Monday, August 16, 2010

Is Development Management failing Development?

Who and what is this “We”, what authority does this “We” have to make such a statement, what power and means does this “We” have to empower men who have sex with men, sex workers, and transgender people?

by Roger Tatoud,
IRMA Steering Committee Member
Senior Programme Manager, International HIV Clinical Trials Research Management Office at Imperial College, London

In July 2010, the United Nations Development Programme (UNDP) released a draft of its Business Case on MSM, transgender people and sex workers.  This Business Case is UNDP’s plan to operationalize the new UNAIDS indicators focussed on these populations within the UNAIDS Joint Outcome Framework. The “aim of all UNAIDS programming is that every person should have the ability to avoid HIV infection and achieve full health and realisation of human rights.”



The goals and ambitions of the Business Case are intentionally bold and broad: “Men who have sex with men, sex workers and transgender people will be empowered to prevent HIV infection and to claim their human rights in at least 15 countries by the end of 2011, and at least 50 countries by the end 2015.” (Draft 0, 25 June 2010, emphasis mine).The strategy is firmly rooted in the empowerment of all marginalised populations, because “empowerment is the first foundation for action” and again because “a core aim of UNAIDS programming will be that men who have sex with men, sex workers, and transgender people should be empowered to avoid HIV infection and achieve full health and realisation of their human rights (emphasis mine).

Despite all UNDP’s good intentions, the strategy is methodologically flawed, defining objectives without having established first the baseline of what it aims to change, targeting metropolitan areas without acknowledging their diversity or having asserted their suitability, ignoring exiting power structures that will either be unable or hinder the implementation of a top-to-bottom framework designed with what seems to be limited input from its beneficiaries or awareness of how it will affect local and regional interventions.

But most importantly, the strategy is confusing aims and goals by setting up a framework around empowerment as the de facto solution that will lead MSM, transgender people and sex workers to avoid HIV infection and achieve full health as well as realising their human rights. It is not that empowerment, which is at no point defined in the draft document, may not be what the targeted population needs or wants, but because the empowerment response automatically implies that MSM, transgender people and sex workers are powerless entities unable to achieve their human potential without the help of an external intervention, in this case forcefully lead by UNDP.

Indeed, the UNDP brochure affirms “We can empower men who have sex with men, sex workers, and transgender people to protect themselves from HIV infection, achieve full health, and realise their human rights” (emphasis mine). Who and what is this “We”, what authority does this “We” have to make such a statement, what power and means does this “We” have to empower men who have sex with men, sex workers, and transgender people? These are questions worth asking because results or lack thereof will depend on the answers.

The proposal was presented during a discussion group organised at the Be Heard pre-conference in Vienna on July 17, 2010. It was pleasing to hear that UNDP has adopted SMART objectives (Specific, Measurable, Achievable, Realistic and Timely). The problem is that deciding bold objectives without knowing the environment in which the intervention will take place makes the whole plan rather meaningless.

The reception was rather cold and critics fumed from the audience, starting with a Russian representative who had never heard of the year-old proposal, which incidentally had not been translated into Russian and willingly exclude drug users (another problem since vulnerable populations often overlap). One of the most constructive and valuable remarks came from an African representative who thought the proposal was too bold and should start with a feasibility study in a limited number of countries. I fully support a feasibility proposal as I am very much concerned with the soundness of the Business Case in its current version. Human rights, their violations and how the Business Case intends to address these issues would also be worth discussing, but I will limit my discussion to empowerment.

In 2000 I visited Thai university friends in Bangkok for the first time. I was
seduced by Thailand which I would discover is not the Land of Smiles of tourist brochures or naive backpacker’s memories (recent civil unrest, as well as a surreal coup d’état in 2006 which I witnessed, are permanent reminders of a turbulent political history). I visited again in 2003 and every year after. In 2006, I had the opportunity and sometimes I think the privilege, to live for 18 months in Bangkok. I came for a job I never got and ended sharing the life of men who have sex with men, sex workers,transgender people and a few non-injecting drug users.

Thailand is a relevant country for the Business Case, with an HIV prevalence of about 30% amongst MSM in the capital’s hotspots (saunas, bar, cruising areas). But don’t make the mistake thinking that the country is MSM-and-gender-variant-friendly; scratch the surface and stigma and discrimination are all around. I met many of these allegedly disempowered and vulnerable people that the Business Case wants to empower; here are a few of them.


Silom Soi 4 is a well know Bangkok cul-de-sac where Thai, other Asian, and Western men meet in the evening to enjoy, amongst other things, a beer and a beauty contest. In May 2007, the Miss and Mister Pink beauty contest saw a large pageant of men and Ladyboys (or Katoey as they are commonly referred to locally). Though the custom can easily be misunderstood by Westerners, it is an occasion to show off your best smile and physical attributes and make some money; often more in one night that can be earn in one month working in a factory. Setting judgement on beauty contests and economics aside, note the second contestant starting from the left, holding her “Miss trying to be beautiful” prize.


The same night saw the election of Mr Pink. That year, the winner then nicknamed Koh, won nearly all male contests as he did the year before and the year after. Not all contestants are MSM; beauty contests are a source of income for all. Koh now has a different name and is a well known model strolling more conventional catwalks. He has a large crowd of online followers and magazines picture him selling products like the once famous Bangkok Roti Bun (which originated in Malaysia and got Bangkokian queuing for hours to buy one and street urchins to set up a re-sale business without the need for a UNDP economic empowerment framework).

