Perfecting their song and dance routines, virgins throughout KwaZulu-Natal are busy preparing for next month’s Reed Dance Ceremony to be held at King Zwelithini’s palace in Nongoma. This ceremony is a big event on the province’s cultural calendar, and the need to prepare young virgins to take part in the ceremony means that the services of virginity testers are in high demand at this time of year. August (aka “Woman’s Month”), is usually the time when final genital inspections are made and the required virginity certificates, that allow girls to board the bus for KwaNongoma, are issued.

While the government has sought to prohibit virginity testing through the recent Children’s Bill, the practice remains a cornerstone of traditionalist attempts to address a range of endemic sex-related social problems such as teenage pregnancy, STIs, child abuse and HIV/AIDS. From the perspective of virginity testers it’s not simply about handing out certificates and dividing what they call “the rotten potatoes from the flowers of the nation.” Ultimately it’s about reviving what many see as two important social values that are rapidly being lost with democracy and its accompanying moral degeneration; that is abstinence before marriage and pride in being a virgin.

Public interest in virginity testing as a culturally approved way to deal with contemporary social ills is growing across the continent, and its revival exposes certain contradictions that hinder the adoption of safer sex practices in many African societies. While group norms favour early sexual experimentation, at the same time the idealised behaviour for boys and girls is to delay sexual initiation. In some local studies young people report a preference for pre-marital abstinence, yet we see a progressive decline in the age of sexual debut. In a recent HSRC study on the topic, as much as 78% of young people surveyed in five South African cities said they favoured abstaining from sex before marriage. Girls especially report a desire to acquire the necessary skills and support that might assist them to remain sexually inactive. While these studies might suggest a persistent discord between indigenous cultural values and imported Christian values, they also suggest an environment that undermines young people’s sexual health decision making.

If such findings are a true reflection of how people feel towards sex before marriage, they reveal a very wide gulf between the professed ideals and the lived realities of our youth. With such wide support for abstinence, we need to ask what is it then that prevents so many from delaying sex until marriage or at least until they reach young adulthood? Apparently there are many things.

For starters there is a whole catalogue of far-fetched ideas and myths that link celibacy, most especially male celibacy, to mental and physical illness. Local studies with men representing different class and geographical backgrounds reveal that many view sex as playing a key role in the bodily regulation of a balanced supply of blood and sperm. Sex was essential for the maintenance of good health. A boy’s first nocturnal emissions are taken as a sign that henceforth sex would be required to maintain a healthy fluid balance. Among the conditions believed to be associated with lack of sex is depression, acne, obesity, violent outbursts and progressive mental deterioration. Prolonged celibacy is also said to carry the risk of sperm “going backwards” up a man’s spine to affect his brain. Should this happen, suicide is reported to be a likely result, but committing rape is also said to be a possibility as the affected man might become excessively violent and confused. The message to boys who grow up hearing such absurdities is that abstaining from sex carries a risk. A sexually inactive man is a danger to himself and society.

Beyond such myths that help to perpetuate the idea that male sexuality cannot be restrained and therefor the burden for preventing pregnancy, rape, HIV/AIDS etc, falls naturally onto the shoulders of women, there are other factors that influence the timing of sexual initiation. Studies from the southern African region have found that perceptions about the sexual behaviour of peers are a significant factor when it comes to early sex. When friends are perceived to be sexually active, the odds are that the youth will also be sexually active. For girls, the absence of a father figure in the home is linked to early sexual activity. For boys and girls urban residence is a predictor of early sexual debut, meaning that a child who lives in an urban environment is more likely to engage in sex from an earlier age than his counterparts in the rural areas. Urban residence in the violent townships of South Africa means that a girl is more likely to encounter perverse forms of stigma and victimisation for being a virgin. In some places virginity is considered to be as detestable an abnormality as lesbianism, with the treatment for both conditions being the same, a “corrective” rape. The threat of this kind of rape exists along side the threat posed by other men who think that sex with a virgin can cure them of AIDS.

