Reports & Evaluations

POSITIVE VIBES WORKSHOP: Sharing the learning

Report by:Given Mutinta Culture, Communication and Media Studies, University of KwaZulu-Natal

“Three decades into the AIDS epidemic and the search for solutions is being challenged by the high HIV prevalence rates in Southern Africa. The need to treat and care for millions of people living with and affected by HIV will remain a priority for decades to come.”(Panos Institute, 2000).

As if reading the same signs of time, IBIS Southern Africa launched an HIV/AIDS programme in 2002 called Positive Vibes with a view to learn from the mistakes of early responses to the epidemic, and came up with innovative approaches to deal with preventions, treatment, care and support. This was after a realisation that one cannot address HIV/AIDS in someone else’s life until he/she has first addressed the disease in his/her own.

“Positive Vibes: Sharing the learning” was the title of the four days workshop held at Rood Vallei Country Lodge from 14th to 18th April in Pretoria. It was conducted by Positive Vibes from Namibia a communication initiative that has emerged from the HIV/AIDS programme of the Danish international development organisation IBIS in Southern Africa.

Positive Vibes facilitates the involvement of people living with and affected by HIV in a way that few HIV/AIDS initiatives have done so far. It uses communication tools to allow people to understand better the needs of children living with and affected by HIV. It also allows people to personalise HIV/AIDS, and to use their personal knowledge and experiences as the basis for their responses to the epidemic. The initiative challenges the pessimistic discourse that surrounds HIV/AIDS, and infuses in people a sense of hope. It combines separate approaches to create a process that allows change at a personal level to become a catalyst for change at a societal level. (Positive Vibes: “Sharing the learning” workshop, 2008). It is a workshop where participants are empowered to move from being passive victims of HIV/AIDS to becoming active to address the epidemic.

Positive Vibes kicked off the workshop with “AIDS and Me talk”. The talk gives people an opportunity to come to terms with HIV in their own lives and develop personal and collective action plans for better ways of dealing with the disease and the problems related to it. It helps to explore and assess the impact the disease has on people. Participants are encouraged to answer a simple, yet important question: “What does HIV have to do with me?” People are taken on a personal journey asking them to look at HIV and consider how it would affect them. The rationale is that people are more likely to address HIV/AIDS with empathy and understanding into people’s lives if they have first addressed it in their own. The talk helps to demystify the HI Virus to give participants a sound understanding of what it means to receive the diagnosis: ‘HIV positive’. AIDS and ME encourages people living with and affected by HIV/AIDS to disclose to their partners, loved ones and to the public about their experiences of HIV. Participants are encouraged to explore both the benefits and risks of disclosure. Basic facts about HIV/AIDS are given through a simple and easily understandable explanation. In doing so, the complicated medical information is translated into simple, everyday language, using images. This is instrumental in breaking down taboos around talking about sex to create the space for exploring, sharing and learning about various options people have for practising safe sex. The talk reveals how all people experience discrimination in some stage of their lives that is not only related to HIV/AIDS. The reason behind this is to unpack the causes of stigma and discrimination, and how to overcome it. The Reproductive rights of people living with HIV are discussed and ways in which HIV-positive people can minimise the risks of HIV infection and re-infection are explored. The aim is to provide participants with necessary, balanced information to make informed choices. Participants are encouraged to prepare personal action plans to respond to HIV/AIDS in their lives, within the groups, organisations, workplaces etc. (Positive Vibes: Sharing the learning, 2008)

The workshop also enables participants to express and deal with emotions associated with HIV/AIDS through what is called body mapping. Body maps are life-sized, mixed media paintings done on paper. With the help of others people draw outlines of their bodies which they fill with paint and other materials in a way that tells their own unique stories on how HIV has impacted on their lives. People map up their emotions and issues. Counselling sessions are provided to the people and issues that come up during counselling sessions are transferred onto canvas. It is believed that mapping helps to rebuild people’s confidence and self-worth by allowing them to remember, understand and heal the emotional pain that walks hand in hand with HIV/AIDS. This is done through listening to each other’s experiences, building support networks and exploring personal stories through art.

Positive Vibes believes in empowering people with skills to be effective speakers. This is meant to fill the visible gap with regards to the discourse on HIV/AIDS. It was after the realisations that positive people want to speak in public about living with HIV but are often not equipped to do so. Positive Vibes therefore provides participants with techniques for public speaking along with monitoring and support. The premise for this is to help instil the confidence speakers need to make a positive impression on their audiences as well as to set boundaries beyond which people are not prepared to go through when talking about sensitive and highly personal issues. Positive speaking is meant to bring an essential human element to the HIV pandemic allowing infected or affected people to talk directly to the public. It does this by focusing on the main aspects that make for a successful communication. The workshop combines theoretical and practical with much of it devoted to practice and peer review. Positive speakers are encouraged to be relevant, simple, clear, humorous, passionate and honesty when telling the stories. Speaking openly about HIV can push people’s comfort zone. Hence Positive speakers are trained on how to make the audience want to hear their stories. It is believed that if people are able to relate to Positive speakers’ stories, they become more interested in listening to what is being spoken. Participants are encouraged to practice public speaking so as to become more comfortable with their own abilities, which can give them confidence to take the new skills to different platforms and audiences.

