HIV & AIDS STIGMA, NAMIBIAN NEWSPAPERS AND HEALTH POLICIES, 2000 - 2012: AN INVESTIGATION OF FRAMING, PRIMING AND AGENDA-SETTING EFFECTS A DISSERTATION SUBMITTED IN FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY (MEDIA STUDIES) OF THE UNIVERSITY OF NAMIBIA BY PERPETUA WANJA NJUGUNA 201778389 APRIL 2020 Main Supervisor: Prof Eno Akpabio (University of Namibia) Co-Supervisor: Prof Kingo Mchombu (International University of Management, Namibia) ABSTRACT Media representation of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) disease has greatly influenced how the disease and those who are affected by it are perceived in the society, thus often causing stigma towards those infected and affected. This dissertation therefore investigated to what extent stigma is present in print media reporting on HIV & AIDS in Namibia. This is because controlling the spread and managing HIV & AIDS in the country has been a major challenge not only for the nation but for other southern African countries due to the high prevalence (Lewthwaite & Wilkins, 2009, p.333). Using purposive sampling, the researcher selected articles in two Namibian newspapers – The Namibian - the largest private newspaper and New Era - the largest government newspaper in Namibia, all totaling 1334 to determine framing of HIV & AIDS stories. This approach was also used to identify texts as well as headlines which were content analyzed because purposive sampling is quite useful given the nature of reporting on HIV & AIDS in the local press (Wimmer & Dominick, 2014, Leedy & Ormrod, 2005). Priming, Framing, Agenda-Setting and Social Construction of Reality theories undergirded the research (Goffman, 1974; Iyengar & Kinder, 1987; Scheufele & Tewksbury, 2007; Berger & Luckmann, 1966) while its philosophical basis was constructivism (Phillimore & Goodson, 2004), which is a theoretical framework which argues that human beings construct meaning from a combination of their lived experiences and ideas. ii There are many findings of the research as there are three stand alone chapters but a brief from all the three: (1) That high level of stigma exists in framing HIV & AIDS stories in the two newspapers; (2) the complex nature of coverage of HIV & AIDS stories is evident in the way reporters write stories about the epidemic as well as those who are affected by HIV & AIDS; (3) how the stories are presented exhibits thematic and contextual characteristics of the epidemic; (4) Policy developers need to incorporate media as key stakeholders; (5) Few of critical persons that deal with issues of HIV or AIDS such as reporters and others working with HIV & AIDS organisations are aware of the UNAIDS Terminology Guidelines – UNAIDS needs to correct that; (6) UNAIDS’ advise that organisations should not use HIV/AIDS should also be subject to their own use of the words as in their various documents, they still use HIV/AIDS; (7) Specialised training of media reporters on HIV & AIDS as well as other stigmatised diseases is inevitable. The principal contribution to knowledge of this study is that a high level of stigma is still driving the way HIV & AIDS is reported in Namibia. Secondly, HIV & AIDS reporting should be regarded as a specialized area requiring specialized training to be given coverage in a neutral and value free manner in the mass media. Thirdly, it is proposed that Namibia specific AIDS reporting guidelines such as this study produced be formulated to address this shortcoming. Words form local languages can be added to the final Reporting Code. Key Words: HIV & AIDS, media, stigma, priming, framing, agenda-setting, social construction of reality, theme analysis, guidelines iii TABLE OF CONTENTS ABSTRACT ii LIST OF TABLES x LIST OF FIGURES xi LIST OF ABBREVIATIONS AND/OR ACRONYMS xii UNFAMILIAR TERMS xiii ACKNOWLEDGEMENTS xiv DEDICATION xvi DECLARATION xvii Chapter 1 1 Introduction 1 1.1 Background to the Study 1 1.2 Statement of the Problem 8 1.3 Objectives of the Study 10 1.4 Significance of the Study 10 1.5. Limitations of the Study 11 1.6 Delimitations of the Study 11 1.7 Methodology 12 1.7.1 Research Design 12 1.7.2 Population 13 1.7.3 Sampling 13 1.7.4 Procedure 15 1.7.5 Research Instruments 16 1.7.6 Procedure 17 1.8 Data Analysis 17 1.9 Research Ethics 18 1.10 Structure of the Dissertation 18 References 21 Chapter 2 24 Literature Review and Theoretical Framework 24 2.1 Introduction 24 2.2 HIV & AIDS Challenges in Africa 24 2.3 Cause of Fast Spread of HIV & AIDS in Africa 26 2.5 Media Effects on