eJournal of the Australian Association for the Advancement of Pacific Studies
Issues 1.2 and 2.1, April 2010



ELIZABETH REID,
THE AUSTRALIAN NATIONAL UNIVERSITY

    Introduction
     
  1. There is an emerging realisation that responding effectively to the HIV epidemic requires approaches that are
    Elizabeth Reid Figure 1. Elizabeth Reid values and human rights-based.[2] This realisation, however, is often driven by a concern to contain the spread of the epidemic rather than a concern for people, their dignity and rights. Thus, for example, the claim is made: ‘If we face concentrated epidemics fuelled by sex work, we know what to do. Targeted interventions that promote education, condoms, sexual health, solidarity, empowerment, and rights for sex workers do work and have contained HIV in Asia’s three main sexually ignited epidemics in Thailand, Cambodia, and south India.’[3] This is not a values and human rights-based approach to HIV work. It is an instrumentalist approach in which it is argued that, inter alia, the promotion of solidarity and the recognition of rights of certain groups achieves the containment of the epidemic. Such approaches echo the instrumental use of women to achieve family planning and population policy objectives.

  2. A values and human rights-based approach involves a particular way of working with people: respectful, listening, empowering, involving. It may involve a decision to work with certain groups because of a commitment to their rights and well-being. The Sarvojana Coalition in southern India does its HIV work with groups of marginalised and poor people in seven states.[4] The Vamp/Sangram collective in Maharashtra,[5] the Sonagachi programme in Calcutta,[6] Naripokkho in Bangladesh[7] and others work with sex workers. The Bandu Social Welfare Society in Bangladesh[8] works with men who have sex with men. The groups they work with are people to whose welfare and interests they are committed and this guides and motivates their work. The values and human rights concerns of one group may lead it to work with the marginalised; another, the poor; another, women; another, indigenous peoples. But for all of these organisations, theirs is not just a commitment to the particular groups that they work with but also a commitment to how to work with them, a commitment to establishing relationships of respect and empowerment for all concerned.
     
  3. However most values and human rights-based approaches to HIV work are funded by donors working within an instrumental aid modality. This creates critical tensions, particularly concerning what constitutes effective outcomes of the intervention. The donor will demand data on people reached, condoms distributed, numbers of sexually transmitted infections treated, and the like. The values-driven organisations can provide such data. However, they may not want to measure their success in this way. They will be primarily concerned to measure themselves through the eyes of those they work with to see whether they have managed to bring their values and principles into the way they do their day-to-day work and to find out if they are experiencing greater dignity and agency in their lives.
     
  4. Little or no research has been carried out to determine whether approaches based on values and human rights may, as an outcome of the way they work, also achieve the instrumentalists’ ends, namely, increased HIV protection, but in different ways, by different pathways. The Poro Sapot Project of Save the Children in PNG is a values and human rights-based project caught in these tensions. It has achieved significant levels of effectiveness in its HIV work with marginalised groups in PNG as measured by instrumentalist measures. But is it effective because it distributes condoms and treats STIs as requested by its donors or is it effective because it works from an acknowledged set of values in respectful and empowering ways?
     
  5. The Paris Declaration on Aid Effectiveness provides an agreed set of partnership commitments whose honouring in development contexts is considered to be constitutive of aid effectiveness. These provide a framework through which the interactions between Poro Sapot and its donors can be viewed. However, these commitments do not seem to capture the complexity and essential messiness of Poro Sapot’s work.
     
  6. This paper explores what it means to say that Poro Sapot is a values and human-rights based project and to understand the extent to which this contributes to the effectiveness of its HIV work. It raises the question of how the effectiveness of values-based approaches can be measured.

    Figure 2. Lae Outreach Volunteer Samson Nipa talks about his life living on the street as sex worker and transgender person at Poro Sapot's first MSM consultation outside Port Moresby, NCD. (Samson died in 2009.)


    The HIV Epidemic In PNG: The Epidemiology
     
  7. Papua New Guinea has a generalised and quite widespread HIV epidemic. Its estimated prevalence is the highest in the Pacific and the rapidity of its spread is the highest in both the Pacific and Asia. One mark of a generalised HIV epidemic is that infection rates are as high or higher in women as in men. In PNG, sixty per cent of known cases of HIV infection, both cumulative and new, are in women.[9] It is not known whether the rate of infection in women is a statistical artefact created by decisions taken about HIV surveillance systems and provider-initiated testing policies but, whatever the statistic, the reality is that many women are infected and are becoming infected.
     
  8. Another mark of a generalised epidemic is that it is geographically dispersed, spreading around the dense networks of pathways and desire lines that constitute the lives of men and women. It is concentrated in the households along these pathways. Families are a site of rapid HIV transmission, for when the virus enters a family it spreads quickly, engulfing parents and children alike. Families and individuals throughout the length and breadth of PNG have been touched by this epidemic.
     
  9. Generalised epidemics also cluster in these pathways. They are not evenly distributed. They cluster where money changes hands, where alcohol is drunk, where sexual networks are dense, amongst the educated and wealthy and amongst those for whom surviving and coping is a constant struggle. These clusters are epidemic spaces. Such clustering is an urban phenomenon but also occurs in rural towns and in villages. Certain villages around Lake Kopiago, a remote area in Southern Highlands Province, are more seriously affected than others: "HIV is full up over there”. So too are there dense epidemic spaces in some settlements more than others in Port Moresby and other large cities: "Nine Mile is full up”.[10]


    The HIV Epidemic: The Driving Forces
     
  10. Social practices, norms and values can create conditions of rapid spread, particularly where these have solidified into cultures of rape, violence and intoxication. These are intensified by situations of extreme poverty, of inadequate access to education and by severely limited opportunities for productive activities, particularly for young men. These conditions create epidemic spaces.
     
  11. Women with children, who are left without support, through divorce, desertion, the neglect of families, or in other ways, may find that their survival strategies place them within epidemic spaces. There are many such women struggling in these spaces in PNG. Informal sex work to make ends meet is now widespread in PNG. A recent survey found that two in five older women exchanged sex for gifts or cash. It also found that two in three women aged 15 to 24 were involved in transactional sex,[11] that is, sex in which women accept or negotiate gifts of cash or consumer goods.[12] Women whose lives are shadowed by violence and the threat of violence live in these epidemic spaces. Again, there are many of them. Research carried out by the PNG Law Reform Commission between 1982 and 1986 indicated that on average two thirds of all women had suffered partner violence.[13] There is reason to believe that this figure has not lessened.[14]
     
  12. Men also live in these epidemic spaces, particularly in those societies which accept or condone excessive drinking or multiple sexual partners or violence in men. There are exceptionally high rates of alcohol abuse in PNG.[15] It is estimated that about half the sexually active men have multiple sexual partners. Studies indicate that most married men have extramarital partners at some stage in a marriage.[16] Feminine men are drawn into these epidemic spaces as life in their families and communities become intolerable. Men who buy sex or who sell it inhabit these spaces.
     
  13. Certain sexual practices, anal sex and brutal sex in particular, make it more likely that the virus will pass from one person to another in an act of unprotected penetrative intercourse. In one study conducted by the Institute of Medical Research in 1993, fifty five per cent of women interviewed said that they had been forced into sex against their will.[17] The 2004–5 baseline research for the Poro Sapot project found that in the previous year, 54 per cent of female sex workers in the National Capital District (NCD) had been forced to have sex, and 58 per cent of female sex workers in Goroka.[18] The National AIDS Council’s 2006 behavioural surveillance survey reported that over half the truck drivers along the Highlands highway claimed to have had anal sex with women.[19]
     
  14. The epidemic colonises those most neglected, rejected, ill-treated, intimidated and abused in a society, as well as those who abuse, neglect and reject. It lays claim to those least able to create a world in which they are protected from it. This includes those living on the margins of communities and societies, including men who desire men, women working as sex workers, and children in families affected by the HIV epidemic. The Poro Sapot Project was established by Save the Children in PNG (SCiPNG) to work in these epidemic spaces.


    Save the Children in PNG
     
  15. Save the Children works for a world that respects and values each child, a world that listens to children and learns from them and a world where all children have hopes and opportunities. Save the Children started working in PNG over 30 years ago and since then has assisted tens of thousands of children and their families in realizing their rights. Save the Children in PNG began to discuss the possibility of working with women who work in sex work, and their clients, in 2002.[20] At that time, earlier work with these women was in abeyance as no NGO, national or international, or other agency was prepared to carry it forward.