Positive Vibes also uses videos in promoting discussions and debates around HIV/AIDS issues. Video facilitation involves emotions and allows people to empathise and associate with those in the films and address HIV/AIDS in their own lives. This technique makes use of the intrinsic qualities of film medium and turns screening into learning process. Participants are encouraged to engage with the films and to link the issues raised in films to their own lives. The main focus of video facilitation is to enable people reflect and share direct experiences of watching a film. The goal of this approach is to allow people to personalise the issues and to identify their own possible responses and emotions raised by the film. Participants are then encouraged to decide on individual and group action, such as challenging stigma and discrimination. Other actions might include the decision to go for testing, practising safer sex etc.

The workshop also articulates on how to facilitate dialogue between children and adults around the needs of children in the context of HIV/AIDS. The emphasis here is that children should be given the space to express themselves through media ranging from paint to digital video. “Children should not only be seen but heard as well” (Positive Vibes: Sharing the learning, 2008). This is done by encouraging HIV positive parents to disclose their own and their children’s HIV status to children. This is designed to help to break the silence that often exists around HIV/AIDS within homes. Parents are not forced to disclose to their children and before disclosing both parents and children are to go through counselling. It was emphasised in the workshop that children should be helped to explore their lives in the context of HIV/AIDS, so as to begin expressing themselves on issues of concern to them.

Participants are also led through a series of children’s drawing exercises and autobiographical storytelling that can enable children explore their feelings on issues affecting them within the context of HIV/AIDS. Positive Vibes shows how children can compile drawings, paintings and writings which can be produced into life books. Positive Vibes believes that children can use mass media to communicate about their needs. Therefore, adult media professionals are to help children raise their stories using mass media. People living with HIV/AIDS are also enabled to produce media that allows decision makers and the wider public to better understand and respond to the realities of living with HIV. Positive Vibes believes that communication is the key means of reducing the stigma that hampers prevention, treatment, care and support for people living with and affected by HIV/AIDS. The approach to participatory media uses the experiences of people living on the frontline of the HIV/AIDS epidemic with the creativity of professionals in telling stories through the media. Rather than media professionals telling stories on behalf of others, Positive Vibes puts the means of production into the hands of people living and affected by HIV/AIDS. Media professionals are however to assist and guide the storytellers (Positive Vibes: Sharing the learning, 2008). This is meant to break down barriers that mass media traditionally places between producers and audiences. The underlying principle of participatory media is to build transferable vocational, leadership and relationship skills as well as self-expression and teamwork skills. This is to instil an ethic of critic duty and a strengthened sense of community to contribute to growth in individual people’s self-esteem.

In the nutshell, Positive Vibes: “Sharing the learning” workshop is an attempt to sensitise and build confidence in people living with and affected by HIV who want to tell their stories. For this to happen media professionals are to help them to personalise HIV/AIDS and develop self-esteem and confidence to understand, and take greater control over HIV/AIDS in their lives. The noble cause of Positive Vibes is a challenge to everyone whether in the media professional or not to help create a platform for people infected and affected by HIV/AIDS to positively talk about their experiences of living with HIV as a way of conscientising people on HIV/AIDS related issues. As long as this is not done the efforts to mitigate HIV remain lame as they lack a positive voice speaking from experience to demystify the disease. Let us do what is within our reach to give positive speakers a platform to share their unique stories that can influence people’s sexual behaviour to change for the better.

It was a workshop worthwhile attending not only for what is in the report. The reporter’s encounter with David the manager for Positive Vibes created an opportunity where CCMS is going to be one of the main beneficiaries of scholarships meant to support research on HIV/AIDS in Southern Africa. On how this will work depends on the outcome of the meeting between Positive Vibes and their major funders Denmark to be held in Copenhagenat the end of May, 2008.

Thank You!

May 2008

Author: Tomaselli, Keyan
Date: 1996
Other Authors: Arnold Shepperson
Place: University of Natal, Durban, South Africa
Published: Yes, in mimeo form. a longer, socially contextualised version to be published in Alali,
Type of product: Mimeo, circulated for discussion to key stakeholders such as representatives of the provincial Departments of Health, NAPWA, NACOSA and the AIDS Consortium
Copyright: Keyan Tomaselli
The Story so Far

Worldwide, there is no single example of a national media campaign that has demonstrably reversed HIV infection trends. Yet such campaigns remain the centrepiece of many government responses. At the core of the problem lies the assumption that knowledge and awareness lead to behaviour change, and that, with careful attention to appropriate message-making, greater impact can be achieved. Media campaigns do readily achieve objectives of “knowledge and awareness”, but it is the terrain beyond that awareness, that is harder to achieve.

In South Africa, the vast majority of those at risk understand the basic mechanisms of HIV infection and the means for prevention. What they sorely lack however, is access to resources that prevent infection:

1. sustainable free condom distribution is largely confined to clinics;
2. STD treatment is constrained by lack of public awareness and limitations within service delivery; whilst
3. prevention activities generally remain uncontextualised within broader activities around sexual and reproductive health.The attraction of a national media campaign to government is obvious in that it provides a visible and tangible response to the epidemic that is of political benefit. It is all too easy however, to allow political imperatives to confine the media campaign, and as was the case of the 1995/96 campaign, these imperatives undermined the process.

Download the entire article

Author: Stein, Joanne
Date: 2001
Compiled by The Centre for AIDS Development, Research and Evaluation (Cadre) Johannesburg, South Africa

This exploratory study has been designed to provide preliminary data regarding whether and to what extent South African media institutions have responded to the need to develop corporate policies and strategies to delimit the impact of HIV/AIDS and to protect the rights of employees with HIV/AIDS.

