Activism, NGOs, and HIV Prevention in Postsocialist Poland: The Role of "Anti-Politics"

Article excerpt

With the collapse of socialism, the number of nongovernmental organizations in Eastern Europe increased dramatically, as part of democracy and capitalism building. In the West, NGOs have served as key players in shaping the response of the HIV epidemic, reflecting both the withdrawal of the state from service provision in line with neoliberal reforms and the activist roots from which many of these organizations originated. As a result, AIDS NGOs and the people who work in them are often characterized as engaging in an activist endeavor in order to affect social and political change that will enable better prevention and care. This article explores the extent to which a similar framework applies to AIDS NGOs in Poland and Eastern Europe, more generally, where the notion of "anti-politics" and disengagement from political activism remains strong. As they developed in Poland, AIDS NGOs have focused on caring for clients, cultivating a professional identity, and abstaining from politics, to the eschewal of advocacy activities on behalf of their clients. This orientation has implications for the types of HIV prevention programs these organizations offer, as well as the possibilities for collaborating with researchers and service providers from the West.

Key words: civil society, HIV prevention, activism, Poland, postsocialism

Introduction

In the immediate aftermath of socialism's demise in Eastern Europe, questions emerged about the role ofthe state and the emerging civil society sector - particularly in the form of nongovernmental organizations (Sampson 1996) - in the provision of goods and services in the new political landscape.1 Fostering civil society through the formation of NGOs served two goals ofthe postsocialist transition: creating democracy and instituting capitalism by providing services where the role of the state was diminished (Kennedy 2002; Mandel 2002). Agencies such as the World Bank, the Soros Foundation, USAID, and the European Union's PHARE held conferences, seminars, and other educational forums to teach Eastern Europeans organizational capacity building, fundraising, and project development (Sampson 1996). The push to build civil society in Eastern Europe reflected a model of the state with a limited role in public sector service provision, in line with neoliberal notions of government. Globally, the advent of HIV and the ensuing epidemic coincided with the declining role of the state, and nongovernmental organizations have been key actors in shaping responses to the HIV epidemic. As Robins and Backstrom (1999) argue, the highly controversial nature of risk and prevention has meant that public health officials often rely on NGOs to deliver prevention and care services to target communities. NGOs pressured governments to develop more compassionate attitudes towards and comprehensive care for those infected with the virus, provide direct services to People Living with HIV/ AIDS (PLWHA), and create and disseminate HIV prevention programs to the most marginalized and vulnerable populations (Petchey et al. 1998; Poindexter 2002). When HIV/ AIDS emerged in the early 1980s, governments throughout the world were slow to respond and failed to develop formal policies to combat the growing health threat, reflecting the perception that this disease was a health concern unique to stigmatized and marginalized groups (e.g., gay men and injection drug users). At the same time, the association between AIDS and an already-constituted social group based on identity (gay man), allowed well-organized NGOs - with fundraising capacity and access to political power - to mount a response (Epstein 1995; Treichler 1999).

The AIDS organizations that emerged, and which have since become paradigmatic of nongovernmental AIDS organizations, combined social and political activism with identity politics (Altman 1994). AIDS NGOs, such as Gay Men's Health Crisis (GMHC) in New York City, have both allied themselves with the state, through collaboration with agencies such as the Centers for Disease Control, and directly challenged the state, such as in the provision of clean needles in places where needle exchange was illegal. …