That Sirleaf/Blair interview…

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The Guardian is having a bit of fun at the expense of Tony Blair, following this interview with him and Liberian President (and Nobel Laureate) Ellen Johnson Sirleaf, during which he sidesteps the issue of gay rights and refuses to answer the question when asked whether governance and human rights go hand in hand.

On one point I think they are both right: that Tony Blair’s presence in Liberia is restricted to a few specific development issues.  He is not in Liberia as a senior global statesman promoting peace and love: he is there as a hired contractor to the Liberian government, who have hired his Africa Governance Initiative to advise them on delivering in some key policy areas.  Criticising him for not pushing gay rights in this context is kind of missing the point: if Sirleaf had thought he was out to make trouble for her in a sensitive policy area, she would never have awarded the contract.  Besides – and I think he missed a trick by not pointing this out – the work he does with the Liberian government probably does advance human rights, just not the ones the journalist is asking about.  In my work on HIV I work on rights, including gay rights, but I would find it pretty absurd if a journalist criticised me for having had no impact on access to education or on extrajudicial arrests.  It’s a shame that the journalist in this case fell into the common trap of reducing all African human rights issues to gay rights.

Nonetheless the interview is embarrassing.  It is profoundly depressing that a Nobel Peace Laureate should have the attitudes Sirleaf has.  Blair’s discomfort is palpable.  Given his record on gay rights in the UK though, I suspect it is partly his embarrassment at the things Sirleaf was saying.  But I really don’t see what the problem would have been with Blair giving a straight answer to the question of whether governance and human rights go hand in hand.  Given his championing of interventionist foreign policy in the cause of advancing human rights when he was Prime Minister, it would be nice to see him nail his colours to the mast.  It is certainly nonsense to hide behind the notion that this episode is an example of “country ownership” and that no-one outside Liberia has the right to comment.  It reminds me of that silly statement a Foreign Office minister made a few months ago which seemed to imply homophobia is OK if it is “traditional”.  If human rights isn’t an issue that transcends borders I don’t know what is, and I would have thought no-one knows that better than Blair.  

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The devil is in the detail

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It isn’t every day that the UNAIDS website carries a feature story about African sex workers fighting for their rights.  The feature in question was published shortly after March 3rd, which is International Sex Worker Rights Day, and described initiatives supported by UNAIDS in two countries: Kenya and Namibia.  It is great that the story is featured so prominently.

I was quite involved in the Namibia work, as I’ve explained here and here.  As a result I read the UNAIDS story very closely after seeing it on Twitter.  And then I wrote to UNAIDS: 

@UNAIDS It’s great you covered Namibia in your sex work story. However there are a couple of inaccuracies in the article. Can we discuss?

I also sent an email.  It’s been a couple of days since I contacted them so I think it is fair to explain here which parts of the story I take issue with.

Firstly, this sentence:

The publications noted that sex workers are disproportionately affected by HIV due to the nature of their work—most of the time they can not negotiate the use [sic] condoms with their clients.

(Emphasis added).

I’ve read every piece of research conducted with sex workers in Namibia, dating back to 2000. The quality of the research is, on the whole, very poor, based on unspecified methods and non-representative samples.  Nonetheless none of the studies says that most sex workers cannot negotiate condom use.  The participants in the community assessment research we set up in October didn’t say this was the case either.  To be sure, condom use is not systematic.  This may have something to do with negotiation skills, but as the assessment showed it is also affected by lots of other things, such as the attitudes of clients, with the fact that police officers use posession of condoms by sex workers as evidence of criminal activity, and lack of supply. It is inaccurate and stigmatising to imply the problem is just about sex workers.

Secondly, this:

The reports include recommendations for action by national and local stakeholders to address these challenges and protect the human rights of sex workers. Such recommendations include addressing violence, abuse and stigma towards sex workers as well as reducing legal and policy barriers that block their access to HIV services.

(Emphasis added).

When sex workers involved in the work asked for changes to laws and policies, they were not doing so on the grounds that it would help them get access to HIV services.  They were doing so because the laws and policies as they stand are one of the main reasons they are so vulnerable to violence, abuse and stigma.  Yes, HIV is a big issue for sex workers in Namibia.  But it is one of many issues.  That much was clear from what sex workers said throughout this project and during their interviews with several Namibian newspapers.  Indeed the quotes from sex workers that UNAIDS uses in its feature more accurately reflect the reality.