An evaluation of media workplace policies and programmes is long overdue. This report explores the extent to which media institutions have thus far developed a proactive response to managing the epidemic through the introduction of workplace policies and programmes, and the extent to which these contribute to prevention as well as to upholding the rights of employees in relation to HIV/AIDS. It also sets out to ascertain whether HIV/AIDS is recognised by management as a threat to business which impacts directly on productivity, costs and markets.

The research findings are supplemented by a set of basic recommendations and guidelines, resource documents and sample policies for the promotion of appropriate policies and practice within media formations.

Download the entire article

Author: Dalrymple, Lynn
Director: DramAidE, University of Zululand and University of Natal
Adjunct Professor: Graduate Programme for Cultural and Media Studies, University of Natal.

Introduction: the legacy of apartheid

South Africa’s apartheid system repressed the social, economic and political lives of the majority of its citizens. It was a form of ‘racial capitalism’ that included both paternalism and a disregard for subaltern interests and aspirations. Most people lacked basic government services like housing, health care, water, sanitation and electricity. Black people were excluded from national and provincial government, and black municipalities had no power or democratic base: they were administrative agents of the white provincial governments. In the eyes of the apartheid government, there were no black urban poor. Anybody living on urban fringes without permission was there illegally and forcibly returned to the rural homelands. Whites benefited under job reservation laws, and once Nationalist party power was entrenched poor whites were almost unheard of.

The apartheid health system was one of the world’s most unequal, fragmented and wasteful. Fourteen racially differentiated health departments – ten for each Bantustan, three for the white, coloured and Indian populations, and one general affairs department -administered and duplicated services. Four provincial departments as well as 382 local authorities were also responsible for health issues. Even after desegregation in 1990, hospitals were still controlled by these segregated health departments. None of them catered for the black urban poor because, in theory, there were no black urban poor.

Apartheid ideology claimed to uphold western and Christian values, and encouraged a positivist view that conservative western knowledge systems were superior. This led to education and health systems that were imposed, top-down, authoritarian and disdainful of alternative ways of learning and healing. The present dispensation faces the problem of de-entrenching the knowledge and practices left behind after generations of this form of governance. The new policy discourse aims to empower previously disadvantaged people by addressing relations of power and knowledge, using a process of consultation through the devolution of power to local government.

This paper explores some of the contradictions inherent in both democratically changing social reality, and delivering practical changes in areas such as employment, housing, sanitation, health, and education. The focus is on building healthy cities that democratically accommodate the needs of the previously neglected urban poor. Foucault’s [1980] theoretical linking of knowledge production and the operation of power provides a useful framework for looking at a process of changing social reality. Relations of power are specific to different societies, being organised through relations of class, race, gender, religion, sexual preference and age, amongst others. However, alternative perceptions and forms of knowledge can challenge dominant knowledge systems [Weedon, 1987]. Within this actor-orientated paradigm the emphasis is on enabling poor individuals, households and communities to help themselves, with policies aimed at meeting basic needs and enhancing human development and empowerment.

What do we mean by the urban poor?

In mid-2000 South Africa’s estimated population was 43.68 million [South African Survey, 2000/2001:47], with 36.2% of economically active citizens unemployed -40.9% of the latter in urban areas [South African Survey, 2000/2001: 378-379]. This suggests that a significant population of South Africans could be categorised as the ‘urban poor’. However, there is a growing consensus – spearheaded by the work of Nobel prize winner Amaryta Sen – that aside from lack of income, poverty includes the inability to reach a minimum standard of living and well being as a result of deprivation of resources, opportunities and choices. Many South Africans’ continued poverty is intrinsically linked to the systematic entrenchment of discrimination during apartheid [Development Update, 2001:76].

Migrant labour was central to the political economy of South Africa for more than a century, and apartheid was in one important aspect the rationalised policy of labour migration. The policy restricted the movement of entire families to urban areas, and male circular migration was predominant. Although apartheid’s demise has changed the pressures and demands for labour, it remains unclear how these changes will affect future forms and patterns of labour migration. Current estimates are that more than 2.5 million legal, and many more illegal, migrants – from rural areas within South Africa and from neighbouring countries – work in South Africa’s mines, factories and farms. [Lurie, 2000: 343.].

Contemporary South Africa migration includes a significant shift of people from rural areas to informal settlements on the urban peripheries. Government’s response to this major problem has been to make forced removals a feature of life in South Africa once again. For example, in the Alexandra renewal project the euphemism for removal is the ‘de-densification of appropriate land.’ People who have built houses illegally in Alexandra are now being moved to outlying areas. Government argues that this is ‘not dumping people but assisting them. We are moving them from an area that is hazardous to their health and providing them with a piece of land. The previous government didn’t do that’. However, the people who are being moved to Diepsloot are angry because they have no access to electricity and running water as they had in Alexandra [The Sunday Independent, 24 June 2001].

The urban poor include growing numbers of street children and orphans. The Health Systems Trust estimates that AIDS would orphan more than 2 million children by 2005 [South African Survey 2000/2001]. Managing this development alone will require the joint efforts and resources of a number of government Departments such as Welfare, Education, Water Affairs and Housing.

The Transformation of Local Government: Defining `Urban.’

