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Reporting from within HIV and AIDS in the South Caucasus: A Manual for Journalists 2 ACKNOWLEDGMENTS

ACKNOWLEDGMENTS

This manual was written by Sandrine Amiel, Mark Grigorian, Jeanne Lawler, Nora T. Schenkel, and Helen Sewell. Special thanks are offered to Michael Randall for coordinating this project and bringing it into fruition.

Particular gratitude is expressed to all those who contributed to this project by providing professional advice and sharing their experiences, notably Helena Drobna, Renate Ehmer, Cynthia Buckley, Jeyhun Najafov and Tiko Tsomania.

This manual built on a series of “Training of Trainers” workshops held in Tbilisi, in September 2006, facilitated by Naomi Goldsmith (BBC World Service Trust) and Helena Drobna (UNESCO). Grateful acknowledgments go to all workshop participants.

The development of this manual was made possible through financial support from the Flemish government.

Published by:

The United Nations Educational, Scientific and Cultural Organization (UNESCO) Culture Sector Division of Cultural Policies and Intercultural Dialogue Culture, HIV and AIDS Project 1, rue Miollis F-75732 Paris Cedex 15, France

Email: culture.aids@.org Website: www.unesco.org/culture/aids

All rights reserved. This document may be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes, provided that mention is made of the source.

© October 2008. United Nations Education, Scientific and Cultural Organization (UNESCO) and British Broadcasting Company World Service Trust (BBC WST)

The designations employed and the presentation of material throughout this document do not imply the expression of any opinion whatsoever on the part of UNESCO or the Flemish government concerning the legal status of any country, territory, city or area or its authorities, or concerning its frontiers or boundaries. FOREWORD 3

FOREWORD

Through the project “Culture, HIV and AIDS”, UNESCO is committed to advocating for and implementing approaches to the which are culturally appropriate, gender responsive and human rights-based. From UNESCO’s perspective, Culture as such is regarded as an evolving and highly dynamic process and important asset with a key role to play in any effective HIV and AIDS response. In fact, lifestyles, traditions, beliefs, gender relations and other characteristics of a society in its rich cultural diversity are considered essential factors for generating the long-term societal and behaviour changes needed to overcome the epidemic’s expansion.

The manual Reporting from Within derives from this conceptual framework. It is part of the broader project “HIV and AIDS in the Caucasus Region: A Socio- Cultural Approach”. Generously supported by the Flemish Government, its objective is the development of culturally appropriate responses to HIV and AIDS in , Azerbaijan and Georgia. Since its launch in 2003, the project has worked in close collaboration with national authorities in each of the three countries, local partners and international experts.

The first phase of the project involved work with local research teams to explore socio-cultural specificities affecting the epidemic’s progression trends at the regional and national levels. This manual is a core component of the project’s second phase working to strengthen the local media’s capacity to address HIV and AIDS in all of its complex dimensions, be they social, economic or political. It builds on research findings from the initial phase that identified the weak role so far undertaken by the media as a major challenge for HIV and AIDS responses in the South Caucasus region.

The central assumption of this manual is that, in a learning society, the media is key in any attempt to build socio-cultural approaches to HIV and AIDS. Besides disseminating accurate information on the epidemic, they can offer a forum where different voices can be expressed and dialogue, whilst drawing the attention of their fellow citizens and policy-makers on the issues that underpin HIV and AIDS such as stigma, discrimination and gender relations. This manual seeks to provide Caucasian journalists with a hands-on, training tool for reporting on these highly complex dynamics.

It is UNESCO’s hope that this manual will help strengthen the case that, if the international community is to develop an effective response to HIV and AIDS, in particular to the stigma and discrimination faced daily by people living with HIV, the design of all strategies, policies and programmes should integrate socio-cultural dynamics.

Katérina Stenou Director Division of Cultural Policies and Intercultural Dialogue 4

REPORTING FROM WITHIN HIV AND AIDS IN THE SOUTH CAUCASUS: A MANUAL FOR JOURNALISTS

ACRONYMS 5

INTRODUCTION 6 Chapter 1: HIV and AIDS: Basic facts 9 Chapter 2: HIV and AIDS in the South Caucasus: Trends and Routes of Transmission 15 Chapter 3: Stigma and Discrimination: How They Drive the Pandemic 20 Chapter 4: Gender Inequality and Harmful Gender Norms 23 Chapter 5: Poverty: A Cause and Consequence of HIV and AIDS 26 Chapter 6: Writing Your Story: Language Guidelines 28 Chapter 7: HIV and AIDS Reporting: Basic Principles and Techniques 32

ANNEXES 37 Annex 1: Glossary of Terms Relating to HIV and AIDS 37 Annex 2: Analytical exercises 40

5

ACRONYMS AIDS Acquired Syndrome ARV Anti-retroviral Drug BBC British Broadcasting Cooperation FBO Faith-based Organisation GBV Gender-based Violence HIV Human Immunodeficiency IDU Intravenous Drug User MSM Men Having Sex With Men NGO Non-governmental Organisation OVC Orphans and Vulnerable Children PLHIV People/Person Living With HIV or AIDS PMTCT Prevention of Mother-to-child-transmission STI Sexually Transmitted UNAIDS Joint United Nations Program on HIV&AIDS UNESCO United Nations Educational, Scientific and Cultural Organization UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV&AIDS UNIFEM United Nations Development Fund for Women WHO World Organization 6 Introduction

Introduction

When HIV and AIDS first emerged, they were regarded primarily as health issues requiring clinical and interventions.1 This approach not only overlooked the diversity of ways in which health is regarded worldwide but also how significantly social contexts influence the discussion, prevention and treatment of illness.

For example, in many Caucasian societies talking about sex is widely believed to be improper and conversations about sexual activities rarely occur within family, community or educational settings.2 HIV and the sexual behaviours associated with its transmission are therefore considered inappropriate for public discussion. As a result, if it is difficult to openly explain how the virus is transmitted, HIV prevention and education can be very challenging.

But the influence of social and cultural factors extends far beyond questions concerning which topics are and are not acceptable to discuss. For example, gender roles, which are culturally constructed, heavily direct the choices available to people. This is demonstrated in many parts of the world where it is difficult for women to make personal choices about protected sex (see Chapter 4 on Gender). General misconceptions impacting on transmission can also circulate culturally - for example, the notion common in particular societies that ‘using a reduces manliness’.

These cultural notions all require careful consideration whenever HIV and AIDS are discussed. In fact, more and more intervention agencies try to understand and respect cultural features and when possible use them as resources for responding effectively to HIV and AIDS. In one example, the United Nations 1 UNIFEM. 2002. Expert Group Consultation on Gender, HIV/ Population Fund (UNFPA) successfully collaborated with Buddhist monks and AIDS and Rights: Developing nuns in to integrate HIV and AIDS information into traditional a Training Manual and Module teachings.3 for the Media. Accessed 7 November 2007 at: http:// Whilst accounting for every social and cultural factor impacting the epidemic ipsnews.net/aids_2002/ IPSEXPGPmanual.pdf is impossible, particular issues such as gender, poverty and stigma are known to have a significant role. The challenge for journalists reporting on HIV and 2 UNESCO. 2005. HIV and AIDS AIDS, therefore, is to supplement their knowledge of the basic facts about in the Caucasus Region: A the epidemic with a broad recognition of the social and cultural factors at play. Socio-Cultural Approach. Paris, For this reason the first section provides an overview of the basic UNESCO. http://unesdoc. followed by an introduction of those social and cultural factors of particular unesco.org/images/0014/ 001411/141152E.pdf relevance to HIV and AIDS.

3 UNFPA. 2004. Culture Matters: Background: HIV, AIDS and the media in the South Caucasus Working with Communities and Faith Based Organizations: Across the world, the media are an important source of information about Case Studies from Country HIV and AIDS for the public. Carefully crafted, relevant reports can help to Programmes. Accessed 7 November 2007 at: http:// reduce the spread of HIV. But without fully understanding the social, cultural, www.unfpa.org/upload/ political, biological and economic factors involved, journalists can inadvertently lib_pub_file/426_filename_ facilitate a more extensive spread of the disease. The former Director of the CultureMatters_2004.pdf AIDS Programme for the PANOS Institute, Martin Foreman, says that media

4 reporting of HIV is a double-edged sword: “Whether or not they actively UNESCO. 2000. Media and seek to do so the media either fuels the epidemic through sensationalism HIV/AIDS in East and : A Resource Book. Paris, and poor ethical reporting, or helps to restrain it by promoting information, UNESCO. understanding and behaviour change”.4 Introduction 7

Given the progression of the epidemic throughout the South Caucasus recently, journalists have a critical role to play in the response to HIV and AIDS. Research conducted in 2003/04 5 has highlighted what appears to be weak media coverage. It found that:

• HIV and AIDS received little media coverage in the region – the media did not perceive it as a priority issue; even less as one that would ‘sell’ newspapers or TV programmes. • HIV and AIDS were covered only sporadically, mostly for World AIDS Day (1st December). For example, between 1999 and 2004, there were only 8 programmes on HIV and AIDS in the Armenian news, 7 of which were broadcast on World AIDS Day. • The content of coverage was often sensational. For example, regionally printed media published expressions such as ‘sex terror’.6 • There were also cases of confidentiality violations: information provided by the media sometimes revealed the identity of people living with HIV, potentially increasing the stigma and discrimination experienced by the individuals involved. • While the basic on HIV and AIDS transmission and prevention received some coverage, it was not always accurate. For example, the researchers who conducted the media analysis in the region noted that journalists were often confused between the meanings of HIV and AIDS. • Media coverage in the South Caucasus did not embrace the full range of HIV and AIDS dimensions. The media researchers found that the main issues covered included statistics on the spread of the epidemic, supposed ‘miracle’ therapies such as , and policies created in response to HIV and AIDS. While some media outlets covered issues of stigma and discrimination, the analysis found that articles on any other socio-cultural factors affecting the HIV and AIDS epidemic were nonexistent.

Why this manual?