Recent studies have found that most abstinence-only programmes are failing to limit the spread of HIV. This is not surprising. Such results are to be expected from any stand-alone, either-or approach to this complex disease that does not account for the particularities of peoples’ lives and the environments that sabotage HIV prevention efforts. There is a desperate need to promote a balanced response to HIV/AIDS that includes all available prevention options, with those options and messages tailored to meet the needs and circumstances of the people they seek to reach. The fact remains that the “ABCs” of HIV are still the only options we currently have to prevent infection. If some young people think that being sexually inactive in the world’s epicenter for HIV/AIDS might not be such a bad idea, then they need to be vigorously encouraged and supported in ways that will allow them to be sexually inactive and protect them from becoming HIV infected after sexual debut.

The abstinence message for young people is an important and relevant message in our current context and it needs to be taken well beyond the realm of moral authority. Neither priests nor virginity testers are best placed to challenge those things that make abstinence before marriage a near-impossibility in our country today. It’s a public health matter that requires public health authorities who are honest enough to acknowledge the ways people think and feel about HIV/AIDS, and courageous enough to speak and act on that truth.

Suzanne Leclerc-Madlala, Mike Saneka, and Sabelo Zondo

(Sunday Tribune 26 August 2007)

Since the dismissal of Deputy Minister of Health Nozizwe Madlala-Routledge HIV and AIDS has featured prominently in the media. Or perhaps it would be more accurate to say that the political crisis precipitated by her dismissal has been the focus of recent media coverage. Even Ronald Suresh Roberts has had his say.

The Mail & Guardian (August 10 – 16 2007, p6) contained a page length feature incorporating a time-line and three articles; Adriaan Basson and Fikile-Ntsikelelo Moya’s “Others have done far worse”, “Nozizwe was set up”, and Rapule Tabane and Zukile Majova’s “Cosatu and others criticize Mbeki”.

The headline of the Weekender read “Fired deputy was a failure at her job, says minister” (Saturday – Sunday August 11 th – 12 th 2007 ). In the article that follows Tamar Kahn reports on the press conference held in Cape Town on the 10 th of August at which Madlala-Routledge informed the press of the circumstances surrounding her dismissal (p2). Kahn’s article “Minister hits back at noisy ex-deputy” also relates how Minister of Health Manto Tshabala-Msimang has responded. On the same page Linda Ensor writes about Madlala Routledge’s reportedly unauthorized trip to Spain in “Who went where, when, and with whose permission”.

In another piece in the same edition of the Weekender Tamar Kahn expresses the opinion that Madlala Routledge was “Author of her own downfall” and “might have been better off working quietly behind the scenes”(p8).

The same edition identifies Patricia de Lille’s statement that, “The president has finally found the courage to fire someone, but he has fired the wrong person…” as the “Thought for the Week”.

The editorial argues that “Sacking deputy health minister was a bad move” on the part of President Thabo Mbeki who has only “further alienated himself from South Africans” (p6)

The New York Times has also responded. See also the series of articles by Caxton Professor of Journalism, Anton Harber, on this site. - Alastair Douglas and Kylie Thomas

IT WAS late at night after a long day, so the President needed someone to take a second look at his weekly internet letter.

He handed it to an adviser, who read it through. “Mind if I cut it back a little bit?” the adviser asked. “This miniskirt metaphor is a bit overdone.”

“I rather liked that,” the President said, pouring himself another whisky. “That’s the sort of touch that has them calling me the poet-president.”

“Yeah, but, they will be calling you the miniskirt president, sir, with due respect, and I’m not sure that’s what you had in mind for Women’s Day. Besides, the letter is a bit long and you can have a go at these journalists and their hospital story without stretching it out.”

“Oh, come on,” the President said, snatching the copy back. “ What’s the point of all this power if I can’t have a bit of presidential licence?”

“Well, chief, be careful. You’re challenging their figures on the baby deaths, but these reporters have spent three months hanging out at this hospital, interviewing staff, taking photos, seeing some bad things. See this stuff about a placenta falling out of a woman in the kitchen because she hadn’t been properly treated? It’s not pretty.”

“But their figures are wrong. You know they’re just blowing this up to sell newspapers.”

“Their figures come from the hospital itself. And they have minutes of meetings in which the staff are saying the same things.”

The phone rang.

“It’s the comms people, sir.”

“Oh, gosh. What bit of theatre are these people thinking up for me now? Can’t they leave me to get on with some real work?”