I. The Municipal System

Since South Africa’s first democratic elections were held, its system of governance changed radically. At the time of change, political parties and analysts agreed that strong provincial governance was critical for effective service delivery. The outcome was constitutionally guaranteed autonomous provincial governance, and municipalities becoming directly responsible for the provision of services to the urban poor. The wall-to-wall entities created by the Municipal Demarcation Act of 1998, with powers and responsibilities to deliver health services, replaced a mixed-up system of municipal, local, rural and homeland councils. There are three municipal categories: metropolitan [unicities]; district municipalities; and local municipalities. Several local municipalities make up one district municipality [Nicholson, 2001].

This system is expected to increase municipal powers, responsibilities and accountability. For example, local government now takes responsibility for providing health services. The transformed local governments have greater political status in the attempt to address the empowerment of previously disadvantaged people. However, there is still no solution to long-standing problems such as lack of adequate finance, capacity and skilled administrators.

II. Primary Health Care

The new national devolutionary approach to public health is based on principles of primary health care within a District Health system, replacing the apartheid’s emphasis on a curative bio-medical approach using hospital-based care, medicine, and advanced technology. The new approach attempts to employ principles of consultation and local empowerment by giving more power and responsibility to municipalities:

Resources must be distributed equitably, meaning that those areas with the least resources should be given the most assistance.

Communities should meet their different needs by being involved in the planning, provision and monitoring of health services.

A greater emphasis should be placed on services that help prevent disease and promote good quality health. This is a shift away from curative services.

Technology must be appropriate to the level of health care. For example, this would mean ensuring that all clinics have fridges for the storage of vaccines before equipping them with high-tech facilities.

There should be a multi-sectoral approach to health. In the Primary Health Care approach the provision of nutrition, education, clean water and shelter become central to health care delivery. So, for example, the department of Water Affairs and Education are important role players within the health system [Nicholson, 2000:26].

This offers communities a more developmental approach to health, in which they are not merely passive recipients; resources and finances shift away from high-tech tertiary hospitals to primary level services; and specialist doctors would play a more supportive role to nurses in clinics. The development of professional nurses who can manage clinics is key to this system.

III. Health Delivery: The District Health System

With the demarcation of municipal boundaries completed, the boundaries of the 180 health districts must be aligned with the new municipalities. For the district health system to work effectively it is important to get the size of the district right. It should be large enough to contain the full range of health services including a district hospital, but small enough to allow efficient service delivery and community involvement. The urban poor are often migrants, making planning and effective delivery a serious challenge. Many are ‘squatting’ illegally on non-residential land on which there is no proper provision for sanitation and water. The shifting nature of these communities also makes it difficult to implement the principle of giving them any real say over their own health care

Challenges in implementing the system

I. Financing local government

Introducing the new Health System is not without its problems, and its integration with the new local government system is by no means complete. Many South African municipalities are in a serious financial crisis. By mid-June 1999 an estimated 633 of the 843 local authorities had debts in excess of R9.3 billion which, together with serious capacity problems, impacted on their ability to deliver services [Reconstruct, 1999]. Part of the plan for financing local government was that wealthy communities within the new municipalities would finance the development of poorer communities. With a few exceptions, this has rarely worked because of the huge disparities in service provision inherited from apartheid. At the time of writing residents in the uThekwini [Durban] unicity are protesting over massive rates increases imposed without consultation. There are many rates and service-fee defaulters, and a number of municipalities have suffered from poor financial management. In some of the poorest areas, local government has little chance of raising revenue. It is still not clear how municipalities will be financed, but many may remain dependent on national revenues for some time [Nicholson, 2000].

II. Financing the Primary Health Care System

The re-allocation of resources to the primary health care system means that hospitals throughout South Africa have suffered. In July 1999, a provincial commission of enquiry in Gauteng investigated hospital care practices at several provincial hospitals [Chris Hani Baragwanath, Sebokeng Academic, Natalspruit, and Tembisa ] after complaints from both health workers and patients. Financial constraints were identified as the core problem. The commission noted that public hospitals lack capacity and infrastructure for coping with growing demand. Hospital managers cited the provision of free primary health care and treatment of children under five, as well as the demand for abortion, as causes of greater pressure on the system. The HIV/AIDS epidemic is also putting undue pressure on available resources for health delivery. [South Africa Survey, 2000/2001:237 -238]

However, as clinics become better staffed and better equipped they are beginning to take the pressure off the hospitals. A spokesman for the KZN Department of Health reported that the number of unbooked mothers delivering in hospitals dropped by 80% in 2000, and that while maternal mortality rates dropped significantly at clinics they increased in hospitals indicating that the referral system is starting to work. Unfortunately, the AIDS epidemic has significantly affected the new system, making it difficult to assess how well it is working [McGlew, 2001].

III. The Relationship between provincial and local government

The devolution of power to local government calls for a clearer distinction between provincial and municipal powers. The powers of provinces in relation to delivering health services are fairly deeply entrenched. The KwaZulu-Natal provincial Department of Health has direct control of 62 hospitals and 500 clinics, all funded and run separately from the unicity and district municipal clinics. The long-term aim is for municipalities to provide all delivery, and for the province to build capacity, monitor the delivery of health services and provide strategic and policy direction. However, there has been no decision on how to manage the staffing and financial implications of this change. For example, the transfer of health workers becomes complicated, because provinces and the municipalities offer different conditions of service.