    The Poro Sapot Project: Its Predecessors
     
  16. The first HIV-related project with women in sex work and their clients, the Transex Project,[21] began in 1996. It was a peer and outreach education project which arose out of research conducted by Carol Jenkins and her team at the PNG Institute of Medical Research (IMR), a statutory body of the government. This research showed significant levels of commercial sex in three urban areas, Port Moresby, Goroka and Lae, with just under five percent of the women living in these towns engaging more or less independently, at least part time, as sex workers.[22]
     
  17. At this time, commercial sex work was not brothel-based nor was it organised or controlled as in other countries. It was largely the province of poor women with limited employment opportunities, low literacy and low levels of education.[23] The women worked free lance although some worked with men, and women, who found them clients, and men who helped them collect the money and protected them.[24]
     
  18. The Transex Project and its successor project the Transex-Plus Project 1996–2000 were IMR’s first major urban programme and its first HIV intervention.[25] When IMR withdrew as the implementing agency, the dense network of committed volunteer peer educators, outreach workers and staff from the project developed other partnerships to keep the work alive.[26] This was a period of fragmentation, appropriation and disarray as various parts of the original project were taken over, or not, by various bodies, usually for short periods of time, in Port Moresby, Goroka or Lae.[27]
     
  19. When, in 2003, SCiPNG was formally invited by the National AIDS Council to become involved in this work, it decided that its initial focus would be on supporting the existing networks of sex workers, their clients and those who control or influence access to the trade established under the Transex projects in Port Moresby. These latter were often referred to as ‘gatekeepers’. The Transex project had included a study of the power structures and gatekeepers that control or influence access to sex work: police, security men, owners and managers of venues where the women work and their staff.[28]
     
  20. The transition phase, which went from February to June 2003, was supported by Save the Children New Zealand (SCNZ) and Save the Children Australia (SCA) and was to become the Poro Sapot Project (PSP). In Tok Pisin, a poro or poroman is a companion or friend, while sapot is help. The PSP project was to be friends helping each other, a statement of its values and approach. The original design document was prepared in early 2003 on the basis of widespread consultations with women in sex work, project staff and stakeholders and drew intelligently on lessons learned from the earlier research and project work in PNG and that done elsewhere. This document had to be laid aside when at least one donor insisted on a document tailored to its specific funding.
     
  21. In Port Moresby and Lae, Poro Sapot’s Phase 1 began in July 2003 with funding support from the AusAID National HIV and AIDS Support Project (NHASP), and SCNZ and SCA, and in Goroka and Kainantu about a year later in August 2004. The primary focus was on women in sex work although in 2002, under one of the transition projects in Port Moresby, the first work in PNG with men who have sex with other men was begun. This became the second primary focus of their work in all cities in 2004 when it was made a condition of funding by a donor.
     
  22. The various documents produced over this period were superseded by the May 2005 PSP design document.[29] At this stage, PSP and SCiPNG felt the need to make a clear statement about the way they wanted to work on HIV as a values and human rights organisation. They had also planned to harmonise the reporting requirements of the various donors during this process but they were not able to do so.


    A Human Rights-Based Approach to HIV Work
     
  23. In 2002, as Save the Children in PNG listened to the entreaties of the former IMR peer educators and staff in search of a nesting organisation, it had little organisational experience in working with the particular groups that PSP was to do their HIV work with: women working as sex workers, men who desire men, the clients of sex workers, and those that determine and mediate access to sex work. It did have experience, however, in applying the principles of rights and values, of a sensitivity to power and gender, and of participatory and empowering approaches to its work with children and their parents. It brought this commitment, experience and sensitivity to its HIV work.[30]
     
  24. In August 2003, Carol Jenkins prepared for UNFPA a review of lessons learned from sex worker projects in Asia, the Pacific and Senegal, including the IMR project that she had been instrumental in designing and implementing.[31] PSP acknowledges this report, and the work of Carol Jenkins in general, as having had and continuing to have, a critical influence on the way it does its work: its values-based approach, its sensitisation sessions with its staff, its work on masculinity and on male sexuality.[32]
     
  25. From this document, PSP drew the values that were to become the core of its HIV work, the 3Rs: Recognition, Respect and Reliance. These were the operating principles of the STD/HIV Intervention Program, most commonly know as the Sonagachi project, initiated in 1992 in Calcutta. The meaning of the 3Rs is described as:

      Recognise the sex worker for what she is – a worker in an economic endeavour, whether legal or illegal is immaterial; she is a woman working for her living. This implies there is never any pressure put on her to get out of sex work, although services may be developed that allow her to save her earnings, invest them in some way, and leave the trade if that is her desire.

      Respect means that the sex worker is treated just as any other person, in an egalitarian manner and is not discriminated against at all. She eats the same food alongside the NGO workers, travels in the same transport, etc. All members of the NGO have to adhere to this, including drivers and janitors.

      Reliance means that the NGO workers rely on the sex workers’ knowledge and experience regarding the sex trade. After all, few NGO workers would have the personal experience to match that of the sex workers. … The factors that create barriers to improved overall safety, including safer sex, and their solutions, have to be identified by sex workers.[33]

    PSP recognised the importance of these principles for developing a values-based and people-centred approach to its HIV work. It set out to think them through in the PNG context and in the contexts of their work. It began by enlarging the scope of the principles by applying them to its work with men as well as its work with women.
     
  26. By 2005, it was also able to draw on the work of Berry, Childe and Theis in a publication of Save the Children Sweden, an early article on a human rights-based approach to HIV work.[34] The principles underlying this approach included the dignity of every human being, equity and non-discrimination, and the right of every human being to claim his or her right to participation and empowerment.
     
  27. Berry et al. proposed as the goal of a human rights-based approach to HIV that all people have the power, skills, knowledge and resources to protect themselves from HIV infection. To this list, PSP, importantly, added 'support': mutual support within the groups, mutual support between the groups and PSP, the support of the gatekeepers, solidarity between the women and men in the project, and the support of families and communities.
     
  28. Human rights-based approaches to development and to HIV work are admirable but remain in the realm of goals and aspirations in the absence of ways of putting them into practice, of translating them into the daily routines of the work. The Sonagachi project and the Transex project provided insights into how this might be done. PSP was to develop these into an impressive portfolio of practices.

    Figure 3. Provincial Police Commnader EHP (PPC) Augustine Wampe presenting the certificate during the graduation ceremony, training police officers, Kainantu, EHP


    The Poro Sapot Project
     
  29. Poro Sapot is one of the largest sexual and reproductive health interventions by a civil society organisation in PNG. It works in four cities in three provinces: Goroka and Kainantu in Eastern Highlands Province, Lae in Morobe Province and Port Moresby in the National Capital District (NCD). In each city, it works in a number of specific sites chosen on the basis of a clustering of sex work or male-to-male sexual activity and where PSP has contacts in the area.
     
  30. At the start, Poro Sapot had only a weak understanding of what an effective peer education programme might be like. In 2003 in PNG what passed for HIV peer education was often characterized by preaching fear to or giving information to the general community. During 2004–5 Poro Sapot received technical assistance from Caroline Francis, an FHI consultant trained by CARE International, to rethink its approach to peer education. Emphasis was placed on interpersonal, often one-to-one, interaction and on changing behaviour, rather than simply passing on information. It adopted a more systematic approach involving life skills training and capacity building workshops, and the adoption of systems for supporting, monitoring and rewarding the volunteer peer educators.[35]
     
  31. Peer educators have now been trained in each city. Currently, about 110 women and 35 men are active. Many more than these have been trained. These volunteers advocate for and promote the human rights of those with whom they work as well as for protective sexual behaviour and technologies. They are supported by a Police Liaison Officer in each city, responsible for working with the gatekeepers. Once a site has been selected and the peer outreach work initiated, the network of gatekeepers in that area is identified and work with them started.
     
  32. Being marginalised is often associated with being estranged from family or community, of being outcast, but social borderlands encompass many forms of social connectedness. Acknowledging this, PSP has started to work with the communities in which the people they work with live and work. The aim is to help communities reflect on the cultural practices, norms and values from which arise the fear, stigma, abuse, exploitation and discrimination that the people they work with experience. These are the driving forces of the HIV epidemic. Through this approach, known as Community Conversations, communities learn how to talk about difficult issues and how to change in ways that they have identified. In so doing, social norms and cultural practices which marginalise and dispossess, and which drive the epidemic, can be addressed.

    Figure 4. Group activity during the peer bridging meeting (problem tree), Kainantu, Eastern Highlands Province


    The Reach of the Poro Sapot Project
     
  33. In the last two years, PSP has made initial contact with several thousand sex workers every quarter and several hundred men who have sex with men. It is probably the country’s largest NGO distributor of female condoms, water-based lubricants and male condoms. Data from the three PSP sites[36] show that, in 2009, PSP staff and volunteer peer educators reached over 27,000 new people and continued contact with over 18,500 (see Table 1).

    TARGET POPULATION NEW OLD TOTAL
    Female sex worker (adult) 7857 7572 15429
    YFSW 5737 2295 8032
    Male clients 3533 1115 4648
    Male clients 3533 1115 4648
    Gatekeepers 2050 1724 3774
    MSM 4072 4417 8489
    Police 438 800 1238
    Others 3602 613 4215
    Totals 27,289 18536 445,825
    Table 1: Contacts by PSP staff and volunteers

     
  34. In 2009, PSP staff and volunteers distributed almost 22,500 HIV IEC pamphlets, almost 10,000 posters, 5,500 key messages and almost 1,500 other IEC materials, including human rights materials and clinic referral cards, to their target populations. In 2009, PSP staff and volunteers distributed about 1,624,000 male condoms, 110,400 female condoms and 267,000 packets of lubricant to their target populations. This is an increase over 2008 when about 36,000 female condoms, nearly 200,000 packets of lubricant and over a million male condoms were distributed.[37] The availability of these protective goods can fluctuate according to the reliability of the supply chain.
     
  35. As well as distribution of condoms and lubricants, the staff and volunteers make sure that their use is understood. In 2009, they held over 3,000 demonstrations of the male condom, over 2,500 demonstrations of the female condom, almost 1,500 lubricant demonstrations and conducted over 5,500 skills training session on condom negotiation. They reached almost 20,000 people with sexual health discussion sessions in Lae and NCD.
     
  36. The Poro Sapot clinic in NCD saw over 2,600 clients in 2009: 1,576 female sex workers, 337 men who have sex with men, 535 clients of female sex workers, and 157 other women and men at risk, including women in the sexual networks of female sex workers but not themselves sex workers, wives of the male clients of sex workers, for example. Almost 3,000 cases of sexually transmitted infections were treated at the clinic. Clients were also counselled, referred to other health facilities and referred to other HIV programmes.


