷無法由單一國家政府獨立解決，且涉及醫藥科技，公共衛生與公共行政等多邊性和多層次之治理特性，以傳統國家為主體的防治體系已受到嚴苛的挑戰。為了維護人類在生態、社會及經濟等三個面向的調和性發展，在全球化的觀點下，不論是全球、區域或國家層次，均應將愛滋病防治政策置於政治議題的首項。
本研究以David Easton所提出在政治系統理論為探索架構，針對愛滋病防治體系的環境因素、治理投入的功能、防治系統的網絡結構與轉換，政策的產出，以及治理的回饋等要素，由全球的視野來探討全球愛滋病防治體系的治理機制，第三章至第五章分別深入剖析這些課題。第六章則以個案研究探討我國愛滋病防治政策。筆者先作政策運作機制的探索與分析，再以問卷調查與深度訪談法，蒐集我國愛滋病防治體系各利害關係者對防治政策推動過程的認知，並檢討我國愛滋病治防政策是否具有和全球接軌的運作機制，以及有無全球化的觀點與思維。
就全球愛滋病危機而言，其影響最大者實係治理體系以外的種種環境因素所致。最初是對傳染途徑的無知所導致的創傷及歧視，其次又因治療與照護所需之龐大經費無著。各國的努力並沒有遏阻愛滋病的擴散，聯合國組織乃出面扮演領導治理的角色，與世界各國積極研擬防治政策以為因應。除了少數國家因國內因素力有未逮外，大部分國家之公部門與非政府部門鑒於二十世紀末期愛滋病流行之嚴重性，紛紛強化其防治作業，在愛滋病防治投入系統有極積的作為。至於治理系統發揮政策運作機制的轉換功能，大體上，在全球化傳染病防治的專業性引導下，愛滋病防治之治理模式與當前的實際運作情況相當一致。在結論中，綜合前述各章節之研究成果，指出並檢驗當前全球治理下愛滋病防治政策產出的效應，並探究其困境或障礙所在，試圖提出政策建議，以系統反饋功能之觀點，提出防治系統下政策運作有效的策略。提出全球防治之政策建議，以期達成全球政策資源之永續發展實為本研究的最終目的。
It is a study devoted to an analysis of the AIDS through global governance model. This study is based on the David Easton’s research theory of political system, exploring the environmental factors, internal and external input function; system transactions; output function, as well as feedback operations.
AIDS is a world wide transmission disease and the most significant and challenging health crisis facing the world for the past three decades, producing serious impact to human life, social security and even the resources of sustainable development. Recently, most of global public problems have filled with multi-lateral with multi-level and complex modes, just like the “AIDS pandemics”, it must move beyond the conceptual trap of state-centric notions of democracy. This study is based on global governance model emphasizing the global public health programs carry on the nature of sustainable development, the legitimacy of participation in international area, governance mechanism based on governmental and non-governmental participatory actors. This study also stresses the sustainable development in ecologic, social and economic aspects, to exploring the AIDS control policy agenda aimed at the establishment of the first priority, nowhere the global, regional, nation-state or community level.
Literature review, intensive interviews, and purposive sampling research are major research tools to deal with global AIDS control system under global governance mechanism, abroad and at home. The case study on the ROC AIDS control policy will be studied in details, theoretically and experientially. This study includes the following seven parts: 1.Introduction; 2. AIDS control system from global perspective; 3. Envornmental factors and input function under global governance of AIDS control; 4. Conversion of AIDS global governance system and its control mechanism; 5. Output functions of AIDS policies; 6. Case study of ROC’s AIDS policy operations; and 7. Conclusions: observation and suggestions.
This study finds some obstacles and challenges in the AIDS control system under global governance. (1) Facing on the collective interests or political sensitive issues, some countries resist the international regime under global governance. (2) With relation to the business interests, the willingness of the participating actors form private sectors concerned are considerably in low motivation joining global governance. (3)The scale and function of NGOs is very in diversity which cause the integration and distribution of participatory role and policy implementation is uneasy and difficulty. (4) The lack of decisional making transparency making less confidence of developing or low-income countries. And (5) the negotiation among stakeholders are not placed in the rational choice in relation to the allocation of political resources.
In Taiwan, there are some additional issues also worthy of noting: (1) the lack of integration of policy initiatives and implementation process of AIDS control in governance mechanism; (2) the absence of the scale and budget of NGOs which is not enough to hold the massive campaign or international conferences for the link of global governance; (3) the shortage of constructive information and materials of AIDS control from international sources makes the control mechanism infeasible because Taiwan is not memberships in UN and WHO. |