IV. The National Government’s shift towards centralisation

One response to a lack of capacity and delivery at local level has been for the State to take more control over the provinces, a debate within both party and government that has intensified during Thabo Mbeki’s presidency. A recurring feature in the debate on the devolution of provincial powers has been whether national government had given the provinces enough powers to bolster their capacity and ability to deliver. Some argue that provinces act largely as implementing agencies for central government, which sets the direction in health, education, and welfare. This tends to stifle the development of talent and energy at the provincial and local levels, and central government is accused of undermining its own principles of grass roots capacity building and participation. [Development Update, 2001:12 -14].

V. The role of traditional leaders

A major issue during the negotiations preceding the 1994 elections was how to reconcile traditional institutions with the new democratic order. At the local and district level in rural areas the amakhosi [traditional leaders] were accorded ex-officio status. However, legislative inertia surrounding the precise roles and functions of traditional authorities has largely reduced constitutional bodies for traditional leaders to ceremonial entities. Traditional leaders have voiced serious concerns about the transformation of local government, mobilising against the changes expected to follow local government elections in 2000. Some compromises were reached, but the impasse between government and traditional leaders remains.

These difficulties are inherent when transforming to democracy from a hierarchical, authoritarian system of governance. Traditional leaders played a political and administrative role in the former homelands and self-governing territories. Colonial and apartheid legislation conferred on them the standing of local bureaucrats. However, pre-colonial institutions were themselves inherently patriarchal and hierarchical, with leaders claiming inherited rights to rule. It remains to be seen how much support will be given to traditional leaders who resist the new discourse of representative elective democratic governance.

VI. Traditional Healers

Traditional healers’ holistic and cosmological emphasis on health has played a significant role in resisting the bio-medical health model. Widely held and espoused in both rural and urban areas, traditional medicine is pivotal to indigenous social structure and religion. Practitioners are thus highly resistant to change, having maintained individual and social equilibrium for generations. Traditional healers are an example of Foucault’s thesis about the production of knowledge, its relation to power, and the ability to resist alternative forms of knowledge.

In South Africa, bio-medical practitioners still tend to scorn traditional medicine, advising people against healers’ advice and medicines. Others seem to have reconciled these two systems, however, and recently government has taken significant steps to recognise the contribution of alternative healers towards health delivery. First, they are often more accessible; second, they live and work in the community; and, thirdly, although they are not cheap, they are a source of comfort and care for many. On the other hand, some practices, such as sharing razor blades, are clearly dangerous in the context of the HIV/AIDS epidemic, and healers need to be persuaded to change in this regard.

VII. The HIV/AIDS Epidemic

Like most of sub-Saharan Africa, South Africa has been hard hit by HIV/AIDS. The government’s responses suggest that HIV/AIDS education programmes have paid insufficient attention to Foucault’s linkage between knowledge production, social practice, and ways of being. In spite of concerted education and communication campaigns the epidemic has not been contained. Sectors of the South African population, including the State President, have either consciously or unconsciously resisted valid bio-medical explanations of HIV/AIDS and ways of preventing infection.

Local government responses to the epidemic are unsatisfactory, suggesting some kind of resistance to the information about the disease. In his HIV/AIDS impact report to the Durban unicity council [Mercury, 27 June] Mr Bheki Nene noted that the council’s responses to the epidemic have been uncoordinated, fragmented, ad hoc, and sectorally focussed. Many sectors had only recently responded to the impact of the disease, while others were yet to respond. The report recommended that an AIDS co-ordinating committee should head the implementation of a council action plan.

Campaigns that overcome this resistance have to employ methodologies that accommodate the participants’ belief systems, and which also promote community participation in planning, providing and monitoring health services. However, Winifred Bikaako [2001] cautions against uncritical use of Western style participatory principles and practices. External objectives and organisational methodologies often dominate these methodologies, not necessarily increasing local autonomy and eliminating dependence. Although traditional ‘pre-western’ organisational forms, often hierarchical in structure, clearly conflict with group approaches, they remain part of the social reality to be changed.

Conclusion

South Africa’s new health system is decentralised, emphasising Primary Health Care delivered at district level. The approach is equity driven, to cater for both the urban and rural poor. However, there are challenges to implementing the approach, and provinces and local governments need to co-operate with commitment and integrity for the system to fall into place.

References

Bikaako, Winifrid. [2001] ‘Self-help Health initiatives of Urban Migrants: A Case of TASO Uganda’, Paper presented at the conference on ‘Building Healthy Cities: Improving the Health of Urban Migrants and the Urban Poor’, Kampala, Uganda.

Development Update: Annual Review

. [2001] Quarterly Journal of the South African National NGO Coalition and Interfund funded by the European Union.

Foucault, M. [1980] Power/Knowledge: Selected Interviews and Other Writings. Pantheon, New York.

Lurie, M. [2000] ‘Migration and AIDS in Southern Africa: a review’. Journal of Science, Vol 96, No 5, pp 343 – 347.

McGlew, D. [2001] Director Communications, KwaZulu-Natal Department of Health, Telephonic Interview.

Nicholson, Jillian. [2001] Bringing health closer to people: Local Government and the District Health System. Health Systems Trust. Durban.

Reconstruct

, [1999] 26 September.

South Africa Survey 2000/2001

. South Africa Institute of Race Relations. Natal Witness, Pietermaritzburg.

The Natal Mercury

, June 27, 2001

The Sunday Independent

. June 24, 2001.

Weedon, C. [1987] Feminist Practice and Post-structuralist Theory, Basil Blackwell, Oxford.

