Voices That "Need to be Heard." Inside OSF's Global Work with Marginalized Groups

In the United States, discussion of marginalized groups often revolves around discrimination, rights, and integration. Elsewhere in the world, though, the focus is more on inclusion versus exclusion—which, arguably, is a more comprehensive and useful frame. 

A commitment to battling exclusion is core to the Open Society Foundations, which has offices in over 30 countries and partners in dozens more. By now, the OSF story is the stuff of legend—how George Soros, the philosopher hedge fund king, used his market winnings to help bring down communism and went on to bankroll a global network of local foundations to advance the ideals of open society, making sure "no one has a monopoly on the truth" and no groups are consigned to the margins.

Soros has now given away over $11 billion through OSF, and in 2013 alone, the foundation gave away $873 milion. Despite all this, Soros has only grown wealthier; he's now worth $24 billion.

Perhaps no OSF initiative is more emblematic of its attack on exclusion than the foundation's huge push over many years to bring the Roma people of Europe into the mainstream, and OSF continues to fund research and services for Europe's most excluded population. Reducing the marginalization of drug users—another widely demonized group—is another of the foundation's signature issues over the past two decades—OSF was a trailblazer for this cause, which has since entered the mainstream. Likewise, as we've reported, it was an early funder of LGBT rights at a time when most mainstream foundations wouldn't touch this issue. In more recent times, the foundation has also taken up the rights of sex workers, legions of whom labor worldwide in a dangerous shadow economy and under laws that tend to do more harm than good. 

To get a better sense of how Open Society is approaching its work with marginalized populations, we recently caught up with Daniel Wolfe, Director of the International Harm Reduction Development program at the foundations. Under Wolfe's guidance, work is underway in more than 26 countries to support the health and human rights of sex workers, drug users, and other marginalized groups. 

One main thrust of the programs in this area is the direct involvement of marginalized people in designing the help they most need. "You hear sex workers talk a lot about rights, not rescue," he said. "Their voices need to be heard."

Wolfe cited a recent example in Asia Pacific Network of Sex Workers, who express their response to some of the rescue approaches with an emblem of a sewing machine with a slash through it. Wolfe paraphrased the message of this group as, "Please don't come to us and tell us you want to teach us how to sew so we can get out of sex work, before you ask us what we tried already and understand about our local context and why we're doing what we're doing."

For drug users, Wolfe said there are similar issues of the approach not fitting the need of the marginalized group. Wolfe described substance abuse treatment programs in which "the beds are empty because the programs are so rigid and demanding" that most addicted people are not able to succeed. 

He also talked about recent research supported by Open Society that calls attention to donor reluctance to address legal and policy issues for these marginalized populations. Wolfe described how funders tend to divide their support between funding core HIV services first, and then consider funding legal services and public policy as a secondary measure. "What we're finding is that HIV services cannot function without access to justice, attention to policy reform, and reform of law enforcement," said Wolfe.

This is where Open Society comes in with its deep commitment to legal empowerment for marginalized groups. "The intersection of health and access to justice is key to our approach," said Wolfe. 

(As an aside, the importance of investing in policy and advocacy work to have maximum impact is a frequent theme at Inside Philanthropy. That said, it's also no mystery that many funders steer away from these more politicized waters and stick with funding direct services.)

Influencing the conduct of government authorities is all-important in OSF's work, and Wolfe sees a particular jump forward lately in the growing awareness of the need to collaborate with police. "This is a way to pay more attention to the legal aspect for these marginalized groups, and not treat the legal issues as an afterthought," he said.

Wolfe talked about the recent work of Open Society in Kyrgyzstan, where the foundation has helped to train police to stop harassing drug users and sex workers who are trying to get condoms and clean needles from health programs. This program reports training about 800 people in the region, and also brought together a special cadre of 25 "friendly police"—those identified as particularly good at harm-reduction approaches.

These "friendly police" make efforts to interact with sex-worker and drug-user communities using a nonjudgmental approach, conducting study tours, and participating in discussions that introduce them to the staff of sex-worker and drug-user groups. As part of the program, they also receive laptops for communication with other officers and civil society groups.

“Increasing numbers of law enforcement officials are recognizing that we cannot arrest our way out of the HIV epidemic, and that it is possible to rethink policing in ways that maintain public order without undermining public health," said Wolfe.

Wolfe sees many positive developments emerging for sex workers and drug users globally. "The emergence of participatory funds like the Red Umbrella Fund is a huge advancement," he noted. 

Wolfe noted that another positive development was a report produced by the United Nations Commission on HIV and the Law in 2012 that looked more closely at the legal environment and advocated decriminalization of voluntary sex work, as well as improved efforts to provide more sex education, harm reduction and comprehensive reproductive and HIV services. Basically, the document sets a global standard for the many evidence-based interventions that are most effective with those affected by HIV.

Wolfe also sees reason for hope in the growth of diversionary programs that send drug users and sex workers to social workers for comprehensive treatment planning instead of charging them and putting them through the legal process. He cited the LEAD (Law Enforcement Assisted Diversion) program in Seattle, which has shown surprisingly positive results in reducing future arrests, with LEAD participants showing "34 to 58 percent lower odds of arrest compared to a control group" that went through the usual justice system process.

Wolfe described how the participants in LEAD benefited from the service being provided "pre-booking"—meaning that if they didn't already have a criminal record, they would not now have one, and that many people responded positively to the intervention of a treatment plan. He noted that dozens of other communities across the U.S. hope to replicate the LEAD program and work on diversionary techniques. 

Both in the U.S. and abroad, Wolfe sees collaboration with law enforcement and efforts at providing legal services to both sex workers and drug users as key to fighting HIV. He also cites the benefit of the growing access to rights and protections for marginalized populations doing their own advocacy and developing their own exit strategies from sex work or drug use, if and when they are ready to exit. 

None of this of this is rocket science to Wolfe, and OSF's work on sex workers rights and drug users is very much grounded in common sense. But this remains edgy and scary terrain for many other funders. Wolfe emphasized that more foundations need to come forward so that systemic change—policy reform and access to justice—can be realized.

"More donors can step forward, and we'd like to see that happen," said Wolfe. "We're going in the right direction, but we still have quite a ways to go."