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Becoming Visible: CFSC and Cameroon's Public Conversations
by Lourdes Margarita A. Caballero

To help the global initiative known as aids2031 identify future AIDS challenges and the kinds of leadership necessary to meet those challenges, the Consortium has facilitated a series of public conversations. In the African nation of Cameroon, these public conversations–involving men who have sex with men, wealthy, educated women and commercial sex workers–preceded a live national radio broadcast of a panel discussion about the realities of preventing and living with AIDS.. In this article, Consortium research associate Lourdes Margarita A. Caballero shares what we heard from people who typically have no voice in their country's national response to HIV/AIDS. She also shares with MAZI readers how communication for social change can help strengthen the response to the pandemic.

In April of last year, the Consortium partnered with Building Capacities for Better Health in Africa, based in Yaounde, Cameroon to conduct public conversations on HIV/AIDS in Yaounde and Douala as part of the aids2031 initiative. We invited people from segments of the population who do not normally speak publicly on this subject as well as AIDS experts and others in power. In separate stakeholder dialogues, people living in the cities of Yaounde and Douala discussed HIV/AIDS, including issues that worried them the most, the impact of the epidemic to their community and the new leadership required to move forward. In all these conversations, the Consortium's goals were to help aids2031 identify new issues among communities with viewpoints that are not adequately heard, and to strengthen the collective response within Cameroon.

Cameroon is distinct: The people most vulnerable to HIV are necessarily poor. Instead, they are wealthy women whose access to discretionary funds makes them a target for men infected with HIV.

The stakeholder dialogues in Cameroon culminated in a nationwide public conversation that was broadcast over the state-run radio station with participation from the government, UNAIDS, university educators and civil society organisations. This process of listening to, and learning from, people who are voiceless reminded all of us in the development community of a truth we too often forget in HIV/AIDS communication: We cannot craft long-term solutions in a vacuum absent meaningful voice from all segments of societies including the most powerless people. Communication for social change is one means for generating interest and excitement and for catalyzing public and private dialogue and collective action.

Although current policies in Cameroon have systematically tuned out the voices of people on the margins of society, the public conversations we facilitated revealed that such people do indeed want to join the debate and exercise their right to shape their own future. It has also sparked the government's interest to learn how communication for social change can help improve the way it responds to HIV/AIDS.

Following are snapshots of the lived realities of men who have sex with men and why dialogue matters to them. We also discuss the new challenges raised by participants and organisers and the insights they gained through the public conversations. Finally, we examine the role of communication in helping Cameroonians achieve the changes they want to see in the national response to HIV/AIDS.

Who are the Invisible?
Men who have sex with men, commercial sex workers and wealthy educated women are among the most at-risk populations in Cameroon, yet their needs have not been given much attention in the national HIV/AIDS strategy. Cameroon is one of the 38 countries in Africa that criminalises homosexuality and sexual contact between members of the same sex is an offence punishable by imprisonment of up to five years. Therefore, few people in this country openly discuss the risk factors facing these 3 groups of people.

There are no official data on HIV/ AIDS among men who have sex with men in Cameroon. The harsh legal environment has fuelled widespread homophobia and has forced men who have sex with men to hide to avoid harassment and imprisonment. It has also prevented them from accessing reliable health information and services, especially on HIV/ AIDS. Men who spoke at the public conversation said the stigma attached to men having sex with men has further contributed making the epidemic “mystifying” to them.

Stigma and Silence Spread AIDS

During the public conversation, participants felt strongly about the stigma that they experience. They said they felt Cameroonians believe that HIV/ AIDS is an issue only for specific people (those in particular risk groups), and is not a larger public concern. Even religious leaders and the media have been guilty of stigmatising men who have sex with men, instead of upholding their rights.

For example, attorney Alice Nakom, an advocate for people who are lesbians, gay, bisexual and trans-sexual, said that, in 2005, the Archbishop of Yaounde publicly denounced homosexuality, which in turn led to a media frenzy that persecuted suspected homosexuals.

Participants also mentioned that health providers have discriminated against them, while the government and the media have done very little to ensure that they get equitable treatment. “Some centres disapprove of people with AIDS. We are not accepted at health care centres,” explains one.

Another said, “The State does nothing, and the media address the topic timidly for fear of being considered a defender of the cause. Both the State and the media [must work together] to prevent discrimination." Participants asserted the need to voice their perspective in the government's national health plan.

On the other hand, according to a 2004 survey, the needs of wealthy and educated women in terms of the pandemic have not been well documented–even though they are a group likely to be most vulnerable to HIV, especially if they are separated, divorced or widowed. Statistics also show that HIV prevalence is about 60 percent higher among women than men in both urban and rural areas of Cameroon. Women also become infected at an earlier age than men. (They are infected between the ages of 25 and 29 years old.) In addition, HIV prevalence tends to increase with level of household economic status.

In spite of these startling figures, the links between gender, age, wealth, education and vulnerability to HIV have been downplayed in official reports. Many behaviour change communication advisers and AIDS workers were unaware of this important data. According to a Building Capacities for Improved Help report, the National AIDS Control Program lacked social and behavioural data to inform their HIV/AIDS strategies. So the government's national plan does not address the needs of the most vulnerable women.