Date: 2003
Compiled by the Centre for AIDS Development, Research and Evaluation(Cadre), South Africa

Cadre is an independent HIV/AIDS research organization focusing on programme development, evaluation and communications. Over the past year we have noted growing concern amongst sectors of the South African population, researchers, academics, government and NGO managers, in response to the loveLife programme.

Rewriting history
LoveLife has been quick to position itself as an innovative and bold intervention that offers hope in a context where all else has failed. For example, a recently produced brochure states “Using advertising strategies similar to those used to market popular brands to young people, loveLife is spearheading a sea of change from the traditional do or die” HIV prevention messages used in South Africa over the past decade, which have had little success in reversing the epidemic” (loveLife: South Africa’s national HIV prevention programme for young people, loveLife, 2002a, p5. Available at www.kff.org)

The above quotation, which sits alongside headlines such as “HIV prevention that works”, “Making a measurable difference” and “A real world, research-based approach”, is at odds with emerging questions about the programme’s efficacy and operating style.

There is plenty of evidence to demonstrate that national government and NGO interventions, alongside the activities of provincial and local governments, smaller NGOs and CBOs, have made distinct and important impacts on HIV/AIDS in this country. Amongst youth, for example, since the late 1990s there has been a stabilization of antenatal HIV and syphilis prevalence, levels of HIV/AIDS awareness in South Africa are amongst the highest in the world, and last sex condom use rates amongst teenagers are far higher than has been seen in similar populations in other countries. The vast majority of South African programmes have been well considered and carefully located in appropriate and sensitive communication messaging and aside from the attempts of the apartheid government in the late 1980s, we have been unable to identify a single example of the “do or die” prevention messaging that loveLife refers to.

LoveLife’s modus operandi is clear: rewrite the history of the struggle against HIV/AIDS in South Africa, whilst at the same time asserting dominance through a combination of slick PR and claims of success.

Public-private partnerships
Drawing on initial support from the Kaiser Family foundation (KFF) and the Gates Foundation, loveLife has rapidly become a powerful entity, establishing “public-private” partnerships with the South African government, media institutions and corporates. LoveLife, is the only HIV/AIDS organisation with its own line item in the South African budget ú- $7.5 million over three years for NAFCI clinics, groundbreakers and loveLife games. No local HIV/AIDS NGO enjoys this benefit. Similarly, commercial agreements with the South African media have led to an uncritical promotion of loveLife, and one wonders whether corporate “partners” are aware of the urgent and pragmatic needs emerging as a consequence of the epidemic outside of the loveLife frame of reference.

Poorly conceived messaging
Lovelife’s billboard messages have been widely criticized for carrying obscure and inappropriate messaging, yet objections have not been seriously addressed by loveLife and the oft repeated refrain is that critical commentators are not “part of the 12-17 year old target market”.

It must be said that the billboard messages are highly problematic both in terms of content, and in terms of reach. Taking the latter point, for example, billboards do not allow for audience segmentation by age. Imagine, for a moment, an eager six year old learning to read by scanning roadside billboards happening upon “Sex is sex: show me the money” or “I only do it skin-on-skin” or “I wanted to wait, but Abram was inside me before I could say no”.

The explicit imagery found in loveLife’s ThethaNathi youth magazine, which is distributed in a number of high circulation daily newspapers, includes, for example: an image of a young male standing with his belt unbuckled being embraced by a young female with her skirt riding up and her legs wrapped around his body (issue 18); an image of a couple embracing whilst a young woman with her legs apart and panties showing looks on (issue 16); a skimpily clad young woman with a chain wrapped around her crotch, whilst the back page features a collage of young males with their flies down with their crotches being examined by a young female (issue 17). What is the point? What is being achieved? How does this relate to the world of a young person’s emotional development and emerging sexuality? How does this contribute to HIV prevention?

Poor understanding of youth audience
LoveLife’s fundamental orientation is towards 12-17 year old youth as a primary target audience. The conflation of this age range into a homogenous entity needs to be problematised. 12-14 year old young people are very different emotionally, intellectually and sexually to 15-17 year olds. They have special and different needs in terms of sexuality education and any dialogue around sex requires an informed and framework of support. LoveLife’s approach contradicts the carefully planned approach to sexuality education that is followed by the Department of Health and Education’s school-based lifeskills programme (problems of delivery aside). loveLife contradicts value systems indigenous to young South Africans, and rides roughshod over many important concerns pertaining to young people.

What of the diversity of South African youth cultures and contexts? What of the distinct psychosocial needs young people have in relation to HIV/AIDS? What of the distinct problems of orphaned young people? What of the trauma of loss of family members, parents, siblings to AIDS? What of sexual coercion? Rape? And what of the very real needs and concerns of parents? Where is the genuine involvement of communities, parents, teacher’s, PLWHAs, community-based organizations?

Baseline and other research
LoveLife©–s stated objective is “to cut the HIV infection rate among young South Africans by 50%, and to establish a new model for effective HIV prevention” (loveLife, 2002a, p1). One would expect that loveLife would have initiated a comprehensive baseline of its intended target population along with a well-defined set of indicators against which to measure its impacts when it was established in 1999. Surprisingly, it is only now, nearly three later, that such a large scale survey is being conducted.

Whilst loveLife presents itself as a rigorously researched and evaluated programme, concerns need to be raised about the fact that much of this research is led and framed by loveLife. Whilst this is not in itself unusual, one would expect a critical and reflective point of view to prevail. This is after all an intervention that involves stakeholders far beyond loveLife. Peer review should be encouraged and “outside” perspectives welcomed. We can ill afford to have the current situation of research findings being decontextualised into PR soundbites and snippets that see only resounding success.

