"Driving on Empty" - A Truck Art Based HIV and AIDS Prevention and Advocacy Initiative

HIV & AIDS – The Leading Development Threat for our Future

HIV and AIDS remains a major development priority. The pandemic affects all races, cultures and socio-economic groups directly and indirectly. Fuelled by poverty, illiteracy, demographics, (disproportionately affecting youth), prevailing gender disparities, social stigma, discrimination and weak health systems, the pandemic is now claiming more and more female and younger victims. According to 2011 estimates from UNAIDS, WHO and UNICEF approximately 30.6 million adults and 3.4 million children were living with HIV at the end of 2010. During 2010, some 2.7 million people became infected with HIV, including an estimated 390,000 children. Most of these children were born to women with HIV, and acquired the virus during pregnancy, labour and through breast feeding.

Multiple efforts are urgently needed to strengthen action on HIV and AIDS and delivery at every development level. Mainstreaming is a critical dimension of the overall integration of HIV and AIDS into national development which requires national, sectoral and programmatic action, with strong linkages to national and sectoral development priorities. Mainstreaming HIV and AIDS into national and sectoral development processes, poverty reduction and human development strategies remains vital to an effective multi-sector and multi-stakeholder response to the epidemic.

Sub-Saharan Africa is by far the region most affected by the AIDS epidemic. The region has just over 12% of the world's population, but is home to 68% of all people living with HIV. In Asia, there were 360,000 people newly infected with HIV in 2009 whereas the epidemic claimed approximately 300,000 lives in the region in 2009. The population of Pakistan is estimated at 187 million in 2011 making it the sixth most populous nation in the world with an alarming average annual growth rate of 1.8%.[1] The IBBS (Integrated Biological and Behavioral Surveillance) conducted by the Government of Pakistan and the HIV and AIDS surveillance Project (HASP) supported by the Canadian International Development Agency (CIDA) in 19 cities, has clearly suggested that HIV prevalence among key affected population groups continues to rise with an average prevalence of 27.2% among injecting drug users (IDUs) in 2011 as compared to 20.8% in 2008; 1.6 % among male sex workers (MSWs) as compared to 0.9% in 2008; and 0.6% in female sex workers (FSWs) as compared to 0.2% in 2007.[2]

The 18th Amendment to the Constitution of Pakistan was passed by the Parliament in 2010 and as part of its implementation, the Ministry of Health (MoH) was devolved by June 2011 with the National AIDS Control Program (NACP) now placed under the Ministry of Inter-Provincial Coordination (MoIPC). The country has drafted its national AIDS policy and legislative framework through the 'HIV & AIDS Prevention and Treatment Act', in order to support the government in providing services to populations at risk of acquiring HIV.[3]

The basic provisions of the policy are intended to guarantee access to free testing, care, support and equitable access to treatment and specific information for people living with HIV and AIDS (PLWHAs) and those who are more vulnerable.

Major challenges the Pakistan Government, donors and civil society organizations face include lack of funding, a relentless increase (upward trend) in prevalence among the high risk population groups and the ongoing turbulent and uncertain security situation of the country. Mobilizing the domestic and external resources presents a major challenge for continuity and scaling up HIV prevention, treatment and long term care. Uncertainty about funding from key donors increases pressure on the Joint UN Team on AIDS to redirect funds or mobilize new resources towards more immediate pragmatic and human resource gap. Despite evidence of limited HIV infection in the general population, prevalence continues to rise among people who inject drugs and among those involved in sex work and continue to have unprotected sex. Not only are these individuals at risk but in a predominantly male domineering society, where women are generally monogamous, their spouses and unborn children at very high risk as well.

Moreover, the country continues to face ongoing conflict, militancy and unpredictable security situation. Many of the interventions sites of HIV and AIDS treatment, care and support are located in large to medium cities in areas of relative security, however, a significant number of those most at risk groups, such as truck drivers and migrant workers, belong to tribal areas such as FATA and Khyber Pakhtunkhwa where the security situation needs to be improved for HIV and AIDS to become a priority issue for the provincial Government health departments.

“DRIVING ON EMPTY” - A Truck Art based HIV and AIDS Prevention and Advocacy Initiative

The concept of ‘masculinities’ informed by recent feminist thought and the women’s movement, has emerged as a means of deepening the discourse on gender. This has opened up the spaces for investigating masculinity. However, ‘gender’  continues to be used in  social sciences and the development sector  discourse as a synonym for ‘women’  and  its relational aspect and clear linkages with ‘masculinities’ have received inadequate attention.

From its inception the Pakistani state has had to confront questions of religious – political identity. And whereas questions of gender per se may not seem visible in the formulation of identity, the emergent profile and the status of its women indicate its largely negative and hyper-masculine nature of the state. Masculinity in Pakistan today has less to do with the vision of gender equality and justice and more with literalism and the pursuit of patriarchal power agendas.