Cameroon's wealthy and educated women themselves also seemed unaware of their high vulnerability to HIV. Or perhaps they were not as open in sharing because of the stigma attached to HIV/AIDS. During the dialogue, there was no consensus on whether prevalence has risen, reduced or stabilised within their group or in Cameroon. BCH said later on that it was difficult to bring this group together because they did not want to expose themselves. Although the wealthy women were not as ready to speak candidly, the dialogue provided a window to a hidden world, and it created an opportunity for further collaboration through local community-based organisations.

Without carefully probing the realities of wealthy, educated women, Cameroon is unlikely to slow the rate of HIV infection among this group.

Commercial sex workers had a stronger voice during the sessions because the government recognises them as a distinct group unlike wealthy, educated women.

Why Dialogue Matters
The aids2031 public conversation became an opportunity for people who are voiceless to confront power.

Amplifying voices is a positive outcome of well-planned dialogue sessions. It is more than just talk, as CFSC practitioner Jim Hunt explained. It is a process that helps participants think together and visualize the change they want to see.

The kind of dialogue that is needed in HIV/AIDS communication now, according to Thomas Tufte, is one that addresses the issues of communication rights because “the strong stigma results in the invisibility of people living with HIV/AIDS and the absence of their voice in the public sphere.”

In the case of Cameroon, it was a challenge for facilitators to motivate participants at the start. For instance, men who have sex with men have been ignored and persecuted for such a long time that it had created frustration. Trust had to be built first to give them the confidence that their opinions will matter and will be elevated to policymakers. By participating, men who have sex with men refused to be silenced, a positive sign.

Challenges Raised By Participants
Participants in all of Cameroon's public conversations said they want the media to be a committed partner. Right now, leaders in the media have not emerged. More media advocates are necessary to help civil society push the State to recognise the dignity and communication rights of groups relegated to the margins of society, help address stigma and discrimination, and break the taboo associated with HIV/AIDS.

Commercial sex workers and rich women believed people living with the virus who have been trained are the future leaders in the HIV/AIDS struggle.

Men having sex with men are slowly organising themselves, but given the harsh political environment, they need allies to help build their capacity and train future leaders.

All three groups see that long-time development organisations, such as the Red Cross and Care Cameroon and others from civil society, are important partners in grooming new leaders who can build synergy among stakeholders. The CFSC Consortium’s local partner and facilitators (BCH Africa) realised during the process they also must strengthen their skills to organize future public conversations with people who are marginalised. The trust building and follow-through with partners is a significant commitment that requires preparation and support.

The participants also expected much from the youth of Cameroon. Commercial sex workers are challenging them to “sensitise their peers, refuse to succumb to the allure of easy money, stay dignified, and choose health in poverty over wealth in sickness.” Such advice points to the need to examine public and private values among Cameroon's young people, especially programmes that will encourage them to fight stigma and discrimination.

How CFSC Can Help Challenge the Status Quo
Communication for social change experts say it is through interaction and dialogue that voiceless people speak truth to power. What we have realised is that people who are voiceless are not limited to people who are poor. And when they speak their truth to those in power, they must be able to express themselves fully, using a platform that they are comfortable with and with the support of stronger institutions. Current CFSC thinking also raises the challenge of using popular cultural genres–radio drama, music, or storytelling–that will give people who seem invisible the courage to step forward and articulate their needs as fully engaged citizens.

Following the individual stakeholder meetings BCH Africa, on behalf of the Consortium, also sponsored a live public dialogue and panel discussion broadcast nationally via the national radio network.. There are many other possibilities to explore. HIV/ AIDS communicators need to get media practitioners on board as well as those living with AIDS to work together because future strategies have to mix the traditional and new media to create safe spaces for people to speak and challenge the status quo.

We know that one-size-fits-all communication doesn't work. Men who have sex with men, wealthy educated women and commercial sex workers all have distinct needs. What may be possible is to develop an evolving and adaptive set of communication strategies and processes all based on principles that uphold respect for human dignity. It is crucial for the stakeholders to be engaged from start to finish. It's critical that each group own the process, sustain it, and take it to the next level.

That's a tough task given the current communication environment in Cameroon. Each group is starting at different points, with some more empowered than others. We know that AIDS communicators must recognise the unique contexts and communication environments they work in so that they will have a realistic assessment of the role of specific communication interventions.

What makes us optimistic is that, after the radio public conversation, Building Capacities for Better Health noted the enthusiastic response from the government. “Those who initially were reluctant to hear about the men who have sex with men are proposing to integrate them among the high risk and vulnerable group in the Round 9 proposal on AIDS.” BCH Africa also said that it sparked interest to learn more about the social drivers of AIDS and what communication for social change can do to help.

This is a ray of hope in the fight againstAIDS and an opportunity those of us in development must seize. It is not every day that people in power realise that a participatory communication process is integral address the epidemic.

The challenge then for the next generation of AIDS communicators is to develop interventions that are inclusive, are based on human rights and recognise the uniqueness and dignity of stakeholders. We also must persevere in our search for allies who will support processes that encourage active listening of stigmatised groups and promote accountability.

We are only as strong as the weakest people in our societies.

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