    Understanding the People the Project Works with
     
  37. PSP conducts and commissions research studies, reviews and evaluations. It collects extensive data for its monitoring and evaluation system. This research and data collection and analysis helps it to become sensitive to the specific dynamics of its various sites. Research commissioned by Poro Sapot and undertaken in Port Moresby in 2004–5 with men who had had sex with another man during the previous 12 months and of women in sex work provided the project with much greater insights into the groups that they worked with.[38]
     
  38. The findings about men who had had sex with another man in the last 12 months showed that those interviewed had diverse sexual networks, commercial and non-commercial, regular and one-time. About two thirds also had female sexual partners. Within the sample were men who had sold sex to men, men who had sold sex to women, men who had bought sex from men, and men who had bought sex from women. Selling sex was commonly reported as an income source. Interviewees supported an average of five family members, including children.
     
  39. Most of those interviewed, about 75 per cent, did not self-identify as men who have sex with men, homosexual or gay. The men interviewed greatly underestimated their risk of HIV infection. Multiple and concurrent sexual partnering was common. Consistent condom use during sex with both male and female partners was low. Major barriers to consistent use included condom access and partner objection. Alcohol use, and sex under its influence, was almost universal while marijuana use was very common as well. Most of those interviewed had been victims of physical and sexual abuse: 60 per cent had been forced to have sex against their will.
     
  40. These findings show the complexity of working with this group. They give some indication of behaviour. Respondents acknowledged having had sex with another man in the last twelve months, but they have extensive and diverse sexual networks with men and women, both commercial and non-commercial in nature. The findings give little insight into desires, identities and values. They also pose programme challenges, for example, what profiles would peer educators to these men need to have?
     
  41. Wilson and Halperin have argued that globally little is known about how to work effectively with men who have sex with men.[39] Poro Sapot provides some insights. In 2006–7 the Institute of Medical Research conducted follow-up research for Poro Sapot using the same methods employed in the initial survey but with a larger sample of 300 men of similar ages and other demographic variables.[40] This second study found marked improvements in knowledge of key prevention methods with nearly universal ability to identify correct and consistent condom use. Knowledge of where to obtain condoms increased. More men reported using a condom during their last sexual act, and more reported consistent and correct condom use over the previous 4 weeks. Increases in condom use were reported with male and female sexual partners, paying and non-paying. Use with some categories of sexual partners increased dramatically, doubling or tripling since 2005. Reported use of water-based lubricant during most recent anal sex doubled.
     
  42. The 2007 survey also measured exposure to HIV/STI prevention interventions during the last year, namely contact with community-based peer educators or visits to drop-in centres, STI clinics and VCT centres. Sixty per cent of respondents reported contact with peer educators, and almost 40 per cent with Poro Sapot volunteers. Of those who reported any contact, three-quarters had had more than one contact. About one-quarter to one-third of those surveyed had visited a drop-in centre, STI clinic or VCT centre. Half or more had visited more than once.


    PSP and Programme Effectivness
     
  43. The draft Papua New Guinea National HIV Prevention Strategy (2008–2013) states that the HIV prevention approaches adopted to date have ‘failed to make significant inroads to reversing the rising transmission of HIV in PNG’.[41] Further, it argues: ‘Prevention interventions tend to largely follow a "franchise model" from international organisations that are largely prescriptive in how behaviours and identities are linked, defined and targeted’.[42]
     
  44. PSP is an exception to this account. And it is one of the most successful HIV interventions in PNG. The effectiveness of PSP has been measured mainly in terms of input and output measures: people reached, technologies and information disseminated, people trained, police and gatekeepers sensitised, access to clinical, counselling and other services, and similar. On the basis of these results, PSP has received high praise.
     
  45. The 2008 AusAID Review of PSP concluded:

      The Poro Sapot Project is reaching large numbers of FSW [women in sex work] and MSM [men who have sex with other men] through an effective peer outreach and support model. It is evident that this target population is increasingly practicing safe sex and demonstrates a willingness to access sexual health services for STI checks and HIV testing with the support of PSP workers. Significant progress is being made by PSP in addressing stigma and discrimination amongst police, gatekeepers and service providers. FSW and MSM are receiving care and support through the drop-in centre [in Port Moresby].[43]

    However, quantitative measures such as these are inadequate in important ways. Such measures fail to capture the quality of Poro Sapot’s work, nor its impact in terms of the personal and interpersonal transformations it assists. They do not enable us to determine whether it is the activities that PSP undertakes that makes it so effective. Or whether it is the way PSP works that makes it so effective. Or both.
     
  46. They do not capture the extent to which the people that Poro Sapot works with are viewed as partners and involved in the work, the extent to which they are encouraged to group together in relationships of solidarity and mutual support, nor their control over their working and social conditions. WHO has argued, on the basis of an analysis of successful projects, that this is a key outcome of effective HIV programmes amongst marginalised groups.[44]
     
  47. The draft Papua New Guinea National HIV Prevention Strategy (2008–2013) argues: ‘Prevention programs need to consider more effective strategies for engaging with men and women in a more comprehensive and meaningful way that has relevance to their reality’.[45] What is striking about the work of PSP is their ability to motivate people, often in situations where sexual intimidation, rape and violence are commonplace, to want to protect themselves, and others, from HIV infection, as well as to protect themselves from abuse and exploitation, and from all forms of indignity. They become engaged in the struggle for recognition, respect and rights as well as for HIV protection.
     
  48. What is it about PSP’s work that creates this motivation? What can be learnt from the work of PSP about effective strategies, called for in the National HIV Prevention Strategy, for "engaging with men and women in a more comprehensive and meaningful way that has relevance to their reality"?


    Transformative Strategies: Embodying Values and Rights
     
  49. The HIV and AIDS Programme of Save the Children in PNG began with a commitment to developing a values and human rights-based approach to their HIV work. But values, rights and principles once adopted have to become lived both by the organisation and those that work within it. This was the challenge for the Programme and for PSP: to work out how to move from the statement to the realisation of its values and human rights commitments in its HIV work.
     
  50. Two key transformative practices have significantly contributed to the project’s move to the embodied practice of these principles:

    • The visual and discursive centrality of the 3Rs: Recognition, Respect and Reliance, and
    • A commitment to reflecting and learning spaces and processes.


    The visual and discursive centrality of the 3Rs: Recognition, Respect and Reliance
     
  51. In meeting rooms and elsewhere in each of the PSP offices there is a visual depiction of the 3Rs. Brief explanations are given for each value. When asked about the way PSP works, volunteers and staff alike consistently refer to the 3Rs. The report of the PSP annual retreat in 2008 states: ‘Values help us make decisions’ and, referring specifically to the 3Rs: ‘Anything we do in PSP will in one way or another come under these values’.[46]
     
  52. Through the practice of reflecting and learning, PSP has taken a set of principles found to be of value elsewhere and made them relevant to the local ‘structures, power dynamics and gender dynamics’[47] of its work sites. It has been a process of internalising and coming to own the 3Rs as lived practice. When asked how they would describe PSP’s results, one replied: 'I now have a sense of who I am in the world'.
     
  53. Once owned, the 3Rs can become sites for contestation and for the claiming of entitlements. A volunteer accusing staff of lacking in respect explained: ‘When they are out with their friends and they greet one of us in the market or somewhere, the friends will ask how they know us. If they say that they work with us, they are breaking confidentiality and not respecting us’. From being espoused values, they have become embodied, lived. A number of PSP staff and volunteers started their work in the Transex project. They identify this personal transformation aspect of PSP’s approach and work as important and innovative. One peer educator explained: ‘When I finished school, I became a sex worker. The IMR project taught me about sex work and safer sex. But since starting work with PSP, I have changed a lot inside. I am a different person. My behaviours and attitudes have changed. I have fewer sexual partners. I have stopped drinking too much. I insist on condoms. I have regular check ups. I feel stronger as a woman and able to change my life.’ This is a critical development from the original approach.
     
  54. When asked how working with PSP had changed their sense of who they are in the world, one peer educator answered intensely: ‘Now I know I have a right to be who I am. I have a right to my sexuality. I have a right not to be abused. And I have a right to be respected.’ Another said: ‘Now I am determined to remain uninfected.’ Those working in and with Poro Sapot have a strong sense of who they are, as women, as men, as transgender, as people, of their responsibilities and rights, and of agency. PSP has created an environment in which it is acceptable and praiseworthy to talk about personal transformations.
     
  55. The original decision to shape PSP’s work around the 3Rs was strengthened by training a senior staff member received from the Melanesian NGO Centre for Leadership, an NGO born out of the National Volunteer Service. The Centre’s emphasis on values and culture in leadership has strengthened PSP’s understanding and practice of a values-driven approach to its work. The internalising of respect has been a fundamental determinant of the success of PSP’s HIV work. Without self-respect, motivation and determination are difficult to achieve and the practices of HIV protection are not used or sustained. Building self-respect and confidence, particularly in people who live within settings of social disapprobation, creates the ability to be strong, vocal, aware and empowered.