In Armenia, Azerbaijan and Georgia a general lack of HIV and AIDS coverage currently exists while HIV rates are rising throughout the broader region. What’s more, the very complicated issues associated to HIV and AIDS have by some accounts created a greater need for specialist health reporters. The combination of these dilemmas in the South Caucasus requires an increase of coverage with a more thoughtful approach to reporting. While this manual will not make you a specialist health reporter, it will introduce particular methods of investigation stressing broad principles of professional ethics to produce more sensitive, in-depth, accurate, diversified and empowering reporting. 5 UNESCO. 2005. HIV and AIDS in the Caucasus Region: A Socio-Cultural Approach. Paris, The approach advocated by this manual seeks to take into account the many UNESCO. http://unesdoc. dimensions of HIV and AIDS. The epidemic is too often presented as a medical unesco.org/images/0014/ issue only, with much of the coverage failing to recognise the social, cultural, 001411/141152E.pdf economic and political dimensions. This manual emphasises in particular how social and cultural factors affect the transmission and prevention of HIV and 6 UNESCO. 2005. HIV and AIDS the care of people living with the virus. in Armenia: A Socio-cultural Approach. Paris, UNESCO. http://unesdoc.unesco. Reporting From Within, the title of this manual, implies that as a journalist org/images/0014/001411/ working within your own national and/or local context, you are extremely 141154E.pdf 8 Introduction

well positioned to identify, interpret, examine and report these socio-cultural issues and their influence on HIV and AIDS. You can therefore make stories relevant, useful and potentially more compelling for your local audience. However, although you are a journalist, you are still part of a given culture or society, and because of this you can also be influenced by certain values, myths or stereotypes. It is essential to question your beliefs and assumptions to avoid contributing to the sensationalism, misinformation and stigma surrounding HIV and AIDS. This manual tries to enhance your critical skills in relation to HIV and AIDS coverage so that you are better able to debunk biases – your own and others’.

Ultimately, this manual considers journalists’ role in society in relation to HIV and AIDS. At the very least, reports should avoid causing further harm. Ideally, they may even contribute to the social changes needed to curb the epidemic.

‘To bring about change, more attention and resources need to go toward developing mutual skills and building understanding and trust between news media professionals and those working in and affected by HIV/AIDS. With coordinated programming between PLHIV [people living with HIV], NGOs and HIV/AIDS program managers and the media, the news coverage of the pandemic can move toward more accurate, informative and empowering reporting.’ Internews, 2006 7

How to use this manual

This manual is aimed at media professionals who want to develop their skills to produce accurate and quality reports on HIV and AIDS; reports that are sensitive to issues of culture, gender and human rights.

The manual starts with the basic biology of HIV and AIDS, followed by an introduction to some of the broader societal conditions driving the epidemic. Potential story ideas are provided throughout and ethics and techniques within the context of the epidemic are reviewed. Journalism trainers can also use the manual for media training workshops on HIV and AIDS. Each Chapter contains specific suggestions for facilitators under the title “Tips for Trainers”.

This manual is meant as a starting point for media professionals in understanding how HIV is driven by societal factors. Quality and diversified coverage of the epidemic ultimately relies on the skills and ability of media professionals to produce in-depth and investigative reporting on these issues. 7 Internews Network. 2006. Voice and Visibility: Frontline perspectives on how the Tips for Trainers global news media reports on HIV and AIDS. Accessed 7 Ask trainees to elaborate on the relationship between culture and health. November 2007 at: http:// How are the two related? www.internews.org/ pubs/health/20061100_ What different definitions of health can be identified? voice&visibility.shtm HIV AND AIDS: BASIC FACTS Chapter 1 9

CHAPTER 1

HIV AND AIDS: BASIC FACTS

To report accurately on HIV and AIDS, you have to have accurate knowledge about the biology of the virus. False information about HIV transmission, prevention and care distributed in the press can significantly contribute to the spread of the pandemic and eventually strengthen the associated stigma and discrimination. Conversely, clearly presenting the basic facts about HIV will help individuals and communities to build a better understanding of the pandemic, and to lessen stigma and discrimination against people living with HIV.

HIV: Human Immunodeficiency Virus

The Human Immunodeficiency Virus (HIV) is a type of virus known as a . Like all other , it needs a (in this case the human body) to survive and to duplicate. What is special about is that they integrate themselves in the DNA of the host cells. This means that the body of a person who is infected with HIV actually produces the virus within his/her own . This is a major obstacle in finding a cure for the infection, as it has so far been impossible to remove the virus from the human body.

What makes this so harmful is the effect that HIV has on the human . The virus targets very specific white blood cells known as CD4 cells. These cells – which are also referred to as T cells or T helper cells – are one of our body’s major lines of defence against disease. Thus, the HI-virus integrates itself into the very same cells that are supposed to fight it. Instead, the CD4 cells now lose their capability of identifying and fighting not only HIV, but other viruses and , too.

The result is, over time, a substantial weakening of the human immune system. Diseases that pose no problem to an HIV-negative person, such as a simple cold, can easily develop into something as severe as in an HIV- positive person, if this person has reached the stage of AIDS.

AIDS: Acquired Immune Deficiency Syndrome

The Acquired Immune Deficiency Syndrome (AIDS) is the final stage in the course of HIV infection. Over time, the number of functioning CD4 cells in an HIV-positive person’s blood drops to very low levels. To compare: a healthy person has 600 to 1200 CD4 cells per millimetre of blood, whereas someone who has reached the stage of AIDS typically has less than 200. As described above, the body has then very little ability to fight off and even trivial diseases can now become life-threatening. This is what we call opportunistic infections – the most important one, manifested by many AIDS-patients around the world, being . Others include a rare form of pneumonia and specific forms of skin . Once the CD4 count of a person living with HIV drops to 200, and /or that person starts manifesting opportunistic infections, this is when doctors conclude that s/he has reached the stage of AIDS.

Please note that it can take a long time, as long as ten years or even more, for an HIV-positive person to develop AIDS. While approximately half of those newly infected with HIV have symptoms similar to those of flu (weakness, , , etc.) within the first two weeks, other people feel no impact and remain perfectly healthy until they start developing AIDS. 10 Chapter 1 HIV AND AIDS: BASIC FACTS

HIV and AIDS: Knowing the difference

All people living with AIDS live with HIV, but someone who is infected with HIV does not necessarily have AIDS. It is therefore extremely important that in writing about the pandemic, you recognize the difference between someone who is only HIV-positive and someone who has developed AIDS. Marking this difference helps to properly inform your audience of the various stages involved in the course of the disease. This counters HIV and AIDS related stigma stemming from fears of death and suffering by informing the public of how people living with HIV and AIDS often remain healthy, productive members of their community for many years.

HIV: How is it transmitted?

As is hopefully clear from the above information, a person can only become infected with HIV, not with AIDS. The HI-virus is carried in only five of our bodily fluids:

1. Blood – to be precise, it is only in the white blood cells. 2.  3 Pre-ejaculate – this is the one fluid often forgotten. It is the liquid produced by the male penis during sexual arousal, before . 4. Vaginal secretions or fluids 5.

No other human fluids, such as saliva or sweat, can possibly transmit the virus!

To transmit the virus from the abovementioned five liquids, they need to be in contact with a part of your body that is not protected by skin.

The main routes of transmission can principally be grouped into three categories:

1. Unprotected sexual relations, mainly vaginal or anal. also poses a very small risk of transmission. Worldwide, unprotected heterosexual intercourse is the most common way of contracting the virus. Women are biologically at greater risk than men because the vaginal mucosa is more easily ruptured during intercourse. 2. Contact with HIV-infected blood. This includes, of course, receiving infected blood-transfusions – a possibility that should be minimized by your country’s blood policy. Furthermore, sharing a needle, a piercing device or other medical devices that have not been properly sterilized are very effective ways of transmitting the virus, as they transfer it directly into the bloodstream. 3. The transmission of HIV from a positive mother to her child. An embryo in an HIV-infected woman’s womb does not carry the virus. However, the child can contract it during the , during delivery or by (remember that breast milk is one of the human fluids carrying the virus). HIV AND AIDS: BASIC FACTS Chapter 1 11

These three categories cover all routes of transmission. This means that you cannot contract HIV by:

• Kissing – remember that saliva is not one of the five transmitting human fluids. • Sharing a plate with an infected person. • Touching an HIV-positive person, for example during a hug or a handshake. This means that bodily fluids such as sweat and tears also do NOT transmit the virus. • Sharing a toilet – remember that , faeces and vomit do NOT transmit the virus. • Insect bites, for example from a mosquito, pose absolutely no risk of giving you HIV.

Generally, one of the best ways to remember how a person can and cannot become infected is to memorize the five bodily fluids that DO transmit the virus (listed at the beginning of the section).

HIV: How can you prevent it?

Each of the three categories of HIV transmission can be countered by very specific means of prevention.

In the case of sexual relations, it is obvious that people should protect themselves as well as possible during intercourse. They should use consistently and in every sexual encounter they have. If married or in a long- term relationship, both partners should get tested for HIV before deciding to renounce condoms. There are today two types of condoms, one for males and one for females, the latter being worn internally in the vagina. It is often said that abstaining from sex is the safest way to prevent contracting the virus. While there is some truth in this, you should be aware in your reporting that for many people, abstinence is not a real possibility (for different reasons).

In the second category – contact with contaminated blood – it is generally drug users who use needles that are at greatest risk. What they can do to reduce risk includes:

• avoid shared needles and syringes; • swallow drugs rather than inject them; • clean the skin at the injection site (as well as the injecting device) with alcohol before injecting.

Please note that again, the safest way of prevention - that is to stop using drugs altogether - is extremely difficult to achieve for many people.

Thirdly, to prevent the transmission from an HIV-positive mother to her child, medications exists that can be used today to decrease the risk substantially by interfering with the virus’ duplicating process. Risk of transmission can also be reduced if the mother delivers her baby via . During this procedure, the baby comes into less contact with the mother’s blood than 12 Chapter 1 HIV AND AIDS: BASIC FACTS

during a natural birth. Mothers can additionally avoid the risk of transmitting the virus to their children by renouncing breastfeeding. However, replacement feeding (by bottle) is not always easily available to concerned mothers. Infants in their first year can be especially vulnerable to malnutrition (which also affects their immune system) and therefore renouncing breastfeeding may present serious dilemmas for mothers. For this reason, the United Nations recommends that:

“When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life and should then be discontinued as soon as it is feasible. To help HIV-positive mothers make the best choice, they should receive counselling and have access to follow-up care and support, including nutritional support.” 8

HIV: What treatment exists?

There is no known cure for HIV and AIDS. Once a person becomes infected with the virus, there is absolutely no way to reverse this status. However, there exist today treatments in the form of medications to help postpone the point at which an HIV-positive person develops AIDS and for those with HIV and AIDS to remain healthy for a longer time. The medication works by slowing down the replication of the HI-virus, and by preventing it from attacking more CD4 cells. These drugs are known as Anti-RetroViral medications, commonly referred to as ARVs.