Poverty in South Asia has a ‘woman’s face’; women’s access and control over productive resources are extremely limited. In addition to suffering from the same deprivations as men, women face the additional suffering of unequal opportunities to education, health, and other social services due to patriarchal control over their sexuality and cultural restrictions over their mobility.

So why put men in this picture? Firstly, gender equality is a long-term process of changing gender relations, and making them more equal, less oppressive and less patriarchal. This involves changing men as they are the gatekeepers of the current gender order. Gender equality efforts are simply less effective if they do not engage men and they burden women with the responsibility for change. Secondly, although many men are violent, there are many who are not and can be powerful allies in the development of society that is not steeped in inequality and oppression. Thirdly, and perhaps more importantly, it is important to realize that men too carry the load of inflexible gender stereotyping and acknowledging that men, as individuals, suffer from gender inequalities, injustices and stereotypes in their own right, particularly due to unhealthy definitions of ‘manhood’ and society’s harsh and unrelenting demands and expectations often have a detrimental impact on their lifestyle and health. Herein, lies a powerful potential for a shift in ownership of these issues.

For this to happen, it is imperative that the perspective on masculinities be deepened. It must allow for the understanding of how the threads of these masculinities and gendered identities go beyond the personal and public acts of discrimination and violence against women and are inherently linked to basic questions about the distribution, expression and effects of power. Socialization not only brings men into gender, but also enters them into multiple and interacting sets of unequal social relations, structured by class and status, race and ethnicity and sexuality. The discourse on masculinity needs to question men's relationship to these structures and their violence, as both beneficiaries of the gender order and sufferers of other forms of oppression with its basis in class, ethnicities, sexuality and nationalistic struggles. The discourse must pull our attention towards interventions that lead to wider social justice and not just change individual (gender) identities. An important aspect of the dialogue must be to examine masculinities in the context of the rapidly transforming economic, social, health and cultural environment in South Asia and the range of conflicts that characterize this region.

AMAL Human Development Network[4] implemented “DRIVING ON EMPTY - A Truck Art Based HIV and AIDS Prevention and Advocacy Initiative”, a research and truck art based advocacy project which aimed at investigating and understanding vulnerabilities of truck drivers to HIV and AIDS which places them, their sexual partners, spouses and unborn children at risk.

To ensure diversity of experiences, cultures, attitudes and perception, respondents were selected carefully on the basis ofage, ethnicity, socio economic status, rural urban divide and truck drivers’ types formed a sample group. Research was conducted in Pir Vadhai and Tarnol, major transportation hub connecting various regions of Pakistan. Research interventions included a Knowledge, Attitude, Behavior and Practice (KABP) study as well as a series of In-depth interviews with truck drivers. The findings were documented and shared with experienced truck artists who were facilitated by project team to propose a series of images and inscriptions that closely related to the findings of the research particularly depicting respondents’ notions of self identity, sexuality, sexual desires, forms of violence and ways in which masculine perceptions, forms, structures, values, beliefs and attitudes have influenced their identity and sexual experiences.

Throughout the project duration, AMAL remained sensitive and responsive towards their need for information regarding rights, HIV and AIDS, referral to service providers and promoted safer sex methods particularly condom use.[5]

The “DRIVING ON EMPTY - A Truck Art Based HIV and AIDS Prevention and Advocacy Initiative” clearly evidences that men’s behavior, attitudes and practices are substantially contributing to the spread and impact of HIV and put men, their sexual partners and families at the front-line of risk. Such behavior and attitudes of men are grounded in culture and patriarchal norms of the society which must be influenced and challenged. The study of Masculinities within the gender discourse is critical to understand the underlying root causes that sustain and promote masculine norms leading to increased vulnerability. Engaging men as partners in the efforts against HIV and AIDS thus becomes the most reliable way to change the course of the epidemic.

[1]HIV/AIDS Health Profile Asia”, March 2011, USAID. Available at http://www.usaid.gov/our_work/global_health/aids/Countries/asia/hiv_summary_asia.pdf(accessed on June 02, 2012)

[2]HIV and AIDS Surveillance Project (HASP), Round IV, 2011” by NACP – CIDA.Available at http://www.nacp.gov.pk(accessed on 29 May 2012) 

[3]Averting HIV and AIDS”, Available at http://www.avert.org/worlstatinfo.htm#(accessed on June 02, 2012)

[4]AMAL Human Development Network, a gender focused HIV & AIDS action group and one of the most visible advocates for prevention, treatment and awareness in Pakistan.  AMAL engages with a number of important related issues in the course of tackling the HIV & AIDS problem with special focus on marginalized and vulnerable groups of women and young children who not only suffer social exclusion but are also highly exposed to the evils of violence, trafficking and sexual abuse. (www.amal-hdn.org.pk). As a founding member of MenEngage Alliance Pakistan (http://www.menengage.org/index.php?option=com_content&view=article&id=68&Itemid=55) and presently hosting the Secretariat, AMAL has consistently committed to mainstreaming masculine structures, norms and behaviors as a core principle of its programming and advocacy efforts.

[5]Sensitization workshops and informal meetings were held during the project duration.

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