4. Civil Society and Solidarity in the Politics of Global AIDS

I broadly understand civil society as an arena of collective action organised around shared interests, purposes and values. Collective action can manifest itself in different spaces and in different associational and organizational forms. Although conventional theories often place civil society in opposition to the state (as the term ‘non-governmental’ suggests) as the central political domain, I think the notion of civil society should be widened to include the relationship to any political domain that is located superior to it in hierarchical socio-political relations (see de Tocqueville 2002; Edwards 2009; Gellner 1994).

It is important to point out that while many speak about the international AIDS movement, the movement is heterogeneous and there are competing power dynamics within it. This heterogeneity is not only about different forms of activism but also about the nature of the issues engaged with by civil society.

The initial civil society response to AIDS in the USA was based on a strong solidarity among infected and affected communities to support each other as reflected in ‘the creation of Gay Men’s Health Crisis (GMHC) and the People with AIDS Coalition (PWAC) and in early 1990s through the pioneering work of the AIDS Coalition to Unleash Power (ACT UP)’ (Smith 2013:13). Here Cohen’s observation of the initial emergence of activism in the USA among urban middle-class white gay men provides important insight into the ways in which solidarity for political action replicated class distinctions via a paternalistic solidarity for gay men from different backgrounds (1998).

The 2012 International AIDS Conference in Washington DC revealed the gap between differences in HIV-related experience in this regard within the USA. A rally on the mall before the opening of the conference, which aimed to show civil society solidarity, was a significant event. It was dominated by African-American participants and their needs while also many street signs in the city centre were targeting condom use among African-American men. The gravity of the situation for members of this particular population can be seen in the special issue of The Lancet (July 2012) launched at the conference.

This can also be read from Cohen’s class-based analysis as an attempt to reproduce middle-class privilege that was challenged by association with a gay disease, thus reflecting a particular view both on the sexuality and the experience of the disease (1998).

I focus on these areas in particular because their links with the institutionalization of activism in the emerging politics of Global AIDS through the formation of new AIDS organizations was important. I also recognize that there were dynamic and influential local civil society actors in a number of different countries including Australia, Brazil, Thailand and India (Biehl 2009; Parker 2009; de la Dehesa and Mukherjea 2012; Power 2015).

This change can be also measured by considering the situation from a generic civil society perspective of looking at the volume of all non-governmental activity on AIDS in the US or internationally. This is not helpful. This approach does not say much about the nature or content of the activity or how it has changed over time.

Arguably these interventions shared a common set of assumptions about the role of civil society that is familiar within US political culture, where community self-help groups are considered to be the backbone of the social make up (Seckinelgin 2002).

Overall, this suggests a ‘process in which knowledge about policies, administrative arrangements, institutions in one time and/or place is used in the development of [these] in another time and/or place[s]’(Dolowitz and Marsh 1996): 344).

This trade-off can also be seen more generally in terms of how treatment access and rights-based health approaches remain unreconciled in a context where pharmaceutical interests still predominate. See recent work by Obijiofor Aginam and John Harrington (2013).

Similar claims to use the civil society response to HIV in Brazil as a model for other contexts have been challenged. Berkman et al. (2005) argue that success cannot be considered as a generic outcome beyond the particular socio-political context in which it emerges. In the case of Brazil, this implies particular ways of engaging with citizenship through social solidarity.

The professionalization of activism has been well observed by Alicia Garza, a leader of Black Lives Matter, in an interview reflecting on her social justice work as a queer African-American activist. She states that ‘San Francisco broke my heart over and over. White progressives would actually argue with us about their right to determine what was best for communities they never had live in’ (Cobb 2016: 35). The implications of this are relevant for international ‘solidarity’ and civil society claims to implement rights-based policies.

Many would point to domestic activism on AIDS in Brazil, India, and South Africa and in Thailand. However, these countries do not present typical socio-political conditions for resource-poor settings in general. Furthermore, the changes witnessed in these contexts also bear witness to the relationship between these countries and the broader policy considerations within the global process. For instance, Joao Biehl’s (2009) work traces reveals the impact of broader neo-liberal policies on HIV and on the experiences of people living with HIV in Brazil (2009). In a similar vein, it is hard to take domestic activism on HIV in South Africa as representative of possibilities in all southern African countries. South Africa presents us with a particular pattern politics of solidarity and awareness of rights due to its history.

For instance, according to Tim Hildebrandt’s (2011) work, even in China regional bureaucracies have considered international AIDS funding as a way of attracting resources into their region.

An important analysis of this particular issue has been developed by Ulla Pape (2014) in her study of the way in which the NGO sector has developed in response to AIDS in Russia.

This is also about a social movement strategy to show the worthiness of the cause to the general public along with the diversity and numbers of people supporting that cause (Tilly 2004).

The idea for its creation emerged in discussion between HIV and human rights activists after the International Conference on AIDS and STIs in Africa (ICASA) in Abuja in 2005. Discussion later intensified at the 2008 International AIDS Conference in Mexico City, leading to AMSHeR’s formal establishment in 2009 (AMSHER 2016). The organization’s pre-conference in Addis Ababa in 2011 at the 16th ICASA meeting was disrupted by conservative anti-homosexuality groups and their venue moved to a UN provided space from the originally planned venue at the Jupiter International hotel (ILGA 2011and mambaonline 2011).

A review of a number of their annual reports shows that gradually MSMGF has become one of the key civil society groups participating in global policy debates on HIV.

This process could also be seen in the particular role played by NGOs for ‘global social governance’ to help regulate and redistribute towards achieving particular global policy outcomes (Kruse and Martens 2015:184–87).

This situation is to a degree context dependent, since MSM issues have been addressed through UNAIDS work in other parts of the world. Conducting research in Myanmar in the autumn of 2014, it was clear UNAIDS in that country (where homosexual relations between men are also illegal) was developing a strategy to conduct a major survey among MSM. While this was important, the stigma and hard-to-reach nature of MSM in Myanmar present important challenges in that context.

It was not, however, clear how far Sidibé is able provide support for grounded engagement with the causes of the problem.

One of the origins of this law-based tool lies in the civil rights movements in the USA where law, broader citizenship rights and other socio-political tools contributed to the important outcomes such as the desegregation of education through the courts (see Alexander 2012). Similar success can be seen with respect to outcomes from the work of The AIDS Law Project in South Africa (Mbali 2013; Hart 2015).