Examining stigma: Us vs. Them

Hey all,

I thought I would share a recent blog post I was privileged to write at a friend's recommendation. (Thanks Jen!) While I am not deeply involved in the AIDS response, I have always been interested (more like intrigued) by the concept of stigma and how it plays out in my life and in other's lives. I think of how I react when a clearly mentally ill person is near, my danger tentacles rise. Or even someone sniffling and sneezing next to me on the bus; I recoil. 

Regardless of the physiological aspects of disease and illness, we all have certain 'ways' we react, whether with compassion, fear or disgust. These have the potential to fuel or quench "othering" in society: the process whereby you identify people as different from yourself or from the norm and deliberately or not, create dominance and subordination in society (Johnson et al, 2004)

We have the power, let's use it effectively. 

Why do people draw a line between “them” and “us”?

Posted on CrowdOutAIDS African English Forum [ http://www.crowdoutaids.org/]

Guest Blogger: Folake Soetan

The great thing about a concept like crowdsourcing is that you get the input of many individuals from varied backgrounds on one topic of interest. Like noses, everyone has an opinion and a suggestion on how to improve the current AIDS situation including improving the lives of young people living with HIV. This is of course what the CrowdoutAIDS campaign is looking for.

While reading through the contributions left by several participants in the Africa forum, I noticed two ‘sides’ beginning to emerge: one was obvious and the other was not. Contributors often referred to a certain group as “they” and “them”, this group being youths living with HIV. Several comments encouraged “them” to disclose their status; “they” should become ambassadors for change; “they” should speak out… This instantly brings up the question: who is on the other side of the equation? If there is a “them”, there will certainly be an “us”.

We recognise that stigma is still one of the strongest driving forces against getting tested and status disclosure. Stigma also intensely restricts the impact of education and advocacy. Even as great strides have been made and many youths are risking their social acceptance and even lives to take a stand against the spread of HIV, there is still intense stigma surrounding a young person who discloses their HIV-positive status, not just to their family, but among other youth.

In seeking to involve youth more in developing an effective AIDS response strategy, it is important for government,  NGOs and/or UNAIDS to recognise both sides of the stigma equation – young people living with HIV and those living without. It is reasonable to expect HIV-positive youth to take a lead in the HIV response with education and encouragement of their peers to get tested. But all potential ‘stigmatisers’, that is the “us”, also have a leading role to play in the response.

Organizations like UNAIDS can create an environment that welcomes openness about one’s status by conducting well-rounded training sessions for youth that include relationship management between those living with and without HIV. How would you respond if your close friend reveals he/she is HIV positive? How would you respond if you discover one of your classmates/colleagues has HIV but you don’t know who? Is it acceptable to ask a person living with HIV questions? What questions would you ask? Asking questions like this in a training environment will reveal inmost prejudices, and prepare all youths to take a stand, even if it is a lonely one, alongside a HIV-positive youth.

Any strategy that seeks to create an empowering environment for people living with HIV must target us, not just them. Youths living without HIV have a vital role to play in the AIDS response. If you are living without HIV, it’s time to stop seeing yourself on the other side of the equation. Only when them and us become we can the issue of stigma in AIDS advocacy be properly tackled.

I used to hate politics....

It's been a while! Quite a lot has happened since my last post that I would love to share in detail. However, due to recall bias (poor use of the term but I must practice my research methods lingo or die), I am unlikely to remember everything I had hoped to share.

The majority of my time has been occupied with writing a 2000 word essay (or better phrased, critical analysis) discussing 'The political barriers to the sustainable financing of health systems in low-income countries'. This topic jumped out at me from a list of 7 options. Mind you there were a lot of other extremely interesting choices such as discussing HIV/AIDS as a security issue (is it a security issue??) but being a citizen of the great state of Nigeria, I couldn't help but think about our current health system.

You might know far more than I do on this topic; no contest, but I saw this as an opportunity to understand what a health system is, what keeps it going and the constraints it faces particularly in developing countries like ours. Without going into too much detail, it is clear from the literature that the challenges faced in development and maintenance of a good health system are created through politics. Of course it follows then that the solutions to these problems are also political! Indeed that is what I have found!