Reporting on HIV & AIDS 36 2.6 HIV & AIDS Reporting in Namibia 40 2.7 Stigma in Media Reporting on HIV & AIDS 42 2.8 Ethical Issues in Health Reporting 45 iv 2.9 Use of Myths, Metaphors and Ideologies in Reporting on HIV & AIDS 46 2.10 The Press in Namibia 53 2.11 Code of Ethics in Namibia 57 2.12 Freedom of the Press in Namibia 57 2.13 Effects of Media Ownership 58 2.15 Theoretical Framework 62 2.16 Chapter Summary 63 References 64 Chapter 3 68 Framing of HIV & AIDS Stigma in the Namibian Print Media 68 3.1 Introduction 69 3.2 Aim of the Study 71 3.3 Statement of the Problem 72 3.4 Objectives of the study 73 3.5 Significance of the Study 73 3.6 Period of Study 74 3.7 Datelines of the Coverage 75 3.8 Limitations of the study 76 3.8.1 Story Sources 76 3.8.2 Reporters in the Coverage 77 3.8.3 The Distribution of Coverage in Namibia 78 3.10 Material and Methods of Study 79 3.10.1 Use of Mixed Methodology Approach 79 3.10.2 Justification for Using a Mixed Methodology Approach 80 3.10.3 Research Philosophy 86 3.10.4 Research Paradigm 92 3.10.5 Sampling Technique 93 3.10.6 Data Collection Methods 94 3.10.7 Data Analysis 95 3.10.8 Use of Content Analysis 95 3.10.9 Justification of Use of Content Analysis by Researchers 98 3.10.11 Use of Discourse Analysis 101 3.11 Theoretical Framework 108 3.11.1 Framing of Stories and Framing Theory 109 3.11.2 Agenda Setting Theory 111 Figure 3.1. How the media sets the agenda in our minds. 112 3.11.3 Priming Theory 113 3.10.4 Social Construction Theory 114 3.12 Research Population 116 3.13 Goals and Use of Guidelines Used to Identify Words and Terminologies 116 3.14 Identification and Definition of Variables 118 3.16 Findings and Discussion 121 3.16.1 Coverage of HIV & AIDS Stories in the Two Newspapers 121 Figure 3.2 Stories with HIV or AIDS headlines 122 3.16.3 Stories on Page 1 of New Era and The Namibian Newspapers 126 Figure 3.4 Stories on Page 3 (See also Appendix II (C)) 127 Figure 3.6 Stories on Page 5 (See also Appendix II (E)) 128 v 3.16.4 Data and Findings of New Era newspaper 2000-2012 128 3.16.5 Findings on New Era Stories 129 Table 3.1 –Stigmatising words in New Era Stories See Appendix IV (A) 131 3.16.7 Data and Findings of The Namibian Newspaper 131 3.16.8 Stigmatising Words in The Namibian stories and their frequency 132 Table 3.2 - Stigmatising words in The Namibian See Appendix IV (B) 133 3.16.9 Analysis of Stigmatising Words Used Often In Both New Era & The Namibian Newspapers 133 Table 3.3 – Grouping of Stigmatising Words/Terms 134 3.16.10 Implications of Stigmatising Words 136 3.16.11 Themes Emerging from Words in the Stories 141 Table 3.4 – Groups of Similar Words and Themes 143 3.16.12 Findings of Groups of Similar Words and Themes 143 3.16.13 Comparison Between Critical HIV & AIDS Reporting Months: November, December and January in the Two Newspapers 145 Table 3.5 – Comparison of Critical Months Reportage in Both Newspapers 147 Table 3.6 – Total Number of Stories across January, November, December 147 3.16.14 Cities/Towns Stories Written From 148 3.16.15 Language Stories Written In 149 3.16.16 Extent of Coverage of Stories 150 3.17 Analysis of Writers for the New Era Newspaper 151 3.17.1 Analysis of Writers for The Namibian Stories 152 Table 3.7 - The number of stories where the headline includes HIV or AIDS 153 3.18 Style of Writing of Journalists in the Newspapers Reviewed 154 3.19 When HIV & AIDS Stories are written in the Namibian Newspapers 154 3.20 Summary of Findings 155 3.20.1 Discussion of Study Findings in Relations to Theoretical Framework 155 3.20.2 Key Findings 157 3.21 Conclusion 159 References 160 Chapter 4 164 The Views of Stakeholders on Framing of HIV & AIDS in the Namibian Media 164 Abstract 164 4.1 Introduction 165 4.2 Aims of Study 167 4.4 Objectives of the study 169 4.5 Significance of Study 169 4.6 Material and Methods 169 4.6.1 Variables used to choose research participants 170 4.6.2 Study Population and Criteria for the Choice of Respondents 170 Table 4.1 – Demographic characteristic of respondents for interviews 171 4.6.3 Use of Terminology Guidelines with Respondents 171 4.7 Methodology 173 Figure 4.1 Structure of a thematic network (Attride-Stirling, 2001) 174 4.8 Theoretical Framework 175 4.8.1 Inductive vs Deductive Approach to Data Analysis 177 4.9 Limitations of Interviews 179 4.10 Research Methods 180 4.11 Results and Discussion 181 vi 4.11.1 Bias and Stigma 181 4.11.2 Theme: Stigma in stories 182 4.11.3 Theme: Liberated 186 4.11.4 Theme: Framing of HIV & AIDS stories.