HIV-positive people start taking ARVs once their CD4 cell count has dropped to a certain level (even if they have not manifested opportunistic infections yet). Once they start taking medications, they must continue this for the rest of their lives. This is all the more important as the HI-virus is an extremely rapidly mutating virus. If a person stops taking his/her ARVs or does not take them regularly, this may give the virus the time it needs to duplicate and become resistant to the treatment!

In addition to existing ARVs, scientists are currently working on a range of future treatments, which are still at the experimental stage. Most are unlikely to come onto the market for several years, but it is important to be aware of the scientific developments in this area. These envisioned treatments include:

• Several new classes of anti-retroviral medications. The constant search for new ARVs is important also to treat new, mutated forms of the HI-virus. • Microbicides, a substance that kills HIV on contact. Eventually scientists hope to incorporate this into creams, gels or foams that can be applied in and around the vagina and anus to prevent HIV transmission during . 8 UNAIDS. 2007. Nutrition and Food Security. Accessed There is also an ongoing debate about the need for further research on the 10 January 2008 at: http:// use of traditional medicine in HIV and AIDS treatment. The reason for this is www.unaids.org/en/ that in many regions of the world, a great number of people turn to traditional PolicyAndPractice/ healers rather than to biomedically trained doctors, as traditional healers often CareAndSupport/ NutrAndFoodSupport/ provide valuable psychological and and are more familiar with default.asp people’s living circumstances. In this sense, UNAIDS calls for “collaborative HIV AND AIDS: BASIC FACTS Chapter 1 13

research to validate traditional/alternative remedies and to understand how they may affect treatment with modern medicines”.

This is especially important as ARVs may not be readily available in every region of the Caucasus and investigating the situation in your community could be a possible idea for a story. In reporting on traditional healers, you should be very sensitive to misconceptions and superstitions that may be promoted.

HIV: the global extent of the pandemic – understanding HIV statistics

In 2007, there were approximately 33 million people infected with HIV across the world. 2,5 million of them were children under the age of 15; and 15.4 million were women. New infections in 2007 numbered about 2,5 million, meaning that there were over 6,800 people infected every day.

You can obtain the newest figures about the global AIDS pandemic, updated annually, from the UNAIDS webpage: http://www.unaids.org/en/KnowledgeCentre/ HIVData/EpiUpdate/EpiUpdArchive/2007/default.asp. UNAIDS provides information clustered by region, as well as a global overview: (http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_ Global_report.asp).

Comparing the UNAIDS Epidemic Update from 2006 with that of 2007, you will notice remarkable differences in the statistics. However, these are not due to actual changes in epidemic trends, but rather to refinements in the methodology for obtaining the figures. This hints to a very important point that you should always be aware of when dealing with HIV statistics: the actual numbers of people living with HIV are extremely difficult to establish accurately.

Therefore, when dealing with HIV statistics as journalists, you should always ask where these numbers come from and how they were obtained. To this end, it is useful to become acquainted with the basic terminology of statistics:

• : is the measurement of the total number of cases of HIV-positive individuals within a given period of time. • : refers to the number of new HIV infections during a certain period of time (and thus do not include existing cases of infection before the identified time period).

However, both prevalence and incidence rates are often based on estimates, especially if given on a national level. These estimates are the result of mathematical calculations that are often very hypothetical.

• Countries with a "generalized epidemic" have more than one percent of the population that is HIV positive. In these countries, national prevalence rates are usually based on surveys of pregnant women attending antenatal clinics. These surveys are meant to be reliable indicators of the prevalence rate in the entire population. However, in some of these countries a considerable number of women do not attend clinics and their HIV-status is therefore never registered. Although there are mathematical models of calculations that take these factors into account, you can see that the resulting national prevalence rate can hardly ever be completely exact. 14 Chapter 1 HIV AND AIDS: BASIC FACTS

• In countries with a low level or concentrated epidemic, high levels of HIV- infections occur only among specific groups of the population, which are then often labelled high-risk groups. For the moment, this is the case in the South Caucasus (see Chapter 2). In these countries, national prevalence estimates are based on surveys of HIV-infection among high-risk groups. Again, you can see that these estimates can only come close to the truth, but never actually tell it entirely.

For these reasons, you may want to be very careful when using statistics in your reports and not rely on them too heavily. After all, telling the stories of individuals and how HIV affects their lives may paint a more accurate picture of the epidemic in your country than just giving abstract numbers.

Tips for Trainers Ask each trainee to find 3 newspaper articles about HIV and AIDS and to check them for factual accuracy. Are statistics used, if so how often and are they clearly explained? Hold a class discussion about the differences between HIV and AIDS and how often people get the two confused. Ask trainees to identify what, if any, myths or false information about HIV transmission currently circulate in their communities. HIV and AIDS in the South CAUCASUS Chapter 2 15

CHAPTER 2

HIV and AIDS in the South CAUCASUS: Trends and Routes of Transmission

Within the past decade there has been a twenty-fold increase in the number of people living with HIV in Eastern and Central Asia. In May 2006, , the executive director of UNAIDS, warned that the HIV and AIDS epidemic in Eastern Europe and Central Asia was one of the fastest spreading in the world.9 Between 2001 and 2007, the number of people living with HIV within the region has increased by 150%.10

The epidemic is still considered to be in its early stages in the South Caucasus, and the number of people living with HIV remains relatively low compared with other countries in the region.11 However, the rapid progress of HIV signals a need for immediate and appropriate responses in order to avoid a worsening scenario.

HIV and AIDS in the South Caucasus

Since the mid- to late-1980s when HIV was first reported in the region, official figures show increases in the number of people infected with the virus. More recently, however, this increase seems to have accelerated, as illustrated by the graph below. In Georgia, over 50% of registered cases of HIV were reported since 2004, and comparable patterns were found in other South Caucasus countries.12 9 UNAIDS. 2006. Eastern New HIV infections in the South Caucasus (2002-2005) Europe and Central Asia Source: EuroHIV are Facing the Challenge. Accessed 23 October 2007 at: 600 http://www.unaids.org/ 500 en/KnowledgeCentre/ Resources/ 400 FeatureStories/ archive/2006/20060516- 300 EECCAAC.asp 200 10 UNAIDS. 2007. AIDS n Georgia 100 Epidemic Update. Accessed n Azerbaijan 10 January 2008 at: http:// 0 n Armenia data.unaids.org/pub/ 2002 2003 2004 2005 EPISlides/2007/2007_ epiupdate_en.pdf

Despite this, the reported numbers of people living with HIV in the South 11 Caucasus are still relatively low compared with those in other former Soviet Latest figure published by UNAIDS estimate prevalence countries. The table above reflects some information collected on the numbers rates among adults aged 15 to of people living with HIV. 49 in Armenia and Azerbaijan around 0,1%, and around 0,2% in At the moment, more men seem to be infected with HIV than women. This Georgia. Conversely, reported may point towards the relative freedom that men in the South Caucasus have rates for Ukraine are estimated around 1,4% , and around 1,1% in sexual affairs, meaning that they have a greater number of sexual partners in Russia. than women and thus a bigger chance of getting infected. Meanwhile the social and sexual restrictions placed on women can seriously reduce their ability to 12 UNAIDS. 2007. AIDS protect themselves from future HIV infection (see Chapter 4 on Gender). If Epidemic Update. Accessed not addressed early in the pandemic, this could result in a reversal of current 10 January 2008 at: http:// infection trends. This dynamic of reversion has been witnessed in sub-Saharan data.unaids.org/pub/ EPISlides/2007/2007_ Africa, where today 61% of people living with HIV are women. epiupdate_en.pdf 16 Chapter 2 HIV and AIDS in the South CAUCASUS

Registered cases of HIV infection in the South Caucasus 13 (Azerbaijan, Dec 2007; Armenia, Dec 2007; Georgia, Jan 2008)

HIV Azerbaijan Armenia Georgia Total 1232 538 1517 Men 984 83,7% 401 74,5% 1155 76,1% Women 193 16,3% 137 25,5% 362 23,9% < age 30 400 32,4% N/A N/A N/A N/A

Some people consider the number of HIV infections to be substantially underestimated in the Caucasus. The discrepancy among official statistics can be explained partly by the reluctance of some country authorities to admit the actual number of people infected with HIV. In addition, many people in the 13 UNESCO. 2005. HIV and AIDS Caucasus (as elsewhere) fear and therefore avoid HIV tests because of high in the Caucasus Region: A levels of misunderstanding, stigma and distrust surrounding the virus. This too Socio-Cultural Approach. Paris, contributes to difficulties in reporting accurate figures. UNESCO. http://unesdoc. unesco.org/images/0014/ The implications of misreporting statistics can be extremely serious. 001411/141152E.pdf Underestimating the figures risks discouraging the commitment and 14 World Health Organization mobilisation of resources; while overestimating them may lead to panic. (WHO). 2008. Sexually transmitted infections/ Key routes of transmission HIV/AIDS: Azerbaijan. Accessed 23 July 2008 Despite the difficulties in reporting accurate numbers, much is known at: http://www.euro. who.int/aids/ctryinfo/ about how the virus is transmitted and which populations are most at risk overview/20060118_4 throughout the region. Recent research reveals that the primary modes of HIV transmission in each of the three South Caucasus countries are relatively 15 UNGASS. 2008. UNGASS similar, as demonstrated by the table below. Country Progress Report: Republic of Armenia. Accessed Registered HIV cases and transmission routes 23 July 2008 at: http:// 14 15 16 data.unaids.org/pub/ (Azerbaijan Dec. 2006 ; Armenia Dec. 2007 & Georgia Dec. 2006 ) Report/2008/armenia_ 2008_country_progress_ Route Azerbaijan Armenia Georgia report_en.pdf Total cases 1010 538 1156 Injecting intravenous drugs 56% 47.4% 62% 16 UNGASS. 2006. Georgia Country Report. Accessed Heterosexual sex 22% 45.3% 31.5% 23 July 2008 at: http:// Other (i.e. Mother to child 22% 7,3% 6,5% data.unaids.org/pub/ transmission, , Report/2008/georgia_ men having sex with men) 2008_country_progress_ report_en.pdf Intravenous drug use is currently the primary means of HIV transmission, 17 UNESCO. 2005. HIV and AIDS putting intravenous drug users at greatest risk. About half of all registered in the Caucasus Region: A cases in Azerbaijan and Armenia and more than two thirds of registered cases Socio-Cultural Approach. Paris, in Georgia resulted from unsafe drug injecting. UNESCO. http://unesdoc. unesco.org/images/0014/ 001411/141152E.pdf In each of the three countries, most injecting drug users are young men. It is generally acknowledged that drug use makes people more likely to engage in 18 World Health Organization high-risk behaviour such as having unprotected sex. Drug use is rarely a solitary (WHO). 2008. Sexually activity in the region and the sharing of needles and equipment is common.17 transmitted infections/HIV/ AIDS: Georgia. Accessed 23 July Heterosexual relations are the second most common mode of transmission 2008 at: http://www.euro. who.int/aids/ctryinfo/ for HIV in the South Caucasus. In Georgia, one out of three individuals registered overview/20060118_16 with HIV were infected through unprotected heterosexual contact 18, while in HIV and AIDS in the South CAUCASUS Chapter 2 17

Azerbaijan it was one out of four 19. In Armenia, unprotected heterosexual intercourse is the main route of transmission for women; accounting for 94% of infections.20

Other routes of transmission include blood transfusions, mother-to- child transmission at birth and unprotected sexual relations between men. It is important to note that each of these currently causes a relatively low proportion of new HIV infections, refuting the cliché that most people affected by HIV and AIDS are .