    Reflecting and learning spaces and processes
     
  56. The annual staff retreat in March 2005 well illustrates this practice. By then, staff were recognising that one of the strengths of PSP was that it was a ‘values-driven’ project and that this was about the everyday routines and procedures of the project: ‘modelling better ways of doing little things in the office e.g. listening, sensitivity, not gossiping etc.’ and thinking about ‘how we use words, like the label "MSM".[48] Many of the dreams of how they would like PSP to look at the end of the following twelve months, the prelude to the annual participatory planning exercise, were about how the work was to be done. Exercises such as these often result in the addition of new activities to a programme but in this case it resulted in an elaboration of better ways of working and being together.
     
  57. Outcomes such as these might be assessed as achievement benchmarks, as indeed they are. The commitment, however, is to a continual deepening and enriching of understanding, motivation and practice. Values became a theme of the retreat.[49] A session was held on the relationship between personal and organisational values. In this session, the talkative became the listeners and the quiet ones the talkers. The feedback from this session was in terms of enhanced team bonding and trust rather than, for example, a matrix of interrelationships between the personal and the organisational.
     
  58. This was followed by a session on the values of Save the Children in PNG, in which one of the things noted was that it was a ‘learning organisation where staff members are able to contribute their own ideas and can make changes to the organisation’. For staff this meant that SCiPNG is an organisation that is ‘about who we are as individuals’. The link between SCiPNG values and HIV work was discussed in four ways: HIV and gender norms; confidentiality and HIV; peer outreach and HIV; and working with marginalised groups particularly vulnerable to HIV infection. For each topic the questions posed were: How does this issue affect our work? and How can we make sure that our values are reflected in how we respond to the issue? Challenging though these topics and questions are, staff participated actively and were willing to reflect on their own behaviours and attitudes.
     
  59. PSP has annual staff retreats, spaces consciously created so that staff can think about what PSP does and think about it constructively and within the framework of the values and developmental practices of PSP and SCiPNG. The methodologies that PSP uses in these staff retreats and in other meetings and fora mirror those practiced in self assessment components of, for example, participatory gender audits.[50] Within PSP, there is continuing reflection and self-assessment, at the level of individuals and of the project, of their values, of their organisational culture, of their sensitivity to and practices of gender. These skills of reflection, self-assessment and learning from the process are not widely practiced in organisations in PNG but are a central part of PSP’s organisational culture.
     
  60. It is the encouraging and strengthening of personal reflective practice, that is, the ability to reflect on one’s behaviours, beliefs and practices and their impact on others, that leads to significant personal transformation. This emerged time and time again as PSP staff, workers and those they work with talked of how institutionalised processes of reflection and self-assessment had led to their no longer drinking, no longer getting drunk and abusive, no longer taking drugs,[51] and becoming absolutely committed to avoiding putting themselves at risk of HIV infection.
     
  61. The valuing of learning spaces and processes also allows fragilities, failures, and uncertainties to emerge. In these spaces, people feel able to tell stories of the difficulty of consistently practicing safe sex, particularly in situations of abuse, or when drinking and drug taking is part of the social foreplay, or if the other person objects, or if money is needed or desired. They often do not tell such stories to researchers or project evaluators.[52]
     
  62. Christopher Hershey considers that, although the IMR study indicated an increase in correct and consistent condom use, stories told in these spaces and the repeat clients at Poro Sapot’s STI clinic indicate a more complex narrative: consistent condom use is still difficult to maintain when partners object, with partners who are trusted, and when sex takes place under the influence of alcohol or marijuana.[53]
     
  63. This more complex narrative shows that we need to be able to capture in our measurements of outcomes the struggle to protect oneself. Poro Sapot increases people’s desire to protect themselves and it creates spaces in which stories of how difficult this is can be disclosed, stories of wanting to protect oneself but failing, even failing time and time again but still wanting to do this, stories of wanting to protect oneself and others and getting better at it.
     
  64. The outcomes which might capture these complex narratives would be about the extent to which people had become motivated to protect themselves and others, about desiring, wanting to do this, and the pathways from motivation to protection. We need to learn to see these outcomes, and to learn how to document and measure them. The spaces and processes for reflection and learning are used in every aspect of PSP’s work. They not only deepen understanding and enrich and render more effective PSP’s work, they also encourage and allow space for the unexpected, the innovative, the emerging. They allow space for non-linear logics.


    Implementing the Transformative Strategies
     
  65. The two core transformational strategies are underpinned by a range of implementing practices, both organisational and programmatic, which are also drawn from Poro Sapot’s engendered values-based approach.


    Organisational implementing practices
     
  66. Four organisational implementing practices are key to the transformation: starting with oneself, inclusion, language and organisational leadership.


    Starting with oneself
     
  67. This practice recognises that all involved in a values-based organisation must be committed to bringing these values into their own ways of thinking and acting. All staff and others interacting with the women and men of the project are continually challenged and supported to examine their own attitudes, to gender and power, to sexuality, sexual orientation and sexual practices, to sex work and sex workers, to difference, including differences in origin, education, status and class.
     
  68. In a Christian society, tendencies to moral disapprobation and judgement can be a struggle for some. Clinic staff, counselors and medical officers in NCD and Morobe have been sensitized to sexual health issues faced by men who have sex with men, usually through personal testimonies by the men themselves. Being motivated by pity, sympathy or charity is considered within Poro Sapot to be disempowering and disrespectful.
     
  69. Gender training provided by a local contractor is available to all staff. About 70 per cent have participated. This too has been transformative for many. One man reported: ‘I used to take my partner for granted. Gender training showed me that there were so many things that I needed to work on. For example, I had never given my bank card to my partner. It has helped develop my relation. Now I appreciate my partner as an equal contributor to what we do and think.’


    Inclusive practices
     
  70. All staff, including administrative and clerical staff, cleaning staff, security staff, and others, take part in staff meetings and retreats, are listened to, and are actively encouraged to speak their minds in their own way. Career pathways are created for the women and men the project works with into the project: to peer educator, to staff and to advancement within the project. This has transformed their lives. These practices bring more perspectives into the work, the principle of Reliance. They also help change the environment in which people work, strengthen solidarity and make people more equal.
     
  71. The equal employment opportunities policy is lived. Women and men who have sex with other men are recruited, promoted and placed in leadership positions. Women are in non-traditional roles: drivers, security guards, finance and management. Here organisational leadership is critical. As one senior manager said: ‘Gender must be a part of everything that we do. People must work and gather in an environment that understands that social change starts with personal transformation’.


    Language
     
  72. PSP struggles to develop and use a respectful and appropriate vocabulary and discourse. Most terms used in PNG for men who have sex with other men, for women in sex work, and for people living with HIV, are judgemental and derogatory.
     
  73. The phrase ‘men who have sex with men’ and its associated acronym, MSM, was imposed on PSP by a donor. Even when used as a description of persons with a particular behaviour, rather than an ascription of identity, it is obfuscating in a culture where the sexual practices of the men may include regular and transient sex with women as well as men, the sale and purchase of sex with both women and men, and non-commercial sex.[54] A language of respect and wit is developing. Many of the women, those abandoned or divorced by their husbands and left to care for children, refer to themselves as ‘problem mothers’, mothers with problems. ‘Sista girl’ has been adopted by some of the men in the project; others have invented words such as palopas to capture their sense of themselves.


    Organisational leadership
     
  74. Being a values and human rights-based organisation involves a different style of management, different organisational priorities and different modes of operating. There is a deep commitment to these transformative practices in the organisation by both its staff and volunteers. Implementing and managing them is, however, a challenge.
     
  75. Strengthening the understanding, commitment to and practice of them in all staff and all volunteers demands a high level of managerial skills, ongoing training and mentoring, abilities to resolve the inevitable tensions and confrontations around them, and agreement on procedures and approaches to sanctioning when transgressed. This in turn requires a particular type of leadership, one that is itself empowering and transformative. Giving people hope and the belief that change is possible enables them to keep going; creating safe places for reflecting and learning, for being themselves, is nurturing; setting standards and codes of conduct allows personal growth. The practices and commitments of PSP work best under the guidance and mentoring of values-driven, gender sensitive leadership. PSP has been blessed with such people, both national and international, since its inception.


    Programmatic implementing practices
     
  76. Four programmatic implementing practices are key to the transformation: sensitisation of the people who control and influence sex work, peer educators, sexual and reproductive health clinical services, and the creation of safe places.


    Sensitisation of the gatekeepers and the police
     
  77. The 3Rs shape this work. The emphasis is on respect for and protection of the dignity of those involved in sex work and in peer education as well as for gatekeepers and police. The aim is to create safe and HIV-protective environments within which social and commercial interactions can take place and at the same time the profits of the gatekeeper institutions can be increased. As a result of this approach, HIV information and supplies is actively requested by gatekeepers rather than being grudgingly received.
     
  78. Sensitisation workshops are provided for the organisations that provide services for the women and men that the project works with, including clinic staff, counsellors and medical officers, and for the police. For example, sensitisation sessions have been held with the staff at Heduru Clinic, the capital city's largest government-run HIV treatment clinic. Very effective work has been done with the police in each city the project works in and in each of its sites.
     
  79. The personal testimony of the people that PSP works with is often included in sensitisation meetings and can be experienced as profoundly moving. Stories abound of changes in attitudes and behaviour as a result.[55]

    Figure 5. Senior Project Officer (Susie Wahasoka) doing the female condom demo during the training (basic HIV & AIDS) with the police officers in Kainantu, EHP

    Figure 6. PSP staff and young people doing the 'sheet of glass exercise' during the sensitization meeting with the community leaders Banana Block settlement, Goroka, Eastern Highlands Province

    Peer educators
     
  80. Peer outreach is a deep commitment in PSP. Learning to take responsibility for and gaining the capacity to do the work can take time for the peers and PSP devotes considerable resources to achieve this. Monthly meetings are held. Data sheets are filled in. Uniforms are provided to build self-esteem as well as to mark the boundaries between outreach work and sex work. Referring to the peer educators as outreach volunteers respects the principle of confidentiality. The peer educators’ capacity building and mentoring programme is tailored to strengthen their sense of themselves as human beings and to ensure the knowledge and interpersonal skills needed as HIV peer educators.
     