The communications office had a suggestion: “Mr President, we can turn this Frere Hospital story to our advantage. Let’s get on a plane first thing tomorrow, fly out and you can go and look for yourself. You’ll show you really care, and we can start preparing measures you’ll announce immediately to fix the hospital. Trevor has that budget surplus he’s been wondering what to do with … and you can pop in and see your mom at the same time”. (Note from editor: This is over the top, Harber. You’re stretching our credulity. Cut the stuff about his mother.)

“Don’t be ridiculous,” the President said. “You know I hate that kind of stunt. It’ll just be a photo op. I’ll leave that stuff to the old man.”

“Not if you make it real, sir. You speak from the heart, you talk to nurses and patients, and you tell them that you will be coming back in six months to see that things are better.”

Another adviser chipped in: “He’s got a point, sir. We have these protests breaking out everywhere about service delivery and we need a way to get the message across that we care about these things, even if we can’t solve them quickly. If you’re out there doing something, people will listen when you ask them to be patient.”

“But don’t I have to see the president of somewhere-or-other tomorrow? “

“Take him with you. You can talk to him on the plane. And he’ll be impressed, sir. He’ll enjoy the photo op.”

Essop burst into the room, helped himself to a long shot of whisky, and blurted out: “Have you seen what those damn reporters are saying in Eastern Cape? And I thought that Oppelt woman was one of us.”

“Oh, shut up, Essop. I’m sick of your bile, day after day,” the President said. “It’s time we made some friends.”

He turned back to the phone. “And does this mean every time a newspaper reports a hospital problem, I have to fly in with the chequebook?”

“No, sir. That’s the minister’s job, sir. Or maybe she’ll send the deputy minister. She loves this sort of stuff. By the way, sir, Madlala-Routledge’s already on her way down there.”

“Really? That woman’s ahead of the game, hey? Get her on the phone and tell her to wait for me.”

“She’ll do whatever you tell her, sir.” - Anton Harber

EVERY now and then there is a story tucked between Paris Hilton and Jake White that cuts through all the nonsense and leaves one thinking: “This is why we practise journalism. This is why it is important. This is what it is all about.”

One such story was the exposé in East London’s Daily Dispatch last Thursday of the appalling conditions in the maternity section of Frere Hospital, which appear to have led to a large number of “stillbirth” deaths.

Deputy editor Andrew Trench led a team of three reporters — Chandre Prince, Brett Horner and Ntando Makhubu — in a two-month investigation, “walking the maternity wards with hidden cameras, attending the mass burial of dead babies and interviewing medical staff”.

It started with a single report of a death, which got them asking questions; it ended with reporters “staffing the Frere mortuary for an afternoon, answering the phone and dispatching porters to collect bodies”.

They found the place horrifically understaffed, showed that senior management knew of the problem for a long time but did little to address it, and published minutes from meetings in which doctors admitted patients were dying because of negligence.

Two images stand out from their writing: a cleaner delivering a baby in front of shocked students; and mass pauper funerals of babies as much as 18 months after their deaths.

It was good, old-fashioned, leather-pounding-the-floor reporting, done patiently and scrupulously. It required little new technology and no fancy notions of “developmental journalism”, just determination, patience and some investigative skills.

Of course, it also required the assistance of some hospital staff, who they paid tribute to in an editorial, and the support of their relatively new, young editor, Phylicia Oppelt, who must have been stretched to allow a team of reporters to do nothing else for an extended period.

“That was the biggest hurdle in the beginning — three people out of about 16 reporters on one story. Everyone had to take the pain, like news editors who couldn’t do a full news diary for weeks,” Trench said this week.

The official response was defensive. The provincial health department was given three days to answer 31 questions the reporters put to them in writing, the newspaper reported. The officials asked for more time and were given it. When the second deadline came and went, the department said they were still working on their response. It came in the form of a full-page advert giving long, detailed, technical answers to each question. It was unreadable, hostile in tone, failed to acknowledge any systemic problems, and will provide a text-book case of how not to deal with a public relations crisis.

“There was nothing spectacular and nothing surprising in their response, “ Oppelt told me. “Being in the Eastern Cape, I have no expectations of the response of the provincial authorities. They are contemptuous of us, refuse to answer our questions, ignore our reporters at press conferences and the MEC has told people she does not deal with the Dispatch.”