The latest “nationally representative” survey of 12-17 year old’s entitled “loveLife’s for us – A survey of SA youth 2001” for example, presents an uncritically optimistic view of the programme. This survey notes that 62% of youth responded in the affirmative to hearing about loveLife. An attempt is then made to demonstrate that this awareness (whatever “hearing about loveLife” may mean) has translated into action on several fronts. The data is presented in simple frequency table form with little comparative analysis between measures. No comparative reference is made to a similar survey conducted in 2000 and many questions are raised. How did loveLife cause 78% of those who had heard about its programme to use condoms, 69% to reduce their number of sexual partners, 63% to be more assertive about condom use, and 20% to have more sex? How compelling and powerful is “hearing about loveLife”?

The report also contains a number of internal contradictions that raise unsettling doubts about research integrity. For example, how is it possible that a “nationally representative sample” elicited the finding that 23% of those who knew about loveLife, reported that they knew via a loveLife Y-centre, when there were only seven Y-centres in discrete communities countrywide at the time of the survey?

Conclusion
We are well aware that HIV/AIDS interventions are complex and there are many other interventions in South Africa and worldwide that have problems in relation to fundamental models, cost-effectiveness and efficiency. Our concern with loveLife is not that things might go wrong along the way. Rather it has to do with the fact that the fundamentals of the programme, and the concerns raised at various levels, are swept away beneath a bluster of research reports and promotional activities that are, in essence, misleading.

Clearly the response to HIV/AIDS in South Africa needs to be located within a climate of transparency, accountability, and critical reflection. We can ill afford that funds be channelled into culturally dislocated high cost interventions that shift attention away from communities and grassroots organizations where the needs are most urgent.

The Unit was established in 1999, and arose out of the integration of the contract research activities of the Graduate Programme in Cultural and Media Studies (CMS) and the NGO, Drama-in-Aids (DramAidE). The Unit works with the Centre for Social and Educational Research (CSER), University College of St Mark and St John (Marjon), UK. This three-way cooperation brings together extensive international experience in participatory research, development and education, health communication, social development strategies, media and development support communication, participatory theatre and educational drama, amongst other areas of practical expertise.

The Unit has a full-time administrative establishment, and calls on a wide range of research and educational skills from the University of Natal and other institutions affiliated with the Eastern Seaboard Association of Tertiary Institutions (esATI).

The Unit’s Director, Prof Lynn Dalrymple, from the University of Zululand, heads up DramAidE, which has been an integral part of the R33 million Dept of Health Beyond Awareness I and II HIV/AIDS media campaigns in South Africa between 1997 and 2000. Prof Keyan Tomaselli is Programme Director of Cultural and Media Studies at the University of Natal. Dr Ruth Teer-Tomaselli, Senior Lecturer in the Programme, has done extensive development work all over Africa for the Forum of African Women Educationalists and other international agencies. members of CMS has consulted for UNESCO, the Dept. of Health, and the Dept of Arts and Culture, Science and technology, etc. Professor Garth Allen, an educational economist, who works extensively in Africa, heads up the CSER at Marjon.

The Unit is available for undertaking contract research and development projects in the KwaZulu-Natal Province.

For further information please contact Prof Lynn Dalrymple.

Cell: 083-653-2053; or + 0351-93911 (work).

Secretarial Offices: Susan Govender:

Web page: as above. Go to Research Unit huperlink.

Rose Mlungwana, University of Zululand:

+ (27) (0)351-93911 (Ext 2272).

UK contact: Garth Allen or Rosemary Thomas (Secretary), Centre for Social and Economic Research, UK. Tel: 01752-636700 (Ext 4301) or 636803. Fax: 1752-636-863. E-mail: stagja@lib.marjon.ac.uk.

Author: DMA Unit
Date:

Working in concert with associate organisations, CCMS has produced, facilitated and/or cooperated on the work listed below:

During 1996/8 K.G. Tomaselli (with W. Parker and A Shepperson).

Policy development with regard to Ministry of Health AIDS media and communication programmes. Developed processes aimed at setting up government as facilitator of health messages instead of originating and distributing them. Strategies outlined making existing organizations (NGOs, CBOs, advertising agencies, social marketing groups, specialised media) the actual agents and originators of locally specific messages and interventions within a broader national and regional strategy aimed at developing new forms of health conduct in respect of AIDS/STDs. Ministry accepted the strategy and is implementing via R7 million tender awarded to the Society for Family Health during 1997 and R37million in 1998/9.

Brownlee, Tracy. An Analysis of a Social Marketing Campaign: a case study for Project for Health And Sanitation Education (Phase), focusing on the vialbility of participatory communication as a model for development, the way external relationships shaped this project, and the development of an alternative model for health communication. Honours Research Essay, Centre for Cultural and Media Studies, 1998.

Epstein, Elaine. The Design, Implementation and Evaluation of a Culturally and Situationally Appropriate STD Education Media Programme in Hlabisa, KwaZulu Natal. 1997. MA Thesis, 179PP.

Epstein, Elaine. The Cultural Construction of Sexually Transmitted Diseases amd its Consequences for Intervention Approaches. Hons Thesis, Centre for Cultural and Media Studies, University of Natal, 1994.

Dramaide, Dramaide: Is Dramaide Making A Difference? Evaluations of the DramAidE Programme. 1996. DramAidE: DramAidE. 306pp.

