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The Two Faces of AIDS

By Melissa Meyer

14 September 2009 | HIV/AIDS Awareness | The Media and HIV/AIDS

Stories on HIV and AIDS in the newspapers this last month make it seem as though South Africa is facing two rather different epidemics.

The first makes ordinary people its victims: a teenager heading a household who is concerned about his younger brothers; an ailing boy who wants a bicycle with a bell; a young singer that supports 200 orphans with her income. This kind of epidemic is fought by activists and ordinary people — some infected themselves, others simply affected. It wreaks households, unties families, destroys communities, steals precious years between mothers and children, strains relationships between siblings, pulls apart spouses and lovers, brings worry, takes lives.

The second epidemic prefers the company of doctors, scientists and politicians. It is all very complicated. Discussions around the issue are laden with technical terms: ARVs, CD4 counts, PMTCT, the National Strategic Plan, TB vaccines, and recently, H1N1. Ordinary people cannot fight this epidemic. Only large organizations and experts are up to the challenge: ministers and governments, the South African National AIDS Council, health MECs, hospital DGs and MDs, the WHO and other NGOs. And above all, it is a very, very expensive affair.

Whilst this illustration may slightly embellish the difference between the two types of HIV and AIDS stories that dominate the media, it is hardly an exaggeration. The social/humanitarian stories are kept distinctly separate from the biomedical/political ones. The AIDS epidemic is one (albeit complex) story, yet it is told as two.

This distinction is artificial and misleading. Portraying the epidemic as an exclusively political and biomedical issue estranges it from the experiences of ordinary people at a time when a much-needed sense of urgency could have been gained from showing how these issues relate to individuals and communities.

On the other hand, failing to consider the biomedical and political context of the epidemic in human-interest stories creates the impression that “ordinary people” are politically powerless and ignorant of the science of HIV and AIDS.

The media alone should not be held accountable for this dichotomy. Activists and politicians have a crucial role to play in portraying the epidemic more holistically. The news this month has shown that activists, like Thembi Nbubane and Annie Lennox, are experts at politicizing the personal; whilst politicians (even Julius Malema) can show that political issues can be personal.

Effectively, these groups straddle the line between the biomedical or political and social or humanitarian sides of the epidemic. Their positions offer unique opportunities to show how interlinked these issues really are. If activists and politicians are mindful to tell the full story of HIV and AIDS, media coverage of the epidemic might me more comprehensive. Perhaps then, when the true pervasiveness of the epidemic becomes apparent, the urgency of addressing it will hit home.

Melissa Meyer is a researcher at the HIV/AIDS and the Media Project.

Circumcision Season

By Melissa Meyer

27 July 2009 | Circumcision | The Media and HIV/AIDS

It is circumcision season again, and newspapers are telling stories of young Xhosa men who flock to the mountains where they subject themselves to mutilation and a certain risk of death.

The casualties have been dutifully tallied: towards the end of the June season, the Sunday Times reported 44 deaths, 270 maimed genitals and 13 penile amputations.

This has been a particularly gruesome initiation season and whilst there has been intelligent discussion in the media around issues of tradition and manhood, coupled with much-need exposure of illegally operating surgeons, the macabre stories of botched circumcisions seem to speak loudest.

A Sunday Times article, titled Circumcision Horror, quite graphically recounts the experience of young Zuko who lost his brother and his genitals during the initiation ritual. The article also tells of illegal traditional surgeons and careless elders. An accompanying article sets this against the broader context of circumcision as a business — generating large profits, attracting unethical practitioners and maiming young men.

Fortunately, some stories have been less about genitals and more about manhood (which one could argue, is the real issue at stake here). A Mail&Guardian article proposes that even circumcisions done in hospital (in this case on a gay man called Themba) can be an initiation into manhood. Compelling photographs of traditional circumcision initiates cleverly set Themba’s experience against that of young Xhosa men, suggesting that both experiences can be a part of ‘becoming a man’.

The star of this year’s circumcision drama, however, has been Thando Mgqolozana. In his debut novel A Man Who is Not a Man, Mgqolozana openly explores the repercussions of a botched ritual circumcision, which goes to the core of traditional notions of manhood. Fortunately for Mgqolozana, his book has generated as much publicity as it has outcry from traditional leaders.