MEN HAVING SEX WITH MEN Worldwide, some men engage in same-sex relations. However, many of these men do not identify themselves as being homosexual or belonging to any identifiable sexual “community”. Nonetheless, they may have sexual relations with other men sporadically, or they may engage in relations with both sexes equally. For these reasons, the expression men who have sex with men (MSM) has been adopted.

Factors influencing HIV transmission

Migration rates are increasing in each of the three South Caucasus countries, sparked by the political transitions of the early 1990s, and coupled with continued and mounting economic pressures. Most migrants are men, travelling primarily to the Ukraine and Russia, which have some of the highest levels of HIV in the surrounding region. However, because much of the migratory movement is undocumented, it is extremely difficult to determine how many people are involved.

When labour migrants are away from their families and social groups, the chances of living in precarious conditions are higher. They are more likely to engage in high-risk behaviours such as having and abusing drugs and alcohol. For example, of the native Georgians who are registered HIV-positive, 79% were infected through drug use or sexual activity while out 19 World Health Organization of the country.21 (WHO). 2008. Sexually transmitted infections/ HIV/AIDS: Azerbaijan. The increased potential for high-risk behaviours experienced by migrants also Accessed 23 July 2008 impacts on family and community members who stay behind. Wives in particular, at: http://www.euro. are vulnerable to sexually-transmitted infections and HIV transmission from who.int/aids/ctryinfo/ husbands who have been away, as married couples do not commonly use overview/20060118_4 condoms. In Azerbaijan most women who contract HIV through heterosexual 20 intercourse claim they contracted the virus through sex with their migrant World Health Organization (WHO). 2008. Sexually husbands. transmitted infections/HIV/ AIDS: Armenia - HIV/AIDS Commercial sex work has the potential to become another factor of country profile. Accessed vulnerability in relation to HIV and AIDS throughout the region. At present, 23 July 2008 at: http:// rates of HIV infection among sex workers in the South Caucasus are thought www.euro.who. int/aids/ctryinfo/ to be relatively low. However, with persistent poverty in the region, the overview/20060118_2 future supply and demand for a commercial sex industry could increase. If work opportunities for women are limited, they are more apt to turn to 21 UNESCO. 2005. HIV and AIDS commercial sex work. At the same time, more men are expected to take up in the Caucasus Region: A migrant job arrangements connected with the development of oil and natural Socio-Cultural Approach. Paris, gas extraction in the region. With large numbers of male workers assigned UNESCO. http://unesdoc. unesco.org/images/0014/ to labour sites, there is an increased likelihood that they will approach sex 001411/141152E.pdf workers. 18 Chapter 2 HIV and AIDS in the South CAUCASUS

While it is fairly acceptable for men in the region to engage sex workers (it is even encouraged for sexual initiation), women who work in this field are severely stigmatised. This stigma contributes significantly to sex workers’ vulnerabilities:

Armed conflict and emergencies

For those journalists covering armed conflicts or emergency situations, the relationship between the pandemic and such events should be highlighted. In both cases, the chaos that results from conflict exasperates all of the factors which contribute to the spread of the epidemic. Population displacement, increased , human rights abuses, breakdown of community and political instability are just a few of the ensuing aspects of armed conflict and emergencies that place populations at greater risk of infection. For these reasons, the 2001 Declaration of Commitment on HIV and AIDS was established by the United Nations General Assembly to integrate HIV activities into programmes and action plans for emergency situations.

Vulnerabilities faced by sex workers Sex workers often lack the personal or social status necessary to negotiate safe sexual practice. This could explain why in Georgia, for example, condom use remains low among sex workers despite the fact that most of them are aware that condoms are an effective means to protect themselves against sexually transmitted infections (STIs). Sex workers often describe being exploited by the police, and so if raped or beaten by clients, they seldom turn to the police for help. The abusive conditions in which commercial sex occurs often lead to drug and substance abuse among sex workers. Because commercial sex work has no official status, sex workers often have limited or no access to healthcare and other support services. Sex workers from small towns or villages often move to cities in order to remain anonymous. When they leave their families and friends, they are deprived of the support provided by those closest to them. This can increase their economic and emotional vulnerability. HIV and AIDS in the South CAUCASUS Chapter 2 19

Sex workers are a diverse group of people including men and women, young and old, single and married people. In Armenia, for example, almost one in four sex workers are married. A large number of these women regard working in the sex industry as part of their economic responsibility - a way to bring food home to their family.

Reporting HIV transmission with care

Although HIV transmission can occur through activities that are severely stigmatized such as commercial sex work or drug use, it is crucial to remember that HIV is not confined to certain people or crowds. Since all social groups are inter-related, no one is completely without risk of contracting HIV.

It is therefore extremely important that the epidemic is not portrayed as something of a threat to only particular groups. Doing so contributes to greater stigma, while encouraging others to wrongly believe that they are ‘safe’ from infection. When reporting on commercial sex work and its influence on HIV and AIDS, for instance, it is necessary to reflect the reality of how it compares with infection rates in other parts of the population.

Reporting on transmission: story ideas and possible angles • Are there known links in your community between drug use and HIV transmission? • Is drug use negatively or positively stereotyped, what is the perception of drug use among different groups, i.e. adolescents, young adults, working professionals? • What social support and counselling services are available to drug users? • Are strategies supported in your community? Are they controversial, who supports, who does not?

Tips for Trainers Ask trainees to present arguments and examples supporting the idea that HIV and AIDS do not only affect certain groups but society as a whole. Discuss the theory of six degrees of separation, how this could relate to the transmission of the HI-virus. Take an HIV-related statistic and ask trainees to discuss what additional information they think is required in order to use that statistic in an accurate and holistic way when writing an article. 20 Chapter 3 STIGMA AND DISCRIMINATION: HOW THEY DRIVE THE PANDEMIC

CHAPTER 3

STIGMA AND DISCRIMINATION: HOW THEY DRIVE THE PANDEMIC

From the start of the pandemic in the 1980s, stigma and discrimination have created serious obstacles to HIV and AIDS prevention, education, treatment, care and support. Stigma and discrimination create vicious cycles: individuals affected by HIV face rejection by friends, family, and communities which causes many people to hide their HIV-positive status. It may even discourage people from taking HIV tests in the first place (especially if there are no possibilities to take it anonymously), thus contributing to a silent spread of the epidemic.

As journalists reporting on HIV and AIDS in the South Caucasus, you have the opportunity to produce coverage that addresses these debilitating cycles. In doing so, you can help generate a deeper understanding of the harmful effects of stigma and discrimination among the population.

Stigma: A definition Stigma is a word of Greek origin indicating a mark, spot or stamp. In the past a ‘stigma’ was placed on the skin of slaves and criminals, to make it obvious to everyone that these individuals were not valid members of the community. Today, stigma can be defined as the devaluation of an individual by the people in his/her environment because of a certain attribute that s/he carries. This could be a physical attribute such as in some societies or certain professions in others. In the case of HIV, the attribute is not so much the infection itself, but rather the behaviour that is (often wrongly) associated with it.

The roots of HIV and AIDS-related stigma

Stigma and discrimination relating to HIV and AIDS stem in part from fear and misunderstanding. When HIV was first discovered in the early 1980s, those infected had already reached the stage of AIDS, and at that time relatively little could be done to treat and help them. Back then, HIV and AIDS were not well distinguished, but rather regarded as one and the same: a deadly condition. An HIV diagnosis therefore created panic, fear, and feelings of helplessness. Today, with the medications now available, HIV and AIDS can be more manageable in ways that can allow people to live for many years with the virus.

Despite this, the fears that commonly surround disease and contagion remain; especially since many people do not well understand HIV and AIDS or the ways in which the virus is transmitted.

The association of HIV and AIDS with behaviours that are already heavily stigmatised in many communities (i.e. drug use, commercial sex work, men having sex with men) is another reason HIV-positive people are discriminated against, whether or not they have contracted the virus through these behaviours. In the South Caucasus, it is common to discriminate against men who have sex with men. Although figures show that this group represents only a very small percentage of people with HIV, the discrimination against men who have sex with men is often transferred onto all those identified as HIV- positive. Stigma and discrimination relating to HIV and AIDS therefore build on longstanding prejudices regarding sexuality, gender, race and poverty. STIGMA AND DISCRIMINATION: HOW THEY DRIVE THE PANDEMIC Chapter 3 21

Individuals and groups often perpetuate stigma, and discriminate as a way to dissociate themselves from others. For example, many people believe that since they do not use intravenous drugs, they do not fall into the category of those who could contract HIV. However, this false sense of security is extremely dangerous, as these people may then fail to protect themselves from infection. Yet the epidemic is not just a risk among specific groups. Since all social groups are interrelated, anyone can contract the disease if they do not take proper care.

