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The gender-HIV challenge in Pakistan: Discussion

How can local changes and lessons from this work be taken to the policy level?

Initial discussion focused on how work that is effective locally can be taken to scale. Imran described how the work with sex workers is one of the first projects of its kind supported by big agencies and is awaiting an extension. But the peer educators involved are very motivated to continue the work they have been doing. But many international NGOs are reluctant to commit to working in Pakistan despite the extensive need for more work like this. At the same time some of the international organizations have shifted towards ARVs and more treatment-based approaches and away from issues such as gender. With the bigger international organizations it is more political. For example, the IMF allocated 9 billion dollars with no mention of cross-cutting issues such as gender in their strategy.

Ultimately, organizations need to be prepared for long-term work and some failures too in the short term. Seeing local change turn into systemic change is difficult, but there are approaches such as Communication for Social Change, and Healthlink’s Communication for Advocacy, which can support such a process.

Communication and power

In many ways a ‘transformative communication’ approach to gender is a return to the roots of effective communication – even while recent times have been characterized by very technical approaches to communication on these issues. Some participants argue that good communication is about changing power dynamics which are at the heart of gender relations, something technical approaches have neglected. Far too often communication is seen as an add on, or reduced to ‘dissemination’ with little understanding of the real scope of communication

The success of the projects described by Imran was in part based on their power audits and analysis of communities, which got beneath assumptions. By engaging sex workers, clients and pimps simultaneously, they were able to develop an intervention that looked at ‘what’s in it for me’ for the participants. By tapping into the self-interest of pimps they were able frame safer sex as good for business and this secured their involvement, just as in the experience in Thailand. They used a ‘business-minded’ lingo to appeal to this group of business-minded people.

An exclusive focus on women, where they may have little decision making power, is not enough. Around 90% of new HIV cases are married women with great social and economic cost. Engaging men has been an important dimension of the work in Pakistan, in part because they need to be engaged in any sustainable change.

Shifting policy and practice – walking the talk?

Addressing gender requires more than just changes in policy on paper. Even where laws and bills are in place, behaviours may remain in place in communities and among groups of powerful men. On paper Pakistan appears to have made progress e.g. Women’s protection Bill, but there has not been much shift in reality or change in attitudes. In Pakistan there is often a mismatch between personal views and the stated objectives organizations are working for. So someone might suggest setting up a local women’s group/network and meetings but when asked, probably wouldn’t let their own wives attend a similar event.

It was agreed that people working for change need to be honest with themselves and ‘ walk the talk’, something that requires self awareness and a connection with what they are trying to achieve. This is especially relevant to groups such as peer educators. In recent polio work in India, Healthlink Worldwide and partners had similarly found that it was vital to get local and nation influential people and decision-makers to think through the issues for themselves. They were supported to empathise with real people’s experiences and the reason why they resisted immunization of children in their communities.

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Key facts

This blog is part of the Spark discussion The gender-HIV challenge in Pakistan.
This discussion includes:
-Intro: The gender-HIV challenge in Pakistan
-Risks and trends in Pakistan

Read more about the Spark project and other discussions