Development and the HIV Epidemic: A forward-looking evaluation of the approach of the UNDP HIV and Development Programme 6. GROUNDING RESPONSES IN PEOPLE'S REALITIES: LISTENING TO HOW PEOPLE TALK ABOUT THE EPIDEMIC
The way people communicate about their own lives and the epidemic is an integral part of their own understanding, which in turn is the basis of action they take. Consideration of the language people use is therefore important to supporting the development of understanding and action. An example of the importance of this was noted by Dr Evelyn Gacad, the National AIDS Programme Manager in the Philippines. She referred to the fact that the recently developed National HIV/AIDS Strategy was written by Filipinos and included use of "Filipino English". This, she said, meant that people reading the strategy would recognise that it had been written by Filipinos, not outsiders, and that this would result in more widespread commitment to understanding and working within the principles outlined in that strategy.
6.1 Key lessons learnt This section is based on the results of interactive discussions held in the field between evaluation team members, partners of the Programme and others who have been involved in using similar approaches. It focuses on developing deeper understanding of the way in which the language people use helps them to understand and act in their own contexts, and the way in which the language used in development practice can either enhance or hinder such understanding and action. If development is to commence with people's perceptions of their own realities, and continue in ways which are consistent with their views about what is desirable and how change comes about, then it is important that they be able to bring their own understanding into the process. If development practice continues to be described and implemented using only the languages of technology, power, medicine, colonialism and social engineering, then there is little chance that different perspectives can even be described, let alone incorporated into the process. Yet this is what often happens in the global response to the HIV epidemic. Programmes are almost always described using words like "targeting", "intervention", "inputs" and "outputs": words which fit clearly into an overriding metaphor of social engineering, and which are not consistent at all with the underlying purpose of most of those same programmes, which is to empower people to respond to the epidemic in ways which make sense within their own cultures and social realities. Two issues were therefore apparent for the evaluation team. First, the need to create space for people to talk using their own chosen words and metaphors, to enable them to describe how capacity is developed in ways which make sense to them. Second, to engage with people in shared reflection about they types of words and metaphors which they are already using. As a result, some alternative metaphor systems could be identified in various contexts: metaphors which are different to the dominant metaphor of social engineering, and which may help explain how capacity development comes about when attempts are made to come to terms with what it means to work in genuinely collaborative relationships. In this section, further background information is provided to explain why the use of language is so important, and how the HDP has attempted to address some language issues. Then, the results of interpretive discussion about the language people are using in the response to the epidemic are summarised, with some tentative conclusions made about the types of metaphors which arise when people talk from the heart about their own experiences. Following description of these key themes, a case study is presented which outlines and explains the way the development of appropriate language and useful concepts became central features of one series of partnerships, commencing with but moving beyond the partnership between the Salvation Army and the HDP.
6.2 The UNDP HIV-related language policy A crucial component of the approach of the HDP has been the promotion of widespread discussion about the use of language in discussions about responses to the HIV epidemic. One example of this is the production of a document entitled, "UNDP HIV-related language policy". This document has been used in UNDP workshops and circulated amongst partners of the programme. The document suggests the use of language which is inclusive and which does not create and reinforce a "Them/Us" mentality or approach; which is drawn from the vocabulary of peace and human development rather than from the vocabulary of war; which uses descriptive terms which are those preferred or chosen by persons described; which is gender sensitive; and which suggests that terms used need to be adequate and accurate. A simple one-page document, this language policy has had far reaching impact, perhaps because its basic purpose and the issues it outlined made immediate sense to the many people who have read it. It has been used all over the world, and evaluation team members have all either seen the document or heard of its use in sparse and unrelated networks, including the HIV and Development Network of Australia, the Global Network of People Living with HIV, the Philippine National AIDS Council's committee on policy development, and networks of NGOs in rural areas of Senegal.
6.3 Noting the emergence of new forms of discourse The UNDP HIV and Development Programme has expressed concerns about the dominance of particular types of language in public discourse about HIV, drawing attention to the way in which some uses of language can limit understanding, but also noting the emergence of new forms of discourse which are more optimistic and empowering to those affected by the epidemic. These include use of, "...a language of processes rather than interventions, of people as responsible actors rather than as manipulable objects of interventions" (Reid, 1994). The approach of the HDP, using the inclusive and empowering processes outlined in Section 5, has enabled people to bring their own experience and understanding into programming responses. The language they use provides a good example of how such processes lead to deeper understanding. In planning the evaluation process, evaluation team members and Programme staff members identified language issues which the evaluation team decided to consider, centring around the use of metaphor in discussions about HIV and development.