A good health system isn't just having doctors and hospitals, although these are necessary. Instead it is really about making healthcare available and accessible to all people. This means that regardless of your income, who you are (big-man syndrome??) or where you live, you have access to healthcare at the point when you need it. It also means that not only can you afford to access the care at that point, but that in getting care, you are not driven below the poverty line. How many of us have heard stories of families struggling to pay gargantuan hospital bills? Or of people dying  because they were turned away at a health centre due to lack of money? (I read one such story as a kid and never forgot.... the story ended with something like "as she stood  outside the hospital clutching her dying baby, it gave one final shudder and cry, stretched out (as if in pain) and died..." It sounds unbelievably dramatic but as the Yorubas say "aimoye" - only God knows how many people have died or been disabled similarly.

I had a discussion with one of my professors, a normal bubbly and enthusiastic lady. To be perfectly honest it wasn't the greatest conversation for other reasons but in the course of discussing a potential topic for my dissertation (due next year) she said point-blank: "universal [health] coverage is not on the Nigerian policy agenda". I could not agree or disagree...I had no idea! So slowly but surely, I am happening on a potential area of research for myself, the makings of what I hope will be a great dissertation. So I'm getting into politics after all. Ah well even Moses was once reluctant... lol

In Pursuit of what? Many things, but definitely change!!

Quick fixes for life

Don't we all want quick fixes for life's problems? A good friend told me to keep it short and sweet. Here goes...

Based on the last post, it is evident that there are no quick fixes to the global health aid/health systems problems. If there were, at least one of the milieu of smart people gathered at the top would have figured something out by now right? Did you know that this 'sustainability problem' is far from new? It's not an issue that has risen up in the last 5 years, although it has become a popular topic within that time frame. We had to read a paper written in 1995 by Anna LaFond titled (you guessed it) "The Sustainability Problem". I won't go into the details here but I do want to take this matter and relate it back to our individual lives.

Isn't the problem with quick fixes in our lives that they are not sustainable? Of course we have the classic examples of crash diets, that is so played out I will give it no further mention. How about our characters? [Character: the aggregate of features and traits that form the individual nature of some person or thing. e.g. affectionate, ambitious, argumentative, secretive, lazy, obedient, harsh etc]


If you have ever tried to change an aspect of your character, one of the things that fundamentally makes you you, you will agree that it is undoubtedly one of the most difficult things ever. If you implement a 'quick fix' without tackling the real root issue (as I know I certainly have), you come right back to the same place.

In the end, human character drives the way the world works. If selfish ambition is the driver, the results always will be win-lose. Those on the losing end in today's world are mainly the poor (and all the things that go along with poverty). No 'quick fix global health or development initiative', in light of this core character issue, is going to solve our problems. Like the bandage on the cracked egg, the egg is still cracked and it's only a matter of time before it breaks. Health problems aren't just health problems, they are social problems, people problems, character problems.

Just a thought....

Health systems and NGOs

Today was a most interesting day as far as my class discussions go. I am privileged to be undertaking an MSc course in Global Health and Development and for me this means navigating a completely new field of politics and economics and seeking to understand how intimately these intersect with health....

It's almost a bit depressing really... I have come away with several conclusions on how the world of health works. So much of it, despite perhaps numerous initially altruistic intentions has become about power. Or has it always been about power? That's a whole other discussion.

We have been discussing the issue of sustainability and that is certainly one of today's buzzwords, as they are called. The concept of sustainable development. To me, it seems like a no-brainer, why start what you can't finish? That's a biblical principle even! But I am learning there are soooo many reasons for doing just that! The current aid industry (donor governments and multilaterals funding initiatives in poorer countries) is designed to promote un-sustainable development!

Simply put, and highly paraphrasing, the incentives for donor government, donor civil society groups (CSO) (NGOs, Community based organisations, faith based organisations etc), recepient governments and receipient CSOs - in case you lost the point of this sentence in this pile of jargon, the incentive for all these bodies to focus their funding on project support rather than programme support is far stronger. What this means is that money from donors, rather than go into the government budget and being used for long-term  government health system programmes instead goes directly to implementing bodies, often in form of NGOs, CBOs and other types of civil society organisations.

