Argument

The Crowd Who Would Be King

Technology is connecting people all over the world, giving them new power and a stronger voice. But is it making government any better?

If there is one word that has been on everyone's lips during the political crises in Iraq, Ukraine, and Afghanistan, it is "inclusive." Heads of state, foreign secretaries, and even military chiefs like NATO Secretary-General Anders Fogh Rasmussen have made headlines in recent months with their cries for more inclusive political processes -- by which they generally mean fair elections, constitutional reforms, reduced corruption, and participation in governance by all parts of society. But repression and faltering political accountability, they say, has all but defeated efforts to produce inclusive governments in these three violent and fragile states -- not to mention in Libya, Nigeria, Egypt, and elsewhere.

The research, however, suggests that things aren't quite so grim.

Many mistakenly interpreted the Arab Spring in 2011 as a harbinger of democratic movements everywhere, and now the pendulum of punditry seems to have swung hard in the opposite direction. Contrary to this doom-saying, however, opportunities for citizen participation in political processes -- even in the conflict states where my employer, the U.S. Institute of Peace, works -- have never been greater, thanks to the ingenuity of a new generation of activists and technologists. This generation has figured out how to exponentially grow the means for executing two of the most critical tasks in any democracy: educating people and engaging both popular and minority sentiment.

The question now is whether that capacity can translate into tangible change -- and what that change might look like.

Three recent studies of "peacetech" tools have documented their use and promise, as well as their limitations. The first, "Citizen Participation and Technology," released in May by the nonpartisan National Democratic Institute (NDI), reviewed nine international programs with which NDI collaborated in countries such as Uganda, Mexico, and Egypt. The programs attempted to leverage technology to improve citizens' participation in politics. It found, broadly, that technology is expanding this participation and is changing the relationship citizens have with organizations and public institutions, even in places where these effects might not be obvious.

One standout from the study comes from Myanmar's 2010 election, widely regarded in the West as neither free nor fair. (It preceded the more recent democratic reforms.) But crowdsourcing allowed Myanmar's citizens to impose greater transparency and oversight on the election, fighting the government's attempts to bar election observers and limit media coverage. Civic organizations, supported by NDI, devised the online Burma Election Tracker, using a combination of available technologies to crowdsource and map wide-ranging reports of violence, intimidation, and fraud. And a second interactive website, BurmaPartnership.org, coordinated and linked activists and organizations to one another and to other resources that could help in monitoring the election. Together these sites increased the public's access to election information and helped activists forge relationships and build coalitions, putting pressure on the government to run fairer elections and curb human rights violations.

A second study, released in March 2013, was done for Transparency International, an international NGO focuses on corruption. The study provides a comprehensive look at the use of technology to promote transparency and reduce corruption. It looked at citizen reporting websites like "I Paid a Bribe," an Indian site that tracks payoffs to public workers and that has been expanded to or copied in Greece, Kenya, Pakistan, Azerbaijan, and at least seven other countries. The report also looked at structural fixes for corruption, such as the mobile-phone-based money transfers that are used to pay Afghan soldiers their salaries, in order to avoid skimming by corrupt bankers and middlemen.

A third report was published by the U.S. Institute of Peace (USIP) in April. It looks at one political process in particular: constitution writing. The authors surveyed political systems from Iceland to Ghana, Somalia to Fiji, Libya to Nepal, and divided the projects into three categories: improved participation; citizen education about constitution writing and their responsibilities; and providing expert guidance to constitution-writing bodies. The report also looked at innovations the authors believe hold special promise, such as using new "sentiment analysis" software to gather and process public feedback in real time throughout the drafting process, or trust-building across communities using videoconferencing platforms like Skype and Google Hangouts. They concluded that increasing usage of new technologies is both inevitable and promising for the development of more inclusive and durable constitutions.