Efforts like these to engage in meaningful dialogue around issues of ritual circumcision and manhood have made valuable headway in the debate around male circumcision. But is this enough?

Circumcision stories of another kind have been unfolding in South Africa, albeit rather quietly. They might not offer the enticing narrative of unfortunate genital amputations following treacherous journeys to the mountains, or an emancipating visit to a hospital, but they are equally, if not more pertinent.

Since January 2008 more than 9000 men have made their way to Orange Farm outside Johannesburg to be circumcised. Their journeys are not motivated by cultural norms or traditions but informed rather by scientific evidence that circumcised men are significantly less likely to contract or transmit HIV.

Macabre reports of botched ritual circumcision could easily discourage readers from getting “the snip” at a time when circumcision (in its medical sense) can be hugely beneficial to a country firmly in the clutches of a devastating AIDS epidemic. Whilst the Mail&Guardian article makes brief, though vague, mention of “the evidence about HIV and circumcision” the other articles discussed here fail to raise the issue at all.

Whilst it would be irresponsible to downplay the seriousness of botched traditional circumcisions, in the interest of HIV prevention, some distinction between the traditional and surgical procedure (and its benefits) is necessary.

Melissa Meyer is a researcher at the HIV/AIDS and the Media Project.

Personalising the pandemic

14 October 2005 | The Media and HIV/AIDS

I didn't know what awaited me when I was asked to facilitate a two-week training course called “Politics of HIV/AIDS Healthcare” on behalf of the Southern African Media Training Trust (NSJ). I came away from the course exhausted, but challenged and inspired by the 18 journalists from around the region who shared in this experience with me.

On the first day of the course the participants laid out their expectations for it: they wanted more knowledge; an opportunity to address the kinds of challenges that the story of HIV/AIDS presents; they wanted to explore how journalists report on HIV; and they wanted to find new, innovative ways of telling the stories of HIV/AIDS.

But one expectation stood out for me: they wanted to "personalise the pandemic”: to understand HIV/AIDS from a personal perspective and to use this understanding to write about the issue more meaningfully.

We didn't know it then, but that expectation would be exceeded beyond anything we could have envisioned on that first day.

I then asked each member of the group to relate their motivation for being on the course and their experiences of HIV/AIDS personally and professionally.

As we went around the table it struck me that not one participant talked about how HIV/AIDS affected them personally, or their families, communities, friends, lovers. Afterwards, I wondered why. Perhaps it was because it was the first day. Perhaps it was because none of us were personally affected by the epidemic. Perhaps it was because too often journalists tend to think of HIV/AIDS being “out there” - something we research and write about, but not something that actually lives inside our newsrooms or inside us.

A case in point is that we don't seem to have many journalists who are publicly HIV-positive in our region. Off the top of my head I can only think of Lucky Mazibuko of the Sowetan or the Namibian journalist David Lush.

But it is crazy to think that in 2005, in a region that has felt the impact of HIV/AIDS more than any other in the world, that we remain unaffected by the virus. The reality of the pandemic in this region demands that we are affected. As we got to know each other over the next two weeks, as the knots loosened and this reality began to unfold, this became increasingly evident.

There's the silence and stigma in K's newsroom, precipitated by the AIDS-related death of her colleague. K tried to talk about it openly but was told to keep quiet by her editor. There's B, who feels terrible guilt over the death of his brother, just a few weeks back: he died of an AIDS-related illness. B has many questions - why did his brother stay silent about his status until he was on his deathbed? Could B have done more? What could he have done under the circumstances? R wanted to pass the information about ARVs that she had learnt onto her sister…

Everyone recognised the lack of workplace and editorial policies on HIV/AIDS in our media organisations.

And then there was H, a participant from South Africa. He's just one of those people you take to instantly. Charming, glowing with confidence and intelligence, a journalist with a lot of potential. H defies every stereotype in the book about people living with HIV/AIDS. When he took his pillbox out of his bag on the fourth day, when we were discussing ARVs, and said something like, “Well you can all look at mine if you like,” the other participants couldn't believe it.