  81. Peer educators have a strong sense of doing something good for the nation and its people. They also have gained a strong sense of doing something good for each other. In particular, strong bonds of friendship, mentoring, solidarity and support have grown between the women and the men volunteers, even though cross-gender friendships are not customary. A bridging peers programme has been developed where volunteer workers reach out to their isolated and hidden peers, especially the many young women, often very young women, involved in sex work.


    Sexual and reproductive health clinic
     
  82. In late October 2005, Poro Sapot opened a clinic in Boroko in Port Moresby. The clinic treats sexually-transmitted infections and offers voluntary counselling and testing for HIV. The clinic is specifically for men who have sex with other men and for women in sex work and for the sexual partners of both groups. A sexual health centre providing dedicated clinical services for marginalised groups is unique in PNG, possibly in the Pacific Islands. It is also an important HIV strategy. Sexual and reproductive health is in itself an HIV prevention strategy as well as creating spaces and opportunities for further HIV work.
     
  83. Health services for the socially marginalised need to recognise the conditions of work and the lifestyles of their users in order for their needs to be adequately met. This requires intensive sensitisation and values work with clinic staff and other service providers. Where treatment cannot be provided in the clinic, and in cities where there is no dedicated clinic, volunteers accompany people to other services in order to minimise discrimination or neglect.


    Safe spaces
     
  84. PSP has striven to create safe spaces in its clinics, drop-in centres, meetings, front-of-house, and other interactive spaces, spaces safe from abuse, free from manipulative and demeaning practices, and rich with mutual respect. It conceives these spaces as sanctuaries, less troubled and troubling than the work and living places of those with whom they work. They are spaces where the 3Rs apply to all in them, staff, volunteers and others. This vision and understanding of the role of these spaces is not always acknowledged, perhaps at times not valued by those unused to sanctuary. Manipulative, drunken and abusive behaviours can occur. Staff training is given on how to handle and defuse such situations.
     
  85. The commitment to being a values-based organisation brings an obligation to address abusive and discriminatory behaviour in the project. When the wife of a staff member turned up with accusations of domestic violence against her husband, these were taken seriously and investigated transparently. Two male staff members have been dismissed for sexual abuse and harassment. Others, women and men, have been asked to leave as a result of physical violence, drunkenness and similar behaviour.


    The Third Transformative Strategy: Gender Sensitivity
     
  86. It becomes clear from this that there is a third transformational strategy that pervades the organisational culture and its work: a commitment to gender transformative practices, that is, to practices, policies, and strategies that transform for the better people’s gendered lives, relationships and work spaces. Any values and human rights-based approach to HIV work must be based on a commitment to such practices for gender equity is a core value and right. It is an essential part of what constitutes a values and human rights-based approach. The question is whether gender transformative practices contribute to making HIV work effective.
     
  87. Gender determines what is expected, allowed and valued in women, and in men, in a given context, society or culture.[56] Gender is socially constructed, reinforced by social norms and cultural practices, hierarchical, and changeable. Gender can be viewed in three aspects: firstly, in terms of the way that masculinity and femininity are constructed and enforced, and contested; secondly, in the nature of the relationships between women and men, and in particular, in the ways in which power is exercised and abused within such relationships; and, thirdly, in terms of the cultural practices and social norms that inscribe and reinforce gendered norms and values.
     
  88. To what extent has PSP supported and enabled its own staff and those with whom it works to confront, question and contest the various gendered dimensions of their lives and the lives of their families and communities? And how has this made its work more effective?


    The lived practice of gender equity
     
  89. PSP’s organisational culture, human resources, vision and practises are infused with a sense of gender equity and justice. This way of working has resulted in those working with or in the Poro Sapot Project having a strong sense of who they are as women and as men, of their rights and responsibilities and of agency. They are mapping out those aspects of their lives within which they can act and can make and sustain changes.
     
  90. In this questioning of gender norms, of the social attributes, opportunities and roles associated with being female and male,[57] they are challenging, and changing, the ways that they, as women and men, their femininity and masculinity, and their sexual identities, have been socially constructed. Further, they have gained a sense of the workings of power in their lives and relationships, a relational understanding of gender.[58] They have stronger insights into the way power and violence can reinforce systems of oppression and exploitation. They are more capable of holding to account those responsible for enacting violence. They are learning to use power constructively. Working with and in Poro Sapot has enabled them to reshape their relationships, the intimate and the mundane, to create more space for themselves to be who they are within them, to make them more respectful, to them and mutually, to make them more just and fair.
     
  91. Since working with Poro Sapot, they have also begun to challenge some of the cultural practices and social norms that construct and reinforce gender, and which spread the HIV epidemic. Many of the women touched by the project now give their husbands condoms before they travel and ask them to protect their families. This is uncommon in the PNG context. Other new and emerging practices include parents talking to their children about sexuality and safety and spouses talking with each other. As a result of the latter, one woman has been asked by her husband to use a female condom in their sex life. They also include managing alcohol and reducing the number of concurrent sexual partners.
     
  92. From these empowering engendered processes, PSP staff and those they work with have gained the motivation and determination to protect themselves and others from HIV, to ensure that their children can become resilient in similar ways, to live lives of greater dignity where they are respected for themselves, and to contribute to the well-being of their nation.
     
  93. PSP has shown that desired HIV-related outcomes can be achieved in ways in which the motivation and determination to be different and to live different lives is created, and the valuing and support necessary to sustain this struggle is provided in safe and respectful spaces and processes. Achieving development effectiveness through values-based and engendered practices and spaces is complex and demanding on an organisation and its leaders. The results however justify the effort.


    The Poro Sapot Project and Aid Effectiveness
    The Paris Declaration on Aid Effectiveness
     
  94. The 2005 Paris Declaration on Aid Effectiveness and the subsequent 2008 Accra Agenda for Action on Aid Effectiveness[59] represent endeavours by bilateral donors, their partner countries, multilateral agencies and others to work together collaboratively and respectfully to render more effective the contribution of overseas development assistance to a country’s development.
     
  95. The Paris/Accra process identifies five partnership commitments which if strengthened would reform the ways that aid is delivered and managed and so increase aid effectiveness and, in particular, increase the impact aid has in reducing poverty and inequality, increasing growth, building capacity and accelerating achievement of the Millennium Development Goals (MDGs).
     
  96. The partnership commitments are:

    • Partner ownership of development efforts: Partners exercise effective leadership over their policies and strategies and co-ordinate development actions.
    • Aid alignment: donor support is based on the strategies and systems of the partner.
    • Aid harmonisation: coordination and harmonisation amongst donors.
    • Managing for results: managing and implementing aid in a way that focuses on the desired results and uses information to improve decision-making.
    • Mutual accountability: the players are mutually accountable for managing aid better and achieving development results.

    The five partnership commitments were included in the Kavieng Declaration on Aid Effectiveness,[60] adopted by the PNG government and its development partners on 15 February 2008, and in the Pacific Aid Effectiveness Principles adopted by the Pacific Islands Forum at Koror, Palau, on 13 July 2007.
     
  97. These partnership commitments claim to be a summary of the lesson of a half-century of experience in trying to achieve beneficial outcomes from, and to avoid creating harm through, aid. The Paris/Accra process is primarily a negotiation between partner and donor countries. However, a commitment to partnerships for development which harness the energy, skills and experience of all development actors[61] means that the partnerships to be harnessed will fall outside of as well as within the public sector.
     
  98. Thus, the five partner commitments provide a framework for studying aid relationships within and beyond the public sector, in this case, the relationships amongst PSP, its donors and the national government.


    Ownership
     
  99. The Paris Declaration identifies country ownership of development efforts as the central challenge in making aid more effective. It commits aid recipient countries to assuming ownership by developing strategies to achieve development results and by taking the lead in deploying both domestic and external resources to support their implementation. The Paris Declaration, the Accra Agenda for Action and the Kavieng Declaration on Aid Effectiveness[62] recognise that national ownership is ownership by the nation, that is, ownership by different levels of government, by civil society organisations (CSOs), by communities and their organisations, and by the private sector.
     
  100. The Accra Agenda for Action calls for a deepened engagement with civil society organisations as independent development actors in their own right. It states: ‘We share an interest in ensuring that CSO contributions to development reach their full potential’.[63]
     
  101. The Kavieng Declaration commits both the government of PNG and its development partners to working closely with NGOs and faith-based organisations.[64] In the case of the Poro Sapot Project, a community-based project is the development actor and the concept of ownership is complex to apply and to assess. But beyond ownership lies a more intransigent challenge: engendered ownership. This involves ensuring that all development actors, all facets of the development processes, are gender inclusive and gender effective, and that the capacity to exercise ownership of the actors and stakeholders beyond the centre, including on the margins, is strengthened.
     
  102. The transformative practices of Poro Sapot have produced strong ownership by staff and those they work with and this ownership is engendered ownership. Poro Sapot is, in the words of the DAC Network on Gender Equality, a ‘gender responsive "driver of change"’.[65] It privileges the silenced voices of ‘problem mothers’, ‘sista girls’ and others from the borderlands of the society found in the centre of towns. It has created a capacity for ownership amongst the marginalised, both women and men, and this has resulted in a strong sense of ownership of the project and of personal and social change.
     
