Communication, Media, and Development Policy

The commonalities lens sees AIDS better

Posted by jontinker on Thu, 2009-02-26 06:26
 

The recent ground-breaking visit of Haitian NGO AIDS practitioners to Vancouver was a spectacular success, suggest evaluations by both the Haitian and the Vancouver participants. Culminating in a public community dialogue on World AIDS Day (1 December 2008), the project tested out the "commonalities lens" approach, which argues that it is more fruitful to examine the similarities than the differences between North and South -- Jon Tinker, Panos Canada.

Lenses are important. How we see the world determines how we feel about it - and how we act to change it. I first proposed the "commonalities lens" in Drum Beat in July 2007. "The North-South lens is blurred, cracked, and warped. At 50 years old, it's long past its sell-by date", I wrote.

The venerable North-South paradigm arose in the early 1950s. Does it still mean anything useful? Its unstated assumptions are that the North is industrialised and the South is developing, that the North is rich and the South is poor, that the North is skilled and the South is not.

Today, all three assumptions contain more exceptions than an insurance policy. Once, North and South were more-or-less distinct and homogenous groups. Now, these terms have little more than an historical validity – although they are unlikely to disappear any time soon.

The North-South lens can cause partial blindness, hindering us from seeing the world as it really is. In the North, it reinforces the stereotype that the South is a different planet, where people are accustomed to poverty and disease, and incapable of organising themselves.

The North-South lens starts by assuming fundamental differences between countries and cultures. The commonalities lens homes in on what we have in common. The North-South lens emphasises what divides us, feeding alienation and patronage. The commonalities lens helps us realise what we share, reinforcing solidarity and mutual learning.

Pieter de Vos (a public health and inner cities specialist from Edmonton), William Booth (former executive director of AIDS Vancouver) and myself have been testing out this approach in Panos Canada for three years.

In December 2006 we teamed up with Panos Caribbean to create "AIDS in Two Cities" , a photo-analysis of the human impacts of, and community responses to, HIV/AIDS in Port au Prince and Vancouver. In one of the richest and in one of the poorest cities in the world, we found that the face of HIV-AIDS was remarkably similar.

Two years later we developed a more ambitious project: the Haiti Exchange. We tested out the "commonalities lens" through a ground-breaking visit of ten Haitian NGO AIDS practitioners to Vancouver. The project culminated in a public dialogue at Vancouver's Simon Fraser University on World AIDS Day, 1 December 2009.

The results, we feel, were spectacular.

A survey returned by 52% of 95 Vancouver participants showed remarkable enthusiasm for our approach. 88% of respondents rated the utility of the commonalities lens at 7 or more out of 10 (average ranking 8.1).

A similar survey returned by 100% of the Haitian participants was even more positive. They all ranked the utility of the commonalities lens at 8 or more out of 10 (average 9.1)

The goal was for Port-au-Prince NGO AIDS activists to share insights and knowledge with their Vancouver counterparts. We wanted to trigger some immediate and tangible results, and to field-test four hypotheses.

First, would the commonalities lens work in practice? Would we truly learn more from similarities than from differences?

Second, could we subvert the rich countries' patronising dispatch of "experts" to "train" the Third World? All too often, this devalues and undermines Southern leadership. This time, the experts travelled in the opposite direction, from South to North.

Third, how useful was our concept that cities are global AIDS crucibles – where AIDS impacts are most intense, and where the most effective responses are being forged?

And fourth, have AIDS organisations perhaps become a tad self-satisfied? After 25 years of campaigning, are some tending to repeat the same old approaches over and over? We surmised that the global North's AIDS community is thirsty for imaginative new activities.

So what did the Haiti Exchange do?

The 10-person Haitian team, convened by our close partner Panos Caribbean, included people living with HIV-AIDS, directors of NGOs, two doctors, a nurse, a psychiatric counsellor, a journalist and three members of a youth theatre troupe. During an intensive five days (26 Nov-1 Dec 2008), they took part in 27 small-group meetings with 20+ Vancouver organisations, involving about 50 people from the city's AIDS community, including public health officials, researchers, and front-line workers in hospitals, clinics, drug centres and anti-poverty programmes. These people all helped make the project happen.

The Haitians were guests of honour at an AIDS concert in the Anglican cathedral, and laid a wreath at the Vancouver AIDS Memorial. A First Nations community leader and artist drummed and sang a welcome to the Squamish Nation's traditional land. They went to a drugs clinic, and to a community kitchen for HIV+ immigrant women from Africa. They had an in-depth discussion with A Loving Spoonful on how to get food to people living with both HIV and hunger. They debated with paediatricians and young gay men, actors and academics – in the Downtown Eastside, the poorest neighbourhood in Canada, as well as in ritzier locales.

The sense of excitement was palpable. The project depended on a small team of francophone volunteers, some of them HIV+, who guided and interpreted for the Haitians as they criss-crossed the city. Each time I tried to thank one I got the same response: "No, I want to thank you. I'm learning so much. I'm proud to be part of it."

Even the most peripheral people often shared this enthusiasm, like the staff in a gay pub, and in the coffee-bar where we picked up daily breakfast supplies. "Wow, that's really cool. Of course we'll put up your poster." And: "Brilliant. Would you like a discount for the coffee?"

