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Thinking inside the Box: You Are the Man!

The expression “thinking outside the box” is one of the most ridiculous fad (common amongst idealist) I have ever heard and I uncontrollably cringe each time I hear it. Thinking outside the box is leading nowhere. Imagine you are lost in the middle of the Sahara with no water and no food, no amount of thinking outside the box if going to help you…

Great discovery and progress were made because people were thinking within the box. They knew the box very well and that’s why they could come up with something innovative. Think about the bankers behind the credit crunch, think about Bill Gates who revolutionised the personal computer. As much as bankers are despised or Bil Gates is despised, they knew the box very well and that’s why they found ways out of it and in the case of Bill, we are nowadays all enjoying the pleasure of endless digression and online nonsense.

Back to business, Orange Cambodia is showing how well they know the “box”, and in this case the TV box. Indeed Orange partnered with USAID to promote HIV awareness through a TV programme they sponsor and called You Are The Man.

Over a two-month period, six Cambodian men between the ages of 18 and 35 will undergo numerous challenges to compete for the title of “real man”.

“This program is very important for men in our country because it will challenge the perception that Cambodian men usually look down on women and go out to drink alcohol,” said Ben L Cheav, brand consultant and media manager of the Orange Brand Elements production company, adding that the program will also educate contestants and viewers about the issue of HIV/AIDS.

The six competitors will be given mark and the winner of the show will receive a grand prize of, hold your breath, US$3,000 and a “cool” motorbike!

How cool, and clever, is that! So, how cool it would be if HIV prevention would start “thinking inside the box” and come up witth some innovative campaign?

MSM in Cambodia: A personal stake?

Alex in Phnom Penh ©peripheries

In a comment published in the Phnom Penh Post, independent consultant Michael De Guzman, put forward a few reasons why interventions aiming at reducing HIV infection and transmission amongst Men who have Sex with Men (MSM) are failing in a developing country such as Cambodia where an uncovered epidemic is brewing and growing.

For Guzman, interventions are not working because MSM have been generally ignored by Behavioural Sentinel Surveillance study. Then, when working groups are finally convened they are mostly comprised of government representatives, rarely willing to hear and even less recognize sexual behaviour outside “the norm”, donor representatives and foreign consultants who are there more for the money than for the personal interest, and sometimes some representatives of MSM (“supposedly”).

For Guzman this is not the best combination one could come with to deal with the discrimination against MSM in a country like Cambodia. Despite being traditionally and religiously much more tolerant than many other countries when it come to MSM (King Norodom Sihanouk showed support for gay marriage in 2004 though this did not materialise into law) men whose family found out about their sexuality are often ostracised by their community. As a consequence, many hide their sexuality and will marry whilst continuing to be sexually active with other men. MSM also receive little attention and have little access to relevant information and prevention tools.

But for Guzman, it is the lack of personal stake that is the main obstacle to outreach programme and other interventions.

“I realised that for all the talk of programs, projects and interventions for MSM, a critical element was lacking in the MSM response to HIV/AIDS. A personal stake. I mean, we were talking about doing outreach, establishing MSM-friendly clinics and advocating for MSM. But on a personal level, what does advocacy mean to a 13-year-old boy who lives in a remote province who’s just starting to realise he’s different from the other boys because he is growing to be sexually attracted to them?”

In this context it does not matter how one is competent or how good is the intervention if there is nobody at the receiving end. Guzman therefore posits that “A personal commitment strengthens and enhances interventions tremendously. On the side of the supposed beneficiaries of these interventions, the personal commitment of a service provider will nurture the client’s own commitment towards their health, in turn making them more receptive to behaviour change messages.”

I could not agree more with Guzman. And for such commitment to grow, there is a need first to recognised the existence of MSM, then to include and involve MSM in future programme and intervention and boldly have these programme led by those who are the most concerned, no matter how much that would irritate or anger (foreign) consultants (for a similar view, read this). This goes far beyond gimmicky empowerment. It is about leadership.

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When “good doers” don’t do any good

Bar Street, Siem Reap, Cambodia © peripheries

IRIN reports how recent legislation against human trafficking introduced by the Cambodian government early this year, is shifting sex work from brothels to bars and karaokes leading to the development of new sexual behaviours increasing the spread of the HIV infection.

Like Thailand, Cambodia’s fight against HIV became another success story when back in 2001 Prime Minister Hun Sen endorsed a 100% condom policy for sex workers. Prevalence amongst sex workers plummeted from 45.8% in 1998 to 12.7% in 2006.

But earlier this year, under US pressure, the Cambodian government enforced a law which though aiming at reducing human trafficking led to numerous abuse of sex workers by the police (see comment at Wisdom of Whores) followed by street protests.

Cambodia men are now joining the “sweetheart” culture of men having unprotected sex with bar and karaoke hostesses who can have on average 14.6 paying sex partner a year but of whom only 42% use a condom regularly according to a Population Services International (PSI) survey.

Won Sopheap, a university student, said he had taken on two sweethearts in the past six months. “A few years ago, people went to the brothels – it was just a fun weekend thing to do – but now a lot of my friends pick up sweethearts at the karaokes. We can trust them more; they don’t have diseases because they’re long-term.”

Worse, the PSI survey observed that clients are often mobile increasing the risk of spreading the disease countrywide. That’s what happened when foreign ideologues with little knowledge and even less understanding put dogma before evidence-based interventions.

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WE does (RED)

Bibi Rusell, former international fashion model and now world renowned Bengali designer started her own version of (PRODUCT)RED with HIV-infected women in Cambodia.

Russell joined the women of MDSF, an initiative started in 2006 by the UN Development Program that now employs 17 women living with HIV in a Phnom Penh factory reports the Phnom Penh Post.

“If you join hands with women living with HIV with affection and confidence, they can create magic with their fingers. Fashion is very important, and it makes you understand the culture of a country,” said Russell.

The goods, a range of accessories and bags will initially be sold in Bangkok and in Canada and will provide a more steady income to women who often live in the margin of a society where stigma and discrimination are associated with being HIV positive.

The contrast with (PRODUCT)RED could not be more different.

Whilst (RED) has teamed up with “the world’s most iconic brands to produce (PRODUCT)RED branded products”, Bibi’s WE (Women Empowered) is directly teaming up with the people that (RED) aims to help through donation to the Global Fund. A bottom-to-top approach that echoes the women’s wish:

“We don’t want sympathy, but support to live a life of respect and dignity,” said MDSF business manager Pham Srim.

But as with nearly everything else from education to culture, charity has been commercialised and whilst (RED) asks its customers to purchase “the power of (RED) simply by upgrading your choice”, WE asks its consumers to empower women directly through their purchase.

“Be embraced, take your own fine self to the power of (RED). What better way to become a good-looking samaritan?!” exclaims (RED).

Being a good looking Samaritan is certainly reassuring, but is the point of charity to exonerate us of the guilt of buying expensive clothes or products? And what’s wrong with being an ugly-looking Samaritans?!

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Clash of the Titans: Abstinence vs Condoms

Ivory Coast Campaign (Click to enlarge)

A few days ago Elizabeth Pisani commented on her website on how the Cambodian government caved in to US pressure. US pro-abstinence ideologues were meddling with a recognised efficacious HIV prevention intervention in exchange for economic advantages.

This was an interesting post and it fitted with one of the main theme explored in Elizabeth’s book, i.e. how ideology can take over epidemiology and surveillance data when it comes to designing HIV prevention programme.

Interestingly, in a Washington Post column, Rev. Sam L. Ruteikara, co-chair of Uganda’s National AIDS-Prevention Committee blew the wind the other way round.

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