How do you reach people at the very margins of marginalisation?
Reaching the people who are the most marginalised in any given setting is one of the greatest challenges development and humanitarian actors face.
The commitment to ‘leave no one behind’, which is intrinsic to the Sustainable Development Goals, has been referenced so many times the phrase has almost lost its meaning. But behind the rhetoric, the goal of reaching those people who are the most underserved and excluded remains utterly fundamental to developing just, equal and prosperous societies throughout the world. But this is complex and challenging work, and it requires innovative partnerships that play to diverse strengths to get there.
For nearly 30 years, Frontline AIDS has been supporting people from low- and middle-income countries whose behaviours are criminalised, and who are excluded from services and support because of who they are or what they do. All our partners are organisations that are led by or have extensive experience serving marginalised communities. Because of this they are trusted by people who often remain hidden from public services and mainstream programmes, such as people living with HIV, LGBT people, sex workers and people who use drugs.
Our experiences of working on community-led responses for almost three decades put us in a unique position to take these learnings and apply them to challenges beyond the HIV sector, such as poverty reduction, humanitarian crises and COVID-19.
Take, for example, the Evidence and Collaboration for Inclusive Development (ECID) programme, which has been working to reduce poverty, realise rights and improve the wellbeing of three million people in Myanmar, Nigeria and Zimbabwe.
The programme, which closed prematurely after 2.5 years due to Foreign Commonwealth and Development Office (FCDO) cuts, supported internally displaced people, LGBT people, people who use drugs, rural women, people with disabilities and other marginalised people to have a much clearer understanding of their rights, feel more empowered to have their voices heard and contribute to policy and decision-making processes.
One of ECID’s main aims was to try a new and innovative approach to accessing services for these groups, by using data as evidence and connecting marginalised people to decision-makers and vice versa.
Frontline AIDS was one of seven consortium partners working on ECID, which was led by Christian Aid. Clearly, Christian Aid has expertise at working with marginalised communities, but we were able to make connections that opened up access to deeper layers of marginalisation. For example, reaching rural women in Zimbabwe who had experienced gender-based violence and are also living with HIV. Or internally displaced people in Myanmar who also used drugs or were living with HIV, further compounding their vulnerabilities.
One of the challenges programmes face that support people who have been marginalised can come from those working on the programme itself. All of us, whether we like to admit it or not, have unconscious biases that need to be challenged and some of us hold conscious ones as well. Indeed, we saw this with ECID, where some implementing partners and civil society groups were resistant to working with LGBT people.
So we worked with ECID partners to use the Looking In, Looking Out (LILO) methodology, developed by Frontline AIDS’ Namibian partner Positive Vibes, which helps organisations examine their values, attitudes, thinking and actions. ECID’s version, LILO Inclusion, was only delivered in Zimbabwe before the programme was cut. But we saw its power, as LILO participants went on to successfully persuade sceptical partners in other countries to give LILO a go. Who knows the change this could have brought in if LILO’s rollout had continued?
Frontline AIDS played a similar role in ACCESS, which worked in complex environments in Lebanon, Mozambique, Nepal and Uganda. FCDO cuts also closed ACCESS early, but its aim was to support the most marginalised people in these settings, such as LGBT people, people who use drugs, sex workers and adolescents and young people, to access comprehensive sexual and reproductive health and rights (SRHR) information and services.
This was another consortium piece, this time led by the International Planned Parenthood Federation (IPPF), and the key strategy was to co-design and test innovative, evidence-based, participatory solutions to reduce people’s risks and vulnerabilities and increase their resilience.
In Uganda, for example, we connected the Uganda Harm Reduction Network to bring in its expertise on the lives and realities of people who use drugs, particularly women who use drugs.
The programme aimed to support the integration of SRH and HIV services and has been developing a community-based scorecard to monitor quality of services for people who use drugs.
Although we have not been able to continue with ACCESS, the experience gained from working on a programme focused on collective outcomes, one that recognised the importance of bringing together different actors on the humanitarian-development nexus, will be invaluable for future partnerships.
COVID-19 and the need for collaboration
Never had the need for innovative, intersectional working been clearer than when COVID-19 erupted. When the crisis began our partner organisations adapted their programmes to prioritise what they knew their communities needed most, things like accurate and reliable information, nutritional support, cash transfers, take-home methadone for people who use drugs, income generation activities and mental health support.
Through our Accelerating Innovation programme, implemented in Uganda and India, we are now investing in the most promising practices that have arisen – solutions that are disrupting conventional ways of working. We aim to demonstrate the impact of community-led responses and share the learning with partners in other countries to address wider health and development challenges.
Our partners and the organisations they support are now at the forefront of linking people living with HIV to COVID-19 vaccinations and providing online mental health support for those whose are in lockdown. Governments and even corporates are coming to them for help to reach the most marginalised with relief and nutrition support.
As COVID-19 continues to escalate integrated services will become increasingly important. By developing broader partnerships the opportunities to reach more people who are marginalised undoubtedly increases, and with it the possibility of reducing the barriers that lead to marginalisation in the first place begins to feel more possible.
Accelerating Innovation is funded by the Elton John AIDS Foundation. It is implemented with Alliance India and the Gujarat network of people living with HIV in India, and with Alive Medical Services in Uganda.
Adolescents and young peopleHuman rightsLGBTSex workersSexual and reproductive health and rights (SRHR)