How, and If, US AIDS Groups Could Be Effectively
Involved in Global AIDS Activities
Analysis of the Global AIDS Action Network
1. The Reality Before Us
Given the explosion of US global AIDS activism in recent months, it must be clear to even the most casual observer that the involvement of US AIDS groups in global AIDS issues is no longer a question, but a reality. Although several institutions have for some years endeavored to make this occur, the involvement has in fact happened because of two fundamental technological changes in the late 1990s.
The first was the advent of effective treatment options (i.e., combination therapy), which created a moral imperative for US activists to assist their colleagues in southern nations. As the US is the only developed country without a national health care system, access to treatment has always been a central element of AIDS activism. With the advent of combination therapy, US AIDS activists were presented with the reality of the treatment access battle being won in part for themselves, but not for millions of others. For a community that had spent over a decade fighting for effective therapeutics, this created a moral imperative.
Had the treatment breakthrough occurred in 1989, it might have resulted in a handful of the largest groups lending their clout to improve US policies and occasionally collaborating with international groups and networks. However, simultaneous to the advent of effective treatments for HIV occurred the birth of the Internet. AIDS groups and activists around the world were no longer limited in their ability to communicate with each other on program activity or advocacy. In 1989 even the largest of AIDS groups in the US would have been strained to establish an ongoing relationship with a southern group. By 2001 even small groups around the world can establish intimate, timely, and sustainable relationships.
The result of US AIDS groups feeling a moral urgency on access to care simultaneous to their being able to communicate directly with southern groups has caused an explosion of interest and activity in global AIDS issues. In GAAN’s opinion the involvement of US groups in global AIDS issues has ceased to be a question of "if". The issue before us is how.
2. The Absolutely Essential Task–Advocacy
Virtually every participant in this consultation agreed that is was extremely important for US groups to advocate on global AIDS issues with their government and corporations. This is because all understood that US policymaking is driven by local concerns with the opinion of "the voters back home" often carrying more weight than anything else.
The US AIDS community, fragmented as it is into many local components, could be an extremely effective force to improve global AIDS policy. In GAAN’s opinion the way to proceed is for groups with existing advocacy capacity to coordinate with each other on global issues where they have expertise (i.e., immigration, treatment access, or human rights). This would result in sustainable working groups comprised of several organizations advocating a shared agenda.
Creating several such teams would not be expensive, but cannot be done without increased resources. GAAN estimates that an all-out advocacy effort by US AIDS groups on global issues would cost between $1,000,000 and $2,000,000 per year. This would support numerous groups working on several issues and revolutionize US advocacy efforts.
Very little of these funds would need to used on "lobbying activities," which most funders are unable to support. However funders can and should support efforts by US groups to undertake global AIDS policy analysis, policy education, and communication activities. Many US groups are willing to undertake global AIDS advocacy and use some of their private funding for activities that cannot be generally supported by foundations or government contracts. But they cannot fund the entirety of advocacy efforts on their own, nor should they be expected to do so. Funders who see the need for an effective global AIDS constituency in the US need to find a way to be supportive.
Much of global AIDS advocacy by US groups will be similar to work they already undertake for domestic issues. However one element must be different–groups need to create credible mechanisms for communication and input with southern groups on policy matters. This could be done several different ways (i.e., direct relationships, global networks, or global agencies), but it must be done. In the long run the best information US groups undertaking global AIDS advocacy can receive is from their colleagues in developing nations.
3. Partners for Real or Partners for Show?
Of thousands of US groups working on AIDS only very few, less then one percent, undertake advocacy work. What is the role of these other groups in global AIDS activities?
For the vast majority there isn’t one. Overwhelmed with local challenges and constrained by the realization that their principal mission is by no means complete, most US groups will not become significantly involved in global AIDS activities. For example, US AIDS groups cannot assume the work of large development organizations, do not wish to do so, and are appalled by the idea. US groups are themselves ASOs and realize that, whenever possible, support should flow directly to groups within the affected community and not diverted to "experts from out of town".
Yet there are challenges and needs within the AIDS pandemic that might be most effectively met via international activities involving US AIDS groups. These would be exceptional situations, numbering no more then a few dozen at any one time. This would not change the world’s response to the pandemic (see advocacy above), but could have profound benefit to select communities both within and outside the US. Again this is not theory, but is underway, as several US ASOs are already engaged in such relationships. Again the question is how to effectively undertake such work.
Participants in this consultation favored US groups undertaking international work almost exclusively via sustainable two-way partnerships between like organizations. A US group seeking to work internationally needs to not only identify what it has to offer a southern group, but as importantly, what it hopes to receive. Such a partnership might focus on specific issues (i.e., working in resource poor situations, or migration) or might receive significant benefit from solidarity between the groups. What is of paramount importance is that both groups proceed with clear recognition of mutual need and mutual respect.
4. On Cultural Competence and Solidarity
There was much discussion in this consultation as to what cultural competence was required to work internationally and what the benefits were, if any, of "solidarity".
Obviously, recognition that nations and cultures can be vastly different is required in international work and many US groups reiterated how they did not want to be "ugly Americans" in working internationally. GAAN found it interesting that few southern groups echoed this concern. Of concern to southern groups were equality in the relationship and mutual respect. As one southern activist eloquently put it, "Why call yourselves partners if you are really only thought of as funders?"
US groups understood this concern and proposed that new mechanisms for partnerships come into existence that would allow independent funding to southern partners and where southern groups could choose a US partner, not always the other way around. In GAAN’s opinion limitations in cultural competence between partnering groups is less important than mutual respect and a mechanism that promotes equality.
One of the more controversial comments in the consultation was that "apparent affinity is not cultural competence". GAAN would argue that the reverse is more likely true. Cultures do have affinity across national boarders, and although they may not equate specifically to "cultural competence", "cultural affinity" opens doors. Obviously, groups with a cultural affinity to groups in a specific nation have an advantage in working there compared to groups that do not.
The benefits of solidarity were also much discussed, but among the ASOs themselves there was no disagreement that "solidarity", "camaraderie", and lessening of feelings of isolation have real benefit. GAAN notes that some participants seemed to assume that this benefit would be principally to southern groups from their theoretically more empowered US counterparts. We do not think this is the case. GAAN observes that many US AIDS groups feel isolated working within American culture and very much want an international relationship with a group that has a shared affinity. In our opinion US AIDS groups need to make explicit the benefits they themselves receive from a sense of solidarity with like groups in another nations. This may be one of the more significant benefits to US groups in working internationally.
5. Conclusion
A true global AIDS community has come into existence in the last few years as organizations and individuals reach around the world to connect to each other. The US AIDS movement has much to receive and much to give to this global community.
The size of this involvement would not be large–perhaps 20 groups undertaking advocacy (cost one to two million dollars) and another 30 to 50 in international partnerships (cost three to five million dollars). However the benefits could be substantial. Throughout the nation, leading AIDS groups would become expert in global issues and able to educate their fellow citizens. Decision makers in government and the corporate sector would need to take into account well organized advocacy campaigns undertaken with the support of many Americans and informed directly by southern groups. Expertise and camaraderie would flow between US AIDS groups and their colleagues in other nations, improving the work of numerous groups to serve better their respective communities.
The involvement of US AIDS groups in global AIDS issues is underway. It is our hope that this consultation will assist in making this engagement, so important to many Americans, as productive as possible.
