Transcript Communicating AIDS Needs Project (CAN)

Ideology and HIV/AIDS
Communication: Experiences from
South Africa
Centre for AIDS Development, Research and Evaluation
www.cadre.org.za
Warren Parker • [email protected]
HIV/AIDS communication




The concept of discourse has to do with constructing
knowledge over a range of texts – by “both producing and
organising meaning in a social context” (Edgar & Sedgewick, 1999)
Discourse has to do with the use of language in the
production of knowledge, and in this sense discourse is
“enmeshed with power” (Hall 1997)
Discourse has potential to be ideological, given that ideology
has to do with discourses that are directed towards achieving
a dominance of ideas, of expanding ideas, of shifting ideas
into ‘common-sense’ through simplification, reiteration and
legitimation
HIV/AIDS communication involves wide-ranging discourses
that occur in many domains and spheres ranging from those
that are interpersonal to those that are mediated through
mass media
The HIV/AIDS communication
environment

HIV/AIDS discourses occur in various contexts:
• Mass media, as a product of purposive HIV/AIDS
campaigns (TV, Radio, Print, Outdoor, Electronic)
• Mass media, unrelated or indirectly related to purposive
campaigns: eg. In news, drama, documentaries, features
talk shows, newspaper columns
• Small media: eg. Leaflets, posters
• Events: eg. Plays, community meetings, story-telling
• Icons, artifacts: Red ribbon, AIDS quilts, artworks
• Policy discourses: eg. conferences, workshops
• Public relations discourses: eg: press releases
announcements, launches
• Structured, interactive: eg. Counselling
• Interpersonal: eg. Conversations, arguments
HIV/AIDS campaign contexts

HIV/AIDS campaigns are formal organised activities,
typically utilising various forms of communication to achieve
objectives related to prevention, care, treatment, support and
rights

Campaigns represent only one element of the multi-layered
discourses that occur in relation to HIV/AIDS

Campaigns contribute to the stimulating individual response,
but:
- there may be contradictions between campaigns
- may contradict regimes of knowledge (eg. Concepts of
disease; non-biomedical belief systems; cultural practices;
faith-based constructions of the epidemic; fear; stigma)
- have a relative meaning in comparison to individual
engagement with the epidemic (eg. Being HIV positive,
knowing people who have died, volunteering)
HIV/AIDS campaigns in
South Africa

There are hundreds of campaigns operating at national and
sub-national level in South Africa

National campaigns with multi-media in combination with
programmatic activities include Khomanani, Soul City, Soul
Buddyz, loveLife, the school-based life-skills programme,
Treatment Action Campaign, condom social marketing
programme

Educational programmes – Tsha Tsha, Gazlam, Beat It

Focused campaigns around condoms, STIs, VCT, TB

Localised campaigns run by provincial and local government,
NGOs – eg. Door-to-door awareness, events, rallies
Ideological discourse - 1st domain

HIV/AIDS communication occurs in the public sphere

Mass media campaigns involve centralised, unidirectional
and top-down models of communication

This approach involves the ‘homogenising’ of audiences who
are often described as ‘target groups’

HIV/AIDS campaign discourses that ‘target’ audiences in this
way are deeply ideological in that they construct meaning in
ways that involve dominance

Whilst this ‘dominance’ of HIV/AIDS discourses may have
apparently benign prosocial purposes – for example,
‘condoms prevent HIV infection’ or ‘reducing ones number of
partners reduces HIV risk’ – the ideological elements of their
content may be misleading
Ideological discourse - 2nd domain

Over and above the primary or stated ‘target audience’,
campaigns function in the domain of policy, strategy, funding,
evaluation and impact that direct discourses towards other
audiences

These other audiences include funders, policy makers,
politicians, researchers, and the general public

Both ideological domains include:
– epistemological foundations and world views
(eg. Biomedical)
– intersections with other ideologies (eg. Capitalism, gender)
– an orientation towards expansion
– an orientation towards dominance
– simplification and reiteration