The response of all three levels of government was equally wholehearted. Our city and province both helped fund the project, and their key officials joined in the public dialogue. The mayor welcomed the team at City Hall (with a tongue-in-cheek claim that he learned his French from strip-cartoons). Canadian diplomats in Port au Prince fast-tracked the visas, and invited the team to hold a press conference in the embassy. The Department of Foreign Affairs asked them to brief top federal officials in Ottawa – even though the project was openly critical of the "expert" model in which Canadian development assistance is heavily invested.

Perhaps most inspiring was the reaction of Governor-General Michaëlle Jean. Haitian-born herself, she is one of the best-loved public figures there. She had planned to meet the team in Ottawa, but a re-scheduled state visit to Europe prevented this. "I am absolutely delighted to extend my congratulations and support", she wrote in a personal message, adding a handwritten phrase in Kreyol, Haiti's national language, which roughly means "Hang in there, guys".

Michaëlle Jean grasped the "expert" issue immediately. AIDS workers in Vancouver, she wrote, "are eagerly anticipating the expertise of the Haitian representatives, which will be received with respect and quickly put to good use".

It was. Haitian nurse Claudia Thomas Riché described hours spent with Canadian AIDS nurses, debating how to get HIV-AIDS and TB care out to hard-to-reach groups. Her summary? "Talk-talk-talk – commonality. Talk-talk-talk – commonality. Talk-talk-talk – commonality".

The commonalities lens enabled Haitian and BC (British Columbian) nurses to discover that they were both tackling similar issues in similar ways, and to start learning from one another. Claudia went back with information on the BC model for partner counselling, and BC nurses are now examining the Haitian success in expanding the role of nurses in AIDS and TB care – something BC has been trying to do for some years. Claudia coordinates HIV & TB training for 500 clinical providers in Haiti each year, and is national coordinator for the Caribbean-wide CHART training programme. No one in BC even approaches her hands-on experience.

Exactly the sort of reciprocal knowledge exchange and synergy we had hoped for. There was plenty more, for the Haitian team included some heavyweight talent.

In Vancouver, Dr André Jolicoeur of Panos Caribbean, the Haitian team leader, gave a grand rounds presentation at St Paul's, Canada's leading AIDS research hospital. At the public dialogue, the Haitians revealed ambitious plans for using anti-retroviral drugs (ARVs) as a means to drastically reduce new infections as well as to treat HIV-disease. This so impressed Dr Julio Montaner, director of the BC Centre for Excellence in HIV-AIDS (CfE), that CfE is now exploring a Haitian-Canadian ARV research project. And Panos Canada, with the Panos Global AIDS Programme, hopes to develop a global information campaign on the same subject.

The Haitian youth theatre troupe performed at the foreign ministry, at a francophone Vancouver secondary school, and at the public dialogue. After a fruitful meeting, its Vancouver counterpart, YouthCO's theatre group, is checking out the Haitians' use of music in interactive theatre. A prominent Vancouver artist is helping us figure out how the city's AIDS-supportive arts community could market Haitian artwork in Vancouver.

In our evaluation survey, the Vancouver participants gave the Haiti Exchange an average ranking of 7.8 out of 10 for overall success. "As a paradigm shift away from powerful, technically and intellectually superior North rescuing helpless, resource-poor South, I say a 10/10." wrote one. "Our group felt very honoured to be able to learn and share", said another. "Just great to sit around the table and informally chat with the two women and translator. I felt a real sisterhood", wrote a third.

The evaluation by the 10-strong Haitian team gave the project an average ranking of 8.6 out of 10 for overall success, and revealed that 9 out of 10 of the Haitians had gained new ideas or insights from the project. “Gave all the Haitian team lots of practical new ideas for fighting AIDS,” wrote one. “It was especially interesting to discover that a rich country like Canada has to face problems which in Haiti we thought were only found in poor countries,” said another. “The great work in Vancouver’s Downtown Eastside deserves serious attention by specialists in any country, rich or poor,” wrote a third.

Using the commonalities lens didn't mean ignoring differences. Far from it. The Haitian team had little experience of how injection drug use fuels Vancouver AIDS. They were intrigued by the city's "harm reduction" strategy, by its safe injection sites and needle-exchange programme. ("But surely this condones illegal drug use?"). Some Vancouver youth had real problems with the focus on chastity in Haiti. "As part of an organization that is ‘sex positive' I do not feel that teaching abstinence is the most effective way to combat the spread of HIV", one commented. Sure, Vancouver NGOs have greater access to cash, but maybe this is counterbalanced by Haiti's strong family and community networks?

So both Canadians and Haitians found ideas which challenged their preconceptions. Good.

The Haiti Exchange persuaded us that our four main hypotheses are probably valid. That the commonalities lens is a powerful tool. That equality and mutual respect are a better basis for development than "Us" training "Them". That cities are indeed AIDS crucibles, and that city-to-city links have real potential. Finally, that there is an overwhelmingly positive response to innovation in AIDS programming.

Panos Canada is now actively planning more such activities. For that, the Haiti Exchange was immensely encouraging. 72% of Vancouver participants ranked their personal satisfaction in the project at 7 or more out of 10. And 65% wanted to be actively involved in follow-up.

We hope that others will see similar potential, and can devise better ways for the commonalities lens to create challenging new projects in HIV-AIDS – or in development more broadly.

We have posted more detailed materials on our website.

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