Dalrymple, Lynne. “The Use of Transitional Cultural Forms in Community Education”, Africa Media Review, 11(1), 75-92.

Dalrymple, Lynne and Preston-Whyte, Eleanor. 1996. Is Dramaide Making a Difference? Empangeni: Dramaide.

Mthembu, Maxwell, As Assessment of the Effectiveness of Radio Information Campaigns on HIV/AIDS Awareness and Behaviour Charge in Swaziland. 1995. MA Dissertation, 60pp. R30

Parker, Warren, The Development of Community-Based Media for AIDS Education and Prevention in South Africa: Towards an Action-Based Participation Research Model. 1994. MA Thesis, 170pp.

Parker, Warren. “Action Media: Consultation, Collaboration and Empowerment in Communities of Cultural Practice”, Africa Media Review, 11(1), 1997, 45-63.

Parker, Warren, Dalrymple, Lynne and Durden, Emma. 1998. Communicating Beyond AIDS Awareness: A Manual for South Africa. Beyond Awareness Consortium, Johannesburg.

Rukambe, Joram. Narrative as `Communication’ in the Campaign Against HIV/AIDS in Namibia: A Case Study of Emma’s Story Docudrama. MA Dissertation, 1999.

Tomaselli, K.G., Shepperson, A. and Parker, W., AIDS Campaigns and Media Policy in South Africa. BEYOND AWARENESS I GUIDELINES, Department of Health, Pretoria.

Tomaselli, K.G. “Action research, Participatry Communication: Why Government’s Don’t Listen”, Africa Media Review, 11(1), 1997, 1-10.

Tomaselli, K.G., R.E. Tomaselli and Rhodes University students): “Media Graphics as an Interventionist Strategy”, Information Design Journal, 4(2) 1984, 99-117 (Open University, Milton Keynes).

Young, M., Walker, D. and Pather, P., Evaluation of Dramaide in Terms of Augusto Boal and Paulo Freire’s Theories of Drama and Education. 60pp. R50.

Young, Miranda, Gender Dynamics and the Role of Participatory/Development Theatre in a Post-Apartheid South Africa: The Example of DramAidE. Research Essay, MA. 35pp.

Zaffiro, James, “Casting Shadows on SADC: Policy in Southern Africa to the Next Century”. Forthcoming Book chapter. Zaffiro was a visiting Professor in CCMS during 1995, and his Department at Central College, Iowa, is formally linked to CCMS.

Date: 1996
HIV/AIDS and STD Advisory Committee to the National HIV/AIDS and STDs PROGRAMME of the Department of Health

The members of the HIV/AIDS and STD Advisory Committee to the National HIV/AIDS and STDs PROGRAMME of the Department of Health, wish to make known their position and views on the criticism of Sarafina II.

The primary concern of Committee members is that the unfortunate events surrounding the Sarafina II musical play by Mbongeni Ngema will damage the recently established, but carefully constructed, National Programme against HIV/AIDS and STD’s. The success of this Programme is critically dependent on public acceptance; the Sarafina II controversy can destroy the credibility of the Programme.

A key component of the Department’s initiatives is the provision of clear, unambiguous and easily accepted messages about the prevention of HIV/AIDS and STDs, within an integrated Education Programme. The conflicting statements made on this issue of Sarafina II can lead to confusion, can compromise the seriousness of the epidemic in peoples’ perceptions and reduce the effectiveness of educational interventions.

Government, women and men in society, and people living with HIV/AIDS, need to be united to contain the HIV/AIDS and STDs epidemic, which is the most terrifying scourge of the twentieth century. The Sarafina II imbroglio breaks this unity and diminishes our capacity to undertake joint activities.

Similar problems can be prevented if major programme decisions on HIV/AIDS and STDs by the Department of Health are taken in consultation with the Advisory Committee.

At this late stage, the Committee will be able to endorse continued Departmental support to Sarafina II, only if Mr Ngema adheres to the recommendations made by the Evaluation Committee on the factual content of the musical play. This endorsement is also contingent on Sarafina II being given a positive clearance by other current inquiries into its production and management.

HEALTH COMMUNICATION ANTHOLOGY

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33. Where Women Have No Doctor. A health guide for women
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43. Radio Announcers Against AIDS Project CD
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44. Street Theater Against AIDS
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45. The Journal of Health Communication, Volume 5, Number 2, April-June 2000.
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Models for health communication in dealing with HIV/AIDS.
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47. A Tool Box for Building Health Communication Capacity
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48. Developing Health and Family Planning Print Materials for Low-Literate Audiences: A Guide.
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49. Teaching not preaching, Dialogue on Diarrhoea
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50. Health On Air: A guide to creative radio for development
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51. Where There is No Artist: Development Drawings and How to Use Them
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52. Guidelines for adapting Stepping Stones
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53. Let us Learn About our Body and Health
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56. How to write a radio serial drama for social development: a script writer’s manual
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57. Health Communication: Lessons from Family Planning and Reproductive Health, 1997
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58. Communication in Water Supply and Sanitation Resource Booklet
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59. HIV/AIDS CD-ROM for Health Workers
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61. Why Bad Ads Happen to Good Causes and How to Ensure They Won’t Happen to Yours
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***

Warren Feek
Director
The Communication Initiative
wfeek@comminit.com
http://www.comminit.com
ph 1-250-658-6372
fx 1-250-658-1728