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Even if constrained in their international choices, recipient countries of global health programmes hold the capacity to autonomously define and pursue their own strategies, policies, and ultimately attain political goals. This is comparatively demonstrated through the analysis of PEPFAR´s implementation in Botswana, Ethiopia and South Africa.

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1. Introduction: Agency in Global Health 2. Global Health Governance and Role of States 3. Recipient States in an Asymmetric System 4. International Developments of States in Africa 5. PEPFAR: Project of Global Transformation 6. Botswana: National Survival against HIVAIDS 7. Ethiopia: Self-Help with External Support 8. South Africa: Changing HIV/AIDS Policies 9. Conclusion: Recipient States Being Sovereign

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Ricardo Pereira is Scientific Officer in the Department for International Relations, Foundation for Science and Technology, Portugal, where he co-manages research funding projects. He is currently a national delegate at the European and Developing Countries Clinical Trials Partnership (EDCTP).

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