The multiple forms of stigma and discrimination

• Institutional stigma can occur throughout hospitals, schools, churches, the media, and workplaces. Laws, rules and policies can also exemplify institutional stigma and discrimination with practices such as compulsory screening of high-risk groups, limitations on international travel, and restrictions on individuals’ rights to confidentiality and privacy. Where such regulations exist, some people avoid being tested through fear of any association to the disease. National laws that maintain patient confidentiality and prevent people living with HIV and AIDS from being shunned are therefore essential. • Self-stigma is likely to occur in societies where HIV-positive individuals are already highly stigmatized. When this is the case, people may internalize stereotypes so deeply that, once they suspect themselves of being infected, their self-esteem is severely affected. They may start isolating themselves to avoid facing the contempt and mistreatment already experienced by HIV- positive people in their communities. • Stigma by association refers to entire families being treated poorly because one of their members are known to be HIV-positive.22 This often rests on the notion that HIV is contracted by behaving somewhat immorally; and, once more, on misinformation about how HIV is transmitted.

Reporting on stigma and discrimination

• What is the extent of stigma and discrimination that HIV positive individuals face in your community/society? • What form does it take? What are the possible consequences of stigma and discrimination for people living with HIV concerning their health, their social status and their economic situation? • How do stigma and discrimination add to the spread of HIV? • What are the mechanisms fuelling stigma and discrimination in your community/society? • Are there initiatives in your community/society that try to respond to stigma and discrimination? Do they use elements of local culture to do so?

22 CHANGE Project and the Tips for Trainers Academy for Educational Initiate a discussion about what forms of stigma and discrimination may exist Development. 2003. Understanding and Challenging within their communities, among which groups and for what reasons? HIV Stigma: A Toolkit for What do trainees think they can do to become aware of their biases? Action. Accessed 7 November 2007 at: http://www. Ask trainees to identify which groups, if any within their communities, are changeproject.org/ currently associated with HIV and AIDS. Are these groups represented in technical/hivaids/stigma. the media at all, if so how and how often? html 22 Chapter 3 STIGMA AND DISCRIMINATION: HOW THEY DRIVE THE PANDEMIC

RELIGION AND THE PANDEMIC

Faith-based organizations have a long history of health-related, humanitarian, and social services. With 70 percent of the world’s population associating themselves to a faith community, religious leaders and communities exercise a considerable amount of cultural, political, social, educational, and economic influence. The combination of this with their wide range of activities and resources has led to faith based organizations playing a key role in the broader civil society response to HIV and AIDS.

In Asia, Hindu religious leaders and Buddhist monks and nuns have integrated HIV prevention and education messages into traditional teachings. In Africa, Christian churches have provided health services for people with AIDS and in various Muslim communities worldwide, children orphaned by the epidemic have been cared for.

Yet, responses from religious communities have not always been positive and some have been known to contribute to HIV and AIDS related stigma. Due to certain behaviours and issues associated with HIV transmission (i.e. drug and alcohol abuse, commercial sex work, sexuality and exploitation), some faith-based communities have expressed strong judgment against HIV-positive individuals, at times condemning HIV as a punishment or equating it to sin for ‘indecent’ or immoral lifestyles.

While these views are not unique to religion, there has been a growing effort among some faith-based communities to more positively and effectively respond to the epidemic, building on their unique strengths.

Religion and HIV in the South Caucasus

As an historical and cultural crossroad, the southern Caucasus is a religiously diverse region. The national religions in each country include Islam in Azerbaijan, Armenian Apostolic in Armenia and Georgian Orthodox in Georgia. In addition to these, a variety of faiths are practiced across the countries including Zoroastrianism, Russian Orthodox and Judaism, among others.

Despite this religious diversity, research from 2003/4 indicated that attitudes towards HIV and AIDS are mostly negative across religions in the three countries. Religious leaders and communities have tended to view HIV as a punishment for what are considered immoral behaviours, such as drug use or sex with multiple partners. Given the prominent role of religious leaders throughout the region - attending inaugurations, parliament openings and playing a significant role in social discussions - a vast range of opportunities exist to more effectively and positively involve faith-based organizations in the response to the epidemic.

Reporting religion

• Which faith based organizations in your region have been working to address the epidemic? • What traditionally has been the relationship between the epidemic and faith- based organizations in your community? • Interview religious leaders about the role of religion in HIV and AIDS prevention and care. GENDER INEQUALITY AND HARMFUL GENDER NORMS Chapter 4 23

CHAPTER 4

GENDER INEQUALITY AND HARMFUL GENDER NORMS

The expansion of the epidemic has revealed how many societies struggle with gender inequalities and harmful gender norms. Gender dynamics impact on HIV and AIDS at multiple levels including transmission, treatment and care. Examples include the constraints placed upon women to control their own sexual and as well as expectations placed on men to have multiple sexual partners.

First, however, before discussing gender inequality and norms within the context of HIV and AIDS, it is important, for the sake of accuracy, to know the definition of the word ‘gender’, especially as it is often confused with the word ‘sex’:

• Sex refers to the biological and physiological characteristics that define someone as a man or woman, such as the sex organs; • Gender refers to culturally constructed roles assigned to men and women influencing what behaviours, activities and attributes are acceptable for each sex. As an example, this would include how having multiple sexual partners for men is usually considered acceptable while heavily stigmatizing for women. To mark the difference in your writing, you can use ‘male’ and ‘female’ for sex categories, and ‘masculine’ and ‘feminine’ for gender categories.23 • Gender inequality refers to the situation where equal rights, opportunities and privileges are not shared among individuals due to their gender roles.

Gender in HIV transmission

Gender inequalities and harmful gender norms put both men and women at risk for HIV exposure. The experiences of women, however, have recently received a good deal of attention due to sharp increases in HIV infection rates among females over the past decade. Of great concern is the reality that women’s rights to safe sexual relations and to autonomy in all decisions relating to sexuality is not respected in many settings worldwide. This often results in little or no control of contraception or HIV prevention methods and restricted access to information and education. Even more alarming is the presence of violence in the lives of women which can lead to HIV transmission as one in three women worldwide has been beaten, coerced into sex or otherwise abused during her lifetime 24 – both inside and outside of marriage.

Gender-based violence, HIV and AIDS 23 World Health Organization (WHO). 2008. What do we Gender based violence refers to violence against an individual or group mean by “sex” and “gender”?. based on their gender. Within the context of the epidemic, gender based Accessed 11 October 2007 violence is recognized as both a cause and consequence of HIV and AIDS. at: http://www.who.int/ gender/whatisgender/en/ The threat and fear of violence often prevents people from: index.html refusing sex to their partners or spouse, even if they strongly suspect • 24 . them of being HIV-positive; 2006. Statement on the taking HIV tests because they fear their partners will interpret this as a Creation of a New International • Agency for Women. Accessed confession of infidelity; 28 May 2008 at: http://www. asking their partners to get tested or to use a condom – this is often stephenlewisfoundation. • org/news_item. taken as an accusation of unfaithfulness; cfm?news=1588 24 Chapter 4 GENDER INEQUALITY AND HARMFUL GENDER NORMS

•  taking their ARVs regularly – many people go to great efforts to hide their HIV status from spouses and partners, this includes hiding medications. Given the extensive stigma that results from the association of HIV with immoral behaviour, any suggestion that one might be infected with the virus often triggers vehement and at times violent reactions. In combination with gender inequality, this leads to a disempowering cycle for women in particular, in which violence and the risk of contracting HIV enforce one another, leaving them with very little means to protect themselves.

Gender roles and norms for men as well impact HIV vulnerability. Expectations of encouraging men to have multiple sex partners or to manifest aggressive sexually dominant behaviour, while also discouraging condom use or medical treatment, are a few examples of behaviours that can put individuals at risk of HIV infection.

Gender within the epidemic

Gender roles also very much influence how individuals cope with the virus – whether living with HIV and AIDS or caring for relatives who are HIV-positive. For example, because HIV and AIDS are associated (often wrongly) with sexual behaviours that are considered unacceptable for women, HIV-positive women tend to be more heavily stigmatised than men in the same situation. A recent study conducted across seven countries revealed that HIV-positive men overall were hardly questioned about how they became infected and were generally cared for.25 In contrast, women were often accused of having had extramarital sex (whether or not this was the case) and received lower levels of support.

Another gender role frequently impacting on the epidemic involves the extent to which women provide care within family units and communities. This extends to family and relatives who become infected with HIV or develop AIDS. This role, considered ‘natural’ in many societies, implies that women carry a heavier moral, social and economic burden for the epidemic than men do. However, while women receive no money or recognition for supporting their relatives, they often face stigma and discrimination simply because of their association with HIV and AIDS. 25 The Body: The Complete HIV/ AIDS Resource. 2008. HIV and Gender roles in the South Caucasus Women Around the World. Accessed 23 July 2008 at: http:// www.thebody.com/content/ In the South Caucasus, where patriarchal values prevail, domestic violence against world/art45489.html women is not an unknown phenomenon. In a survey carried out in Georgia in 2004, more than 22% of the interviewed women reported that they had been a victim 26 UNESCO. 2005. HIV & AIDS of physical violence by their husband or partner at least once.26 For Armenia, it is in Georgia: A Socio-Cultural suggested that violence against women may even be considered an exhibition of Approach. Paris, UNESCO. 27 http://unesdoc.unesco. ‘manly courage’ by some people. The violence experienced by women in the South org/images/0014/001411/ Caucasus and worldwide is a major factor of their vulnerability to HIV and AIDS. It 141169M.pdf severely lessens their ability to negotiate for themselves, since they often risk domestic violence if they ask husbands or partners to use condoms. Fear of 27 UNESCO. 2005. HIV & AIDS violence can also deter women from being tested for HIV or disclosing their HIV- in Armenia: A Socio-Cultural positive status to their male partner. Approach. Paris, UNESCO. http://unesdoc.unesco. org/images/0014/001411/ Generally, gender inequality is found in many forms in the South Caucasus, not all of 141154E.pdf them as obvious as domestic violence. In each of the three countries, family serves as GENDER INEQUALITY AND HARMFUL GENDER NORMS Chapter 4 25

the fundamental social institution around which much of society is organised. Within the family, a woman’s position is often lower in both social and economic respects, and discussing sexual relations or insisting on using protection during intercourse is generally not acceptable for women. In a survey carried out in Armenia, people were asked whether a woman should refuse sexual intercourse with her husband if she knew that he had a sexually transmitted infection or another . 21% of female respondents and 27% of male respondents did not think that these were strong enough reasons for a wife to withhold sex.28

Outside the family structure, Caucasian societies tend to place greater sexual restrictions on women than on men. Premarital sexual relations, for example, are regarded as normal and even useful for men to gain experience. The situation for women however, is completely reversed. Virginity is considered an essential requirement for any bride and premarital relations are perceived as immoral. These sexual patterns have a strong influence on both men’s and women’s vulnerability to HIV and AIDS.