Over the next week, he did more to challenge people's preconceptions and stereotypes about HIV/AIDS than if I had stood there day in and day out talking up a storm. Just by being there.

More and more our stories about ourselves and the worlds we inhabit were woven into the sessions - it was no longer about the world “out there” but the world “in here”.

By the end of the course, we all felt that we had exceeded the expectation to “personalise the pandemic” in our lives and in our work. We realised that if we could achieve this, then we would begin to find new angles and interesting, creative ways to write about HIV/AIDS.

This is a challenge I issue to all of us who produce journalistic work on HIV/AIDS. We all need to attempt what was achieved in this course: we need to talk about HIV/AIDS openly in our own lives, to understand its impact on us as people, and by doing so, begin to address it in our work.

We all complain that audiences are bored of HIV/AIDS. They're not bored of the issue, they're bored of seeing the same tired formulas reproduced again and again in HIV/AIDS stories. If every journalist that cares about this particular story could “personalise the pandemic”, we'd not only be better professionals, but also perhaps we've got a shot at being better people. - Natalie Ridgard

Manto madness must not sidetrack media

7 October 2005 | AIDS Denialsm | The Media and HIV/AIDS | AIDS Politics

With qualifications to her name such as a BA from Fort Hare University, a diploma in Obstetrics, a Master's Degree in Public Health from a Belgian university and a Health Care Systems Planning certificate from the United Kingdom, Mantombazana Edmie Tshabalala-Msimang is a reasonably qualified health minister. But test public support for this particular politician, and you're bound to get an earful.

As well-learned and travelled as she is, South Africans are less than pleased with Manto, who hasn't been in the public's good books since she took up her ministerial duties at the beginning of the Mbeki era. Despite this, she's been tenacious. She became a MP after the 1994 elections and took charge of the health ministry in 1999.

The health minister was in the news again this week. A Sunday Times article by Carmel Rickard and Claire Keeton reported the “ Constitutional Court's indignation at the way the minister had behaved in refusing to make submissions on the merits of her case to the Appeal Court .” The article noted:

“The attitude of the Minister of Health, Manto Tshabalala-Msimang, towards the Supreme Court of Appeal was this week described as ‘deplorable' and as ‘bordering on outright disrespect.'”

Tshabalala-Msimang, who is often referred to as “Doctor No” for her former refusal to administer antiretrovirals to pregnant mothers, has faced an array of court cases which in most cases she has lost. Has the TAC ever had to pay legal fees in a case against the minister, for example? A quick-witted journalist would do well to calculate the amount of taxpayers' money the health minister has spent paying legal bills defending the indefensible.

A second Sunday Times article by reporters Brendan Boyle and Buddy Naidu published on the same day and headlined “Manto roasted on Aids stance”, highlights the manner in which a former US ambassador Richard Holbook spoke of the health minister.

He (Richard Holbrook) then asked De Beers SA managing director Jonathan Oppenheimer: “But why [does] Manto remain? Why your President keeps Manto, who continues to give her monthly sermons on garlic and lemon juice, is beyond me.”

Holbrook was addressing an HIV/AIDS briefing, which the likes of John Kerry, a former US presidential nominee, tycoon Richard Branson, actress Angelina Jolie and Anglo American Chairman Sir Mark Moody-Stuart attended.

From the TAC's Zackie Achmat to South Africa 's Constitutional Court judges, from the official opposition to the international arena laughing at our Health Minister, it is safe to say she's unpopular at best, even hated by some. One could almost admire the resilience with which she clings to her post.

She has stuck with President Thabo Mbeki, whose indecision over HIV/AIDS has also lost him support and attracted much criticism. And what of her other dodgy ally, Matthias Rath? It appears now that that relationship is also under fire According to an I-Net Bridge report published in May, Tshabalala-Msimang has denied endorsing Rath, though other reports such as one run by Cape Times in June contradict this. (See the September 9 Journ-AIDS blog for more on Rath.)