The 2nd domain includes processes of legitimation and
structural relations and fostering of communicative power
Despite HIV/AIDS and other social
problems such as poverty or
unemployment, surveys consistently
show that young South Africans are
highly optimistic about their futures.
loveLife’s message reflects this
powerful optimism, motivating young
people to accept sexual responsibility
as an essential part of a healthy
lifestyle that will help them to achieve
their goals and aspirations. (loveLife
2003a:5)
HIV/AIDS in South Africa

South Africa has a population of 45 million and a diverse
economy that has wide polarities between rich and poor

Majority of people are poor as a product of under and
unemployment, but there is a highly active economic sector
including mining, manufacturing and industry that is
competitive globally

Factors underpinning HIV/AIDS include economic forces
related to migrancy, urbanisation and poverty

Approximately 4.5 million South Africans are HIV positive

HIV affects all age groups, race groups and economic strata

Female risk is exacerbated by factors related to sex
(biological vulnerability), gender (power differentials)
Population-based HIV prevalence, 2002
Little significant progress in HIV
prevalence

Antenatal HIV prevalence
amongst youth has
remained much the same
over the past four years

Population-based studies
show high prevalence, and
disproportional effects on
young females (2004)
Males 15-19
2.5%
Females 15-19 7.3%
Males 20-24
7.6%
Females 20-24 24.5%

Teen pregnancy
rates have
increased (1998/2004)
But, some progress in condom use

Progressive increase in reported last intercourse
condom use
• 1998, DHS, females, 15-19, 21.2% (unmarried partner)
• 2000, BAC, males and females, 15-30, 52%
• 2002, NM/HSRC, females 15-24, 46.1%; males, 57.1%
• 2003, RHRU, females 15-19, 55%; males, 57%

Increase in perceived ease of access
• 2000, BAC, males and
females 15-30, 75%
• 2002, males and females,
15-24, 95%

Increased public sector
procurement

Demand-based logistics
system, widespread access
(including commercial and
social marketing availability)

Quality control of product
HIV/AIDS campaigns - 2nd domain

Campaigns need to secure funding to be sustained

In the 2nd domain, Campaigns are characterised by claimsmaking about the context, about the ‘target group’, and about
intended and ‘claimed’ impacts
• what is the problem
• who personifies the problem
• what is the solution
• how we will make a difference
• how ‘we’ have made a difference

And legitimation
• these are our partners
• this is what people in power say about us
Patterns of ideological discourse

Patterns of ideological discourse discourse are described here
using HIV/AIDS campaigns as a case study, but these
patterns occur in many aspects of social policy
Case study – loveLife

loveLife was first initiated in 1999 as a project of the USbased Henry J Kaiser Foundation (KFF), working with a
number of SA implementing partners (NGOs)

Founding ‘partnerships’ include being initially convened by
the wife of the President, an advisory board comprised of
business, political and entertainment figures, most of whom
had little knowledge of HIV/AIDS

Technical advisory group nearly exclusively US-based

Youth depicted as the driving force underpinning HIV
prevalence

‘Target audience’ defined as youth 12-17

Initial goal described as halving youth HIV prevalence in 3-5
years

Budget requirement - $20-40 million per annum
Quantification

“If current infection rates continue, half of all South Africans
below the age of 15 could become infected over the next 10
years”

Primary focus on quantification grounded in epidemiological
assumptions

Human subjects are constituted as numerical objects
divorced from the complex of social interactions that frame
their existence

Numbers provide authority, and knowledge of the world is
described numerically
Causality

“Of those who know about loveLife 76% say loveLife has
made them more aware of the risks of unprotected sex; 65%
say loveLife caused them to delay or abstain from sex”

Internally conducted research utilising leading questions
used to construct a causal relation between loveLife and
response

Masks the complex of vulnerabilities and complexities that
underpin HIV risk and prevention

Reduced to assumptions that ‘knowing about loveLife’ is
causally connected with sexual behaviour
Moral panic

