By Kaila Mintz (special to CDHR)
An independent global civil society solidarity movement is essential to effectively encourage, monitor, expose and critique institutional global health responses. Solidarity and mobilization on HIV/AIDS is generally the standard-bearer for other global health responses founded on human rights principles. Activist Mark Heywood, a founder of South Africa’s influential Treatment Action Campaign (TAC), notes that, “the game-changer was to be the rise of a global activist movement that reset the agenda for AIDS.”
During the 45th Union World Conference on Lung Health, I witnessed the lessons and legacy of human rights-based collective activism around HIV/AIDS in action. My new colleagues in the global tuberculosis (TB) activist community pushed conference organizers to adopt strategies from International AIDS Conferences, such as establishing a civil society focal person in the conference secretariat, to better integrate civil society activism into discussions for a more effective global health response.
Given complex health interdependence and a lack of global government, some call for “international collective action” to displace the central role of states in global health. However, local health systems and broader national and international policy frameworks, including free trade agreements, remain central to health outcomes. Beyond these high-level policy considerations, how can “Western” civil society and non-governmental organizations most appropriately support and build the capacity of “Southern” partners for advocacy? How can we help amplify a range of voices, while recognizing the multiple, interdependent benefits accrued through solidarity?
These are questions I have been contemplating lately, as global health engagement from the perspective of civil society solidarity is a relatively new area for me. Making a professional transition from the world of government diplomacy to civil society research and advocacy is necessitating a great deal of reflection, learning – and humility. Through this process, and with incredible mentors, I’m seeking to grasp how efforts to address the injustices that underpin and sustain global health challenges such as HIV and TB can be achieved in ways that are respectful, inclusive and responsive to the needs, concerns and strengths of partners around the world. In this spirit, these initial personal reflections are not meant to represent the views of my own organization or others.
Shared engagement – shared benefit?
Undoubtedly, there are myriad ways in which civil society partnerships can support and strengthen local activism in the developing world, and contribute to global health goals:
- Access and information-sharing. A key contribution by Western organizations is to simply share access to a broader range of funders, decision-makers and influencers – ideally amplifying the concerns or solutions raised by partners. By re-tweeting findings of a key report published in the global south, a Western group shares its reach with influential politicians, celebrities or wealthy funders. Strong civil society networks alert members of information, opportunities, challenges and resources. This is particularly important in contexts where information is suppressed by authorities, or where reliable electricity or internet is limited.
- Research and legal support. Many global health challenges are usefully addressed through national-level litigation. Western groups are often well-positioned to harness pro bono law assistance, or provide direct legal or research support. Without denying the capacity of local expertise, this reduces the costs borne by partner organizations. Ultimately, this burden-sharing should be discussed and coordinated, so that expertise provided matches need, aiming to build the capacity of local groups, where needed.
- Communications support, and advocacy that never sleeps. Global partnerships on time-sensitive issues allows advocacy to benefit from multiple time zone engagement. Moreover, Western organizations may be able to assist with drafting and editing powerful statements, or share media experience and contacts that help get messages heard.
- Solidarity for solidarity’s sake. Standing together demonstrates simple strength in numbers. Unfortunately, sometimes it takes a global movement, with a range of voices, to legitimize the positions or demands of certain partners.
The points I’ve enumerated above focus primarily on “benefits” for partners in the South. It’s critical to acknowledge that Western groups also receive significant benefits – often unstated or unacknowledged – through “supporting” partners:
- Information-exchange: a two-way street. Many of these connections facilitate awareness of new opportunities (and challenges) for Western groups, from closed-door meetings otherwise unknown, to media interest that can be nurtured to further other initiatives.
- Leveraging grassroots connections. While new forms of online social activism, or “clicktivism,” create alternative opportunities for social justice engagement, attention spans remain limited. Rallying people for protests or other tangible shows of solidarity often remains elusive for Western activists (climate marches notwithstanding). Southern organizers seem to deftly use personal and community connections, and deep-rooted social justice concerns, to effectively mobilize. Western advocacy often relies on these networks – such as images of thousands rallying in iconic “HIV Positive” t-shirts, thanks to Treatment Action Campaign (TAC) organizing in South Africa – to claim mass support.
- Perhaps most crucially, Western groups’ legitimacy is enhanced through partnerships with grassroots organizations. Funders ask fair questions: are we truly representative of the people we aim to speak with and on behalf of? Who informs our research, outreach and advocacy? Do we acknowledge the benefits we accrue from these relationships, and how are we giving back? By forging genuine, equal partnerships with diverse stakeholders, and recognizing their contributions to our own work, we can develop meaningful responses.
This rosy picture of the mutual benefits of North-South civil society collaboration provides a backdrop for some critical reflections: namely, that Western groups’ strengths can easily lead them to dominate the agenda, decisions and spotlight, potentially destroying the very partnerships being sought. Unless advocates truly and openly acknowledge these risks and work diligently and relentlessly to address them, we risk reproducing power asymmetries in our own organizational relationships – privileges we otherwise fight in global health structures.
