Our Insights

Positive Vibes has always had a learning focus as part of its implementation design and monitoring practice, and we are now seeing a consolidation of this in the way teams are thinking about their work and in how they engage partners, which brings the accompaniment approach to life, but is also reflected back internally.

We ensure ongoing work to develop our methods, strengthening practices and systems (including financial management and monitoring, evaluation and learning), critical reviews (at multiple levels) and strategic resource mobilisation enable all of this work.

No one is voiceless

Everyone has something to say, something worthwhile, some truth of their own – from the power of their own experience – that has meaning and value. Everyone has a personal story, and a narrative that reflects how they perceive the world, and how they experience the world. Story is voice, and in that personal narrative lies power.

Marginalisation does not remove voice

Nor does it extinguish it. Instead, through the exercise of power and privilege, marginalisation excludes people from spaces and opportunities where that voice can be recognised and expressed and appreciated. Extreme marginalisation – resulting through persecution and violence or threats to safety – suppresses voice, but it does not remove it. No one is voiceless.

Coming to Voice is a process

PERSONALISATION – doing the internal psychological, emotional and cognitive work of looking in, looking back, looking out, looking forward; identifying the lifeworld and the environment in which it is located.

PARTICIPATION – opportunities for people to legitimately and authentically engage in processes and with material that is about them, that belongs to them, that affects them, and to speak to that material – to interpret it, to give it meaning.

ACCOMPANIMENT – in suppressive environments especially, people sustain their will and energy and confidence for movement and response when they are consistently, intimately, appropriately companioned by supportive “others” who believe in and affirm their human capacity to make their own responses in their own time and commit in some way to walking alongside in solidarity.

FACILITATION – a way of working with individuals and communities defined by “enablement” rather than “intervention”; not unlike the ethics of counselling, facilitation seeks to stimulate and support the unveiling of strengths in people and communities to make a response in their own lives, instead of prescribing or providing solutions, assuming people are unable or deficient.

The human spirit is resilient

Despite environments where power and privilege work to silence voice, to erase story – to suppress – people on the margins do not quickly give in to despair, as if they have abandoned all hope. Even in harsh conditions, people are capable of a remarkable optimism – hopefulness, vision, yearning and believing for a future better than what they are presently experiencing – that sustains them in life.

People are the experts of their own lives

Each person lives their lives within a rich tapestry of personal experience and perception that interfaces with a sophisticated, complex, intricate social, cultural and traditional environment. Communities are not homogenous and, in order to do good work amongst those who are marginalised – whose voices are often suppressed – it is valuable and necessary to tune into their personal lifeworlds, to find their voice and story, to understand how life works in that space.

Everyone’s Understanding is Unique

When asked by PV, people described good healthcare, effective service, efficiency, privacy and accessibility as very different things: such as good attitude, smile, non-judgemental, no strange looks from nurses, time to talk, honesty, short wait time, having enough staff, discrete, confidential, easy to reach, close etc. Don’t assume others think the same way as you.

Need to adapt thinking and ways of working

Organisation need to adapt their thinking and ways of working to consciously dismantle their own power that inadvertently marginalises those with lesser power:

• to facilitate, protect, defend, promote spaces for authentic and legitimate participation by communities;
• to respect the capability, insight, intuition and sensitivity of local communities to say what things mean, and to make choices about direction; to lead;
• that respecting the leadership of communities does not mean organisations abdicate or abandon communities. Accompaniment means participation – to learn, to appreciate, to acknowledge, to support, to encourage, to celebrate – in the space where one does not lead;
• to support the inner work of personalisation within individuals and collectives where coming to voice is a healthy foundation for movement;
• to design programme in a way that is sensitive and considered of the local realities of people and places – their lifeworlds — and to do so with communities so as not to presume or usurp local knowledge and expertise; or to implement activities that compromise the privacy, dignity or safety of people at the margins;
• to facilitate, rather than intervene.