The minister of health’s special adviser, Prof Ronald Green-Thompson, had the national chief director of hospitals at his side when he visited and interviewed staff on Monday. He emerged to pronounce the hospital’s operations “normal”.

As seems to be the case with increasing frequency, the substantive and humane response came from Deputy Health Minister Nozizwe Madlala-Routledge, who left the South African Communist Party conference at the weekend and flew down unannounced “to see for herself”. After a two-hour visit, she said the situation in the hospital’s maternity section was “a national crisis”.

“We definitely intend to take up the matter, we are just not sure how to deal with it yet,” her special adviser said.

Oppelt said the lesson for her team was that “we might not work for a national paper, we might be a small, regional paper, but people realise they can make a difference in a very fundamental way, and that makes me very positive.

“I am so proud,” she said.

I am sure that those who say the media always gets it wrong, is staffed by people too junior and inexperienced to do a professional job, is only motivated by the desire to sell papers and make money and does not serve the national interest will now swallow their words. For once, maybe, there will be a letter from the presidency praising journalists for their role in drawing government’s attention where it is needed. Right? - Anton Harber

Twenty-year-old Chris is a student at a Durban tertiary institution who works part-time as an HIV/AIDS peer-educator for the institution’s Student Counseling Centre. His job is to facilitate workshops that will spur fellow students to practice safe sex. When briefed about a recent UNAIDS report that identified a reduction in the number of concurrent sexual partnerships as possibly the key to reversing the tide of HIV/AIDS in the region, his first reaction was to laugh. Then he added: “Now I know we are all going to die. That’s what we don’t want to do, guys or ladies. That would be the end of life.” Equating life with the pursuit of love and the excitement and intrigue of juggling several romantic relationships simultaneously, holds a particular irony for tens of thousands of young people like Chris living in AIDS-ravaged southern Africa . It’s this very same pursuit that is resulting in an all-too-real ‘end of life’.

Discouraging casual sex outside of marriage and advocating mutual monogamy between sexual partners was once the special preserve of missionaries. Today, in the name of public health as opposed to Christian morality, policy makers are being advised to do the same. But unlike efforts to promote HIV prevention through the use of technologies like condoms, microbicides or vaccines, the promotion of faithfulness is construed in much the same way as the promotion of abstinence; a nice idea but hardly realistic. Behavioural change in the context of HIV/AIDS is possibly the most difficult and most contentious preventive measure to promote. Perhaps this explains why, as a society, we have long given this option short-shift. But as with all things related to our tepid response to HIV/AIDS, we have come to pay the price of shying away from the challenge.

While the “Be Faithful” element of the ABC approach to HIV prevention is only now being recognised as pivotal for averting further social and economic disaster in the region, this is coming at a time when there seems to be greater incentives for multiple sexual partnering than ever before. Studies on the views of tertiary-level students in southern Africa, those who should know better according to some who still believe that HIV prevention is matter of awareness, reveal the challenge of convincing youngsters to forgo multiple concurrent partnering for the sake of disease prevention. Whether studying marketing in Gaborone, education in Lusaka or psychology in Durban , students report that the stress of campus life and the pressures to keep up with or impress peers are major motivations for seeking and maintaining several sexual relationships simultaneously.

For young men studying at regional tertiary institutions the pressure to prove themselves as normal and manly in the eyes of their peers is the number one reason given for their desire to have more than one girlfriend at a time. Keeping ‘back-ups’ in the event that one disappoints you by cheating is also given as a justification for concurrency, as is the ‘problem’ when a particular girlfriend is menstruating or doesn’t want sex for whatever reason.

It is likely that the motivations for multiple partnering amongst men have not changed that much through time, unlike those for women. Women’s motivations for seeking multiple partners appear to be more complex. For one thing, contemporary aspirations for gender equality often seem to carry a prescript for doing as-the-men-do. Tragically, those same aspirations are putting young women at very high risk for HIV. For many young women students being faithful to a singular boyfriend whom they say is likely to already have other girlfriends or, if not, will at some point get others, is viewed as senseless, and some would even say stupid. Additional boyfriends act as a hedge against heartbreak, providing a ready shoulder to cry on in the expected eventuality that one boyfriend will hurt you. In the words of Gladys from Zambia : “Having several partners is to me an advantage because when one disappoints you another comforts you. It reduces your stress. When I hear so-and-so is cheating I just don’t worry myself as I’m doing the same. You can never trust men.” University women in Botswana hold similar views: “It’s rather stupid to be faithful to one as he’ll betray you. Then you feel unattractive and uncared-for, even suicidal, so what’s the use?” For many women students in southern Africa having multiple concurrent partnerships contributes towards boosting self-esteem, feeling loved, and, if the guy is from a higher class, improving one’s status amongst peers.

