Media and HIV/AIDS in East and Southern Africa: a Resource Book

SOUTHERN AFRICA: A resource book © The United Nations Educational, Scientific and Cultural Organization — 2000

This book has been prepared by the Communication Division of UNESCO. Editor: S.T. Kwame Boafo in collaboration with Carlos A. Arnaldo.

The authors are responsible for the choice and the presentation of the facts contained in this book and for the opinions expressed therein, which are not necessarily those of UNESCO and do not commit the Organization.

The designations employed and the presentation of material throughoutthis publication do not imply the expression of any opinion whatsoeveron the part of UNESCO concerning the legal status of any country,territory, city or area, or ofits authorities or concerning the delimination ofits frontiers or boundaries.

Layout & cover design: Eric Loddé

Printed by: Panoply TABLE OF CONTENTS

PART I. GENERAL REVIEW

Introduction S.T) Kwame Boafo and Martin Foreman CHAPTER | ABC of HIV/AIDS 15 Martin Foreman CHAPTER 2 Ethical Guide 25 Martin Foreman CHAPTER 3 Media functions in HIV/AIDS prevention and management 37 Wambui Kiai

PART Il. INVESTIGATIVE REPORTING ON CAUSES AND SPREAD OF HIV/AIDS: CASE STUDIES CHAPTER 4 Highly mobile population drives the spread of HIV/AIDSin Kenya 51 Rose Lukalo CHAPTER 5 The impact of migrant populations on the spread of HIV/AIDS in Uganda 63 Charles B. Rwabukwali et al. CHAPTER 6 Migrants with HIV/AIDS: A challenge to the media in Tanzania 70 Mkasafari Mlay CHAPTER 7 The impact of negative cultural practices on the spread of HIV/AIDS in Zambia 75 Parkie Mbozi CHAPTER 8 In Namibia AIDSis stalking the active at work whoare also the active in bed 83 Rukee Tjingaete

PARTIll. CONTENT ANALYSES OF MEDIA COVERAGE OF HIV/AIDS CHAPTER 9 Mass media and the AIDS pandemic in Kenya, 1997-98: A moral panic perspective 91 Lewis Odhiambo CHAPTER 10 The coverage of HIV/AIDS in Ugandan media: A content analysis study 109 Nassanga Goretti Linda CHAPTER 11 The Zambian newspapers and AIDS 121 Francis P. Kasoma CHAPTER 12 The coverage of HIV/AIDS in Namibian media: A content analysis study 133 Kingo J. Mchombu

PART|

GENERAL REVIEW INTRODUCTION

S.T. Kwame Boafo, Martin Foreman, Sector of Communication, Panos Institute, Information and Informatics, London, England UNESCO, Paris, France

The HIV/AIDS epidemic — the epidemic of often confused response to AIDS, sometimes Acquired Immune Deficiency Syndrome that spreading fear and hostility, sometimes pro- results from infection with Human Immunodefi- viding cool and accurate analysis. All too ciency Virus — is perhaps the worstcrisis facing often the media have reported uncritically the Africa today. Within the last twenty years this statements of governments, non-governmental fatal disease has spread to every country on the organisations and individuals. This can globe. By the end of 1998 it had taken the lives change. At the start of a new millenium,there of almost 14 million people. A further 33 mil- is an opportunity and a need for all the media lion were living with the virus, 22 million of to provide the leadership that will encourage whom were in Africa. the public and the leaders of our communities More than any other disease, HIV/AIDSis to take positive steps to overcomethis disease. as much a social as a medical problem. Primar- These steps will differ from country to ily transmitted through one of the commonest country. There are many Africans, from farm- human activities, sexual intercourse, it brings ers on the banks of the Nile to miners in the protracted illness and early death to men and Copperbelt of Zambia, from prosperous busi- women in the prime of their lives, kills new- nesswomen to homeless and impoverished born children and leaves their older brothers refugees, from the active youngto the resting and sisters in emotional and physical misery. old. Our cultures, languages, traditions, land- The epidemic feeds on the deep divisions scapes and histories are rich and varied; our within our societies — illiteracy, ignorance, potential without limit. This resource book poverty and inequality between the sexes — and cannot reflect such variety and wealth; it can, deepensthose divisions by making our commu- however, speak to our common humanity, nities poorer. helping us to share our experiences and unite In all but a few countries, the response to our response. HIV/AIDS can be defeated; it AIDShas been inadequate. Millions of men and needs only the commonwill to do so. women whoare fully aware of the threat of HIV are unwilling or unable to protect themselves and HIV: WHAT IT IS, WHAT IT DOES their partners. Community, religious and political leaders have failed to understand the extent HIV is a virus — an organism too small to be and the complex nature of the epidemic and have seen by the naked eye. Viruses survive by failed to provide the leadership required to pro- entering and reproducing within the living tect their citizens’ lives and livelihoods. Andall cells of larger organisms. HIV belongs to the too often the reaction towards those affected by class knownasretroviruses, whose reproduc- the disease has been fear, hatred and contempt tion is based on RNA(ribonucleic acid) rather instead of the compassion and assistance that than DNA (deoxyribonucleic acid). they and society as a whole require. HIV enters and replicates within a type of Since the beginning of the epidemic, the blood cell called CD4 cells. These normally media have both reflected and moulded the form part of the body's immune system,circu-

lating in the blood and attacking disease organ- There is a 25% to 40% chanceof this happen- isms. As it replicates, HIV destroys CD4 cells, ing. That figure is significantly reduced if the reducing the body’s immunity to other diseases. mother takes Zidovudine (AZT — other drugs Eventually these other diseases, known as are also under development for this purpose). opportunistic infections, overcome the body’s About 3% of cases worldwide are the result of resistance andthe patient dies. Although an indi- mother-child transmission; the rate in Africa is vidual whose immune system has been compro- about 8%. mised by HIV is subject to any disease, some HIV can also be transmitted in transfusions opportunistic infections are more common than of blood products if they are not screened others. These include Mycobacterium avium (tested) and through injections of medicinal or complex (MAC), which causes tuberculosis; recreational drugs if the injecting equipmentis Pneumocystis carinii, which causes a severe not sterilized. It can also be transmitted in any form of pneumonia; herpes viruses; toxoplas- other situation where the blood of an individual mosis and a range of bacterial infections. with the virus enters another’s bloodstream. Although tests are available to indicate This occasionally happensin hospital accidents, whether an individual has contracted HIV, they when a syringe with infected blood accidentally are not widespread in many parts of Africa. pricks a nurse, doctor or other patient. It may That means that many people only discover happen during shaving and male or femalecir- they have contracted the virus whentheyfallill cumcision (also known as genital mutilation) if with an opportunistic infection which may not the cutting implementis not sterilized between respond to regular treatment. Others learn the use. It can also be the consequence of a road or fact when a recently born child falls ill. other accident where several people’s blood is Because the virus can be transmitted from spilled. mother to new-born, diagnosis of AIDS in the The virus is not transmitted by mosquitoes, infant confirms that the mother, and probably bed lice or other insects, nor by sharing cooking also the father, is HIV-positive — living with the or eating utensils, nor by physical contact such virus. Depending on the severity of the illness as hugging, kissing or sharing a bed,toilet facil- and on how far advanced the HIV infection is, ities or other aspects of home life. the individual may recover. Inevitably, however, with their immune system weakened, SEX AND RISK without treatment they will fall ill again and eventually die. Even though sex is the commonest means of HIV transmission, it does not occur in every HARD TO CATCH sexual act. A number of factors influence whetheror not the virus will pass from one per- It is not easy to contract HIV. The virus has to son to another andit is impossible to estimate enter the body through the bloodstream andthat the extent of the risk in each individual act of only occurs in clearly defined circumstances. intercourse. All that can be said is that the more The commonestis sexual intercourse, when the often an individual has unprotected (without a virus in seminal fluid enters the bloodstream condom) sex with a partner with HIV, the more through the mucous membraneof the vagina or likely they are to contract the virus. rectum, or when the virus, present in vaginal In general, however, in any act of intercourse fluid or in blood in lesions in the rectum, enters a woman is more liable to contract HIV from a tiny lesions in the penis. Worldwide, about 90% man with the virus than vice versa. This is of cases of transmission occur this way. because the virus is present in greater quantities HIV can also be transmitted from a mother in semen than in vaginal fluid and because the with the virus to her new born child in the epithelium (the layer of cells) of the vagina and womb, during birth or through breast-feeding. cervix appear more subject to minuscule rup-

tures than the penis. In the absence of other fac- contract the disease. In fact HIV can be con- tors, such as other sexually transmitted infec- tracted by anyone who has sexual intercourse or tions and howrecently the infected partner con- comes into contact with contaminated blood, tracted the virus, a woman is twice aslikely to and experience has shownthatthe result ofallo- contract HIV during vaginal intercourse than a cating “responsibility” for AIDS is often to lull man. Anal intercourse — which is practised by those mostat risk into a false sense of security. men with womenas well as with other men — is a much higherrisk for both partners. THE GLOBAL EPIDEMIC The presence of sexually transmitted infections (STI’s, often known as STD’s), such as By mid-1999 HIV had spread to every country chancroid or gonorrhoea, which result in sores on the planet. Sex between men is the predom- or lesions, significantly heightens the risk of inant means of transmission in some countries, infection. The rapid spread of the virus in much such as the United States and the Scandinavian of Africa is at least partly the result of high rates countries. In other countries or regions, such as of untreated STI’s; in 1996, there were 65 mil- Russia or the state of Manipurin India, shared lion cases of treatable STI’s in Africa, represent- syringes or needles in recreational drug injec- ing one case for every five adults on the conti- tion are the predominant means of transmis- nent. sion. Worldwide, however, the virus is most often transmitted during sex between men and THE ROOTS OF AN EPIDEMIC women. Because womenare physically more vul- Diseases, like plant and animal life, evolve. nerable to HIV than men, and because men,on Every so often a virus that has lain dormant or average, have more sexual partners than undiscovered for years suddenly appears: recent women,the rate at which women worldwide examples include legionnaires’ disease, first are contracting the virus is rising faster than observed in the United States in 1976, and men. Between 1997 and 1998, the number of Ebola, discovered in the same year in Zaire. menbelieved to be living with HIV rose by 7% We may never knowthe point at which HIV (from 17.2 million to 18.4 million); in the ceased to be a harmless virus infecting Central same period, the number of women with HIV African chimpanzees to become a worldwide rose by 13% (from 12.2 million to 13.8 mil- killer of men and women. Thefirst cases of lion). AIDS were reported in June 1981 in the United Geographically, the epidemic is worst in States and in 1983 in Uganda, but there is evi- Africa, with up to one in four adults in some dence to suggest cases in the United States in cities being HIV-positive. Rates in Asia are 1969, in Europein the 1950’s and in what is now much lower, with perhaps fewer than one in the Democratic Republic of the Congo in 1959. 100 adults living with HIV, but the speed with Morespeculatively, there are suggestions of HIV whichthe virus is spreading and the far greater infection in different parts of Africa dating back population in Asia suggests that, unchecked, to the 19th century. There is no truth in the the epidemic may equal the intensity of Africa rumour that the virus wasartificially created — and surpass it in terms of numbers affected it has existed since long before the development sometime in the next 20 years. of technology to manipulate genetic material. Elsewhere, numbersare static or increasing In the early days it was suggested that spe- more slowly. In North America roughly one in cific groups of people — gay men in the United 200 adults has contracted the virus, compared States, sex workers (prostitutes) in Africa and to one in 400 in Western Europe. Rates in Latin African men and women in Eastern Europe and America are similar to North America and South Asia — were either “responsible” for the hover around one in 1,000 adults in the rest of epidemic or were the only people who could the world.

AFRICA AFFECTED spread belief that a man’s need for sex is beyond his control. For many men anything that appears In 1998 alone, 4 million adults and children in to interfere with their sexual lives, such as an sub-Saharan Africa contracted HIV and by the appeal to abstinence or use of a condom,is a end of the year almost 23 million people were threat to their masculinity. believed to be living with the virus, a million of Impelled by these attitudes, men, on average, whom were children. Across the region, 8% of report more sexual partners than women. In a adults — approximately one in twelve — were HIV- study of 12 African cities, men reported casual positive. sex (with more than one partner in the previous These figures mask substantial differences 12 months) up to 18 times more frequently than between countries. In terms of intensity of the women. The implications of this are that women epidemic, Southern Africa is worst affected with are likely to contract HIV butless likely to trans- up to one in four men and women between the mit the virus to other sexual partners while men age of 15 and 50 being HIV-positive in some are morelikely to contract and transmit the virus. areas. In terms of absolute numbers, South Africa In the long-term, this means that more women was worst affected by the end of 1997 (the latest than men will contract HIV. date for which country estimates are available), Compoundingthis situation is the fact that with 2.9 million people living with the virus. many men do not consider sex as a consensual Ethiopia followed with 2.6 million and Nigeria activity; sex has to take place when the man had 2.3 million, decides and without a condom if he chooses. In North Africa and the Middle East the fig- Wives are often beaten or ejected from their ures were much lower: 19,000 new infections in homeif they refuse to submit to their husbands 1998 and a total of 210,000 living with the dis- and many womenare at risk outside the home. ease. About one in 800 adults in the region were South Africa sees an estimated 1.3 million rapes believed to be HIV-positive. a year — one for every nine sexually active men. In such circumstances, many women find it MEN, SEX AND POWER impossible to protect themselves from infection with HIV or other STT’s. [Rape is not confined to The spread of HIV primarily depends on patterns women: in prisons or other single sex environ- of sexual behaviour — how often men and women ments some men rape other meneither as a sub- have sex and whothey have sex with. Not every- stitute for sex with a womanorto establish power one’s sex life is the same and patterns of sexual over their victim. In other situations, however, behaviour are strongly influenced by social, cul- sex between men maybe an expression of mutual tural and psychological factors over which men desire or the result of one’s desire and the other’s and women havelittle control. In addition to sex- financial need.] ually transmitted infections, described above, two Not all men behave this way — at any one factors in particular lie behind the epidemic in time only one in three or one in four men have sub-Saharan Africa and many other parts of the casual sexual relationships. Some menrespect developing world: male attitudes and poverty. their partner’s wishes, and factors such as lack Concepts of masculinity are changing. Never- of confidence prevent other men from having theless, men are generally expected to be strong, frequent sex without protection. It is, however, to be leaders, to be the primary provider of their this general expectation that men can insist on families’ food and shelter and to defend them- intercourse on demand and without use of a selves, their families and their societies from condom, which places both men and womenat aggressors. Virility — the ability to perform sexu- risk of infection. Men do not protect themselves ally — is an essential componentof masculinity in because male attitudes tell them not to; women almost every society. Young men are expected to do not protect themselves because men do not prove their sexual prowess and there is wide- allow them to.

WOMENAFFECTED Poverty leads many men and women to migrate in search of work, to cities or large pro- Women are affected by HIV/AIDS, directly jects in their own country or abroad, in formal or through their vulnerability to the disease and the informal employment. In new environments, sep- fact that they may pass the infection to their new- arated from families and friends, where the lan- born children, and indirectly in many ways. guage and culture may bevery different, sex may Womenare the chief carers in a community, provide a meansofalleviating loneliness for both both in hospitals and the home; they are often men and women or a much-needed source of expected to take such a role even when they them- income. selves are sick with HIV. Women whose husbands die of AIDS may be expelled from their homes THE BURDEN OF STIGMA accused by the man’s family of causing his death even when, as is most likely, the man contracted Perhaps the greatest problem confronting those the infection elsewhere and passedit to her. Old living with HIV and those working in AIDS care women find themselves taking care of grand- and prevention is the stigma attached to the virus children when their sons and daughters die, at a that arises from the powerful combination ofdis- time when they expected to be looked after in ease, apparentillicit sexual intercourse and death. their old age. Stigma prevents many from recognizing they are Women who challenge the status quo, by at risk of infection; it prevents many others from raising the issue of women’s vulnerability and admitting they are HIV-positive, which in turn pre- trying to organize means of prevention, may vents them from seeking physical and psychologi- be accused by men of addressing issues that cal support and from protecting their partners; and the leaders do not consider appropriate or stigma prevents a compassionate response from which threaten the status of men as community individuals and society at large to the disease. leaders. Stigma feeds on itself. Fear of saying “I have HIV”leads to denial and adds to the secrecy and THE IMPACT OF POVERTY shamethat surround the disease. Denial too feeds on itself; the more people who deny they have Poverty exacerbates the inequality between the HIV orare at risk, the easier it is to believe that sexes in a numberof ways. Unable to find a steady society itself remains unaffected, even when hun- independent income, many women enter sexual dreds a day are dying ofthe disease. relationships they would not otherwise choose. A few women and men, such as the Ugandan Many women whoare single or widowed, or musician Philly Lutaaya in the late 1980’s, have whose husbands have migrated in search of work, had the courage to combat stigma and help edu- find it difficult to provide themselves and their cate their fellow citizens by being open abouttheir children with food, shelter and clothing without HIV-positive status. Sometimes, however, the the assistance of men. Some men provide gifts in stigma and hostility are overpowering; in Decem- exchange for sex, but usually on their terms. This ber 1998 Gugu Dlamini wasstoned to death by her exchange can take many forms. The couple may neighbours in a South African township after she be a sex worker and herclient, a teenage girl and tried to help others with the virus by publicly a businessman whopays for her school uniform or announcing that she was HIV-positive. books, a middle-aged widow and a migrant sales- man whovisits her two or three times a month or SOCIAL AND ECONOMIC CONSEQUENCES any other situation where a woman’s need matches a man’s desire. For some, the relationship will be In May 1999 it was announced that AIDS was no more than the exchange of sex for money, but now the world’s fourth leading cause of death — for others there may also be a long-term emo- and it led to more mortality than any other tional bond. infectious disease.

The social consequences of the epidemic are TREATMENT staggering. Those mostat risk, sexually active adults, are the most productive members of In the last five years HIV/AIDShas highlighted every society, earning incomes for themselves, one of the mostglaring differences between the their families and their communities by tilling industrialized and the developing worlds: a dis- the fields or manufacturing goods, transporting, ease which responds to successful treatment in buying, selling and exporting products or pro- Western Europe or North America almostinvari- viding other services. Furthermore it is adults ably leads to death in Africa and Asia. The rea- whoraise children, provide for them and teach son is simple: the high cost meansthat treatment them to become productive membersofsociety. is only available in those countries and to those When a child or grandparent falls ill and individuals who can afford it. dies, it is a tragedy for the family, but when HIV/AIDSrequires two types of treatment - adults fall ill and die, that tragedy is com- antiviral (also known as antiretroviral) therapy, pounded by repercussions that affect the whole which combats HIV itself, and treatment for community. If a mother falls ill, not only is her opportunistic infections. Antiviral drugs are not incomelost, but the household tasks that women a cure for HIV, but when administered in con- traditionally perform — such as cooking and tak- junction with regular monitoring of the individ- ing care of the children — are neglected or per- ual’s health, they reduce AIDS to a long-term formed less well by the husband,if present and manageable disease for many people. This con- healthy, or by the older children. Cultivation is dition is similar to diabetes, which also cannot less efficient and livestock eat less well. Chil- be cured but can be kept under control. Unlike dren lose schooling if they have to stay at home diabetes, however, HIV can be transmitted and to look after a sick parentor if there is no money individuals with the virus who take antiviral to pay for fees or transport. drugs can still pass the virus to others. Eventually grandparents, older siblings or aunts and uncles take over running of the house- MEDICINAL DRUGS hold, but age or inexperience often mean these tasks are performed less well and income is By mid-1999, 15 antiviral drugs had been either severely reduced or lost. The children’s approved by the US Food and Drug Adminis- emotional stability may suffer not only from the tration (FDA) and a similar number were under death of the parent(s) but from the new environ- trial. HIV antivirals are generally divided into ment in which an aunt or uncle may be disin- three types: nucleoside analogues, non-nucleo- clined, or a grandparent unable, to provide the side reverse transcriptase inhibitors and pro- love and attention that came from their parents. tease inhibitors. Treatment with only one type Although still uncommon in Africa, in many of antiviral, such as Zidovudine (commonly cases children find themselves homeless, either known as AZT)is generally not beneficial; it is placed in orphanages or scavenging on the combination therapy — a combination of drugs, streets. sometimes known as a ‘cocktail’ — which pre- Despite this grim scenario, some experts, vents the virus from replicating. This combina- including the World Bank,believe that the over- tion may include up to 20 pills a day, which all economic impactof the disease in Africa will must be taken at specific times, before, during not be severe. Populations will grow more or after meals, depending on the drug. The cost slowly, but are unlikely to go into decline, while of such a combination can reach US $10,000 high rates of unemployment may mean that a per patient per year. rise in deaths will not affect overall economic Ensuring that patients receive the right production. Others paint a gloomier picture and antiviral treatment dependsnot only ontheabil- factors such as social unrest may yet have to be ity to pay for the drugs, but on access to doctors taken into account. with equipment to measure the extent of viral

activity and the body’s immuneresponse. That nancies to about one in 10 or 12. Financialassis- information confirms whether the current com- tance from the French, US and other Western bination is working or whether another combi- governments has allowed thousands of pregnant nation should betried. women access to Zidovudine across the conti- Antiviral drugs are available on a very lim- nent and at the time of writing another cheaper ited basis in Africa, as part of drug trials or drug, nevirapine, is proving effective in trials. imported by wealthy individuals. For the vast However, the stigma attached to AIDS pre- majority of Africans, however, antiviral drugs vents large numbers of women from taking the will not be available in the foreseeable future. drug, since they may not wish their husbands or Furthermore, the crisis in health care funding birth attendants to learn they have contracted facing much of the continent means that even HIV — even when their husbands may be the the cheaper drugs that cure or provide relief source of infection and the birth attendants are from opportunistic infections such as fever, diar- close members of the family. rhoea and pneumonia are often unavailable. VACCINATION TRADITIONAL HEALERS The difficulty in persuading sufficiently large Lack of access to the appropriate medical ser- numbers of people to change their behaviour, vices and a long history of indigenous medicine the high cost of antiviral drugs and the general have led many Africans to consult traditional belief that prevention is better than cure, all lie healers to relieve symptoms and, many have behind the drive to find a vaccine that will either hoped, to cure AIDS. While traditional healers prevent individuals from contracting HIV or can often alleviate pain and other symptoms, the prevent the virus from replicating once it is in claims by some that they can cure the disease the body. has been problematic. On the one hand, such Developing a vaccine is not easy, however, claims lead members of the public to be scepti- and the process is made more difficult by the cal of Western medicine and diagnosis, and, on fact that there are various strains of HIV, which the other hand, the fact that none of these are common in different parts of the world. “cures” has proved effective leads some sup- Strain B is commonest in Western Europe and porters of Western medicine to be sceptical of North America, for example, while strains A, C all traditional healers. and D are commonestin Africa. Given the lack of adequate medicalfacilities Financial and ethical considerations also in muchof Africa, there is a role for traditional play a role. In the early 1990s, pharmaceutical healers to provide services, particularly in alle- companies devoted almostall research to poten- viating the symptoms of opportunistic infec- tial vaccines against the B strain in anticipation tions. In some countries there is consultation that there would be a market for such a product between practitioners of Western medicine and in the industrialized world. Proposed testing of a traditional healers; in others, however, co-oper- candidate B strain vaccine in Uganda led to ation is proving moredifficult. widespread protest when it was alleged that not only would such a vaccine bring no benefit to MOTHER TO CHILD that country if developed, but that those on whom the candidate would be tested had not The one area where antiviral drugs are increas- been fully informed of the potential risks. ingly available to the African public is the pre- In the late 1990s, the financial support of vention of transmission of HIV from mother to Western governments and foundations such as her newborn child. Limited doses of Zidovudine the one established by Bill Gates, the founder of reduces the likelihood of the child contracting Microsoft, have enabled the New York-based the virus from about one in three or four preg- International AIDS Vaccine Initiative (LAVI) to

establish partnerships between northern and Because sexual behaviour is not fully under southern researchinstitutes. These are intended to our conscious control, informationin itself is not develop vaccines appropriate for Africa and else- enough to ensure change in sexual behaviour. where in the developing world and to ensure that Individuals at risk not only need to learn what all trials are ethical and fair. At the end of 1998, behaviour change to make, but need the psycho- two such initiatives were announced, one in logical support to makethat change. This support Kenyaand one in South Africa. generally comes from one’s peers, in formal or informal groups. While both men and women EMPHASIS ON PREVENTION “network”, in the fields, at the well, in offices, at market, in bars, women are more likely to use As long as antiviral treatment remains out of these opportunities more to discuss the emotional reach and until] a vaccine is widely available, pre- and health issues that lead to a desire to change vention is essential to bringing the disease under behaviour. Men are less likely to discuss such control. Prevention, whether abstinence, mutual issues and are, therefore, at a disadvantage - a fidelity or use of condoms, looks simple, but as disadvantage that has repercussions on their the social and cultural context described above partners. Establishment of mechanisms which makesclear, it is not. Ensuring that 300 million help men in particular to change behaviour — sexually active men and women across Africa e.g. discussion groups in the workplace — is, protect themselves and their partners during every therefore, a critical factor in preventing further act of intercourse, and ensuring that the 10 mil- spread of HIV. lion African children who become sexually It is likely, however, that deeper structural mature each year know how to protect them- changesare neededto ensure the reduction in the selves, is a difficult and complex task. spread of HIV in Africa and elsewhere in the A numberof conditions must be met to ensure developing world. Inequalities between men and widespread effective prevention. These include women must be tackled at a broader level than basic information about HIV transmission and HIV and, because poverty lies behind some meansof preventing transmission; psychological women’s sexual behaviour, they require eco- support for men and women whowishto protect nomic support to reduce their dependence on themselves from the virus; deep-rooted social men. Finally, widespread treatment of other sex- change that will reduce the pressure on men to ually transmitted diseases will severely reduce dominate their partners and enable women to opportunities for HIV to spread. have greater control over their sexual lives; poverty reduction schemes; and provision for the OPTIONS FOR CHANGE treatment of other sexually transmitted infections. The severity of the epidemic has meant that Options for people who wish to protect them- most Africans are aware of HIV/AIDS and have selves and their partners from HIV are: abstain- some idea as to how to protect themselves. That ing from sex; ensuring mutualfidelity with their does not mean, however,that they are sufficiently long-term partner; using condoms with all sex- informed. Womentend to be less aware of the ual partners; non-penetrative sex; or masturba- threat and, as has been seen, are less able to pro- tion. Insistence on only one or other form of pre- tect themselves than men. Men and women who vention, such as abstinence orfidelity, is likely are illiterate or have little access to the print or to fail, because it does not take into account the broadcast media are less likely to be informed context of people’s lives. than those who are educated or who have regular Eachofthese options has advantagesanddis- access to radio and the press; and each year a new advantages. Abstinence and non-penetrative sex generation reaches sexual maturity, often without are not options for many men or their women the accurate knowledge they need to protect partners. Fidelity is not a guarantee, because one themselves and others. partner may be faithful to a partner whois not.

10 Male condoms are widely available but, In manyparts of the world some of the most despite appearances, not simple to use; many effective NGO’s have been those which are men who would use them may be too embar- drawn from the communities most affected by rassed to admit that they need practice to do so. the epidemic, in particular groups of people Female condomsare rare and often expensive. living with HIV/AIDS. Masturbation as a form of sexual relief is still At the beginning of this new millennium it considered a taboo or weakness in manyparts seems that African leaders are finally respond- of Africa, although increasingly recommended ing to the challenge of AIDSin their midst. The as an option. presidents of South Africa and Ethiopia have Discussion of sexual issues to resolve such joined their Ugandan and Senegalese peers in problems is often difficult, whether between recognizing the threat of the epidemic. The partners who have just met or couples who experience of Uganda, once the worst affected know each other well. As described above, country on the continent but where rates of workshops, discussion groups and other means infection have dropped amongst young adults, of allowing individuals to explore and under- and of Senegal, where rates have remained stand their own and their partner’s sexuality are consistently low, indicates that where the will an essential componentin tackling HIV/AIDS to combat the disease is universal, it can be and other STI’s. overcome.

THE POLITICAL RESPONSE AND Now

The political response to HIV/AIDSis similar The HIV/AIDS pandemic in sub-Saharan across Africa, although the strengths of the vari- African countries is a clear and present perni- ous organizations may vary from country to cious threat which demandsurgentattention. An country. The global response to the epidemic is integrated approach using all relevant means co-ordinated by UNAIDS -— the Joint United and channels in society is required to confront Nations Programme on AIDS — which is spon- the threat and the use of communication media sored by seven UN agencies (see chapter on The is especially important in this respect. Bringing ABC of HIV/AIDS). UNAIDS works with both about positive results in the efforts to stem the governments and non-governmental organiza- prevalence of HIV/AIDS depends, among other tions at both international and national level. things, on the existence of an informed public National responses are usually co-ordinated by that is sensitive to the causes, spread and pre- National AIDS (Control) Programmes, the com- vention of the epidemic. The mass media have a position and effectiveness of which varies from significant role to fulfil in creating and sustain- country to country. ing public opinion and the political will to deal Non-governmental organizations (NGO’s) with the problem. have played a majorrole in fighting AIDS since The media can expose certain trends and the beginning of the epidemic. Frequently, they phenomena in the community or society that have drawnattention to key issues such as sexual facilitate the spread of HIV/AIDS and inform behaviour that governments have been unwilling the public about them. They can also play a cen- or unable to address. NGO’s are funded from a tral role in educating the public about the impor- variety of sources, including foreign govern- tance of preventive measures and serve as sign- ments and donor agencies. Given the prolifera- post to dangers. They can help create public tion of NGO’s and of funding sources, it is not awareness and mobilise public opinion against surprising that relations between NGO’s and trends, phenomena and practices which favour governments and between national and interna- the spread of the epidemic. Active involvement tional or foreign institutions have sometimes of media organizations and communication been strained. practitioners in efforts to deal with issues of

11 HIV/AIDSis critical, if knowledge and aware- professionals must pay particular attention to ness are to be increased and risk behaviours the confidentiality of an individual’s HIV status; reduced amongdifferent population segments in use appropriate language which reduces or African countries. avoids stigma; be critical in their reporting of The challenge then is to prepare journalists claims of effective cure or treatment; be careful and other media professionals for the task of about repeating misconceptions and irrelevant using media resources to arouse, mobilize and controversies; be diligent about verifying infor- sustain public opinion which support the efforts mation and presenting a balance view of gender against the practices. The initial step in this issues. Wambui Kiai of the University of process involves the generation of interest, Nairobi, Kenya, takes up the subject of media awareness, knowledge and understanding functions in HIV/AIDSprevention and manage- among media practitioners themselves about the ment in Chapter 3. She stresses the need for the disease, its modes of transmission, its preven- media to provide, on a regular basis, accurate tion and management as well as their commit- and factual information on the epidemic and to ment to the efforts to prevent and control the demystify it by presenting its statistics in human spread of the epidemic. In responseto this chal- terms. She calls for a pro-active approach in lenge, UNESCOin 1998 initiated a project on media coverage of the epidemic and calls for preventive information based on investigative more intensive training, networking and build- journalism and HIV/AIDSin East and Southern ing up of solid sources of information on the Africa. The project’s objectives were to: (i) epidemic which are accessible to media practi- identify a few pertinent trends or phenomenain tioners. the region which contribute to the spread of Part II presents case studies of investigative HIV/AIDS; (41) carry out in-depth investigation reporting on selected trends and social phenom- on the relationship between the phenomena and ena which are suspected to contribute to the the prevalence of the disease; and (iti) study the spread of HIV/AIDSin five East and Southern extent to which the incidence of HIV/AIDSis African countries. These trends are migrant pop- reported in the media. ulations; certain persisting cultural practices; This publication presents the reports and and high consumption of alcohol. papers prepared underthe project. It contains In Chapter 4, Rose Lukalo of the African practical and technical guidelines for media Women and Child Features Service, Nairobi, practitioners specializing or interested in Kenya, reports on patterns of migrant popula- HIV/AIDSissues. Part I presents a general tions (refugees, internally-displaced persons, overview of the HIV/AIDS epidemic andits long-distance truck drivers, migrant workers demographic, social and economic impact in including itinerant commercial sex workers, and sub-Saharan African countries; common con- tourists) and their links with the spread of cepts, terms and definitions, ethical HIV/AIDS in Kenya. Noting that population approachesto reporting on the disease as well mobility brings into play certain conditions that as media functions in HIV/AIDS prevention encourage the spread of the disease, she calls for and management. more thorough examination of the issue of Chapter 1 by Martin Foreman of the Panos mobility in HIV/AIDS intervention pro- Institute, London contains terms and acronyms grammes. Charles B. Rwabukwali and his col- commonly used in writing about HIV/AIDS. It leagues at Makerere University in Kampala, presents definitions, explanations and examples Uganda,report on similar patterns in neighbour- of use to a wider audience as well as informa- ing Uganda in Chapter 5. They observethat, in tion of particular interest to the media. Martin general, people who are on the movetend to Foremanalso discussesethical issues that media lack the requisite level of knowledge, percep- professionals need to consider when reporting tion, awareness and precautions required to on HIV/AIDSin Chapter 2. He notes that media avoid infection and the spread of the disease. In

12 Chapter 6, Mkasafari Mlay, a freelance journal- tioners had high level of awareness of ist in Dar es Salaam, reports on the same theme HIV/AIDSissues, the disease received little in Tanzania. She observes that people who are coverage in the Ugandan media during the away from their homesare often tempted to do study period. things they would not dare do at home. In Chapter 11, Francis P. Kasoma examines Parkie Mbozie of the University of Zambia, the coverage of HIV/AIDS in Zambia’s leading Lusaka, reports on the impact of a number of newspapers. His findings show that, in general, cultural practices on the spread of HIV/AIDSin the newspapers were more interested in giving Zambia in Chapter 7. His investigation reveals their readers current information and hard facts that practices such as ritual cleansing; spouse about the disease than in features, and in pre- inheritance; puberty rites; polygamy; and cir- senting background information. The findings cumcision rituals contribute in some waysto the of the study by Kingo Mchombuof the Univer- transmission and spread of the disease in the sity of Namibia of how the disease was covered country. In Chapter 8, Rukee Tjingaete, a free- by the leading newspapersandthe national radio lance writer in Windhoek, reports on his investi- in Namibia are presented in Chapter 12. His gation into the social phenomenon of high alco- findings lead him to the conclusion that hol consumption and its impact on the spread of Namibia’s media coverage of HIV/IADS was HIV/AIDSin Namibia. He notes that high rates generally low, superficial and not adequately of alcohol consumption increases the likelihood sustained over a long period of timeto create the of rape and unprotected sexual intercourse — both necessary impact in terms of awareness and of which are associated with the transmission change in behaviour. and spread of the disease. Taken together, the conceptual discussions, Part III deals with findings and recommenda- the investigative reports and the findings from tions from content analytic studies of media the content analytic studies point to the need: coverage of HIV/AIDSin four East and South- for enhanced training for media professionals ern African countries during the period of Janu- in East and Southern Africa on HIV/AIDS ary 1997 to June 1998. In Chapter 9, Lewis coverage; to create HIV/AIDS resources cen- Odhiamboof the University of Nairobi analyses tres and databases easily accessible to media the coverage of the disease by the three leading professionals; for workshops and seminars to newspapers in Kenya from “a moral panic per- sensitise editors, producers and media man- spective.” His study reveals, inter alia, that most agers about the social and economic costs of of the stories reported in the print media were HIV/AIDS and other major health risks in the product of local journalists’ initiatives; that Africa; and for a more sustained and intensive the newspapers relied mostly on local writers use of media resources in support of efforts to and commentators; and that the main informa- prevent and manage the spread of HIV/AIDS tion sources were local organizations, in Africa researchers andscientists. The findings of Linda Throughthis publication, UNESCO hopesto Nassanga Goretti’s analysis of the coverage of contribute to the generation of the requisite the epidemic by Ugandan print and broadcast interest, awareness, knowledge and understand- media are presented in Chapter 10. Her study ing among media practitioners of the prevalence showed that HIV/AIDSwasreported in the form of HIV/AIDS in African countries and its of news stories, news analysis, feature stories immense social, demographic and economic and letters to the editor and the sources of infor- impact. It is equally envisaged that the publica- mation were mainly local, supplemented by for- tion will stimulate efforts to integrate preventive eign and international syndicate/feature ser- information on HIV/AIDSin the regular fare of vices. She remarksthat, although media practi- mass media in African countries.

13 ABC oF HIV/AIDS

Martin Foreman, Director, AIDS Programme, Panos Institute, London, England

This ABC contains terms and acronyms commonly used in writing about HIV/AIDS. In addition to definitions, explanations and examples of use to a wider audience, the symbol WW: indicates information of particular interest to the media. Words in bold are defined elsewhere in the ABC.

abstinence Sexual abstinence means refraining from all sexual activity with others.

adolescence The period of intense emotional and intellectual development between childhood and adulthood, when boysand girls go through the physical changes knownas puberty.

AIDS Acquired Immune Deficiency Syndrome — the disease caused by HIV.

anal intercourse Penetration of the anus by the penis. Anal intercourse is practised by men with women and with other men. HIV is twice as likely to be transmitted in unprotected anal intercourse as in vaginal intercourse

antibody See HIV antibodies.

anti(retro)viral Having the property of attacking (retro)viruses. See also combination therapy, non-nucleoside reverse transcriptase inhibitors, nucleoside analogues and proteaseinhibitors.

ASO AIDS Service Organisation: usually a community-based non-governmental organisation which undertakes one or more of the following tasks: educating the public about HIV transmission and means of protecting oneself; providing pre-and post-test counselling; and care of individuals who have contracted HIV or developed AIDS.

asymptomatic Not having symptoms. People with HIV are asymptomatic until they develop opportunistic infections which mark the onset of AIDS. This asymptomatic period can last 10 years or more.

AZT Azidothymidine; the earlier name for Zidovudine.

casual sex In epidemiological terms, casual sex usually defines situations where an individual has more than one sexual partner in a 12-month period. An alternative term, best avoided, is promiscuity.

15 CD4cells A type of blood cell, also known as T-helper cells or T-cells. When the immunesystem is functioning normally, CD4 cells protect the body by recognising and destroying viruses and bacteria. HIV enters and replicates inside CD4 cells, disabling the body’s immune system and eventually leading to the development of AIDS. circumcision, female See female genital mutilation. circumcision, male The operation which removes the foreskin from the penis. There is someevidence to suggest that circumcised menareless likely to contract and transmit HIV than men whoare uncircumcised. Some people believe that male circumcision, though it has fewer harmful consequences than female circumcision, should also be described as genital mutilation. combination therapy In HIV/AIDS, combination therapy is the administering of two or three different types of antiretroviral drugs at the same time. Com- bination therapy is more effective in treating HIV/AIDS than monotherapy. condom, female A pouch made of polyurethane inserted into the vagina before intercourse and held in place by a loose inner ring and fixed outer ring. The female condom prevents conception and provides protection from sexually transmitted infections. Unlike the male condom,it does not depend on the man’s erection. The female condom,with the inner ring removed, can also be used for protection in anal intercourse with men or women. condom, male A sheath unrolled over the erect penis. Male condoms made from latex or polyurethane prevent conception and transmission of HIV and other sexually transmitted infections. contaminated blood (products) In the context of AIDS, any blood or blood products which has been infected with HIV. Screening identifies blood with the virus and prevents it being used in transfusion. contraception Any method that prevents a woman from conceiving a child, such as the pill and diaphragm. Of all contraceptive methods, only the male and female condom also offer protection from infection with HIV and other STIs. cost of treatment The direct cost of treatment for HIV/AIDS includes: doctors’ fees, test fees (for the HIV antibody test, X-rays etc), hospital fees, fees for drugs and other forms of treatment and fees for home and hos- pice care. See also indirectcosts.

16 counselling Providing information and advice. Pre-test counselling helps individuals decide whether to take the HIV antibody test. Post-test counselling provides an opportunity for those who test HIV-negative to learn how to protect themselves from future infection, and advises those who test HIV-positive how to maintain their health and how to avoid transmitting the virus to others. d4T, ddC, ddl Examples of nucleoside analogue drugs, used in combination therapy to prevent HIV replicating. diagnosis Interpretation of a disease. HIV Infection cannot be diagnosed, only confirmed by an HIV antibody test. Diagnosis of AIDS may be made whena patient contracts an opportunistic infection; where possible, the diagnosis of AIDS should be confirmed, or eliminated, by an HIV antibodytest.

DNA Deoxyribonucleic acid. The genetical material of most living organisms. See also RNA. drugs, antiretroviral See antiretroviral. drugs, injecting The term usually refers to the injection of drugs for recreational pur- poses - either drugs produced only for recreational use, such as heroin, or medicinal drugs injected in combinations or doses intended for recreational use. Non-sterilised injecting equipmentcarries a high risk of transmission of HIV and other diseases such as Hepatitis. drugs, recreational In addition to those which are injected, recreational drugs may be inhaled (eg cocaine, marijuana, tobacco) injected (eg heroin), eaten, chewed or swallowed (eg qat, coca leaf and “ecstasy”) or drunk (eg caffeine, alcohol) to alter physical sensations and mental attitudes. Medicinal drugs may also be misused as recreational drugs. Recre- ational drugs such as alcohol which make peopleless likely to protect themselves during sexual intercourse carry an indirect risk of HIV transmission. dry sex In some African cultures, women use substances to reduce or prevent flow of vaginal fluid during intercourse because their male partners prefer the sensation of “dry sex”. Dry sex heightens the risk of HIV transmission as it increases the likelihood of bleeding and if a condom is not used.

ELISA Relatively cheap HIV antibodytest. If a blood test is positive, where possible it should be confirmed by the more accurate but more expensive Western Blottest. faithful See fidelity.

17 female genital mutilation Also known as female circumcision. The partial or full removal of the clitoris, labia minora and labia majora. fidelity Faithfulness to one’s sexual partner and abstaining from casualsex. Fidelity only protects an individual from HIV whenit is mutual — i.e. when both partners are faithful to each other. gender While sex describes physical status — whether an individual has a penis and testicles or breasts and vagina — gender describes the socially constructed differences between men and women and the cultural roles which they are expected to fulfil. heterosexual See sexual orientation.

HIV Human Immunodeficiency Virus: HIV is a retrovirus which enters CD4 blood cells, where it converts its RNA into DNA by using an enzyme knownasreverse transcriptase. This allowsthe virusto replicate itself. It also disables the body’s immune system and eventually leads to the development of AIDS.

HIV antibodies When confronted with infection, the immune system produces antibodies which circulate in the blood to attack the pathogen. With many diseases, the antibodies overcome the pathogen; in the case of HIV, antibodies are produced but they do not succeed in preventing the virus from replicating.

HIV antibody test A test to confirm whether an individual has HIV antibodies - and therefore whether they have contracted the virus. A positive result suggests they have contracted HIV. Where possible, a second test is generally used to confirm an initial positive result.

HIV-negative Not having contracted HIV.

HIV-positive Having contracted HIV/living with HIV. homosexual See sexual orientation.

IAVI International AIDS Vaccine Initiative: a non-governmental organisation based in New York, with significant funding from Northern government and other sources, whose goal is to support research leading to the developmentof a vaccine/vaccines that will prevent all or most HIV transmission throughout the developing world. immune system The immune system comprises a number of mechanismsto protect the body from disease. These include the lymph glands, which produce CD4cells.

IDU Injecting drug use(r).

18 incidence The incidence of a disease is the rate at which new infections occur, usually expressed in terms of annual increase. HIV incidence of 10% means that 10% more people will contract the virus in a given year than in the previous year. incubation period The period between infection with a virus or pathogen and the appearance of symptoms. HIV is unusualin that the incubation period maybe ten years or more. indirect costs The indirect costs of a disease generally include loss of income from the patient and from those who take time off work to care for the patient, attend their funeral and look after their dependents. Social costs, which maylead to additional economicloss, include such items as loss of schooling by those whocare for relatives with the disease and poorernutrition resulting from lack of incomeor labour to gather food and prepare meals. infected Although this is the word most commonly used to describe an individual who has contracted the virus, many PWA groups prefer to avoid the term and use “living with HIV”instead. infectious Capable of infecting others. An individual who has contracted HIV is infectious — through sexualintercourse, contaminated blood, injection equipment or mother-to-child — whether or not they have developed symptoms of AIDS and whether or not they are taking anti(retro)viral drugs. informed consent An HIV antibody test should only be undertaken as the result of informed consent—whenthe individual fully understands, as the result of pre-test counselling, the implications of the test and the possible impact of the result on their lives. injecting equipment Usually a manufactured syringe, but the term may refer to any instrument, such as one made from a ballpoint pen, used to inject drugs. Failure to thoroughly sterilise injecting equipment between each use can lead to transmission of HIV and other diseases. intravenous, intravenous drug user (VDU) Intravenous meansinto the veins. The term IVDU is no longer used because many individuals who inject drugs inject into a muscle, not into a vein.

Kaposi’s sarcoma A skin tumour. Kaposi’s sarcoma (KS) is a common opportunistic infection in some population groups in Europe and North America, but uncommon in sub-Saharan Africa.

19 masturbation Using one’s hand for sexual pleasure, generally to achieve orgasm (sexual climax). Masturbation can be practised alone or on a partner. Solitary masturbation cannot lead to HIV infection; masturbation of a partner can only lead to HIV infection if there are is an open cut or lesion on the masturbator’s hand or the masturbatee’s genital area. monotherapy The administering of one type of drug. Monotherapy in HIV is generally not recommended becauseit can lead to drug resistance and a faster deterioration of the patient’s state of health. However, monotherapy is practised to prevent mother-to-child transmission. morbidity Theincidenceof a disease. mother-to-child transmission HIV can be transmitted from a mother with the virus to her newborn child in the womb, during birth or through breastfeeding. Transmis- sion occurs in 25% to 40% of cases without prophylactic treatment. If the mother takes Zidovudine (AZT) during the pregnancy and refrains from breastfeeding, transmission rates fall to 10%. Other drugs are being developed to prevent mother-to-child transmission — whichis also knownas perinatal transmission.

