Causes, Experiences

HIV: A heavyweight in my suitcase

I have been travelling to different countries for a long time. I was born in one country and raised in another. My parents are not only from different countries, they are from different continents.

Canada, USA, inter-railing in Europe, a university internship in overseas, four years abroad for my first job, volunteering in different African countries and tourism around the world. So far, I have visited 26 countries in total.

I can not imagine no longer travelling and exploring other places of the world. Travelling from one place to another is what has made me the person I am today.

But now things won’t be as easy as saving money and booking holidays.

Since I found out I was HIV positive my life has been passing in slow motion. Each day I am more conscience about how much my life has changed. It won’t be as simple as taking some pills each day for the rest of my life. Now I need to check laws. Am I allowed to enter this country? For how long? Work permit? Resident permit? Will I be able to continue my career in international development?

There are 24 countries where I could get deported if they found out I am HIV positive.

From now on I am categorized as PLHIV (people living with HIV) and I will face discrimination in my international movements.

For example, long stays for study or work require permits that could include an HIV test. I am not against HIV testing if it is done with the intention of stopping people from remaining infected without knowing it. But when tests are used simply to deny visas, I cannot support them.

The Global Database on HIV related travel restrictions gives different categories:

  • Countries without restrictions.
  • Countries with entry bar.
  • Countries with short term restrictions.
  • Countries with long term restrictions.
  • Countries with unclear laws/practices; more information needed.
  • Countries without information.
  • Countries deporting people with HIV.

I encourage you to check about your own country legislations.

doi:10.3402/gha.v6i0.20472

Fig. 1. Status of HIV-related restrictions on entry, stay, and residence in 193 member states of the World Health Organization in June 2011.

We are in 2015, and just 5 years ago, the USA removed its “travel ban” for PLHIV to enter, stay or reside – the ban that meant there could not be international HIV/AIDS conferences in USA. This ban was place from 1987, the year I was born.

Some bans are supposedly based on economic concerns: how much does HIV cost the national health system?

If the reasons are economic why not extend the travel ban to people with other diseases/disabilities or family history of diabetes, cancer, heart disease, alzheimers, alcoholism, mental disorders or obesity? Those cost a lot of money too.

In real life, nobody is free of getting sick at some time or another.

Other justifications are based on the perceived danger to public health or public safety. As somebody with HIV, I have developed a high awareness of my situation and I and other HIV positive people engage in different levels of activism to reduce new infections. This does not mean that all people with HIV are “good citizens”, but this goes beyond moral or judicial judgement, also applied to non-positive citizens.

To be forced to declare your positive status, if you will face discrimination to obtain a visa, only dissuades people from getting tested.

HIV ban restrictions don’t stop the spread. People need to get tested to prevent new infections, but this won’t be universalized until HIV positive people stop suffering from stigma and discrimination.

I have already travelled abroad since discovering my HIV status. I took a note from my doctor in case I faced some problems carrying my medicine. My next step will be to move back to my host country in Africa, where I will sign my contract, my boss will pay all the legal requirements for a non-citizen and I will start paying taxes.

My diagnosis doesn’t mean I can’t or won’t contribute.

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Causes

#850calories

The World Food Programme and UNHCR recently announced that refugees across Africa are facing dramatic cuts in their food rations. The new, reduced WFP rations equate to around 850 calories, a figure that inspired a new campaign that hopes to generate awareness of the dramatic food ration cuts in camps across Chad, Central African Republic, South Sudan, Liberia, Burkina Faso, Mozambique, Ghana, Mauritania and Uganda.

Yep, that’s a lot of refugees – an estimated 800,000 – in a lot of countries, living on less than half their recommended daily calorie intake (for reference, average recommended calorie intakes are 1,000-1,400 for children under 5, 2,000 for adult women, and 2,500 for adult men).

So, why have the WFP cut rations so dramatically? To put it simply, they are facing a funding gap of $186 million; and in the absence of these essential funds, food supply sheds are becoming increasingly bare and rations are being reduced in order to be shared over a largely-food-dependent refugee population. As has been well documented in the UNHCR’S three-part Tracks blog series, lack of food availability has devastating consequences for refugees, who respond to such crises by utilising ‘negative coping strategies’. These strategies may include turning to forms of dangerous and exploitative labour such as prostitution, selling off of assets such as livestock, unsustainably over-exploiting natural resources such as firewood, and removing children from education in order to generate more income.

Undoubtedly, the immediate solution here is to find the $186 million. This funding is needed in order to restore current food supply back to full rations, to address the “unacceptable” levels of acute malnutrition, stunting and anaemia in camps, and to prevent the likelihood of further ration cuts later in the year. Without this funding, food insecurity in camps will persist, and could ultimately escalate to the point of famine. As the 850calories campaign writes, “the world is facing a famine inside the UN’s refugee camps.”

