Ideology and HIV/AIDS Communication: Experiences from South Africa

1. Ideology and HIV/AIDS Communication: Experiences from South Africa Centre for AIDS Development, Research and Evaluation www.cadre.org.zaWarren Parker • warren@cadre.org.za

2. 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

3. 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

4. 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)

5. 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

6. 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

8. 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

9. 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)

10. 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)

11. Population-based HIV prevalence, 2002

12. 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 pregnancyrates have increased (1998/2004)

13. 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

14. HIV/AIDS campaigns - 2nd domain • Campaigns need to secure funding to be sustained • In the 2nd domain, Campaigns are characterised by claims-making 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

15. 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

16. Case study – loveLife • loveLife was first initiated in 1999 as a project of the US-based 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

17. 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

18. 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

19. 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

20. 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

21. Legitimation

22. 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)

23. 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

24. 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]

25. 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]

26. Conclusions

27. 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