All three studies are bullish on the untapped potential of these technologies -- but they are also skeptical about the sweep of what the technology can fix. Technology, for all that it can do to connect people and give them a voice, can't fix social and political problems on its own. As the USIP authors put it, "New technologies are tools, not panaceas." Similarly, the NDI study says, "Despite the exuberance for technologies, there is little data available on the impacts they have had on the political processes and institutions they are intended to influence."

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It is true, of course, that technology alone can't fix a broken political system -- but that doesn't mean it isn't doing significant good. The last decade has seen a vigorous conversation on the relationship between online discourse and what is often called "the public sphere." The concept is most often associated with philosopher Jürgen Habermas, who wrote in his 1964 essay "The Public Sphere: An Encyclopedia Article" that it was the "realm of our social life in which something approaching public opinion can be formed." It is in this realm that technology is arguably having the most pronounced political impact, changing the way people articulate their preferences to the state and, in turn, hold the state accountable.

According to New York University professor Clay Shirky, social media is a tool that strengthens the public sphere -- and a robust and active public sphere is necessary to increase political freedoms around the world and to create political change. Larry Diamond, a founder of the liberation-technology program at Stanford University, echoes this sentiment and points toward a highly controlled society -- China, where citizens have used microblogging site Weibo to identify corrupt officials -- to best understand this phenomenon. In 2012, Yang Dacai, the head of the Safety Supervision Bureau in Shaanxi province, was jailed for bribery after online activists shared photos of Yang wearing extravagant accessories far beyond the economic reach of the average civil servant.

For experts like Diamond and Shirky, the Internet's decentralized architecture, the spread of cell phones, and the sheer popularity of social-network applications have combined to produce a revolution in social activism. Others, however, have taken issue with this. Writer Malcolm Gladwell, for example, has argued in the New Yorker that a crucial distinction exists between traditional activism and its online variant. Social media, he says, is effective at building loosely affiliated networks, which are the opposite in structure and character of effective social-change movements of the past. These past movements had hierarchies, rules, procedures, and centralized control. Gladwell, like many others, finds digital activism to be a weak substitute for the kind of activism that requires close relationships and close collaboration and that produced the American civil rights movement of the 1960s and 1970s.

But what do the activists themselves think? I've studied or spoken to many in the course of my work in Iraq, Afghanistan, South Sudan, Egypt, and elsewhere. They say that social networks have increased the speed with which information travels, making it easier to organize and crowdsource, but they also recognize that these networks can make misinformation and propaganda harder to fight. "Today, social networks spread information in seconds," Irina Pakhomova, a Ukrainian activist, told techPresident, a news site dedicated to how the Internet is changing politics and advocacy. "Many share incorrect information citing unreliable sources." As another example, the Islamic State, in its recent power grab in Iraq, used social media -- to great effect -- to sow fear and confusion across its networks, hijacking hashtags about the World Cup and other major events to spread propaganda.

But despite this dilemma and how these networks can be used to identify, track, and ultimately intimidate, they still serve an essential community-building role. Wael Ghonim, who launched the "We are all Khaled Said" Egyptian Facebook group that helped fuel the Tahrir Square demonstrations, said during a TED talk that, "Platforms like YouTube, Twitter, Facebook were helping us a lot because it basically gave us the impression that, 'Wow, I'm not alone. There are a lot of people who are frustrated.'" Even Ahed Al Hendi, a Syrian dissident who had been jailed and tortured by Bashar al-Assad's regime, said during an October 2012 discussion at USIP that the concrete gains from social media platforms were substantial, claiming, "Facebook and social media taught us how to be more rational, how to build campaigns about human rights and raise awareness in the country."

Today's activists from Ukraine to Syria, Iraq to Egypt, clearly believe the new technologies and their interactions with conventional media such as radio, television, and print are invaluable tools in expanding the public sphere, helping to galvanize and express public opinion. And, as we have seen from the research, these tools are being used increasingly in hopes of producing more inclusive and responsive governance.

