How does the presence of interstate patronage impact the use of physical repression by client regimes? Previous studies have failed to comprehensively conceptualize and measure these important relationships between states. Moreover, previous studies have devoted limited attention to investigating the substantive implications of these relationships on domestic and international politics. This dissertation presents an original conceptualization and measurement of interstate patronage from the United States to every country in the 1946-2010 period. The dissertation then turns to an analysis of how patterns of US patronage impact state repression in client regimes. The findings indicate that US patronage improves human rights in autocratic client states - however, the receipt of US patronage leads to worsening human rights in democratic client settings. The findings have implications for scholars, policymakers, and observers of international politics.