In Zambia, the nation’s Home Affairs Minister tells gay rights advocates to “go to hell” while an HIV treatment advocate faces jail time for speaking of the need to reach vulnerable populations. In Kenya, Uganda, and Zimbabwe, homophobic views voiced by leaders are reported to have fueled sentiments “that homosexuality is ‘un-African,'” with that bigotry driving the spread of HIV among men who have sex with men. In Tanzania, harassment by health workers, brutality by police, criminalization by law leads to the institutionalized abuse and neglect of people who sell sex, inject drugs, and men who have sex with men. And in Senegal, according to an interviewee quoted in a just-released report, “the Minister of Health consults with MSM [men who have sex with men] while the Minister of Justice throws them in jail.”
All of which continues to raise an increasingly urgent question among those invested in sustainable global health efforts: when donors talk of a shift to “country ownership,” who owns the response to unmet needs in family planning, reproductive and sexual health, maternal health and HIV? That is the focus of a new report from amfAR, the Foundation for AIDS Research, the Health Policy Project, a USAID-funded project of Futures Group, the International Planned Parenthood Federation of Africa Region, and the Planned Parenthood Federation of America, examining the role of, and challenges to, civil society organizations as countries assume ownership of donor-supported health efforts.
The report, Advancing Country Ownership: Civil Society’s Role in Sustaining Public Health, seeks to define the role of, as well as the barriers to organizations often serving as the only forces representing the interests of the most marginalized. With the term “most marginalized,” depending on where you are, including women, girls, young people, disabled people, indigenous people, members of racial and ethnic minorities, migrants, immigrants, impoverished people, gay and transgendered people, and the often overlapping groups of those who sell sex for a living, or use injecting drugs, the stakes of being represented are high. But the report makes clear, the role of civil society organizations, as well as their rights, are ill-defined even as movement towards ever greater involvement and investment by recipient or partner countries gathers steam. Questions left open in the countries where their work is the most vital in meeting the needs of the underserved include whether they can participate in allocation of funds, raise and use funds from foreign donors, function without government interference, share information and raise awareness of the needs they are best positioned to know. The stakes are high, the report says, not only because inclusion of the most affected populations is essential to effective use of resources, but because the alternative is frightening. The report gives ideas of how civil society participation, and with it human rights and equitable services, can be accomplished, including insistence by donors that countries receiving funds adhere to United Nations standards that protect human rights, and that most countries are, nominally, at least, signatories to.
How much is at stake is spelled out in “Treat Us Like Human Beings” Discrimination against Sex Workers, Sexual and Gender Minorities, and People Who Use Drugs in Tanzania, a Human Rights Watch report gathered during the last year through interviews with civil society and government representatives as well as academic researchers and, most hair-raisingly, those who have experienced arbitrary arrests, torture, extortion and life-threatening exclusion from services in Tanzania. A close up look at one country, it serves to fill in the blanks left by routine news coverage of new homophobic laws, failures to meet the needs of injecting drug users, and sex workers worldwide.