NA(C)P National AIDS (Control) Programme: government-sponsored body which oversees the national response to HIV/AIDSin each country, working with UNAIDS, non-governmental and other organisations. non-governmental organisation Non-governmental organisations (NGOs) vary in size, budget and scope from unpaid volunteers in a small district to large international institutions. Most NGOsare non-profit organisations. non-nucleoside reverse transcriptase inhibitors A type of antiretroviral drug. Non-nucleoside reverse transcriptase inhibitors prevent HIV from converting its RNA into DNA. non-penetrative sex Sexual activity which does not involve penetration of the vagina, anus or mouth. Non-penetrative sex does not allow transmission of HIV unless infected semen or vaginal fluid from one partner comes into contact with a cut or lesion on the other partner’s body. nucleoside analogues A type of antiretroviral drug. Nucleoside analogues prevent the newly-created DNA of HIV in a disabled CD4 cell from building new virus. opportunistic infection Infections which attack the body more easily when the immunesystem is weakened. Theoretically, any disease can be an opportunistic infection; in practice, the commonest opportunistic infections are: Mycobacterium avium complex (MAC) causing tuberculosis; pneumonia (PCP); herpes viruses; diarrhea; toxoplasmosis.

20 oral intercourse Penetration of the mouth by the penis. Practised by women with men and men with other men. palliative Palliative treatment relieves suffering but does not cure the underlying condition. pathogen Any disease-causing micro-organism. Pathogens include viruses, many bacteria, fungi and protozoans. perinatal transmission See motherto child transmission. pre-test counselling See counselling. post-test counselling See counselling. prevalence HIV prevalence is the total number of people with a virus at any one time. In some urban areas, for example, HIV prevalence among adults is over 30% — more than 3 in 10 adults is living with HIV. prevention programmes Government or NGO projects or campaigns designed to raise awareness of HIV and the means of preventing transmission, among the general public or a more narrow audience (eg young people, sex workers and their clients, migrant labourers etc). prophylactic A prophylactic measure is one which prevents spread of a disease. Prophylaxis is sometimes also used to mean contraception. prostitution See sex work. protease inhibitors A type of antiretroviral drug. Protease inhibitors prevent HIV from being released from infected CD4cells. protected Protected sexual intercourse meansintercourse with a condom. puberty Puberty refers to the physical, including sexual, changes that occur when a child reaches adulthood. See also adolescence.

PWA / PLWA / PLWHA P(L)WA: person (living) with AIDS(i.e.: having developed the symptoms of AIDS). PLWHA:person living with HIV/AIDS (whether or not they have symptoms of AIDS).

Retrovir Trade name for Zidovudine. retrovirus See virus.

21 risk Risk of HIV transmission occurs in any situation where the virus may be transmitted from one individual to another —- e.g. in an act of unprotected intercourse or when unscreened bloodis transfused.

RNA Ribonucleic acid. An organic compoundstoring genetic information. screen Screening blood means testing blood for the presence of HIV antibodies. semen / seminal fluid The penis ejaculates semen, the liquid which contains sperm, the male contribution to conception. Infected semen is the primary route through which men transmit HIV to their sexual partners. seroconversion The moment at which an infection enters the bloodstream and the individual converts from seronegative to seropositive (in the context of HIV/AIDS,converts from HIV-negative to HIV-positive). seronegative Without a specified pathogen in the blood. In the context of HIV/AIDS,seronegative is the same as HIV-negative. seropositive With a specified pathogen in the blood. In the context of HIV/AIDS, seropositve is the same as HIV-positive. serostatus Literally “state of the blood”. In the context of HIV, the term indicates whether a person has contracted the virus or not. sex work Sex work, often referred to as prostitution, is the exchange of sexual intercourse or other sexual activity for money or goods. Both women and men can be sex workers; the clients are almost always men. sexualactivity Anyactivity, alone or with a partner, which involves direct or indirect stimulation of the sexual organs. sexual identity Most individuals identify themselves as men/masculine or women/feminine. In every culture, however, a few individuals either wish to changetheir sexual identity or consider they have elements of both sexes in their psychological and/or physical make-up. See also gender. sexual intercourse The definition of sexual intercourse can vary according to the speaker. Some people consider only vaginal intercourse as sexual intercourse and see anal intercourse and oral intercourse as forms of sexual activity. Vaginal, anal and oral intercourse may all lead to transmission of HIV if a condom is not used.

22 sexual orientation Refers to an individual’s pattern of sexual attraction. In Western terms, individuals are seen as heterosexual(attracted to the opposite sex), homosexual(attracted to the same sex) or bisexual (attracted to both sexes). In other cultures, sexual identity and sexual orientation are often defined differently.

sexually transmitted disease See sexually transmitted infection.

sexually transmitted infection An STI (also known as sexually transmitted disease or STD) is any infection only or primarily transmitted through sexual intercourse. STIs which causelesions or ulcers, such as gonorrhea, multiply the risk of transmitting HIV up to sevenfold.

social marketing Male and female condomsare sold through social marketing in many parts of Africa. This comprises an affordable, subsidised price and marketing and sales similar to commercial items such as beers and other products. This approach increases sales and helps to remove the stigma of condomsand sexual intercourse.

STD or STI See sexually transmitted infection.

stigma A markof social disgrace.

Sugar Daddy, Sugar Mommy In some cultures the slang term used for older men whopay,directly or in kind, for the sexual services of younger women,or for older women whosimilarly pay for the services of younger men.

symptomatic Having symptoms. A person with HIV is asymptomatic; a person with AIDS is symptomatic. taboo Contrary to a society’s customs and / or laws. Despite taboos, many sexual practices such asoral and anal intercourse exist in many,if not all, societies.

T-(helper) cells See CD4 cells. testing See HIV antibody testing and counselling.

UNAIDS Joint United Nations Programme on HIV/AIDS co-ordinating the global response to HIV/AIDS. UNAIDS is sponsored by seven UN agencies: the UN Children’s Fund (UNICEF), UN Development Pro- gramme (UNDP), UN Educational, Scientific and Cultural Organiza- tion (UNESCO), UN International Drug Control Programme (UNDCP), UN Population Fund (UNFPA) the World Bank and the World Health Organization.

23 unprotected Unprotected intercourse is intercourse without use of a male or female condom. Unprotected intercourse can lead to transmission of HIV andother STIs. unscreened Unscreened blood has not been tested for HIV antibodies and may carry HIV. See also screen. vaccine A preparation of disease-producing micro-organisms, or their parts, used to stimulate immuneresponseand raise the body’s resistance to a disease. There is currently no vaccine that prevents individuals from contracting HIV; vaccine development, co-ordinated by IAVI, is a global priority. vaginal fluid Fluid produced by the mucous membrane — lining — of the vagina. In someAfrican cultures vaginal fluid is welcomed by both partners. In other cultures women are encouraged to find meansofrestricting vaginal fluid because men prefer dry sex. vaginal intercourse Penetration of a vagina by a penis. viral load The quantity of virus in the bloodstream. The viral load of HIV is measured by sensitive tests, unavailable in most of Africa. Ability to measure viral load is a key componentin effective combination therapy. virus A micro-organism which is capable of independent life and repro- duction within a living cell. Most viruses store the genetic information they need to reproduce in DNA.Retroviruses, such as HIV,store their genetic information in RNA. wasting syndrome Term used to define the rapid loss of weight that often accompanies the development of AIDS.

Western Blot See ELISA. window period It takes the immune system up to three months to produce antibodies to HIV that can be measured in the HIV antibody test. During this window period, an individual tests negative for the virus but is nevertheless capable of transmitting it to others.

Zidovudine Thefirst developed and most commonly known nucleoside analogue; commonly known as AZT.

24 AN ETHICAL GUIDE TO REPORTING HIV/AIDS

Martin Foreman, Director, AIDS Programme, Panos Institute, London, England

INTRODUCTION press. A 1997 study confirmed that the greater access Africans had to the media and to accurate Only 200 years ago the agricultural society information about contraception, the more which sustained most of humanity for thousands likely they were to use family planning tech- of years began to give way to the industrial soci- niques’. On the other hand, uncritical reporting ety that gradually spread from Europe and North of such issues as the supposed AIDS treatment America to the rest of the world. Now, we are Kemron in the late 1980s misled many into entering an age where new information and believing that the disease was less of a threat communication technologies are changing the than it has proved to be. economic, political and cultural profiles of every Few, if any, of those who reported the Kem- society in which welive’. ron issue intended any harm. Indeed, almost The media are at the heart of these changes everyone working in the media wants their con- and the media themselves are undergoing rapid tribution to help prevent further spread of HIV change. Even in Africa, where access to the andto help alleviate the problemsofthose living media is frequently limited by illiteracy and with the virus. However, the varied nature of the poverty, the growth in the numberofradio sta- media, its different “players”, content, goals and tions and radio receivers, satellite television and audiences, meanthat there will never be a single the Internet has begun a process of social change message or series of messages acceptable to all that is as yetlittle noticed and often misunder- the media, the public and those working in HIV. stood. Indeed, at times messages are contradictory, as The media can be an essential tool in com- religious radio stations condemnthe use of con- bating HIV/AIDS. More than any other disease, doms and health columnists advise that con- AIDSis driven by a combination of social fac- domsare essential. tors, including inequality, stigmatisation and This chapter examines the ethical issues of ignorance. Whetheror not they actively seek to covering HIV/AIDS. It is written primarily from do so, the media either fuel the epidemic the perspective of newsreporters, feature writers through sensationalism and poor or unethical and producers of documentaries, but the points reporting, or helps to restrain it by promoting it makes are applicable to all who work in the information, understanding and behaviour media. change. The media shapeattitudes and influence national agendas for good orforill; it educates 1. AN ETHICAL APPROACH To HIV or misinforms; it investigates or ignores malpractice; and it raises or ignores questions of Ethicsis the study or practice of morals; an eth- cultural values that lie behind the epidemic. ical approach to a subject is the one intended to While the impact of the newer media in result in least harm and greatest good. An ethi- Africa has not been assessed in depth, evidence cal approach to HIV/AIDS, whether from the confirms the wide influence of radio and the media, the medical profession or the public at

' Forfurther discussion, see World Information and Communication Report, UNESCO,1999. > “Mass Media and Reproductive Behaviorin Africa’, Charles F Westhoff and Akinrinola Bankole, Macro International Inc. Calverton, MD, USA, 1997.

25 large, aims to achieve a reduction in the numbers which stipulated that people with HIV/AIDS of people who contract the virus andto relieve, were entitled to the following rights, amongst as far as possible, physical or psychological dis- others: life; non-discrimination backed by equal tress suffered by those living with HIV. protection and equality before the law; the high- The theory is easy to describe; the practice is est attainable standard of physical and mental more difficult. The fact that HIV infection is health; freedom of movement; privacy; work; strongly identified with the highly emotional freedom of opinion and expression andthe right issues of sexual behaviour and death, makes it to freely receive and impart information; mar- difficult to agree how to achieve the goals of riage and the founding of a family; and partici- reducing transmission and relieving distress. pation in public and culturallife.’ One group advises the use of condoms; others The problem for many people living with insist on abstinence from sex outside marriage. HIV/AIDS and their families is ensuring that Some wish to publicly identify people living these rights are implemented. In Africa there is with HIVto protect others from the disease; oth- little tradition of using the law to guaranteeindi- ers see that strategy as harmful to society as a vidual human rights and those most affected by whole. Even the apparently simple question as to human rights abuses are often those who are whether to supply antiviral drugs to pregnant least able to seek redress. One area of exception women with HIV to makeit less likely for them is South Africa, where the AIDS Law Project to transmit the virus to their children can be con- was set up in 1993 by Justice Edwin Cameron, troversial, as seen in South Africa in early 1999. whohassince declared that he himself is HIV- positive. ALP offers a legal service, runs a tele- 1.1. Stigma and humanrights phone advice service and has taken legal action For many the greatest problem confronting on behalf of people with the virus who believe those living with HIV and those working in they have been discriminated against. AIDS care and prevention is stigma. As Zam- bian social worker Elizabeth Mataka says, “being HIV-positive is considered deviant in 2. THE MEDIA AND HIV. WHAT ARE THE ISSUES? African society... They tend to deny their situation at a personallevel, especially as the disease An informed and ethical approach to reporting is wrongly seen as bordering on a person’s HIV/AIDS is no different from an ethical moral character.” * approach to HIV/AIDS in the workplace, in a Stigma is not universal, but it is widespread. hospital or any other setting. However, the To overcome the consequencesof stigma, many media have greater influence. A doctor who working in HIV/AIDSprevention and care look betrays the confidentiality of an individual’s to strengthen awareness of human rights across HIV status generally harms only that patient; a the continent. In 1994, the African Network on newspaperwhich betrays that confidentiality not Ethics, Rights and HIV published the Dakar only harms that patient but feeds into the cycle Declaration, comprising 10 principles that of discrimination and stigma described above. should guide the response to HIV/AIDS,includ- Reporting HIV/AIDS provides many chal- ing responsibility, involvement, partnership & lenges. A reporter’s desire to present a sober, co-operation, non-discrimination and confiden- optimistic image may be confronted by an edi- tiality. In September 1996, UNAIDSand the UN tor’s or sub-editor’s desire to prevent a sensa- Commission on Human Rights issued guidelines tionalist, negative view. Audiences may com-

3 “Mass Media and Reproductive Behaviorin Africa”, Charles F Westhoff and Akinrinola Bankole, Macro International Inc. Calverton, MD, USA, 1997. AF-AIDS(listserv) discussion, posting [247] RE: PRE-ICASA 2: Stigmatisation and Discrimination in African Communities — Zambia [244], 29 June 1999, * Abstracted from UN Commission on HumanRights, Fifty Third Session, Item 9(a) provisional agenda, Second International Consultation on HIV/AIDS and Human Rights, Geneva, 23 - 25 September 1996. Available on www.unaids.org/unaids/ document/humright/3797.html.

26 plain that the subject has been covered too paid jobs, taking skills with them that are not much. Frank, respectful discussion of sexual easily replaced. matters may be censored. International agencies This section covers topics that are frequently may want a specific viewpoint covered. Some the cause of confusion or poor reporting of health workers and NGOsdistrust the media and HIV/AIDS. refuse to help them. Civil servants and politicians may not take kindly to investigations into 2.1. Confidentiality their inefficiency or corruption. Lack of time to Confidentiality means not publishing the name research an article may result in bland reports. of an individual with HIV without their permis- Reporters themselves may hinder good sion. The rule is simple but not always easily reporting. Some rely too much on optimistic and applied. When the focus of a report is an indi- misleading press releases, others on the state- vidual willingly discussing their HIV-positive ments of government ministers or other commu- status to educate people and reduce stigma, the nity leaders which reflect “official” attitudes to question of confidentiality does not arise. How- the disease that are far removed from the reality ever, there are many other cases when reporters that most of the population face. Some learn that an individual has HIV butfew,if any, reporters, without any evidence, distrust non- cases where that information should be pub- governmental organisations or people who are lished or broadcast withoutthat individual’s per- open about their HIV-positive status, suspecting mission. The rule to follow is that it is the right that their primary goal is to attract funding. of individuals to maintain their confidentiality Male reporters may hold commonattitudes, and the duty of reporters to respectit. including violence against women,that underlie [There is an argumentthat identifying people the spread of the virus. with HIV protects others who might engage in At a meeting of West African gatekeepers in unsafe sex with them. However, there is no evi- 1997, participants pointed out five areas where dence that “outing” people this way prevents they considered the media were failing in their any further transmission of the virus and there is responsibility to cover the epidemic’: some evidence to suggest it encourages irre- - lack of involvementin the issue, often the sponsible behaviour. Furthermore, it is the role result of poor training and lack of aware- of the media to report this discussion, not to take ness of health issues; part in it, and it should be noted that falsely - sensationalism; declaring an individual to be HIV-positive can - avoidance of key topics, such as living with be libellous. | HIV; Two specific areas can be looked at in more - lack of preparation or transparency; detail. The first is the example of community - lack of a collaborative approach. leaders with HIV whotake antiviral treatment These deficiencies are not universal. An increas- while arguing that the country is too poor to ing numberof journalists in Africa demonstrate afford such treatment for its citizens; the ques- exemplary coverage of the epidemic while sem- tion here is not the individual’s serostatus but inars, workshops and media networks encourage the contradiction between their actions and and permit reporters to develop their skills. words. Whether that information should be These will be needed for the foreseeable future reported is a matter of debate. The second ques- as the pressures described abovepersist, inexpe- tion is that of identifying victims of rape, irre- rienced individuals enter the profession each spective of their serostatus or that of their year, and skilled journalists move into other attacker; whatever the circumstances, names areas of reporting or leave the media for better and details of rape victims should never be

* Abstracted from the report of the second Pop’Mediafrique seminar held in Abidjan, 15-19 June 1997 organised by the Population Reference Bureau, Washington DC and African Consultants International, Dakar.

27 broadcast or published, since even an intended work. Such “cures’”’ may even harm those who sympathetic approach from the media can lead take them and impoverish those who buy them. to further stigma and even attacks by members Sometimes the media become directly of the public. involved when they carry paid display or classified advertisements for AIDS “cures” and edi- »» Ethical reporting of HIV/AIDS requires tors or reporters are encouraged to carry news that the confidentiality of those with the stories promoting these “cures”. However, the virus and their family and friends, is res- media should neither accept nor condemn pected. Identities or addresses should not uncritically announcements of new treatments be revealed or hinted at without their per- or potential cures. Indeed, the media can mission and reporters should not pressurise encourage attempts to develop effective treat- people with HIV into revealing their identi- ments and cures by thoroughinvestigation to ties. Information given in confidence ensure that those undertaking research do so should never be passed or made accessible efficiently and honestly. When covering new to others, inside or outside the media. drugsor “cures”, the following questions should be kept in mind: 2.2. Reducing stigma - What is the treatment or cure intended to The media frequently use words such as do? “scourge” and “plague’”’ which add to the gen- Is it intended to treat opportunistic infec- eral perception that HIV/AIDS and those who tions or to attack HIV itself? are affected by it should be avoided. Similarly, - How doesit work? politicians, other community leaders and mem- “You rub it on the skin and the symptoms bers of the public sometimes use words such as go away” is not an adequate answer. What “promiscuous” and phrase their ideas in a way substancesare in the treatment and what is which reflects negative attitudes towards the the biological process through which they disease and people living with the virus. These affect the progress of HIV or the opportu- words are often repeated or reported without nistic infection? comment; in this way the media unwittingly or - Are there any side-effects? What are they unwillingly reinforce stigma. and how serious are they? Side-effects include symptoms which did »» Ethical reporting of HIV/AIDS requires not exist before the treatment was taken, that the media use language and ask ques- such as nausea or headaches. tions that reduce or avoid stigma and, - Have the proponents undertaken compara- where possible, reduce or avoid reporting tive trials? the negative attitudes of others to the Properly monitored and independent com- disease. parative trials — which compare the course of the disease in those who took thetreat- 2.3. Treatment and “cures” ment with those who did not take it — There is currently no cure for AIDS and the confirm whether or not the treatment has a drugs that significantly prolong the life of peo- beneficial effect. Have such trials been ple with HIV are unavailable or unaffordable to undertaken? How many people were invol- most Africans. Confronted with a fatal disease, ved? What werethe results? Have they been it is not surprising that individuals seek any published or can the detailed information form of medicine that might help them;noris it be given to the journalist? Can the namesof surprising that healers seek meansoftreating or those who took part in the trial - both who curing AIDS; and, unfortunately, it is not sur- received the treatment and who did not, prising that a few unethical individuals promote including those for whom the treatment did “cures” for the disease which they know do not not work — be given to the journalist?

28 - What measurements were used to confirm ments, smallpox vaccinations or other that the treatment worked? human-madeactivities. Recovering from one or more opportunistic transmission diseases is not an indication that the treat- - HIV is contagious (eg by touching someone, ment was successful against HIV. The suc- or breathing the sameair); cess of treatments designed to attack HIV - HIV can be transmitted by mosquitoes or can only be confirmed by tests which mea- otherinsects. sure the level of the virus’ activity in the prevention blood both pre- and post-treatment. - taking antibiotics before sex prevents trans- - Has there been peer review? mission; Haveall the above issues been monitored by - full-bodied, young, healthy-looking people an independent team of experts who confirm do not have HIV; the process andthe successof the treatment? - condoms are not needed in long-term rela- Proponents of the treatment who avoid direct tionships. answers to someor all of the above questions symptoms & disease should be treated sceptically. - people with HIV/AIDSalwayslooksick; - HIV/AIDS only affects certain groups of »» Ethical reporting of HIV/AIDSrequires that people, such as whites, sex workers or cer- all claims of effective treatment, from wha- tain ethnic groups. tever source, are subject to scrutiny and not treatment reported uncriticaily. - the disease can be cured by traditional healers or other medicines; 2.4. Misconceptions - the disease cannotbetreated. Misleading reports on HIV/AIDS stem from a otherissues numberof sources, including: - the clothing and possessions of people with - carelessly used, misunderstood or misused HIV/AIDS must be destroyed if they fall ill language; ‘ or after their death. - scientific or pseudo-scientific information reported indiscriminately; »» Ethical reporting of HIV/AIDSrequiresthat - sensationalised information; media professionals do not repeat miscon- - reports influenced by the personal attitudes ceptions or report irrelevant controversies of writers or editors; such as the origins of the disease. If mem- - sub-editors’ headlines; bers of the public, or experts, are quoted - repetition of information thatis out of date or repeating misconceptions, their words distorted; should be refuted by corrective quotes from - inappropriately used quotes. national or international experts. Reporters sometimes confuse data, for example failing to distinguish between the virus HIV and 2.5. Sources of information the syndrome AIDS,or between the general pop- The many sources of information regarding ulation and the adult population when reporting HIV/AIDSinclude: the extent to which HIV affects a community. - international organisations, such as Sometimes reporters covering the epidemic UNAIDS; repeat commonly-held, but mistaken, myths - governmentorganisations andofficials, such about the disease, with potentially serious conse- as National AIDS Control Programmes; quences. Such mistaken beliefs include : - national or international non-governmental origins/cause organisations, including religious bodies - the disease is the result of witchcraft; and organisations of people living with - its origins lie in biological warfare experi- HIV/AIDS;

29 - national or international universities and or institutions in the short term but which other academics; result in long-term improvement in care - pharmaceutical companies; and prevention. - individuals with HIV/AIDS experience or living with the virus. 2.7. Men and women Ideally, each source should provide information There is clear evidence that men’s behaviour that is independently verifiable, complete, plays a morecritical role in the transmission accurate and relevant. In practice, many organ- of HIV than women’s. Public attitudes, how- isations and individuals, consciously or not, ever, including those of the media, which are slant information in a way that presents them- dominated by men, tend to “blame” women. selves in a favourable light. Reporters will Sex workers or women in general are often sometimes be aware that the facts being pre- seen as the “source” of the disease. When a sented are incorrect or insufficient but lack of man learns that his wife is HIV-positive, it can time, lack of resourcesor political pressure pre- be easier for him to blame her for bringing the vent them from investigating further. One solu- infection into the family than to recognise that tion to this problem is persuading editors or it is far more likely to have been his own producers to support reporters who need to behaviour. undertake more research. In fact, it is men’s domination of women’s Sometimes reporters suspect a hidden sexual lives, as seen in violence against agenda, eg from international organisations, women and such customsasthe belief that sex that does not in fact exist. Overcoming such with a virgin girl will cure an older man of unjustified suspicion is difficult and depends on AIDS, that lies at the heart of the epidemic. others persuading the reporter to adopt a more HIV/AIDS will only be overcome when neutral and analytic point of view. womenachieve the social independence that allows them to protect themselves from HIV. »» Ethical reporting of HIV/AIDS requires the ability to distinguish facts and the implica- »» Ethical reporting of HIV/AIDS requires tions of facts from the presentation and an understanding of the unequal relations from the institution presenting them. between men and womenthat exist in every society and the distorted perspective 2.6. Investigative reporting of the epidemic that results. Wherever The media can and should play a significant role possible, media professionals should be in highlighting deficiencies in the response to trained in gender issues and take care to HIV/AIDS.These include such issues as bureau- ensure that reports present a perspective cratic incompetence that prevents adequate med- which accurately represents the expe- ical supplies from reaching hospitals and clinics rience of both men and women. and corruption within government departments and NGOsthat prevents funds reaching those 2.8. Minorities who need them. By reporting on such issues in a In every society there are groups of people manner which maintains the confidentiality of looked down uponbythe general public, such those who bring them to the media’s attention and as sex workers, prisoners and members of confirmsthat the facts are correct, the media can minority ethnic communities. Prejudices about play a key role in ensuring a proper response to such groups often lead to misconceptions such the HIV/AIDSepidemic. as the belief that sex workers “entrap” men. Some of these groups, such as prisoners or »» Ethical reporting of HIV/AIDS requires men who have sex with men, may be at high research into and reporting of issues risk of contracting HIV, but public attitudes which may notbring credit to individuals makeit difficult to target them for prevention.

30 »» Ethical reporting of HIV/AIDS requires maintain an appropriate distance from,all that minority groups within a society are institutions working in HIV/AIDSpreven- treated with respect. Those who are parti- tion. cularly vulnerable to HIV should be described as such and notas potential sources of 2.11. Reporters or health educators? infection for the broader community. Some non-governmental organisations and governments consider the media’s first duty is to act 2.9. Sex as health educators persuading the public to HIV is predominantly spread by sexual inter- change their sexual behaviour. Some mediapro- course. It is often stated that public discussion fessionals, such as health columnists, welcome of sexual matters is taboo in Africa. Until very such a role. Manyothers believe that the media’s recently the same was true for most societies first responsibility is to provide the public with across the world. Openness about sexual behav- facts about the broaderissues relating to the dis- iour began in Western Europe and North Amer- ease and the responsetoit. In the short term this ica before the advent of HIV/AIDS, but has can lead to confrontation — in June 1999 one accelerated as a result of the epidemic. Some of health minister in Southern Africa accused the the success in limiting spread of the virus in country’s media of scaring away foreign donors parts of the industrialized world may have come with their negative reporting of the government’s from willingness to be frank about sexual handling of the epidemic — butin the long term behaviour. it should lead to a more transparent and effective Failure to discuss sexual matters in most response to the disease. African societies, whether in the public sphere or the privacy of the bedroom, is one factor »» Ethical reporting of HIV/AIDSrequires that behind the rapid spread of HIV. There is wide- media professionals be aware of the poten- spread evidence, as seen in the experience of tial conflicts between their roles and others’ the Uganda teen-oriented publication Straight perception of those roles. Talk, to confirm that open and honest discussion of sexual matters in the media helps reduce 3. GUIDELINES FOR THE MEDIA transmission of the virus. Given these and other ethical issues, guidelines »» Ethical reporting of HIV/AIDSrequires an can help media professionals cover HIV/AIDS. open and respectful discussion of sexual In 1997 a group of senior media professionals issues. from Burkina Faso, Cote d’Ivoire, Mali, Mauri- tania and Senegal drew up the following princi- 2.10. Maintaining a distance ples to assist the media: Some media professionals find that interna- - respect for the rights of people living with tional or national organisations working in HIV/AIDS; HIV/AIDS prevention, including NGOs and - training for journalists on HIV/AIDS commercial enterprises such as pharmaceutical issues; organisations, offer payment for writing and - concern about accurate reporting of facts publishing “positive” stories on the epidemic. and figures; This well-intentioned approach not only sub- - an approach to reporting that involves the jects editorial judgement to non-professionals community; but also encourages dependency and discour- - collaboration with HIV/AIDSorganisations ages professionalism among reporters. and people living with HIV/AIDS; - making the link between sexually transmit- »» Ethical reporting of HIV/AIDS requires ted diseases and AIDS; that media professionals work with, but - appropriate language;

31 commitment to increased coverage of Statistics should be quoted with care and HIV/AIDSissues; in a manner that can be understood by no discrimination linking HIV/AIDSto a individuals who have no experience in particular ethnic group, country or com- HIV/AIDS. munity. lack of sensationalism To the above should be added: Sensationalism covers issues without ana- relevance lyzing them, and encourages a simplistic, Irrelevant information should be omitted, emotional response from readers and vie- such as an individual’s HIV-positive status wers. Sensationalism gives the impression if the status is not the focus of the report, that there are two kinds of people in the or address, if the public have no need of world — the “good” who read sensationa- the address. Similarly, relevant informa- list papers and the “bad’’ who appear in tion should be included. As one example, the news reports and features. Non-sensa- reports on aspects of AIDS in other coun- tionalist reporting breaks down these bar- tries, such as HIV among the military, riers and encourages a response which should not give the impression that the helps readers/viewers/listeners sympa- problem does not exist in the home coun- thize with those affected. try if in fact it does. As another example, appropriate admission of ignorance the extent of HIV infection in a group of Reporters sometimes listen to statements sex workers should, where possible, or read press releases without fully include the rate of infection among clients understanding their contents. The state- of sex workers. ments may presume knowledge that the accessibility reporter does not have or it may be that Audiences have different languages and the speakeror writer has notclarified their dialects and different levels of education. own thoughts. Reporters whorepeatinfor- Young people speak differently from their mation that they do not understand lose parents. Politicians, academics, footballers, the opportunity to educate themselves and popstars each have a certain style. The may mislead the public. By admitting urban educated elite have a different voca- ignorance and asking for help, reporters bulary from those whoareilliterate and live gain the respect of others who are fully in rural areas. Media professionals should committed to limiting the spread of HIV. be aware of the abilities and needs of their recognition of the context of HIV/AIDS audience and use the appropriate language HIV/AIDStouches almost every aspect of to reach them. our daily lives. It is transmitted during scepticism sexual intercourse, one of the most com- Media professionals should be sceptical. mon human activities; its transmission Opinions which appear to conflict with often depends on the unequal relationship information from leading experts should between men and women; it leads to loss not be reported as fact. Press releases or of workandloss of schooling and breakup speeches should not be quotedif there are of family life; it affects our ability to care grounds to believe that the information for ourselves, our families and our com- given is inaccurate or misleading. munities. Too often, HIV is reported as an Wherever possible, statistics should be issue that affects other people. Reporting confirmed with a reputable organisation, the context of the disease and the fact that such as the National AIDS Programme, it affects “us”, not “them”, can help the UNAIDSor leading NGO. public and policymakers develop strate- clarity gies to protect themselves and others from Information should be precise andclear. the worst impact of the disease.

32 4. LANGUAGE - languagethat is value neutral, gender sensitive and empowers rather than disempo- In early 1999, a good description of a Kenyan wers, education programmehighlighting the risks of The following chart is modelled on lists drawn HIV transmission among one ethnic group, was up by UNDPand other organizations since the headlined “Project targets repulsive practices”. start of the epidemic. It should be revised regu- The practice described was “wife inheritance”, a larly and modified according to the needs of the respected tradition in that group. community it serves ~ a community which Languageboth reflects and moulds ouratti- includes the media, the general public and those tudes. Words often carry emotions that encour- living with HIV/AIDS. age a positive or negative response - and the In addition to the words above, some techn- response evoked may not be the response that ically accurate words should be avoided. They the reporter wanted. The most appropriate lan- include: guage reporting HIV/AIDS is language which - “body fluids” in relation to HIV transmis- is, as far as possible, neutral of emotion. sion. Some body fluids (blood, breastmilk, The United Nations Development Pro- semen, vaginal fluid) can transmit HIV; gramme (UNDP) includes the following princi- others (saliva, sweat, tears) do not. Specify ples in their guidelines for reporting HIV/AIDS: the fluids involved; - language that is inclusive and does not - “gay/homosexual” generally refers to men create or reinforce a “them/us” mentality; who follow a Western lifestyle of only - vocabulary drawn from peace and human having sex with other men. The words are development rather than war; inappropriate in African cultures where the - descriptive terms preferred by the persons context of sex between men may be very themselves (eg “sex workers”, not “prosti- different. “men who have sex with men”is tutes”); preferred;

Avoid Because Use instead

AIDS / HIVcarrier no-one “carries” the virus or disease HIV-positive living with HIV person/ man/woman with HIV/AIDS

AIDSvirus the virus exists whether or not HIV, the virus which the individual has developed AIDS causes AIDS

AIDStest the test does not confirm whether an individual has developed symptoms HIV (antibody) test of AIDS

catch AIDS it is impossible to “catch” AIDS contract HIV become HIV-positive

full-blown AIDS there is no “partly-blown” AIDS AIDS

HIV and AIDS they are not two diseases HIV/AIDS HIV or AIDS

innocent no-one chooses to contract HIV omit the word

safe sex no sex with a partner is 100% safe safer sex

scourge/plague the words are sensationalist, create disease alarm and inadvertently stigmatize epidemic those with the disease illness

33 - “infected” appears to place more empha- afford to ignore an epidemic which reduces the sis on the infection than on the individual; number of people who will buy their products the phrases “(living) with HIV”, “HIV- and restricts the buying power of those who sur- positive” or “(having) contracted HIV” vive. A society where a quarter or more of the are preferred; population is preoccupied with sickness and - “patient” is only accurate if the individual death is not a society which will fatten the wal- concerned is in hospital or the story lets of media owners. A healthy society means a focuses on their medical treatment; healthy economy. - “promiscous” has accrued a negative mea- Reporting HIV/AIDS in a manner most ning; “having more than one sexual part- likely to lead to lower transmission of the ner” is preferred; virus and greater care for those whoare living - “prostitute” also has negative connota- with HIV is a difficult task. Media profession- tions for some. “Sex worker” is a prefer- als are continually confronted by conflicts red term; over time, policy and confidentiality, by preju- - “PWA” Some people living with dice and ignorance, by reluctance to confront HIV/AIDS dislike being referred to by issues of sex, illness and death, by government initials; “people (living) with HIV/AIDS” reticence or by malpractice or corruption. is preferred; Each individual and institution must devise - “rate”? can mean prevalence or incidence (see their own meansof resolving these conflicts. chapter on ABC of HIV/AIDS). The word should not be used withoutclarification; WORKPLACE ISSUES - “risk groups” is an epidemiological term referring to individuals whose behaviour The media’s responsibility to cover AIDS eth- regularly places them at risk of contrac- ically extends to their responsibility to provide ting or transmitting HIV. It is often inac- a workplace that supports staff living with curately interpreted to mean that those HIV and staff whose close family members who are not membersofthe risk group are may be living with the virus - differently unlikely to contract HIV. “Risk beha- expressed: staff who are “infected or viour” is preferred; affected”. Some media institutions and/or - “sufferer” and “victim” are best avoided media associations have drawn up guidelines because they suggest a passive, helpless designed to support those affected by the dis- response to the disease; ease. Such guidelines vary from country to - “vectors” of transmission: the term dehu- country and institution to institution, but gen- manises the individuals or groups referred erally cover the following points: to. “HIV-positive” is preferred. - recognition by the employer that (The chapter on “The ABC of HIV/AIDS” employees with HIV/AIDSdo notpresent includes other appropriate language for report- a risk to otherstaff; ing the disease.) - confidentiality for those “infected or affected”; 5. CONCLUSION - education programmes on transmission, prevention and support for those “infected Whatever the circumstances in which they work or affected”; and whatevertheir goals, all media professionals - no discrimination by employers or col- have an interest in ensuring accurate, relevant and leagues against employees or job appli- accessible reporting of the causes, extent and con- cants with HIV; sequences of the epidemic. Even those media - the same job security and conditions for whose primary or sole goal is making money employees with HIV as employees with through sales of newspapers advertising, cannot other long-term serious illnesses;

34 the same rights for staff to take care of Media professionals are encouraged to raise people with HIV/AIDS as for any other issues within the organisation they work as a medical condition; means of encouraging discussion around company policy on HIV/AIDSfully disse- HIV/AIDS and an informed and ethical minated and regularly monitored by both response. the company and staff members.

35 MEDIA FUNCTIONS IN HIV/AIDS PREVENTION AND MANAGEMENT

Wambui Kiai, Lecturer, School Of Journalism, University of Nairobi, Kenya

INTRODUCTION communities such as those in East and Southern Africa where the message of prevention has not The earliest reported case of the Acquired become engrained. This potential is best looked Immune Deficiency Syndromewasin the United at when onepictures the infection pattern of the States of America (USA) in 1981. Since then, HIV virus as a chain: it starts with two people, medical experts and researchers, social scien- but if either one of them is not careful in his/her tists, psychologists, and recently the media have sexual behaviour, up to hundreds or thousands of been galvanized in efforts aimed at preventing people can be infected over a period of time. and managing the disease. For Africa, this has Indeed, some researchers have contended that been termed as the greatest medical challenge in the world is divided not into those suffering from recent decades; while a cure remains elusive, the AIDS and those not suffering from AIDS, but delicate and fragile social, economic and politi- into those who know they have AIDS and those cal context presents peculiar obstacles in the pre- who do not know (Berer and Sunanda, 1993). vention and management of HIV/AIDS. The focus on HIV/AIDSis further justified This is unlike in the developed countries, by the fact that most of those affected by it in where the new combination therapies, but- some countries of East and Southern Africa, are tressed by intensive mass educational cam- aged between 15-45 years (Sessional paper No. paigns, have succeeded considerably in offer- 4 on AIDS in Kenya, 1997, AIDSCAP, 1996). ing a window of hope for those suffering from Indeed, this should accelerate the efforts the disease and for those who are involved in towards HIV/AIDSprevention and management its management and prevention (Piot, 1997). as this is the most productive cadre of people For those involved in HIV/AIDSprevention and their deaths affect their families (particu- and management, the picture at times appears larly if they are the sole breadwinners) and the to be gloomyand disheartening. economyas a whole. The figures on the spread and prevalence of In the bid to combat the epidemic and its HIV/AIDSas well as on the number of people threat to the survival of the human race, who have died from the disease (see Introduc- researchers and programme/project personnel tion) may not mean much to those who have are intent on developing the most innovative and remained untouchedin the sense of not knowing creative strategies. The search for alternatives anyone close whois either infected with the has highlighted the crucial role of communica- AIDS virus, or who has developed full blown tion and media in the support of these efforts. AIDS. This is one of the most significant cate- The mass media in particular have attracted gories of people who should be the focus of pre- great interest because of the perception of its vention strategies because the incubation period role as a powerful and influential tool. Towards of the HIV virus makes everyone vulnerable. this end, several countries have initiated and One infected person who appears healthy maintained mass media projects. and whohasnotbeentested for the virus has the This chapter examines the functions of the ability to cause enormous potential damagein media in HIV/AIDS prevention and manage-

37 ment and includes the general impact of about Kshs 3,800 million. In 1992, as much as HIV/AIDS which presents an outlook on the 15 per cent of all hospital beds were occupied background on the magnitude of the illness: a by AIDSpatients. brief discussion on the role and functions of the One of the most severe consequencesof the media in development; examples of current disease is the loss of young adults in their most approaches on media and HIV/AIDS; and pro- productive years, which translates into the loss poses somestrategies that can be adopted. of the most well educated and professionalcat- egory of the population. Conversely, this affects THE Impact oF HIV/AIDS human resource development, the size of the labour force, productivity and it negates huge Sceptics in the media may be tempted to ask investments in education and professional why there is so much fuss about HIV/AIDS. development. Productivity is affected by time This necessitates a look at the impact and spent on medicalcare as sick leave, higher med- future projections of the epidemic. Studies of ical expenses and the care of those affected by the epidemiology of HIV/AIDS underscore HIV/AIDS,as well as attendance of funerals. It the statementthat it is one of the most impor- is estimated that about 6,000 funerals are taking tant challenges that Africa has faced, espe- place daily in Africa as a result of AIDS (The cially in the post independenceera. The fig- Sunday Nation, Sunday June 13, 1999). At the ures continue to escalate; the World Health community and household levels, AIDS at times Organization estimates that by the end of claims the lives of productive people who have 1999, about 30-40 million people would have been contributing to the household budget or been infected with HIV, and that the rate of whohave been breadwinners, which propels the new infections is 8,500 daily. This raises the households into poverty. issue of the potential negative consequences of The effects of HIV/AIDS on the social fabric multiple infections particularly in sub-Saharan of African society, though difficult to quantify, Africa where the trend of testing for HIV has are no less explosive than the economic ones. not become deeprooted. Thestigma attached to the disease hasled to dis- Studies indicate that the highest proportion crimination and even violence against some of AIDScases are between 14-39 years and that women when they disclose their HIV status to adolescents are becoming sexually active at a their husbands. In addition, structures estab- younger age, meaning that the risk of AIDS is lished for the care of the sick are over-stretched higher amongthis group. Further, there is con- and women are increasingly burdened as they cern aboutthe fact that the reported cases do not are traditionally charged with the care of the represent the real picture of the magnitude of sick and ailing. For the girl-child, their future is infection as some peopleare unable or unwilling jeopardized as they are sometimes withdrawn to seek medical care or to go for testing. It is from school to help care for those who have important that accurate documentation is carried AIDS and are at home. This is besides the fact out as this underlines the need to intensify that the numberof orphans has increased and is efforts on HIV/AIDS prevention and manage- set to increase if the epidemicis not arrested and ment by presenting a true picture. managed effectively. For the media to present a clear and repre- The media fraternity is not immune to sentative picture of the disease, it is necessary HIV/AIDS as people who are potentially vul- that all facets of its impact be well understood nerable to infection and as relatives and friends and studied. On the economic front, public of those who become infected. Thus, they expenditure on health and welfare will be should be well advised like all sectors of society, devoted to the control and management of to use existing tools (such as communication HIV/AIDS. In Kenya, for instance, it is esti- channels) to support efforts to prevent and man- mated that expenses related to HIV/AIDS is age the illness.

38 COMMUNICATION AND HIV/AIDS regard of the need to makeparticipation integral to the whole process. The existence of high aware- The absence of a cure or vaccine for HIV/AIDS ness levels of HIV/AIDSin the absence of behav- and the urgent need to reach people on the impact iour change indicates that effective communica- of the disease as well as the need to preventit have tion approaches and strategies have not been resulted in the emphasis on mass education of developed and applied to support programmes populations. This inevitably means that effective and projects on attitude and behaviour change. communication approachesandstrategies should Attention in the planning and implementa- be identified and applied to reach people in a way tion of communication approaches andstrate- that affects them emotionally and motivates them gies is critical, given the sensitive nature of to change their behaviour. Changing human HIV/AIDSeducation, which requires that refer- behaviour is a concept and goal that has long ence be made to sexuality. This complicates the eluded researchers and programme/project offi- process of education on HIV/AIDS generally cers, since humanbeingsare individually affected and communication on the samein particular, by different factors in terms of changing attitude because it demands an understanding of the rea- and their behaviour. sons and motivation for specific sexual behav- It is crucial for the media and for those iour and relationships of different groups of peo- involved in media and HIV/AIDSprevention to ple. For the mass media, the issue is even more understand the relationship between communi- delicate given the fact that the channels used are cation and HIV/AIDS. Various organizations open to the public and the needto refer to cul- have developed different communication models tural factors and good taste, especially with which they have used in training medical and regard to adolescents and youth. social workers, programme/project officers, outreach and community workers, peer educators BACKGROUND OF THE MASS MEDIA IN EAST and counselors. In the AIDSCAP/FHI experi- AND SOUTHERN AFRICA ence (1997), an effective communication model which affects behaviour change involves five Various organizations in Africa have launched steps: awareness of the problem; gathering of media programmes and projects using different knowledge and skills by the target audience; channels, including the mass media and alterna- motivation to take action; preparation fortrial of tive media. It is important to study the history the new behaviour; and the sustenance of the and context within which the mass media have new behaviour. operated to understand their performancesofar. In spite of the lack of consensus on how com- The mass media have attracted the attention of munication affects behaviour, a discussion on the many practitioners of development because of subject is important, given the severity of the their wide reach andin the case of broadcasting, impact of HIV/AIDS and the centrality of the their immediate reach. The first radio station mass media as part of the communication process was established in Kenya in 1924 in wireless (Parrish-Sprowl, 1998). This discussion of neces- service form and in 1953, the African Broad- sity must lay emphasis on the fact that most com- casting Service was started with programmesin munication efforts in development have not been Kiswahili, Arabic and local languages. Broad- as effective as desired because communication casting served the interests of the settlers and has not beenintegrated as a primary processat the was an extension of what was happening in the level of conceptualization as noted by Parrish- “mother” countries. Sprowl. The reality has been that communication The situation was different with regard to the is referred to as a last resort and it is frantically print media where publications in English, applied in the form of mass media campaigns Kiswahili and local languagesproliferated in the without due regard to proper planning, implemen- 1930s, buttressing the nationalistic spirit and tation, monitoring and evaluation, and in total dis- activities. In 1959, the East African newspaper

39 was launched by his highness the Aga Khan, developed or even defined. This means that most while The Kenya Times newspaper was started countries have not given thought to whatpriori- in 1983 by the Kenya National African Union ties they should have as regards communication (KANU). The East African Standard had been or what communication agenda they should established by the settler community in 1902. establish. This has given rise to a situation Historically, most African governments took where populations, especially those in the rural the opinion and model that the media were too areas, have limited access to media channels, important a resource and tool to be left in the and where most people are not conversant with handsofprivate investors. Thus, the media were the way media operate and function. viewed as being important to national integra- In Kenya, political interference has for long tion and development as exemplified by Kwame haunted the media. While therestrictive single- Nkrumah’s statement: party environment was reversed when Section “Tt is part of our revolutionary credo that 2 (A) of the Constitution was repealed in 1991, within the competitive system of capita- freedom ofthe press is yet to be fully achieved. lism, the press cannot function in accor- The governmentstill has recourse to laws and dance witha strict regard for the sacredness policies that enable it to threaten the press: of the facts and that the press, therefore such laws include high fines in the case of should not remain in private hands.” defamation, and room to disable printing (Gadzekpo, 1997 ). presses. Human rights activists and media Although this goal is commendable,it has led to practitioners have over the last seven years the shackling of the media through direct and been pressurizing the governmentto releaseits indirect control by governments in most African stranglehold on the broadcasting media. To countries. Until recently, most of the broadcast some extent, some milestones have been media in Africa were under the complete control achieved with the licensing of private radio and of governments and the private press has had to television stations. It has been observed, how- deal with threats of de-registration, sedition and ever, that those who obtain licenses are usually defamation cases and the destruction of equip- ‘politically correct’. ment like cameras and printing presses. It has Great discontent has been expressed at how been noted that journalists have had to undergo the media cover developmentissues and this arrests, detention, beatings, and confiscation of includes coverage of HIV/AIDSissues. Much their publications. The legal and political envi- of this can be attributed to a lack of awareness ronment under which the media operate has and knowledge on how the media operate and often been hostile, lacking in freedom, and the constraints within their working opera- thorny which further constrains their work tions. Musa (1996) has discussed the need to (Mwagiru, 1998). review and redesign the structure and owner- The prevailing scenario where the mass ship of the media. In his opinion, the structural media are still under the control of the govern- areas of routine professional practices, prof- mentis pathetic given the potential reach of the itability and survival have constrained major- media. In Kenya, the highest selling daily the ity empowermentby the media. These include Nation, has a circulation figure of 180,000- time constraints and strict adherence to dead- 200,000 with a reach of about 2 million readers lines, as well as the notions of “impartiality” (it is estimated that 10 people read one newspa- and “objectivity”. Other obstacles include lack per). Estimates of radio listeners in Kenya have of adequate training facilities and the curricula been put at about 21 million making the radio an in operation as well as ownership which set ideal medium for mass education and communi- specific priorities and which demand a certain cation ( Kiai, 1999). profit margin. The latter factor has led to a The media also operate in the background skewed emphasis on politics on the part of the where communication policies have not been media.