It's unfortunate that media attention on Tshabalala-Msimang may have side-tracked real in-depth investigations into AIDS policy and implementation. When asked recently on SAfmwho his favourite comedian was, comic Mark Banks quipped, “Oh, Manto Tshabalala-Msimang!” Her outlandish antics are an easy target, but it would be terrible if they distracted the media's attention, even slightly, from an impending health disaster. – Lunga Madlala

Media must provide context when tradition and medicine collide

1 October 2005 | Government Policy | Circumcision | The Media and HIV/AIDS

Two traditions that bear an impact on HIV/AIDS prevention have caught the attention of the press over the last few weeks.

The National Council of Provinces (NCOP) is scheduled to hold public hearings on the Children's Rights Bill, which is stirring controversy amongst traditionalists because of its proposed outright ban on virginity testing. But it is not only traditional culture that is at stake, according to some, but also the HIV-prevention benefits of these practices.

Bongani Mthethwa's report in the Sunday Times on September 25 noted the challenge the Children's Rights Bill poses.

“Under a section on social, cultural and religious practices, the Bill condemns anyone who takes part in what it calls genital mutilation and calls for the prosecution of such people under criminal law.”

While some hail the benefits of virginity testing for HIV/AIDS prevention, others say human rights are violated by the practice.

“[Promoting virginity] is a good cause, given our current Aids pandemic, but we still need to take a stand as a country aspiring to be fully democratic. Like many parts of the developing world we face difficult choices and they are often choices that appear to be conflicts between tradition and modernity,” University of KwaZulu-Natal anthropologist Suzanne Leclerc-Madlala told the Sunday Times.

But according to the report, the Bill does not ban traditional male circumcision practiced by Xhosas, creating perceptions of double-standards and even tribal bias.

Male circumcision has hit the headlines for different reasons recently, with HIV/AIDS expert, Francois Venter, advocating circumcision as probably being the “ best available AIDS vaccine against the virus in the country”. In an Associated Press(AP)article, Venter, who is clinical director of the Reproductive Health Research Unit at the University of Witwatersrand, encouraged the TAC to promote circumcision as a prevention tool given that existing methods were “failing to slow the spread of the epidemic”.

Venter told a congress of health activists in the Treatment Action Campaign that a recent survey in Soweto indicated that circumcised men were 65 percent less likely to contract AIDS than those who had not been circumcised.

"We dream of a vaccine which has this efficacy," said Venter. "The results are phenomenal."

The APreport highlighted the dangers of traditional circumcision in terms of HIV/AIDS prevention. Some traditional communities in South Africa practice circumcision, but there have long been calls for tighter medical controls to limit health risks from blunt and contaminated instruments.

"We don't want our men to go to the chop shop but have medical circumcision," said prominent HIV/AIDS activist and head of the TAC, Zackie Achmat.

While using “blunt and contaminated instruments” is a concern in traditional male circumcision, the identification of virgins could pose another dilemma. Although promoting abstinence, virginity testing can also pinpoint likely victims for men who believe the myth that sex with a virgin will cure them of HIV/AIDS.

The Sunday Timesarticle presents a fairly well-rounded story; but one interesting aspect not explored in the article is what our own Health Minister, Manto Tshabalala-Msimang, thinks about these issues. What is her take on the various initiatives that people are taking to save their communities from the devastation of AIDS?

Unfortunately an extensive search revealed that Tshabalala-Msimang has been tip-toeing cautiously, being mindful of her every move. It appears she has not said anything publicly about either of the contentious issues of virginity testing or circumcision, preferring to stick to her familiar chant of “Garlic diet! Garlic diet!”

(Tshabalala-Msimang's medically unsubstantiated olive oil and garlic campaign diet has fuelled public confusion since it was first reported by the South African Press Association among others in 2003. But this needs to be the subject of another blog all on its own …)

Back to the Sunday Timesreport: it would've been interesting to hear what the Health Minister's stance is on a Bill that the article claims has taken on “tribalistic undertones”. The same Bill has many virginity testers in KwaZulu-Natal arguing that the government has double standards as it continues to protect male circumcision.

The media's role is vital, as it is with any other issue, but especially in this instance where two worlds seem to be at loggerheads with one another: the traditional versus the medical. Each side is arguing that their methods are the better option in AIDS prevention. In this context of confusion and contestation, it's imperative that the media provide clear, considered reporting for the many South Africans personally affected, and for the politicians currently designing new laws that will have a long-lasting impact on all of us. - Lunga Madlala

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