The reason I think this is important is because the whole idea behind the work we did in Namibia was to move away from the standard survey approaches which ask sex workers the same standard questions about condom use and access to services, and to give sex workers space to talk, among other things, about the issues that HIV programmes aren’t helping them with and maybe even won’t help them with.  We achieved this to an extent, so it is frustrating to see this message get homogenised into the same old narratives that we normally hear.  I’ve written before about the need HIV policy wonks have to only discuss things that have categorically been shown to have an epidemiological association with HIV.  That’s fine up to a point, but if we’re really committed to listening to communities, we’ve got to take what they are saying at face value.

Participatory research and generalisability

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Yesterday I shared some media coverage of international sex worker rights day events in Namibia, as well as reports of some work I was involved in last year that were launched on the same day.

I want to draw attention to one of the reports in particular.  Because there has been very little research on sex work in Namibia, and because most of the programmes designed to support sex workers are framed around a very narrow HIV focus (information, condoms, cajoling or even coercing people to get tested and have STI check ups; and no attention to issues like violence, discrimination and insecurity), UNFPA and UNAIDS wanted to do a bit of qualitative research to look in more detail at what was going on.  

Although I’m a big fan of epidemiological research (quantitative and qualitative), and I use the results of research all the time, it seemed in this context that it wasn’t particularly feasible (given the resources available) or appropriate to see this as a classic research project, with publication in a peer-reviewed journal or changing national policies as the ultimate goal.  What seemed more important, given that a major new HIV programme aimed at sex workers was about to be launched, was to document some of the specific situations in the towns that the programme was going to target, to help influence the sorts of things that get addressed, and to identify and point out any gaps in the programme.  Moreover, there are quite a few sex workers in Namibia who are very involved in community work, whether in relation to HIV or more broadly, and we wanted to help them get even more involved.  

So we decided to provide some introductory training on one qualitative method – focus group discussions – and got them to think through what sorts of issues their colleagues might want to discuss.  We used those suggestions to develop a guide, and sent them out to conduct their own research.

The report describes the results in detail.  It also describes the limitations, of which there are many.  Although I remain adamant that the purpose of this activity was never to extract data that will tell the whole story and represent the realities of sex workers throughout Namibia, some common themes come out of each of the five towns.  But there are also differences.  It’s the differences that interest me.  I wanted to give people an opportunity to discuss and think about what was going on in their own towns, and what, practically, immediately, might be done to fix some of the problems in each town.  And to an extent, I think that’s what we got.  It’s not generalisable; in fact the results from each town are probably very biased.  We know, for instance, that in most of the towns, we failed to talk to any male or transgender sex workers.  But if we recognise the biases and their relevance to each town, but use the information to get positive change in each town, then that’s OK.

We’ve also got a team with a new set of skills, who can do the same thing again, or can replicate it in other towns, or – why not – help other marginalised groups like men who have sex with men, migrants, or people living in slums do the same thing.

Maybe “research” is the wrong term to describe using research techniques in creative ways.  This participatory approach isn’t new to community development work: far from it.  It isn’t new to public health researchers either.  Practitioners have been advocating it for decades.  But it remains a marginal rather than a maintream practice.  So that’s why I’m making it a big deal.

Update: The Namibian Sun carried a feature describing the assessments on 7th March 2012. The article is a good reflection of the findings, although some of the stock sex worker library pictures they’ve used as illustrations are a little unfortunate.

Sex worker rights and HIV: Namibia

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The 3rd of March was International Sex Worker Rights day, marked by sex worker rights activists and defenders across the world.  Although sex workers have been campaigning for rights in Namibia for years, the movement is still very much “emerging” since, until the last 3 years or so, they have received very little support.  

In Namibia, as in many other countries, sex workers have limited opportunities to be heard when they want to talk about human rights, and as a result, the discussions are often constrained by the need to relate them to issues like HIV (as I discussed here) or trafficking.

In this context it is heartening to see not only that news outlets in Namibia gave significant coverage to the events organised by local sex worker organisations (front page of The Namibian; articles in New Era and Republiklein), but that the coverage didn’t focus just on the HIV angle, and acknowledged the broader issues.  Since the event took place, some of those involved have told me that the feedback from different decision-makers has been very positive, and they are optimistic that we are now seeing a step-change in how some of the media and decision-makers are approaching sex worker rights.

I’m particularly proud to have played a role in supporting some of the work that went into these events, with the support of UNFPA and UNAIDS: this review of the literature on sex work and HIV in Namibia:

This report of a series of local assessments done by sex workers to investigate human rights, health and HIV in five towns:

And this report of a national policy meeting, which aimed to get programmes and policy makers to pay more attention to the issues of human rights of sex workers:

The job isn’t done of course: it has barely started.  But many of the partners in Namibia have committed to following up on this work, so things are looking positive.

For more of a discussion on the aims of the local assessments, click here.