40 FUNCTIONS OF THE MEDIA IN HIV/AIDS mosquitoes can transmit the HIV virus), PREVENTION AND MANAGEMENT and on prevention methods. In Africa, one has to deal with myths and interpretation of The primary aim of current mass education on the disease as a curse. The media can assist HIV/AIDSis to reach those whose HIVstatusis in correcting this by consistently referring negative to encourage them to retain this status; to the transmission patterns of HIV/AIDS to support those whosestatus is positive to urge and the importance of going for testing and them to be careful so as not to spread the virus proper care of those whoare infected with and to maintain hope through positive living; the virus. This is a method that has been and generally to educate society as a whole to adopted by the Kenyan press in the cove- develop sustainable structures that will con- rage of road accidents, which are especially tribute to the prevention and effective manage- high. Readers are always updated on how ment of HIV/AIDS. In communication, the high the figure is and that this issue has not focus has been on identifying methods of com- been dealt with effectively. As a standard municating messages on HIV/AIDSthat will procedure, articles on HIV/AIDS preven- motivate individuals to change their attitudes tion could contain essential information and and behaviour. Ways in which the media can data as background, including information support educational efforts on HIV/AIDS pre- on where to seek assistance such astesting vention present a vital question in these educa- and counseling. tional efforts. The media have been viewed as being influ- Humanizing the statistics and demystifying ential in building awarenessacross different sec- the epidemic: tors of society on HIV/AIDSand the importance As in most areas of specialized writing, of being careful in sexual behaviour and prac- media practitioners have to develop tices. While the media have been termed as hav- methods of putting a picture to thestatistics ing limited effects in attitude and behaviour that are being generated from epidemiolo- change, there are experiences which have shown gical and medical research on HIV/AIDS. that their contribution can be invaluable and The bland presentation of the figures most indeed highly powerful in determining behav- of the time means nothing to the audience iour change. The main strength of the media has and particularly those who do not perceive been viewed as that of agendasetting, meaning themselves to be at risk. A case in point is that the sustenanceof a topic for long in the pub- that of a recent newsarticle, which reported lic forum will lead to extensive and hopefully that out of 53 deaths in one parastatal orga- intensive discussions that spur some action on a nization, 40 have been from AIDS (The given topic. This strength has attracted enor- Daily Nation, June 9, 1999). A follow-up mous attention in Africa, partly given the need could be made on this kind of story by to democratize authoritative structures andto re- investigating how many organizations have design society for effective development. similar experiencesand placingthisin holis- Besidesthe traditional role of the media, other tic context to include the social, economic functions can be categorized as: and cultural dimensions. For instance, discussing the global - Providing accurate, factual information on figure of those infected as more than 33 HIV/AIDSon a regular basis: million people may be better imagined as Although research has shown that there are the population of a country, or a city or a high awareness levels on the existence of section of the population such as adoles- HIV/AIDS(over 90 per cent in some coun- cents. This helps the audience to have a bet- tries), some misinformation exists on the ter picture of the magnitude and urgency of transmission patterns (for example, that the situation and possibly to begin rumina-

41 ting over what effect such statistics may Educating society on the need for commu- have. This is an approach that is being nity-based structures in HIV/AIDS preven- adopted in the training of writers in areas tion and management: such as economics and environment, where Most governments in East and Southern the prevalence of statistical data has often Africa have medical care systems that have appeared to be bland, dull and technical to been inadequate in the care of HIV/AIDS. journalists. The medical communities have grappled for long with the control of diseases such as Presenting the opinion of the public on the malaria and with the reduction of child mor- disease: tality rates through immunization. The esca- Since the discovery of the disease, most lating figures on HIV/AIDSnecessitates that governments have attempted to putin place other options be identified, developed and programmesthat will contribute to its pre- sustained since the health care systems are vention and effective management. These currently grossly inadequate for the care of programmes have been established under HIV/AIDSpatients. the auspices of national AIDS and STD’s The community-based approach has control bodies and there has been tremen- been viewed as a solid and sustainable dous work aimed at improving the capaci- method of many development problems and ties of hospitals and clinics in testing for the issues. Such an approach, in this particular virus and in intensifying and developing case, would seek to empower communities better educational projects. to develop home-based care of HIV/AIDS The media can promote these efforts by patients. This approach is useful in that it frequently following up on cases of brings the issue of HIV/AIDScloser andit HIV/AIDSand on the experiencesthat indi- seeks to equip the community with the viduals and communities have had in the requisite skills while challenging its mem- programmes. As an example, there have bers to take the responsibility of the care of been complaints raised in Kenya on the lack patients. In addition, the patients convalesce of counseling for those about to undergo in an environmentin whichthey are familiar testing and for those who are found to be and where there is some comfort. HIV positive. Such sentiments can be dis- The media need to lobby for such couraging to others who may understand approaches and to challenge societies to the need to be tested but who then use this tackle HIV/AIDS head-on, rather than let to justify their avoiding thetest. people bury their heads in the sand. Thereis Questions such as the levels of public still a semblance of stigma attached to involvement in the formulation of public HIV/AIDS, and the media should be aggres- policies and the methods of implementation sive in supporting efforts to removethis need to be investigated as it is now clear stigma and in developing in the public the that the beautiful policies that African attitude that this is a disease like other governments have developed often have disease. only a cosmetic value. The needto translate these policies into local languages and to Presenting a holistic picture of HIV/AIDS: simplify the “officialese” is an issue that the Most of the information on HIV/AIDSin media can be involved in as this holds the the mediais statistical and related to public policies up for public scrutiny. Such scru- statements on the trends. This is based on tiny can assist policy-makers to understand the current media structures and news the impact or effects of their policies as values that tend to give prominence to well as the strengths and gaps in the per- public personalities. As such, most of the ception of the public. stories are government pronouncements on

42 HIV/AIDS which are primarily warnings local populations. At the global level, the and information on the extent of the spread. issue of lobbying for support for the provi- It is on rare occasions that the mass sion of new combination therapies should be media critically analyze the impact of pursued in the media and sustained. When HIV/AIDS on the socio-economic front. some“experts” announce that they have dis- This contributes to the invisibility of the covered new treatment, they should be held disease and the public lethargy in attacking up to public scrutiny and their claims verified the problem urgently. Society should com- thoroughly. The media should analyze criti- prehend well the consequences of ignoring cally such trends and also bring into the the impact of the epidemic, such as the public arena for public debate such issues. threats to the socio-economic fabric and For instance, it would be interesting to inves- structures. The media are well placed to tigate whether pharmaceutical companies, undertake such a task, but this needs to be a which import combination therapy treatment, deliberate policy on the part of media orga- can be exempt from taxation by governments nizations. to make them cheaperfor the public.

Advocating for accountability and responsi- EXPERIENCES ON MEDIA AND HIV/AIDS bility in the HIV/AIDS prevention and PREVENTION AND MANAGEMENT management sector: The desperation on the part of HIV/AIDS Various organizations have established pro- patients in seeking treatmentfor their infec- grammesand projects on media and HIV/AIDS tion has given rise to a sharp increase in prevention and management; these experiences “medical experts” who claim to have a cure differ in terms of results and findings. In the for the disease. These patients are vulne- Democratic Republic of Congo, for example, rable to unscrupulous experts whoare out to Population Services International (PSI) initiated gain from their plight. Some of the medical a project in collaboration with the National associations like the Kenya Medical AIDS programme and funded by USAID Kin- Association (KMA) have been keen cautio- shasa ( PSI, 1992). The project targeted the ning the public on seeking treatmentthat has youth aged 12-19 and prospective parents who not stood the test of rigorous examination by were 20 to 30 years of age. The project was the medical and scientific fraternity. based on the country’s rich tradition in music and The vulnerability displayed by HIV/ drama and sought to communicate the message AIDSpatients indicates that a gap exists in of safer sexual practices. Thus, media materials the provision of treatment that society can were developed and messages conveyed through trust or depend on. Thus, it is easy for some broadcast announcements, music, video, talk to exploit this gap. This raises the issue of shows, interviews and contests. the lopsided nature of treatmentat the global Evaluation of the project indicated that posi- level: those who are infected with the tive attitudes evolved andthat there wasintention HIV/AIDS virus in the developed world to practice safer sexual behaviour. There was evi- have some hope and they live longer dence of increased awareness regarding asymp- because of the new combination therapies. tomatic carriers; increased acceptance and Those in the developing world havelittle reported practice of abstinence and mutual hope because of the expense and inaccessi- fidelity and increased knowledge and accepted bility of such treatment. use of condoms for AIDS prevention. This highlights the issue of public health In Tanzania, the World Bank initiated a pro- care systems and their management as well ject which focused on radio spots. The project as the need to encourage local scientists to included posters/calendars, cartoons, newspaper develop treatment that can be available to flashes, and counseling. Similar use of mass

43 media is evident in Malawi and Zambia with an PROPOSED STRATEGIES FOR MORE EFFECTIVE emphasis on radio spots and use of radio pro- MEDIA EFFORTS ON HIV/AIDS PREVENTION grammes. In Kenya,a project wasinitiated based AND MANAGEMENT. on a 1992 needs assessment by the National Council for Population and Development While the media have been faithful in the cov- (NCPD) and the Family Planning Association erage of issues related to HIV/AIDS preven- of Kenya (FPAK) with support from John Hop- tion and management, deliberate and well kins University Population Communication designed efforts aimed at promoting better Services (JHU/PCS), which targeted adoles- communication through the media have not cents. The project, which was funded by been adequate. There have been meetings USAID, featured media activities such as radio organized in East and Southern Africa aimed programmes, print media and letter answering at raising media practitioners’ consciousness service. The radio programmes included a talk on the need to cover HIV/AIDS prevention and the provision of a forum for the youth to and management issues more intensively and question HIV/AIDSexperts on the programme. widely. Additional work could focus on the The programme was designedas a variety show following strategies: with the requisite musical background (Nduati & Kiai, 1996). Training media practitioners in the basic A media project that originated in Uganda concepts of HIV/AIDS and which has been adopted in Kenyais that of There is no doubt that there are high aware- the Straight Talk newsletter. This project was ness levels of the need for greater and more launched by the Ministry of Information, effective coverage of HIV/AIDSonthepart of Uganda AIDS Commission, the Save Youth media practitioners. This situation is akin to from AIDS, and UNICEF. The newsletter, that of high public awareness but minimal which began in 1993 and which is issued once behaviour change for most countries in sub- every month as an insert of The New Vision Saharan countries. Seminars and workshops newspaper,initially laid emphasis on sexuality. should be re-designed to ensure that the media This, however, broadened to encompasshealth adopt a pro-active approach in the coverage of and psychological issues (Nduati & Kiai 1996). HIV/AIDS prevention and management The mushrooming of youth clubs in Ugandan issues. schools has been attributed to Straight Talk. A method that has been used recently by Some of the constraints cited in the use of the Kenyan Chapter of the African Council for mass media include limited media coverage of Communication Education has been to ground radio programmesandstructural difficulties in interested journalists in the basic concepts of coping with issues raised by adolescents during specialized subjects. This has been applied in radio programmes. This is because the pro- relation to the environment and there is evi- gramme usually has a particular focus, but the dence of greater interest amongthe journalists. adolescents at times call in on a different sub- This methodis beneficial in that it demystifies ject requiring urgent assistance. Other needs concepts that may appear to be difficult and identified have been on the need to use local technical to the journalists, thus equipping languages, and for greater collaboration with them with confidence and creating an interest media houses to ensure greater communication for further research and reading. on HIV/AIDS prevention and management Despite this interest, constraints exist in the issues. In addition, there is a need for the incor- use of this approach. A much ignored butsig- poration of greater creativity and diverse struc- nificant category of the media are the editors. tures in programming, and moreeffective coop- In the meetings with journalists, they have eration with stakeholders such as parents, expressed their frustration at following up on health officials and education officials. specialized issues which are “spiked” by edi-

tors. Editors should be sensitized on the need to they can refer to as a quick reference. The have more effective coverage of HIV/AIDSpre- Zambian Institute of Mass Communication vention and management issues. Innovative (ZAMCOM)has developed a resource book approaches are required, however, because for the media on HIV/AIDS, and there are logistically, it is difficult to get editors who are plans to replicate this effort in other countries often media managersatonesitting or meeting. in the East and Southern region. Another required publication would be an Advocacy and lobbying for regular inventory of organizations and experts allocation of space in the mass media involved in this area in each of the countries in This strategy has been well applied by human East and Southern Africa. This is useful as a rights and democratization activists. In the publication that can be easily accessible to all Kenyanpress, for instance, it is now common journalists who require specific information to have specialized writing on humanrights and credible sources whom they can interview and political issues, sometimes by experts and seek opinion or clarification from. from these areas. This trend has been realized by lobbying for space for the coverage of such Establishmentof a network on media and issues, but more importantly by commitment HIV/AIDSprevention and management on the part of these organizations in ensuring Networking as a strategy has fast gained cred- that the space is used regularly. Most editors ibility in most development work in East and are willing to allocate space for columns, but Southern Africa. The idea has proved to be they require full commitment that the space effective in that there is shared information on will be used. emerging trends, constraints and challenges Some of the columnists have taken up the and on strategies to deal with these. Such a writing as a part of their crusade, while others network in this case would seek to sustain con- have been supported by donor agencies. Orga- tacts between the media and experts working nizations involved in HIV/AIDS prevention on HIV/AIDSprevention and management. and managementcan develop a pool of writers Contact between the different groups of or a syndicate where there is shared responsi- specialists may serve to reduce or removesus- bility for the columns. picion of each other and to create understanding of the working environment in which each Publication of reference materials works. The media have often been accused of for the media being casual; most of these accusations are Mediapractitioners often complain that there based on a lack of understanding of how the is little reference material developed for them media work and the constraints they face. Sim- as an audience on specialized subjects such as ilarly there has been the public perception that HIV/AIDS prevention and management. The scientists are locked up in their lofty and ivory structural constraints within media houses are towers, isolated from society, “spewing” tech- an obstacle for journalists who would like to nical jargon that cannot be understood by the specialize in technical areasasit is a laborious ordinary citizen. effort identifying and accessing relevant and Networking would help the media to put a essential background material. One effective face to these scientists and to explain to the strategy would be to develop materials which public through coverage, the emerging trends simplify basic concepts on HIV/AIDSpreven- on HIV/AIDS prevention and information. An tion and management, such as the epidemiol- additional benefit of this would be the devel- ogy, socio-economic impact, and trends in sci- opment and maintenance of sources for jour- entific, medical and social science research in nalists for their articles and programmes on the area. Journalists then have a text, which HIV/AIDS prevention and management.

45 REFERENCES Mwagiru, Makumi(1997). “A Return to Basics: Media Rights as Fundamental Human AIDSCAP/Family Health International (1996). Rights.” Africa Media Review, Vol. 11, No. 2 AIDSin Kenya: Socio-Economic Impact and (88-104). The African Council for Policy Implications. Nairobi. Communication Education (ACCE), AIDSCAP/Family Health International (1997). Nairobi. Making Prevention Work: Global Lessons Nduati, R. & Kiai W (1996). Communicating learned form AIDS Control and Prevention, with Adolescents on HIV/AIDS: Experiences Nairobi. from East and Southern Africa. International Berer, Marge & Ray Sunanda (1993). Women Development Centre for Research (IDRC), and HIV/AIDS: An International Resource Ottawa. Book. London: PandoraPress. Parrrish-Sprowl, John (1998). “Organizational Gadzekpo, Audrey (1997). “Communication Communication: Linking Key Processes to Policies in Civilian and Military Regimes: Effective Development.” Nairobi: Paper pre- The Case of Ghana.” Africa Media Review, sented at the 11th Biennial Conferenceof the Vol. 11, No. 2 (31-51). The African Council African Council for Communication for Communication Education (ACCE), Education, October. Nairobi. Piot, P (1997). Fighting AIDS Together. The Kiai, Wambui (1998). “An Overview of Media Progress of Nations. UNICEF, New York. and Environment in Kenya” in Karembu Population Services International (PSD (1992). Margaret and Kiai Wambui (eds). The Zaire Mass Media project: A Model Understanding Environmental Communi- AIDS Prevention Communications and cation. The African Council for Com- Motivation Project, Washington, DC. munication Education (ACCE), Nairobi. World Health Organization (1998-2002). Ministry of Health (1997). Sessional Paper No.4 Regional Strategyfor the Control of Sexually on AIDS in Kenya. Nairobi. Government Transmitted Diseases. Printer. Musa, Danladi (1996). “The Sleeping Dog Cannot Bark: Media and Mass Disempowermentof Civil Society in Africa.” Africa Media Review; Vol. 10 No.3 (79-92), Nairobi.

PART

INVESTIGATIVE REPORTING ON CAUSES AND SPREAD OF HIV/AIDS: CASE STUDIES

HIGHLY MOBILE POPULATION DRIVES THE SPREAD OF AIDS IN KENYA

Rose Lukalo, African Woman and Child Feature Service, Nairobi, Kenya

BACKGROUND Forty per cent of the population live below the poverty line, and the situation is worse in Kenya covers an area of approximately 569,000 rural areas. Distribution of income and con- square kilometres out of which 11,200 square sumption is staggered disproportionately kilometres are covered by inland water. Only towards the rich with the richest 10 per cent about 20 per cent of the land is arable, the rest consuming 47.7 per cent while 80 per cent of being classified as arid and semi-arid land. the population share out 37.8 per cent among These geographical conditions have led to a themselves. The widespread poverty in Kenya concentration of Kenya's 29 million strong has created conditions in which people are population in the central and southern parts of constantly on the move in search of better the country where population densities average living conditions and this has implications for 47 people per square kilometre but reach 230 the spread of infectious diseases including persons per square kilometre in the most AIDS. densely populated areas while northern Kenya has areas averaging only three persons per MOBILE POPULATION AND THE SPREAD OF AIDS square kilometre. The incidence of the AIDS IN KENYA epidemic relates directly to population densities with incidence of the disease found to be Even in the semi-darkness of dawn there is highest in Nyanza, the Western provinces and movement. Busia Town on Kenya's western the Central Province. By 1997, up to 30 per border with Ugandais already alive with activ- cent of all Kenyans lived in urban areas where ity as people carry their wares towards the the majority do not have access to proper sani- “Bus Park” open market where they hope to tation, and the demand caused by an average makea little money. yearly growth rate of 2.6 per cent has strained Many come from the nearby Sophia Estate services. while an equally large number have crossed The World Development Reportfor 1998/99 the border from Ugandatravelling early to lists the Gross National Product as US $9.3 bil- avoid the clinging humidity that will soon trap lion (Kenya shillings 604.5 billion) with an everything. Paul Wanyama has carried beans average annual growth rate of 2.3 per cent and and groundnuts from Uganda while his col- Gross Domestic Product of US $9.89 million. leagues bring in second-hand clothes and elec- Indicators for the quality of life are poor with tronics as well as grains. In the evening they child mortality resting at 90 per 1000 births. will carry homesalt, cooking oil and soap to Nearly one in every four children under the age sell on the other side of the border. Sitting next of 5 suffers from some degree of malnutrition. to him and protected from the swelling heat by Life expectancy at birth is 57 years for men and a perforated sheet of polythene hung on three 60 years for women. Adult literacy is 70 per sticks is Michael Wegesa who makeshis living cent for women and 86 per cent for men. exchanging Kenyan and Ugandan currency.

51 As the market and shops open for business, deeply rooted. This, she says, leads to risky sexual traffic flowing into the Town increases rapidly behaviour and high HIV infection. and traders are kept busy by a constant flow of "In almost every housein this Division thereis enquiries. The high mobility of people in Busia is someone with AIDS." typical of busy border regions and areas to which Movement between rural and urban homes people are attracted and brings into play unique even within a restricted area like Busia District is conditions that encourage the spread of AIDS. now frequent and may explain the rapid increase in “When you think of a border town,there is a lot HIV infections. Mobility associated with migra- of movementin and out," says Maureen Ong'ombe tion is usually temporary; people leave their vil- of the Kenya AIDS Non-governmental Organiza- lages hoping to find seasonal or temporary work tions Consortium, KANCO. "Border towns are a but always hopeto return home. Despite moving to good example of possible impacts of mobility. town, migrants tend to keep in touch with their They tend to be cosmopolitan with a mix of peo- families and friends at home, ensuring regular con- ple interacting on different levels many of whom tact especially over weekends and holidays and an are only there temporarily," Ong’ombe, who works infected individual may spread HIV/AIDSto oth- as Communication Officer for KANCO,says. ers at both ends of the chain. There tends to be more money in circulation, Fred Majani, a counsellor with REEP, is living which encouragesan active sociallife as is evident with HIV andhe believes his experience demons- from the loud music that spills out of the numerous trates the reality of many people from the area. bars and lodgings and hotels in Busia Town. Along After graduating as a clinical officer he took up a the main street it seems that every other shop is a posting as a district health officer in a neighbour- bar and lodging and as early as 10 a.m. patrons are ing district. In this way he believed he would in evidence. Little information exists to link mobil- remain close enough to be home every weekend ity directly with the spread of AIDS in the town with his wife who looks after the home in Busia and the surrounding Busia District, but infection and still be within easy reach of his work station rates for the District are estimated at 30 per cent of where he earned living. During this period he had the population and are among the highest in several relationships with women and he believes Kenya. Nationally, the highest infection rates are one of these resulted in his infection which he found amongst working men who have money and passed to his wife. are mobile. Mobility linked to urbanization has long been Mary Makokha works with people with recognized as a factor in the spread of AIDSin HIV/AIDSin Butula Division of the District and Kenya butlittle has been done to understand the believes migratory patterns do impact on the inci- enormity of it, the vulnerability it creates and its dence of HIV/AIDS, changing coping methods impacts on the lives of people. Without this under- and social attitudes to sexuality. People usually standing, it is impossible to define prevention leave their homesin search of better economic strategies which work. In 1960, only 7 per cent of opportunities, sometravelling only a short 10 kilo- all Kenyans lived in urban centres but this number metres to settle in areas where it is easier to find has risen to 28 percent of Kenya's 29 million peo- jobs or to trade while others travel further. In the ple and is largely attributed to economic factors case of Busia, Makokha says they come from both [UNFPA, 1998]. sides of the border and have intermarried and The capital, Nairobi, for example, has experi- interacted to such an extent that it is difficult to enced rapid growth rising from a population of define people by nationality. 343,500 at independence in 1963. "During thelast In their new context, different lifestyles and National census in 1989, the population of Nairobi coping methods emerge. Makokha, who co-ordi- was recorded to be 1,324,570 with a total male and nates the Rural Education and Economic Enhance- female population of 752,597 and 571,973 respec- ment Programme [REEP] in Butula, Busia Dis- tively," says Nairobi Mayor Councilor Samuel trict, says promiscuity coupled with alcoholism is Mbugua. The Council now estimates the popula-

52 tion of Nairobi to be over 3 million with a growth the government of Kenya is encouraging com- rate of 6%, more than half of whomlive in slums. munity-based care, based on the context of the While a population growth rate of 2.6 has extended family to care for people living with played a role, the urbanization process in HIV/AIDS. Kenya is largely attributed to rural-urban "It is important to understand that relation- migration. Young school-leavers in search of ships in the sium are borne of need and practi- employment and other opportunities in the cality," says Owiti, explaining that those who urban centres are the most dominant migrants. end up in the slums usually did not plan their It is in the slums on the periphery of towns lives to turn out this way and most only intend to where many of those who migrate from rural be there temporarily. areas end up. The lucky ones find employment "A man working as a night watchman in the at minimum wage while those who are not as city might enter into a relationship with a lucky find themselves trapped in poverty with- woman simply to ensure that he has someone out the meansto travel back to their homes and providing security for his house while he is restricted hope of ever leaving the slums. away,’ says Owiti. In exchange, the womangets Ann Njoroge works with people living with food, shelter and a measure of protection for her- HIV/AIDS in Korogocho slums on the eastern self. It is not uncommon for men living in such side of Nairobi. The Eastern Deanery Aids arrangements in the urban centres to leave Relief Program of the Catholic church provides behind wivesin the village. medical, psychological and spiritual services The fact that slums are inherently unhealthy and Njoroge says 68 per cent of the 4,000 peo- places with lack of access to running water and ple currently in the programme are single stinking open sewers, no electricity, no roads, mothers with children. Most of them came to high crime rates, over-crowding and limited Nairobi looking for economic opportunities. access to health facilities only aggravates the "Many of these womenare alienated from risks. These factors also make it difficult for their rural families for a variety of reasons," those planning AIDSinterventions to reach pop- explains Njoroge who says one of the aims of ulations living in these areas. The result is that the programmeis to reconcile these mothers Kibera, said to be the largest slum in sub-Saha- with their families. "To date we have managed ran Africa, has a high incidence of HIV/AIDS to reconcile almost 170 families and this helps estimated at 25 per cent and growing. Currently to put the mothers at rest by allowing them to the KICOSHEP programmeserves close to 700 plan for their children with their families children orphaned by AIDSbut hundredsof oth- before they die.” ers cannot be reached. Alienation from rural families has reached Attitudes towards sex have definitely critical proportions as Ann Owiti, coordinator changed. Achola-Ayayo (1998) conducted a of a community-based programme for AIDS study on sexual practices and risk of the spread orphans and their families in Kibera slums, of AIDS and found that three quarters of inter- knows too well. The Kibera Community Self- viewees in urban areas no longer believe in cul- help Program (KICOSHEP) which Owiti coor- tural values thatrestricted sex before and outside dinates is based in Mashimoni, one of 13 vil- marriage. This is strong evidencethat social, cul- lages that constitute Kibera, the giant slum in tural and economic changes have taken place the heart of Nairobi. Kibera is hometo anesti- with rapid urbanization. mated 850,000 people who, in common with With an average population growth rate of most poor communities world-wide, have had 2.6 per cent, the population of Kenya was the social and economic systems on which expected to reach 50.2 million by the year 2025. members of the community depend for their Revised projections released recently, however, survival, challenged and stretched to capacity suggest that the AIDS epidemic could stabilize by AIDS. Ironically this comes at a time when the population at 32 million in 12 years time at

53 which point population growth will have slowed communities. One such study of truck drivers to 0.6 per cent because of HIV/AIDS. andtheir assistants found 1/3 to be HIV infected Busia represents a microcosm in its own and there was evidence that they had travelled right but also features significantly in the pattern widely within six countries served by Mom- of spread of the disease in Kenya. Busia is the bassa Port including Kenya, Uganda, Tanzania, most westerly point of the Trans-Africa High- Zaire, Burundi, and Rwanda. way in Kenya. The Highway begins at Mombasa As early as the mid-80s, scientists had seaport and cuts a swathe inland to serve six showna series of epidemics among sub-popu- land-locked countries. Everywhere the Highway lations with varying levels of risk. Data from a goes the epidemic follows and the samepatterns study led by Dr. Peter Piot showedclearly that appear to hold along other significant road net- HIV infection in Kenya spread first and most works. extensively to Commercial Sex Workers Townswith the highest recorded incidence of (CSWs). This was followed by STD clinic HIV/AIDS include Nakuru, Kisumu and patients likely to include clients of CSWs and Nairobi at 20-30 per cent, followed by Mom- finally to the general population as evidenced bassa, Kakamega and Thika with a prevalence by slow and then accelerating spread among of 10-20%.(Kenya, Mulindiet. al., 1998). With pregnant women. This led to interventions that the exception of Thika,all these urban areas are directly targeted truck drivers, CSWsand later also major truck stops on the Highway. Thika, to other groups classified as “high-risk” such on the other hand,is a rapidly expanding indus- as beachboys, watchmen, soldiers and prison- trial centre and has in recent years attracted ers, targeting the distribution and use of con- droves of people from all over the country who doms and education on how HIV/AIDSis come in search of employment. spread. The piece-meal targeting of high-risk Boom towns have grown aroundthe truck populations has had some success but has not stops with many sex workers to whom the truck addressed the whole phenomenon of mobility, drivers and their assistants may turn while away the vulnerabilities it introduces and the impact from their spouses. on the spread of HIV/AIDS. Part of the prob- Although they are not counted as migrants, lem is technical. long distance truck drivers are of particular con- "It is a subject that is difficult to research cern becausethey are at high risk and can spread because of the very fact of the mobility of the HIV/AIDS and STD's long distances. They people,” says Maureen Ong'ombe of KANCO. travel frequently, often through urban areas with The study group would be constantly changing high levels of HIV and because they are away and migration, being such a temporal phenome- from homefor long periods of time, they tend to non, would raise questions as to the validity of have many different sex partners. these studies. She says this is further compli- A 1994 study showed that about one half of cated by attitudes towards the whole issue of truck drivers arriving in Rwanda from Mom- sexuality as a private matter. "People tendtotell bassa and Nairobi, Kenya, were HIV positive. you what they think you wantto hear and study Another study of 200 adolescents who frequent results would not be authentic unless the truck stops in Kenya found that half the boys researchers cultivate a long-term relationship and onethird of the girls reported having had at with members of the study group." least one STD indicating early sexual activity In the case of migration, mobility is largely and hence vulnerability to HIV and AIDS. driven by the quest for a better economic poten- Studies have also supported the theory that the tial. Nothing demonstrates this process as geographic distribution of HIV and AIDS clearly as the relationship between the spread of reflects a diffusion process in which majorroads HIV/AIDSand the military. act as principal corridors for the spread of the Prior to the establishment of a military base virus between urban areas and other proximal at Gilgil, about 120 kilometres to the west of the

54 capital Nairobi, there waslittle to draw people part of. This programme aims to encourage pre- to this small town. Although the town rests on vention, advocacy, policy debate and programme the trans-Africa highway, truckers and other development in military and defence forces. travellers preferred to stop in Naivasha and Nakuru where tourist attractions had helped to PEOPLE IN CRISIS: REFUGEES AND THE INTERNALLY establish thriving urban centres. Once the mili- DISPLACED tary barracks was set up in Gilgil things changed. Sessional Paper No. 4 of 1997 on AIDS in “People recognized military officers as peo- Kenya says the influx of refugees from different ple with money, and theyset up all sorts of busi- countries in the region has had a negative impact nesses around them,” says Major Samuel on the AIDSsituation in Kenya. There are a Ndegwa, who is involved in HIV/AIDS pro- numberof "permanent" refugee camps in Kenya, grammesin the military. Commercial sex work- most of them located in the North East and ers were among the first group attracted know- North West of the country. In the North East ing that the military is mostly made up of there are three camps, one near Dadaab and two salaried and unaccompanied men who would, others in Garissa Town. They are home to about therefore, be more vulnerable to sexual 119,000 refugees mainly from Somalia. advances. The liberal availability of alcohol in In the North West 1s the UNHCR Kakuma the camp did not help matters. Camp near Turkana housing about 51,000 Ndegwasays the isolation of soldiers from refugees mainly from Sudan, Ethiopia and Soma- family and friends coupled with their high lia. There is also a camp at Lokichoggio close to mobility are critical issues that have encouraged Kakuma. Thousands of other refugees who have the spread of HIV/AIDS amongthis population, been able to obtain residency papers live and and national borders do not limit the movement intermingle without hindrance alongside the rest of soldiers either. "Our soldiers have served on of the population while others remain among the UN Peacekeeping missions everywhere... nameless, faceless unregistered population. Thou- Yugoslavia, Jordan, Namibia, West Africa and sands of local and expatriate employees have all over Kenya”he says. moved into Lokichoggio alone to provide assis- "These people have feelings and needs just tance to the refugees while many others use the like you and me. When they are taken away town as a base for conflict resolution and devel- from their wives and girlfriends for even a opmentactivities targeted at South Sudan. whole year without a break, what can we The Sessional Paper, adopted by Parliament expect?” on 25 September 1997 to guide organizations The links between CSWs and military offi- and institutions addressing AIDS in Kenya,says: cers have roots in history. Margaret Gatei of the "the need to collaborate with other agencies is National AIDS and STDs Control Programme critical. The government will collaborate and (NASCOP)in the Ministry of Health recounts work closely with UNHCR to mountpreventive that the famed Pumwani sex workers are education programmes and provide health and descendants of a group of military camps. These social support to those infected with HIV". womenare currently part of a study which aims Beyond this broad statement, nothing is said of to understand their apparent resistance to what needs to be done and who should be HIV/AIDS. involved or what interventions should be put in The extent of infection in the military is con- place. To date, much of the work of rehabilita- sidered high and has led to the establishment of tion and repatriation has been left to the United several HIV/AIDS prevention programmes. One Nations through the High Commission for of these is the Civil-Military Alliance to Combat Refugees which has for some time recognized HIV and AIDS, a regional network of military HIV/AIDS as a serious problem requiring a organizations which the Kenya ArmedForcesare strategy.

55 UNHCRsaysthe majority of HIV infections claimed to be on a mission of ethnic cleansing. in refugee situations are sexually transmitted. The four districts, Mombassa, Kwale, Taita “The disintegration of community and family Taveta and Kilifi, have a population of about 1.9 life leads to the break-up of stable relationships million people including a significant population and the disruption of social norms governing of people who have migrated to the area in search sexuality.” of work in the lucrative hotel industry.It is these "Interaction between the refugees and local people from "up-country" whothe raiders were population is likely to happen and hence the need said to be targeting. to provide service to all. Failure to do so would More than 70 people were killed in the skir- be counterproductive in terms of preventing the mishesandat least 5,000 people sought refuge in spread of STDsand HIV," says a UNHCRreport. church compoundsin the area while the majority "A major lesson of the AIDS pandemic so far has of victims found shelter in the homesofrelatives been that HIV spreads faster in conditions of or friends and other safer areas of Mombassa. poverty, powerlessness and social instability — Many others, especially women and children, conditions that generally prevail for refugees." moved back inland to live with extended family Refugee populations are recognized by the and friends in their places of origin. These peo- Kenya governmentas being particularly vulnera- ple are more difficult to identify but based on the ble but there is silence on which government original population of the affected areas the total organs or individuals are expected to co-ordinate number of people directly affected by the vio- and follow up on recommendationsas well as the lence and terror may run to 100,000. means and resources. Programmes undertaken These are notthe first cases of internally dis- by UNHCRhave understandably been preoccu- placed people. An estimated 350,000 people pied with providing refugees with the basic were displaced by the ethnic conflicts of 1992- essentials although HIV/AIDS programmes are 1995 which affected three of Kenya’s eight now part of the parcel. It is clear that greater link- provinces — Rift valley, Nyanza and Western age may be necessary between UNHCRandthe Provinces. Many of these people have yet to national programme on HIV/AIDSprevention if return to their homesfor fear of repeat attacks. both are to realize their goals and the mandate Lucy was, until 1997, a resident of and the policy framework may need to be Mishoromoni in Mombassa. “Before I came here expandedto include other areas. (Mombassa) I used to live in Narok at a place Related to the refugee mobility is the largely called Maela. We were also chased away from ignored plight of the internally displaced within there in 1993,” she says referring to the Rift Val- Kenya. The international community says pri- ley clashes. “I have lived here for about 18 mary responsibility for their safety and assis- months and now I have to moveagain,” she says tance lies with their own government which has ponderously. not responded adequately. Manyof those displaced from the Rift Valley Since there is no one agency within the UN fled to Nakuru, the largest town in the Province, with overall responsibility for the internally dis- where they have started self-help groups and placed, a numberof different UN agencies have small developmentprojects such as tree planting been designated on an ad hoc basis by the UN and kitchen farming as well as tailoring and car- Secretary General to administer programsfor the pentry. They have also started an AIDS aware- displaced including UNHCR, UNDP and ness campaign after noting a shocking increase in UNICEF. the incidence of the epidemic among their popu- Ahead of the 29 Decemberelections held in lation. Infection rates for Nakuru shot up from 10 1997, four of the six districts in the Coast per cent in 1990 to about 25 per cent in 1997. Province to the east of Kenya experienced violent Frederick Ndungu Njenga, Coordinator of raids by armed gangs operating under the Griss Self Help Group based in Molo Town, 40 umbrella of Association of Pwani Peoples who kilometres west of Nakuru, says the area faced

56 serious socio-economiccrisis following the sud- area and in muchof North Eastern and Eastern den and large influx of people fleeing ethnic Provinces of the country, who were largely clashes. ignored by development efforts. Cattle "Most of those who came to Molo are rustling, which is traditionally part of the cul- young people and women without meaningful ture of many pastoral communities, has in employment, technical skills or the means to recent years taken on a more violent character. generate an income,” Njenga adds. "They (attackers) take their time to gang He says they have not received muchin the rape their victims in the presence of the whole way of assistance and they are not recognized family," says a report compiled by the Kenya as a "real" community and so development Human Rights Commission (KHRC) and MS activities were not targeted at the community Kenya. "In almost all cases, victims report the for some time. The hard circumstances forced incidents to the local police station but it's only many into sexual relationships for emotional in a few cases that any action has been taken." reasons as well as for money and the number Khadijah Adam, an AIDS counselor at Pepo of HIV/AIDS soon began to show up among la Tumaini Jangwani, a community-based care the 400 women and morethan 300 youths over programme for orphans and people with AIDS, the age of 15. Griss, formed in 1992, has says the systematic use of rape as a weaponis increasingly had to face the burden of address- responsible for the spiraling incidence of AIDS ing the spread of the epidemic within the com- in the area. Barely five years ago, Isiolo was munity and with support from several other among areas regarded as having a low inci- organizations, introduced home-based care and dence of AIDS with less that | per cent infec- health education programmes particularly tion rate. Now it is categorized among 29 dis- amongthe youth. tricts with "medium prevalence” failing in the A similar story of violence and social dis- 10-19 per cent range. Currently Khadijah ruption is told in Isiolo District, in mid-Eastern works with seven women's groups whose Kenya. membersare living with AIDS and she says "They attacked my family and stole all my there are many more. property, including the ugali that was cooking Those families displaced to urban centres at the time of the attack," a victim of banditry by the violence find themselves without reportedly told the development organization, money or any assets and both children and MSKenya. "They also raped my wife, daugh- adults may be coerced into sex for basic needs ters and even my sons. Later the same night, including food, shelter and security as well as they attacked my neighbourjust before killing for money. another neighbour who tried to come and save "Some residents of Manta and Maili Saba the situation." "I have finally decided to shift suburbs have abandoned their homes and have from my house to town and all I can sayis: I sought refuge at Pepo la Tumaini Jangwani." am a refugee in my own district." "Peter" says he abandoned his farm after Isiolo District covers an area of 25,605 being attacked four times. During the last square kilometres. It is part of what was for- attack he and his wife were raped andall their merly known as the Northern Frontier District, household itemsstolen. a semi-arid mass of land transformingitself to It is clear that steps need to be taken to the Chalbi Desert in the north of Kenya. The introduce intervention programmes designed district is home to about 100,000 people, most to address the unique conditions in situations of them nomadic pastoralists representing five arising out of civil conflict if Kenya is to meet major ethnic groups — Borana, Meru, Turkana, the stated policy of "building a national Samburu and Somali Rendile. response to the epidemic". To date there have Since colonial times, banditry has been syn- been few attempts to understand why and how onymous with the lives of the people in this civil conflict and similar complex emergencies

57 affect the risk of HIV/AIDSorto identify the rance of AIDS and foreign customs all con- reason why vulnerability increases in these tribute to the increased possibility of HIV trans- situations. mission, especially among young people who travel. Often they do not understand the risks TOURISM posed in a foreign society. This ignorance is compounded by the ignorance and lack of Despite its decline in recent years, the tourism understanding in the local population, and is industry is still one of Kenya's biggest revenue particularly true for hotel employees and those earners. At its peak in 1996, Kenya attracted in related service industries including commer- close to one million visitors a year earning up to cial sex workers who often follow the tourist US $500 million. Tourism contributed as much trail. as 10% of the GNP (1996). All government "Whenthe tourist ships are reported to be efforts are directed at ensuring that Kenya docking by the media, there is an influx of becomes a primary safari destination and that CSWsto Mombassa Town," says Esther Gatua the numberof tourists is increased. Targets are of KANCO. Currently a programme at Muko- set at attracting 2 million visitors annually and mani Clinic in Mombassa is working with to this end infrastructure including roads, provi- CSWsto understand the problems posed by sions for air travel and all other meansoftrans- HIV/AIDS. All the sex workers in the pro- portation. grammeare required to have a certificate which Now the governmenthas an aggressive inter- they show to all partners indicating that they national marketing campaign in place and have been screened for HIV and STDs within because tourism is so critical to the economy,to the current month. No corresponding AIDS a large extent it determined the denial, which prevention campaign exists for other workers wasthefirst response to the epidemic. associated with tourism. "There is still denial in this country. Initially Until he fell sick, Wafula worked for six it was because somepeople thoughtthat talk of years in a small hotel in Malindi. A strong AIDS was sensational and would hurt the imposing man with a hearty laugh, Wafula aug- tourism industry,” says Ong'ombe.Shesaysatti- mented his meagre salary by indulging the sex- tudes are much more practical now but there ual fantasies of women tourists who paid him remains an assumption that awareness among to have sex. In 1997 he was diagnosed with tourists should be the responsibility of their AIDSand thoughat first able to pay his med- home country; other than placing condoms ical bills, illness eventually forced him out of within easy reach, nothing is done to address the the job and he returned home wherehe died of campaign towards tourists. Nowhere in national tuberculosis in 1999. plans and policies looking at tourism is HIV or At age 18, Christine Nyambura had justleft AIDS even mentioned. Although no research high school and was iucky to find employment has been conducted locally to examine the in Nakuru in one of the better-known hotels. A impact of tourism on HIV/AIDS, studies from huge box of free condoms had been placed in other tourist destinations around the world indi- front of her at her station in the reception and cate that interaction between tourists and local clients as well as co-workers often teased her populations represents high risks for those about it or made suggestive remarks. Tired of involved. dealing with the comments, Christine eventu- These studies indicate that tourists generally ally moved the box to a less obtrusive position do not consider themselves to be at greater risk and forgot about it. Today, she wishes she had of infection while on holiday than at home and bothered to think about the reason why the con- most tourists respond positively to HIV/AIDS doms were placed there. prevention campaigns. Factors such as loneli- Christine was infected with HIV in 1996 ness, freedom from familiar strictures and igno- and is saddened by the fact that she had the