  103. This contextualised ownership, or ownership from within, has been achieved in settings where both sex between men and sex work are against the law.[66] This illegality creates practices of abuse, including blackmail and the threat of blackmail, rape, gang rape, police abuse, gang bashings, and more.[67] These abusive practices flourish in the absence of legal sanctions and protections.
     
  104. Poro Sapot is strongly in favour of decriminalisation of the laws on sex work and homosexuality. Outreach workers and those they work with report police harassment and victimisation even though Poro Sapot has worked intensively to improve relations with, and the awareness of, the police. The criminalisation of these behaviours adversely affects the effectiveness of their work. This is in line with the HIV literature that effective responses are more difficult in situations where same-sex practices and sex work are illegal.[68] A stronger national respect for the rights of the marginalised and stronger national ownership and support of initiatives such as PSP could have led to action to bring the law into a more supportive rather than a conflictual role. It is the government’s responsibility to create an enabling environment to maximise such contributions to the nation’s development.[69]
     
  105. Ultimately, national ownership refers to political leadership, developmental vision and willingness to change. Ownership is about political commitment. PSP works in socially and politically fraught arenas. There is a diversity of views, amongst politicians and those who elect them, on sex work and male-to-male sexual behaviour and on the role of the law with respect to these practices. PSP has joined in partnership with Dame Carol Kidu, the Minister of Family and Community Development, her department and others to stimulate public discussion and to work towards the reform of these laws. National and international support, including donor support, is urgently needed for the creation of spaces for discussions and debates on what needs to be changed to improve the lives of the marginalised and on how to bring about such changes, including law reform.


    Alignment
     
  106. The Paris Declaration states that there has been insufficient integration of global programmes and initiatives into partner countries’ broader development agendas, including critical areas such as HIV/AIDS.[70] This is the only reference to the HIV epidemic in the Paris/Accra documents. There is an indirect reference to HIV-dedicated funds in a later paragraph which also contains the only reference in the Declaration to gender: ‘Similar harmonisation efforts are also needed on other cross-cutting issues, such as gender equality and other thematic issues including those financed by dedicated funds.’[71]
     
  107. Development initiatives which fall outside of the public sector, as Poro Sapot does, must also align with national mandates and global commitments. The work of PSP is aligned with the provision of the Constitution of PNG which respects the rights of women and guarantees them equality within the law as well as social and economic equality. It works within the Papua New Guinea National HIV and AIDS Strategic Plan 2006–2010, the National Gender Policy and Plan on HIV and AIDS 2006–2010 and with gendered national policies on development. It also aligns with PNG’s international commitments under CEDAW, under international human rights law, and under other international instruments that relate to gender and to HIV.
     
  108. As well as the mission statements and activities being in line with national HIV and gender mandates, the organisational culture of Poro Sapot is permeated with gender, transgender and HIV sensitivity. PSP has a policy that all staff receive gender training and attend sessions on the issues faced by men who have sex with men and transgenders. In implementing this they draw on local gender training expertise and on gender sensitive technical assistance. HIV-related workshops are a core part of staff capacity building. Further, in its work Poro Sapot builds country capacity and knowledge of national, regional and international gender and human rights commitments.[72]
     
  109. There is much that other development players can learn from Poro Sapot. It is important to strengthen the processes through which the gender and human rights lessons of PSP can be transferred to other actors inside the sector, to other sectors, and beyond, including the donor community.[73] The commitment to alignment must include a donor commitment to learning from those who are successful in so doing. One modality for achieving this end might be a joint participatory values and human rights audit, joint in the sense that all donors participate equitably with and are open to learning from PSP and other stakeholders. This would make possible more genuine partnerships, partnerships based on shared recognition of interdependence.


    Harmonisation
     
  110. The principle of harmonised, transparent and collectively effective donor action is conceived as a defragmentation measure[74] to improve aid complementarity and reduce duplication and cost. It applies as much to projects and programmes as to the overall aid architecture, to civil society initiatives as well as to the public sector.
     
  111. Since its start, PSP has been supported by a diversity of donors and donor initiatives: AusAID,[75] Family Health International (FHI), UNICEF, NZAID, Save the Children Australia and Save the Children New Zealand. This funding has not been pooled, jointly programmed or coordinated. PSP has been asked to produce separate project documents (FHI) and has had to agree to separate and differing deliverables. Its donors have different reporting cycles and requirements. This is an ineffective use of PSP’s sparse developmental resources of people and time. The mechanism for harmonising and attempting to render effective this aid, in the absence of a common donor platform or joint donor action, has been PSP itself. Its attempts to do so have inevitably had limited success.
     
  112. Another modality chosen for the implementation of the harmonisation principle is programme-based approaches.[76] In the Paris/Accra process, the principle is often interpreted as a commitment to move from small interventions to fewer larger programmes. This is often rationalised by an understanding of aid effectiveness and efficiency in terms of aid delivery mechanisms: budgetary allocations and systems for financial management, procurement, audit, and results measurement. However the evidence for the increased effectiveness of programme-based aid modalities is weak.
     
  113. Aid effectiveness could equally be understood in terms of its social outcomes and impacts, its social and distributive effectiveness. In this understanding, size or scale is neutral. PSP can be seen as a small-scale transformational development space. The values and rights-based practice of development has shown that small interventions may significantly benefit the lives and well-being of the marginalised and others.
     
  114. The Accra Agenda for Action does not exclude or disallow small interventions. To this extent, approaches such as that of PSP are not disallowed by the Paris/Accra process. But the Accra Agenda does not speak out in favour of small interventions. In complex systems, as gendered and transgendered spaces always are, small ‘butterfly’ initiatives may have significant outcomes and impact.[77] There is a need to contest and resist the insistence on the transition to programme-based approaches. There is much to be learnt from effective small-scale initiatives that can be applied whatever the scale of the development effort. One challenge that the development community could take up is the development of modalities for better putting into practice the lessons from small, effective values and human rights-based interventions.


    Managing for results
     
  115. The modality chosen to implement the principle of managing for development results seeks to secure as outcomes of aid partnerships a limited set of agreed, time-bound and measurable results. To this extent, it assumes that the outcomes of aid partnerships and aid initiatives arise from linear, cause-effect relationship and so can be predicted. The use of baseline studies against which progress can be measured is drawn from this linear logic. It presumes that what may later be of interest can be known in advance of an intervention.
     
  116. As a modality, managing for results favours the measurable over the imponderable, the more easily measurable over the complexly measurable, and the available over the as yet to be measured. In some situations this may seem to suffice. An example might be the percentage of women police officers having received scholarships. However, even in this case, what is illustrative is trend data: what happens over time and why. The analysis would need to include such things as the availability of child care, the attitudes of husbands or fathers, the gender composition of the selection committee, the gender culture of the police force, etc.
     
  117. Documentation and monitoring systems need to be able to capture unexpected results and to document the strategies of resistance and claims for entitlement that women and other dispossessed develop to respond to their life situations. Projects that include the provision of agricultural inputs to men only or the assumption that women’s labour can be unremunerated, for example, can become sites for unpredicted struggle and defiance. In cases such as these, not only may the systems developed to monitor changes from the baseline be unable to capture these outcomes, but these outcomes may not be recognisable, within the system, as results. The greater the participation, the more the listening, the more privileging of the silenced and the marginal, the less linear and predictable the pathways to change may be.
     
  118. PSP provides an important example of the unpredictable and unrecognised. The women with whom PSP works are provided with female condoms as a means of protection from HIV, one which is under their control and requires little or no negotiation with clients or partners. The condoms are keenly sought after and willingly used to help keep themselves uninfected and alive. Data is kept on numbers of female condoms distributed to whom and on problems in the supply chain. It does not capture however an unforeseen resourceful and relevant use that women are making of them.
     
  119. Word of the value of female condoms has passed around and now women who travel from the Highlands to Lae or Madang to sell their produce insert these condoms before setting out. The journey is known to be dangerous for women. Vehicles are often stopped and the women on them raped as well as robbed. Never before and not elsewhere have women had some protective agency over the feared outcome of HIV infection from rape. A story is told of a gang of men in the act of raping the women when one man recoiled in horror saying that one of the women had this terrible infection growing inside her and no-one should go near her. He had mistaken the extruding rim of the female condom for a fungal-like infection and she was spared being raped.
     
  120. Where value is placed on empowerment or agency or self-respect or trust as developmental outcomes, objectively verifiable indicators of progress may not be appropriate. PSP illustrates this well. PSP reports against a quantitative framework imposed by one of its major donors. It captures and disseminates data on, for example, condom and lubricant distribution, reported condom usage, the distribution of national HIV materials, numbers of sites and of people reached, and numbers of outreach volunteers.
     
  121. Such a reporting framework is drawn from an input-to-output linear logic. The assumption underlying the reporting framework is that achieving such results constitutes sustained HIV-protective behaviour and/or the improvement of people’s well being. However the evidence for the veracity of these assumptions is lacking,
     
  122. On all these indicators, PSP is achieving impressive results. What makes the project so successful, however, lies beyond or beneath these measures. It lies in the strong personal and collective commitment to protection and the sense of agency that it creates. It is results such as these that create the possibility of sustained change, in the behaviours, practices and values that challenge the spread of the HIV epidemic and in the lives of those it touches.
     