It is too early to tell the outcomes of today's violent conflicts that are spawning the chorus of calls for more inclusive governments. But this is certain: The public sphere is growing. And in a world where 3 billion people are expected to enter the global middle class over the next two decades and have greater access to technology in their daily lives, the power of technology-enabled citizen networks to pressure governments and large institutions to act is only going to grow -- putting new potential to prevent wars and solve humanity's most pressing problems within reach, if not in our grasp.

Photo by Lam Yik Fei/Getty Images

Argument

The Missing Link

In 2013, 57 percent of people living with HIV were women. So why has the media frenzy around Truvada, a drug regime that could help prevent infection, excluded them?

Earlier this month, the World Health Organization (WHO) recommended that a medication used as an HIV treatment should also be used as a preventative measure against contracting the virus. This is also known as a pre-exposure prophylaxis, or PrEP. A spate of articles debating PrEP sprung up alongside the WHO announcement: New York magazine ran a cover story with the provocative title "Sex Without Fear," declaring that Truvada, the drug regime used in PrEP, could "revolutionize gay life" by restoring a certain sense of pre-AIDS sexual freedom. (The Food and Drug Administration approved Truvada for preventative use in the United States in 2012.) Meanwhile, a POZ magazine piece by an HIV/AIDS researcher called the WHO recommendation "unhelpful," arguing that some gay men would see it as a reason to stop using condoms. A New York Times article picked apart the claim that Truvada, if used correctly, can be up to 99 percent effective, while the Wall Street Journal reported on New York Governor Andrew Cuomo's new AIDS Eradication Plan, which includes ramping up use of Truvada.

The precise implications of the WHO recommendation are thus still unclear -- but there's no arguing that, under the right circumstances, they could be huge. If used in conjunction with condoms and taken every day, Truvada could help prevent new HIV infections among gay men, a population still deeply afflicted by the HIV/AIDS pandemic. A recent report from the U.S. Centers for Disease Control and Prevention showed that annual diagnoses of HIV in the general population have declined by one-third, but doubled among young gay and bisexual men.

Yet in this new, animated debate over Truvada, where are the women?

The WHO announcement and subsequent media coverage have focused on men who have sex with men. In 2013, however, 57 percent of all people living with HIV worldwide were women. In sub-Saharan Africa, that figure is even higher, with woman comprising 59 percent. And women in the United States aren't spared, especially in certain communities: For instance, African American women are 15 times more likely to contract HIV than Caucasian women.

"The conversation about PrEP is dominated by white, rich, gay men from the [Global] North," said Jessica Whitbread, interim global director of the International Community of Women Living with HIV, during a panel discussion at the 2014 International AIDS Conference in Melbourne, which is taking place this week. Whitbread herself is not an advocate for PrEP, but she is concerned with what she sees as an all-too-typical exclusion or marginalization of women in matters of HIV/AIDS, sex, and reproductive health generally.

Others who think PrEP could make a difference for women see the same problems, rooted in norms, assumptions, and practices that have bedeviled the effort to protect women from HIV/AIDS for decades. They are problems that extend from the international to the highly local level.

Kenyan-based HIV researcher Dr. Nelly Mugo conducted a PrEP clinical trial on discordant heterosexual couples (that is, where one partner has HIV and the other does not), which showed promise that consistent, daily use of PrEP along with continued use of condoms could keep the uninfected partner free of HIV. But putting this into practice will be anything but easy, given how women are excluded from discussions of sex -- or worse. "[Our] field was cognizant of the challenges to women and young girls when we started the trials," Mugo said in an interview. "Even in societies that are progressive, condom use in partnerships can be challenging."

Men in the African context, Mugo said, sometimes feel a woman's desire to use a condom as a challenge to their manhood. As a result, women cite having significant difficulty negotiating use with partners. This is just one example of the ways in which many African women have little say over their sexual lives: Marriages are sometimes arranged, husbands take multiple sexual partners, polygamy is sometimes practiced, and sexual assault, including that inflicted under the guise of child marriage, and domestic violence are rampant.