58 meansto protect herself right under her nose. "The regional impact of tourism is highly "T just didn’t think that the condoms had concentrated with the coastal area being by far anything to do with me,” she says. All the mes- the biggest and this in itself has implications," sages she had received on HIV/AIDS sounded Dr. Sobbie Mulindi of Patient Counselling Ser- as though they were geared to womeninvolved vices at the largest referral hospital, Kenyatta in high-risk relationships. She and her National Hospital, explained. In the same con- boyfriend were in a monogamousrelationship text, thousands of Kenyans travel abroad each and although he had relationships before that year and both their information and medical she was aware of, this wasthefirst time she had needs must also be addressed. been sexually active in a relationship. Her boyfriend who also works in tourism had been MOBILITY AND GENDER carrying the virus and had unknowingly passed the infection to her. An interesting aspect of the mobile popula- "I realize now that being in a new place tions in Kenya is the distinct gender break- where everyone was essentially a stranger down. More men than womentend to migrate meant that any relationship I entered into to cities like Nairobi and other urban centres would be risky,” says Christine. "It’s not like where they can find work, leaving women when you live in a village where you know behind in the villages in the case of rural- everyone and you know their behaviour. You urban migration. As can be seen from popula- can literally recount what they do and whothey tion figures for Nairobi, the societies to which were with every day.” people migrate as well as those left behind are Christine feels health education messages distinctly polarized according to gender. need to consider the changingrealities of peo- Similarly, truck drivers leave behind their ple and advise them that risky sexual relation- wives. In the case of refugees, the bulk of ships are not only those in which prostitutes are those in refugee camps and the internally dis- involved but also those that take place in cir- placed are women and their children while cumstances where there is any form of doubt. men remain behind on the battlefields or seek More emphasis should be placed on encourag- out new meansof survival. Within urban areas ing voluntary testing by everyone entering a similar patterns are recognized and docu- new relationship and less emphasis should be mented. Women tend to be over-represented placed on labelling people as belonging to high among the urban poor and in slums, although risk groups such as truck drivers and commer- they are often in the minority when the whole cial sex workers. "We are all at risk at some population is considered. time or another," Christine insists. The polarization predictably leads to new Despite cases like Wafula’s and Christine’s, coping mechanisms and the breakdown of little mention is made of AIDSin relation to social norms, especially those governing sex- tourism in Kenya's policy framework documents. uality, and results in increased vulnerability to It appears to be assumed that visitors to Kenya, risky sexual behaviour and HIV/AIDS. In most of who are from western countries and addition to social trends brought on by human Japan, have already been sensitized to AIDS and mobility, there are also important changes in the meansof avoiding it and are therefore at low the structure of families with an increasing risk. R.A. Obudho, Editor of the African Urban number of homes where women are the head Quarterly noted this presumption. "If you trace of the family. A significant number of women the progress of this disease, it came in from the (24.2 per cent) never marry but do have chil- west," he says adding that the annual introduc- dren, according to studies conducted by the tion of three-quarters of a million visitors should United Nations. Most of these women con- not be ignored and must be part of the national centrate in urban areas where such norms are strategy addressing AIDS. considered acceptable rather than in rural

39 areas that still tend to frown on single-moth- amenities are best developed and climatic con- ers. They often have different sexual partners ditions favour human habitation. As a result, over the years. local populations tend to migrate in search of opportunity, trade and communication with CONCLUSION neighbouring countries within the same region. Millions of people are on the move around To date, efforts in Kenya to control the spread Kenya each year. Their reasons for moving and of HIV/AIDS have concentrated on health edu- their circumstances differ widely. But they all cation and awareness creation about the dis- face the same problemsofdislocation, the need ease based on the knowledge that it tends to to adapt to new, often different and even diffi- spread fastest among people who engage in cult surroundings, even if for brief periods of risky behaviour. Almost the whole population time, the lack of social support structures at has been reached with information on AIDS their destination, compromised employee and studies have shown that knowledge about rights, unexpectedly harsh economicrealities the disease is widespread. However, this has and the absence of family members. not encouraged people to change their behav- Efforts to stop the spread of HIV/AIDS our. must begin by recognizing this high mobility of “Despite having information at hand, people people as a point of intervention and focus continue to put themselves at risk on a daily specifically on reaching people on the move basis,” says Dr. Mulindi. “Since the inception with programmesthat address their real vulner- of the National AIDS Control Programmein abilities. This must not be done in a piecemeal the late 1980s, there has been a presumptive manneras has been the case in the past, where belief that traditional health education about certain groups such as CSWsaretargeted as HIV/AIDS would be sufficient to induce wide- high risk, while others like tourists are ignored spread behaviour change. This has not proved in the assumption that they have been catered to be the case.” for elsewhere. Clearly there are more powerful factors that The single most important challenge that continue to influence the choices that people Kenya has faced in her post-independencehis- make, even in life-threatening situations as tory is the HIV/AIDS epidemic. The National those posed by the risk of being infected with AIDS/STD Control programmehas reported HIV/AIDS. over 77,000 cumulative cases of AIDS since Human mobility has contributed both posi- 1984 and an estimated number of 1.7 million tively and negatively to the creation of Kenya people infected with HIV. The latest situation as it exists today. The increasing movement of analysis of HIV/AIDS in Kenya says the epi- individuals and large populations of people demic has yet to stabilize and HIV infection within and outside the country is part of the rates have increased nationally from 3.1 per structure of modern Kenya and cannot be cent to 9 per cent in the past seven years. The stopped. The strategic geographical position of epidemic remains powerful and dynamic.It is the country with access to natural harbours; its evolving with changing and unpredictable pat- natural resource base; its reputation as an eco- terns, but a key factor that appears common to nomic centre for Eastern Africa and the relative all areas where the epidemic explodes is the peace that it has enjoyed in a region known for movement of people. conflict, have all contributed to its attraction as HIV/AIDSintervention programmes must a destination within the region and abroad. look at the issue of mobility with greater thor- The semi-arid and arid nature of the land to oughness beginning with research to scientifi- the north has seen developmentefforts concen- cally define the common conditions that trated along a central band and it is within this encourage exposure to HIV/AIDS and thus band that agriculture, industry and social influence the impact and spread of HIV/AIDS

60 in Kenya. Using these research findings, it will not just health under which all responsibility for then be possible to design appropriate interven- HIV/AIDS programmesis traditionally heaped. tions that really reach people whereverthey are. In addressing the trans-border spread of This will require greater linkage in addressing a HIV/AIDS, Kenya must go beyond isolated problem of such scope and with so many facets. interventions to develop broader programmes in NGOsand international organizations need to partnership with neighbouring countries which encourage greater levels of coordination in their are equally affected by the same phenomena research and in the development of subsequent because mobility knows no borders. Failure to prevention programmes. The private sector must contain and control the spread of HIV/AIDS now be brought in. Efforts to engage employers in will demand more expensive and difficult inter- prevention programmes need to be expanded to ventionslater. address the needs of employees; the need to be able to support a family on the salary provided, REFERENCES needs for proper housing arrangements for employeesor regular leave to enable them to visit World Development Report 1998, the World partners. Bank. All government ministries and departments The State of the World's Population, 1998. must be involved in tackling the underlying inse- Publication of the United Nations Population curities caused by mobility and migration and Fund. HIV/AIDS on the whole. Mobility precedes the P. Kenya, S. Mulindi, J. Onsongo and M. Gatei, many vulnerabilities that lead to susceptibility to “HIV/AIDS in Kenya: Situation Analysis”, risky behaviour and has numerouscauses. Simi- National AIDS/STD Control Programme larly, it demands solutions that are developed (NASCOP) September 1998. from a multiplicity of fronts as it affects every A. Achola-Ayayo (1998), “Sexual Practices and department touching tourism; trade; regional the Risk of the Spread of STDS and AIDSin cooperation; immigration; peace and security, Kenya”, in HIV/AIDS In Kenya: Situation gender; industry, transport and communications; Analysis for National AIDS/STD Control planning and national development as a whole - Programme (NASCOP) September 1998,

61 THE IMPACT OF MIGRANT POPULATIONS ON THE SPREAD oF HIV/AIDS IN UGANDA

Charles B. Rwabukwali, Department of Sociology, Makerere University, Kampala, Uganda with Swizen Kyomuhendo, Department of Social Work and Social Administration Makerere University, Kampala, Uganda and David C. Kaiza, Department of Mass Communication, Makerere University Kampala, Uganda

INTRODUCTION Dr. Elizabeth Madra. “Indeed, the only thing which will come to your mind much moreis The phrase "migrant population" brings to drinking, smoking andsex... so there you can mind imagesof large numbers of people undu- pick up infections in between.” lating beneath baggage, with half-naked chil- The history of refugees stretches decades dren clinging to mothers’ sides looking hun- into Uganda's past. For years, the country has gry, and tired, but with expressionless faces. In had a permanent presence of stateless and most cases, these images are exactly what mobile people: it begun in 1955 when Sudan, migrant populations are. Often they haveleft then under the domination of Anglo-Egyptian behind them, wars, smoking huts and upturned rule, yielded the first ever reported wave of lives. refugees into the country. Four years later, eth- However, this description leaves out the nic strife in Rwanda to the south of Uganda, inconspicuous trickle of youth fleeing rural brought in another batch of refugees. This was poverty, nor does it include professionals such in 1959. When the 1960s came, Sudan once as long distance truck drivers, business people more produced refugees. This time, it was ten- and armies. This last category, rarely hungry, sion between the Arab-Muslim North and the mostly travelling alone and often maintaining Christian, Animist black South. secure lives, are more mobile compared to As yet, Uganda had not produced any mass refugees. It is only that their more affluent displacement. This changed in 1970 when Iddi bearing makes them less dramatic than Amin came to power. The political and eco- refugees. nomic atmosphere quickly degenerated and If this is so, it is as well: of the migrant per- soon got worse, enough for the country to keep sons, refugees are the most susceptible to any generating refugees for the next three decades. kind of suffering. For them, there has always There was the mass fleeing of Ugandans, espe- been hunger, statelessness, loss of rights and cially the Northern Langi and Acholi tribes who property, and discrimination. Now with the had been the supporters of deposed President spread of HIV/AIDS, refugees too are the Apollo Milton Obote. most susceptible to catching the deadly dis- The next and perhaps the most significant — ease. and certainly the most publicized-refugees out “When you are concentrated and living in of the country were the Ugandan-Asians. In one place, you are idle, you are not active, you 1972, President Amin proclaimed an economic don't move anywhere to anything,” says direc- reform, a spurious policy that consisted of tor of Uganda's Aids Control Program (ACP), expelling Asian professionals and business men.

63 Their departure left a tragic economic gap of neighboring villages or districts, they do not 50,000 entrepreneurs. fit the stereotype of refugees. Yet in Uganda, When Amin wasoverthrown in 1979, it was they number 233,000. the turn of his own ethnic groupto suffer polit- Uganda's political atmosphere for the last ical persecution. This third wave of Ugandans decade has been producing them at an ever were from the North-west part of the country increasing rate. The worst hit part of the coun- known as the West Nile. Their fault was that try is the Northern region which, for the 14 they were the tribe from which Amin came. years that Museveni has spent in power, has They fled into Sudan and the former Zaire. been undercivil strife. The rebel group, Lords From 1988, Sudan began to produce a steady Resistance Army (LRA), assisted by Sudan, flow of refugees as a result of the increased has abducted, maimed and killed thousands of warfare between the Sudanese Peoples' Liber- people. ation Army (SPLA) and the Khartoum govern- As a result, the Northern districts of Gulu, ment. Arua and Kitgum, have between them, con- In 1990, something else happened which, tributed 193,000 (79.7%) of the 233,000. The by the reverberation of its consequences, was other 40,000 (20.3%) come from the Western the most important movement in Uganda. A districts of Bundibugyo, Kasese and Kabarole. section of the Ugandan army, composed of These last three districts began experiencing Rwandese Tutsis, broke off and fought its way wars only in the last few years during which a into Rwanda where their parents had fled over rebel army, called the Allied Democratic three decades ago in 1959. It took four years Forces (ADF), have taken on the national army of guerrilla warfare for the Rwandese Peoples’ and terrorized the local population. Forces (RPF) to evict the Hutu-led govern- In a country of 20 million people, the exter- ment. However, not before elements of Hutu nal refugees form a ratio of one to 90 people extremists Interehamwe attacked Tutsis and while the internal ones are one in 78 Ugan- moderate Hutus to produce the worst massacre dans. in Africa’s history and subsequently one of its But what does all this history and numbers worst mass movement. The resultant irony was mean? The legacy of refugees that began in that the Hutus who in 1959 threw out the Tut- 1955 still continues to plague the country and sis, now ran into Tanzania, ex-Zaire and often spreads into the Great Lakes region. For Uganda. the numbers of refugees, whether they come So far, this history is that of externally dis- from across the boarderor from otherdistricts, placed people. By their magnitude and drama, bring enormous problems both for themselves nature of the movement and alienation they and for their hosts: close to half a million help- traverse, coupled with the intense gaze of less people lean heavily on food supplies, on international media, this category fits well into living space and stretch out health services. the noun “refugee”. In a poor country like Uganda that itself By July 1997, Uganda had a total of has little to offer even the employed citizens, 207,287 foreign refugees living within her the situation is acute. “Mobility is bad if it is boarders. Of these, Sudanese compose in such a way,” says Dr. Madra. ‘People are 179,750 or 85.9%. The rest were distributed going to be exposed to a lot of depression. You between people from the Democratic Republic are so worried, you are pre-occupied with your of Congo, Rwanda, Somalia, Ethiopia and future, the future of your children, you have Kenya. lost a lot, you don't have anything on your However, there is another category of dis- own, you are totally dependent on relief, your placed people who are rarely thought of as housing may be bad, and your health may be refugees. These are the internally displaced bad.” persons. Because they have only moved to

HIV/AIDS AND MOBILITY are Ntandi, Kayimbi, Butama in Bundibugyo and Acholpii in Kitgum. In Uganda, worry over the connection between In all these camps, the health predisposition HIV/AIDS and mobility has been a major pre- is gloomy, the basic cause being congestion. occupation with the authorities. Migrants, "The camp situation has got is own vices,” says whether they move in frightened masses or as World Vision International programme officer, businessmen,are associated with the spread of the Stuart Katwirikirize. "They have brought many disease. people together — they are just huts; one after "They are highly vulnerable, they are a another. People who were spread over vast source of spreading it because they have con- pieces of land have scaled down to just a camp tacts with other people,” says a Church of — a whole sub-county brought to 10 acres of Uganda Developmentofficial, Frank Rwakab- land.” wohe who is head of programmes division. Food and water shortages follow. The "One person passes on to another and...so it squalid huts become breeding groundsfordis- will just keep multiplying.” eases. The illness commoninall these campsis Thefirst cases of the virus in Uganda were malaria, acute respiratory infection, diarrheal along the Trans-Africa Highway. The western diseases, helminthiasis, skin disease and more district of Rakai is the most synonymous with recently, though more worrying, HIV/AIDS. the disease. It is this district through which UNAIDSestimates that 930,000 Ugandansare long distance trucks passed. The 1979 inter- currently infected with the disease. The infec- vention of Tanzania in the overthrow of Amin tion rate is put at 9.5%. An estimated 1.8 mil- has sometimes been blamed for the introduc- lion have already died from the disease. tion of the disease into the country. This is, However, Dr. Madra and another Ministry however, a doubtful supposition, but it shows of Health official, Dr. Saul Onyango, caution the concern with mobility and disease commu- against making inference between migrants nication. and the AIDSstatistics. "We have to be really The movementof labour within the country objective," warns Dr. Onyango, "the chances of is also blamed for the initial spread of somebody who is a migrant getting HIV is the HIV/AIDS. However, to state that travellers same as for any other person. The fact that you are the vehicle for the virus to spread is trite. In have to take into consideration is the knowl- Uganda, as in all African countries with edge base of the individual — what are their refugee problems, the mass movementof peo- perceptions and then what precautions are they ple garners more concern from authorities taking to prevent infection?" fighting the disease because displacementren- According to the authorities dealing with ders the displaced, more than any other group, the disease and refugees, it is knowledge, per- vulnerable to catching the virus. ception and precautions against infection that In Uganda, refugees generated from the displaced people do not have. Butit is not all North and West of the country, as well as from that they lack. outside the boarders, are found in Mbarara, "There is the extra risk as far as migrants Gulu, Kitgum, Masindi and Bundibugyo dis- are concerned," says Dr. Onyango. "In most tricts. Within Mbarara, a Western district, cases, you are displaced from your normalsit- 20,000 Rwandan refugees occupy Oruchinga uation. That puts you at a bigger risk because Refugees Resettlement camp. Bundibugyo and the issue of the economywill come in. Whatis Gulu, Western and Northern districts respec- your financial situation?" tively, have a new generation of refugee camps That situation is absolute poverty. Most of called "protected villages", because they are the people that live in campsare peasants. They the places into which the nationals fleeing are without savings and dependenton the food army-rebel crossfire are herded. Among these crops their land yields. The declined produc-

65 tion of the cash crops (cotton) and in the ians and rebel bullets, they also take away the national economy hit this group hardest. cohesive social structures once present in Besides, the economic gains made in the peace time. The nationalsoldiers, if they pro- regime of President Museveni has been more tect the people, also see their women as pawn- pronounced in urban areas thanin rural areas. ing ground. Migrants are bitter about the Eighteen percent are petty traders, 15.1% stu- Uganda People's Defense Forces (UPDF). dents, 17.1% idlers, while the salaried workers "Most of us, our wives, are here,” complains a make only 18.3%. With this line up, economic Local Councilor of Kasitu village in Bundibu- well-being collapses very fast in the face of gyo, "now when they (UPDF) see you poor instability. and useless, they take advantage of your wife. According to Dr. Onyango,in the face of She lands on a soldier who has cash." such intense deprivation, perception and pre- One 36-year old widow, whose husband caution offer little protection. “One of the died at Oruchinga camp,is uncertain about her issues which really plays a big role in the own health. "I suspect my husband might have transmission is poverty. People are willing to caught AIDS." compromise their knowledge and attitudes for Mrs. V. Kibirige, coordinator of the ACP just getting somelittle survival.” condom distribution programme, believes the The poverty created in this forced depriva- gender aspect of vulnerability is most impor- tion disorganizes the lives of the refugees. tant. "I would consider mainly the women and Besides their health, the realities of the new the girl child to be more vulnerable because social situations they find themselves in change normally, when they move from anarea, they their family compositions and their sexual pat- need support and they can't get it,” she says. terns. The lack of awareness about AIDS further “Sometimes they might offer themselves so compoundstheir problems. Addedto that, they that they can get the support they need in terms are susceptible to paid sexual advances from of food and shelter." their new neighbors. Prostitution is not uncom- Even among the refugees, there is an mon. Families break up very fast. In a survey uneven distribution of fortunes. The external carried in three camps, it was found that 12.8% refugees tend to fare better than the internal of the refugees had lost their spouses while ones. The reason is that external refugees, another 14.0% had divorced. because of their longer history, have benefited "All my relatives and friends were aban- from political solutions. They are often given doned by their partners,” said a 42-year old land on which to make a living. But then Rwandan refugee living in Oruchinga camp. again, it is the internal refugees who have had This desperation has got a gender biasto it. longer exposure to HIV/AIDS awareness cam- The women remain with the children and have paigns. to look after them. The lack of awareness andthe difficulty with A 28-year old womanliving in Butama pro- which to provide sex education to mobile popu- tected village, formerly a petty trader in lations is the point that the ACP has been focus- Bundibugyo, has had to share her husband ing on. "It is very bad because you arein a sit- since joining the camp. "My husband has now uation whereby you are not exposed to any edu- married three extra wives," she says. "He may cation programme,” says Dr. Madra. According not be using condoms." to her, the danger comes in because the refugees Mr. Katwirikirize explains: "One of the from neighbouring countries have not got the ways migrants can meet (their) needsis to just same exposure to HIV/AIDS awareness educa- fall prey (to) some scavenger men who can tion that Ugandanshavereceived. take advantage of (them)." , "We do not know how much AIDSaware- The notoriety of the protected villages is ness is created in their own countries of ori- that while they put distance between the civil- gin," she says. "We don't know how muchthey

66 have been sensitized but they are entering a coun- public information programmeto be a success, try which hasa highly sensitized population. Now, the target that a communicator aims -at comprises they are going to mix with these people.” the mind, theattitudes, beliefs and lifestyle of the The movementof soldiers is another route for audience. It is these elements that lead to behav- spreading the disease. iour change: hence, the communicator, most "A soldier, whether white or black, has got to often the journalist, is a crucial ingredient in have sex, has got to smoke, has gotto drink...also fighting the disease through the media. under such a situation of war where they need a For journalists, the most important elements in lot of surgery, they get blood transfusion, because public information are gathering information, the of bullets, accidents and landmines. In the informationitself, and the way in whichit is pack- process,if the blood is not screened, they pick up aged. In gathering information on public health, infections. So that is where mobility becomes a the journalist must identify the root causes of risk factor. When youtalk of mobility, you have to HIV/AIDS. These are fairly well known. The include the soldiers.” journalist must also identify the patterns of the Realization of the potential of migrant people disease; the age group,the area of the country, the in spreading the virus has led to a conscioustar- social and economic disposition of that section of geting of those with the highest risk potential. the population that suffers most. These are the long distance truck drivers. The The next step is to identify which audiences ACP hasbeen educating these drivers. the journalist is speaking to. These are differen- Dr. Madra said that before they started their tiated along age groups, educational levels, programme,the rate of spread of the virus along social backgrounds and habits. The importance these routes was enormous. This was com- of this is that the ways in which messages are pounded by the fact that the drivers did not have packaged differ with the audiences at whichitis one, but many sex partners along these routes, aimed. The risk behaviours of each group must besides the wives whotheyleft behind for as long be identified; if the youth, is it casual unpro- as a month at times. tected sex, drug needles, peer pressure, high-risk According to Dr. Madra, offsetting the tide of socialization? HIV spread through migrants is a burden of edu- The messages must be crafted to match the cation. Her recommendation for aiding this is age group. To communicateto adults in the same through setting up counseling and testing units way as teenagers is useless. Teenagers have their among the migrant communities. Introducing the ownjargon andinterests. The message should be triple strategy of information, education and com- attractive enough to catch the imagination of the munication (IEC) strategies is another important audience; it must always have a sense of newness weapon. Other recommendationsinclude services and novelty. They must be repeated all the time, for other infections, addressing the social and eco- but mostly at the hours when people are at greater nomic conditions in campsas well as encouraging risk of catching the virus. government to end wars. The communicator must create a sense of The spread of the disease through migrants, authority; what are the statistics? Who is when these are refugees is different, because delivering them? Is the source believable? Is while truck drivers might control their habit, for she/he knowledgeable? Are they liked by the refugees, the drive is not desire, but desperation. audience? The communicator must create a recognizable structure of communication, CONCLUSION which identifies the message with the campaign. For instance, in Uganda, government The fact that the mass media are the single newspaper, The New Vision publishes a most important way to reach large populations monthly youth pull-out called Straight Talk. It also makes them the single most important is about AIDSandis targeted at the youth. The weaponin the fight against HIV/AIDS. For any communicator must use different types of com-

67 munication. It should be on television, radio, be entertained. Telephones must be connected newspaper and magazines. There must be mullti- to the radio and TVstations. In this feed back, media. Often, interpersonal and group communi- the communicator must allow a great amount cation must be created in the communities. of participation from the audience. Feedback The communicator must create a channel also tells the communicator whether his mes- for feedback. If in the newspaper, letters must sage has been used the way he intended.

68 MIGRANTS WITH HIV/AIDS: A CHALLENGE TO THE MEDIA

Mkasafari Mlay, Journalist, Dar es Salaam, Tanzania

INTRODUCTION and non-governmental organizations as well as bilateral and multilateral efforts to control the Transmission of HIV/AIDS in Tanzania like in spread of HIV/AIDSin Tanzania. According to other African countries is mainly through het- Lina Lengaki, a librarian at National Aids Con- erosexual sex. The HIV virus transmission trol Programme (NACP), there are about 200 through blood donation and unsterilized medical institutions in the country dealing with instruments is becoming minimal as measuresto HIV/AIDSrelated issues. ensure blood safety and general safety are taken The media have a role of sensitizing people by health workers. Any person from any race, to live “safely” wherever they are. Media orga- nation or of any age can be infected, as the nizations in Tanzania face the challenge of dreadful disease has no racial discrimination, reporting AIDS as a majorcrisis of our time and, geographical boundaryor age limit. therefore, journalists must be knowledgeable According to the WHO fact sheet no. 97 about HIV/AIDS so that they can formulate revised August 1998, about 1.9 million AIDS appropriate programmes with appropriate mes- cases have been reported by country authorities sages for different groups of people on since the disease was discovered. Although HIV/AIDS. there has not been any medical cure or vaccine, the disease can be controlled by an inexpensive MIGRANTS AND THE SPREAD OF HIV/AIDS method. Behavioural changeis the only reliable IN TANZANIA preventive measure and the cheapest so far. Every human being can afford to change his/her “People who are away from their homestend to behaviour without incurring much expense. do things they would not do while they are at However, concerted effort of individuals, gov- home. In most cases they find themselvesin cir- ernments, international organizations and others cumstances which tempt them or force them to are needed towardsachievingthis goal of people indulge in such things as prostitution and drug changing their behaviour. At national and inter- taking”, said Amina Alli, a well informed national levels, it becomes difficult to control researcherat Irish Aid office on HIV/AIDS and the spread of HIV/AIDS becauseof the nature the social impact of the disease. of the disease, as well as the social, economic With increasing poverty and unemployment, and political factors which force a person to do the spread of HIV/AIDSwill continue as people, things which may eventually make him/her especially young girls and boys are forced to becomeinfected with the HIV virus. movefrom oneplace to another looking for means In trying to escape social, economic and of survival. “Street girls you see during day time political hardships, people move from oneplace here in the city become sex workers at night and to another and thus migrate with HIV/AIDS. there is an organized network dealing with this This tendency of migrating with AIDS within illegal business here in Dar es Salaam,” she added. the boundaries of a country or from outside a It is almost 17 years since the first three country has made it difficult for governments AIDScases were diagnosed in Tanzania. It was

69 in 1983 when at Kagera hospital in Kagera momentis more prevalent in Dar es Salaam fol- region for the first time Tanzania confirmed lowed by Mbeya, Kagera and Kilimanjaro that the HIV virus had crossed the borders and which are all border towns. The reason for Dar entered the country. Since then, the disease has es Salaam being number one, according to Mr. spread at a very high speed like bush fire dur- Tibakweitira, is because it is also a business cen- ing the dry season. “Thereafter, reported cases tre, apart from being an entry port. Most gov- continued to rise rapidly. By 1986 all regions ernment head offices are here. It has a harbour in Tanzania Mainland had reported AIDS serving neighbouring countries. Thus because of cases. By the end of 1997, the number of the diversity of activities, people from different cases had risen to 103,185. However, this is a parts of the country and even from outside find considerable underestimation as many cases themselves in Dar es Salaam. This situation has go unreported. The actual numberis estimated created a conducive atmosphere for young girls to be four or five times the reported number. to come to Dar es Salaam with the hope of get- No one knowsfor sure when and how the HIV ting employment. Unable to be employed they virus got into Tanzania, but people in Kagera end up selling themselves. Evidence to prove region say the disease was there before 1983 this is at Mawenzi Hotel, the once Skyway as they had cases before presenting similar Hotel and Ohio Street, to mention just few symptoms and had coined a namefor it — places where these girls are vividly seen during “slim” or “Juliana”. night time. Althoughit is not known when and how the Long distance truck drivers from Dar es HIV virus crossed the borders into Tanzania, the Salaam to Zambia and Malawialong the Tanza- Executive Director of WAMATA (People in nia-Zambia route and those from Dar es Salaam Struggle Against AIDS) G. Tibakweitira, shed to Rwanda and Burundi have a tendencyof hav- some light when interviewed by the author of ing “short term lovers” at every stopover. Taking this chapter. He recalled how business centres at the Dar es Salaam/Zambia route for instance, the border area of Kakuyu on the Tanzania side the road passes through the coast, Morogoro, and Mutukula on the Uganda side became cen- Iringa and Mbeya before entering Zambiaat tres of spreading HIV/AIDSin the early 1980’s. Tunduma. The drivers would park for the night, He said immediately after the war with the drink and be entertained by their lovers. Some Amin regime, Tanzania’s economy washeavily of the women, however, confided that they were disrupted, followed by a period of immense not permanent dwellers of any of the stations, scarcities. However, there were plenty of com- but kept on changingstations along the route to modities on the Ugandan side. This situation “appear new” and attract new drivers. “Keeping where on one side there was scarcity and no track of these sex workers ts not easy because money to buy those goodsfacilitated the set up most of them come from otherparts of the coun- of night bazaars at the two centres where people try, and once they succumb to HIV/AIDS they exchanged not only commodities but also plea- go back to their home villages”, said Theophil sure. “There was a high level of intermingling of Likangaga, the Iringa regional Health Officer. people from Uganda, Rwanda and Tanzania at The African Medical Research Foundation Kakuyu and Mutukula where there wasa lot of (AMREFP) has taken an initiative of educating enjoyment”, he said. the drivers in a mannerthatfits their life-style. The Director said that all business centres in The Foundation distributes a lot of literature at Tanzania including fishing villages and mining the stopovers, and has also trained people to centres were centres of attraction where people provide AIDS education at these stopovers. from different parts of the country visit. In this From Kakuyu in the Kagera_ region, case, young people — girls and boys — are the HIV/AIDShasspread to almost every village in ones most involved in looking for a better Tanzania. HIV/AIDSis present in colleges,pris- future. That is why AIDS in Tanzania at the ons, big plantations, army camps, refugee

70 camps, mining centres andin fishing villages. provide employmentto the youth in rural areas HIV/AIDSis also present in tourist attraction and sufficient income for survival. Thus, rural areas. Dr. Kateregga, who is in charge of the urban influx by young people with hope of AIDS programme at UNICEFin Dar es Salaam, getting employment has increased in recent associates the rapid spread of HIV/AIDSin Tan- years. Two decades ago, urban dwellers zania with the opening of new transport facili- accounted for hardly 4% of the population. Of ties which enable quicker movement of people late there has been a rapid influx from the rural from one place to another. “The numberofair- areas and now the urban population is esti- lines coming and leaving Tanzania has increased mated at 40% whichis in itself a major devel- more than ever before. Even local transport has opmental problem. been madeeasier. Think of the numberof buses Asstated by Tibakweitira and Amina,after coming and leaving Dar es Salaam from up failing to get employment, these young people country daily”, she commented.All these allow involve themselves in prostitution. “So long as interaction of people unknown to each other there are people who depend on prostitution for and, as Amina said, people who are away from their survival it will become difficult to control their homesare tempted to do things they would the spread of the disease”, commented a worker not dare to do at home. at Kwetu Counselling Centre. Kwetu Coun- Schools in the past were consideredas a “‘win- selling Centre is a home project for young girls dow of hope” with a less infected population. who are in need of special protection measures Today that hope is fading away as unsafe sex is after being deprived of family protection, love, being practised by primary school pupils. Songea shelter, care and support. There are also women Girls Secondary School Headmistress, Mrs. Anna who have been forced into commercial sex trade Chiguro, says between January and December by poverty and broken marriages. 1997, 12 students were expelled from her school A lady who wasbeing counselled at Kwetu and by the end of the first term in 1998 seven stu- Centre said she came to Dar es Salaam from dents had been expelled from the same school. Kagera when she was a younggirl. She spent her “This implies that students are practising unsafe life in Dar es Salaam as a sex worker but after sex, although they are aware of the dangers of being counselled she thought it was good to go practising unsafe sex and despite efforts by teach- back to Kagera and stop the sex business. “I have ers to counsel them,” the headmistress said. only one grown-upchild and I always feel embar- Mrs. Chiguro’s statement reveals a similar rassed when very young boys cometo me and ask problem expressed by the UNAIDS Country Pro- me to go bed with them. After all I am sick, I gramme Advisor, Mulunesh Tennagashaw, when have AIDS,” she said. She made a plea that peo- she says: “there is a high degree of AIDS aware- ple with HIV/AIDSshould be helped by govern- ness among the people but they are failing to ment and people with good will, if people are change behaviour because of a combination of serious about controlling the spreading of AIDS. different factors. People know what they should Othersituations are the mining centres such as do but they are not doing what they are supposed the Tunduru mining area. The acting regional to do”. mining engineer, Mr. Oforo Ngowi, says the new Almost every person interviewd was pes- mining centres are not governed by law and are simistic about the possibility of controlling the high risk areas as far as HIV/AIDSis concerned. spread of HIV/AIDSin Tanzania because of a Women know that is where moneyis, and go numberof factors. The major factor hindering there to offer services to the men whopayforit. campaigns against the spread of the disease is The Mbinga/Tunduru is just one among many in poverty. Tanzania is rated among the poorest other regions of Tanzania. Other establishments countries of the world, with per capita income with similar characteristics and life exist in of 260$ US. Agriculture, which is the back- Arusha, Mwanza, Shinyanga, Morogoro and bone of the country’s economy, has failed to Mbeya regions.

71 In these areas, the chances of spreading of HIV/AIDS when married people stay in dif- HIV/AIDSare there, and the situational factors ferent locations for long. encourage it. As migrants, after making money or In recent years, Tanzania has hosted hun- after a short while, they go back to their tradi- dreds of thousands of refugees from the neigh- tional communities. In instances where they are bouring countries of Rwanda, Burundi and the already infected with HIV/AIDS, they pass it on Democratic Republic of Congo because of to others whenever they have sex. This explains political instability in those countries. They the high rate of HIV/AIDSbeing reported and the have always been kept in camps. In Karagwe high percentage increases every year. district, for instance, refugees were twice the There are a considerable number of men who numberof the local inhabitants. In one of the haveleft their families in search of employment. camps (Bamako) the refugees numbered over The majority of these are in big plantations of half a million. Commenting on the situation in tea, sisal, tobacco and sugar. A typical case is in refugee camps, the coordinator of Red Cross Makete District in Iringa. The number of activities in Kagera region, Mr. S. Ndyetabula, orphansas a result of parents having died of says women and children outnumbered men, HIV/AIDSis alarming. With a population of and young girls who have lost their parents in about 120,000, the number of orphansis 13,000 the war take care of themselves. “These became which is 10.5% of the whole population. This is vulnerable to rape as they have no protection. revealed in a study done by Ledian Mfuru of They miss sex education, and hence practice Tanzania AIDS Programme (TAP). Makete dis- unprotected sex at an early age.” The coordina- trict has the highest number of AIDS cases in tor adds that food provided is not preferred by the country. Because the district is very poor the refugees as they are more used to potatoes economically, men are forced to leave their and banana. Thus women venture to surround- homes and seek employmentin tea plantations ing villages looking for food and firewood. In in the neighbouring district of Mufindi, also in the process they interact and even may the same region. Lack of good provisions like exchange sex for food. Sexual acts among accommodation in these plantations, forces refugees take place in alarming degrees because married mento leave their families behind in the of idleness and psychological despair. The care of their male friends. The labourers stay refugee camps were turned into big business long in the plantations and most find other centres attracting businessmen, women and lovers around their area of work. Similarly, the prostitutes from other parts of the country and wives who wereleft behind in the care of other outside the country. It was during this time of men, find themselves temporary lovers. Finally, the refugee influx in Kagera region that rape when they come home, the chances are that cases increased and in one ofits districts, 250 either one or both of them could have been rape cases were reported. infected by HIV/AIDS. Indeed, people living away from their Cases abound of men having to look for homes maybe forced to do things they would work outside their home area, and leaving their not dare to do while they are at their homes. wives behind. This encourages promiscuity, and Quite often the media in the country have high chances of contracting HIV/AIDS. One reported incidences where prisoners have famous area for this practise is the Kilimanjaro complained of sodomyin the prisons. Prisons region. Most Chagga men who are employed Assistant Commissioner of Songea region, Mr. outside their villages leave their wives behind L. Y. Yaunde, when interviewed would not to tend the small coffee farms while they go to agree with this allegation. Supported by his towns to look for employment. On coming surbordinates Lameck Mmbaga and Mkwanda back, anything could have gone wrong. But the Hasseid Mkwanda, they denied that sodomy practise is being discouraged as men and took place in prisons. He says, “HIV/AIDS women are becoming conscious of the dangers cases detected amongprisoners does not mean

72 in any case that the infection takes place while ists can contribute to the fight agains the those prisoners are in prison. It is because of spread of HIV/AIDS. However, a retired poor food in prisons which accelerates the senior information officer, Mr. Willie Mbunga, symptoms of AIDS, making people believe believes that HIV/AIDSproblem is a big chal- that there is a high rate of infection among lenge to the journalists. He believes that jour- prisoners”. Whether it is the prisoners or the nalists are not well equipped to deal with this prison officers whoare telling the truth, one dreadful disease. thing is obvious, that most prisoners are Mbunga suggests that AIDS education young, energetic and sexually active. They should be introduced in journalism training find themselves in a situation where they are institutions so that there will be no excuses of denied their human rights. This being the case not being able to preach correct messages and they become hostile and end up committing be good example of HIV/AIDSprevention. inhuman acts such as rape and sodomy. It is this a very big challenge facing journalists and media institutions which calls for a A CHALLENGE TO THE MEDIA “spirit of working together between media, politicians, non governmental organizations as “A feature story from an individual journalist well as bilateral and multilateral bodies. This aimed at stopping the spread of HIV/AIDS will enable journalists to be knowledgeable on cannot bring a meaningful result towards this social, political, cultural, economic and moral hazard” says Joys Mhavile, Deputy Managing affairs which contribute to the spreading of Director of Independent Television.She HIV/AIDS in Tanzania and elsewhere. The believes that concerted efforts of all journalists experience of all the above people should there- aimed at formulating programmes against the fore form a base for a resource book on combat- spread of the disease is the best way journal- ting the spread of HIV/AIDSby journalists.

73 THE IMPACT OF NEGATIVE CULTURAL PRACTICES ON THE SPREAD OF HIV/AIDS IN ZAMBIA

Parkie Mbozi, Department of Mass Communication, University of Zambia, Lusaka, Zambia

INTRODUCTION lives of most African ethnic groups, have also contributed to the transmission of the disease. Some call it the silent epidemic. Others In the case of Zambia, our investigations describe it as a plague. All the descriptions, bring out three categories of culturally-defined including the local nicknames, carry the same and instigated sexual patterns and social rela- message: HIV/AIDS presents itself as the tions which can be associated with HIV trans- fastest growing, most notorious and multi- mission and the spread of AIDS. faceted disaster known to mankind. Though The first category consists of social conduct generally a global problem, the statistics pre- resulting from the belief in the powers of an sented during the past 18 years tends to suggest external force, usually in the form of a spirit that Africa in general, and sub-Saharan Africa in which can befall a person if someprescribedtra- particular, is at the epicentre of the disease. ditionalrituals are not carried out. Ritual cleans- Within the African continent, twelve countries ing, the process of “cleansing” the surviving in the East, Central and Southern African region partner of the spirit of the deceased spouse, is account for 30% to 40% of HIV/AIDScases. found in this category. In the case of Zambia, the 1997 statistics of The second category consists of a set of the Ministry of Health (MOH)projected that 1.2 social or sexual traditions and practices which million of the population of 9.8 million were are an outgrowth of beliefs related to a perceived carrying HIV and at least 200,000 were reported role or roles and/or responsibilities of an indi- to have died of AIDS-related complexes as at vidual in a social relationship, such as a mar- that date. Sadly, all the data reveal that the riage union. In this classification are found youth (i.e. 15 to 40 years of age) are the most puberty rites (initiation ceremonies); “dry sex” affected, a situation which is described as a cat- and the general use of herbs to boost sexual per- astrophe for the country’s socio-economic formance, polygamy, and circumcisionrituals. development. The last category consists of social relations Attempts to explain the uniquely high cases based on tradition which dictates that something of AIDS/HIV in Africa in general, and Zambia has to be done in a particular way simply in particular, have pointed to a range of socio- because it has been done like that for years. economic factors which include the worsening These include property and wife inheritance economic conditions and the general breakdown which embraces the habit of having a sexual in the social and health care systems. As many relationship with a young sister of the wife groups have pointed out, there is no doubt about (known as Mpokeleshi among the Bemba-speak- economic shortcomings as determinants of the ing groups) as a way of “anchoring”the old rela- high rate at which this deadly disease spreads. tionship. However, there is also evidence that some nega- Though steps have been taken to eradicate tive cultural beliefs, traditions and practices, these cultural practices from modern Zambian which are deep rooted in the social and sexual social life, especially in the light of the AIDS

75 pandemic, there are traces suggesting that such were aware that cleansing wasrife in their com- habits are still a part of Zambian life, albeit in munities, with 80% indicating that sexual varying degrees. cleansing was the most common. We interviewed 15 widows and widowers RITUAL CLEANSING who were cleansed in the last eight years and found that at least half were sexually cleansed, This custom is documented as one of the most some even twice or three times. This was the deep-rooted and widespread among Zambia's 73 case with Mollie Chikasha, 51, a Lenje by tribe ethnic groups. Though sometribes use other now living with someof her children and mother means to “cleanse” the surviving partner of the in Shandyongovillage, about 54 kilometres west spirit of the dead spouse, sexual cleansing (or a of the Zambian capital, Lusaka. Mollie said that relative of the deceased having sexual inter- she had been sexually cleansed twice after losing course with the surviving partner in a ceremony two different husbands in a period of nine years. closely monitored by other relatives) is the In 1985, Mollie was sexually cleansed by known and acceptable way among most of Zam- Chishimba, the youngerbrotherto herfirst hus- bia's big ethnic groups. These include the Tonga band, Mwila. Nine years later, in 1994, Mollie and allied groups of the Southern and Central was sexually cleansed again by a relative of her Provinces, the Bembas and someallied ethnic second husband, Amon Chikasha. Since then she groups of the Northern, Luapula, Central and has not married again and she did not show any Copperbelt provinces, the Lunda-Luvale of signs of resisting a third cleansing. Northwestern Province and sometribes found in Our investigations found that in some cases the Eastern Province. sexual cleansing took place even when the per- The AIDS organizations in the country, son chosen to cleanse may have been aware of including the Ministry of Health, are concerned the dangers of such sexual interaction. This that, in spite of their concerted efforts to eradi- happens due to fear of sanctions resulting from cate sexual cleansing, the habit is not dying out non-compliance. as fast as expected. John Kansenzi, Director of “When my brother died I was under intense the AIDS Programmeat Harvest Help (a grass- pressure to have sex with the widow. They (the roots nongovernmental organization based in the two families) even offered me money so that I Southern Province), confirmed that the practice could do it. In the end I accepted,” confessed is still rampant, especially in isolated rural areas. Mwilu Kasiketi, a Kaonde of Solwezi town in Mr. Kensenzi said that the belief in sexual the Northwestern Province. intercourse as a way of cleansing is so strong In some cases, sexual cleansing occurred among the village communities that they can not even when the widow did not even know who even accept the use of a condom as they believe was going to carry out the ritual. This happened that the condom would not permit the “blood to in the case of Judith Nasho, now retired nurse meet” and, therefore, the ritual would have been and a coordinator of a home-based care branch incomplete. in Lusaka, who ended up contracting syphillis Recentstudies also attest to the prevalence of from her cleanser. Judith narrated her ordeal: sexual cleansing. A 1995 study by the Nursing “They put me in a small hut at night. I did not Council of Zambia, for instance, observes that even know what was happening. They had 72% of Zambia's population still adhered to 'the wrapped me in one of my husband's garments. traditional practice of the surviving partner In the night somebody I did not even recognise sleeping with a deceased spouse to “prevent the came and cleansed mein their way (sexually). It haunting of the surviving by the ghost of the was so painful. Later I went through a thorough dead”. A more recent (1997) study by Winda medical check-up during which it was discov- Nasilele in the Maambadistrict of the Southern ered that I had contracted PRP (syphillis). I got Province showed that 94% of the respondents treated for it but up to now it still hurts me.”