“LoveLife’s design responds to the fact that the sexual
behaviour of teenagers drives the epidemic in South Africa.
This assertion is based on the large proportion of the South
African population that are under the age of 20 years (40%),
a significant number of whom report high-risk sexual
behaviour…”

Youth are positioned as amoral and hypersexual,
irresponsibly ‘driving’ the epidemic
Moral panic is a type of myth. It functions at the connotative
level, separating historical moments from their historicity,
inflating particular aspects of the ‘moment’ whilst masking
others.
Moral panic identifies the object of blame and apportions
culpability


Legitimation

Research claims to impact - largely derived from internally
conducted research with little methodological explanation,
and failure to contextualise loveLife as being one of a
number of programmes reaching youth

Endorsements by Peter Piot (UNAIDS), Stephen Lewis (UN),
Nelson Mandela, Jimmy Carter and Clinton (former SA and
US presidents), Hollywood actors

Links to media corporates through partnerships with parallel
branding

Claims under the auspices of the KFF Mandela Awards,
sponsored satellite sessions at AIDS conferences, Global
Prevention Working Group, Kaisernetwork.org

Structural links to Global Fund, SA govt, companies such as
AVIS
Legitimation
Addressing contradiction



Critique moderated by links to the media and consequent
communicative power
Discourses outside South Africa not readily contested
Obvious contradictions moderated by subtle shifts to the
goalposts. The initial claim that loveLife would halve youth
prevalence in three to five years:
- Rephrased as to “cut the infection rate amongst young South
Africans by 50 percent,” without reference to the initial three to five
year timeframe (2002)
- Rephrased as to “substantially reduce the infection rate” without
reference to the goal of 50 percent HIV reduction (2003)
– Rephrased as “now in its fifth year… in the middle of what was
originally designed as a 10 year campaign” (2005)
Ideological commonalities

Ideologies involve masking of underlying factors and
interpretations

Ideologies are contradictory as a product of simplification and
reiteration of particular knowledge

Ideological patterns occur in many aspects of HIV/AIDS
discourse

Combined with, and supported by, structural linkages,
ideologies become all powerful, hegemonic
Ideological commonalities

Microbicides… men are all powerful and determine sexual
interaction… women are innocent powerless victims… men
are unfaithful… women not… microbicides will be available in
“5, 6, 7… years”… microbicides need billions of dollars of
investment.
[Contradictions: status quo preserved through biomedical
intervention; imbalanced power relations maintained, no focus
on direct empowerment of women]

Vaccines… prevention doesn’t work… biomedical intervention
is the only way… billions of dollars of investment needed
[Contradiction: prevention has worked]

Antiretrovirals should be the focus of investment…
[Contradictions: Effective ARV roll-out will take many years; the
larger proportion of people with AIDS are dying; very little
concern about palliative care, counselling, economic support to
families]
Ideological commonalities

HIV/AIDS response needs billions of dollars… funds
should be centralised globally… investment should be
made in centralised vertical programmes…
[Contradiction: Many effective interventions have been
grassroots, community-oriented, decentralised, low cost eg. Gay men responding to AIDS in the early 1980s,
Uganda and Thailand in 1990s]

Large mining and industrial corporates are feted for
providing ARV programmes to treat workers living with
HIV.
[Contradiction: Corporates profit out of geographic
inequalities that give rise to migration (and foster HIV
infection); residential family housing not provided and
patterns of migration sustained]
Conclusions
Critique

Critique involves identifying dominant discourses

Ideological discourses involve vested interests and mask
underlying causes

Critique involves bringing contradictions to the surface

Ideologies intersect to perpetuate dominance - eg.
Biomedicine versus social action in response to HIV; vertical
top down communication and centralised programmes
versus horizontal communication and community
organisation

Quantification and claims-making are seductive as they
foster imagined logical solutions to social problems

Ideologies are forward-looking, seldom addressing the
present. Goalposts are moved to address contradiction

Critique is imperative if response is to be effective