Would increasing a woman’s sense of self-worth then lower her risk of exposure to HIV? Perhaps to some extent but not entirely. Beyond psychological and emotional reasons for maintaining a small stable of boyfriends, there are financial and social reasons. It is largely for these reasons that older boyfriends are entertained; they have jobs and social standing in the communities. Referred to as ‘ministers’ in South Africa, ‘investors’ in Zambia, or ‘patrons’ in Botswana, women not only value the material benefits that derive from these relationships but also the social benefits that include opportunities for mixing with the elite. Young women students view their liaisons with older men as ‘networking’. It’s a way of acquiring contacts amongst powerful people, some of whom may be in positions to help with securing good jobs after graduation. For these women sexual networking is a strategy for building social capital.

Understanding what prompts people to seek multiple concurrent partnerships is a first step towards designing effective messages and interventions to promote partner reduction or mutual faithfulness. To date the relatively high levels of knowledge that young people in southern Africa have regarding HIV/AIDS has resulted in little else beyond some acknowledgement that AIDS is a problem. It hasn’t resulted in behavioural change.

While they may not admit to it when filling out a survey questionnaire, many if not most young people in the region know they are at risk for HIV. Increased knowledge of HIV/AIDS seems to have led to a tacit acceptance of HIV risk, and it’s a risk they are willing to take. For people like Chris who are tasked with convincing their peers to take the threat of HIV/AIDS more seriously, peers who associate sticking to one partner with the ‘end of life’, promoting faithfulness means nothing less than attempting a re-orientation in what is for many a way of life. As difficult as it may be, our best hope for a long-term solution to the HIV/AIDS crisis lies in changing that very way of life. - Mike Seneka, Sabelo Zondo and Suzanne Leclerc-Madlala

South African Deputy Minister of Health Nozizwe Madlala Routledge was dismissed from her post on the eve of National Women’s Day. At an HIV/AIDS and the Media Project forum held in March this year, Madlala-Routledge engaged in conversation with journalists and editors about media coverage of HIV/AIDS. She said, “In the health budget vote debate last year I called for a national consensus on health issues because I believe, that in the face of the pandemic, health should be above party political differences as well as above individual personalities.”

Last month Madlala-Routledge placed the right to life of babies at Mount Frere Hospital in the Eastern Cape above her concern for her own position. She did what few other political leaders have dared to do, she declared conditions at Mount Frere Hospital a national emergency, and in the process risked losing her job.

And now the Deputy Minister of Health, who refused to toe the party line and remain silent in the face of so many unnecessary deaths, has been dismissed.

The message the government is sending out to women in South Africa is clear:

“Don’t tell us how you are struggling to feed your children.

Don’t tell us about how you have been raped and beaten.

Don’t tell us about how your babies are dying.

A good woman knows that she must hold her tongue or be punished.”

Nozizwe Madlala-Routledge is an example to us all. We need to take courage from her brave, dissenting voice and resist the attempt to silence her with our own brave words and deeds. Madlala-Routledge has been dismissed. This too is a national emergency. - Kylie Thomas

Over a period of five consecutive days (Tuesday 17 th July to Saturday 21 st July) I looked through the mainstream daily The Star for articles about HIV and AIDS. There is a large pile of newspapers lying on the floor next to me – these are sections of The Star that contained no mention at all of HIV/AIDS. And on my desk there is less than a page of handwritten notes that record the few mentions of HIV/AIDS that I came across.

In total four articles appeared in the paper over the course of five days that even mentioned HIV and AIDS. Of those four articles none actively engage with the epidemic in any depth. While journalists may mention HIV and AIDS, the epidemic is always secondary to the story.

In the Tonight section on Tuesday 17 th July there is an article by Diane de Beer that focuses on an actor who plays an HIV positive character in the play Rent , currently being staged in Johannesburg (page 7). The article also mentions the fact that one of the other characters in the show is also HIV positive but does not explore what the significance of this might be for audiences in South Africa in the time of AIDS.