76 Like most other widows, Judith and her five the Bembas, Lozis and Ngonis. Sexual cleans- children also lost most of their property to rela- ing and levirate marriage are related in the sense tives of her late husband. that the person who takes part in the sexual Wealso learnt that the pressure for ritual sex- cleansing ritual more or less automatically mar- ual cleansing sometimes comes from the family ries the spouse of the deceased. of the surviving partner, due to fear of something Our investigations showed that, as with sex- happening to the surviving spouse. This hap- ual cleansing, levirate sexual relations, whether pened in the case of Theresa, who was co-mar- as full-fledged marriage or an ordinary relation ried to Godfrey with Lenshina for about 10 years between the surviving partner and relative of after Godfrey's death in 1991. Realizing that the deceased, take place even in instances where Godfrey had died of symptomsrelated to AIDS, there are misgivings about the cause of death. Godfrey's parents objected to sexual cleansing, Also, as in sexual cleansing, levirate mar- although Morgan, Godfrey's cousin, was chosen riages sometimesoccur due to pressure from rel- as Godfrey's successor. atives and the rest of the community. This was Thealternative form of cleansing — grazing evidentin a case involving Anne Chola, a widow of the groins over the body of the surviving in one of the Zambianvillages, as she narrated to spouse from chest to knee (known as kuchutu a team from the Law and Womenin Africa: among the Tonga-speaking people) — did not “They appointed somebody in the family to please Theresa's relatives who felt that she had replace my deceased husband,but I refused not been properly cleansed. Also worried that because I was upset about their accusations something bad may occurto her, Theresa started that I had killed my own husband with having affairs with Godfrey's relatives in the whom I had been married for many years. hope that that could serve as some form of sex- They would not take no for an answer. They ual cleansing. Although without confirmation of threatened me saying, ‘If you refuse to be the cause of her death, Theresa died in 1997. married in the family it means you know There has been no studyto directly link ritual why’, meaning that it would be an indica- sexual cleansing to the HIV/AIDSprevalence in tion that I killed my husband. There was so Zambia, but there is evidence of significant sex- much pressure — in-laws, my ownrelatives ual interaction resulting from this tradition. and other membersof the village — that I reluctantly agreed and even got a son after SPOUSE INHERITANCE some months. After that he started beating me badly andill-treated my children. Then A related cultural practice, which also promotes he chased me, physically taking me to my the exchange of sexual partners after death in a father. He took awayall the property.” family, is wife or husband inheritance (also This case also illustrates that, apart from pres- referred to as levirate unions). In its formal sure from relatives and society at large, levirate sense this involves marrying off the surviving relationships can result from the desire to take partnerto a relative of the deceased which,as T. over the widow and property of the deceased. Richards (1969) says about the Bemba, wastra- Sadly, apart from increasing chances of HIV ditionally meant to ensure that there is continu- contraction due to exchange of sexual partners, ity of the family, its reproductive role and to such relationships often fail to be consolidated ensure proper care of the minor children of the and end up breaking; thus leaving the widow and deceased. Among the Tonga-speaking people of children in a more desperate and vulnerablesit- the Southern Province, for instance, a younger uation. Given the fact that most cases of HIV brother or cousin of the deceased would take transmission are reported to have occurred het- over the widow and most of the property of the erosexually and that AIDS as the cause of death deceased soon after burial. The practice was is usually not disclosed to the relatives, inheri- also observed among other major tribes such as tance of spouses poses high risks of exchanging

77 the HIV virus and, therefore, is significant in investigations, we found a marked increase in understanding the HIV/AIDS prevalence in polygamy in Mweembaand Shandyongovil- Zambia. lages of the Lusaka rural area between 1994 and The closeness of spouse inheritance to HIV 1998, transmission can be pictured from the case of In the case of Mweemba village, from a Belita Chinyanta (not real name), 35, of Chi- cohort of 37 marriages, polygamous ones had tentabungavillage in Chongwedistrict, about 60 gone up from 30% in 1994 to 43% in 1998. In kilometres east of Lusaka. Belita lost her hus- Shandyongo village, out of the investigated 21 band, a soldier in Kabwe, in 1996. Within the marriages, polygamous ones had increased from same year she was “inherited” by a relative of 38% to also 43% during the same period. Both the soldier in Chitentabunga Village. Two years cases confirm the continued prevalence of later, in 1998, the second husband also died of polygamy in somesections of the Zambian soci- AIDS-related complexes after which Belita was ety, in spite of the efforts aimed at reducing the sexually cleansed and “inherited” by another numberof sexual partners exposed to a particu- man. In April 1999, both Belita and her third lar individual in the advent of HIV/AIDS. husband weresick and Belita is one of the 500 In spite of the dangers it poses, polygamyis people under the care of Ntumeni home-based widespread andaffects every level of the Zam- care in Chongwe. Although not tested for HIV, bian society. As indicated by Elizabeth Mataka, the local and home care-givers are convinced Director of Family Health Trust, a local NGO that this is one of the cases of full-blown AIDS. involved with AIDS programmes, in some cases the risks associated with polygamous unionsare POLYGAMY often due to lack of happiness and satisfaction either as a result of economic hardships or other Another old pattern of sexual relationships, frustrations. In other cases, it is the desire to common in Zambia and some other African have children, especially in the event that the countries, is polygamy. It is related to sexual first wife is barren. This was the case with Regis cleansing and wife inheritance in the sense that Nyerera, also of Mweembavillage, who was some polygamous marriagesare a result of tak- offered his wife's younger sister because his ing over the wife of a deceased. This is the case older wife could not produce children. with headman Peter Nanguma, 54, of Simaamba Among some ethnic groups, such as the village in Siavonga district who is married to Bemba-speaking people, a man has an uncodi- two women and has fifteen children. Mr. fied right to have a sexual relationship with his Nangumatold the investigating team that he wife's younger sister (known as mpokeleshi in inherited the second wife from a cousin who Bemba). This is looked at as a way of rejuvenat- died in 1974. ing the marriage as it is assumed that at some Polygamy, in many cases in the Zambian point a man gets sexually fed up with his wife. society, ranges from two to ten wives. In iso- Given the evidence that having many sexual lated cases, though, it can mean more than 10 as partners increases one's chances of being was the case with 65-year-old religious leader exposed to HIV, polygamy and extramarital Isaac Matongo, who stunned the country in relationships, both of which are culturally toler- 1994 when the press revealed that he had 55 ated, play a part in trying to understand the wives, the youngest of whom was only 16 years HIV/AIDS prevalence in Zambia. The dangers old at the time. of polygamy in relation to HIV contraction can Although traditionally only a few ethnic be illustrated by the case of Cholwe Muleya (not groups, particularly in the Eastern and Southern real name), 39, of Misisi compound in Lusaka. provinces, were believed to be polygamous, Althoughnot told about her HIV status, Cholwe recent studies suggest that marrying more than has suffered various complications which are one wife is now a nationwide practice. In our associated with AIDS, including genital infec-

78 tions which she says she got from her polyga- initiation soon after her husbandofficially indi- mous husband offive years. cated his desire to marry her to her parents, then Cholwe, now under the care of the Catholic living in Kitwe, one of the four major cities of Church-supported Home Care Programme, nar- Zambia. Having missedtheritual at the puberty rated to this writer that she married her husband stage, Millie's initiation was centred on marriage as the third wife in 1994, after divorcing herfirst which included looking after herself, her hus- husband of 15 years and with whom shehadfive band,relatives and general domestic affairs. children. In 1997, she got pregnant and gave Since Millie and her parents lived in town, birth to a baby girl in March 1998. It is from there was no immediately available grandmother then that her health problems began to manifest or an old aunt to conductthe initiation ritual. In themselves. Zambian families it is a taboo for parents to dis- “At the time of marrying my husband I was cuss matters relating to sex and sexuality with just okay. However, since then, especially their children as only grandparents are supposed after giving birth, my health has deteriora- to do so. In the absence of grandparents, Millie's ted. I first developed rashes all over my parents hired old women (commonly known as body, then my body began to swell. Later I banachimbusa) who are renownedfor the initia- could feel very hot at night with persistent tion of girls and women preparing for marriage. chest pains. I was diagnosed as having The fee for the whole exercise was K120,000 tuberculosis and put on treatment. In the (equivalent to US$ 50). process I had genital sores. When told one From about a year before the day of the mar- of the wives about the sores, she told me riage, the initiation process began, which that even our husband hassimilar sores.” included lessons in some secluded places. While Cholwe was going through all this, her Depending on the subject, demonstrations would child was not spared as she showedsignsoflife- have to be carried out. This particularly hap- lessness from the beginning until tuberculosis pened during lessons on love-making during claimed her in March 1999. Fed up with nursing which an old woman would lay on top of her for a sick wife, Cholwe's husband abandonedher. therapeutic demonstrations. The next stage of The case was taken to the court, which ruled that initiation involved the kitchen party, one month the husband should pay Cholwe K2,000,000 before marriage, during which other women (equivalent to US$ 900) for her medical costs. would join in advising her on more or less the same subjects of looking after a marriage. The INITIATION CEREMONIES process ended only on the eve of the wedding with a ritual which involved a hide-and-seek Another practice related to culture is the initia- game between her and her husband in the sense tion ceremony or puberty rite which is only indi- that her initiators hid her in some dark place rectly related to HIV transmission becauseit almost naked, and asked herfiancé to find her. does not directly involve sexual interaction as is “During all this time the emphasis was on the case with someof the other practices already how to please your husband in bed and being discussed in this chapter. The processofinitiat- submissive to him at all times including making ing a girl is significant to the understanding of love to him whenever he demands,” Millie nar- HIV/AIDSin Zambiaas it plays a crucial role in rated. shaping a girl's perception of sex and sexuality. This is the kind of ritual which most Zambian This process, which many a Zambian woman womenhaveeither gone throughorare yet to go undergoes, can be illustrated by the personal through and which has cometo be accepted as a experience of Millie Chileshe Kashina, a former necessary process in the Zambian society. initiatee living in Lusaka. Among the Tongas, Bembas, Lozis, Ngonis and Now separated from her husband of five Nsengas, a girl underwentinitiation soon after her years, Millie began to go throughthe process of first menstruation, though the period ranged from

79 one month, as among the Tongas, to as many as resulting from the use of one type of herb or between six and 12 months. Among other ethnic another. One investigation showed that the con- groups, such as the Lambas and Ndambos of tinuance of the practice is mainly due to the fact Northwestern province,a girl wasinitiated before that the perceived benefits or reasons for its prac- the onset of the first menstruation to give her tice tended to outweighits inherent dangers, espe- some preparation. cially in the light of HIV transmission. The gen- Concerns have been raised by AIDS informa- erally highly positive perceptions about the prac- tion organizations aboutthe values inculcated into tice of dry sex helped to maintain a market for a woman with regard to sex and sexuality during both male and female traditional medicinesto sat- this ritual. Many representatives of these organi- isfy it. A traditional herbalist, “Doctor” Nawa of zations believe the emphasis on submissiveness Matero township, for instance, regularly adver- of woman to man andsexual satisfaction partly tises himself in the Zambia Daily Mail as the accounts for the disempowerment of the woman “famous bedroom doctor” and “Lusaka's top class to negotiate for safe sex and also forces her to herbalist’. “Dr’ Nawasells both male and female resort to “dry sex”, all in order to please her hus- sexual medicines which are taken in various band. Traditionally, initiation rituals had some forms and cost as much as K250,000 (or positive values aimed at strengthening marriages. US$100). However, the HIV/AIDSreality poses a strong Aswith the initiationritual, the practice of dry challenge to this cultural practice. sex is Meant to consolidate relationships. How- Felicia Sakala of the Young Women's Christ- ever, with the advent of HIV/AIDS, concerns ian Association (YWCA), also observed that: have been raised linking it to HIV transmission “Even if a woman is aware of the risks involved due to genital ulceration of both male and female in unprotected sex, she may find it difficult to organs during sexual intercourse, which in turn insist on safe sex. For a woman,insisting that facilitates the exchangeof blood agents,including her husband use a condom could result in her HIV. being battered, divorced or abandonedfora girl- The cases of cultural practices discussed in friend” (1995). It is against this background that this chapter suggestthat, though a lot ofeffort has initiation ceremonies need to be examined in gone into eradicating some of the negative prac- attempts to explain the high incidences of tices, there are strong indications that these prac- HIV/AIDSin Zambia. tices are still going on among some communities and families. In some cases the practices go on “Dry SEX” PRACTICE even where people are aware of their dangers in the light of HIV/AIDSand other STDs(sexually Related to, and usually resulting from, the initia- transmitted diseases). In other cases, especially in tion ritual is the “dry sex” practice, which is the remote areas, it would appear that these tradi- reported as another widespread culturally inspired tions are carried out either from lack of accurate sexual habit in Zambia. “Dry sex” is described as information aboutthe relationship of each or one sexual intercourse with a woman who hasa very of them to HIV transmission or simply due to lack tight vagina, achieved through the repeated use of of information altogether. local substances and herbs. Like the other culturally-related practices, dry sex is also traceable to THE WAY FORWARD the traditional society. The practice has seeped through into modern Zambia and, like initiation Given the complexity of some of the highlighted ceremonies, recent studies suggest that it is one of cultural practices, many individuals and groups the most widespread practices and cuts acrossall we interviewed suggested a combination of social strata and ethnic groups. strategies, ranging from increased information In her 1991 study, Nyirenda found that as high to legislation, in attempt to root out these prac- as 86% of the respondents practiced dry sex tices. As a cross-cutting intervention, more

80 information will be required, using a combination is conducted from about 14 years, as tion of both interpersonal and mass media among sometribes, to the period shortly before forms of communication, with messages specif- marriage. This suggestion is based on the ically highlighting the relationship between expressed concerns about the strong urge for a each of the traditions discussed and HIV trans- girl to try out the sex skills taught during initia- mission. tion, which puts her at risk of engaging in pre- Moreinformation is recommended because, marital sex in the event of delayed marriages. as many people interviewed suggested, the per- It must be noted that the suggestions for petuation of some of the practices is based on changes in, rather than complete abandonment lack of information relating these practices to of, the initiation rituals is based on the observa- the prevalence of HIV/AIDS. In some cases, tions by most people interviewed and other their perpetuation is due to myths and miscon- studies of communication sources which sug- ceptions about the disease. This particularly gest that for now this is a critical source of applies to communities in rural areas and high- information and counselling, especially on mar- density areas of cities. Increased information riage. The relevance of these rituals is also should constitute the thrust of any future based on the generally low parent-to-child com- attempts to eradicate the beliefs which buttress munication because of taboos aboutsex. some of the highlighted cultural practices. In On parents not discussing HIV/AIDS mat- line with this strategy, co-opting families and ters with their children, it was suggested that influential local personalities such as headmen, such taboos could be discouraged through politicians and church elders among the com- increased information which focuses on munities was also suggested. This could have encouraging and highlighting the beauty of par- some considerable impact in the struggle to ent-child dialogue. This strategy would also eradicate ritual sexual cleansing in the Southern have to involve working closely with the fami- Province of Zambia. Also, given that most of lies to strengthen the familyties. the mass media sources of information hardly Apart from the information interventions, reach the rural population, the use of local there were also some suggestions for either the media such as theatre, puppetry, drama and alteration or total abolition of some ofthe cul- open meetings was suggested, particularly by tural practices by using the judicial system. To rural-based home-care givers. this effect, there were specific suggestions that The information intervention is particularly the relevant sections of the law should be required in practices that directly involve the amended so that people who engage in some of exchange of blood agents These include sex- these practices can be prosecuted. This would ual cleansing, partner inheritance, polygamy, particularly apply to property grabbing and sex- dry sex and circumcision practices. In cases of ual cleansing. the initiation ritual, it was strongly suggested On polygamy, property grabbing, cleansing that the initiators should be sensitized about and wife inheritance, there were suggestions for HIV/AIDSso that ultimately the content of the interventions that would empower the woman initiation would be altered to include, and put to be able to stand on her own and be able to emphasis on, HIV/AIDS awareness and general take steps for redress in cases where she feels reproductive health and empowermentof the unjustly treated. This recommendation is based woman as a substitute for submissiveness and on the realization that in most cases some of sexual satisfaction. The sensitization of the tra- these practices have been carried out against the ditional institutions is already being success- woman's will but that the woman may be in fully undertaken among traditional healers in such a weakposition that she cannoteasily take Zambia such a step. A combination of these suggested Another suggested change in the initiation interventions, carried out systematically and ritual is increasing the age at which theinitia- with the involvement of the concerned commu-

81 nities, should provide somestarting point in Nyirenda, Maya (1991). “An Investigation of altering some of these negative cultural prac- the Behavioural Aspects of ‘dry sex’ in tices in light of HIV/AIDS. Lusaka Urban”. Lusaka, University of Zambia. REFERENCES Richards, Audrey (1969). Bemba Marriages and Present Economic Conditions, Nasile, Winda (1997), “A study on the Tonga Manchester: Manchester University Press. Traditional Cleansing Ritual Kusalazya, in Sakala, Felicia (1995). ““Womenat Risk of HIV the Advent of HIV/AIDS Pandemic: A Case Infection”, in Voices of Women, Vol. 9, Study of Maamba”. Lusaka, University of March. Lusaka: Young Women's Christian Zambia. Association.

82 IN NAmisiA AIDS Is STALKING THE ACTIVE AT WORK WHO ARE ALSO THE ACTIVE IN BED

Rukee Tjingaete, Windhoek, Namibia

INTRODUCTION bed”. She said that unless there is substantial change in sexual behaviours, the epidemic Namibiais a vast, sparsely populated country on impact of the disease on the economically active the South Atlantic coast of Africa, with a popu- population group will cripple production and the lation of 1.6 million inhabitants. The average country will rank as one of the highest afflicted population density is 1.7 persons per square nations on earth. kilometre and it is one of the lowest in Africa. Although the first four cases of AIDS were Namibia is bordered by Botswana, South Africa identified in 1986, more than half of the and Zimbabwein the east, Angola and Zambia reported 21,737 infections were reported in the in the north and South Africa in the south. More period 1996-1997 alone. Approximately 3,500 than half of the population live in the northern of these reported infections involved full-blown regions of the country, a semi-tropical district AIDS cases. According to sentinel data col- with the highest rainfall. The country is mostly lected by the Ministry of Health and Social Ser- arid and semi-arid and a considerable part of vices from antenatal clinic patients at selected Namibia is labelled desert. The Namib Desertis sites, there was a rapid progression ofthe epi- found along the coastline in the west and covers demic during the last half of the 1990’s. The about 15% of the total landscape. The Kalahari present number of cases is based on diagnostic Desert forms Namibia’s border towards tests for clinical reasons, screening of voluntary Botswana and South Africa in the southeast. blood donors, voluntary testing for insurance Namibia gained independence from South companies and for people applying for external Africa on 21 March 1990 after having been training scholarships. Therefore, these figures under foreign rule for more than 100 years. may not represent the total picture of the epi- Since independence, Namibia has been plagued demic in Namibia. by a very high rate of unemployment and The breakdownof these cases by region, age poverty mostly attributed to the return of the and gender showsthe following trend: country’s more than 90,000 refugees from 1. The regionsin the northern part of Namibia Angola, Zambia, Tanzania and Botswana. (Caprivi, Kavango, and Owambo)constitute 51.7% of all reported HIV infections HIV/AIDS IN NAMIBIA: AN OVERVIEW and AIDS cases. The southern part of the country hasthe least reported cases of 12%; HIV/AIDS, the killer disease, is rampantly 2. A total of 54% of the reported cases are spreading its death trail in most Namibian vil- male compared to 44% who are female; lages and cities at night. The worst hit age cate- 3. Most of the reported cases (69%) fall within gory is between 15 and 40 years, the country’s the sexually active and economically active most sexually and economically active popula- age group of 15-40 years; tion group. Only recently, the Minister of Health 4. The most afflicted region is the Caprivi and Social Services coined the phrase that in with the peak age group affected being bet- Namibia “the victim is unfortunately the active ween 20 and 24 years (NACP Report July at work whois incidentally also the active in 1997) |!

83 Thereport also indicated that the principal cause The intervention of local breweries in sports of death in hospitals for the ages of 5 years and through sponsorship seems to contribute to older in Namibia is HIV/AIDS. While factors under-age drinking. Castle Brewery’s sponsor- directly attributed to the rampant spread of ship of the national soccer team provides the AIDS in Namibia are said to be manifold, the company with access to the youthful population following sources are perceived to constitute its who consumecans of Castle beer during soccer main death-trap: (i) prostitution involving matches. Zeenao Hoveka, the Deputy Director tourists; (ii) border migration patterns along the in the Ministry of Youth and Sports, said: newly constructed Trans-Kalahari and Trans- “The impact of alcohol adverttsement Caprivi highways; (iii) sexual ignorance due to during these games is negative and is high rate of illiteracy; (iv) lack of public aware- directly linked to the heart of other social ness campaigns through media; (v) alcohol ills such as teen pregnancy, drugs, deviants abuse; (vi) cultural aversion towards the use of and the spread of AIDS. We cannotafford condoms, cultural taboo on open discussion of to isolate the AIDS epidemic from all other sex and the resultant adolescent ignorance about sources of social degradation. human sexuality; (vii) increasing incidence of Unfortunately, everyone of the big shots in child rape; (viii) the subordinate social and eco- the brewery business is chasing profits at all nomic status of women; and (ix) the traditional costs and at the expense of society”. healing practice involving the use of unsterile (Personal interview on 17 August 1998). cutting instruments (for example, circumcision). Local experts are convinced that the spread of In this chapter, we used data collected HIV/AIDS in Namibia is relatively faster in through field interviews, official statements and higher alcohol consuming regions. For example, research statistics to investigate and analyze the A.K. Mwilima, the Acting Medical Superinten- relationship between alcoholism, rape and sex- dent in the Caprivi region, believes that the ual defilement of young people and the spread increasing number of rape occurs under the of HIV/AIDS in Namibia. influence of alcohol. Similarly, police spokes- person Ratjindua Tjivikua said that most inci- OuR FINDINGS dences of rape involving the youth are committed under the influence of intoxicating sub- Since independence,the rush through the metro- stance. Therefore, more resources should be politan districts sometimes led to unfulfilled committed to social awareness campaigns in dreams and expectations for many young rural Namibia. The same call was made by Libertine dwellers. Failure to find employmentin the city Amathila, the Minister of Health and Social Ser- forced them into squatter areas where they live vices in an interview on 28 August 1998. The in squalid conditions. Out of frustration women Minister also told a press conference held in resorted to prostitution and begging while the Windhoek on 7 November !997 that, in the face men mainly resorted to the bottle, crime and of the astoundingly high HIV/AIDS rates, drugs. Today, prostitution, substance abuse and Namibia must redouble her efforts to make mugging are common features of life in the AIDS prevention information accessible to country. The situation is even more exacerbated everyone through campaigns. by the absence of stringent regulations against Furthermore, a survey initiated by the petty crime. Namibia’s socia] control agents Namibian Network of AIDS Service Organiza- (such as the courts, police, peers, church, politi- tions (NANASO) on knowledge, attitudes and cians, parliamentarians) seem to lack the will to sexual practice among the youth showed that combat under-age drinking, mugging and pros- approximately 80% of young Namibians are titution. aware of the HIV/AIDS transmission. But,

' National AIDS Control Programme. “Situational Analysis of AIDS in Namibia: Let’s Crash AIDS”. Windhoek: Namibia, 1997.

despite this high level of awareness, the latest Keneth Abraham, a private medical practi- figures indicate that the epidemic continues to tioner, said the picture painted by thesestatis- double every two years. These figures tics is alarming. He warned that the present prompted the Deputy Minister of Health and government policy on AIDSis inadequate to Social Services, Zedekia Mujoro, to remark: “crash” it. According to him, the information “It seemsas if at this stage, the correlation campaigns conducted by the Ministry of between HIV/AIDS awareness and beha- Health and Social Services should not focus viour change is weak. That is precisely on the use of condomsalone. Hesaid: why I propagate an intensification of our “The AIDS awareness campaigns should prevention efforts and at the same time not de-emphasize extraneous and interve- challengingall of us to comeup with indi- ning factors such as alcoholism,drugs, genous, innovative and efficient homelessness and unemployment in approachesto get our people to act on this society. They remain the causal incentives high level of awareness. Approachesthat to unprotected sexual behaviours. The will strengthen the correlation between information campaigners should not treat knowledge and behaviour change”. some causes as less causal. Theyall lead (Telephoneinterview on 26 August 1998). to death”. (Personal interview on 28 The epidemiological report published by August 1998). National AIDS Control Program (NACP)in Similar views were expressed by Andreas 1998 under the title “Let’s Crash AIDS”con- Oberholzer, the Windhoek Medical Superin- tains devastating statistics. It summarizes the tendent (interviewed on 20 August 1998), who total number of deaths due to AIDS, hospital- said that the use of substance normally lowers ization due to AIDS and rate of infection the rationale of the addict and thereby his detected during pregnancy. The data indicates defence against rape or unsafe sex. that in 1997 a total of 11,608 new HIV infec- Abner Goagub, the Director of NACP, dis- tions were added to the list of the Laboratory agrees. According to him,there is a genuine Services of the Ministry of Health and Social need for concern. But he does not think that it Services (MOHSS). This wasa slight increase is right to raise the alarm bell because of the compared to the 10,576 infections reported for 1997 epidemiological report. There are more 1996. However, this is a substantial increase if reported cases today because of improved compared to the 4,045 reported in 1992. diagnostic methods, openness and willingness The rate of HIV-related hospitalization had to be tested. For example, the support and also increased in the same period. According compassion that Sara Kamapoha, a very to the report, this represents “an important attractive and courageous young woman, indicator of the increasing workload, costs and received whenshe declared that she was HIV- an overall burden on the health service of positive, has helped to reduce the stigma Namibia’. In 1997, a total of 3,908 persons attached to HIV/AIDS in Namibia. Sara went were hospitalized for this condition, compared on to demystify HIV/AIDSin a television doc- with the 2,620 who were hospitalized in 1996. umentary funded by the United States Infor- The data also show that the total reported mation Agency in 1998. She courageously number of deaths in hospital due to AIDS in declared that, although the HIV stigma is not 1997 had also surpassed that reported for both easy to live with, she had become more com- 1996 and 1992. However, these figures do not fortable and at peace with herself for “going include deaths which occurred at home or in public”. An HIV patient at Katutura Hospital private hospitals. On the basis of ongoing sur- whopreferred anonymity said, “She represents vey results, the MOHSSestimates that there is Namibia’s resistance against the killer disease a total number of 150,000 persons living with and also the role model for manyofus.”(inter- HIV/AIDSin Namibia. viewed on 12 August 1998).

85 She also accused the Namibian Broadcasting 6. the conducting of a baseline information sur- Corporation (NBC)of lack of commitmentto the vey on AIDS. cause of AIDS. She said: “If I had the information that I have today Long-term plan about the right to say no to sex or to use the It is a comprehensive five-year plan that is cur- condom, I would have been a healthy person rently being implementedto achieve the following with a future. If there is a war that the NBC objectives: should highlight, it should be the one against i. the prevention of HIV transmission; AIDSinside our own borders but not the one ii. the reduction of the social impact of HIV in Congo. We are slowly dying from AIDS. infection; Without information, more people will die iii. improved counselling skills; just like me. There are still many people out iv. advocating community-based homecare; there who are ignorant like | was when I got v. improved epidemiological surveillance; and infected”. vi. provision of safe blood. The problem of alcohol among the youth is also confirmed by Pohamba Shifeta, the President of PREVIOUS CAMPAIGNS the National Youth Council, whosaid that five out of 10 young people between the age of 16 and 25 Although national campaigns against HIV/ AIDS are alcohol addicts (interviewed on 27 August started immediately after independence, the year 1998). He agreed that high unemploymentrate in 1996 heralded jointactivities aimed at AIDS pre- Namibia often leads the youth to commit street vention by institutions such as the Ministry of crimes such as pick-pocketing and mugging. Basic Education, Ministry of Youth and Sports, NANASO,University of Namibia, Polytechnic, NATIONAL POLICY ON HIV/AIDS Ministry of Broadcasting and Information, Juve- nile Justice Programme and UNICEF. It wasalso Namibia’s response to the AIDS epidemic won realized that since MOHSS campaigns were the highest political endorsement when President mostly carried out on an ad hoc basis, there was Sam Nujomapersonally launched the National no sustainability despite the huge amount of AIDS Control Programme on 4 July 1990. The donor funds allocated for that purpose. For exam- national policy is based on two key plans: ple, an Independent Review Team concluded that the Information, Education and Communication Short-term plan (IEC) programmerun by the NACPfor the Min- The implementation of a strategy whose develop- istry was a complete failure and that the materials ment mainly evolved from the following Global they produced were sometimes inappropriate’. In AIDSStrategies of the World Health Organiza- response to why the IEC programmewasnotsuc- tion: cessful, the team was informed that the funds 1. the setting up of a sound managementstruc- were in fact not for material development. ture for the programme; The UNAIDSinitiative was also launched in 2. the appointment andtraining of regional Namibia as a joint effort by country representa- administrators; tives of all the United Nations agencies to assist 3. the developmentof regionaltesting sites; national efforts. Its strategies were informa- 4. the training of counsellors and health wor- tion collection, analysis and exchange. These kers; included the sharing of information on 5. the promotion of AIDS education in schools; HIV/AIDSactivities in Namibia prevention, and care and research. The UNAIDS campaign,

> Quoted in “Final Review of the Medium Term Plan I (1992-1996)” prepared by an Independent External Review Team in July 1996.

86 which was part of a major global programme The in-depth interviews confirmed that focused on advocacy and promotion of political there is an alarming high rate of alcohol commitment and multi-sectoral involvement in consumption among the youth that combating the AIDS epidemic in Namibia. increases the likelihood of rape and unpro- Aspart of the information collection function, tected sexual intercourse. a long-term study was commissioned for the There is a general sense of apathy and period 1996-2000 to investigate the impact of hopelessness as a result of poverty and HIV/AIDS on the Namibian economy. Prelimi- unemployment which motivate the youth to nary results indicated that the Namibian govern- find consolation in alcohol. ment would need US$100 million for that period There is a general feeling that most national to meet all the expenditure on HIV/AIDSpreven- information campaigns against HIV/AIDS tion’. are not sustained and, therefore, do not always achieve the desired effects. CONCLUSION Despite an increasing social awareness, the official statistics show an unabated increase While there are possibly many other ad hoc of AIDS in Namibia, particularly in the findings that could be derived from this report, Northwestern and Northeastern regions. the major conclusionsare the following:

* “Economic Consequences of HIV/AIDS in Namibia: A Rapid Assessmentof Costs’. Published by WHO/UNAIDS,Draft Report, November1996.

87 lil

PART

CONTENT ANALYSES OF MEDIA COVERAGE OF HIV/AIDS

MASS MEDIA AND THE AIDS PANDEMIC IN KENYA, 1997-98: A MORAL PANIC PERSPECTIVE

Lewis Odhiambo,' School of Journalism, University of Nairobi, Nairobi, Kenya

INTRODUCTION associated with the sub-Saharan region’s mass media scholarship. Since the onset of HIV/AIDS, public pro- This study examines the nature of and trends nouncements from official and unofficial in mass media coverage of the HIV/AIDS pan- sources about sexuality have appeared in the demic in Kenya during an 18-month period, news media and, increasingly, questions around from January 1997 to June 1998. Although the sexuality and morality have become linked with original study design provided for an examina- drug abuse, prostitution, homosexuality, and ill tion of Kenya’s only national broadcast station, health (Rocheron and Linne, 1989). In Kenya, a the Kenya Broadcasting Corporation’s radio debate counterpoising sexual rights against cul- coverage along with the three national newspa- ture was recently sparked by President Daniel pers, Nation, Kenya Times, and East African Arap Moi when he accused a women’s profes- Standard, a numberof logistical and financial sional group, the Kenya chapter of the Federa- constraints made this impractical. Consequently, tion of Women Lawyers, of advocating the broadcast system was excluded. “immorality” when the group suggested that the question of homosexuality be addressed by the HIV/AIDS IN Kenya: BACKGROUND, TRENDS law instead of being swept “under the carpet” AND PROJECTIONS (Daily Nation, March 19, 1999). Consequently, the Kenya Television Network (KTN, “Newsat It is widely acknowledged that the HIV virus Nine”, March 22, 1999) conducted op ed inter- was probably introduced in Kenya around the views with a cross section of Kenyansall of late 1970’s or early 1980’s (Ministry of Health, whom concurred that homosexuality was for- 1997). But it was only in the early 1990’s that eign, immoral and threatened the cultural and the Kenya government acknowledged HIV/ moral foundation of Kenya. All, that is, except a AIDSasthe greatest public health challenge and local psychiatrist, Dr. Frank Njenga, who ‘an issue of national priority” (NCPD and CBS, expressed the view that homosexuality was a 1994: 127). Since then the National Council for biological and cultural issue which Kenyan law Population and Development (NCPD) and the should immediately come to terms with. If any- National AIDS Control Programme (NASCOP) thing, this controversy spelled out the emotion- of the Ministry of Health have worked closely to alism and ignorance that attend questions of monitor data on seroprevalence levels and AIDS sexuality in Kenya and, perhaps, in other sub- infection in order to evaluate and design the Saharan countries. And the mass media did not country’s responsestrategies. seem to be in any better position to enlighten Indeed AIDS remains the greatest public their audiences on the issue despite the much health challenge the world over. Since 1984, touted “development journalism” perspective when the disease wasfirst reported in Kenya,

' The research assistance of Isaac Lamba of Population Studies and Research Institute and Rerimoi Chemjor of the School of Journalism is gratefully acknowledged.

91 420,000 people had developed full blown AIDS The current levels of HIV/AIDS infection by February 1999, 70.0 per cent of them under are raising critical questions regarding mortality 25 years of age. Thus, HIV/AIDSis not only a and morbidity rates in Kenya. According to a phenomenal public health problem;it is a cata- recent UNICEF-Kenya country office document strophic demographic and economic problem (1999), “the gains in child survival, growth and for Kenya as well. development in Kenya are being undone by the Estimates of the prevalence and spread of HIV/AIDSepidemic. Child mortality is rising HIV/AIDS point to a very rapid increase in with alarming speed... (it has) increased from infection rates. For instance, HIV seropreva- 60 to 70 per 1000 between 1993 and 1998,” and lence among womenattending antenatal clinics in parts of Kenya where the AIDS epidemic is at urban and semi-urbansentinel sites rose from mature, it has risen from 123 to 189 per 1000 2.0 per cent in mid 1980’s to 14.0 per cent in from 1989 to 1998, respectively. This means 1994. At the same time, sentinel data obtained that in such places the HIV/AIDS pandemic has from people attending clinics for sexually trans- reversed the child mortality status to the 1960’s mitted diseases (STD clinics) indicate that the situation. UNICEF had also estimated that by proportions of those with HIV infections rose the end of 1996, over 300,000 children under from 31.0 per cent in 1989 to 58.0 per cent in age 15 would be orphaned in Kenya. Factored 1993 (Rau et al., 1996). Meanwhile, NASCOP into the current mortality rate, the number of estimates that in 1994 nearly 300,000 adultsliv- AIDS orphans is projected to increase to ing in urban areas and twice that numberin rural 600,000 by the end of the year 2000 and reach areas, in addition to 60,000 children nationwide, 1 million in 2005. were infected. It also estimated that by 1996 some 230,000 new infections were occurring POLICY RESPONSES TO THE HIV/AIDS annually. Overall, the national infection rate has PANDEMIC risen from 3.1 per cent in 1990 to 9.0 per cent in 1997 with the urban average currently standing From the start, the Kenya government’s policy at 12-13 per cent and rural average at 8-9 per response pattern to the AIDS pandemic showed cent (NASCOP, 1998). a gradualist approach in three phases (Rau The Kenyan data also tell us that the major et. al., 1996). The first phase (from 1984 when modes of HIV transmission are heterosexual the first AIDS case was diagnosed in Kenya to sexual intercourse, mother-to-child transmis- around 1987) was characterized by an official sion, and blood transfusion but these may view “that HIV/AIDS was not a serious prob- changeas issues of drug abuse and homosexual- lem” for Kenya (Rauet al., 1996: 3) since it was ity come to the fore. At the moment, however, associated with homosexual lifestyles which the pandemicafflicts mainly young, working were not officially acknowledged in this coun- age, sexually active adults aged 15-50 years. try. Hence, although the National AIDS Council Decomposition of infected cases by sex shows was created in 1985, it did not become opera- that there may be no significant variability, but tional until 1987 when it was transformed into women tendto be infected at younger ages than National AIDS/STD Control Programme men dueto their relatively younger ages of sex- (NASCOP), and only then did it initiate ual debut and marriage. Thus, the peak HIV HIV/AIDS awareness campaigns in the mass infection age group for women is 20-29 years media and through interpersonal channels. where about 45.0 per cent of all female infec- The next phase of government response tions are bunched; the corresponding age group (from 1988-1991) was characterized by a more for males is 30-39 years with 35.0 per centofall “realistic appraisal of HIV/AIDS as a poten- male infections. This pattern of infection speaks tially harmful health issue although the percep- to the relative vulnerability of young females to tion still persisted that AIDS was no more harm- the HIV/AIDS pandemic (Baltazaret al., 1996). ful than other diseases” (Rau et. al., 1996: 4).

92 Moreover, the Ministry of Health’s campaigns MASS MEDIA AND THE HIV/AIDS PANDEMIC regarding the consequences of AIDS met with generally sceptical audiences, perhaps because Underscoring the importance of obtaining accu- of the low-key nature of the campaigns. In addi- rate information on mass media coverage of tion, there were virulent media criticisms of HIV/AIDSissues are the following facts: the condom use by influential religious leaders 1993 Kenya Demographic and Health Survey who suggested that condoms were “a Western (NCPD and CBS, 1994) collected baseline data solution” inappropriate for Kenyans. However, on knowledgeandattitudes of a national sample phase three of government response (1992- of women and menregarding HIV transmission 1995) marked a significant departure from the and prevention. The survey found that 99 per sceptical scenario hitherto adopted (Rau et. cent of males and 98 per cent of females al., 1996) and official surveillance data were reported having heard of AIDS; 96 per cent and released and a national conference on AIDS 90 per cent of males and females, respectively, held in 1993. The Minister for Health said they knew that the HIV virus could be acknowledged that AIDS had become a transmitted through sexual intercourse; and 35 national crisis (Africa Confidential, 1993), per cent of males and 29 per cent of females while government and international donors knew thatit could be transmitted through injec- made socio-economic impact assessments of tions. But there was muchless knowledge about the pandemic (e.g. Nalo and Aoko, 1993, mother-to-child transmission with only 5 per Forsythe ef. al., 1993). From then on, cent of males and 7 per cent of females citing NASCOP assumed a stronger coordinating this mode. Meanwhile the possibility of HIV role in the field activities of non-governmental transmission in the course of circumcision was organizations (NGOs) and religious groups hardly known to females and only 5 per cent of working in the HIV/AIDSfield. males. Thus, in general, the Kenya government’s Thus, while Kenyans were generally aware policy responses to the HIV/AIDS pandemic of the existence of AIDS, their knowledgeofits were driven by hypothesized economic conse- mechanisms of transmission was at best rudi- quencesof the disease, not its social and demo- mentary. In fact, the 1993 KDHSdata also show graphic impacts. In fact, until very recently the that there were widespread misconceptions policy scenario in Kenya revealed a consider- about AIDS. For instance, over 55 per cent of able “undercurrent of scepticism or downright the sample believed that the HIV virus could be opposition to more aggressive positions on transmitted through mosquito bites, about one in HIV/AIDS prevention and care (Rauet. al., three respondents thought it could be transmit- 1996: 6). In addition, resistance to sex education ted through kissing, over one in four through in schools by some religious groups coupled touching the dead or via eating utensils, and 24 with opposition to condom promotion at some per cent thought the HIV virus could be passed senior government levels have made the climate through sharing clothes. for health education around the HIV/AIDS pan- Moreseriously, even though a vast majority demic considerably inhospitable. Others have of the respondents believed that the spread of argued that a “variety of legal, ethical and cul- HIV could be prevented (about 86% males and tural issues related to HIV/AIDSprevention and 79% females), only about 36 per cent of the the well-being of families affected by male respondents and 21 per cent of females HIV/AIDS remain to be actively debated and believed condom use could preventits transmis- acted upon” (Rau ef. al., 1996: 7). Usually, the sion. It is no wonder that of the 32 per cent of foremost arena for such debates is the mass the men whoreported having had two or more media, so it is of interest to find out how the sexual partners during the six months preceding mass media in Kenya have handled the issue of the study, only 20 per cent used condoms with HIV/AIDSin recent times. those partners. Hence, knowledge of AIDS and

93 the mode of HIV transmission did not translate polygamy have been identified as constituting into appropriate behavioral responses such as special risk groups in the context of HIV/AIDS increased condom use. Could this have anything since they face the danger of being targeted by to do with the way matters concerning the the mass media for special treatment. In this HIV/AIDS pandemic were reported in the mass regard, the mass media would be seenas a crucial media? componentof an interactive relationship between Since HIV/AIDSis a new disease it is only event, news-making, and political and profes- natural that most people will have heard aboutit sional actions that may stigmatize such social mainly through the mass media. In fact others groups through amplification of fears associated have termed AIDS a “media epidemic” in view with HIV/AIDS. of the fact that since its incidence it has gener- Some previous studies of the relationship ated massive media attention, particularly with between the mass media and the AIDS pandemic regard to the politics of its origins. Such contro- have employed the concept of moral panic. Pat- versies have been associated with the notion of ton (1986) and Altman (1986b) have shown how moral panic (Altman, 1986a). homosexuals have been stigmatized by the mass The idea of moral panic has been used in media, fundamentalists and politicians to such an sociological studies of deviance (Becker, 1963; extent that provision of health care for seroposi- Ericson, 1966; Scott and Douglas, 1972), youth tive and AIDSpatients has been hindered. In the sub-cultures (Cohen, 1972), and drug addiction United Kingdom, Weeks (1985) and Fitzpatrick (Young, 1974). But it also points to a “political and Milligan (1987) employed the concept to epidemic” because it draws attention to special explain the AIDScrisis. Unfortunately ourlitera- population groups (such as gays or prostitutes) ture search could unearth no such studies in sub- as well as health issues. In this respect, “the Saharan Africa. more a disease is experienced collectively, par- It is important to point out, however, that in ticularly by an already stigmatized group, the the context of sub-Saharan Africa where clearer will be its political dimensions”(Alt- HIV/AIDShas been associated mainly with het- man, 1986a: 21). Such political dimensions may erosexual sex, the concept of moral panic may go be reflected in mass media reporting of issues beyond identifiable fringe groups and may concerning the disease. But the concept of moral encompass whole ethnic entities and cultural panic has also been useful in explaining certain practices. That is, it may also cometo signify a types of reporting. In this regard, moral panic is wide range of sexual attitudes, marriage prac- orchestrated when patterns of behaviour, tices, and social behaviours that may berightly or whetherprivate or public cometo be selected by wrongly characterized as constituting health the mass media as unusual or symbolic of a risks. To the extent that such practices as threat to the fabric of society. According to polygamy and non-circumcision,for instance, are Cohen (1972): widely considered risky and are reported in the “A condition, episode, person or group of mass media as being so, groups identified with persons emerges to become defined as a such practices may be stigmatized and public per- threat to societal values and interests; its ceptions and, hence, actions against the spread of nature is presented in a stylized and stereoty- HIV/AIDS may beseriously influenced by such pical fashion by the mass media; the moral stigmatization. barricades are manned by editors, bishops, politicians and other right-thinking people; THEORETICAL EXPECTATIONS socially accredited experts pronounce their diagnosesand solutions; ways of copying are This study set out to examine the content, trend evolved or (more often) resorted to.” and quality of coverage of HIV/AIDSissues in In Kenya, social groups who do notpractise cir- three Kenyan national newspapers. Given the cumcision like the Luo, or who practice historical reticence of official policy responseto

94 the epidemic as outlined above, we expected to 1998. The daily and Sunday editions of the find the independent and concernedpress to be newspapers were sampled and analyzed as a unit particularly critical of government over the since, for this study, no theoretical or empirical spread of the disease. Thatis, if there was some- justification could be made for treating them body to blame for the spread of the disease, we separately. expected that it would be the government, par- For each newspaperedition, the total number ticularly the Ministry of Health, whose slowness of stories on HIV/AIDS wasrecorded in a tally in providing the necessary information and pol- sheet. This yielded a total of 1,638 newspaper icy framework for confronting the epidemic editions for the study, a volumethat was consid- would be faulted. ered too large given the time and resources We have also reported above that govern- available for the study. Therefore, a representa- ment response to the HIV/AIDS pandemic was tive probability sample of these newspaperedi- premised more on its economic rather than its tions was selected through a multistage sam- health and demographic consequences. Hence, pling design in which, first, the three national we expected media coverage to be slanted more newspapers were purposely selected on the toward the social consequences of the disease. basis of their span of coverage. Second, given This expectation was further strengthened by that HIV/AIDS coverage may be systematically the fact that we thought the government, biased depending on major local and interna- through the Ministry of Health, would be the tional events, a composite week (Wimmer and main source of stories about HIV/AIDS. In this Dominick, 1983) was constructed for each connection, we expected HIV/AIDSstories to month of the study period. This involved a ran- be concerned mainly with prevalence, preven- dom selection of each day of the week (with tion and awareness of HIV/AIDSandtherise in replacement) with the sampling rule that no two the cost of health care in the wakeofthe disease. days of the week maybeselected, and that every In terms of quality of coverage, we expected day of the week was represented for every that most of the stories would be fairly balanced, month of the study period. This yielded 18 given that health, and particularly HIV/AIDS, is a weeks for a total of 378 newspapereditions. technical area in which most Kenyan journalists Due to some missing editions and non-publica- would safely stick to the facts without venturing tion during public holidays, our actual sample into speculative opinion. Becauseofthis, we also was reduced to 340 newspapereditions. expected the stories to be of middling technical The unit of analysis was individual story competency and to be reasonably constructive. (feature, editorial, letter to editor or commen- Wethought mostof the stories, particularly those tary) whose content was examined in terms of of feature length, would be sourced from interna- (1) numberofarticles, (2) their size (in cm.’), (3) tional wire agencies or foreign correspondents, type (whether news, feature, editorial, photo- but we also expected that there would be a signif- graph/photofeature, book review,letter to editor, icant numberof stories originating from local science feature, regular column or cartoon), (4) newsrooms. These theoretical expectations con- placement (front page/page 2, page 3, other stituted our working hypotheses. inside page, special feature/magazine section, or back page), (5) prominence (edition lead, page MATERIALS AND METHODS lead, main editorial, or special commentary), (6) origin (foreign, local or international syndicate), This was a content analysis of three national (7) main event (or occasion), (8) main actor daily newspapers and their Sunday magazine (researcher/scientist, government, NGO, the editions, namely, Daily Nation, Sunday Nation, United Nations system, etc.), (9) main subject East African Standard, Sunday Standard, Kenya (prevalence, prevention, awareness, medical Times and Sunday Times, over an 18-month costs, economic costs, demographic impact, period spanning January 1, 1997 to June 30, politics of AIDS, etc.), (10) presence of blame

95 attribution for HIV/AIDS, (11) who is blamed, On the other hand, there were very wide as well as subjective evaluation ofthe articles in variations in space taken up by individual arti- termsof (12) constructiveness, (13) balance, and cles among the three newspaper groups. The (14) technical competency. Nation had the widest variation in terms of Thetally sheet (the main research instrument) article length over the 18-month period cov- was designed with the help of an expert computer ered by this study with a standard deviation programmer to assure flawless entry of the data (SD) = 261.22, followed by the Kenya Times into a micro computer for analysis. Two trained (SD = 191.01) and the Standard (SD =174.67). and experienced coders wereretrained for the pro- This might mean that the Nation and the ject and a pretest of the coding schemefinally Kenya Times carried some lengthy features or yielded an intercoderreliability of .831 using commentaries which the Standard did not. Scott’s pi index (Scott, 1955). This was consid- In fact, this contention is supported by Fig- ered more than adequate in view of the existence ures 1-4 which showtrends in the coverage of of subjective evaluation variables such as balance, HIV/AIDS throughout the 18-month period. constructiveness, and technical competency, the Figure 1 shows the trend of mean monthly precision of whose definition was at best shaky coverage of HIV/AIDSin all three newspaper during training. The pi index waspreferred to the groups during the period under study. It is Holsti (1969) formula because the former corrects apparent that the intensity of coverage was for the numberof categories used in each nominal highest during January 1997 and dropped data variable as well as for the probable frequency sharply in February, and in March 1997 of use. It is calculated as: HIV/AIDS coverage reached its lowest point pi = {(% observed agreement - % expected though it began to rise gradually and reached agreement)/(1- % expected agreement) }. another (though relatively lower) peak in July- The subsequent data aggregation and analysis August 1997 before declining again in Sep- was done using the SPSSPC+ computer soft- tember-October. Thereafter coverage began to ware and involved mainly frequency distribu- rise again and peaked in November of the tions, charts and simple cross tabulations to same year. The most notable feature of cover- indicate associations and differences in the age during 1998 is that there were hardly any treatment of HIV/AIDSstories by the three articles on HIV/AIDS during February, newspaper groups. although by March coverage averaged around 80 cm.2 per month up until June. RESULTS The high coverage reflected in Figure | in January 1997 is cloned in Figures 2 and 3 which Patterns and trends in HIV/AIDS Coverage depict the patterns of HIV/AIDS coverage in the The 340 newspaper editions examined carried Nation and the Kenya Times, respectively. The 99 HIV/AIDS-related articles. East African minor peaks occurring in August 1997 are appar- Standard (the Sunday Standard included) car- ent also in the two figures indicating, perhaps, ried comparatively morearticles, 42 in all, com- that the two newspapers covered similar events. pared to 30 in the Nation and 27 in the Kenya The Kenya Times, however, sustained a high Times (inclusive of their Sunday editions). In tempo of coverage of HIV/AIDSfor almost three terms of space, however, the Nation had some months, from November 1997 to January 1998 of 1592.75 cm’ of space devoted to HIV/AIDS- nearly 148 cm’, unlike the Nation coverage which related articles compared to 1190 cm? in the was relatively higher in November 1997 but Kenya Times and 902 cm’ in the Standard. declined to an average of only around 30 cm”dur- However, as shown in Table 1, the differences in ing December1997 to January 1998, inclusive. space devoted to HIV/AIDSbythe three groups For the rest of the 1998 period, coverage in the of newspapers was notstatistically significant, Nation showed an increasing trend while the as the F-statistic of .895 (Eta? =.239) shows. Kenya Times coverage was declining. Overall,

96 however, coverage of HIV/AIDSin the Nation assigned jobs of covering formal events, its and the Kenya Timesreflect a surprisingly similar journalists and correspondents showed greater pattern, the slight variations notwithstanding. innovation in initiating their own stories and This may speak, not necessarily to commitment features. But it could also mean that the Stan- by individual journalists to an important national dard editors have not clued in to the health beat issue but, perhaps, to routine attention to assigned as an important newsroom activity, something duties, regular beats or events. that the editors of the other two rival newspa- The pattern of coverage in the Standard, on pers might have paid moreattention to. the other hand, deviated radically from those of Our speculation about the treatment of the other newspapers. Not only did the Standard HIV/AIDSstories in the Standard appeared to cover most of the HIV/AIDSevents in January, be borne out by the distribution of articles by February and April 1997 as well as during a long type as shown in Table 2. Whereas in the stretch from September 1997 to February 1998, Nation and the Kenya Times most of the space its pattern of coverage reflected dramatic swings devoted to the pandemic went to news and a throughout the period. Moreover, from February regular column and, to a lesser degree, to fea- 1998, its coverage of HIV/AIDS was well above tures, the bulk of the space in the Standard went average (> 150 cm’ from Marchto June 1998). In equally to news, features and photographs addition, the newspaper’s coverage was a lot (24.66%). In fact, regular columnists at the higher around June-August 1997 than those of Standard hardly covered HIV/AIDSin contrast the other newspapers. to those at the Nation and the Kenya Times who The pattern of coverage in the Standard contributed 40 per cent and 39 per cent, respec- could mean that rather than depend only on tively, of total space devoted to HIV/AIDS.