6.4 Understanding the role of metaphor as a means of understanding reality The every day language of people, within many languages, is pervaded by the use of metaphors, to such an extent that these metaphors influence the way people understand the world. This has been documented and explained by Lakoff (Lakoff, 1992). An example provided by Lakoff is that metaphors such as, "Love is a journey" enable us to understand all sorts of complexities about love, which may otherwise remain an abstract concept which is very difficult to understand. Such metaphors may be primarily used in literature. However, there are more complex, more pervasive metaphors which are infused into our every day understanding. Put together, these result in "systems" of metaphorical use which influence not just our understanding of single concepts, but also the relationships between many different concepts. Use of metaphorical systems, rather than just single metaphors, is a feature of many discussions about HIV. The most dominant and obvious metaphorical system is the system of the metaphor of "social engineering".
6.5 The "social engineering" metaphor Within the metaphor system of social engineering, an example of a single metaphor is the use of the term, "expert". The idea is that an "expert", just like an engineer working with a mechanical system, can learn all there is to know about a particular situation, through observation, and then change that situation, through some sort of "intervention", to make the whole thing "work better". No one says that social systems are mechanical, but an unconscious implication of use of this metaphor is that the methods used to fix machines can, by and large, be transferred to the field of human development. Such simple use of metaphors may appear harmless enough. However, when they are put together within an overall metaphorical framework, they come to dominate the ways people think about particular situations. Again, referring to programming responses to the HIV epidemic, consider the following terms, which appear again and again, and think about how they may influence the way people think about the epidemic: input There would be no problem with use of these terms within a metaphorical system of "social engineering" if they enabled better understanding of different situations and if they led to more effective responses. The problem is that use of this particular metaphorical system has been so pervasive that it has led to exclusion of other ways of talking about the HIV epidemic. As one participant from Zambia noted, "They used these methods to deal with smallpox. Now they're trying to do the same with HIV. HIV is far more complex than smallpox, but the language they use does not acknowledge that". The result is that the use of this metaphorical system has limited the development of effective responses to the epidemic. The way in which use of this metaphor has worked against the inclusion of many people's concerns within an epidemic intricately linked with culture and values was highlighted by Eduardo San Miguel, from Mexico: Social engineering does not refer to social relations. It seemed to be very technological, market oriented, reflective of state intervention versus participation in activity, with a high role for hierarchy. Authority without taking anybody into account. Language consistent with this metaphor was most often used by participants responding to the list of "Concepts UNDP is not currently using" (see Appendix 2). Common reactions to this list involved recognition that these types of terms were often used by funding agencies, and often led to forms of project proposal writing and reporting which conflicted with participants' own experiences in working with people in their own contexts. Some participants noted, for example, that they have to work with people in one way and report back to international agencies in another way.
6.6 How do people talk about the epidemic? The evaluation team paid close attention to the way people are talking about the epidemic, in order to see if it was possible to identify aspects of emerging new types of discourse which are being used in people's everyday experience of responding to the epidemic. This process involved listening to the language people are using and considering whether there are some alternative metaphorical systems already in use. Through these sorts of listening processes, of which the evaluation was merely a simple example, a more comprehensive understanding of use of language may evolve, helping to connect the processes used in development assistance with the realities of people's lives. Using interactive processes, the evaluation identified some recurring metaphors which seemed to form metaphorical systems, centering around concepts of "farming", "war", "building", and "family". Importantly, use of different types of metaphors seemed to vary between countries. This may reflect different cultures, but also may arise from different experiences of the epidemic.