Bangkok also used to have its own Pride but the event has not been running for a few years. The year 2006 saw a particularly impressive parade followed by a party in Lumpini Park during which a condom fashion show took place with the participation of SWING members. The show was later repeated on World AIDS Day in December. SWING stands for Service Workers in Group an organisation set up in September 2004 by Surang Janyaem in response to the demand for male sex worker support groups. “Sex Workers” would not have gone down well with the local authorities and “cultural sensibility”. Surang previously volunteered for 20 years for another group of sex workers rightly called “Empower”.

Nevertheless, that did not stop the service workers to come together to support each other and to put a fantastic show and to promote condom use. One of the bold objectives of the Business Case is to ensure that 50% of large municipalities will have informed vocal and capable organisations of men who have sex with men, sex workers and transgender people that are recognized as partners to advance universal access. SWING and other groups such as M-Plus and Fasirong did not wait.





This picture of Sak (middle, above) was taken whilst a friend was helping him dressing up as a Katoey in my room (a 30 sq. meter, no air-con, neon-bleached space where the temperature rarely fell below 30C) before "going to work". Sak used to live an extravagant city lifestyle, changed from boy to girl many times, but has now disappeared. In deep North-eastern Thailand, aka Isaan, some populations will never be reached by UNsDP’s empowering programme, should they need it, like the young ladyboy pictured here near Mukdahan a border town with Laos, 10-hours from Bangkok by bus.

Paradiso is one of my favourite hangout in Bangkok, very few if any foreigners go there as it is well hidden from the mainstream places. It is a place to enjoy a Karaoke night with the locals until morning lights, something impossible in the centre. Something to do with the police, who usually more interested in money than in people's sexuality as
shown on this picture taken when Bangkok set up a new record (since then beaten) for the longest condom chain, an event organised by UNESCO.

Behind each of these pictures is a story. I have hundreds of other pictures from the time I spent living in Thailand. Though these may only represent the high
end of a spectrum and are definitively not representative of all that is going on (which is more difficult to immortalise in pictures and that I have left aside in this occasion). The people who shared bits of their lives with me were and remain instrumental in my understanding of the life of those who were not "as lucky" as I am to have been born in the "Wonderful West". They continually influence and contribute to my views on ways of enabling "good change" (a basic definition of Development put forward by Chambers in 1997).

Empowerment is an unknown concept to them (and to many other) and I doubt it would score high on their agenda or that they would understand why good doers in the Global North are so obsessed with it. Empowerment has come to represent the latest incarnation of colonialism, a well meant, cuddly way not only to tell people what they should do, but also what they should need and what they should ask for on the ground - we can do something for them.

Empowerment is not part of my equation, as I have no power to give, and neither does UNDP or any other NGO.




As someone put it to me talking about previous similar documents, “Though well-intentioned, they [...] frequently reflect an attempt by the big agencies to catch up with realities they had only begun to discover and explore, which was laudable on their part, but meant that they were being led by the representatives of the presumed beneficiaries, who sometimes were quite well empowered themselves but who rarely had the kinds of social science training and background that were required".

To its credit, UNDP is doing a lot of good work particularly in capacity building, which may be a better means than empowerment to achieve the Business Case’s goals, but there seems to be little connection between this work, the planned work proposed in the Business Case and the outputs it identified. A way forward is to ditch the institutional “cheap talk” of empowerment and identify SMART, meaningful, and relevant objectives for the target populations the proposal is focussing on and to developed a rigorous, dare I say scientific, approach to implement them.

Ensuring that everybody is heard will be crucial. Remarkably, the draft Business Case, still under consultation, states that UNAIDS will be accountable for achieving its stated bold results in at least 20 of the world’s 144 low and middle income countries by the end of 2011, with clear allocations of effort and responsibility in each region and country.

What it if fails?


***


Empowerment is an Anglo-Saxon concept which has no direct translation in French, Italian, Spanish or German or, I believe, any other language than English (if mistaken please empower me with that knowledge). For more on empowerment and how to use it, see Mick Moore's “Empowerment at last” published in 2001 and which discuss “cheap talk”. See also Laura Agustin on why Empowerment is failing people who “need to be empowered.” And do not miss reading a few life stories collected by Chris Littleton for UNESCO Bangkok, in “Mekong Erotics: Men Loving/Pleasuring/Using Men in Lao PDR.”

3 comments:

Andrew said...

SWING was an offshoot of the 25 year old sex workers organisation in Thailand named EMPOWER. I think they know what empowerment is!
Whilst I agree that the idea of UNDP or UNFPA, in the case of sex workers empowering anyone is ridiculous, the fact is that this 10th outcome framework piece on MSM, TGs and sex workers came about becuase of demand from the regional and International MSM and Sex Workers networks, and has been discussed in sex worker organisations all over the world. (Can't speak for the MSM groups on this though)
Of course what sex workers wanted and what has ended up being written are different- but for the original UNAIDS outcome framework to have not addressed MSM, Sex Workers and TG's at all was far worse than any problems of how to operationalise what we now have.
And IDUs aren't in this because they had and still have one of the outcome framework sections all to themselves.
Andrew Hunter
Asia Pacific Network of Sex Workers, Bangkok.

Roger said...

Andrew,

It would be educating to know why "what sex workers wanted and what has ended up being written are different".

And of course the point is not about not including MSM, Sex Workers and TG in the framwork, but very much about the operational side of the Business case.

And why do we keep thinking in Silo? IDU on the one side, MSM on the others? Are they always different populations? Why MSM and sex workers are in the same group? Are they always one and the same?
I am teasing you here, but I thought the point was made very clear in Vienna that this was not working.

vb.

Bachir said...

Thank you Roger for developing and illustrating in detail one of the challenges that have burdened the HIV response globally for many years. Hope voices will become more audible for meaningful changes.

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