Figure 1. Trend in the coverage of HIV/AIDSby the three newspapers, 1997-98.

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Table 1. Frequency of and space devoted to the coverage of HIV/AIDS in three Kenyan newspapers, January 1997-June 1998.

Newspaper Space (cm.’) Mean Standard Number Space Deviation of Cases

Nation 1,592.75 106.25 261.22 115 Standard 902.00 81.63 174.67 114 Kenya Times 1,190.00 84.32 191.01 111 Total 3,684.75 90.84 212.32 340

Statistics: F = .895; Eta? = .239

97 The data in Table 2 also confirm the basic enced the likelihood of the coverage of such a similarity in the coverage of HIV/AIDS by the story 25 per cent of the time. It is worth noting Nation and the Kenya Times that was already that only the Standard carried an editorial on apparent in Figures 2 and 3. Both newspapers HIV/AIDS, something we found surprising in had no editorials, photographs, book reviewsor view of the fact that the Ministry of Health or science features on the disease, and neither did government was the most blamed agencyfor they carry any cartoon of the same. Onthe other HIV/AIDSasdiscussed below. hand, the Standard had just over 15 per cent of the total space devoted to HIV/AIDStaken up PLACEMENT OF HIV/AIDSARTICLES by readers’ letters. Meanwhile, the fact that news was the second most important genre of Coverage of a story is one thing, but its place- HIV/AIDS coverage speaks to the key role of ment within the newspaperis yet another, and the assignments editor as a gatekeeper. In the the decision in this regard lies, not with the edi- Nation and the Kenya Times, whether or not an tor who assigns the story but, for the majority HIV/AIDSstory was carried depended 35 per of the stories, with the chief sub-editor. In this cent of the time on the decision of the assign- regard, this is the next most important gate- ments editor; in the Standard, he/she influ- keeper. As shown in Table 2, most of the

Figure 2. Trend in the coverage of HIV/AIDSin Nation, 1997-98.

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Figure 3. Trend in the coverage of HIV/AIDSin the Kenya Times, 1997-98.

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Figure 4. Trend in the coverage of HIV/AIDSin the Standard, 1997-98.

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HIV/AIDSarticles in the Nation appeared in lead, or whether it was the subject of the main the features section (nearly 55%). Consistent editorial or special commentary in a newspaper with news, features and readers’ letters as the edition. Table 2 also shows the percentage dis- most dominant genres in the Standard, nearly tribution of HIV/AIDSarticles by their promi- 65 per cent of such stories appeared mainly in nence. Over 62 per cent of the Nation articles “other inside pages” of the newspaper com- and 65.5 per cent of those of the Kenya Times pared to 35.71 per cent in the Nation and 45.65 were special commentaries, presumably by in the Kenya Times. regular correspondents. On the other hand, the Placementof an article on page one and on Standard treated over 89 per cent of their sto- the back page of these newspapers often indi- ries as page leads in their inside pages while cates the importanceit is accorded. During the the Kenya Times used 31 per cent of them as period under study, the three newspapers car- page leads. Noteworthyis the finding that 12.5 ried HIV/AIDSstories at least once on the per cent of the Nation stories were edition front page. In fact, the Kenya Timesdid so with leads indicating how prominently the Nation over 4 per cent of their stories. Meanwhile, the gatekeepers regarded HIV/AIDSstories. In Nation and the Kenya Times placed HIV/AIDS fact, 37.5 per cent of HIV/AIDSarticles were stories nearly 5 per cent and 4 percent, respec- either edition or page leads in Nation, 34.5 in tively, on their back pages. On the whole, how- the Kenya Times, and 93 in the Standard. The ever, HIV/AIDSstories were treated as pretty implication of this finding is that HIV/AIDSis routine fare for readers and were mostly con- a “big story” in Kenya, at least in the opinion signed to “other inside pages” by the newspa- of print editors. pers. A slight deviation from this pattern is their treatment in the Kenya Times where OrIGIN OF HIV/AIDS articLes nearly 11 per cent of them were treated as important local news and placed on pagethree. We also examined whether or not the articles carried by these newspapers were the handi- PROMINENCE OF HIV/AIDS ArTICLES workof local journalists or of foreign wire services and international news or features syndi- Closely related to placement of articles is the cates. Table 2 shows that the stories were over- issue of their prominence.In this study, promi- whelmingly local. Nearly 90 per cent of the nence was measured by whether or not an Standard stories were locally sourced as were HIV/AIDSarticle was an edition lead, page 88 per cent of the Nation stories and 85 per

Table 2. Percentage distribution of HIV/AIDSarticles in three Kenyan newspapers bytype, placement, origin and source, 1997-98.

Variable Nation (%) Standard (%) Kenya Times (%)

Type of article News 35.71 24.66 34.21 Feature 11.90 24.66 13.16 Newsanalysis 4.76 2.74 5.26 Editorial 0 2.74 0 Photograph 0 24.66 0 Book review 0 0 0 Letter to editor 7.14 15.07 7.89 Science feature 0 0 0 Regular column 40.48 1,37 39.47 Cartoon 0 4.11 0

Placement Front/page 2 2.38 1.41 4.35 Page 3 2.38 4.23 10.87 Other inside page 35.71 64.79 45.65 Feature/magazine section 54.76 29.56 34.78 Back page 4.76 0 4.34

Prominence Edition lead 12.50 3.57 3.45 Page Lead 25.00 89.29 31.03 Main editorial 0 3.57 0 Special commentary 62.50 3.57 65.52

Origin of article Local 88.10 89.71 85.00 Foreign 7.14 10.29 7.50 International syndicate/ agency 4.76 0 7.50

Source ofarticle Ministry of Health 9.76 10.29 10.52 Other governmentofficial 2.43 8.82 7.89 Politician 0 1.47 0 Religious body 0 1.47 0 Workshop/seminar 12.20 2.94 7.89 Scientific report 0 2.94 2.6 Researcher 12.20 5.88 13.16 Research institute/univ. 4.88 0 0 NGO/UN 14.63 7.35 15.79 Journalist’s initiative 36.59 50.00 34.21 Reader/ letter to editor 731 27.94 7.89

100 cent of the stories in the Kenya Times. Mean- social groups in the wake of HIV/AIDS, devot- while, the Standard did not carry any ing nearly 17 per cent and 13 per cent of their HIV/AIDSstory from an international news or stories, respectively, to this category. Other features syndicate. important actors were the Ministry of Health/government and NGOs whoseactivities Sources oF HIV/AIDS arTICLes and/statements comprised over 15 per cent of HIV/AIDSarticles in each of the three news- Consistent with local origin of most of the sto- papers. ries, our results also show that most of them were the outcomeof individual journalists’ ini- Supjects OF HIV/AIDS ArTICcLes tiatives, maybe at the behest of their editors. Journalists at the Nation contributed nearly 37 Wealso investigated whatit was that constituted per cent of HIV/AIDSstories during the period the main topic or subject in the articles and the under study; at the Standard and the Kenya results are reported in Table 3. Again, the Stan- Times the proportions of individual journalists’ dard deviated considerably from the other two contributions were 50 per cent and 34 percent, newspapers in what they reported as the main respectively. A significant proportion of such subjects of their stories: 35 per cent of them had articles in the Standard, however, came from HIV/AIDSprevention as their main topic, while readers (27%). Other important sources of such nearly 19 per cent of them focused on “other stories were non-governmental organizations social costs” of the pandemic. The newspaper (NGOs) and the United Nations system for the also paid significant attention to the politics of Nation and the Kenya Times (14.63% and HIV/AIDS (13.5%) and its economic costs 15.79%, respectively), individual researchers (12.16%), something that the other two newspa- for the Nation and the Kenya Times (12.20% pers appear to have found unappealing. and 13.16%, respectively), workshops and In fact, the Nation and the Kenya Times seminarsfor the Nation (12.20%) and the Min- devoted most of their coverage to social costs of istry of Health for the three newspapers. The HIV/AIDS (21.42% and 23.68%, respectively) finding about the importance of seminars and and on stories that dealt with claims of break- workshopsas source of news wasrather unex- through in HIV/AIDS management and cure pected in view of the many such events that (19.04% and 21.05%, respectively). But the two take place in this country virtually every week. newspapers also gave considerable attention to HIV/AIDS prevalence (16.67% and 13.16%, MalIN AcTors IN HIV/AIDS ArTICLES respectively) and awareness (16.67% and 15.79%, respectively). On the whole, the news- Given the sources of the articles, we thoughtit papers seemedto considerthe social costs of the would be interesting to find out as well who the pandemic to be the most important topic and, main actors in them were, that is, who was hence, their relative focus on stories claiming talking or working on HIV/AIDS. Table 3 breakthroughs in managementand treatment of gives the percentage distribution of the HIV/AIDS,as well as on its prevalence, aware- HIV/AIDSarticles by main actor and subject. ness, and prevention, the marked exception of For Nation and Kenya Times articles, the main the Standard with regard to “breakthrough in actors were individual researchers and scien- cure” notwithstanding. tists (61.11% and 52.63%, respectively) while for the Standard they wereprivate citizens, BLAME ATTRIBUTION IN HIV/AIDS ArrTICLES families and social groups (over 55%) and the Ministry of Health (21.74%). In fact Nation To what extent was the spread of HIV/AIDS and the Kenya Times also focused in a major blamed on somebody, institution or behaviour? way on the plight of individuals, families and Who or what was it that was blamed? These

101

Table 3. Percentage distribution of HIV/AIDSarticles in three Kenyan newspapers by main actor and subject, 1997-98.

Variable Nation (%) Standard (%) Kenya Times (%)

Mainactor Researcher/scientist 61.11 10.14 52.63 Ministry of health/government 16.67 21.74 15.79 NGO 16.67 10.14 13.16 UN agency 2.77 1.45 2.63 Research institute/university 2.77 0 2.63 Religious body/ official 0 1.45 0 Private individual/family/group 16.67 55.07 13.16

Main subject HIV/AIDSprevalence 16.67 8.11 13.16 HIV/AIDSprevention 9.52 35.14 7,89 HIV/AIDS awareness 16.67 8.10 15.79 Medical costs of HIV/AIDS 0 1.35 0 Economic costs of HIV/AIDS 4.76 12.16 5.26 Demographic costs of HIV/AIDS 9.52 2.7 10.53 Other social costs of HIV/AIDS 21.42 18.91 23.68 Politics of HIV/AIDS 2.38 13.51 2.63 Breakthrough in cure 19.04 0 21.05

questions were investigated by scrutinizing for the HIV/AIDS pandemic, though this was whetheror not any of the articles carried by the overshadowed by the recognition that the main three newspapers during the period of study problem wasreckless lifestyles (nearly 30% in apportioned blame; the results are reported in the Nation and the Kenya Times and 20% in the Table 4. The table shows that 52.38 per cent and Standard). 51.16 per cent, respectively, of the articles in the Nation and the Standard blamed somebody or QUALITY OF COVERAGE HIV/AIDS something for the incidence or spread of HIV/AIDS while the majority (58.69%) of The quality of coverage of HIV/AIDS was Kenya Timesarticles did not. investigated in terms of the constructiveness, Table 4 also shows that the Ministry of balance and technical competencyofthe articles Health and government received by far most of we examined. These subjective evaluation crite- the blame for HIV/AIDS followed by reckless ria are the more important given the finding lifestyles. But there wasalso significant recogni- above that most of the articles were written by tion that lack of resources hampered the fight local journalists for a local audience. The results against HIV/AIDS with nearly 18 per cent of of this investigation are reported in Table 5. the Standard, 14 of the Kenya Times and 14 of In terms of constructiveness, the results show the Nation stories citing lack of resources as the that most of the stories were constructive and culprit. Meanwhile, Kenya being a tourist desti- informative, but a significant proportion of them nation and a country with a sizeable numberof could only be characterized as being of average refugees from neighbouring countries, it is not quality. the Kenya Times had the most“very con- surprising that more than 9 per cent of the arti- structive” and “constructive” articles (13.15% cles in the three newspapers blamed foreigners and 57.89%, respectively) followed by the

102 Nation with 11.9 per cent and 54.33 per cent, per cent of those carried by the Nation and 76 respectively. The proportion of the Standard per cent by the Kenya Times. In fact, none of the articles falling under these categories were 5.88 Standard articles were technically “very incom- per cent and 47.05 per cent, respectively. As the petent”, a factor which has no doubt contributed index of constructiveness shows, the Standard’s again to its low score (index of competency = performancein this score of 2.062 (p <.001) was 2.217, p <.001) in this measure of quality of significantly below the other two newspapers. coverage. In terms of balance, the Nation had the most balanced articles with over 76 per cent of them DISCUSSION AND PROGRAMME IMPLICATIONS being “very balanced” or “balanced” followed by the Kenya Times with about 73 per cent and This section discusses the findings of the study. the Standard with just about 50 per cent in the It also draws some lessons for programmes same categories. In fact, the other 50 per cent of aimed at using the mass media to combat the Standard articles were only of average qual- HIV/AIDS in Kenya. As is evident from the ity or biased and, as the index of balance of results, HIV/AIDS is a phenomenal social, 2.227 (p <.001) shows, the newspaper wassig- health and demographic catastrophe for Kenya nificantly below the others on this score as well. and the print media have given it varied atten- Finally, investigation of the technical compe- tion in recent times. The discussion that follows tency of the articles shows that most of them in is aimedat clarifying what we have observed in all the three newspapers were either simply the data with background information and “competent” or of “average quality”. Taken knowledge webring into the study that the data together, 95 per cent of the Standardarticles fell per se could not tell us. Such information and under these two categories, and so did nearly 78 knowledge, read together with the results of this

Table 4. Percentage distribution of HIV/AIDSarticles in three Kenyan newspapers by blame attribution, 1997-98.

Variable Nation (%) Standard (%) Kenya Times (%)

Is there blame for HIV/AIDS? Yes 52.38 51.56 41.30 No 47.62 48.44 58.69

Whois to blame? Foreigners 9.09 8.82 9.52 Truck drivers 0 2.94 0 Prostitutes 4.54 0 0 Gays/lesbians 0 0 0 Recklesslifestyle 31.82 20.58 28.57 Polygamy 0 0 0 Men/husbands 0 0 0 Women/wives 0 0 0 Other ethnic group 0 5.88 0 Nobodyin particular 0 0 0 Medical sector 22.73 29.4] 28.57 Government 13.64 8.82 19.05 Religious organizations 4.55 5.88 0 Lack of resources 13.64 17.64 14.29

103 study, subsequently form the backdrop for the HIV/AIDS coverage was rather low key and recommendationsthat follow. lackadaisical, if not outright apathetic during long stretches of time in the study period. DISCUSSION Three scenarios suggest themselves as explanations for the level of coverage that HIV/AIDS The finding that there were 99 HIV/AIDS- received during the period January 1997 to June related stories in the sample of 340 newspaper 1998. The first scenario has to do with the fact editions constituting this study may be inter- that 1997 was the year of the second multi-party preted in various ways. It may be argued that elections in Kenya and electoral politics this is a reasonably adequate attention for a received more attention than any other problem that was hardly well understood by events/issues in the media. In fact, such atten- Kenyans at the time of the study. On the other tion to politics remained high well into 1998 hand, the seriousness of the pandemicin this pushing HIV/AIDSto the background ofedito- country would suggest that its coverage should rial attention. This interpretation is lent credence have been more intense, even sensational. Yet by the finding that from December 1997 this wasstrictly not the case over the 18-month through April 1998 the average space allocated period understudy. In fact, it may be argued that to HIV/AIDS by the three newspapers wasless

Table 5. Percentage distribution of HIV/AIDSarticles in three Kenyan newspapers by constructiveness, balance, and technical competence, 1997-98.

Variable Nation (%) Standard (%) Kenya Times (%)

Constructiveness Very constructive 11.90 5.88 13.15 Constructive and informative 54,33 47.05 57.89 Average 33.33 30.88 26.31 Neither constructive nor informative 0 10.29 0 Biased and confusing 2.38 5.88 2.63 Index of constructiveness 3.139 2.062* 3.127

Balance Very balanced 11.90 4.23 12.20 Balanced 64,29 46.47 60.97 Average 16.66 39.43 19.51 Biased 4.76 9.86 4.87 Very biased 2.38 0 2.43 Index of balance 3.116 2.227* 3.064

Technical competency Very competent 15.00 0 15.78 Competent 55.00 50.00 55.26 Average quality 22.55 44.59 21.05 Incompetent 5.00 5.40 5.63 Very incompetent 2.50 0 2.63 Index of technical competency 3.005 2.217% 3.064

*Significant at p < .0O]

104 than 50 cm’, and that from May 1998 onwards and pattern of HIV/AIDS coverage in only one attention to such stories averaged over 120 cm’ newspaper, the Standard, the other two papers and wasrising. having almost identical treatment of such sto- Secondly, the Kenya government’s policy ries. As the data clearly show, the Standard response to the HIV/AIDS pandemic wasfairly missed some important events, has relied more tentative as discussed earlier and government than the other newspapers on their ownstaff for officials remained ambivalent about the serious- HIV/AIDSstories, does not routinely cover ness of the problem until fairly late into 1998. In HIV/AIDSas news, and does not have a regular fact, it would appear that, because the govern- column on the pandemic.Instead, the Standard ment had not founda fitting response, the oppo- publishes more readers’ letters on the disease, a sition of certain powerful groups (such as the fact that could conceivably lead to a lot of con- church and traditional value constituencies) to troversies on the problem. Also, the newspaper the provision of reproductive health services virtually ignored the topic of HIV/AIDS around especially to the youth, it found it politically the height of electoral politics in Kenya (August unattractive to tackle the HIV/AIDS problem, 1997-February 1998). Yet, as the findings of this particularly in the context of declining financial study on placementofarticles show, HIV/AIDS and other allocations to the health sector. In fact, is a big story in Kenya: they were frequently a government policy paper on HIV/AIDS(ie., treated as important local news (page three sto- Ministry of Health, 1997) that was drafted for ries), occasionally as edition leads, but more parliamentary approval in 1996 wasnotoffi- often as page leads; moreover, occasionally cially published until late 1997. This means that HIV/AIDS constituted the subject of the main interventions on HIV/AIDS have lacked an editorial or special commentary. appropriate policy framework. Consequently, It is particularly significant that most of the even though the Ministry of Health, and stories were the product of local journalists’ ini- NASCOPin particular, has been working with tiatives, that the newspapers relied overwhelm- other local and international agencies on ingly on local writers and commentators, and HIV/AIDS in the areas of research, awareness that their newsmakers were locally based orga- and prevention, such efforts had of necessity to nizations, researchers and events. Yet the results be low key during the period under study, and also show that politicians and religious leaders the level of press attention that our results have were hardly important sources of HIV/AIDS captured may be a reflection of this official stories (Table 2). Given the heated controversies indecisiveness. that politicians and religious leaders have often The third explanation for the level of cover- generated over family planning and other repro- age that HIV/AIDS received during the period ductive health questions, the finding that these under study may have to do with the inability of important policy and opinion leaders have not editors and reporters to properly appropriate been involved by the press in the debate over HIV/AIDSand its impacts on society as news- HIV/AIDS could only mean that this society worthy or of humaninterest. To clearly recog- had yet to come to proper grips with the reality nize the news value of HIV/AIDS, journalists of the pandemic during the period of the study. and their editors need to have more than passing In fact, if the mass media do notinvolve policy familiarity with the subject as well as with the makers and opinion leaders in the debate on this health beat. Moreover, newsrooms must clue in important national agenda then we can expect to the idea of health being an important social, that any other efforts to contain and reverse the not just medical, issue that spans politics, eco- spread of HIV/AIDS will only have limited nomics and the structure of society, as well as impact. possess some idea of the sociology of disease. It is of prime importance that the mass media Another important finding of this study is concentrate on efforts to create awareness about that there was significant variation in the trend HIV/AIDS and its potentially multifaceted

105 impact on society. In this regard, it is only may not appear high, yet when analyzed proper that media attention should be focused together with other survey data (e.g., Kenya on its prevalence and ways of prevention. In Demographic and Health Survey, 1993) which fact, this is all the media can do in the fight show that most Kenyans associate HIV/AIDS against the disease. The results of this study with multiple sexual partners or indiscriminate show that, taken together, the three newspapers sex (euphemistically called here “reckless analyzed here gave gravely inadequate atten- lifestyle’’), or that prostitutes, truck drivers, gays tion to matters to do with prevalence and pre- and lesbians and polygamists were hardly vention of HIV/AIDS. In fact, other than the blamedin this study, speaks to the potential for Standard, the other newspapers devotedless foreigners to become an important target group than 17 per cent of the space they allocated to for blame or specialized treatment in HIV/AIDS HIV/AIDSto questions of its prevalence and coverage. If that happens, then the moral panic ways of prevention. perspective will have assumed its more familiar Is the moral panic perspective an appropriate form illustrated in Patton (1986), Altman, theoretical framework for discussing HIV/AIDS (1986), Fitzpatrick and Milligan (1987) and reporting in Kenya? The fact that more attention Weeks (1985). was given to the social costs of HIV/AIDS and Finally, the results of this study have given us claims of a breakthrough in the cure and/or man- someindication of the ability of Kenyan journal- agement of the disease, indeed, suggests that ists to handle such a complex subject as coverage of the disease is beginning to take on a HIV/AIDS. The overall assessment of this ability moral panic reportorial approach outlined earlier is that the pandemic has been moderately well in this study. It will be recalled that, according to covered in terms of how informative, balanced this perspective, moral panic is orchestrated and technically competent the articles have been. when patterns of behaviour, whether private or Yet this may properly be said to apply only to the public, cometo be selected by the mass media as Nation and the Kenya Times coverage; the Stan- unusual or symbolic of a threat to the fabric of dard wassignificantly below par in its handling of society. Our results show that “reckless such stories. At the same time, moderate perfor- lifestyles” were identified in about 30 per cent of mance is not good enough fora life-and-death the articles as being responsible for HIV/AIDS issue such as HIV/AIDSthat demandsclear in Kenya, followed by the Ministry of understanding and appropriate behavioural Health/government. Taken together with lack of response. A number of policy and program- resources, the press in Kenya may be beginning ming implications for media coverage of to create the impression that Kenyansare practi- HIV/AIDS are accordingly indicated by this cally defenseless against HIV/AIDS, since it study. may be correctly argued that provision of resources for dealing with a problem of such IMPLICATIONS FOR POLICY AND PROGRAMMING complexity is indeed beyond the capability of ordinary mortals. Hence, the only realistic 1. The quality of HIV/AIDS coverage as option open to Kenyansis restraint from “reck- established in this study points to the need less lifestyles” and to get the government to do for enhancedtechnical training of Kenyan more in the way of combating the epidemic. journalists, not just in specialized fields It is significant, however, that the press has such as health and science journalism, but not singled out foreigners, migrants or other all round training to empower them to social groups to blame for the status of handle complex stories more competently. HIV/AIDSin Kenya. Nevertheless, the data sug- That is, efforts to improve the skills and gest that of all social groups investigated, the professional status of Kenyan journalists three newspapers blamed“foreigners” in about 9 need intensification as this society per cent of their stories on the pandemic. This becomes more complex and diversified.

106 2. There is need to establish HIV/AIDS resource health, science, and crisis journalism, centers to assist journalists to access data and and to determine areas in which they information faster and moreefficiently. One may require support. way of doing this would be to identify a cen- 6. Institutional support may be required to tral institution, such as the ACCE/School of empowerthose to be involved in the trai- Journalism’s Documentation Center in ning programmesthat have been suggested Nairobi where a data bank and a fixed-time to effectively carry out such training. project may be established to prepare Support may be sought from the news fact/data sheets in readily usable form for organizations themselves and from other distribution to newsrooms and regional developmentpartners that are already wor- resource centers for use by journalists. The king in HIV/AIDSarea. advantage of such a central}institution is that it would avail Kenyan-specific data on REFERENCES HIV/AIDS obtained from the National AIDS Control Programme (NASCOP), Central Altman, D. (1986a). AIDS in the Mind of Bureau of Statistics (CBS) and the National America. New York: AnchorPress. Council for Population and Development eaannnnnn- , (1986b). AIDS and the New Purit- (NCPD)that routinely collect data on the anism. London:Pluto status and trends of HIV/AIDS in Kenya. Baltazar, G., H. Odido, J. Stover, A. J. and The staff of the Documentation Center, with Tom Mboya Okeyo (1996). technical support of one part-time quantita- "Epidemiological aspects of HIV/AIDS in tive social analyst and a copy writer, would Kenya.” In S. Forsythe and Bill Rau (eds.), prepare news releases, features and other AIDSin Kenya: Secioeconomic Impact and articles on different aspects of the pandemic Policy Implications. Nairobi: Family for distribution to newsrooms and regional Health International/ AIDSCAP11-24. resource centers. Becker, D. (1963). Outsiders: Studies in 3. Train a cadre of health journalists through Deviance. New York: Free Press. seminars, workshops and short courses in Cohen, S. (1972). “Mods and Rockers: The the local schools of journalism and com- Inventory as Manufactured News.” In S. munication over, say, a two-year period. Cohen and Y. Young (eds.) The 4, Sensitize editors and media managersto Manufacture of News. London: Constable. establish health desks and regular health Erickson, K.T. (1966). Wayward Puritans: A beats in their newsrooms and encourage Study in the Sociology of Deviance. New them, through seminars and workshops, to York: Willey. appreciate the social significance of health Fitzpatrick, M. and D. Milligan (1987). The and, hence, health as having an important Truth about the AIDS Panic. London: news value. Junius. 5. In light of points 1-4, there is need for fur- Forsythe, S., D. Sokal, L. Lux, T. King, and A. ther research: Johnston (1993). “An Assessment of the - to specifically carry out a training Economic Impact of AIDS in Kenya." needs assessment of Kenyan media Mimeo. houses and rural journalists, Holsti, O. (1969). Content Analysis for the - to study the nature and pattern of Social Sciences and Humanities. Reading, HIV/AIDS coverage in Kenyan elec- Mass.: Addison-Wesley. tronic media with a morerealistic bud- Ministry of Health (1997). “Sessional Paper get and time frame, and No. 4 of 1997 on AIDS in Kenya”. Nairobi: - to assess the training capacity of GovernmentPrinter. Kenyan institutions in the areas of

107 Nalo, David and Monica Aoko (1993). Scott, R. and J. Douglas (eds.) (1972). "Economic Impact of AIDS in Kenya," Theoretical Perspectives on Deviance. New Nairobi: Ministry of Planning and National York: Basic Books. Development. Scott, W. (1955). “Reliability of Content NCPDand CBS(1994). Kenya Demographic and Analysis: The Case of Nominal Scale Health Survey 1993. Nairobi: National Coding.” Public Opinion Quarterly, 17: Council of Population and Development and 321-325. Central Bureau ofStatistics. Weeks, J. (1985). Sex, Politics and Society: Patton, C. (1985). Sex and Germs: The Politics of The Regulation of Sexuality since 1800. AIDS. Boston: South End Press. Harlow: Longmans. Rau, Bill, Stephen Forsythe, and Tom Mboya Wimmer, R.D. and J.D. Dominick (1983). Okeyo, 1996. "HIV/AIDS in Kenya: An Mass Media Research. Belmont, Calif.: Introduction to the Epidemic.” In S. Forsythe Wadsworth. and Bill Rau (eds.), A/JDS in Kenya: Young, J. (1974). “Mass Media, Deviance and Socioeconomic Impact and Policy Drugs.” In P. Rockand and M. McIntosh Implications. Nairobi: Family Health (eds.) Deviance and Social Control. International/ AIDSCAP, pp. 1-10. London: Tavistock. Rocheron, Y. And O. Linne (1989). “Aids, Moral Panic and Opinion Polls,” European Journal of Communication. 4: 409-434.

108 THE COVERAGE OF HIV/AIDS in UGANDAN MEDIA: A CONTENT ANALYSIS STUDY

Nassanga Goretti Linda, Mass Communication Department, Makerere University, Kampala, Uganda

INTRODUCTION terns have been found to influence HIV prevalence. Migration and mobility may be seasonal Background where people go to look for work in urban areas The HIV/AIDSepidemic is still a big threat to or it may be work that involves movements like humanity as medical research done so far has not long distance truck drivers, traders, military and come up with definite measures on how to con- security personnel. Studies have shown that occu- tain it. HIV/AIDS has transcended borders and pational travel is often associated with high rates affects people irrespective of age, sex orstatus. of changes in sexual partners and unsafe sex. In the Sub-Saharan region, Uganda accounts According to research carried out in the Rakai for a big share of the HIV/AIDScases. Thefirst district, findings showed that populations living documented AIDS cases were identified in close to the highway had a 38.5% HIV seropreva- Rakai District in 1982 but this rapidly spread to lence compared with 25.4% in trading centres other parts of the country. In a Report to Parlia- and 8.6% in rural villages (Tarantola and ment by the Minister of Health, Dr. Crispus Kiy- Schwartlander, 1997). We have to acknowledge onga, the cumulative figure of HIV positive peo- that human behaviour is very dynamic and can- ple stood at 1.9 million (New Vision, Nov. 17 not, therefore, be explained by one generaltheory. 1998). However, most of these cases are not Asnoted in the HIV/AIDSSurveillance Report of reported to the 20 Surveillance Units geographi- March 1998, although data from HIV infection cally distributed around the country including sentinel surveillance sites continue to show major hospitals, antenatal and STD clinics. The declining trends in the urbansentinel sites and HIV/AIDS Surveillance Report of March 1998 stabilization in the rural sites, the rates are still by the STD/AIDS Control Programmeunderthe high in both cases and that there is need for Ministry of Health puts the cumulative AIDS increased effort to improve and sustain existing cases which had been reported to the Surveil- AIDScontrol initiatives. lance units at 53,306. Of these cases, 49,432 (92.7%) were people aged 12 years and above NATIONAL RESPONSE TO THE HIV/AIDS EPIDEMIC while 3,874 (7.3%) were children below 12 years. Of the adults, 22,445 (46.2%) were males National response to the epidemic has been in and 26,104 (53.8%) were females. Although the three phases: (1) 1980-1986; (ii) 1986-1990; and male to female ratio is approximately 1:1, the (iii) 1990 and beyond. In the first phase, it was male to female ratio in the 15-19 age group is mainly individual communities, NGOsand reli- 1:6, with boys making up 12% of the cases and gious organizations who were active in the fight 88% being girls (NADIC Fact Sheet No. against AIDS. In the second phase, havingreal- 97/001). ized the seriousness of the epidemic, the Ministry The main modeof transmission among adults of Health became fully involved through the was found to be unprotected sex with an infected AIDS Control Programme. An Information, Edu- partner. Residence, mobility and migration pat- cation and Communication (IEC) campaign was

109 embarked on which greatly increased people’s tions. There are two dailies, the government- awareness to more than 90%. In the third phase, owned New Vision with a circulation of about following a review by a National Task Force on 35,000 copies and The Monitor, whichis pri- AIDS, a multi-sectoral approach was adopted vately owned, with a circulation of about 32,000 involving government, NGOsand external agen- copies. Other private papers range from tri-week- cies. The Uganda AIDS Commission was estab- lies to bi-monthlies. These include: The Crusader, lished to coordinate all the HIV/AIDSactivities. The Market Place, The People, The Microscope, The numberof infected people would perhaps The East African, The Voice and Njuba Times. be even higher had it not been for the govern- Worthy of note is that all these papers with the ment’s early acknowledgmentof the problem and widest circulation are in English. There have been its adoption of a policy of openness. This has paid attempts at publications in the local languages by off. The Report on the Global HIV/AIDS Epi- the government, but these have not been very suc- demic (1997:13) recognizes Uganda as a model cessful as the circulation is still mainly within the with the best surveillance system which showed regional towns and does not penetrate into the that infection rates were dropping in younger age rural areas. There is Orumuri for the Western groups. Region, Bukedde for the Central, Etop for Eastern To facilitate its work, the Uganda AIDS Com- and Rupiny for Northern. Magazines on the mar- mission (UAC) set up a National AIDS Docu- ket range from social magazines like Chic, mentation and Information Centre (NADIC) and Secrets, Bella, to specialized ones like ARISE a AIDS Control Programme (ACP) units in various woman’s magazine, and leisure magazines like ministries, including that of Information. To sup- Dine-Out. Becauseofthe low literacy rate of 62% plement the government’s efforts in the fight and low eductaional levels, the newspapers tend against AIDS,there have beeninitiatives by local to circulate mainly in the urban and peri-urban NGOs, United Nations and other external agen- areas. cies. Among these are: UNAIDS,the AIDS Sup- port Organisation (TASO), People Living with The broadcast media AIDS (PLWA)and Phily Lutaya Initiative. All The government-owned Radio Ugandawasfor a these have injected funds into information cam- long time the only station in the country until the paigns using the media which has greatly media liberalization in 1983. Since then, 13 FM enhanced people’s awareness on HIV/AIDS stations have been created: Radio Sanyu, Capital issues. As more people are joining the formal Radio, Central Broadcasting Service, Radio workingsector, there is less time for interpersonal Simba, Radio Maria, Star Radio, Voice of Toro, or group communication. Increasingly, people Radio Paidha, Top Radio, Freedom Radio, Radio are relying more on mass communication or mass Messiah, Voice of Teso and BBC Africa Service. media as a source of information for what is hap- Several others are in the planning stages and will pening in their immediate environment and the start soon. Apart from four of those operating,all world at large. the FM stations are based in Kampala and use mainly English. Whereas Radio Uganda has a THE MEDIA IN UGANDA variety of programmesin 28 languages, including English and Swahili, the FM stations mainly have The print media commercial and entertainment programmes. Up to 1983 when there was medialiberalization, Radio Uganda has an advantage over othersta- the government-owned newspaper did not have tions in that it covers the whole country, unlike any serious competitor. Although there was no the FM stations that broadcast within a certain specific legislation barring private newspapers, range. Having government support and funding, the environment wasnot conducivefor their oper- Radio Uganda can afford to pick news country- ation. With media liberalization and a moretoler- wide, particularly through the information offi- ant government, there are now several publica- cers stationed upcountry.

110 Like Radio Uganda, the government-owned lic is likely to attach the same importance. The Uganda Television (UTV) wasthe only television media have the powerto structure issues and to set station in the country for a very long time. After an agenda for the public to focus on. the liberalization, four private stations were created: Sanyu Television, Channel T.V/CNN,Light- Statementof the problem house and M-Net. Apart from M-Net to which In the 1980s when AIDS wasfirst identified, one needs to subscribe, the other stations can be there was a lot of media coverage on it. How- accessed free of charge but they all do not cover ever, the momentum wasnot kept up and in the the whole country. Except for UTV which mainly 1990s, HIV/AIDS issues no longer got much carries local programmes,the bulk of programmes coverage. Since media focus on those impor- for the other stations are mainly imported English tant events or issues in society, it is as if programmes. HIV/AIDSwasnolongeras big a problem like Although the circulation figures for newspa- it was in the 1980s. pers are relatively low in Uganda,the print media According to the Minister of Health, Dr. are influential since governmentofficials, the Kiyonga (World AIDS Day 1997), although business community and the urban elite rely on there was evidence of positive development them as an important source of information. As in such as high awareness of HIV/AIDSof over other developing countries, the radio is the 90% with positive sexual behavioural change medium for the mass. Given its wider coverage, and significant declining trends in HIV infec- the variety of programmes and the use of many tions, AIDS still remained a major cause of local languages, Radio Uganda is the major death in Uganda. There is, therefore, need to source of information for most people in Uganda. go beyond the role of HIV/AIDS information Although radio access is quite high, it must be dissemination or awareness stage. The media pointed out that there are genderdifferentials and can play an influential part as an agent of men tend to have more access to the medium. In change so that the knowledge acquired is the Uganda Demographic and Health Survey translated into practice or the desired behav- (1995), it was found that there were 56.8% ioral change. Thus, there is need to re-examine women whohad no access to any media as com- the whole communication process of the pared to 31.4% men. There are also disparities HIV/AIDS messages, if the communication depending on socio-economic and educational objective (behavioural change) is to be status. The urban and peri-urban tend to have achieved. more media access than the rural population. As Williams (1989:244) explains while discussing Study objectives the dependency theory, with urbanization and The purpose of the study was to analyze media industrialization, people’s dependency on the coverage of HIV/AIDS in Uganda. The specific media increases and the more a society is involved objectives were to: in high degrees of changeor conflict, the more its (i) find out the nature of the coverage in dependency on the media. Since there is a high terms of numberof articles, the type of expansion rate of urban areas, socio-political and articles, where they are placed and their economic changesas well as the situation ofinsta- prominence; bility/armed conflict experienced in Uganda, (ii) find out the media’s sources of informa- media influence in the country is increasing. tion on HIV/AIDS; As the media have become major sources of (iii) find out the main actor(s) in the articles information, and there is a tendency for people to covered by the media and the main sub- discuss what appears in the media, the media have ject(s) focused on; considerable influence in shaping public opinion (iv) find out if there is a relationship between and people’s behaviour. Depending on how the migrant populations and the prevalence of media prioritize issues in their coverage, the pub- AIDS;

111 (v) find out the reaction to HIV/AIDSin terms 9-15; March 16-22; May 4-10; September of who is blamedforit; 1-7; October 6-12; November 10-16; Decem- (vi) find out how HIV/AIDSpatients are repor- ber 22-28. Coverage on the World AIDS Day ted on; which falls on 1 December was also analyzed. (vii) find out the technical competency of the This sample gave a representative picture of the media's handling of HIV/AIDSissues; and treatment of HIV/AIDS issues by the media in (vill) provide a basis for designing a strategy for Uganda. using the media to combat HIV/AIDSin Uganda. Findings and data analysis After the data collection, the information was Scope of the study coded and aggregated. These primary data The study examined media coverage over a formed the basis for discussion with information period of 18 months (January 1997 - June 1998). from secondary sources being used as back-up. It looked at the print and broadcast media. The The data were analyzed quantitatively using fre- media with the highest circulation or widest quency distributions and rank correlations to reach within the country were used to represent examine patterns in the media coverage. others. For the print media, The New Vision and The Monitor were used as samples to represent Media coverage of HIV/AIDS the other print media. Radio Uganda has the The amount of media coverage of HIV/AIDS widest reach since it covers the whole country. was foundto be quite low. Of the 119 days used The other stations operate within given distances as sample, there were 233 articles on HIV/AIDS and none of them cover the whole country. in The New Vision, The Monitor and Radio Radio Uganda was selected to represent the Uganda. Assuming that a newspaper on average broadcast media. has 75 articles, for the two papers, this would be 150 articles a day. For 119 days, there may be The research design 17,850 articles. For Radio Uganda,a bulletin on The research used both qualitative and quantita- average has about 15 articles so for 119 days, tive methods to analyze the media coverage. A there would be 1,785 articles. The combinedarti- content analysis was done of newspaperarticles cles during the survey period would be 19,635. and radio newsbroadcasts between the period of The 233 articles on HIV/AIDS gives a 1.19% January 1997 and June 1998. In-depth interviews representation. with reporters and editors were also conducted to Of the 357 editions studied, 72 (20.17%) had get their views on the HIV/AIDS coverage. In one article on HIV/AIDS, 32 (8.96%) had two addition, secondary sources of data were used to articles, 13(3.64%) had three, while 22 (6.16%) supplement the primary data from this study. had four or more articles. World AIDS Day, (December 1) recorded the highest number of Population sample articles 28 (7.84%). The New Vision had the Dueto the limited time and the multiplicity of the most coverage 97 (41.63%), followed by The media in Uganda, the researcher used four Monitor 79 (33.91%) and Radio Uganda monthsto represent the 18 months of study. Two accounted for 57 (24.46%) (see Table 1). months were randomly selected, ie. July 1997 The New Vision particularly gave consider- and March 1998 while the other two were able coverage to the HIV/AIDSissuesin the four selected through constructing of composite page monthly pull-outs called Straight Talk and months. The composite months helped in ensur- Young-Talk. The inserts contain sex-education ing a more representative sample since the two materials including information on HIV/AIDS composite months were spread through a period issues. Straight Talk is a project that was started of eight months. One week was taken from suc- in 1993 by UNICEF. The project’s target group cessive months, i.e. January 5-11; February are mainly the youth. It was realized that they

112 needed information during the transition 163 (69.96%); foreign sources, 20 (8.58%) period from adolescence to the adult stage. In and international syndicate/feature services most African societies, it is assumed one accounting for 12 (5.15%) (see Table 3). should get information on sex matters just The major source of the programmes were before marriage, yet many young people do NGO/United Nations which accounted for 44 engage in pre-marital sex without knowing the (18.88%); the Ministry of Health with 36 risks involved. Besides, many parents are shy (15.45%) and governmentofficials with 27 to give sex education to their children. The (11.59%). Articles out of reporter’s/columnist’s media havetried to fill this gap. Radio Uganda initiatives were 22 (9.44%) (see Table 4). also hosts two weekly programmes from the The few articles resulting from a Straight Talk Foundation: “Life Watch,” is a reporter’s/columnist’s initiative reflect the 15-minute programme and “Youth Straight general perception among journalists that Talk,” is a 30-minute programme. These take AIDSstories no longer sell. In an interview the form of drama, interviews, talk shows, and with an editor of The New Vision, Mr. J.B. magazine programmes. Wasswa, he said that, except for information Most of the HIV/AIDSarticles in the print on major break throughs on AIDSlike about came under the category of news stories 103 possible cures, his paper did not want to (44.21%) and others were in features, news dampen people’s spirits by over focusing on analysis, letters to the editor, photograph/ AIDS. This, for example, could drive away photo feature and occasionally as cartoons prospective investors to Uganda, if they (see Table 2). thought that the potential market would not be In the print media, the length of the articles realized due to the high AIDS prevalence ranged from 20 articles (8.44%) with less than rates, he explained. 10 cm2 to a total of 14 (19.44 %) pages out Among the NGOs/United Nations Agen- of 72 pages on World AIDS day. Most of the cies cited as sources were: UNAIDS, NADIC, articles were placed in the inside pages 75 WHO, STD/ACP, TASO,Philly Lutaya Initia- (32.19%) and on the special features page 36 tive, PLWAS, UAC, Safe Motherhood and (15.45%). A few were on the front page/page Family Planning. According to a survey con- 2, 12 (5.15%) on page 3, 11 (4.92%) and 5 ducted by Uganda AIDS Commission, by (2.15%) on the back page. There were six August 1997, there were 1294 HIV/AIDSpro- (2.58%) articles which were edition leads or grammesorprojects registered in Uganda. the main editorials. Most of the articles were page leads 39 (16.74%) and special commen- Reporting on HIV/AIDSpatients tary were 21 (9.01%). Generally, the individual HIV/AIDS patients For Radio Uganda, the duration of the were not focused on much. There is a tendency HIV/AIDSarticles ranged from 18 (31.58%) to be pre-occupied with numbers/statistics and articles with less than one minute to 10 neglecting to highlight the needs and problems (17.54%) articles which had up to three min- of the AIDSpatients. This gives an impression of utes. On World AIDS Day, there were 4 the AIDS patients not being worthy of societal (26.67%) minutes out of 15-minutes news concern apart from the fear of spreading the time that were devoted to HIV/AIDSissues. virus to others. Often times HIV/AIDSis associ- Almost half of the articles 27 (47.37%) were ated with immoral behaviour like prostitution, headlined while the other half 27 (47.37%) drug addiction and alcoholism and AIDS were non-headlined. patients are portrayed as social outcasts. In the articles analyzed, the main actor was the Min- Sources of information on HIV/AIDS istry of Health or government, 71 (30.47%). For both broadcast and print media, the Although the category of private individual/fam- sources of the articles were mainly: local with ily/social group had 67 (28.76%), most of this

113 was under social groups not individual AIDS HIV/AIDS high risk groups patients. Where the individuals were focused Almost half the articles had HIV/AIDS blame on in 28 (12.02%), the images portrayed were attribution: 95 (40.77%) while 97 (41.63%) did negative. not attribute blame. Most of the blame is put on Most articles were concerned’ with nobody in particular, 84 (36.05%). Recklesslife HIV/AIDSprevention, 94 (40.34%), HIV/AIDS style had 37 (15.88%). Husbands/men were also awareness, 57 (24.46%), HIV/AIDSprevalence, cited in 27 articles (11.59%), and wives/women 55 (23.61%) and demographic costs of AIDS, 13 in 5 (2.15%) articles. Prostitutes were cited in 6 (5.58%). A few talked about the claim to cure (2.58%) articles. Although somestudies carried AIDS, 6 (2.58%) (see Table 5). out have linked HIV/AIDS to migrations or mobility, this factor was not reflected in the present study. Truck drivers, foreigners or other eth- Table 1. Coverage of HIV/AIDS. nic groups were not blamed for HIV/AIDS(see Table 6). No. of Monitor| New Radio Total articles Vision Uganda However, mention should be made that Rakai town where HIV/AIDS cases werefirst 28 18 26 72 reported in Uganda used to be a busy overnight 10 13 9 32 stop for truck drivers. The area has suffered 5 1 3 many deaths due to AIDS. For migrant workers, 4 in Kampala and other towns, working men from 2 up country areas tend to have two homes- one in

the village and one in town, with a wife in each. A-mPR]_wplmofre 0 0 In addition, men whotravel on official duty or

business trips also often engage in sex outside COPE 1 their regular partner(s). Generally, it is the men 9 0 who have more than one sexual partner which

[oO 0 increases the risks of spreading AIDS. 0 In a NADICreport, it is noted that women 2 continue to be blamed for bringing HIV into a family when their HIV status is identified first, epee]

Wimp 0 14 - - - 0 for example, through the illness of a child. Yet, the socially sanctioned behaviours of their male TOTAL 719 97 57 partners are more likely to have been the cause of

Table 2. Types of HIV/AIDSarticle.