Furthermore, many women face serious economic constraints that increase their risk of exposure to HIV. Globally, women make up the majority of the world’s poor and illiterate populations. They are often deprived of equal opportunities on the formal labour market, so commercial sex work can become one of the few or only options available for their economic survival. In addition, women who are economically dependent on men tend to have less power to negotiate safer sexual relationships because they fear being abandoned by their partner.

Reporting on gender inequality and harmful gender norms • What are women’s and men’s traditional roles in your community/society? How do traditional gender images make people vulnerable to HIV infection? Do HIV and AIDS re-enforce or weaken these gender images? • What is women’s economic situation? Is there gender-based poverty in your community that contributes to the spread of the epidemic? • What forms does gender-based violence take in your community/society? How does it contribute to the spread of HIV? • What means and strategies (if any) do women have to negotiate safer sex with their husbands/partners?

Tips for Trainers Ask trainees to describe typical gender roles in their communities/ societies. What is expected of men and women respectively? How do these expectations affect people’s vulnerability to HIV and AIDS? 28 Analyze a range of stories from the local press from a gender perspective. UNESCO. 2005. HIV and From which perspective is the story covered – a masculine or a feminine AIDS in the Caucasus Region: A Socio-Cultural Approach. point of view? Who covers them – male or female reporters? How are the Paris, UNESCO. http:// genders represented? Do the articles contain gender stereotypes or biases? unesdoc.unesco.org/ How could the article be rewritten in a more gender-sensitive way? images/0014/001411/ 141152E.pdf 26 Chapter 5 Poverty: a cause and A consequence of HIV and AIDS

Chapter 5

Poverty: a cause and A consequence of HIV and AIDS

‘The current and projected socio-economic impact of the epidemic is so devastating that fighting AIDS and fighting poverty become one and the same battle.’ UNDP, 2002 29

Poverty is of great concern within the South Caucasus region. Over the past 15 years, Armenia, Azerbaijan and Georgia have endured significant economic hardships. Statistics from the World Bank show that the poverty level in all three countries is high, with an average of 46% of the population living below the poverty line.

But what exactly is the relationship between the epidemic and poverty? How do they influence each other? The reality for many worldwide is that poverty creates conditions encouraging HIV transmission while HIV and AIDS contribute to greater and more widespread poverty - two dynamics reinforcing each other in a downward spiral.

Poverty as a cause of HIV

Poverty reduces access to a wide range of basic needs such as proper nutrition, healthcare, medication, education, training and employment. The daily constraints imposed by poverty mean that it can be extremely difficult and sometimes impossible to avoid risky behaviour. For people who are literally concerned with their daily survival, immediate needs outweigh the risk of an infection that could cause death years ahead. Thus, a sex worker may agree to having unprotected sex with a client when she knows this will provide her with the means to afford a dinner for her family that night.

Hence, poverty often leads to survival strategies that can increase exposure to HIV. Commercial sex and labour migration are both examples of situations in which people face greater risk of infection – yet often, these are the best or even the only options available to earn an income. Another concern is that poverty can lead people into drug and alcohol abuse, as they may feel that alcohol and drugs help them to cope with the reality of their lives.

Poverty as a consequence of HIV and AIDS

While poverty can increase HIV transmission, being diagnosed with HIV leads many people into higher levels of poverty. An HIV diagnosis is not easily digestible news for anyone, and many people fall into depression, which may affect their ability to continue work. Others lose their job as soon as their HIV- positive status becomes known to their colleagues and superiors (remember 29 UNDP. 2002. HIV/AIDS and Chapter 3 on stigma and discrimination). Where the necessary medication Poverty Reduction Strategies. is not freely provided by the state, the cost of treatment with ARVs can Accessed 8 September 2007 create financial problems even for those who still have a job. This can begin a at: http://www.undp. org/hiv/docs/alldocs/ debilitating cycle, as each of these can affect their health and create additional hivprsEng25oct02.pdf economic burdens. Poverty: a cause and A consequence of HIV and AIDS Chapter 5 27

Please note that since many HIV infections occur among young people, it often hits them at the prime of their working life.30 This can increase not only individual poverty, but, if the epidemic expands, greater poverty at the societal level.

Reporting on HIV and poverty • How does economic hardship contribute to the spread of the epidemic in your community/society? • How does HIV increase levels of poverty in your community/society? • What are your government’s strategies to address the link between HIV and poverty? • What are the most common poverty-induced survival strategies in your community/society? How do they put people at risk?

Tips for Trainers

Hold a discussion in which trainees reflect on general poverty-related 30 Cruisaid and the Terrence problems in their communities/societies. How does poverty affect the Higgins Trust. 2003. Poverty health, working choices and family situation of those concerned? and HIV – Lessons from the Hardship Fund. Accessed Ask trainees to draw a diagram illustrating the links between HIV and AIDS 17 November 2007 at: and poverty. http://www.tht.org.uk/ informationresources/ Ask trainees to brainstorm and gather ideas for stories that highlight publications/ different links between poverty and HIV and AIDS. policyreports/ povertyandhiv.pdf 28 Chapter 6 WRITING YOUR STORY: LANGUAGE GUIDELINES

CHAPTER 6

WRITING YOUR STORY: LANGUAGE GUIDELINES

As journalists, you are aware of how your choice of language can strongly influence people’s perceptions and understandings of a subject. In the case of HIV and AIDS, your words can either help dissolve stigma and discrimination, or they can increase it by fuelling prejudice, fear and misunderstanding.

Accurate and appropriate language that is respectful and does not feed stigma is therefore vital. Being familiar with the socio-cultural issues surrounding HIV in your community and your country (as they have been presented to you in Section I) and knowing the basic biology of HIV and AIDS will help you achieve this.

The destructive impact of sensationalism

There are heated discussions about appropriate HIV and AIDS-related language use. One of the biggest criticisms concerns sensationalism. Strong adjectives, nouns and superlatives such as ‘killer disease’, ‘the AIDS scourge’ or ‘the worst disease’ can often be found in related coverage. While perhaps useful in catching the attention of the public, these fuel panic and fatalism and have seriously strained the relationship between the media and those living with and affected by HIV and AIDS.

The media and PLHIV: A difficult relationship A global online survey conducted by Internews evaluated the perceptions of people living with HIV and HIV and AIDS program managers on the epidemic’s news media coverage. Findings revealed that although the quality of reporting seems to be increasing, a good deal remains to be improved. Central points of the critique included: • Coverage: There is a general unhappiness about the scope and the character of HIV and AIDS coverage in the media, which is considered to be too marginalized, focusing too heavily on statistics and singular events like World AIDS Day, and ignoring the complexity of issues around HIV and AIDS. • Language: The language used to report on HIV and AIDS is still perceived to be stigmatizing – portraying people living with HIV and AIDS as passive victims, or even criminalizing them. • Conflict of interests:Some people living with HIV and AIDS feel that the media’s goals and the goals of HIV activists oppose one another. While the latter seek to sustainably raise awareness about HIV and AIDS and to increase support for HIV-positive people, the media are felt to be looking for stories of sensational and “breaking-news” character. Recommendations to improve this situation included: • The media should bring more investigative stories about social issues around HIV and AIDS, including more stories about those infected and affected to give the disease a face and a voice. WRITING YOUR STORY: LANGUAGE GUIDELINES Chapter 6 29

• Portrayals of people living with HIV and AIDS should try to focus more on their positive living. They should show how HIV-positive people are often very proactive in their community and in the prevention of HIV and AIDS. • Media outlets should employ journalists specialized in health issues to write about HIV and AIDS. Apart from training journalists, efforts should be made to sensitize editors to the importance of consistent reporting on the topic. Internews 2006 31

For these reasons, UNESCO developed ‘Guidelines on Language and Content in HIV- and AIDS-Related Materials’ to provide best practices for writing on the topic in English, French and Spanish (Russian to be published shortly). PDF versions are available free of charge on UNESCO’s website: http://portal.unesco.org/en/ev.php-URL_ID=35417&URL_DO=DO_TOPIC&URL_ SECTION=201.html

Further in this chapter you will find examples of terms that are considered appropriate or that are to be avoided. However, it has to be acknowledged that the language recommended by HIV activists and organisations is not always suitable for journalists and their respective media. Some of the expressions are rather technical and risk being unappealing to an audience not particularly familiar with HIV and AIDS terminology.

The following example illustrates this tension with regard to the term ‘orphans and vulnerable children (OVC)’ that is commonly recommended as the expression for children who have lost one or both parents to the epidemic.

Finding the right words 32

“If I had to use ‘vulnerable children’, [my readers] would be really confused. Our job is to help readers understand the issues – not to make it more difficult.” Anso Thom, Health journalist

“My listeners would not understand what I’m talking about if I referred to children orphaned by AIDS as ‘orphans and vulnerable children’. It’s too NGO-ish. I just use the word ‘orphan,’ otherwise no one would know what I am talking about.” 31 Internews Network. 2006. Brenda Wilson, Radio correspondent Voice and Visibility: Frontline perspectives on how the global news media reports on As journalists you are assigned the – at times very difficult – task of choosing HIV and AIDS. Accessed 7 between language that HIV-positive people consider to be the most respectful, November 2007 at: http:// and expressions that are more commonly known among the wider public (but www.internews.org/ often felt to be discriminatory by PLHIV). An ongoing and open dialogue with pubs/health/20061100_ the people you write about should help you make those decisions. If there voice&visibility.shtm is an agreement between you and your interviewees/informants concerning 32 Both examples are taken from the goal and the content of your article, then you should be able to find Malan, M. 2008. Debating HIV/ a compromise regarding the language. However, if a term is consistently AIDS Language: Talking about rejected by your partners, then it will be in the best interest of all involved if HIV/AIDS. Gender & Media you respect that. Diversity Journal, pp. 68-73. 30 Chapter 6 WRITING YOUR STORY: LANGUAGE GUIDELINES

Avoid Use Explanation HIV/AIDS HIV and AIDS The first terms implies synonymy of HIV or HIV&AIDS and AIDS, while the latter marks the distinction between the two. Generally, it is recommended to use just HIV unless specifically referring to AIDS or to both HIV and AIDS.

