Not only in the media, but also in academic and public discourse, the history of AIDS and HIV in Switzerland and other Western European countries is often referred to as a “model case.” Since the mid-1980s, exemplary prevention approaches were allegedly developed here—approaches that other regions were encouraged to adopt. But how do people in the countries receiving this international AIDS aid perceive it? Conversations with activists from Turkey paint a picture that is both critical and contradictory.

Many of the first AIDS aid organizations were initiated by healthcare professionals, explains Tuğrul Erbaydar, a physician and founding member of the AİDS Savaşım Derneği (Association for the Fight Against AIDS). Only later did people realize the need to work together with those directly affected. The World Health Organization and the EU played an important role in pushing for this change. While Erbaydar acknowledges the positive impact of international cooperation in the early years, he contrasts this with his experiences from the mid-1990s onward, when large EU-funded projects began to dominate AIDS aid efforts in Turkey:

“Personally, I believe that such large projects cause great harm. […] At the top of these and similar organizations are academics with a scientific perspective or teams whose income depends entirely on acquiring projects. […] So, they operate based on project opportunities—and these are always large projects. That’s not necessarily a bad thing, but it creates a kind of ‘project professionalism’.”

At the same time, Erbaydar views project-based funding as a “manipulation mechanism”:

“One condition, for example, is that there must be partnerships. Ostensibly, it’s about cooperation. But that’s a lie. The message is: ‘You shouldn’t do anything on your own.’ Because if you manage something alone, you might free yourself. And liberation is not the goal. The goal is for you to remain bound to the EU. In this way, the actions of the European Union amount to a form of imperialism. […] So what came out of all these project partnerships? Are our scientific networks now stronger? No.”

The interview with Erbaydar was conducted as part of a research project on the role of activism in the history of European AIDS aid. The project focused on five case studies: Turkey, Poland, the UK, Germany, and the European level. One of our goals was to challenge the Western European perspective that terms like “model case” or “best practice” imply. Still, the question remains: was our project itself one of those described by Erbaydar?

The EU, as our funder, also placed great emphasis on partnerships with local organizations and individuals. However, the collaboration was often made difficult by differing interests. Our academic perspective stood in contrast to the strong practical orientation and everyday challenges of our partner organizations in Turkey. Nonetheless, the cooperation had positive aspects for both sides. By telling their stories—most explicitly refusing anonymity—our interview partners actively intervened in the struggle over how the history and current state of AIDS and health policy in Turkey is interpreted, particularly in opposition to the government. In fact, the impetus to publish these interviews came from them.

Another factor to consider is the difference in time horizons. Project timelines, which typically span only a few months or years, don’t align with the long-term nature of fighting AIDS or the short-term nature of immediate problems. Work is often done on issues that receive funding, not necessarily on those for which people feel most competent, passionate, or that are most urgent. In the words of Buse Kılıçkaya—a Kurdish, Alevi, trans person, sex worker, and activist:

“I don’t want to name any person or organization, but in one of the meetings, I heard someone say: ‘If there were just a few more HIV-positive people, we could get a project funded.’ I don’t like this kind of work. I think many organizations are not genuinely interested.”

This focus on project-based work is especially problematic given that core funding for many areas of social and health services is insufficient or even declining. This is not only true for Turkey but also for many other countries, including Switzerland. International organizations, foundations, and private funders often step in, but they prefer funding impressive projects rather than administrative salaries, and their interests can shift quickly.

Canberk Harmancı from Pozitif Yaşam Derneği (Positive Life Association) in Istanbul reports:

“Especially since Turkey joined the G20, many donors have said: ‘You are now an industrialized country, so you no longer fit into our target group.’ As a result, they withdrew their support. Even the work of foreign diplomatic missions has shifted thematically. Sexual health is no longer a priority. Given the political situation in Turkey, the focus has shifted more toward democracy, press freedom, or protecting livelihoods.”

One cannot ignore the geopolitical dimensions of international health programs, often evoked through the term “imperialism.” When Erbaydar points out that such programs are often linked to migration policy, he encourages us to closely examine the explicit and implicit interests behind financial flows:

“I mean, is it a bad thing that family planning or contraceptive methods reach certain areas? No, it’s a good thing. But the script for cooperation between international institutions and small local NGOs is different—it’s not about benefits for local women. There’s another agenda behind it. If international projects are structured this way—and I think they all are—then despite their apparent usefulness, they can lead to long-term negative consequences.”

Finally, we seldom ask under what conditions an approach can truly be considered exemplary. There are hardly any programs that can be transferred uncritically to other places, groups, or time periods. Instead, we should ask how the diversity and contradictions of local approaches might form the basis of a future health policy. What might genuine equal-level international cooperation look like, and what obstacles must be overcome? Kemal Ördek, former sex worker and co-founder of Kırmızı Şemsiye Cinsel Sağlık ve İnsan Hakları Derneği (Red Umbrella Association for Sexual Health and Human Rights), describes the Global Network of Sex Work Projects (NSWP) this way:

“There’s a board with two representatives from each continent, and the focus is often on Asia, Africa, Latin or South America. So it’s not a Western perspective that dominates. Because the NSWP is a network of sex worker initiatives from many different countries, it follows a horizontal model of representation. I have no fear of a Western imposition there.”
In contrast, she says, “with WHO, UNAIDS, and similar institutions, there is generally a Western perspective. In many ways, they are hostile to sex work. They justify this with Western arguments or say things like: ‘Muslim sex workers? How can that be? Being Muslim and a sex worker doesn’t go together.’ […] These are orientalist statements. And then, we speak up.”