Interview : Siobhan Riordan, Positively Irish Action on AIDS

In this interview taped in January, PIAA Director Siobhan Riordan discusses the struggle for autonomous community-based AIDS organizing given the reality of dependency on public funds.

So is it just a coincidence that most "ethnic minority" AIDS service groups, including PIAA, started up around 1989-90?

Well, PIAA was established in 1989 by a group of Irish drug and HIV workers and of Irish lesbians and gay men who wanted to support the very high numbers of Irish people in London living with HIV.

At that time, research coming from the experience in America showed that the community-based approach was the most effective to work effectively with different populations affected by HIV. Both in terms of getting access to your target population and in terms of using the right language, of being familiar with the people that you want to reach.

The British government had specifically set aside money that had had to be spent on community-based HIV programmes. There is no question that it’s that government strategy which enabled a lot of the ethnic organizations to come into being.

The strategy has changed now. As resources shrink, the ethnic minority groups are the first ones to go. There is a lot of anger about being considered expendable.

Also, we have something here called the "new business culture." It’s very difficult for small community organizations to function within that culture. PIAA, for example, requires the equivalent of two full-time posts just to do the paperwork required by this business culture. So that’s forty or fifty thousand pounds that aren’t going to people living with HIV but instead must be diverted to dealing with statutory authorities. And a lot of community organisations have gone under as a result of that, simply from a lack of the resources to work within that culture. It is very worrying.

Does the contradiction between the desire for autonomy and the reality of funding make political campaigning difficult?

We intend to campaign. But it is going to be difficult, because we were not set up to campaign the health authorities or the government. We were set up to provide a service to people living with HIV. So every hour I have to spend campaigning is an hour taken away from our real purpose. It becomes very frustrating, then, trying to balance the needs of the people we work with the needs of the organisation.

There’s no question that we make decisions not to do certain things because it might threaten our funding. But - and this is a big "but" - our service is based on sound research. We are the experts. We know what is needed. We are doing the health authorities a favor by telling them. We’re saving their time, as they don’t have to go out and find out what’s needed.

So today what is your top priority ? Are you being forced into a defensive situation...

We feel that we are being forced into defending what has been achieved. And, at the moment, we want to try to avoid taking that path, because it drains so much energy and so many resources from our primary purpose which is to care for people with HIV and to influence policy at a broader national and international level.

We have two options : Either we fight or we change our funding base. We don’t want to do the latter, because for us it is a political issue. If we stop applying for statutory money to pay for the service, it is like saying that those statutory authorities are not responsible for community-based HIV care. And they are.

The Irish dimension

What kinds of ties do you have with the home country?

One of the ironies of our work is that we actually have people in Dublin who phone us to find out what’s happening elsewhere in Ireland, because we have this unique, pan-Ireland knowledge about what’s happening. We also inform services in Ireland about the needs of people coming over.

Much of our work focuses on risk reduction for drug users. So, for example, users on methadone prescriptions in Ireland were on much weaker dosages. We worked with doctors so they could make appropriate prescriptions for people going home for holidays, or to tell their families about their status. And for us that’s an incredibly important prevention strategy.

The language of drug use is very different here from what it is in Ireland. For instance crack isn’t really evident in Ireland yet. So many young Irish people come to London, and get involved in crack use without knowing much about it. We provide them with what we call "street advice."

In the past, drug services in Ireland were based on the idea that you must not take any drugs at all. So many Irish people who have used drug services have had this punitive experience. When they come over to London, they are very reluctant about approaching services here. This is one of the problems. When they do go, they tell the worker what they think the worker wants to hear. So we make workers aware of that, encouraging them to stress the confidential and non-judgemental aspects of service.

Have you been involved, for example, in setting up a needle exchange center?

No, that’s not how we work. We work with existing needle exchanges to ensure that they have an "Irish dimension." As a minority community in the UK, we don’t have the resources to run needle exchanges. And, we shouldn’t have to. That’s very much a political decision : Irish people have as much right to services in this country as their UK counterparts. For us, it’s about making sure that those services fulfill their obligations to Irish people. M