When Regulation Travels: Distrust and Disrespect

ABSTRACT Endeavoring to avoid the pitfalls of being too trusting of regulated entities' compliance claims, regulators sometimes create regulatory systems with elaborate requirements for verification. But as these accountability and verification regimes attempt to circumvent one set of problems, they may inadvertently create others. Building on organizational research on “routine dynamics,” this article shows how the institutionalized skepticism of these regulatory regimes may unintentionally reinscribe patterns of privilege and disadvantage as regulators enforce rules and guidelines that inevitably have biases built into them. It also shows how the official, scripted universalism of regulatory stances can be undermined by unscripted, sometimes disrespectful, interactional stances of monitors and inspectors. Data from a study of five HIV clinics providing treatment and conducting research in the U.S., Thailand, South Africa, and Uganda show why regulatory encounters that are intended to be even‐handedly but respectfully distrusting can systematically disadvantage even excellent clinics in poorer countries.