HIV/AIDSarticle type Monitor New Vision Radio Uganda Total l News 29 30 44 103 2 Feature 15 13 - 28 3 Newsanalysis 4 6 1 11

4 Editorial 1 1 - 2 5 Photograph/photo feature 3 10 - 13

6 Book review 1 1 - 2 7 Letter to editor 3 13 - 16

8 Science feature 4 5 - 9 9 Regular column - ] - 1

10 Cartoon 3 - - 3

114 the initial infection (NADIC, 1997:11). In a Northern part of the country has gone on for national survey by Ankrah et. al. (1993:89) it about 12 years, this has had significant impact on was found that transient sexual relations the spread of AIDS. increased the risks of the spread of HIV. They Another study done in Rakai by Karungi note that casual sex was mainly a feature of (1996) found that the travel of respondents cor- towns and trading centres. They attribute this to related with the HIV serostatus. He found that the fact that these locations provide women with respondents who had travelled or whose partners the opportunity to work and live independently had travelled since 1979 (outside the country or of the patriarchal constraints of village life, a within) were at a higherrisk of contracting HIV. phenomenon which permits casual sex. In the Of those who had travelled outside Uganda, survey, among the respondents who admitted to 27.7% were HIV positive while of those whose casual sex, only 5.2% of the men had used con- partners had travelled, 36.4% were HIV posi- domsall the time in their last five sex encounters. tive. Of those who had travelled outside Rakai On the other hand, no woman had used a con- but within Uganda, 23.4% were HIV positive dom in all the last five casual sex encounters. In and 23.8% of those whose partners had been another study by the Uganda Media Women’s outside Rakai but within Uganda 23.8% were Association in 1998, one of the problems dis- HIV positive. Of the respondents who had not covered was the spread of AIDS and other STDs been away from home, none were HIV positive. in the war zones and in the Displaced People’s The researcher concluded from this study that Campsthroughsoldiers raping womenanddefil- mobility increases the spread of AIDS and that ing girl-children (UMWA, 1998). Since the further one is from home, the more thelike- Uganda’s situation of armed conflict in the lihood of acquiring HIV.

Table 3. Sources of HIV/AIDSarticles.

Sources Monitor New Vision Radio Uganda Total

1 Local 52 63 48 163

2 Foreign 7 8 5 20

3 International

4 Syndicate/feature service 7 5 - 12

Table 4. Sources of HIV/AIDS programmes.

Sources of HIV/AIDS Monitor New Vision Radio Uganda Total programmes

1 Ministry of Health (MOH) 9 21 6 36

2 Other Govt. Minister/official 6 3 18 27

3 Other politician -- 2 2

4 Religious org./official 7 2 7 16

5 Workshop/seminar 4 3 10 17

6 Science report 1 - - 1

7 Research 8 5 - 13

8 Research centre/university 1 4 1 6

9 NGO/UNAgency 10 23 11 44

10 Reporters’/columnist initiative 12 9 1 22

11 Listener/letter to producers 6 5 - 1]

m5 HIV/AIDS awareness among media about HIV/AIDS issues and that, in most practitioners cases, they wrote goodarticles on the subject. The articles analyzed show that media practi- The editors said that it was their duty to keep tioners had a high level of awareness of people informed abouthealth issues, including HIV/AIDSissues. Of the articles, 27 (11.59%) HIV/AIDS. They, however, admitted that most were rated as very constructive and informa- of the coverage was in the urban areas where tive, 104 (44.64%) were constructive and infor- the organizations involved in HIV/AIDSactiv- mative, 56 (24.03%) were average, 2 (0.86%) ities are based. In an interview with J. Kigozi, were neither constructive nor informative, Editor at The East African newspaper, he said while another 2 (0.86%) were biased and con- that his paper did not carry many HIV/AIDS fusing. Also, 187 (80.26%) were average and stories except for reports from organizations above in balance and 6 (2.58%) were taken to like the Uganda AIDS Commission and be very biased or biased (see Table 7). UNAIDS. Heexplained that the paper was On technical competence, 74 (31.76%) business oriented and most of the coverage was were rated as of average quality, 111 (47.64%) centered on this. Kyazze-Simwogorere, a Mon- were competent or very competent, 5 (2.15%) itor editor, said that the paper has a health page were incompetent or very incompetent (see where HIV/AIDSstories are run. He explained Table 8). that there was no specific policy on HIV/AIDS Like other members of the public, most coverage but articles which are newsworthy on media practitioners are very much aware of HIV/AIDS were carried by the paper. At the HIV/AIDS and havethe ability to communi- Crusader newspaper, the Chief Editor G. cate these messages well. According to the Lugalambi, said that most HIV/AIDSarticles study, only 4 (1.72%) articles were found to be were from freelance journalists and that so neither constructive nor informative and 5 long as they were well researched, the paper (2.15%) were judged as being incompetent. carried them. Most of them were usually run on These findings tallied with the views of the the health page but sometimesthey featured on editors of the leading newspapers in the coun- other pages, depending on the news worthiness try and Radio Uganda, when they wereinter- of the article, he explained. Apart from the edi- viewedto get their views on HIV/AIDScover- tor at The East African who said his paper age in their respective media. largely carried reports on HIV/AIDS, the other A New Vision editor J. B. Wasswa and N. editors judged the stories on HIV/AIDSas Ojwe editor of Radio Uganda Newsroom con- being constructive and the journalists as being curred that their reporters were well informed competent in handling them.

Table 5. Main subjects of HIV/AIDSarticles.

Subjects of HIV/AIDSarticles Monitor New Vision Radio Uganda Total

1 HIV/AIDSprevalence 25 25 5 55

2 HIV/AIDS prevention 30 42 22 94

3_| HIV/AIDS awareness 12 23 22 37

4 Medical costs of AIDS - - - ~

5__| Economic costs of AIDS 1 3 3 7

6 Demographic costs of AIDS 9 1 3 13

7 Other social costs -- 3 3

8 Politics of AIDS - 1 - 1

9 Claim of ability to cure AIDS - 5 j 6

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Table 6. Blame attribution for HIV/AIDS.

Blameattribution Monitor New Vision Radio Uganda Total

1 Foreigners/foreign body - 1 - 1

2 Truck drivers - - - -

3 Prostitutes 4 1 1 6

4 Gays/lesbians - - - -

5 Recklesslife styles 9 12 16 37

6 Polygamy - - 1

7 Husband/men 13 9 5 27

8 Wives/women 2 I 2

9 Other ethnic social group - | 1

10 Nobodyin particular 29 46 9 84

1] Medical sector 3 2 1 6

12 Religious org. -- --

13 Lack of resources/aid 7 2 9 18

CONCLUSION AND RECOMMENDATIONS covered were from the Ministry of Health/Gov- ernment. Others were from NGOs and United Summaryof findings Nations Agencies. There were a few articles HIV/AIDSissues are given little coverage in the which were through the reporter’s initiative. The Ugandan media. The articles come mainly as most frequent subjects of the articles were newsstories, news analysis, feature andletters to HIV/AIDS prevention, prevalence, awareness the editor. The sources of this information are and demographic cost of AIDS with verylittle mainly local, supplemented by foreign andinter- focus on the individual AIDS patients. Where national syndicate/ feature services. A few arti- this was focused on, the portrayal was mainly cles in the print media find their way to promi- negative. There was blameattribution in half the nent pages- front page, back page or page 2 and articles but this was directed at nobody in par- 3, while the majority are on the inside pages and ticular. Where blame wasattributed, this was on in the feature section. Some articles come as reckless life styles, prostitutes, men and some page leads while most come as special commen- cases on women. The media practitioners were taries. found to be highly aware of HIV/AIDSissues For Radio Uganda, apart from HIV/AIDS and had the technical competence to report on issues that come as newsitems, there are other these issues. programmes that carry these issues. These include Family Life Education, Life Watch, Conclusion Youth Straight Talk, Drama and Features, and Whereas the media have done a commendable Rural Outreach Programme. Most of the news job in raising people’s awareness about articles analyzed were non-headlined. As in the HIV/AIDSandthe rate of infection has dropped newspapers, most of the articles originated from relatively, there is still more to be done with local sources, supplemented by foreign and respectto effecting behavioural change. Depend- international syndicates/feature services. ing on the way the media handle HIV/AIDS For both print and radio, most of the events issues, the public is likely to perceive it in the

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Table 7. Constructiveness of HIV/AIDS articles.

Constructiveness of articles Monitor New Vision Radio Uganda Total

1 Very constructive & informative 4 3 20 27

2 Constructive & informative 34 44 26 104

3 Average 25 25 56

4 Neither constructive nor informative - -

5 Biased & confusing - 2 -

Table 8. echnical Competence in HIV/AIDSArticles

Technical competence Monitor New Vision Radio Uganda Total

1 Very competent 6 4 5 15

2 Competent 30 37 29 96

3 Average quality 29 28 17 74

4 Incompetent - 2 3 5

5 Very incompetent --- -

same light. In the early stages when HIV/AIDS not all people, particularly in the rural areas, have cases started to be reported in the 1980's, access to the mass media. Even for those who HIV/AIDSfeatured prominently on the media have access, the media may be good for giving agenda. At the close of the 1990’s, HIV/AIDS information due to their capacity to reach many was no longer "big" news. Some considerable people simultaneously but if one expects behav- coverage of HIV/AIDSis given on World AIDS ioural change, then there is need for other chan- Day but elsewhere it is not generally on a consis- nels to be used such as interpersonal/group com- tent basis. The media have a challenge to keep the munication, theatre and posters. public constantly reminded of the seriousness of Asin otherpatriarchal societies, men dominate HIV/AIDS. decisions in the home including those concerning Although there was not much direct blame sexual relations. A man’s sexual prowessis judged attribution in the study, the images associated with by the number of women and children he has. HIV/AIDSpatients tend to be negative such that Even amongtheelite this attitude persists. One infected people become outcasts in society. finds many men with more than one sexual part- Sometimes, people suffer illness with similar ner. Except for female sex workers, it is very rare symptomslike HIV/AIDSandthey fear going for for a woman to have more than one sexualpartner. treatment in hospitals, so they die out of shame of It is, therefore, necessary not only to focus on being recognized as having HIV/AIDS. The womenin the fight against AIDS but also on the media thus have to endeavour not to portray men. The case in the family planning campaigns HIV/AIDSso negatively that people living with earlier used is a goodillustration of the interplay AIDSor those with symptomsare afraid of seek- of gender relations. Initially, most programmes ing treatment which could prolongtheir life. were targeted at women but there was not much However, to contain the HIV/AIDSsituation, change until the realization that women alone do media as channels of information dissemination not make independent decisions and men also need to be supplemented by other sources since started to be targeted. The samesituation pertains

118 to HIV/AIDS communication. For example, on REFERENCES the use of protective measures like condoms, in most cases, the male makes the sexual advances Ankrah, E. M. et. al. (1993). "AIDS in Uganda: and it would be an insult if a woman suggested to Analysis of the Social Dimensions of the him to use a condom. Epidemic”. Faculty of Social Sciences, Thefight against HIV/AIDS needs a multi-dis- Makerere University, Kampala. ciplinary approach, but aboveall, there is need to Uganda AIDS Commission, Kampala 1997. keep the public informed. The media havea vital "HIV/AIDS Pandemic and Uganda’s role to play, especially radio which is the most National Response". accessible medium for the majority. The media Karungi, C. (1996). "Social Economic houses need to move away from the old Determinant’s of HIV Serostatus: A Study of approaches to communication which involved Rakai District.". Master of Arts in mere dissemination of information. With the Demography Thesis, Makerere University. information explosion where people have multi- Ministry of Health. “HIV/AIDS Surveillance ple sources and channels of information to choose Report”. Kampala. March 1998. from, information has to be put into context oth- Ministry of Health. “Uganda Demographic and erwise people may just simply ignore the infor- Health Survey”. Entebbe. 1995. mation if it appears irrelevant to their immediate NADIC Bulletin. Uganda AIDS Commission, environment. December 1997, Kampala. For the journalists to properly inform and edu- National AIDS Documentation and Information cate the public, they themselves must be informed Centre (NADIC). Fact Sheet No. 97/001. first. Government, NGOs, United Nations and Kampala. other external support agencies should keep jour- Report on the Global HIV/AIDS Epidemic. nalists abreast with any new developments or UNAIDS/WHO,December 1997. breakthrough as well as current status of the epi- Tarantola, S. and Schwartlander, B. "HIV/AIDS demic. In Uganda, the NADIC of the Uganda Epidemics: Dynamism, Diversity and AIDS Commission, could serve as the centre for Discrete Declines?”. In Laga, M. (ed). AIDS monthly briefings to journalists or to be responsi- in Africa. Rapid Science Publishers, 1997. ble for sending out press releases. Since editors Research International East Africa Ltd. "Uganda claim that HIV/AIDSstories no longersell, there Media Survey". Nairobi, 1995, is need to train journalists to package the Uganda Media Women’s Association. "War in HIV/AIDSissues in a way that will make them Uganda: Voices of Women". Kampala, 1998. sell. This can be donein the mediatraininginsti- Williams, F. (1989). The New Communications, tutions or through seminars/workshops for those Belmont-California: Wodsworth. already practicing. World Bank Report, 1996.

119 THE ZAMBIAN NEWSPAPERS AND AIDS

Francis P. Kasoma, Department of Mass Communication, University of Zambia, Lusaka, Zambia

MEDIA BACKGROUND lier, it supported the nationalist struggle forself- determination and independence. This editorial It is important that we give the backgroundofthe policy cost it advertising from the economically- newspapers which were the subject of the con- well-to-do whites. But its circulation increased tent analysis study. These are, the two govern- by leaps and bounds, to the extent that it was mentdailies the Times ofZambia and the Zambia later renamed Central African Mail. It was Daily Mail and their Sundayeditions, the Sunday renamed Zambia Mail at independence when Times of Zambia and the Sunday Mail. We will Astor sold the newspaper to the Zambian gov- also give the background of The Post, a pri- ernment who within a few years madeit a daily vately-owneddaily. newspaper and named it, Zambia Daily Mail The Times of Zambia is the country’s oldest (Kasoma, 1986). newspaper having been founded in 1943 as a The Post wasstarted by private Zambian busi- newspaper for white settlers who had come to nessmen in 1991 at the climaxof the agitation by settle in the then Northern Rhodesia, as Zambia a sizeable section of the Zambian community for was known during colonial rule (Kasoma, 1986). democratic governance which resulted in the re- From its inception to the year of Zambia’s inde- introduction of a democratically elected govern- pendencein 1964, the newspaper was known as ment in the same year. Its ownership spread Northern News. It became a daily in 1953 at a across the political divide since both United time when Northern Rhodesia becamepolitically National Independence Party (UNIP) and Move- part of the Federation of Rhodesia and Nyasa- ment for Multiparty Democracy (MMD) mem- land, a political structure that was vehemently bers owned shares in the newspaper. It soon opposed by the African nationalists. Because it established itself as an outspoken newspaper was the organ of the white settlers, the Northern critical of the government in power, first the News was supported by the people who con- Kaunda and later the Chiluba governments. trolled the country’s industry and commerce,the Unlike the other two dailies, The Post is not pub- whites, who preferred to place advertisements in lished on Sundays. the newspaper rather than in the African Mail. All three daily newspapers are essentially Because of bigger advertising space, the newspa- town newspapers which circulate almost exclu- per has always had a highercirculation than the sively in the main urban centres. They are very Zambia Daily Mail. At independence,efforts rarely found in the countryside wherea little less were made to make the newspapera national than half of Zambia’s populationlives. organ rather than one for the whites only. In 1978 The three newspapers were chosen as sub- the government nationalized the newspaper. jects for this study because they are the only The Zambia Daily Mail started as the African daily newspapers in the country. Mixing them Mail at the height of the nationalist struggle in with other newspapers which appear less often 1960. It was started with capital from the editor would have compounded the basis for compari- of the Observer newspaper in London, David son in the study. It would also have made the Astor. From its commencement, as indicated ear- study too wide and less focused.

121 EARLIER STUDIES National Mirror and radio and television programmes of the Zambia National Broadcasting This is the third study this researcher has under- Corporation (ZNBC). taken on the Zambian media and the coverage of The study wascarried out in 1993. Unlike the HIV/AIDS. earlier research, this study found that most of the Thefirst study, “The Zambian press and the stories were local and not foreign. Rarely were AIDScrisis”, (Kasoma, 1990/91) looked at the the stories published on page one. The predomi- HIV/AIDSstories which the Times of Zambia nant type of story was the feature story. Not and the Zambia Daily Mail published in 1986, much emphasis was placed on advertisements in when the Zambian governmentofficially recog- all the newspapers, but particularly the Mirror nized the presence of the Human Immunodefi- which did not carry any advertisements. There ciency Virus (HIV) which leads to the Acquired were only four editorials published during the Immune Deficiency Syndrome (AIDS) in the whole year, two in the Times and two in the Mail. country, and 1989 when it was assumed, by this Very few letters to the editor were published by researcher, that HIV/AIDS had become well- all the newspapers. knownin the country. As in the earlier study, most of the stories The first study established that 60% of the were about “AIDS tests, widespreadness, sick- newsstories published in the two daily newspa- ness and deaths’. “Cause and prevention” came pers were foreign. The two newspapersalso did second and “cure and vaccine”third. Noneofthe not regard HIV/AIDSstories important enough stories contained MI. Most of the stories were to deserve page one treatment. Only 22% of the not new but had been published before. stories were used on page one, of which 8% were The present study followed the 1993 study lead stories. closely. It looked at the HIV/AIDS publicity in The two newspapers only published nine edi- the Times, the Mail and the Post. torials between them during the two years, four Originally, the intention was to include radio in 1986 and five, all by The Times, in 1989. A and television programmes of the Zambia total of 29 letters to the editor were published. National Broadcasting Corporation (ZNBC). But The most commonly discussed subject-area by the researcher was told by ZNBC senior man- both newspapers was that of “AIDS agementthat no tapes of either the radio ortele- tests/deaths/widespreadness” which surfaced in vision programmeswere kept since they werere- 50 (45%) articles in 1986 and 84 (47%) in 1989. used for other programmes due to an acute and Only 12% of the articles contained Mobilizing persistent shortage of funds to purchase new Information (MI), (Kasoma, 1990/91). tapes. It would have been useful, particularly to MI is described as any information that look at television programmessincestudies else- allows people to act on attitudes and desires they where indicate that television publicity of already have (Kasoma, 1990/91:50). As Kris- HIV/AIDS has some considerable impact in tiansen and Harding (1984:243) havestated, “the other parts of the world. notion of MIis particularly relevant to studies of Apart from the two earlier studies by this health reporting because the literature of fear authorreferred to above, there have not been any communications are more likely to promote a media content analysis studies on HIV/AIDS in given behaviour when specific details about Zambia. But there have been other surveys on the actions which will counteract or prevent the disease in the country. These include Mbozi’s health threat (i.e. how, when, where) are explic- study on the impact of billboards on HIV/AIDS itly and precisely described. on youths in Zambia (Mbozi, unpublished). The The second study, a “Content analysis of focus of this study was to determine howuseful AIDS stories in Zambian media’, (Kasoma, the anti-HIV/AIDS billboards had been to the 1996), was much broader. It included not only youths of the country who werethe target group. The Times and the Mail but also the Post, Mbozi’s conclusion was that billboards did not

122 have much impact partly because of the way they of the total articles the newspaper published, had been created (without pre-testing and no used in the inside pages. Most of the stories 63 involvement of the youths) and partly because (57%) were not new. They contained material the messages they carried did not answer the that had already been published by the newspa- needs of the youths on the issues. Other factors, per. Only 49 (45%) contained new information. such as the placementof the billboards and their Most of the articles 87 (74%) were local. subject matter, also negatively influenced their There were 26 (23%) reports which were foreign. impact. This is a suggestion that the focus of attention was on the local as opposed to the foreign RESEARCH METHOD HIV/AIDSscene. Regarding the categorization of the articles Theeditions of the three newspapers were exam- according to what they treated, most of the sto- ined for 1997 and the first six months of 1998. ries were dealing with the combinedtopic of This involved physically visiting the respective “cure and vaccine” which recorded 36 (33%). newspaper libraries and examining the cuttings The next highest category was the area of “test, as well as the full editions of the newspapers to widespreadness, sickness, deaths” which ensure that reports were not left out. received 28 (25%) stories; “cause or prevention” As in the previous studies, a checklist con- had 11 (10%). There was only one story which taining 14 items was used. For each story a sep- treated the topic of “origin of HIV/AIDS”. Sto- arate form of the checklist was completed. It is ries which dealt with “other” topics were 45 the data from these which were usedfor analysis. (41%). The “other” topics were wide-ranging and included subjects like “home care of AIDS RESULTS patients”, “counselling”, and “AIDS orphans”. The fact that a sizeable numberof the stories The Zambia Daily Mail treated “other” topics suggests that the range of A total of 110 articles were examined of which matters raised in the coverage of HIV/AIDS had 73 (66%) were newsstories, 35 (32%) were fea- grown as people devoted more attention to the tures, one editorial (.9%), and two letters to the devastating effects of the pandemic. editor (2%). No story contained any MI butall the stories It is noteworthy that although the Mail pub- were easily comprehensible. lished the highest numberofarticles of the three Only five stories, representing 5% named a newspapers examined, it had only oneeditorial. person as dying from AIDS suggesting that Theeditorial was published on 2 December 1997 Zambians were still shy to associate people’s to mark the World AIDS Day which falls on deaths with AIDS since it was regarded as a December1. It, ironically, called on Zambians “shame disease” referred to only in euphemisms not to wait until December | to make themselves like “died after a long illness”. active on preventing the spread of HIV/AIDS. Seven of the articles, representing 6% of the The fact that the newspaper published only one total number of articles the newspaper pub- editorial strongly suggests that the editor did not lished, gave figures of people dying from AIDS. think HIV/AIDS was a subject that warranted But the figures were misleading and contradic- commenting on. tory. For example, three of the stories gave 21 It is also surprising that the Mail published million as the figure of adults who were infected only two letters on HIV/AIDSfor the 18 month with HIV/AIDS in Sub-Sahara Africa. But one period. The newspaper did not think the of the stories gave the figure as 14 million. A few HIV/AIDS newsstories were important enough self-confessed people were named in a number to deserve being used as page one lead stories. of stories as being HIV positive. Only four of the stories were used as page one Surprisingly, only three of the stories dis- leads. There were 106 articles, representing 96% cussed, either wholly or partly, negative cultural

123 issues about HIV/AIDS. Onetreated beliefs infected with HIV. The story said it was about sleeping with a virgin as making HIV pos- unAfrican to have sex with a dog. The other itive people become HIV negative. The second story said the use of condoms was against discussed the practice of succession rights for African cultural tradition. widowsin which they are made to have sex with a relative of their deceased husband as responsi- The Post ble for spreading HIV infection. The third was Out of a total of 378 newspapers searched, the about the practice in which certain men who are Post only published 19 stories about HIV/AIDS. impotent make their wives have sex with another Of these, 17 (89%) were news stories and one man so that he can bear them children. wasa letter to the editor. The newspaperdid not publish any editorial on the subject. Most of the The Times of Zambia stories, 11 (58%) treated new subjects while A total of 78 articles were published of which 47 eight (42%) were on subjects already reported. (60%) were newsstories, 25 (32%) features, two The newspaper published only one foreign (3%) editorials and four (5%) letters to the editor. story, representing 5% of all the stories it pub- There was only one page oneleadstory. lished. The rest 18 (95%) werelocal stories. Again it should be noted that the Times, like Only two stories (11%) were published on the Mail, published very few editorials on page one. They were both used as leads. One HIV/AIDS. The newspaper published only two was about a Dr. Ngosa, a Zambian, who was editorials. Like its sister government paper, the reported by the London Daily Mail as having Times did not think HIV/AIDS stories were been charged by the British Medical Council for important enough to deserve page one treatment. not taking the HIV test soon after a woman All the stories, except one, were used on the claimed she had been infected with HIV by him. inside pages. The other was about Zambian President Freder- Unlike the Mail, however, most of the stories ick Chiluba urging scientists to find an AIDS 47 (60%) were new while 31 (40%) had been cure instead of manufacturing condoms. reported before. It is remarkable that all the sto- Regarding the topics treated by the newspa- ries the newspaper published werelocal. per, the Post gave equal treatment to the two Regarding the categorization of the type of topics: “cause or prevention”, eight (42%) and stories the newspaperpublished, most of them 29 “test, widespreadness, sickness and deaths”, (26%) dealt with topics of HIV/AIDS “tests, eight (42%). The area of “cure and vaccine” had widespreadness, sickness and deaths’; “‘cure and only two (11%) stories. There were no stories vaccine” had 18 (23%); while “cause or preven- about origin of AIDS. Stories covering ‘other’ tion” had 11 (14%). There were no stories deal- were seven (37%). They included alleged mis- ing with the “origin”. But 31 (40%) of the stories conduct by Dr. Ngosa and discrimination of dealt with “other” topics. HIV/AIDSpeople in society. There was not a single story which contained Noneof the stories contained MIbutall sto- MIwhile all the stories were easily comprehensi- ries were easy to understand. No one was ble. No one was named in any ofthe stories as namedin any of the stories as having died from having died from AIDS, although seven of the AIDS. But three stories (16%) gave somestatis- stories contained statistics of people who had tics about HIV/AIDS. One said 400,000 chil- died from AIDS. Apart from a couple of self- dren in Zambia below 15 were infected with confessed people, there was no one named in HIV in 1996. The other said 1,000,000 children the stories as having HIV/AIDS. were with HIV in 1997. The third one said in The newspaper published only twostories 1998 there were 30 million people with which touched on the subject of negative cul- HIV/AIDS in the world while sub-Sahara tural issues. One was about a man who Africa had 14 million cases and Zambia allegedly had sex with a dog to avoid being 100,000.

124 Two people were named in twostories (one published one story on the subject. The most in each) as having HIV. There were no stories heavily publicised topic area was “test, wide- whichtreated negative cultural issues. spreadness, sickness, deaths’ which had 42% attention from the Post, 33% from the Mail and COMPARING FREQUENCIES 23% from the Times. “Cause and prevention” had 42% from the Post, 14% from the Times and The Mail, as indicated earlier, published the 10% from the Mail, while “cure, vaccine” had highest number of HIV/AIDSstories, 110 in 33% from the Mail, 23% from the Times and all. The Post had the least numberofstories 10% from the Post. In the category of the (19) while the Times came second with 78 sto- “other”, it is the Mail that led with 41% fol- ries. lowed by the Times at 40% andthe Post at 37%'. However, looking at the type of stories pub- These statistics mean that the areas of “test, lished in terms of whether they were newssto- widespreadness, sickness, deaths” and “cure, ries, features, editorials or letters to the editor vaccine” received the most attention from the (Table 1), the Post, comparatively, published three newspapers, strongly suggesting that the more newsstories (99%). The Mail came sec- general public in Zambia, according to the deci- ond at 66% and the Times third at 60%. This sion of the editors, wanted to know how wide- means that all the three newspapers concen- spread HIV/AIDS was and what wasbeing done trated on giving people newsrather than back- to arrest its spread. The area of “cause and pre- ground information which features usually con- vention” of HIV/AIDS got the least attention tain. In fact, the Post did not publish any fea- after “origin”. The interpretation is that editors tures at all while the HIV/AIDS hole of the knew that the cause and prevention of Mail and the Times contained 32% features HIV/AIDS were common knowledge in Zambia apiece. The Post did not carry any editorials and required verylittle publicity, if any. while the Mail had one and the Times two. But the Times published more letters to the editor THe HIV/AIDS stories NEWSPAPERS TELL (5%) as against 1% for the Post and 2% for the Mail. In this section, we discuss the main details of the In terms of “local” versus “foreign” stories contents of the stories the newspapers pub- (Table 2), all the stories (100%) published by lished. the Times were “local”. The Post had 95% while the Mail had 74%. This was a strong indication Cure that the focus was on the “local” HIV/AIDS The three daily newspapers devoted a lot of scene and not on what was happening outside space to cure for HIV/AIDS. Muchof the space Zambia. was given to the controversy surrounding the Considering the categories of “new” and claim by Mulenga Lukwesathat the drug Herb- “not new”stories (Table 3), the Times published iron Tisaniferon, which his MLN Laboratory 60% “new”stories while the figures for the Post had developed, could cure AIDS. The Medical and the Mail were 58% and 47% respectively. Council of Zambia (MCZ) and governmentdis- Conversely, the Mail’s reportage consisted of missed the claim and bannedthe use of the drug mostly (57%) “not new”stories or repetitions of by doctors in the country until after it had been what had already been published. tested scientifically. But the test itself was Table 4 clearly suggests that the three news- reported not to have been conclusive because papers did not think the origin of AIDS was those who werecarrying it out had, reportedly, worth wasting valuable space on. Only the Mail run out of funds. An angry Lukwesa, who

' The frequencies do not add up to the original total figures or to 100% because some stories were counted more than once since they could deal with more than one category.

125

Table 1. Frequency of type of stories.

NEWSPAPER TYPE OF STORY

News Feature Editorial Letters Total

Mail 73(66%) 35 (32%) 1 (.9%) 2 (2%) 110 (100%)

Times 47(60%) 25 (32%) 2 (3%) 4 (5%) 78 (100%)

Post 18 (99%) - - 11%) 19 (100%)

Table 2. Frequency of local andforeign stories.

NEWSPAPER TYPE OF STORY

Local Foreign Total

Mail 87 (74%) 26 (23%) 110 (100%)

Times 78 (100%) - 78 (100%)

Post 18 (95%) 15%) 19 (100%)

Table 3. Frequency of “new” and “not new”stories.

NEWSPAPER TYPE OF STORY

New Not new Total

Mail 47 (43%) 63 (57% 110 (100%)

Times 47 (60%) 31 (40%) 78 (100%)

Post 11 (58%) 8 (42%) 19 (100%)

Table 4 . Frequency of categories of stories.

NEWSPAPER CATEGORY OF STORY

Origin Cause and Test, sickness, Cure, Other prevention widespreadness vaccine and deaths

Mail 1(%) 110.0%) 28 (25%) 36 (33%) 45 (41%)

Times - 11014%) 29 (26%) 18 (23%) 31(40%)

Post - 8 (42%) 8 (42%) 2 (10%) 7 87%)

126 claimed to have made K2.5 billion from sales were excited about the commencementof the of the drug, warned the government and the trials of the new vaccine. MCZto keep off his drug. He had sympathis- Sustiva was reported to be found useful as a ers in Membersof Parliament who advised the drug for AIDS patients. The Tropical Diseases governmentnot to discourage people like Luk- Research Centre in Ndola was reported to have wesa who were claiming to discover drugs that appealed to Zambians to come forward and could heal AIDS. Other supporters included help test the Chinese drug called Fesol. The the general public (letters to the editor) and the French drug, Pasteur Merieux, was also Traditional Herbalists and Healers Association reported to go on trial in Uganda. which urged Zambians to stop fighting and The cost of treating AIDS patients was a instead find a cure for AIDS. subject of a numberof stories. One story quoted The Times and the Mail also supported Luk- the Central Board of Health as saying the AIDS wesa.In two editorials (one for each), the news- treatment bill would reach $21 million in the papers called on the governmentnotto discour- year 2005. Another, again quoting the Central age traditional healers and other people who Board of Health, simply said treating AIDS claimed to have found a cure for AIDS. But the patients had becometoo costly. government was adamant. It closed the contro- The building and opening of an HIV/AIDS versy by ruling that Herbiron Tisaniferon could private hospital in Chilanga, near Lusaka, also only be used as a traditional medicine. received considerable space. The hospital, the The newspapers gave extensive coverage to only one in Zambia, was built by a Dutch traditional healers and others claiming to have woman, Pola van der Donck, in memory of her found medicine that could heal AIDS. They brother who had died of AIDS. It was being included a retired nurse from Kitwe who managed by the Catholic Church. But the punch claimed that her Jaroots Herbal Formula story was the one which said scientists were healed AIDS-related diseases. Another woman still a long wayoff to find an AIDScure. in Kapiri Mposhi also claimed to have medicine to heal AIDS. A woman medical doctor WIDESPREADNESS AND PREVENTION who was reported to be operating from a Kabwehotel claimed that she had an injection Zambian newspapers, contrary to expectations, that cured AIDS. But none of these claims hardly publicized negative cultural practices were reported to have been authenticated by that lead to increase in HIV infections, in spite medical experts. of the fact that Zambians knew this was a big The newspapers also reported progress problem in the fight against HIV/AIDS. Only being made to find a genuine AIDS cure and one story in the Mail specifically referred to vaccine against HIV. Some of the medicines traditional practices as contributing to the named included Virodene, a drug developedin spread of HIV infection. Instead of publicizing South Africa which, like Herbiron Tisaniferon, the common cultural practice in which widows had split the South African authorities with the are made to have sex with a relative of the government being in support of it and the deceased husband, usually a brother, the news- Medicines Control Council (MCC) being papers (particularly the Times ) publicized a against it. Another drug named in the stories story in which they said widows whose hus- was Azidothymide (AZT) which one of the sto- bands had died of AIDS were becoming sexu- ries warned could be dangerous if not admin- ally reckless. A curious story was reported by istered properly. The medicine was said to be the Mail in which the United Nations Popula- available in Zimbabwe. tion Fund (UNFPA) wasreported as calling on Several stories announced the launching in Zambians to maintain traditional and cultural the United States of America of tests on humans values (presumably positive ones) to fight of an HIV vaccine. One story said Zambians HIV/AIDS.

127 A numberof stories reported on seminars for HIV TEsTS truck drivers who were widely believed to be spreading HIV because of the numberofgirl- Some considerable publicity was given to the friends they had along their routes. Somestories issue of HIV tests. In some stories, a chain reported that the incidence of HIV infection shop manager in Lusaka was reported to be among girls was higher due to factors such as carrying out “silent HIV tests” among his prostitution, “sugar daddies”, a name given to employees. The manager admitted that he was promiscuous men,and the rising incidences of subjecting workers to the HIV test. In another incest. Generally, the stories said the HIV infec- story, a man who was HIV positive was tion of women washigher than that of men and reported to have hung himself. was increasing at an alarmingrate. Somestories reported that fear of undergo- Zambia was reported to be ranked fourth in ing HIV tests was common among Zambians. the HIV/AIDS infection in Africa while Malawi Prostitutes were among those who wereafraid and Zimbabwe were said to be AIDS trou- of knowing whether they were HIV positive or blespots where five young people, aged between not. Onestory said they were shunning joining 10 and 24 years were reported to be infected Tasintha, an organisation to reform prostitutes, with HIV every minute, according to the Wash- because it required them to undergo an HIV ington Line, a USA Embassy publication in test. A few stories said HIV tests were neces- Lusaka. The most popular form of prevention sary if the spread of HIV/AIDShad to be con- against HIV infection, judging by the number of trolled. One story, however, quoted a Japanese stories published on it, was the condom which doctor in Lusaka as saying the HIV test using was embroiled in endless controversies. For anti-bodies was unreliable because it did not example, some newspaper reports alleged that reveal infections which were four weeks or condoms were not safe to prevent HIV infection less old. because they had holes. But the Central Board of Health was quick to put out a statement in which CHILDREN AND ORPHANS it emphatically said there were no holes in condoms. Somestories said condoms were more A considerable number of newspaper reports effective to preventing HIV infection than they said manychildren were infected with HIV. No were given creditfor. specific numbers were suggested but the prob- A numberof governmentofficials, including lem was said to be very serious. To emphasize Vice President Godfrey Muyanda and President the seriousness of the problem, the theme Chiluba, were often quoted as discouraging the “children living with AIDS” was chosen for use of condomsand preaching abstinence as the the World AIDS Day on 1 December 1997, only sure prevention against HIV/AIDS. They Publicity about the so-called AIDS orphans were supported by the churches. Femidom, the wascarried out by the Times and the Mail. The female condom, also received some publicity Post did not publish a single story. Many of the and similar condemnation, from the same people stories kept repeating the fact that life was get- and organizations criticizing the use of con- ting tough for the orphans many of whom had doms. to eke out a living from the streets. Govern- Government ministers and the Zambia Con- ment promised assistance for families looking gress of Trade Unions (ZCTU) repeatedly after AIDS orphans. One story predicted that expressed worry about the serious effects on the number of AIDS orphans in Zambia would Zambia’s economy of the spread of HIV/AIDS swell to 600,000 by the year 2000. There were, pandemic. The ZCTU wasreported to have been generally, no specific figures given for the alarmed at the prevalence of HIV/AIDSinfec- numberof AIDS orphans in Zambia during the tion at work places and urged its member unions period covered by this study. Reference was to help fight the epidemic. merely made to thousands of AIDS orphans.

128 TREATMENT OF HIV/AIDS PEOPLE Living with HIV/AIDS, Society for Women Against AIDS in Zambia, Alangizi Women Asso- Wide publicity was given to the treatment ciation of Zambia and the Zambia National AIDS accorded to HIV/AIDS people. Someofthe sto- Network. ries quoted people who were HIV-positive as saying that they were being discriminated against by DISCUSSION AND RECOMMENDATIONS society, including at work places. This, certainly, contributed to the reticence of HIV-positive peo- A number of issues stand out in the findings of ple to come out in the open, which a couple of this study. These are the stress on publishing local stories complained against. There were only a stories, the lack of MIin the stories published, the few Zambians such as Winston Zulu, David few editorials published, and the stress on pub- Chipanta and Clement Mufuzi who had comeout lishing newsstories rather than features. in the open and were regularly quoted by the press as being spokespersons of HIV positive Localstories people. Some stories accused those who had In myfirst study, it was established that Zambian comeout in the open as having been paid a lot of newspapers had a preponderance of foreign sto- money for doing so. ries on HIV/AIDS. The explanation given then Positive living by HIV people was a common was that HIV/AIDSwasa new disease in Zambia subject in manystories. Positive living organiza- and editors wanted to show that HIV/AIDS was tions were reported to be mushrooming through- “out there” and not a problem in the country. out the country, particularly in Lusaka and Cop- Moreover, most of the information on HIV/AIDS perbelt provinces. To promotethis, the Common- made available to the editors was from outside wealth Youth Programme,based at the University the country, mainly the North. By the time of the of Zambia in Lusaka, was reported to be organiz- current study, the situation in Zambia had ing workshops and seminars for the so-called changed so much that Zambia is said to have “AIDS ambassadors” — people who were HIV become the fourth HIV/AIDS country in Africa positive who were sent around the countryto tell and one of the highest in the world. HIV/AIDS their colleagues that being HIV positive was not wasnow real threat to the country and deserved the end of the world and also warn society about a lot of publicity. the dangers of contracting HIV. To support the promotion of positive living, a Lack of mobilizing information numberof counselling centres were reported to The lack of MI in HIV/AIDSstories published by have been started in the country, particularly in Zambian daily newspapers is remarkable. It major urban centres. These counselling centres partly means that those whofile the stories that were partly to take care of AIDS patients. The are published are not concerned with follow-up most reported HIV/AIDS counselling centre by action by giving people information such as far was Kara Counselling Centre in Lusaka. addresses, telephone numbers etc. which people Some publicity was also given to the need for can use to act on the information. This is particu- home-care for AIDS patients. Development Aid larly important since the stress on the HIV/AIDS from People to People was reported in one story publicity by the newspapers is not on giving to have trained 200 HIV/AIDSpatient handlers knowledge such as how HIV is contracted and and counsellors at a workshop in Ndola. how it can be prevented, but on giving practical A number of banks were reported to have information such as where to get HIV tests, donated funds to HIV/AIDS organizations such where to go for counselling and where as Kara. According to press reports, the country HIV/AIDS organizations are and how they can be had a number of HIV/AIDS organizations. They contacted. This information was simply not pro- included the Catholic Church Home Care (based vided in the HIV/AIDSstories the three newspa- on the Copperbelt), Network of Zambian People pers published.

129 Accordingly, this researcher recommends seem to appreciate the role of the media that a series of seminars/workshopsbe held for regarding what they can do and not do in com- senior reporters of the three newspapers to bating the pandemic. Many people think it is teach them how to include MI in newspaper merely a question of publishing articles or stories. broadcasting material that warns people against the danger of contracting HIV/AIDS Few editorials and telling them how the disease can be con- Editorials serve as agenda-setters. Through tracted. them, newspapers maynotbe ableto tell their Journalists in Zambia ought to include in readers what to think but they certainly do tell their reportage the counselling aspect of the them what to think about. By publishing a neg- HIV/AIDSsufferers. They need to provide MI ligible numberof editorials on HIV/AIDS, the to HIV/AIDSpatients about where they can Zambian daily newspapers were sending a obtain counselling help. For this to be effec- clear message, as already pointed out, that tive, the mass media channels in the country HIV/AIDS was not worth editorializing on. If need to set up HELPLINESbydisplayingtele- in the earlier two studies a preponderance of phone numbers where people with HIV/AIDS editorials on HIV/AIDS was found, it would can call toll-free to seek advice. Zambia has a have been concluded during the current study number of HIV/AIDScentres which can give that editors had becometired of writing on the such advice but the people, particularly the issue, pandemic as it may be. But the finding HIV/AIDSsufferers, hardly know about their of the earlier studies was the same; there were existence or how they can get in touch with hardly any editorials published on HIV/AIDS. them. It would be very useful if media houses Therefore, it is strongly recommended that got in touch with these centres with a view to a series of seminars or round-table discussions requesting them to regularly publicize their be organized for the top two editors of each of activities and how HIV/AIDSsufferers can the three newspapersto discuss why they shun benefit from these services. away from writing editorials on HIV/AIDS. The media also need to establish regular features and broadcast productions to keep in Preponderanceof newsstories constant focus the HIV/AIDS predicamentin The fact that the most popular story was the the country. These could take the form of reg- news story is an indication that the newspapers ular columnsin the daily and weekly newspa- were more interested in giving people current pers discussing topical issues on the subject as information and hard facts about HIV/AIDS well as providing up-to-date information about rather than backgrounders. Since reportage in developments of the disease. The once-in-a- Zambia is mainly based on speeches made by while articles published in newspapers and officials, most of the newsstories were report- productions on the national radio and televi- ing speeches made by mainly governmentoffi- sion station are simply not enough. If cials. There was hardly any in-depth well- HIV/AIDSis the pandemic it is supposed to researched newsitem.It is recommended that be, then it ought to be treated as such by the a series of seminars/courses be organized for media, making the people constantly aware of senior reporters in the country to teach them its existence. howto report effectively on HIV/AIDS. To further promote the HIV/AIDS awareness, the mass media in Zambia could also be Sensitizing media people involved in the promotion of jingles and atten- The biggest problem is that journalists and tion-catching gimmicks,all directed at keep- other media people in Zambia are not attuned ing Zambiansconstantly aware of the presence to what it means to use the mass media to of the devastating disease in their midst. For combat HIV/AIDSorits effects. They do not this, the press could make use of self-con-

130 fessed HIV carriers who could be madeto par- bia. It is, therefore, a topic that should interest ticipate in publicity-seeking stunts which journalists and editors in all respects. would bring the reality of HIV to the Zambian population. Such stunts would also help in REFERENCES bringing the ever-increasing HIV-positive community in Zambia to being less discrimi- Mbozi, Parkie. “AIDS billboards and their influ- nated against by society. ence on the youth in Zambia”. Unpublished Master of Mass Communication Thesis. CONCLUSION Lusaka: University of Zambia. Kasoma, Francis P. (1986). The Press in The results of this study make more senseif Zambia, Lusaka: Multimedia Zambia. they are read in conjunction with the two ear- Kasoma, Francis P. (1990/91). “The Zambian lier studies. The three studies have clearly Press and the AIDS crisis’. The established a pattern on how the media in Commonwealth Association for Education in Zambia have reported on HIV/AIDS. Journalism and Communication (CAEJAC) This particular study has confirmed that Journal, Volume3, pp. 48-59. there are certain things that ought to be done Kasoma, Francis P. (1996). “Content Analysis for the publicity on HIV/AIDS to be more of AIDS stories in Zambian newspapers”. effective than it has been. But this will only Unpublished Report, Lusaka: Zambia. come about if the recommendations made in Kristiansen, Connie M. and Christina, M. this report are implemented. Harding (1984). “Mobilization of health HIV/AIDS is a pandemic that has the behaviour by the press in_ Britain,” potential to devastate the population of Zam- Journalism Quarterly, Summer.