6.7 The "farming" metaphor system Many participants in Zambia used words and expressions that are often associated with farming. For example:
Farming in African societies is often done by women, and is connected to sustaining life through providing food for family members. It involves responsibility, care, patience, knowledge, attentiveness, and being sensitive to the surrounding environment (changing weather conditions, droughts, floods, access to water, etc.). Farming in the African context means interaction with natural surroundings, and an understanding of interdependence. It also means that even if you have to put in a lot of work, the product of your work will not come immediately, but the product of your work may be essential for surviving. Farming is not linear: it is not a question of putting in the seed and waiting for the result. Conditions change and responses must change accordingly. Farming follows certain cycles and is process-oriented. Note the similarities with approaches in sustainable human development, and with the approaches of the Programme. The responses to the HIV epidemic of the women quoted above centre around responsibility, care, flexibility, and the changing of responses after taking into account many different circumstances. The responses were future-oriented and illustrated hope in what many other people would see as the most grim of circumstances. The Programme works with concepts that form an integral part of a farming metaphor, such as "nourishing", but it has not consciously used this metaphor. Many of its initiatives involve similar understandings of the importance of preparing the ground, planting seeds of hope, and following up with nurturing processes rather than use of control and reporting mechanisms.
6.8 The "war" metaphor system Some words used by evaluation participants can be used within several metaphors. This illustrates the importance of interactive exploration to identify patterns of meaning behind use of words. Words that are used within the metaphors of both social engineering and war include, "targets", "operations", "interventions" and "they". Some other words used in a metaphor system based on war are:
Within the war metaphor the perception of the enemy varies. The enemy may be the virus. Often, however, the enemy is perceived to be the HIV-infected person, either as the one who destroys others or as one who is already infected, degraded, made unworthy, demoralized through being victimized and thus no longer one of 'us':
Other people may also be seen as enemies:
Amongst people engaged in effective and voluntary responses to the epidemic, the perception of the enemy is often very different to that in the above quotes:
6.9 The "building" metaphor system The metaphor of building was used in several ways amongst evaluation participants, and was particularly noticeable amongst evaluation participants in Mexico. It is used to illustrate construction and creation processes, as processes involving collective action and solidarity. The building is often seen as a home - providing sanctuary and protection. The metaphor of building was also used in the context of constructing barriers:
In Mexico, exploration of the building metaphor revealed that building was associated with traditions of neighbours and friends helping each other in building homes. It evokes such associations as "solidarity", "reciprocity", "mutuality", and "belonging in a community". When discussing people's decisions about when to discuss being infected, concepts like "coming out" and "out of the closet" were used in association with the concept of building. Interactive reflection in the workshop in Mexico revealed that coming out can make you vulnerable because it could put you in the open with no protection, with no shelter, with the risk of losing belonging. Use of the metaphor helps make clear some connections between the issue of "coming out" and the issue of "enabling environments".
6.10 The "family" metaphor system Language centring around the concept associated with "the family" was often used by participants in the Philippines. This was not observed during the workshops held in the Philippines, but was identified during later interactive processes when evaluation team members who had visited the Philippines reported back to others. Hence, use of the metaphor has not been discussed with participants in the Philippines, and its inclusion here is very tentative, aiming to provoke discussion rather than to draw conclusions. Use of this metaphor was typified in discussion about the fact that many successful projects started with very humble beginnings, with no clear understanding of long term goals or even general directions. People simply, "... came together" to explore what they might do. People work together, support one another, and grow together, just as children grow within a family. There was a strong sense of nurturing new developments in a caring way in the Philippines. For example, many NGOs which have worked successfully on issues around the epidemic in Manila are now engaged in encouraging the development of NGO initiatives in other regions of the country. This work was often reported as using similar approaches to those used by the Programme. For example, the use of validation was important. One NGO worker drew attention, for example, to the importance of what she called,
6.11 The use of inclusive processes in enabling people to share their understanding This discussion on metaphors is included as an example of the way the inclusive processes explained in Section 5 create the opportunity for people to bring in their own understanding of reality, and to develop effective responses based on that understanding. The language people use is but one indicator of their understanding. Inclusive processes enable the sharing of ideas using language which the people involved relate to and understand, and also the development of responses to which people feel committed because they are based on their own choices. Limiting the way people speak about the epidemic, even when this occurs unconsciously, will almost certainly hinder the development of effective and sustainable responses. Active listening, the promotion of dialogue as a means of developing shared understanding, decision-making, and consensus are therefore important components of new programming practices in sustainable human development. Such processes are based on mobilizing the expertise of all involved rather than on the notion of "experts" coming in from outside and determining what responses should be developed within specific contexts.
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