AIDS test, HIV test, Clearly, neither an AIDS test nor an AIDS AIDS virus HIV/HI-virus virus exists, as AIDS is the syndrome that develops from HIV.

Infected Infected with You cannot be infected with a syndrome; with AIDS HIV, HIV- hence the expression ‘infected with AIDS’ positive does not make any sense.

AIDS victim, People living “Victim” and “sufferer” are among those AIDS with HIV or terms most rigorously contested by sufferer AIDS HIV&AIDS activists. They are perceived to be disempowering, in that they imply passiveness and immediate sickness, whereas HIV-positive people can remain healthy and productive members of their communities for a long time.

Innocent HIV-positive The expression ‘innocent victim’ is often victim person, used to refer to HIV-positive children or Person with to people who have acquired HIV through medically- blood transfusion, etc. However, the term acquired HIV implies that other HIV-positive people are to blame for their HIV-status. Such insinuations severely fuel stigma and discrimination.

Having several ‘Promiscuous’ is a term that conveys strong partners, judgement. Simply stating that someone has Having multi- several sexual partners is more objective partnered and helps to avoid fuelling stigma and relationships discrimination.

Prostitute Sex worker ‘Prostitute’ and other expressions (e.g. ‘street walker’) do not reflect the fact that sex work is usually a form of employment and not a preferred way of life. WRITING YOUR STORY: LANGUAGE GUIDELINES Chapter 6 31

Generally, you will be well advised to use the same terms to describe people you are talking about that they use themselves, whether it is homosexual men or drug users. You should generally spell out abbreviations – that means, write ‘people living with HIV’ or ‘HIV-positive people’ instead of PLHIV, and ‘men having sex with men’ instead of MSM, where possible.

Some HIV and AIDS activists are also trying to move away from any language using military metaphors, such as ‘the fight against AIDS’ or ‘to combat HIV and AIDS’. Although these expressions are very commonly used, some people perceive them as being discriminatory (implying that HIV-positive people need to be fought against) and also as fuelling a fatalistic perception of the epidemic. Instead, you can use more objective terms like ‘response to HIV and AIDS’, ‘HIV and AIDS intervention strategies’, etc.

Those are only a few examples of recommended terminology. Apart from the UNESCO Language Guidelines, you can also reference UNAIDS terminology guidelines under http://data.unaids.org/pub/Manual/2008/20080226_unaids_ terminology_guide_en.pdf (available in English).

Summing up, two parameters should consistently influence your choice of language:

1. Ask yourself whether the terms used transmit correct and accurate information – which expressions like ‘AIDS test’ or ‘AIDS-infected’ clearly do not. 2. Ask yourself whether or not the very same people you write about are happy with the terms you use to describe them. 32 Chapter 7 HIV AND AIDS REPORTING: BASIC PRINCIPLES AND TECHNIQUES

CHAPTER 7

HIV AND AIDS REPORTING: BASIC PRINCIPLES AND TECHNIQUES

In an international survey questioning people living with HIV about media coverage, most respondents had a low regard for their local media.

‘This included the quality of the coverage about HIV and AIDS and the portrayal of PLHIV which they said ranges from infrequent, inconsistent and inaccurate to crisis- driven, sensational and superficial.’ Internews, 2006 33

The last chapters stressed the importance of taking into account different perspectives on HIV and AIDS, as opposed to strictly biomedical ones. As a journalist working from within your own country or community, you are in the ideal position to report on issues such as poverty and gender within the local context. As a member of the society you write about, you are familiar with its values and beliefs, this can make your stories more relevant and compelling for your audience. However, it is important to be aware that for the same reason, you yourself may be influenced by biases that stem from your cultural background and that, in some cases, it may be hard for you to write about certain issues objectively.

Furthermore, how you write about certain issues may be impacted or even restricted by other subjects – for example, if you write about stigma and discrimination, you may have to question the authority of well respected religious leaders.

Yet the basic principles of journalism should help you to deal with these obstacles.

Accuracy is one of the foremost principles of journalism. Checking the validity of so-called facts before reporting them should be a matter of course for journalists. False information about transmission and the disease can have a tremendously negative impact. Inaccuracy in the context of HIV and AIDS reporting can fuel stigma and discrimination, and/or communicate misinformation – both of which can contribute to the spread of the pandemic.

33 Internews Network. 2006. Therefore, any story about HIV and AIDS needs to be based on a thorough Voice and Visibility: Frontline investigation that draws from reliable and balanced sources of information. perspectives on how the You will find a list of suggested sources under ‘Balance’. As noted in Chapter global news media reports on 1, you will further ensure accuracy by becoming well acquainted with HIV HIV and AIDS. Accessed 7 and AIDS terminology. It is especially important that all medical information November 2007 at: http:// www.internews.org/ you give about treatment are correct. Information about new findings in the pubs/health/20061100_ search for a cure for HIV and AIDS, when reported without due investigation, voice&visibility.shtm can endanger people who are desperate to salvage their health. HIV AND AIDS REPORTING: BASIC PRINCIPLES AND TECHNIQUES Chapter 7 33

Case study: Armenicum In 1999 a pharmaceutical company in Armenia announced that it had invented a radical new drug to treat HIV. This medication was called Armenicum. News about the innovative super-drug spread rapidly around the world. According to Armenian sources more than a million people rushed to register for the treatment. The drug’s inventor, Alexander Ilyen, was convinced of its effectiveness. “At the moment it’s premature to say it’s a cure. I’m very careful about the results we have achieved. But I’m convinced that we will prove that we can cure HIV” he told a BBC reporter.34 But the reporter discovered that Armenicum was not only ineffective against HIV, but that it could actually harm patients. Eventually the head of the laboratory, Tigran Davtyan, acknowledged that he had not carried out adequate, thorough research.

When writing about new findings, you may therefore want to check your information with pharmaceutical companies and medical organisations and research it in medical journals.

Lastly, in terms of accuracy it is also important to remember that getting the facts right is not only about presenting statistics and the science. In fact, statistics and science can be very limited and rarely provide the full story, especially since they are usually ‘estimates’. In many cases, there is a great deal of uncertainty surrounding these figures – remember what was said about HIV statistics at the end of Chapter 1. Instead, investigating beyond the numbers and uncovering the social, cultural and economic dimensions of the epidemic to present the real world day-to-day realities can often improve accuracy and allow your audience to better relate.

Balance is a principle that has so far suffered within HIV and AIDS reporting. Biomedical perspectives have often dominated the coverage and those communities most affected have been frequently overlooked. Yet, presenting different perspectives in your reporting is one of the basic recommendations of conduct for journalists and an important means to ensure objectivity (see below). In the context of HIV and AIDS it is all the more important because of the many misconceptions about how people contract the disease, and because so little is known about the experiences of those affected.

Ideally, your reports should be based on a wide variety of sources and balance the voices of scientific experts or government officials with those of people affected. Below is a non-exhaustive list of possible sources.

• People living with HIV for insights into the living conditions of those affected, their experiences (such as stigma or access to medication) and their activities (for example in prevention campaigns). 34 BBC World Service. 1999. • Medical professionals for medical verifications about transmission and Discovery: Armenicum. treatment. See: http://www.bbc. co.uk/worldservice/sci_ • National AIDS centres for information on your country’s national tech/highlights/000720_ response to the epidemic. armenicum.shtml 34 Chapter 7 HIV AND AIDS REPORTING: BASIC PRINCIPLES AND TECHNIQUES

• International organizations 35 involved in the response to HIV for additional information on the situation in your country and on the global trends in transmission, treatment and prevention efforts. UNAIDS, for example, has representatives in each of the South Caucasian countries. • Non-governmental organisations (NGOs) for the role of civil society and comments on national responses to HIV and AIDS. • Peer-reviewed journals for details of new findings along with the latest social and medical information about HIV and AIDS.

Balance is also about the tone of reporting. The before mentioned global survey conducted by Internews found that one of the major points of critique that people living with HIV have about media coverage is the often gloomy character of the stories (see p.38). Reports about successful leadership in HIV prevention efforts, about achievements in treatment and response, and about HIV-positive people leading healthy and productive lives – all of which are a reality – will help balance the tone of coverage.

Objectivity within reporting requires that journalists observe and examine their own views. Hence you are always challenged to make sure that your own biases do not influence your coverage. This is not always an easy task, as they may be deeply ingrained in your thinking. Also, most HIV transmission has to do with sexuality and gender – topics not easily discussed. However, sticking to the principles of balanced and accurate reporting should help you become aware of your own subjectivity.

Gender-sensitive reporting on HIV and AIDS is an effective way to improve objectivity, as it helps to unveil gender biases common in your community and also, possibly, how they affect you and your work. However, gender inequality is sometimes an almost invisible problem, and it may not be easy to gain a rational understanding of these issues.

Adding a gender perspective throughout all of your reports, even when gender is not the explicit focus, is an important means to address the matter of gender inequality. The assumption is that all issues covered by the media impact men and women, often in different ways. If you write a report on poverty and HIV, for example, interviewing equal numbers of men and women will balance their perspectives and help you compare how the two genders are affected (differently) by poverty. Generally, there are certain questions 35 International Organizations that you can ask yourself to ensure you are paying attention to the gender are here defined as implications of your reporting or of media coverage in general 36: intergovernmental bodies with sovereign States as members. 1. Who gets covered – mostly men or mostly women?

36 The questions and 2. From what perspective are stories covered – men’s or women’s? recommendations are based on UNIFEM/IPS. 2003. Gender, 3. What stereotypes are conveyed? HIV/AIDS and Rights -Training 4. Are stories written in a way that upholds traditional values and norms, Manual for the Media. See: http://ipsnews.net/aids_ even if they contribute to gender inequality? 2002/ipsgender2003.pdf HIV AND AIDS REPORTING: BASIC PRINCIPLES AND TECHNIQUES Chapter 7 35

You might write a gender-specific story with a direct focus on power relations between men and women. This may be a delicate manner, though, as many people may be unwilling to acknowledge that there is inequality in the relations between men and women, especially if they are the ones who benefit from the resulting power imbalance. Hence you may want to take an indirect perspective, for example by writing about the role of women’s leadership in a community organization that is involved in HIV and AIDS prevention, or about their economic disadvantages in certain areas.