In 2012, I heard and saw these problems firsthand when I visited clinics in Uganda, funded by the U.S. President's Plan for AIDS Relief (PEPFAR). I interviewed women in a group called the National Community of Women Living with HIV/AIDS (NACWOLA). All of them had HIV, and each one said her husband had infected her. They were all experiencing stigma, some of it life-threatening, because of their diagnosis. One woman had lost custody of her child to the ex-husband who infected her. Another woman was brutally beaten by her dead husband's family and run off the property they owned together, prior to his death.

The women I interviewed in Uganda -- and others I spoke to in Cameroon -- said over and over again that access to preventative reproductive health care was practically non-existent. (This included under PEPFAR-funded programs.) If not the logistics of getting to a clinic or dealing with corrupt supply chains, cultural norms often stood in their way. Mugo pointed to these problems as well: "We can't even get women condoms," she said.

PrEP wouldn't be immune to these barriers; use among women, for instance, would require clear channels for accessing the treatment and robust information about how to use it, which would not be easy to provide. But for now, that doesn't matter: Last year, Uganda said it wouldn't approve Truvada for use by anyone, based on "moral grounds." A program manager at the Ministry of Health told IRIN that PrEP would lead people to "engage in reckless sexual behavior."

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To be sure, before activists and providers can wage a full-on battle against those seeking to deny any at-risk population access to PrEP, there is a drug company standing in the way. According to Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition (AVAC), drug-maker Gilead has "dragged its feet" to get approval for Truvada in the seven countries outside the United States where clinical trials initially took place. As a result, PrEP isn't yet available anywhere but the United States.

That said, Warren is hopeful that this will soon change. South Africa and Thailand are reportedly reviewing Gilead's application for approval now.

At the International AIDS conference in Melbourne, I asked a Gilead representative why the company hadn't applied for approval in more African countries. He said it was difficult negotiating with some governments, due to stigma around homosexuality and the idea that Truvada would promote promiscuity among the general population. Scaling up, in other words, will be slow going.

He emphasized that Truvada isn't a magic bullet, but added that, for women, it could be a very valuable tool -- even in the absence of condom use. "They don't really have a choice sometimes, now do they?" he said of women, underscoring the challenges they face in using protection. Truvada alone, which would not require asking a partner to use a condom, might provide at least some protection for women in desperate situations.

Amy Corneli, a public health expert, presented research in Melbourne showing that, were they to use PrEP, some women might not use condoms.* To Corneli, this speaks to a need for more education. She said that, ultimately, women require multiple prevention options, potentially including microbicides and vaginal rings. "One size doesn't fit all," she said.**

However, no microbicides or rings are approved for the prevention of HIV (though several are in the pipeline). Meanwhile, Truvada exists and has WHO backing. But even if it were approved throughout the world tomorrow, it would likely affect women very little. For until women and their needs are included equally in the discussion of PrEP (and HIV prevention more broadly), Truvada likely could not have the game-changing impact many people wish for it.

"PrEP is an option for many people, not only for gay men," AVAC's Warren wrote in a recent Huffington Post article. "Oral PrEP should be integrated into comprehensive, high-impact prevention programs for all people at risk internationally, with particular attention to key populations but also for young women and married women who continue to bear the brunt of the epidemic."

*Correction, July 31, 2014: This article originally said that Amy Corneli's research was conducted on women taking PrEP. It was not. The study was an "intentional survey," meaning that it assessed what participants might do if they were taking PrEP. The article also stated that Corneli "disagrees" with the Gilead representative quoted in the previous graf, which she did not explicitly do in her interview. (Return to reading.)

*Clarification, July 31, 2014: This article originally stated that Corneli thinks microbicides and vaginal rings might work better than PrEP. She believes women need multiple HIV prevention options, which might include PrEP, microbicides, and vaginal rings. (Return to reading.)

Photo by PEDRO UGARTE/AFP/Getty Images