"I want to sit at this table"

The symposium "Hard to reach! HIV prevention for & with African communities" shows how HIV prevention should work: not just for, but with the experts in their own living environments.

There were many demands on that Friday in Cologne. But probably the most impressive came from Maureen Ndawana from the African Health Policy Network in the UK. "I am so loud because there are so many voices inside me," she calls out to the audience in a bright purple dress. "Who says women with HIV have to be thin and ugly? Who says they have to be quiet?" she asks rhetorically.

Making one's own voice heard - the voices of people from Africa and HIV-positive people themselves - this goal was the focus of the symposium "Hard to reach, my ass! HIV prevention for & with African communities" on September 30 in Cologne.

"Ten years ago, nobody would have thought such a symposium possible," said Tanja Gangarova, Migration Officer at Deutsche AIDS-Hilfe, in her welcoming address. In the past, it was common practice in HIV prevention to talk more about migrants than with them. The idea that the target group was difficult to reach had become commonplace. The conference aims to dispel this myth. "Everyone is hard to reach for someone," emphasizes sociology professor Hella von Unger. It always depends on the type of approach - and of course on who is speaking.

For people within the African community itself, it is not difficult to approach other people from the same community. So what could be more obvious than working together with these people? But that sounds easier than it is. "The success of participation also depends on 'How willing are we to give up some of our power?" explains Tanja Gangarova. This is not a given.

A central concept of the symposium is therefore "genuine participation" - in contrast to the forms of sham participation that are still often practiced. Lillian Petry from the AfroLeben Plus network reports that if someone is looking for black people to cook or drum for events in front of the camera, migrant organizations are often asked. However, the planning takes place at tables where there are no migrants. "I want to sit at this table," demands the activist.

The symposium is intended to be a step in this direction. Deutsche AIDS-Hilfe has organized it together with AGHNiD, a network of Africans who are committed to the health of members of their own community. Coordinator Omer Idrissa Ouedraogo emphasizes that African people do not lack the knowledge and will, but rather the necessary structures and money.

Ouedraogo, who comes from Burkina Faso and has been in Germany since 2007, describes a trip to the 2010 World AIDS Congress in Vienna as a key experience. As a participant in the participatory research project PaKoMi, he and other migrants presented their work there. The fact that people from the African community themselves reported on their projects at the congress was something completely new. This experience inspired them to set up their own network. "PaKoMi showed that there are many migrants who want to make a difference in Germany," he says. Ouedraogo calls for the skills and resources they bring with them to their new home country to be used.

However, information about the target group is needed in order to be able to carry out prevention work.

Two examples presented at the symposium showed that the participatory approach is also finding its way into science. Inevitably, as Claudia Santos-Hövener and Carmen Koschollek from the Robert Koch Institute reported. The initial idea was to use an epidemiological research project to gain an idea of knowledge and attitudes towards HIV and other sexually transmitted diseases. However, it turned out that this was not so easy. "We can do this if we do it together," Africans emphasized in the preliminary discussions. After all, addressing the African community as a target group for HIV prevention is a balancing act. Figures show that this is important: ten to fifteen percent of all initial HIV diagnoses in Germany concern migrants from sub-Saharan Africa, reports Claudia Santos-Hövener. Yet this group only makes up 0.25 percent of the population.

At the same time, however, stereotypes must be avoided. Santos-Hövener warns that the image of Africa = AIDS must not be allowed to develop in people's minds.

The Robert Koch Institute tried to avoid falling into this trap by working together with people from the community. For example, they acted as peer researchers and recruited study participants.

The data collected in 2015 and 2016 showed that many facts about HIV are known, but not about hepatitis. Around 40 percent were also unaware of the anonymous testing services and only 64 percent of respondents were aware that HIV is not a reason for deportation in Germany. One of the researchers' recommendations is therefore that testing services need to be made better known in the African community.

But what is this community that seems to play such a central role? In her presentation, Hella von Unger states that community is something that arises from within and is not imposed from outside. Communities are also not necessarily ethnically determined. And those who belong to a certain ethnic group do not necessarily have to belong to the corresponding community.

The sociology professor helped design the PaKoMi research project, which was located at the interface between politics, science, professional practice and migrant lifeworlds. Between 2008 and 2011, case studies were carried out in various cities.

Von Unger gives a few practical tips on how to carry out such participatory projects. Among other things, she advises using simple language, relying on leading figures from the respective community and organizing informal events to get in touch with the target group.

She emphasizes: "It's not easy to talk about HIV and migration here in Germany." For Germans, migration is always associated with danger. At the same time, Africa is a place of longing for many. "Fear and desire play together." This frame of interpretation needs to be broken by pointing out, for example, that most migrants are young and healthy.

During the course of the conference, it became clear time and again that migrants infected with HIV have to deal with two problems: As foreigners who may not speak German and do not understand the structures. And as HIV-infected people who suffer from prejudice and stigmatization. The symposium shows impressively that there is strength and will in the networks of African migrants to fight against these problems. And it also shows that there are open ears for their concerns in politics at federal and state level. Among the guests are Gesa Kupfer from the Federal Ministry of Health, Dr. Anne Bunte, Head of the Cologne Health Department, and Hans Hengelein from the Lower Saxony Ministry of Health and Social Affairs.

At the same time, however, structural difficulties were also identified: For example, that projects are often initiated but not continued on a sustainable basis. And that migrants often work on a voluntary basis, but the relevant positions at the offices are still occupied by white people. It is no coincidence that Tanja Gangarova concludes the conference with an appeal to give up power - to those who, as experts in their own environments, know exactly how to reach their fellow human beings.

(Inga Dreyer)