Confidentiality Journalists are generally encouraged to reveal sources when possible in order to increase the creditability of their reporting. However, given the intense stigma and discrimination surrounding the epidemic it is recommended that the identity of people living with HIV and AIDS be disclosed only with explicit consent in all circumstances. Because HIV-positive individuals are often judged not only for having HIV but also for the ways in which people assume they have contracted it, extra consideration should be given to ensuring that confidentiality is protected unless explicit consent is given.

Conducting interviews with people affected

As mentioned earlier, there is a great deal of mistrust between the press and those affected by the epidemic. This is largely the result of past sensational, fatalistic and simplistic portrayals of HIV and AIDS issues in the media. Many people are also afraid of facing public rejection and stigmatisation should their identity being disclosed. The rights of those living with HIV and AIDS – including their rights to privacy and dignity – therefore must be respected in all circumstances.

While journalists are skilled at interviewing, those being interviewed are not usually familiar with the process and can easily feel intimidated. Advanced preparation is key to the entire process and includes:

• Learning as best possible about HIV transmission and the course of the infection; • Familiarizing yourself with the living conditions of those you interview and how this may have contributed to their becoming infected; • Awareness of the level of stigma and discrimination that your interviewees may face.

‘Journalists often ask HIV-positive people to tell negative and terrifying stories about their lives –

even if they are not true. [Survey] participants also cite 37 misquotation, sensationalizing, inexperience and lack Internews Network. 2006. Voice and Visibility: Frontline of preparation as well as breaching of confidence and perspectives on how the misquoting. This includes interviews broadcast without global news media reports on their knowledge and their names used despite explicit HIV and AIDS. Accessed 7 refusal to grant permission.’ November 2007 at: http:// Internews, 2006 www.internews.org/ pubs/health/20061100_ 37 (referring to research from Ukraine) voice&visibility.shtm 36 Chapter 7 HIV AND AIDS REPORTING: BASIC PRINCIPLES AND TECHNIQUES

Obtaining full consent before you interview someone with HIV or AIDS is critical. This means they should be aware of the possible consequences of the interview. In the countries of the South Caucasus people sometimes refuse to give interviews, fearing that their relatives may learn about their disease, and that they may become objects of public hatred and violence.

As a journalist your reports can help address fears, inhibitions and taboos, but there is always a risk that your stories may have damaging consequences instead. For instance, you may want to write about someone with HIV in your report to explain how fear and stigma help to spread the virus. But fear and stigma are so deep-rooted that by identifying your interviewee’s status you risk exposing him or her to the very difficulties you are trying to highlight. You always have the choice to conduct an anonymous interview, but if you do this you may want to explain why your interviewee was afraid to be identified. ANNEX 1 37

ANNEX 1

Glossary of terms relating to HIV and AIDS

AIDS – Acquired Immune Deficiency Syndrome: a combination of signs and symptoms that occur when HIV has compromised the immune system to such an extent that opportunistic infections can take hold easily.

Antibody – a special kind of protective blood that is used by the immune system to identify and neutralize foreign objects in the body, such as bacteria and viruses.

Antigen – a substance that triggers the production of .

Anti-retroviral drugs (ARVs) – medication used to treat retroviruses like HIV. They block the replication process of the virus, thus keeping the at a comparatively low level.

AZT – another name for , an anti-retroviral drug which is commonly given to help prevent mothers from passing HIV to their babies.

CD4 cell – an immune system cell () that is specifically attacked by HIV.

CD4 count – a laboratory test which counts the numbers of CD4 cells in the blood. In effect this measures the strength of the immune system. AIDS is clinically defined when someone has less than 200 CD4 cells in each cubic millimetre of blood.

ELISA – Linked Immunosorbent Assay – a laboratory test used to detect antibodies.

Epidemic – the (unexpectedly) wide and rapid spread of disease through a population of a particular geographical area. The use of the term epidemic may be subjective, depending on what is considered wide, rapid and ‘unexpected’.

HIV – Human Immunodeficiency Virus – the virus that leads to AIDS.

HIV transmission – at the biological level, the passing of HIV from one person to another through exchange of bodily fluids (vaginal fluid, pre-ejaculate, semen, blood, breast milk). The term transmission is also used on a macro level to refer to patterns of how the virus is passed on among certain groups or in a certain region – for example, in the South Caucasus the main route of transmission is currently the injection of drugs.

Immune system – a collection of mechanisms in our body that protects us from disease by identifying and killing invading viruses and bacteria. In the context of HIV and AIDS, the term often refers to specific white blood cells that are part of our immune system and that are specifically targeted by HIV. 38 ANNEX 1

Incidence – the number of new HIV infections during a certain period of time.

Long-term carrier – someone who lives with HIV for 7-12 years and has a stable CD4 count without taking anti-retroviral medications.

Microbicide – a substance designed to destroy or reduce the infectivity of microbes, such as bacteria or viruses. In the context of HIV and AIDS, scientists are trying to develop such a substance that could then be applied to the mucosa of the vagina or anus to protect people from the HI-virus. However, it is not sure when or if microbicides against HIV will come onto the market.

Mother-to-child transmission / vertical transmission – the passing of an infection from mother to baby, whether in the womb, during child birth or through breast milk.

Mucosa – the membrane lining of all body passages that communicate with air such as the vagina, anus, nostrils and the interior of the mouth. In the context of HIV and AIDS, vaginal and anal mucosas are especially vulnerable to HIV transmission, because they rupture easily during sexual intercourse.

Nevirapine – an often given to pregnant women with HIV at the time of labour, and given to the baby within 72 hours of birth, to help prevent the baby from contracting HIV.

Opportunistic infections – infections that usually do not cause illness in a healthy person, but that have their “opportunity” when someone’s immune system is weakened. These infections can include tuberculosis, pneumonia, , herpes, and many more.

Pandemic – an outbreak of a disease on a multiregional or global scale.

PCR – Polymerase Chain Reaction – a laboratory method of detecting HIV directly by copying its genetic material multiple times.

PLHIV – People/person living with HIV or AIDS (PLWHA has also been used in the past).

Prevalence – the measurement of the total number of cases of HIV-positive individuals within a given period of time.

Protease inhibitor – a class of anti-retroviral drugs that inhibits the HI- virus from replicating itself.

Reverse transcriptase – the enzyme that HIV uses to convert its genetic material into DNA so that it can hijack a cell.

Reverse transcriptase inhibitor – a class of drugs that interferes with the reverse transcriptase enzyme which is needed by the HI-virus to replicate. ANNEX 1 39

Serostatus – the result of a blood test showing the presence or absence of antibodies against an infectious organism. If someone is infected they have a positive (i.e. they are HIV-positive). If they are not infected their serostatus is negative (i.e. they are HIV-negative).

Sexually Transmitted Infection – STI – an infection passed from one partner to another during sexual activity.

T – white blood cells or immune cells that help defend the body against infection.

Triple – a combination of 3 different drugs taken to control the levels of HIV in the body.

Vulnerability – Within the context of HIV and AIDS, vulnerability refers to the range of demographic, behavioural, cultural and social factors placing people and/or communities at risk for becoming infected with HIV.

Viral load – the amount of a given virus (i.e. HIV) in the body, measured in the bloodstream.

Virus – a minute infectious particle that is only capable of replicating within living cells.

Zidovudine – (AZT) an antiretroviral drug, the first medication approved to treat HIV. 40 ANNEX 2

Annex 2

Analytical Exercises

Exercise 1 Understanding the role of a journalist in relation to HIV Write a short statement about what you feel the role of journalists should be within society including what you feel is the best service that the media can provide to the public. Does your vision perceive the media as communicators and/or providers of information, education and entertainment? Finally, with respect to your previous statement, write a few sentences about your role as a journalist when writing about HIV and AIDS, (no more than 300 words).

2 Finding an original story Find an original, local HIV and AIDS story that your media outlet should cover. Create a list of the organisations or individuals that you would contact during your research. Using appropriate language: 1. Write a news or story brief of no more than 200 words to sell the story to your Editor; 2. Write an additional news or story brief of no more than 200 words to show that you have considered any difficult issues which might arise in the course of your research and/or reporting.

3 Discovering local opinions on HIV and AIDS Carry out a vox pops (a series of interviews with members of the public) with people who form part of your target audience/readership. Ask how they feel about people living with HIV and AIDS and find out where their understanding comes from. Write a report based on what you find (no more than 1000 words), and include the most pertinent quotes.

4 Contemplating gender inequality: Getting personal How do you personally see the role of men and women within your society? Are they each treated equally? • If not, can you give an example of how you might contribute to this? • If so, consider whether gender inequality within your society could be hidden in some way. Look back on previous reports you have written and ask yourself whether any of these reports include your personal biases, opinions and stereotypes. • If so, what could you do to make your reports more impartial in future? • If not, ask others (particularly women) whether they find any biases, opinions or stereotypes in those reports. Can you reveal a problem which you did not know existed with your work? Write a reflective essay based on your findings, explaining what you have considered and/or discovered, and what conclusions you have reached. ANNEX 2 41

5 Understanding the implications of your reports: a case study The leader of an organisation representing immigrants in your home city tells you s/he is worried about the rising number of HIV cases among migrant populations. Your city has recently seen a massive influx of a people from a neighbouring country. The local population resents the newcomers and is reacting xenophobically. You decide to write a report on the issue. What implications might your report have? Explain in less than 500 words.

6 Issues of confidentiality Should you ever reveal the name of someone who is HIV-positive without their consent? Consider the following news stories: • A 17 year old sex worker in Azerbaijan was convicted of trying to infect her clients with HIV. • A woman in Georgia who contracted HIV through a blood transfusion won compensation from the blood bank after taking them to court. If you were reporting these stories, what considerations would you take into account while deciding whether to name the person concerned? What actions, if any, would you take to justify your decision? Write a brief explanation of your thought processes and the implications of your decision.

7 Discovering the human face of HIV Write a personality-based story about someone living with HIV – preferably someone who is unusual in some way, such as a sports person or a TV presenter. If necessary your interviewee can remain anonymous – discuss this possibility with them if they are concerned about giving the interview. For the most part of your interview you should forget that your interviewee is HIV-positive. Look for information that will help you to write an account of his/her daily life. Find out his/her hopes, desires and fears. Treat him/her like any other person. When you have compiled enough details for an interesting article, then ask your interviewee how HIV affects his/her life. How does their drug regime interfere with their day? Have they ever experienced stigma and/or discrimination as a result of their HIV status? How would they like to be treated by others? Write an article to show that this person is a human being, not just an HIV statistic.