Language is Important

Language in relation to sexual and gender diversity is a contested space in Africa. While the term ‘LGBTI’ has linguistic hegemony in the West and increasingly around the world, the local and historically embedded encodings of sexual and gender diversity are multiple across the region. For example, in South Africa in Venda queer people may be referred to as ‘matula’ (taboo) or ‘matudzi’ (bad omen).

PV works towards culturally congruent LGBT+ advocacy programmes especially in rural areas, where in countries like South Africa, of a lack of inoffensive terms for sexual and gender diversity is  common.

One of the key challenges is that English language terms such as ‘LGBT+’ are often a foreign notion with only a gradually increasing familiarity with the term ‘gay’ across Southern Africa. Likewise, lesbian and bisexual terms are being replaced with women who have sex with women etc as many women in other circumstances might prefer to only have sex with women, but due to safety and societal norms find themselves in heterosexual relationships.

In many ways there is growing dialogue around ‘politically correct’ terms such as LGBT+ and the ways in which they decontexualise, are overly long-winded, and do not land well in contexts across the region.

Integrated Services Necessary

Ranges of services are presently provided in compartmentalised ways, organised by ‘specialisation’ into departments between which clients are transferred. Clients may meet with an initial nurse or counsellor in a consulting or examination room. HIV counselling and HIV testing take place in a separate section of the facility, staffed by different nurses. Family Planning is a separate department. TB-screening is a separate department. Each area may have its own queue or waiting area.

Given that “visibility equals vulnerability”, and the realities of a busy, congested, high-traffic facility, this is a less than ideal design for an integrated service, especially one that is intended to be KP-sensitive. Amongst other effects:

It increases wait-time and through-time in the facility.

It increases the level of visibility and exposure for key populations to staff and other service-users; there is a higher chance of a KP-client leaving midway through the visit, or avoiding seeking services entirely.

It requires a client to repeat a history several times, depending on how many service providers he or she is required to see.

Improving integration is a technical, systems and culture issue, and one of practical design. It requires a different way of thinking about how health workers are trained, how the health system operates within the environment of the facility, and how the physical layout of the clinic is organised to facilitate smooth and efficient movement of clients from entry to exit. It presents a programming opportunity for modelling thoughtful design of a KP-friendly health facility.

Key Populations are not Homogenous

Men who have sex with men have a significantly better experience with service-providers than do women and trans people, and consistently so across facilities and cities. And arguably, in some ways, cis-gendered lesbian and bisexual women are even less catered for than trans people.

In the data-collection systems of these health facilities, no provision is made to capture lesbian or bisexual women who may be referred for services. They are instead captured as ‘sex workers’. The data-collection tools that are consistent with the District Health Information System (DHIS) recognise “MSM” and “Sex Workers”.

Power in Coming to Voice

In a human rights sector driven towards a particular kind of strategic activism and advocacy, where communities are mobilised and power is confronted, there are steps – stages – before people in marginalised communities can speak truth to power.

Before people can express voice to respond to their external environment, there is a process through which they must come to voice; to construct their own narrative to themselves about themselves within their internal environment. To be both author and reader of their personal story. To become conscious – aware – of their lifeworld and the forces and factors within and without that act to limit, control, suppress or exclude.

Learning how to think and speak about power may be a significant step before raising voice to speak to power. Coming to voice within is a prerequisite to expressing voice and may include making choices for oneself to not engage that external environment.

Visibility equals vulnerability

In an environment that is not safe, that does not feel safe, that does not feel private, people feel more vulnerable the longer they are exposed to the public. And, in fact, this is more than perception: gay men, trans men and trans women especially report that prolonged exposure and visibility subjects them to a greater sense of self-consciousness and stigma, to harassment, to abuse.

This occurred walking from home, waiting at a bus stop or taxi rank, taking public transport, walking through town to the facility, passing security, engaging with the receptionist and identifying the reason for the visit, waiting in a waiting area, standing in line to see a nurse or doctor, moving between departments, personnel and services within the facility, waiting in line to collect medications, and the journey home.