However, this crisis will not be ‘solved’ once the international community has closed the funding gap and returned refugee camp food rations to normal quantities. This disaster has to be seen not as the failure of the UNHCR, nor of the WFP, nor of a single state or refugee population. This disaster is a collective failure, and one which represents the failures and inadequacies of the current international refugee regime. Without addressing these inadequacies and putting other policies and strategies in place, this crisis will, unfortunately, occur again. There are three main reasons for why this crisis will not be solved simply by closing the $186 million funding gap:

  1. Many refugees in Africa live in semi-permanent protracted camp settlements (i.e. camps which have existed for more than five years, in which refugees are largely dependent on humanitarian assistance). These camps would have initially been designed to be short-term, emergency-response-driven settlements in order to provide protection and assistance to refugees, but in many cases across Africa have now existed for over a decade. It must be noted that many such camps are characterised by self-sufficient and income-generating livelihood activities; but humanitarian assistance continues to play a vital role in providing not only food assistance, but other services such as health and education.
  2. In the midst of ongoing conflict, the refugee population continues to grow: in December 2013, for example, the UNHCR estimated that South Sudanese refugees were arriving into neighbouring countries at a rate of around 1000 a day. The humanitarian community is therefore under pressure not only to protect and assist existing refugee populations, but to also be able to cope with increasing numbers of refugees arriving into camps every day.
  3. Finding money is getting harder. For example, Martin Ohlsen, the WFP Country Director for the Democratic Republic of Congo, in a recent interview spoke of ‘donor fatigue’; of the effects of the global financial crisis; and of the increasing number of crisis ‘hot spots’ in the world. He argued that “donations are rather for current crisis regions, such as Syria”, and that as a result aid organisations are all competing for available funds. Although it is imperative that the $186 million funding is provided in order to solve this current African refugee food crisis, it is clear that funding challenges will remain in the future as protracted refugee camp settlements and ongoing conflicts continue to demand humanitarian assistance alongside other global crises.

The fact that this current crisis has gone relatively unnoticed in the Western media is a disaster in itself, but also ill acts in parallel to the challenges of drumming up the necessary funding. As was described by blogger Tom Murphy (who tweets at @viewfromthecave) in a recent article: “Media reports, including one I wrote, shared the announcement and then moved on”.

And as those media reports move on, the WFP food stocks continue to dwindle and hundreds of thousands of African refugees continue to go hungry.

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Advocate, Causes

Four Critiques Of RCTs That Aren’t Really About RCTs

As most people who follow international development know, the use of randomized controlled trials (RCTs) has sparked impassioned debate between so-called “randomistas” and the researchers, practitioners, and evaluators who oppose RCTs. Academics have been arguing about the merits and ethics of RCTs since they first came into use, and bloggers of all stripes have  contributed to the debate over the last few years. (A compilation of posts can be found here.) I hear these same conversations take place among my graduate school classmates and professors, whose opinions on RCTs are also divided.

In each of these arenas,  strong criticisms of RCTs have been made, some of which I don’t have good answers to. But many of the common critiques I hear really apply to research, aid work, and evaluation in general, and I fail to understand why these criticisms are levelled at RCTs specifically. I find it particularly troubling when researchers, aid workers, or evaluators make these critiques of RCTs without applying them to their own work.

Below are some examples of common critiques that I don’t believe are really aimed at RCTs.

“Studying People”

Many of my classmates and professors dislike RCTs because they are uncomfortable with the idea of “studying people,” particularly if nothing is provided to those people (in the case of a control group). In particular, for many RCTs, teams of surveyors go to people’s homes, schools, or workplaces to observe them or ask them questions, often of a personal nature. Opponents of RCTs argue this is voyeuristic and intrusive and that it interrupts people’s daily lives – and all for the unsavoury purpose of “studying people.”

Yet, as Kirsty Newman has explained, these complaints apply to much social science research, which is similarly based on going to other places, talking to people there, and gathering stories or data about them. Research is, in its essence, the study of people, done with the aim of extracting knowledge about them and their community, lifestyle, or past experiences and without providing benefits to them. I don’t think it makes sense to oppose RCTs on the grounds that “studying people” is bad, without also opposing the many forms of research that affect people in the same ways.

“Withholding Treatment”

I also frequently hear opponents of RCTs argue it is ethically wrong to “withhold treatment” from some people (again, in the case of a control group). RCTs rely on the ability to compare those who received an intervention with those who did not. Opponents believe that “withholding treatment” from anyone is unethical and that organizations should offer their interventions to everybody. They argue it is unfair for some people to receive a service while others don’t.