131 THE COVERAGE OF HIV/AIDS IN NAMIBIAN MEDIA: A CONTENT ANALYSIS STUDY

Kingo J. Mchombu, Department of Information and Communication Studies, University of Namibia, Windhoek

A GENERAL SOCIAL BACKGROUND is, therefore, a significant percentage of the population which cannot directly access HIV/AIDS Namibiais a big country in Southern Africa, sur- information provided in the written format. rounded by Zambia and Angola to the North, In the print media, there are five main news- Botswana to the East, South Africa to the South, papers, namely: The Namibian, New Era, and the Atlantic ocean to the West. The popula- Observer, Die Republikien 2000, and Almegine tion stands at 1.7 million and is scattered Zeitung and a few magazines and newsletters unevenly throughout this large, arid but beautiful issued by various bodies outside Windhoek. country. Economically, per capita income stands With the exception of the New Era whichis gov- at an average of N$ 3608, ranging from a low N$ ernment owned, the rest are privately owned. 1070 in Omahekeregion to a high N$ 11,359 in The main languages of publication are English the Khomas region. Thus there are wide dispari- (three papers) and Afrikaans (one paper). The ties in income per capita, which has made Almegine Zeitung is a German language paper Namibia one of the most unequal societies in the targeting the large German community in world (UNDP and UNAIDS, Namibia Human Namibia. The Namibian and New Eraalso carry Development Report, 1997), This economic stories in local languages, mainly in Oshivambo, characteristic is largely a legacy of the policy of Otjiherero, Afrikaans and Lozi. The print media apartheid which South Africa, the former colo- are dominated by a few newspapers, mostly nial master had introduced and practised in based in the capital city, Windhoek, with a heavy Namibia for more than 70 years. The present urban bias in their coverage. According to CSO Government, which came into power in 1990 (1994), 25 per cent of households in Namibia after a long and protracted liberation war, is buy at least one newspaper per week. making efforts to address income inequalities Namibia has six radio stations, but only the through land redistribution, economic empower- Namibia Broadcasting Corporation (NBC) has ment, broader access to education, and a bal- nation-wide coverage. The others are: Radio 99, anced economic, social, and infrastructural Channel 77, Radio Energy, Katutura Community development of the whole country. Radio, and Kudu Radio. Radio ownership has The country’s literacy rate stands at 66 per been growing steadily from a low 50 per cent in cent and the school enrolmentrate is 90 per cent, 1990 to 60 per cent in 1991, and very likely a which effectively meansthat about 10 per cent of much higher figure today (CSO, 1994). Again, the children of school going age do not attend there is an urban bias in radio ownership, with 76 primary school and 34 per cent of the population per cent of urban households owning a radio as are functionally illiterate. The literacy map compared to 50 per cent of rural households. shows variations: whereas the Khomas region According to NBC,their radio coverage reaches has 84 per cent literacy rate, the lowest is in 95 per cent of the population. Figures from Cen- Kunene at 45 per cent literacy rate (Namibia tral Statistics Office, howeverindicate a slightly Human Development Report, 1997:15). There lower percentage (76.6 per cent) (CSO, 1994).

133 Background to the HIV/AIDS problem LITERATURE REVIEW in Namibia HIV/AIDS wasfirst reported in Namibia in In the early 1960’s, the dominantbelief was that 1986. Since then, it has spread to all corners of media messages would always be followed by the country and has become an epidemic esca- the adoption of the communicated ideas through lating at an alarming pace (UNDP and the so called "magic bullet theory". This domi- UNAIDS. Namibia Human Development nant belief in the impact of media has now been Report, 1997). The above report uses the fol- modified and the belief is that the media do not lowing figures to show how serious the situa- have such complete control over the social tion has become: change process. DeFluer and Ball-Rokeach - AIDS has become the leading cause of (1988: 218) (and many others) have, however, death in the country; noted that the mass mediastill play a major role - There may be more than 150,000 in the social learning process and have influence Namibians infected with the virus; on how individuals acquire new ideas, attitudes, - 20 percent of the 15-49 age groupareesti- and change orientation in society. mated to be infected with HIV; To succeed in the above goal, however, the - 39 per cent of the 20-24 age groupareesti- media must have a coherent strategy on the cov- mated to be affected with HIV; erage of HIV/AIDS. Someattempts at research- - Globally, Namibia ranks as the third most ing media coverage of HIV/AIDS have already affected country in the world. been madein other countries, particularly devel- In practically every country in Eastern and oped countries, but few studies have comeout of Southern Africa, the HIV/AIDS pandemicsit- the developing countries (Childers, 1988; Lester, uation is as gloomy as (or worse than) that 1992; Basil and Brown, 1994). An “action plan" depicted by the abovestatistics. The following of purposeful and impact-bearing information questions arise from the HIV/AIDScrisis: dissemination can only emerge after an assess- Whatrole can the national media play in con- ment of current practices of media in the cover- taining and managing this epidemic? How age of HIV/AIDSin a specific country so as to have the Namibian media been performing in identify strengths, weaknesses, and gaps in the their coverage of HIV/AIDS and how are the dissemination of information on AIDS. various factors associated with the spread of The research method chosen to analyze HIV/AIDS handled? What prominence is media coverage of HIV/AIDS was content given to the key factors which cause analysis. The appropriateness of content analysis HIV/AIDS infection among the population? for this type of study is supported by many How can the Namibian media be improvedto researchers in the social sciences. Adams and help society to combat HIV/AIDS? Schvaneveldt (1991: 299) point out that: “con- It can be argued that through frequent cov- tent analysis is a research tool for the scientific erage of stories highlighting HIV/AIDS, giv- study of speeches, records, and other written ing prominence to the factors which either communications to determine key ideas, themes, cause or lead to individuals getting infected words, or other messages contained in the with the HIV/AIDS virus, the Namibian record”. Supporting the above, Holsti (1969) has media makea major contribution towards man- defined content analysis as a procedure for aging and ultimately defeating this terrible dis- applying the scientific method to documentary ease. The media play a dual role of setting the evidence and Krippendorff (1980: 7) asserts that social agenda for politicians and policy makers “content analysis is one of the most important and disseminating useful information directly research techniques in the social sciences; it to the public which enables them to learn how seeks to understand data not as a collection of to avoid the disease. physical events but as symbolic phenomena and to approach their analysis unobtrusively”. It

134 would appear, therefore, that the choice of con- qualitative descriptions are used to present the tent analysis for this study is supported by other various aspects found in the coverage of each researchers in the social sciences including mass content category. communications. Factors: refers to the key terms or contentcat- egories which play an important role in the PURPOSE OF THE STUDY spread or management of HIV/AIDS. Factors or content categories were measured in terms of the Given the seriousness of the HIV/AIDS pan- frequency of occurrence. demic in Namibia and the constructive role the Content categories: refers to the key terms or media can play, the purpose of this study was to factors found in a media story on HIV/AIDS. examine the coverage of HIV/AIDS in Namib- This was measured in frequency of occurrence. ian media and make recommendations for Namibian media: refers to the nation-wide designing a media strategy to combat the dis- organs of news and information dissemination, ease. The study also examinedlocally produced specifically NBC Radio and the following three materials supporting HIV/AIDS campaigns to newspapers: Namibian, New Era, and Repub- assess and evaluate the materials and make rec- likien 2000. The coverage of HIV/AIDSin the ommendations for improvement. Namibian media was measured in frequency counts. RESEARCH QUESTIONS AND DEFINITION OF TERMS RESEARCH METHOD

To give the study rigour, the following research Three newspapers: Namibian, New Era, and questions were formulated to provide guidance: Republikien, which are the leading newspapersin 1. To what extent have the Namibian media Namibia with national coverage, were chosen for covered the core factors influencing the the study. Namibian Broadcasting Corporation spread of HIV/AIDSin society? (NBC) Radio wasselected becauseit is the lead- 2. What angles have the media given in their ing radio station in the country with national cov- coverage of the core factors? erage. The three newspapers and NBC Radio 3. What weaknesses are apparent in media were selected because they are leaders in the coverage of the various factors associated Namibian media and have some influence on with the spread and management of both policy makers and the general public. The HIV/AIDS in Namibia? Namibian and New Era, both publish mainly in 4. How have the Namibian media performed in English, with a few stories, mostly translations, in the coverage of general and preventive fac- the local languages, whereas Republikien pub- tors compared to factors which cause HIV? lishes mainly in Afrikaans. NBC Radio is multi- 5. What are the extent and nature of local lingual and broadcasts in English, with pro- publications produced to assist in spreading grammesin local languages including: Damara- the message on HIV/AIDS? Nama, Oshiwambo,Afrikaans and German. From the above research questions, one can The content analysis study covered a period of derive a number of key concepts or terms which 18 months, from January 1997 to June 1998. All will be briefly explained to make this report the copies of the three newspapers were content clearer to its readers. analyzed as well as radio programmesstored in a Coverage: refers to the presentation by the computerized database at NBC. The main media of stories on HIV/AIDS. Coverage was research wasprecededbya pilot study which was measured in frequencies. aimed at giving the research a sense of direction. Aspects or angle: refers to the central mes- The pilot study analyzed stories on HIV/AIDSin sages which are conveyed during the handling of the issues of one month of the two English lan- a factor or content category. Interpretative and guage dailies in Namibia, Namibian and New

135 Era. The pilot study revealed twofactors: first MONTHLY COVERAGE OF HIV/ AIDS was that stories on HIV/AIDS by the two IN NAMIBIAN MEDIA newspapers were rare and to make meaningful interpretation one had to have a large sample of The data collected showed there wasa total of 42 issues. articles on HIV/AIDS from the Namibian, 20 Second was the problem of determining from the New Era, 68 from the Republikien and meaningful interpretation of the occurrence of 35 from NBC Radio. On average, this is about the selected categories: for example,if the con- nine articles per month. Given the importance of cept of drug abuse appeared twice in 20 sto- the subject to the survival of Namibian society, ries, what significance would this have — wasit this average is considered to be too low. Perhaps high or low? It was, therefore, decided to of significance is the fact that, during the period broaden the categories to have a yardstick for under review (1997—mid-1998), 2 December, measuring the weighting and prominence whichis set aside to commemorate World AIDS given the initially selected terms (alcohol day, was not marked by a larger output than nor- abuse, rape, risky sexual behaviour, STDs, and mal of stories on HIV/AIDS, except in the discrimination against AIDS victims). This Republikien which had seven stories in Decem- decision led to the broadening of the content ber 1997. In contrast, the search for stories on analysis to look into all central messagesin the HIV/AIDS in the New Era in December 1997 stories analyzed. This broadening, it was revealed wasnotfruitful. believed, would provide a morereliable plat- The frequencies of publication of the news- form for making suggestions on improving papers vary, the New Era is published twice per Namibia’s media strategy. week, while both the Republikien and Namibian All copies of the three newspapers were are published daily except during weekends. At scanned for stories on HIV/AIDS and content NBCradio, only stories stored in their database analyzed. For radio, stories were obtained from were used. It should be pointed out that a lot of a computerized database kept by NBC, and HIV/AIDSinformation may be broadcast during only stories on HIV/AIDS falling in the 18- programmes such as chat shows and phone-in month period were content analyzed. The unit programmesbut was not stored in the database. of analysis was the whole story falling under It is likely, therefore, that the numberof stories any of the following categories: spot news, edi- with HIV/AIDS coverage on NBC under-repre- torial, and commentaries — all were analyzed in sents the total coverage of the subject. terms of key words or factors. The coding of There are two waysto interpret this finding. the content was done by student assistants and One would be that the various organizations do two documentalists. The coding was cross- not make enough use of the media to publicize checkedfor reliability and there was high inter- HIV/AIDS. The other is that, if such initiative coder agreement of about 85 per cent. has not been taken by the existing structures, the media lack the capacity and will to produce fea- FINDINGS AND INTERPRETATIONS ture articles on this burning issue.

After scanning the three newspapersand radio, PORTRAYAL OF GENERAL HIV/AIDS CONTENT the following numberof stories on HIV/AIDS CATEGORIES IN THE MEDIA were found: Namibian, out of 366 issues, 42 issues had relevant stories (11.4%); New Era, As already explained, the categories which out of 237 issues, 20 issues had relevant stories were covered in the sampled issues were (8.4%), and the Republikien, out of 376 issues, divided into two groups, the first group (Table 68 issues had relevant stories (18%). NBC 1) consists of stories oriented towards general Radio had 35 stories found in their computer- issues, with some bias towards prevention of ized database. HIV/AIDS. The second group [shownin Table

136 2 |] consists of stories on factors which cause b) HIV positive patients continuing to have HIV/AIDS. unprotected sex after they have undergone Below is a brief discussion of the content cat- counselling; egories and how they were portrayed by the c) the youth have a high knowledge of media. HIV/AIDS, yet the problem of teenage pregnancies is on therise. HIV/AIDS AWARENESS Indeed, NBC Radio, quoting the 1997 Human Development Report, notes thus: The category which featured most frequently in “The report shows that although over 90 all the media stories was AIDS Awareness percent of Namibians have adequate infor- (Namibian, 43%; New Era, 65%; and Repub- mation about the disease and its dangers, likien, 43%; NBC Radio, 43%). In most cases, for most, the challenge of translating this the concept was portrayed as of critical impor- information into sustained behavioural tance in stemming the spread of HIV. On several change remains.” occasions it was described as the only "cure", in Mention wasalso madeseveral times of the varia- the absence of drugs to combat HIV/AIDS. tions in levels of AIDS awareness, most notably There was a strong assumption that aware- that rural areas, and the northern part of Namibia, ness of HIV/AIDS by members of the public in particular, lag behind the rest of the country in would lead to safer sexual behaviour and avoid- their awareness of HIV/AIDS. ance of other behaviours which lead to con- One major constraint noted by counsellors tracting HIV. However, in some cases it was was shortage of information resources and also reported that awareness of HIV/AIDShas materials they could use to explain and discuss not led to changed and safer behaviour. Exam- the whole subject of HIV/AIDS with patients ples given of this contradictory situation and their families. At the moment, manyliter- include: ally have nothingat all. One counsellor, quoted a) unprotected sex by prostitutes, if custo- by one newspaper, had this to say: mers demand; “The ideal solution would be regional

Table 1. Portrayal of general content categories in HIV/AIDS newspaperstories.

Namibian New Era Republikien NBC-Radio n= 42 n= 20 n=68 n= 35

Aids awareness 18=43 13=65 29=43 15=43

Going public 5=12 3=15 2=3 nil

Statistics 16=38 2=10 28=48 10=29

Women 14=33 4=20 8=12 2=6

Discrimination 12=29 4=20 9=13 5=14

Children 12=29 3=15 10=15 4=11

Namibia 30=71 14=70 47=69 26=74

AIDS drugs/cure 7=17 5=25 14=21 1=3

Sex education 1=2 3=15 2=3 2=6

Counselling 6=14 1=5 4=6 2=6

Labour practices 10=23 l=5 9=13 4=11

Impact on economy 10=24 3=15 18=26 6=17

Youth 4=10 5=25 9=13 7=20

Other diseases 3=7 2=10 1=2 nil

137 centres for counsellors equipped with up- cles, this content category was represented as to-date information and relevant materials follows: The Namibian, 12%; New Era, 15%; preferably in a range of languages and Republikien, 3%; not found in the stories cov- region specific posters.” (Namibian, 3, ered by Radio. The most significant event was April, 1998). the launching of a video, sponsored by the In a story appearing in the Saturday Star (South American Embassy,titled Emma, featuring a Africa) of 29 August 1998, it was observed young woman who had discovered she was HIV that: “posters and pamphlets are not working by positive and decided to share her experience themselves...there has to be a communication with others. This story was well covered by all back up, especially interpersonal communication the newspapers in January and February 1998. in communities...many...are aware of AIDS and The story was covered from two broad have had some form of education but they are not angles. One angle was to show that HIV positive following it...cultural beliefs are a stumbling people are normal and should be treated as nor- block...in black communities, there is still a mal people and not rejected by society. The sec- stigma attached to the use of condoms.” ond angle had HIV positive peopleasits target, Another reason given whyit is difficult to and the message wasthat life does not end when translate awareness of AIDSto practices in a real one is diagnosed as HIV positive; one mustlive situation, is the linkage to socio-economic factors positively. and empowerment. Writing in the Saturday Star, The coverage of this category wasfairly low Aurelia Dyantyi notes that: “the solution should in relation to its significance in creating AIDS be to address socio-economic status. Some awareness. It is still believed by many people women find themselves infected because they that AIDS does not exist and also that if one lack the power to negotiate with their looks perfectly healthy, the person cannot have partners...and because ofthat it becomesdifficult the HIV/AIDSvirus, hence the strategic role of for them to practice safe sex.” the small number of people who havetested pos- The writer of the above story concludes that, itive and are willing to help educate the public until women are empowered, the AIDS epidemic that one can be HIV positive but look normal will continue. The issue of empowerment,it and healthy was not sufficiently exploited to would appear, has not received adequate coverage achieve this communication goal. in the media. A possible conclusion from this presentation STATISTICS is that, whereas awareness of HIV/AIDSis a necessary step towards changed behaviour, there are Statistics were often covered as part of other other factors which influence behavioural change. content categories (Namibian, 38%; New Era, One must, therefore, go beyond awareness of 10%; Republikien, 41%; Radio 29%.) The most HIV/AIDSto create changed practice which will popular statistic was the number of HIV/AIDS lead to safer practices, in line with the prevention positive people in Namibia (variously given as of HIV/AIDS. Similarly, it should be noted that 150,000, and 108,000, although the first figure other weaknessesin the portrayal of AIDS aware- was more popular). There was also mention of ness include scarcity of back-up materials which unreliability of statistics on HIV/AIDS due to are region specific and written in the different lan- under-reporting for a number of reasons: exclu- guages of the country. sion of figures of those who die at home, some AIDS-related deaths not recorded as such, and GOING PUBLIC some health officials’ reluctance to report AIDS as cause of death,if it may result in loss of insur- This refers to the few people who have been ance benefits for the family. The statistics serve diagnosed as being HIV positive and have a monitoring purpose and dramatically highlight decided to tell their story. In the sampled arti- the increasing dimensionofthis terrible disease.

138 The message underlying the statistics was in society and denial of sexual andreproductive often that HIV/AIDSis a serious disease and rights was also mentioned several times. When many people are already infected. The effect officiating in the project “My Future, My was to convey a sense of urgency and the need Choice”, the Swedish Ambassador to Namibia for the public to be extra careful. is reported to have noted that “Fifteen to twenty four year old females have almost double the DiIscRIMINATION/CARE FOR SUFFERERS HIV infection rates as compared to their male This was another high profile topic found in counterparts. Sexual relations between older manystories in the media (Namibian, 39%, New men and young womenare largely responsible Era, 40%; Republikien, 20%; Radio, 14%.). The for bringing HIV into the younger age group” problem AIDSsufferers face when other mem- (Namibian, 3, April, 1998). The issue of mother bers of society discover their plight was the to child infection wasalso raised. main focus. The newspaperarticles indicated Given the situations portrayed in the media, disapproval of the rejection of AIDSpatients. In women are an important target group in the fight one issue of the Namibian, reference was made against HIV/AIDS. The media were, however, not to a "controversial AIDS colony" in Thailand very successful when it came to addressing gen- started by Buddhists for AIDS patients, accom- der issuesin the fight against AIDS. For example, panied by a picture of an emaciated patient. In the issue of empowerment was hardly covered. In most cases, the media took the stance of advo- addition, apart from pointing out that there is a cacy on behalf of AIDS victims. high likelihood of infected mothers passing on the One conclusion from the stories, it would disease to their babies, there was hardly a detailed appear, is that the extent of fear of associating discussion of how to preventthis from happening. with AIDS victims is quite great. However, apart from vague appeals for the better treatment CHILDREN of AIDS victims, the media did not provide sub- stantive information to address the fears of the This was anotherfairly well covered content cat- public — that any contact with AIDS victims egory (Namibian, 29%; New Era, 15%; Repub- would result in getting infected. Neither was likien, 15%; Radio 11%). It referred to several detailed information on how to care for those aspects. One aspect was orphans whose parents whoare terminally ill, and at home, with AIDS have died of AIDS and problems of caring for actually provided by the media. this numerically growing group. Another dimension covered wasthe rejection of children whose WOMEN parents have both died by their next of kin. Infection rates of babies by mothers who are This content category was more frequently HIV positive was also highlighted. Republikien mentioned in the Namibian (33%) than in the (1, April, 1998) reports of cases where families New Era (20%). While for the Republikien it do not want to report that they are caring for was 12% followed by a low 6% from Radio. AIDSorphans because they are ashamedtolet it The angle taken in most cases was to portray be knownthat they have relatives who have died women as more vulnerable, and morelikely to of AIDS. Facilities available for caring for catch HIV/AIDSthan their male counterparts. AIDSorphans were also given publicity. Thefact that in affected families, the first person to know might be the women was also AIDS pruGs/CURE raised often. There was frequent mention of young The portrayal of this content category had a women, for example, who fall victim to older fairly high frequency of mention in the newspa- men because of their economic and sexual dis- pers, but had low coverage in Radio (Namibian, empowerment. The subordinate role of women 17%; New Era, 25%; Republikien, 21%; Radio

139 3%). Several messages were dominant: a cure countries. Negative policies of organizations for HIV/AIDS does not exist, existing were scrutinized, including dismissal of work- HIV/AIDS drugs are too expensive for patients ers and compulsory HIV testing as a condition in developing countries. Often there was brief for securing employment. With the exception but superficial mention of some of the drugs. In of the Namibian which has a strong advocacy the month of February, newspaper stories were stance on social issues, the item did not enjoy dominated by news of three South African high coverage (Namibian, 24%; New Era, 5%: researchers who claimed to have discovered an Republican, 13%; Radio, 11%). Another HIV/AIDScure. Subsequently, other reports fol- aspect portrayed was the effort made by some lowed dismissing the claim as yet another hoax. organizations to provide support to campaigns The emphasis in the media reports was on "no against HIV/AIDS amongtheir workforce, and cure”rather than reporting on the slow but steady to the public in general. research progress which has been made towards prolonging life and stemming deaths of AIDS IMPACT ON THE ECONOMY patients. The ongoing scientific research on the disease was not well reported; rather the stance This content category focused on the adverse was that little progress has been made towards effects of the HIV/AIDS pandemic on the econ- understanding and finding a cure. omy, at national, institutional, and family levels. It was well covered by the media (Namibian, COUNSELLING 24%; New Era, 15%; Republikien, 26%.; Radio, 17%). The implied reason was that HIV/AIDS The concept of counselling had fairly high fre- was attacking the most productive and educated quency of mention in the Namibian (14%), but sectors of the population. The overall message the frequency was quite low in the New Era was oneof urgency, that AIDS will have a devas- (5%), Republikien (6%), and Radio (6%). Coun- tating impact on the country unless steps to con- selling was often depicted as an importantser- trol it were taken at once. vice to those who are HIV positive and their The media coverage gave several examples of family members to enable them to cope with this “good practise” by organizations both in potentially terminal disease. Often organizations Namibia and elsewhere in helping to fight providing such services or training were men- HIV/AIDS among their workforce. A possible tioned and their contact telephone numberspro- media strategy would be to target the top man- vided. agement of institutions who should do more and The major weaknesses, in current media maketheir institutions invest more resources in strategy, in the handling of this concept was the the fight against AIDS,rather than leaving it to lack of support materials for the counsellors to the Ministry of Health and donor agenciesalone, workwith, and the failure to change behaviour of because ultimately the AIDS epidemic will affect some HIV positive individuals who were coun- their profit margin due to loss of highly-trained selled and were reported to have continued with human resources unprotected sex after counselling. YOUTH LABOUR PRACTICES The youth were portrayed from several angles This content category was portrayed in terms of and frequently mentioned by the mass media mistreatment of HIV/AIDSaffected persons by (Namibian, 10%; New Era, 25%; Republikien, various companies and government depart- 13%; Radio, 20%). As a group, they were mostat ments. Quite often, the newspapers highlighted risk of contracting HIV/AIDS. The youth were discriminatory practices against the affected also portrayed as disempowered, particularly persons both in Namibia and neighbouring girls who are often taken advantage of by boys

140 and older men, leading to a higher than average ALCOHOL ABUSE infection rate. The youth also had lack of control and limited access to the media. Access to con- This concept was portrayed from several doms was often said to be regulated by adults or aspects. One angle of presentation was in rela- stoppedall together. Communication between the tion to alcoholism which made individuals youth and adults was often one way and the views ignore responsible behaviour. In the Namibian of the youth were not heeded, whichled to resent- of 30 March 1998, a writer quotes an intervie- ment and communication breakdown. This is by wee commenting on prostitutes and clients far the most important target group in terms of the behaviour: “both clients and prostitutes were fight against AIDS and they pose communication usually very drunk and unlikely to think twice challenges not yet fully addressed by the media. aboutthe risk of HIV infection ..?’(p.1). Sexual behaviour change among the youth would Another angle was that of minors who get be a major step forward towards controlling the addicted to alcohol, and are preyed upon by rapid spread of HIV/AIDS. adults who can afford to buy them alcohol. Alco- hol wasalso portrayed in relation to the margin- SEX EDUCATION alized tribes whofindit difficult to escape from alcohol abuse. A story in the NewEra of 21-23 This concept was portrayed as a necessary addi- November 1997 notes “since the 1970's, alcohol tion to AIDS awareness,to enable young people in abuse has spread among both female and male schools to understand their sexuality. Sex educa- members of the Xoe. Under the influence of tion, it was hoped, would help in reducing the alcohol, the sexual partners feel no responsibil- problem of teenage pregnancies, STDsinfection, ity in using condoms”. and the spread of HIV/AIDS. One sensed there From the evidence found in the mediastories, was an ambivalence on the desirability of sex edu- alcohol abuse is a major factor in the spread of cation. That it should be provided to combat the HI/AIDS, but apart from the New Era, all the spread of HIV/AIDS,but it should not be a licence other media organs paid little attention to this for young people to practise sex too early in their factor (Namibian, 5%; New Era, 30%; Repub- lives. The latter attitude was symbolized by the likien, 0%; Radio, 6%). A more effective media “True Love Waits” Campaign launched by Presi- strategy should include more coverage of alco- dent Nujoma and the Churches. Asin the case of hol abuse and how this leads to behaviour which the category of youth, the handling of this concept is more likely to increase the chancesofgetting showsthat there is a cultural resistance to provid- HIV/AIDS. ing open and explicit sexual education to members of the young generation. Although the media SEXUALLY TRANSMITTED Diseases (STDs) reported well on these concerns, it was unable itself to overcomethe barriers. The handling of this concept was to link STDs with a higher possibility of also getting HIV/ PORTRAYAL OF FACTORS WHICH CAUSE HIV/AIDS AIDS. The theme was the need to get quick medicalattention, if infected with STD; to avoid The portrayal of the factors which may cause sexual partners whoare likely to have STDs; and HIV/AIDS was analyzed separately (Table 2). wear condomsduring the sexual act. The central The assumption was that the frequency of message in the sampled stories was that persons appearance of the HIV/AIDScausing factors in with a high rate of infection with STDsalso the sampled issues would be higher than of the have a higher rate of infection with HIV. There general factors. The assumption, however, was was low frequency of appearanceof the concept proven incorrect, as the coverage of general in the Namibian (7%), Republikien (6%) and factors far surpassed the coverage of Radio (9%), as compared to the New Era (30%), HIV/AIDScausing factors. which gave it greater prominence.

141

Table 2. Portrayal of content categories causing HIV/AIDSin stories

Namibian New Era Republikien NBC-Radio n=42 n= 20 n=68 n=35

STDs 3=7 6=30 4=6 3=9

Prison 4=10 1=5 1=2 2=6

Homosexuality 2=5 3=15 0=0 0=0

Alcohol abuse 2=5 6=30 0=0 2=6

Rape and defilement of minors 3=7 5=25 3=4 2=6

Risky sexual behaviour 6=14 4=20 9=13 0=0

Non condom use 4=10 5=25 7=10 2=3

Migrant workers 6=14 2=10 1=2 2=6

Deliberate spreading of HIV 4=10 0=0 6=9 1=3

Tuberculosis (TB) 4=10 5=25 5=7 2=3

Drug abuse 0=0 2=10 1=2 1=3

PRISON ulation is small in relation to the rest of the population, most inmates are in danger of tak- The main message in handling the concept of ing out the infection into their families when prison was that it is a high risk place because they have served their sentences. The frequency male prisoners practise sodomy. Female prison- of mention of this concept was very low all ers are often coerced or “persuaded” to have round (Namibian, 10%; New Era, 5%; Repub- sexual relationships with male warders, both likien, 2%; and Radio 6%), and an improved behaviours often lead to the rapid spread of media strategy should lead to a higher fre- HIV/AIDS. Other conducive factors mentioned quency in the mentioning of the concept of include: overcrowding, skin diseases, violence, prison life as one conduit through which AIDS gangsterism which sometimes leads to gang may spread into the rest of the population, and rapes of male prisoners by other males. In the how prisoners and warders can deal with this Namibian of 27 January 1997, the Minister of situation. Correctional Services is reported to have recognized the seriousness of the situation, when she HOMOSEXUALITY said “we are sitting on a time bomb—and need to movefast”. The concept of homosexuality had fairly high The portrayal of prisoners and the occurrence in the New Era (15%) butit was less HIV/AIDS issue revealed several conflicting frequently mentioned in the Namibian (5%), and contradictory attitudes. There was recogni- and completely ignored by the Republikien and tion that condoms should be supplied to prison- NBCRadio. In most of the coverage, the mes- ers to combat the spread of HIV/AIDS. On the sage was that homosexuality is risky sexual other hand, such supplying of condoms would behaviour which maylead to the rapid spread of be tantamount to condoning sexual practices HIV/AIDS. Underlyingthis direct linkage, how- (sodomy) not accepted in main stream society. ever, was the notion that homosexual behaviour The level of AIDS awareness among prisoners was abnormal in African society, and the claim wassaid to be very low thus fuelling the rapid that where it existed, it was a decadent behav- spread of the disease. Although the prison pop- iour imported from Western countries. There

142 was, often, some high levels of intolerance RISKY SEXUAL BEHAVIOUR voiced in readers’ letter columns and radio chat show programmes. Coincidentally, at the time of The above concept includes prostitution and writing this report, several governments in multiple sexual partners. The frequency of men- Southern Africa, including Namibia, were con- tion of the concept was quite high in the Namib- sidering making homosexual behaviourillegal. ian (14%), New Era (20%), Republikien 13% In most instances, it was difficult to discuss the but low in NBC Radio (0%). The dominant mes- subject unemotionally. sage in the coverage of risky sexual behaviour One may conclude from the infrequent men- wasthat there was a link between prostitution, tion of the concept in certain mass media organs multiple sexual partners, commercial sex work- that the target group may find it difficult to ers and HIV/AIDS. From the coverage, it is access information on HIV/AIDSand how to apparent that behaviour change is complex and protect themselves from HIV, in the context of takes time but most of the stories lacked suffi- their preferred lifestyle, particularly if they live cient depth to convince anyone indulging in far away from urban areas which are more cos- risky sexual behaviour to adopt safer sexual mopolitan and tolerant of non-conventional behaviour. behaviour. NON-CONDOM USE RAPE AND DEFILEMENT OF MINORS The use of condomswasportrayedas a vital ele- The coverage of rape had several aspects to it. ment in the practice of safe sex and prevention One aspect portrayed involved adults, possibly of STDs, HIV, and teenage pregnancies. It already HIV positive, raping womento deliber- enjoyed highest frequency of mention in the ately spread HIV to their victims. In one such New Era (25%), followed by the Republikien case, a soldier connived with hospital staff to get (13%), Namibian (10%), and NBC Radio (6%). a certificate that he had tested HIV negative There was recognition that the prevalence of whereashe had,in fact, tested positive and went high rates of teenage pregnancies and STDs and had sexual relations with a woman to pass infection in the country was indicative of low on the disease. Both the soldier and hospital use of condoms. This meantthat there is a high nurse were taken to court. percentage of the population whoare exposed to Another dimension portrayed in the sam- HIV/AIDS because they are practising unsafe pled stories involved males who were HIV pos- sex. The cultural tension underlying the whole itive raping minors, allegedly after being insti- terrain of communicating information to combat gated by traditional doctors that such an act HIV/AIDSis perhaps nowhere morein evidence would make them cleansed and cured of than in the use of condoms. To convey messages HIV/AIDS. The New Era of 27-29 June 1997, adequately, one needs to use explicit sexual lan- reports on a case of 18-months and two-year- guage which is culturally considered either old toddlers who were both brutally raped. An taboo or vulgar. It is not possible, for example, underlying problem was that often when to explain how to put on a condom or femidom women were raped they were blamed for without using explicit language. tempting men to rape them, for example, by There was, therefore, a major information wearing short dresses or walking alone at gap, particularly with the target group of youth night. Again, in spite of this factor being a who are at high risk. In the Namibian (27, causal factor in the spread of AIDS, it was not November,1997), a youth peer educator is covered as frequently as one would have quoted as saying: expected by most of the media organs except “Most (youth) don’t know how to put on a the New Era (Namibian, 7%; New Era, 25%; condom or say no to a guy...when people NEC Radio, 6%; Republikien, 4%). talk to young people, they don’t give youth

143 a chance to speak. You can’t just say don’t different media organs. The New Era had 20 sto- drink. You have to give them a chance to ries, followed by NBC Radio which had 35, participate in the talk.” while Namibian had 42, and the highest was the The above quoted statement also reveals an Republikien with 68 stories. The pattern of cov- underlying tension between the young and older erage on a monthly basis also varied in terms of generation concerning the control of the com- frequencyin all the newspapers. In some months munication process by membersof the older there were several stories covered, the highest generation which leads to communication break- number for the Namibian per month wasfive down, and some frustration and resentment stories and the lowest was zero; for the New Era among the youth. In anotherissue of the Namib- the highest was three stories per month, and the ian (3, October, 1998), it is reported that “con- lowest was zero, and for the Republikien the dom distribution is very poor indeed: “the coun- highest number of stories per month was eight, sellors tell people they should use condomsbut while the lowest was one. Comparable figures don’t have any to give them’. Calls have also for NBC Radio could not be worked out because been made by the youth to supply free condoms of problems with the database print out which to all high schools in the country. Clearly did not indicate monthly breakdowns. changed patterns of sexual behaviour depend on One conclusion from this pattern of coverage timely supplying the necessary inputs and at an is that weeks could pass without a story on affordable price, to sustain the new behavioural HIV/AIDSappearing in the media. The variation change. At the moment, it would appear this of coverage from one month to anotheralso indi- vital link required to change and sustain safer cates that there is no clear editorial policy to give sexual behaviouris largely missing. prominence to this important subject in the media by providing sustained coverage. Most of MIGRANT WORKFORCE the stories were of the spot newsvariety, focusing on local seminars, workshops and speeches The category of migrant workforce includes sev- given by politicians and other leaders during eral subgroups who are forced to live far away these workshops. Feature articles and investiga- from their families, often in “bachelor” quarters tive reports were the rare exception. The general by the nature of their work. The particular impression is that the New Era tended to have groups mentioned often included: lorry drivers more feature stories than the others, although who ply the highways, soldiers wholive in bar- overall it also had fewer stories than the other racks far away from their families, sailors who media organs. visit ports as part of their work, and miners Namibia’s media coverage of HIV/AIDSis (Namibian, 14%; New Era, 10%: NBC Radio, generally low, superficial, and not sustained long 6%; Republikien, 2%). The message behind the enough to create the necessary impact in terms portrayal of the concept was that the migrant of awareness and change of behaviour. Although labourlifestyle was a major conduit for the spread newspapers and radio have an importantrole to of HIV/AIDS, particularly as the behaviourof the play in managing HIV/AIDS, the former is migrant workers was often rowdy, linked to alco- urban based, and cannot disseminate HIV/AIDS hol abuse, and risky sexual behaviour. information to most of the population who live in rural areas or small towns. Radio has wider DISCUSSIONS AND CONCLUSIONS coverage which makes it the most important media for the dissemination of HIV/AIDSinfor- The study content analyzed the issues of three mation. The flow of information divides newspapers and NBC Radio programmesover a Namibia into urban information-rich, and rural 18-month period, from January 1997 to June information-poorsectors. It is not surprising, 1998. In this period, it was found that the pattern therefore, that many stories in the newspapers of coverage of HIV/AIDSstories varied in the mentioned that AIDS awarenessis lowerin rural

144 areas than urbanareas. Thereis, therefore, need to sexual behaviour; condom use is low and inci- have alternative media strategies which focus on dencesof teenage pregnancies and STDsinfection rural areas, and other hard-to-reach sectors of the is high. Apart from targeting the youth with more population. To be noted is the need for informa- information messages, media strategy must also tion in local languages, rather than mainly English include training IEC communicators to provide or Afrikaans which are not understood by many interpersonal communication and two way com- people in rural communities. munication exchanges which include demonstra- The findings also reveal certain characteristics tion. The issue of empowerment mustbe built into about the portrayal and interplay between some the communication strategy, in particular, target- key factors in HIV/AIDS infection and current ing young womento enable them to learn how to media strategy. Below, we highlight some of the take charge of their sexuality and notfall prey to crucial aspects. older men and young men. Womenare the second major target group Major TARGET GROUPS which must be focused on to combat HIV/AIDS. The findingsindicate that: There are several major target groups in the media 1. Women catch the HIV virus more easily than strategy on HIV/AIDSin Namibia. The majortar- their male counterparts but the media por- get groups include the youth, women, top man- trayal was unable to present and explore this agement of various institutions, and policy mak- factor in any depth. ers. The youth are a major target group and have 2. Sexual disempowermentis a major factor to take a centre stage, if the fight against causing women to be at a disadvantage in HIV/AIDS is to be successful. Present media protecting themselves against HIV/AIDS; strategy indicates there are several weaknesses. included here is the plight of young women 1. Communication from adult controlled media who are preyed upon for economic reasons is mostly one way which does not give the by older men. Again, effective media strategy youth a chanceto state their case; this leads should target the conflictual situation invol- to frustration and refusal to comply with the ved in these sexual relations to enable women suggested (dictated) behaviour. and young girls to managethesituation. 2. Access to condomsis often regulated and 3. There are a host of cultural practices which rationed by adult controlled structures and are aimed at reinforcing the subordinate role often stopped completely. of womenin society which put the lives of 3. The youth appear to have a high level of women at greater risk. The laws which pro- AIDS awareness, but depict low levels of tect womenin society, and their humanrights behaviour change. In somecases, it would should be focused on by the mediaas part of appear the youth have “theoretical”? know- an improvedstrategy. ledge which needsto be backed up bypracti- Another subgroup of women is made up of the cal demonstrations to enable them to bridge commercial sex workers, who are at highest risk the gap between awarenessandaction. because of the nature of their “profession”. The 4. The issue of empowerment, which affects media strategy should involve targeting this young girls specifically, but also all the youth group, and possibly training some of the prosti- in general, is not yet part of the media tutes to become information providers because agenda. they are already part of the group and nonjudg- 5. Somecultural resistance to expressing expli- mental in their approach. The media strategy cit sexual messages maystill be acting as a should also provide women with clear scientific blockage in the smooth communication of reasons why they are in greater danger than HIV/AIDS messages. their male counterparts, as well as ensuring the Among the youth, high AIDS awareness has been message content focuses on issues of sexual, achieved. However,thereis little adoption of safe economic, and cultural empowerment.

145 The top managementofinstitutions and policy between rural and urban areas, with urban makers should also be targeted to take the initia- dwellers having a higher level of AIDS aware- tive and introduce AIDS campaign and facilities ness. This is perhaps not a surprise because of (brochures, condoms, etc.) in the work place to the concentration of media and other informa- widen social mobilization and provide information sources in urban areas. The linkage tion from multiple channels. between HIV/AIDS awareness and change in sexual behaviouris still a weak one. In other REPORTING ON SCIENTIFIC RESEARCH words, knowledge has not affected attitudes on HIV/AIDS nor behaviour. The time factor is important in changing behaviour of people, with certain The media stance in most of the stories analyzed groups who are more innovative in society tak- was to stress the “no cure” message which was ing the lead. However, availability of condoms useful and strategic because it gave the AIDS to sustain the new behaviour is essential to awareness and prevention greater prominence as make the changes sustainable. Some form of the line of last resort. The effect of this coverage, saturation coverage of HIV/AIDSis essential however, might be that those who already have to make a breakthrough in peoples’ attitudes contracted HIV/AIDSare not in a position to and behaviour. know what options they have and how they can The media coverage of HIV/AIDS was also plan their own survival strategies. Other examples spasmodic, showing highs and lows from one of weak coverage ofscientific subjects concerned month to the next, rather than sustained for a with HIV/AIDSinclude the handling of HIV pos- long time. Such sustained coverage of the itive mother-to-child infection, and home care of HIV/AIDSissue is necessary to build up and terminally ill AIDS patients. There were some maintain awareness and keepthe level of inter- clear information gaps on howto stop the infection est high. There are several players in the AIDS from mother to child occurring, and also how to awareness campaign trail, each with their own take care of someone whois terminally sick, and agenda and philosophy. There are state organs, cope with some of the opportunistic diseases such NGO’s of various descriptions, donor agen- as sores and diarrhea, TB., without getting cies, churches, etc. In some cases, the various infected as well. The fear that such families players have conflicting goals and this may undergo should be addressed by providing simple lead to some confusion. For example, the information which they can apply and be reas- churches stress awareness of HIV/AIDS and sured. no-sex as the goal, while other players stress The protocol of reporting of scientific research awarenessand safe sex as the goal. The church was exposed by the claims of three South African efforts, while laudable, may tend towards researchers to have discovered a cure for AIDS, secretiveness and hence making the task of which wasa false claim, but it took several weeks creating a culture of safe sex, which permits before the sham was exposed. Had the reporters open discussions of sexuality, more difficult. had enough experience on howto report scientific The findings show that a large number of and research reports, this would not have occurred, people still think AIDS does not exist. A useful and there would be better coverage of the research media strategy would, therefore, make greater advances which have been madein this field. use of the individuals who are HIV positive and are willing to educate others and let them AIDS AWARENESS see that an HIV positive person looks quite healthy and normal. The coverageofstories of The findings indicate that this was the most such individuals has followed the same pattern popular category of all the key concepts. Indi- of coverage on other HIV/AIDSissues, a short cations are that the level of awareness varies burst of interest but no continuous coverage.

146 REFERENCES DeFluer, D. and S. Ball-Rokeach (1988). Theories of Mass Communication. Adams, G. and J. Schvaneveldt (1991). Longman: London. Understanding research methods. London & Holist, O. R. (1969). Content analysis for the New York: Longman. social sciences and humanities. Reading, Basil M. and Brown W.(1994). “Interpersonal Mass: Addison-Wesley. communication in newsdiffusion: A study of Krippendorff, K (1980). Content analysis. "Magic" Johnson's announcement”, Beverly Hills, Calf.: Sage. Journalism Quarterly, Vol. 71, No. 2, Lester, E. (1992). “The AIDS story and moral pp. 305-320. panic: How Euro-African press constructs Childers, D. (1988). “Media Practices in AIDS AIDS”, Harvard Journal of Communication, coverage and a model for ethical reporting Vol. 2, No.3 and 4, pp.230-241. on AIDS victims”, Journal of Mass Media UNAIDS (1998). “UNAids estimates” in Ethics, Vol. 4, No. 2, pp.60-65. SANASO,January-April, p. 10. Central Statistics Office (1994). Population and UNDP and UNAIDS, Namibia Human Housing Census in Namibia, 1991. Development Report 1997. Windhoek: Windhoek: CSO. UNDP,1997.

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