Showing posts with label Be Heard. Show all posts
Showing posts with label Be Heard. Show all posts

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.”

Friday, August 13, 2010

BE HEARD! - Presentations Now Available from AIDS 2010 Event

Condoms Aren’t Enough! 
Will Pills and Lubes Define the Future Of Sex? 
Click 'n Learn right here!

More than 100 of the world's top experts on human rights and HIV among sexual minorities led presentations and workshops in Vienna on July 17 at BE HEARD, an all-day conference event that addressed soaring global rates of HIV among men who have sex with men (MSM). The event preceded the launch of AIDS 2010, the XVIII International AIDS Conference (IAC) and had nearly 600 participants.

IRMA was an event sponsor and Steering Committee members Ian McGowan, Jorge Sanchez, Roger Tatoud and Jim Pickett led a 2-hour session with other top researchers including Drs.Gaudensia  Mutua, Jorge Saavedra and Patrick Wilson called "Condoms Aren’t Enough! Will Pills and Lubes Define the Future Of Sex? An Overview of New HIV Prevention Tools in Development."

Below are 5 of the presentations - please give each of them a click and learn. The first - directly below - begins with Dr. Mutua's talk - "Basic Concepts about AIDS Vaccine Research."








 


Hosted by the Global Forum on MSM & HIV (MSMGF), BE HEARD focused on challenges and solutions to achieving universal access to HIV-related prevention, care, treatment, and support services for sexual minority communities worldwide.

Monday, July 5, 2010

World's Largest Conference on Health and Rights of Gay Men [co-sponsored by IRMA] to Address Worsening Global AIDS Crisis

Press Release

[IRMA is an event sponsor and Steering Committee members Ian McGowan, Jorge Sanchez, Roger Tatoud and Jim Pickett are leading a 2-hour session with other top researchers called "Condoms Aren’t Enough! Will Pills and Lubes Define the Future Of Sex? An Overview of New HIV Prevention Tools in Development." Thanks to IRMA, interpretation services will be available in a number of languages for select sessions.]



UNAIDS Executive Director Michel Sidibe and 
US Congresswoman Barbara Lee to join 
Global Fund Executive Director Michel Kazatchkine
Research Experts and Activists 
in Vienna for Day-Long Event

More than 100 of the world's top experts on human rights and HIV among sexual minorities will lead presentations and workshops in Vienna on July 17 at BE HEARD, an all-day conference event to address soaring global rates of HIV among men who have sex with men (MSM). BE HEARD is the largest gathering to focus on the disproportionate impact of HIV among gay men. The event will precede the launch of AIDS 2010, the XVIII International AIDS Conference (IAC).

Hosted by the Global Forum on MSM & HIV (MSMGF), BE HEARD will focus on challenges and solutions to achieving universal access to HIV-related prevention, care, treatment, and support services for sexual minority communities worldwide. The event comes at a time when MSM in low- and middle-income countries are 19 times more likely to be infected with HIV than the general population, yet only one in five has access to the HIV prevention, care and treatment services they need.

"MSM have been at disproportionately high risk of HIV infection since the epidemic started," said George Ayala, Executive Officer of the MSMGF. "Yet our issues remain severely underrepresented at the international level. As prevalence rates among MSM are surpassing 30 percent in countries rich and poor alike, there is no time to waste. BE HEARD is one of very few dedicated venues to focus on this staggering crisis."

The day will feature work by activists from around the world, as well as plenary speeches from UNAIDS Executive Director Michel Sidibe, US Congresswoman Barbara Lee, Global Fund Executive Director Michel Kazatchkine, and AIDS-Free World Co-Director Stephen Lewis, among others. The program will highlight a wide array of the most pressing health and human rights issues facing sexual minorities today, including the criminalization of homosexuality, new biomedical approaches to HIV prevention, and the spread of HIV among men who have sex with men in low- and middle-income countries.

Click here for the program.

BE HEARD is the largest event of its kind, with over 600 attendees from more than 100 countries. The attendance of activists from low- and middle-income countries has been a high priority for the organizers, reflected by an extensive scholarship program for participants from the global south. Due in part to this scholarship program, more than 50 percent of registered attendees will be traveling to the conference from low- and middle-income countries.

The MSMGF launched the biennial event in 2004 as a "pre-conference" to the International AIDS Conference in response to concerns that MSM health and human rights issues are often ignored at local and international levels.
"We are disappointed that such neglect remains reflected in the program of this year's International AIDS Conference," Ayala said.

"Only 2 percent of all scheduled sessions specifically address the needs of MSM. BE HEARD aims to counter this invisibility and silence."

The event will run from 8:30AM to 6:00PM on Saturday, July 17, at the Vienna University of Economics and Business. A 7:30PM reception will follow at Heuriger Fuhrgassl-Huber (Ottakringer st 222-224, 1160 Wien 1160 Vienna), hosted by the Office of the Mayor of Vienna. MSMGF will also hold a 1:30PM press conference on July 20 at IAC Press Conference Room 1 that will address the current state of health and human rights of sexual minorities worldwide, including a discussion of selected findings from BE HEARD.
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