  123. It is how Poro Sapot goes about its work that creates these outcomes. In particular it is the centrality to its work of the two core transformative practices: the reflecting and learning spaces and the visual and discursive centrality of the three Rs: recognition, respect and reliance. It is this praxis that needs to be recorded, tracked and reported on. PSP is attempting to do this. It encourages its volunteers to record stories and incidents as well as input and output data on their data sheets. It is using methods such as the Most Significant Change methodology (MSC) to capture stories of personal, attitudinal and organisational change from the perspectives of those most involved. However these measures have limitations. Developing a monitoring and evaluating system that can capture and analyse anecdotes and stories has proved difficult and the process time consuming. Yet without this the richness of the data is lost. There are similar limitations with MSC data.
     
  124. Modalities for implementing the Paris/Accra principle of managing for results will need to be able to capture processes of development practice, to capture values and affects, if results such as those of PSP are to be recorded and valued.


    Mutual accountability
     
  125. The mutual accountability principle aims to redistribute power so that countries, donors and other development partners become more accountable to each other and to their constituencies.[78] This would make more genuine partnerships possible, partnerships based on shared recognition of interdependence.
     
  126. Power is exercised through the non-verbal as much as the verbal. It is felt as well as experienced. It silences as well as privileging. Mutual responsibility for effective aid requires the development of a sensitivity to the workings of power as a precondition to its redistribution. Partnerships with civil society organisations need to be particularly sensitive to its workings. Many civil society organisations have experienced the imposition of power in their interactions with donors and governments whilst they themselves are committed to power with others rather than power over others.
     
  127. The reports of the annual staff retreats of PSP[79] identify difficult power relationships with donors as the lowest point of their year and looking after donor requirements, especially reporting requirements, as problematic. Language has been proscribed by one of its donors: the use of the verbs "empower’ or ‘organise’ in reporting, for example. Language has been imposed: the use of phrases which ill fit PNG contexts, such as ‘men who have sex with men’, or ‘commercial sex worker’, for example. Programmes have been imposed without discussion or agreement, as a condition of funding. This is not a shared recognition of interdependence, much less a journeying together.
     
  128. Mutual accountability needs mutually respectful and responsible relationships. Meetings, missions, visits, the provisioning of meetings, reviews, mutual learning all absorb scarce resources of time, people and funds. They can be an expression of the workings of power over others when they are not mutually beneficial and jointly arranged. The Kavieng Declaration raises these issues in the context of mutual accountability. Attached to the Declaration is a Protocol for Mounting Development Partner Missions to PNG[80] which sets out the shared principles and operating guidelines to ensure more effective conduct of such missions. It also establishes in its targets to 2012 an annual ceiling on the number of development partner missions to PNG.[81]
     
  129. PSP has sought to find ways of ensuring that such interactions arise from genuine partnerships. The HIV and AIDS Programme of Save the Children in PNG, which includes PSP, has developed a set of principles and procedures for the partnerships it wishes to develop with others.[82] They apply to all partnerships that HAP undertakes but apply particularly to partnerships involving international consultants, advisors or organisations. The principles speak about open communication and transparency among partners, respect for the integrity of each other’s work and the need to strive for a developmental approach.
     
  130. These principles and procedures aim to ensure that the programme’s commitments to its beneficiaries and partners can be carried out in respectful spaces and processes and that the effectiveness of its work can be furthered through such partnerships.
     
  131. PSP’s relationship with AusAID has provided a model of mutual accountability within a respectful partnership. It has been a journey of mutual respect.[83] AusAID, at first through its National HIV and AIDS Support Program and then through its successor the Sanap Wantaim program, has provided financial and moral support to PSP since June 2003. Over the intervening years, AusAID staff have recognised the value of PSP’s work, spoken out in support of it and understood how others could benefit from it. AusAID has provided ‘steady and much appreciated support’ and created ‘a candid and flexible partnership that has gone beyond simple funding’. [84] They have arranged for the visits of two Australian Parliamentarians in the last two years, visits which inspired PSP staff and volunteers and which provided a form of validation of their work.
     
  132. Some important lessons for the Paris/Accra process can be drawn from the experience of Poro Sapot. The Paris/Accra process requires that donors micro-manage less but engage more, engage as co-learners, engage in intelligent ways. The measurement of processes and of outcomes or results of values and human rights-based initiatives is one such challenge to intelligent partnerships. Dialogue at the national level between partner and donor governments provide occasions for policy debates and values discussion which could support and make even more effective the work of development actors such as Poro Sapot.
     
  133. The Accra Agenda for Action recognises that additional work will be required to improve the methodology and indicators of progress of aid effectiveness. It asks for a report back on this to be made to the Fourth High Level Forum on Aid Effectiveness in 2011. Poro Sapot has insights to offer to this endeavour.


    Conclusion
     
  134. Organisations that work on HIV from a values and human rights-based approach have as their primary focus the physical, social and moral well-being of those they work with. They follow the moral conflicts and systems of structural violence that mark their lives. They journey with them as they endure and resist hardships, discrimination and oppression in their daily lives. They work with them in their quest to create better lives for themselves and for their children.
     
  135. This is different from working to contain an epidemic and yet this paper argues that a concern for values and human rights may well be the approach that makes containment of the epidemic possible. For as the lives of people are transformed through such practices, as they themselves acquire a sense of agency, a determination to change patterns and practices of discrimination and cruelty, they become motivated to protect themselves, their children and others from disease and humiliation.
     
  136. The Poro Sapot Project is effective in its HIV work. It is effective because, as a values and human rights-based organisation, its primary focus is on the well-being of those it works with. Poro Sapot sets out consciously to transform people’s gendered sexual and social lives. In the reflective spaces that it creates in its work, people flourish. In these spaces people talk about the struggle to protect themselves. They inspire and support each other. It is these processes of reflecting, learning, being valued and growing as human beings that lead to the desired HIV-related outcomes. These practices strengthen people’s ability to withstand and survive the HIV epidemic.


    Endnotes

    [*] Photo of Elizabeth Reid, from 'High achiever rates Tillyard Prize at the top,' Marketing and Communications, ANU online: http://info.anu.edu.au/mac/Newsletters_and_Journals/On_Campus/097PP_2006/11PP_November/_tillyard.asp, accessed 3 June 2010.

    [1] An earlier version of this paper is a part of P. Fairbairn-Dunlop, N. Mason, E. Reid and M. Waring, Pacific Gender and Aid Effectiveness Case Study Report, Prepared for NZAID and AusAID, 5 February 2009.

    [2] 'Leading Edge: Rights of vulnerable people and the future of HIV/AIDS,' The Lancet Infectious Diseases, vol. 10, issue 2 (February 2010):67.

    [3] David Wilson and Daniel Halperin, '"Know your epidemic, know your response": a useful approach, if we get it right,' The Lancet, vol. 372 (August 9, 2008):423–26, p. 424.

    [4] Elizabeth Reid and Sundar Sundararaman, End of Project Evaluation Report: Challenging AIDS Related Poverty: Interventions with ownership, diversity, reach and innovation for poor and marginalised communities in South India (IN 033 A07). Co-financed by HIVOS and the European Union, 28 September 2009, Available from SIAAP, South India AIDS Action Programme, Chennai.

    [5] Sampada Gramin Mahila Sanstha (SANGRAM) (n.d.), online: http://www.sangram.org/, accessed 26 May 2010.

    [6] 'History of Durbar,' in Durbar Mahila Samanwaya Committee (n.d.), online: http://www.durbar.org/html/history.asp, accessed 26 May 2010.

    [7] Shireen Huq, 'Journey Without Maps: the story of Naripokkho,' in Gender and Development in Brief, Issue 14 Gender and Citizenship, 2004, online: http://www.bridge.ids.ac.uk//bridge/dgb14.html#2, accessed 26 May 2010.

    [8] 'Bandhu Prevent AIDS,' in Bandhu Social Welfare Society, (n.d.), online: http://www.bandhu-bd.org/, accessed 26 May 2010.

    [9] The 2007 Estimation Report on the HIV Epidemic in PNG, Government of PNG, August 2007, p. 29.

    [10] Elizabeth Reid, 'Interrogating a Statistic: HIV Prevalence Rates in PNG,' Canberra: SSGM Discussion Paper 2009/1, online: http://rspas.anu.edu.au/melanesia/discussion.php.

    [11] Susan Hunter, 'Families and Children Affected by HIV/AIDS and Other Vulnerable Children in PNG – A National Situational Analysis,' UNICEF PNG, Draft of 2005, p. 23. Quoted in Papua New Guinea: Violence against Women: Not Inevitable, Never Acceptable! Amnesty International. September 2006. p. 18.

    [12] Helen Epstein, 'The Fidelity Fix,' New York Times, 13 June 2004.

    [13] Quoted in Papua New Guinea: Violence against Women: Not Inevitable. Never Acceptable! Amnesty International, September 2006, p. 5.

    [14] AusAID Office for Development Effectiveness. 'Violence against women in Melanesia and East Timor: building on global and regional promising approaches,' 2008, online: http://www.ode.ausaid.gov.au/publications/pdf/vaw_cs_png.pdf.

    [15] Strategic Directions for Human Development in PNG, World Bank, Asian Development Bank, AusAID, World Bank Publications, 2007, p. 93.

    [16] Strategic Directions for Human Development in PNG, pp. 89–90. See also Trevor Cullen, 'HIV/AIDS in Papua New Guinea: A Reality Check,' in Pacific Journalism Review, vol. 12, no. 1 (2006):155–66, p. 156.