However, a similar critique could be made of aid programs in general, which Kirsty also noted. Like all providers of aid, those conducting RCTs have the funding and capacity to provide programming to a certain number of people. All aid projects provide services to some people and not to others, and no organization can include everyone in its interventions. In their inability to provide assistance to everyone, and the feelings of unfairness that result, organizations implementing RCTs are largely representative of NGOs in general.

External Validity

A more technical critique of RCTs is the argument that they lack external validity – a program that an RCT finds to be effective will not necessarily work in other settings. Because their results cannot be generalized, the argument goes, RCTs are useless.

But alternative types of evaluations (which are often based on before-after differences or comparisons of non-random treatment and control groups) face exactly this same problem, as Timothy Ogden explains. Organizations often use non-randomized evaluations to determine whether a program should be scaled up or expanded to additional areas, based on results from its initial implementation. However, there is no reason to think these evaluations would have higher external validity than RCTs.

Little Use

A final critique I want to address is the belief that the knowledge generated through RCTs rarely gets used to create improvements in aid. The results of RCTs are generally published in journals and primarily read by academics, not by people designing projects or making policy. For this reason, critics argue, RCTs do not actually lead to improvements, because they are inaccessible to the people in a position to them.

This is another way in which RCTs are no different from other types of evaluation, a point Kelly Steffen makes here. It’s no secret that organizations are typically resistant to admit failure or make changes, and a common complaint among evaluators is that their reports often go unread and their recommendations are frequently ignored. Though I think people in both areas are working to overcome this problem, neither RCTs nor other types of evaluations get used as much as they should.

These four arguments aren’t necessarily incorrect, but they’re not really criticisms of RCTs. Unless we consider them reasons to stop doing research, aid work, or evaluation in general, these critiques do not offer compelling reasons to stop doing RCTs. Instead, we should think more about how to best counter these shortcomings in all facets of development and social science work.

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#stopthemission

I am a member of the reality TV generation. Big Brother made the UK go crazy when I was 10 and there have been god-knows how many terrible versions of that since then. I don’t like any of these programs, I should note, but nobody my age could possibly deny knowledge of them and their various formats. I don’t even really remember when MTV played music on it. Pretty depressing right?

Wrong.

When I read this post about a ‘humanitarian reality TV show’ featuring refugees (actually, internally displaced people but who wants any facts ruining ‘reality’ tv?) I couldn’t believe it was real. It sounds like a dark joke in some terrifying dystopian comedy. I looked for a listing of the show but couldn’t find any. I hoped it was an internet invention, like alots or bonsai kittens. It’s quite hard to check because the sites are in Italian and, being an ignorant Englishman, I only speak my mother tongue. Luckily, I had a kindly Italian friend on call to check it out.

It is most definitely a real thing. Here are her notes on what she could find out about the format:

  • program, created in collaboration with UNHCR and Intersos
  • 8 VIPs put into 4 pairs
  • live for 15 days in close contact and collaborate with volunteers from missionaries in Mali, South Sudan and Congo
  • all adventures/stories told in the studio
  • objective is to share experience, raise awareness of the issue

Where to begin! The original post on African Voices articulates well the myriad of issues surrounding making a spectacle out of some of the most vulnerable human beings on earth. 15 days seems an appropriate amount of time for a humanitarian effort, particularly one spread across three enormous and incredibly different countries. The VIPs are a couple of actresses, a journalist, a prince:

“…the kind of people you see on TV all the time, talk shows and things, TV presenters. Whether it’s a dancing show, cooking show, politics talk show, or humanitarian reality show, TV presenters in Italy never change”

Which is reassuring to those people who might, I don’t know, think that UNHCR has lost its damn mind. Television isn’t responsible for making informed, nuanced television about poverty or about Africa – The Newsroom and its exalted writer Aaron Sorkin showed us that only recently. We know TV executives to be cretinous and lazy but, goddamnit, the UNHCR should know better.

Of course, because we know that television is full of uninformed, gawking lunatics doesn’t mean we should forgive them for dreaming up this dizzying new low of bad taste.  We need to tell them off, undoubtedly, or this crap will keep happening. Sign this petition to shout back. Tweet UNHCR about it, call them, email them, write them a letter, protest outside their offices, construct a crude macro image to mock them – do something!

For some reason, people in charge of television seem to think that we want this stuff. Inevitably, as a member of the reality TV generation I assume that a) this is about me, the viewer and b) I can somehow affect the outcome of this situation. Maybe this last decade or so of terrible television has been useful after all – as a generation, we expect to be able to alter television. This is the kind of activism we have been training our whole lives for.

UNHCR Italy is on twitter. It should be quick easy enough to fill up there timeline with the thoughts of sane human beings. Use #stopthemission, it might get them to at least clarify what they are thinking.

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Advocate, Causes

We Need To Do Something About Television

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