- Administrative hegemony on power? Western organizations play an important coordination or convening role in civil society networks for health – facilitating list-servs, coordination calls, meeting minutes, sign-on letters, and so on. This administrative leadership is a powerful organizational support to a diffuse global movement. However, it risks skewing decision-making power through seemingly insignificant tasks. To combat this, organizations might encourage rotation of coordination positions among network members to spread and build capacity, and help diffuse power accumulation.
- Acknowledge the power of language skills. What can be a meaningful contribution from Western organizations – fluency in English, and a solid grasp of resonant messaging – can quickly turn into a passive tool of subordination, as the pen-holder often directs the message. As I jumped in to assist drafting press statements during the Union Conference, I had to remind myself to pause to consult, to understand the meaning behind words – because even so-called “factual” or “grammatical” edits can shift meaning, and may otherwise be disrespectful to drafters operating in languages not their own.
- Displacement of jobs and opportunities. Just as “brain drain” draws capacity away from local health systems, or “voluntourism” replaces opportunities for skilled workers in the developing world, Western engagement risks displacing meaningful employment in partner organizations. Sometimes, the appropriate contribution is not to do the research, but to provide or seek funding for Southern researchers to do the work themselves.
- Legitimacy risks. While it’s generally good practice to publicly recognize the contributions of Southern partners, experience in Ethiopia showed me that some organizations partnering with external organizations face real risks of being perceived or branded as agents of Western values and domination – particularly those taking a human rights-based approach to health. Western advocates should seek to understand the political, economic and social contexts their partners work in. While Western advocacy may be informed and led by Southern partners, public acknowledgement of these collaborations may need to be nuanced to protect these partners. Often, this calls for staying silent, providing background support, even if it entails forfeiting public “credit.”
A year into a new line of work, I won’t claim to have figured out effective and equitable solidarity for global health. At times, potentially conflicting imperatives seem almost paralyzing, particularly with the urgency brought on by social media campaigns and the cacophony of competing interests. Nonetheless, some powerful observations and teachings I’m gathering point to a few reflections:
- Nurture strong alliances and situational awareness. Building relationships with a range of partners – on an ongoing, iterative basis – provides for insights from a multiplicity of views. Even under time pressures, it’s important to seek out and trust the views of partners.
- Share credit – and risks. Sometimes, it’s best to let others lead, and stay silent. And sometimes, it’s up to us to say things that others cannot, or to recognize that the positions we take may be unpopular. We can mitigate these risks by developing and communicating a clear value system that underpins all of our decisions – and remaining true to it. That said, we should carefully consider the risks to partner organizations and causes, and adjust our actions accordingly when needed.
- Consider and acknowledge the benefits we accrue – and give back. An important corollary of understanding the benefits of partnership is to step up when asked for assistance by partners, even if this engagement is outside our core mandate or interest. For instance, AIDS-Free World used its 2014 World AIDS Day statement to publicly acknowledge TAC’s contributions and amplify their fundraising efforts, issuing a call for global support to “save the life of TAC.”
This kind of “paying it forward” goes beyond altruism to truly build an interdependent, supportive and egalitarian network of partners. By critically reflecting on and recognizing the mutual benefits of cooperation, we can extend the reach of individual actions, assisting each other in our collective efforts to further global health goals.
AIDS-Free World. “This World AIDS Day, save TAC’s life.” Press Release. 1 December 2014.
Web. 14 December 2014. http://www.aidsfreeworld.org/Newsroom/Press- Releases/2014/WAD-2014.aspx
Heywood, Mark. “The unravelling of the human rights response to HIV and AIDS and why it
happened: an activists’ perspective.” In AIDS Today: Tell no lies and claim no easy victories (2014 Edition). International HIV/AIDS Alliance. 10 Oct. 2014. Web. 1 Dec. 2014. http://www.aidsalliance.org/assets/000/001/014/ESSAY1_MarkHeywood_original. pdf?1412944701
Frenk, Julio, Octavio Gómez-Dantés, and Suerie Moon. “From sovereignty to solidarity: a renewed concept of global health for an era of complex interdependence.” The Lancet 383.9911 (2014): 94-97
 Mark Heywood, “The unravelling of the human rights response to HIV and AIDS and why it happened: an activists’ perspective,” in AIDS Today: Tell no lies and claim no easy victories (2014 Edition), International HIV/AIDS Alliance, 10 Oct. 2014
 Julio Frenk, Octavio Gómez-Dantés, and Suerie Moon, “From sovereignty to solidarity: a renewed concept of global health for an era of complex interdependence,” The Lancet 383.9911 (2014): 96
 AIDS-Free World, “This World AIDS Day, save TAC’s life,” Press Release, 1 December 2014.
Kaila Mintz is a Project Coordinator with AIDS-Free World and is currently completing a Master of Arts in Immigration and Settlement Studies at Ryerson University in Toronto, Canada. In 2013-2014, she served as a Research Assistant to Stephen Lewis, supporting his role as a Visiting Distinguished Professor at Ryerson. Prior to this, she served as a Foreign Service Officer with Foreign Affairs, Trade and Development Canada (DFATD), which included an assignment in Addis Ababa, Ethiopia from 2009-2011. Kaila can be reached at firstname.lastname@example.org.