    [17] Quoted in Papua New Guinea: Violence against Women: Not Inevitable. Never Acceptable! Amnesty International. September 2006, p. 6.

    [18] G. Maibani-Michie, W. Yeka, D. Prybylski & D. Colby, 'Baseline Research for Poro Sapot Project,' A Program for Prevention of HIV/AIDS among MSM in Port Moresby and FSW in Goroka and Port Moresby, PNG Institute of Medical Research and Family Health International, Asia & Pacific Department, September 2005.

    [19] J. Millan et al, Papua New Guinea 2006 Behavioural Surveillance Study within High Risk Settings, 2006.

    [20] Project design document, Poro Sapot Project (PSP), Phase 1: July 2003, Strategic Directions for Human Development in PNG, December 2006, Save the Children in PNG, Port Moresby, May 2005, p. 1.

    [21] The Transex project worked initially with transport and sex workers, hence the name, and was part of a larger HIV and Sexual Health Project funded by AusAID in cooperation with the Department of Health. Specific activities were additionally funded by USAID, WHO, UNFPA and UNAIDS.

    [22] Carol Jenkins, 'Situational Assessment of Commercial Sex Workers in Urban Papua New Guinea,' Prevention Research Unit/GPA, WHO, September 1994.

    [23] Carol Jenkins, 'Guidelines for partnering: scaling up to implement comprehensive sex worker HIV/AIDS interventions in the Asia-Pacific region,' UNFPA, August 2003, p. 46.

    [24] 'Female sex worker HIV prevention projects: Lessons learnt from Papua New Guinea, India and Bangladesh,' UNAIDS Case Study, UNAIDS, Geneva, November 2000, p. 23.

    [25] 'Female sex worker HIV prevention projects,' p. 24.

    [26] Project design document, Poro Sapot Project (PSP), Phase 1: July 2003 – December 2006, Save the Children in PNG, Port Moresby, May 2005, pp. 22–25.

    [27] For further details, see the PSP Design document, Section 2.1.

    [28] Carol Jenkins, 'Final Report to UNAIDS: Police and Sex Workers in Papua New Guinea,' submitted to the Director of PNGIMR October 12, 1997, p. 7.

    [29] Project design document, Poro Sapot Project (PSP), Phase 1: July 2003 – December 2006, Save the Children in PNG, Port Moresby, May 2005.

    [30] PSP Project design document, May 2005, pp.19–20.

    [31] Carol Jenkins, 'Guidelines for Partnering: Scaling-up to Implement Comprehensive Sex Worker HIV/AIDS Interventions in the Asia-Pacific Region,' PhD, prepared for UNFPA, August, 2003.

    [32] Personal communication, Christopher Hershey, PSP Project Manager, 17 July 2008.

    [33] Jenkins, 'Guidelines for Partnering,' p. 35.

    [34] J. Berry, M. Childe, & J. Theis, ‘Rights-Based Approaches to HIV/AIDS,’ in Promoting rights-based approaches: experiences and ideas from Asia and the Pacific, ed. J. Theis, Save the Children Sweden, 2004, quoted in the May 2005 PSP Project design document, pp. 18–19.

    [35] Christopher Hershey, R'eflections on Poro Sapot: One model of care for men’s sexual and reproductive health,' 11 June 2008, Paper prepared for an AusAID-sponsored video conference on Men’s Health and Sexuality, pp. 1–2.

    [36] PSP 2009 Report on activities, Attachment A, pp. 1–5.

    [37] Hershey, 'Reflections on Poro Sapot,' 11 June 2008, p. 2.

    [38] G. Maibani-Michie, W. Yeka, D. Prybylski & D. Colby, Baseline Research for Poro Sapot Project: A Program for Prevention of HIV/AIDS among MSM in Port Moresby and FSW in Goroka and Port Moresby, PNG Institute of Medical Research and Family Health International, Asia & Pacific Department, September 2005.

    [39] Wilson and Halperin, '"Know your epidemic, know your response,"' pp. 424, 425.

    [40] G. Maibani-Michie, W. Yeka, D. Prybylski & D. Colby. Evaluation of the Poro Sapot Project: Baseline and End-of-Project (EOP) Studies: An HIV Prevention Program among MSM in Port Moresby and FSW in Goroka and Port Moresby, PNG Institute of Medical Research and Family Health International, Asia & Pacific Department, November 2007.

    [41] Papua New Guinea National HIV Prevention Strategy (2008–2013): Expanding and Scaling up the Response, Papua New Guinea National AIDS Council (NAC), 2008, p. 13.

    [42] Papua New Guinea National HIV Prevention Strategy (2008–2013), p. 19.

    [43] Review of Poro Sapot Project, July 2008, AusAID. p. 31.

    [44] WHO, Toolkit for Targetted HIV/AIDS Prevention and Care in Sex Worker Settings, Geneva, 2005, p. 10, online: http://www.who.int/hiv/pub/prev_care/sexworktoolkit.pdf.

    [45] Papua New Guinea National HIV Prevention Strategy (2008–2013), p. 19.

    [46] Report of the NDC Retreat 2008, Poro Sapot Project, p.12

    [47] Report of the NDC Retreat 2008, Poro Sapot Project, p. 15.

    [48] Report of the Save the Children in PNG Poro Sapot Project Staff Retreat 2005, Motupore Island, 9–13 March 2005. pp. 10–11.

    [49] Report of the Save the Children in PNG Poro Sapot Project Staff Retreat 2005, p. 14 and Annex 4.

    [50] See for example, A Manual for Gender Audit Facilitators: The ILO Participatory Gender Audit Methodology: a Gender Equality Tool, The International Labour Organisation, Geneva, 2007, pp. 20–21 et passim.

    [51] In this aspect of its work, PSP seems to have achieved similar results to Alcoholics Anonymous or Narcotics Anonymous, movements badly needed but not strongly present in PNG.

    [52] Maibani-Michie, Yeka, Prybylski & Colby, Evaluation of the Poro Sapot Project. See also Review of Poro Sapot Project, AusAID Port Moresby, July 2008.

    [53] Hershey, Reflections on Poro Sapot, 11 June 2008, p. 8.

    [54] Maibani-Michie, Yeka, Prybylski & Colby, Baseline Research for Poro Sapot Project.

    [55] Hershey, Reflections on Poro Sapot: One model of care for men’s sexual and reproductive health, 11 June 2008, Case study 1 & 2. See also Annex Six: Most Significant Change Stories, Review of Poro Sapot Project.

    [56] Achieving Gender Equality and Women’s Empowerment, NZAID, May 2007, p. 23.

    [57] Achieving Gender Equality and Women’s Empowerment, p. 23.

    [58] Achieving Gender Equality and Women’s Empowerment, p. 23.

    [59] Accra Agenda for Action, Third High Level Forum on Aid Effectiveness, Accra, Ghana, 4 September 2008.

    [60] Kavieng Declaration on Aid Effectiveness: A Joint Commitment of Principles and Actions between the Government of PNG and Development Partners, 15 February 2008.

    [61] Accra, Agenda for Action, para. 16.

    [62] Kavieng Declaration on Aid Effectiveness, Ownership section.

    [63] Accra Agenda for Action, para. 20.

    [64] Kavieng Declaration on Aid Effectiveness, para. 3.

    [65] Draft Statement of Collective Intent on Gender Equality and Aid Effectiveness, DAC Network on Gender Equality, Draft of 13 December 2007, para. 6.

    [66] Christine Stewart, Prostitution and Homosexuality in Papua New Guinea: Legal, ethical and human rights issues, Working Paper No. 19, Gender Relations Centre, ANU, 2006, online: http://rspas.anu.edu.au/grc/publications/papers.php, accessed 16 March 2010.

    [67] Notes on incidents, Jason Lavare, PSP Area Coordinator (Male Sexuality), 29 October 2008.

    [68] Wilson & Halperin. "Know your epidemic, know your response," pp. 423–26.

    [69] Accra, Agenda for Action, para. 20.c.

    [70] Paris Declaration on Aid Effectiveness, para 4. iv.

    [71] Paris Declaration on Aid Effectiveness, para. 42

    [72] DAC Network on Gender Equality, para. 7.

    [73] Making the Linkages, Issues Brief 1, DAC Network on Gender Equality, July 2008, p. 4.

    [74] Paris Declaration on Aid Effectiveness , para.33, Accra Agenda for Action, para.17.

    [75] Initially the National HIV/AIDS Support Programme (NHASP) and then Sanap Wantaim.

    [76] Paris Declaration on Aid Effectiveness, para. 32, Accra Agenda for Action, para. 15e.

    [77] Rosalind Eyben, 'Power, Mutual Accountability and Responsibility in the Practice of International Aid: a Relational Approach,' Institute of Development Studies Working Paper 305, University of Sussex Brighton, May 2008, p. 25.

    [78] Paris Declaration on Aid Effectiveness, paras 47–50. Accra Agenda for Action, para. 24.

    [79] Reports of the Annual Staff Retreats of PSP, 2005 and 2008, for example.

    [80] Kavieng Declaration, Annex III: Protocol for Mounting Development Partner Missions to PNG.

    [81] Kavieng Declaration, Annex I: Targets and Indicators for 2012, para. 8.

    [82] Learning Points for Strengthening Partnerships, Draft of 6 September 2007.

    [83] Personal Communication, Hershey, discussions of 6 March 2010.

    [84] Personal Communication, Hershey, email of 16 March 2010.

Contents

URL: reid.htm
Page constructed by Carolyn Brewer.
Last modified: 19 July 2010 1422