Why? Several reasons:
1) If donors think a government is corrupt, they won't want to give them money that will go into some people's pockets (not unreasonable)
2) A two-year project with a specific target e.g. the UNAIDS 3 by 5 initiative to get 3 million people on ARVs by 2005, has "deliverables". Meaning there are tangible effects of the money invested and the results, relative to programme support, are quick. Plus with tangibles, you can gain public support/approval for your 'investments'.
3) As I mentioned before, power and influence among states are a huge deal in the global sphere. Each state, perhaps (as Nietzsche would agree) in deciding to do something good, also has another agenda. Money buys influence. In particular, long term support could buy influence for a rich country donor in a poor country (say perhaps with highly desirable natural resources). However, sustainability calls for local ownership that eventually sees transfer of health investment (and any influence that comes with it) from donor hands to the state..... I personally think this argument is pretty weak, maybe someone else can back it up.
4) In a state where individual donors are acting alone, ie competing for turf in the recipient country - as is usually the case (why?) - a crafty government could turn them against each other (not sure I fully grasp this one)
5) Recipient countries may prefer project support because it allows them maintain sovereignty. As is sadly the case money absolutely buys influence and giving to a state government's programmes tends to give donors the 'right' to dictate how the money is used. This is not always in the best interest of the people
6) Donor CSOs must maintain a good image, how would it look to promote clearly unsustainable strategies? Also they may get to implement the 'projects' being funded meaning the money gets ploughed back to them. I do believe in purer motivation so I was pleased to learn that these organisations, though seemingly contradictory, do call for government programme support
7) Back to sinister motivations, a recipient government (that is not interested in its people) may also prefer project support funding. Why? Well if your government is perceived as bringing in NGOs and international donors that deliver tangibles in remote areas or chronically under-served areas, this garners political support for your regime! But being a project, funding is bound to end and oversight on your part will no longer be required leaving your government re-elected and your people bewildered. The effects of 'starting what you can't finish' are felt the most by the poorest not receiving any regular government support.

One could argue both ways, why give a man born blind sight for 5 minutes and take it away forever? Isn't that torture compared to if he had never seen? Or is it better that he has had a 'taste'? Not the same as life and death.... but food for thought.

8) Should have been number 1, assumed (and typically proven) efficiency of project implementation by CSOs rather than going through long government bureaucracy.... However, depending on the case, state initiatives may have more reach if they are better established and foreign CSOs don't engage local leaders/people
9) lastly, recipient CSOs depend on project money as their primary source of income to fund their activities. If the money goes into the budget (programme support), they are left with nothing. Similar to before, money also buys influence here. An NGO with money, has far greater potential to lobby the government to change policies than one without. Simple.

So we keep talking about sustainability.... If these motivations are anything to go by, we have a depressing unsustainable project-based future ahead of us... What is needed?

A fundamental paradigm shift (changing from one way of thinking to another, a transformation that doesn't just happen but is driven by agents of change - taketheleap.com) This is needed in the way we think about aid and development. I don't wish to be pessimistic but as long as states are more concerned about power and being #1 globally (why? Aren't we all going to die anyway? Why not enjoy the life that we do have?) this shift will not come. It needs to be driven by agents of change, those of us who can see beyond the need for power and politics (in reality it's a sad need for significance, being 'the' instead of just an 'a'). If we look past self interest to the needs of the people, at least to some extent collaboration between donors, and best practices in government programmes - two key drawbacks on sustainability, will start to draw closer to reality.

In pursuit of solutions!

Number two

Ha! How quickly the second follows!

I would like to share perhaps on of my proudest accomplishments to date. The Doctors on Air Medical Mission was an event that was planned as a CSR initiative for PathCare Nigeria and Megalectrics (Classic FM, Beat FM and Naija FM) to provide free medical services to the poor in the Obalende area of Lagos, Nigeria.

I had the profound privilege of being the coordinator of the event which meant handling all the details from planning to execution, with the help of an extremely capable support team (Wole, Dr Ademolu, even Jire you know yourselves!).

We involved about 15 private (top quality, typically reserved for the rich) clinics and NGOs to provide services such as eye exams (even free glasses!), kidney function tests, cancer screening etc as well as the Ministry of Health and primary health centre. I won't go into every detail of the planning process, although I do want to talk about the impact of corruption on your ability to 'do a good thing'. Perhaps that will be another day's entry. But here is one newspaper's coverage of the event:

http://www.vanguardngr.com/2011/08/pathcare-classic-fm-embark-on-healthcare-mission-for-the-poor/

What an honour to be quoted in it!

The hardest

The first blog entry is always the hardest I think. So it will probably be the shortest. What does one say to start off with?

Short intro:

Name: Folake

Country: Nigeria

Current location: London, UK

Education: BSc in Biology, Chemistry from University of Oregon, USA.

MSc in Global Health and Development (in view) University College London, UK

Interests: Health, Photography, Relationships, Mentoring etc

It is my hope that the subsequent blogs will reflect my developing and changing view of the world around me, in particular with regards to health, God (how he is related to everything), and life as I see it, sometimes through a camera lens.

Looking forward to the blogging experience!