On Wednesday 18 th July in the main section of The Star there is an article about the group of Bulgarian nurses sentenced to death for allegedly intentionally infecting babies with HIV. The headline was: “Ruling in Libyan HIV case lifts medics’ hopes” (page 4). Their death sentence has been commuted.

On the same day on the same page is a story about the biggest condom ever made, “Condom maker reaches for the skies”. The “condom” hot-air balloon was made for a Dutch festival to increase awareness of safe sex. The article mentions the AIDS crisis in Holland in the 1980s and refers to the increase in sexually transmitted diseases in the Netherlands in the present.

On Thursday 19 th July in the main section of the paper there is a story that is not credited to any specific writer but instead is “brought to you by LoveLife”. The headline is: “I am building for myself the life I never had” and is the life-story of a young man whose HIV status is not disclosed. While he mentions that both his sister and his brother have died, he does not say whether or not they died of AIDS related diseases. Had this article engaged with HIV and AIDS it could have contributed to HIV and AIDS awareness and prevention in South Africa . Instead HIV and AIDS are implied rather than overtly stated. This only contributes to the silence that continues to surround HIV and AIDS in South Africa .

There was no meaningful mention of HIV/AIDS in this sample of The Star newspapers and there was certainly no analysis of what is the most pressing social issue we face in this country now.

The commodification of poverty is becoming more fashionable by the hour. For instance, a new restaurant in Greenside, a trendy suburb near Johannesburg ’s CBD, allows its patrons to enjoy their dining experience as if they were in a shack. Not that there’s anything wrong with shacks themselves – many South Africans live in them – but not by choice, and they certainly don’t pay lucrative prices to use enamel crockery while sipping their latte on Gleneagles road, looking ‘shack chic’.

This phenomenon is hardly unique to South Africa though. It is more an affliction of a Western exoticisation of Africa (and the poverty that it contains).

Recently an exhibition opened in Sydney , Australia , that allows people a voyeuristic peek into the ‘real’ life of a ‘real’ African child through the comfortable distance of a virtual show. The tent where the exhibition is staged is just a stone’s-throw away from a trendy Sydney street, far removed from the reality of hot and dusty Sudan .

The One Life Experience , launched by World Vision, is “an interactive walk-through exhibition that gives visitors the chance to experience life through the eyes of impoverished African children who have been affected by Aids.”

While there might be some form of educative merit in this notion, there is more clearly a patronising, exploitative attitude that perpetuates and takes advantage of a sense of Western guilt without prompting any action.

What is just as troubling is the kind of reporting that has followed from the event, which is mostly just a re-hashing of the press release . The journalists do not seem to exhibit a sense of shock or offence, or even of any impropriety, but infer rather that the exhibition’s artistic worth is valid, poignant and educative – not manipulative and one-dimensional.

"There’s so many massive statistics like a child dies every three seconds as a result of poverty, 30 000 children die every day and it kind of has got to a point where it’s almost like water off a duck’s back," said World Vision Australia’s national events co-ordinator Eva Daly.

Ok, I get what she’s saying, I think, but “water off a duck’s back”? Seriously? AIDS has had such an overwhelming toll on human life and one can’t help but find the statistics boggling, but at the same time, one can’t escape the harrowing mortality of it and the realisation of its personal affects.

I sincerely doubt that an artistically shallow, even pretentious, exhibition in an upmarket Sydney suburb does more than elicit pangs of guilt, sentimental sympathy and a reassurance that the viewers are better off than the exhibition’s subjects.

Whether the “impoverished” African children subjects are real or fictitious, and whether any real victims of AIDS or poverty in Africa are receiving royalties from the show is also unclear. These kinds of representations completely overlook what is in fact being done in Africa , and while their concern might be appreciated, their ineffectual sympathy is not.

However, the point must be made that although the show may have missed the mark by some way, at least issues of poverty and AIDS in Africa are being publicised. Awareness is being created, even though it might be coming from an uncritical, patronising Western standpoint.

What is troubling is when this is the only way the issue enters the mainstream media in the West and there are no critical voices raised. Surely after more than 20 years of reporting on the epidemic, the media would have learned something about how recycling stereotypes causes more harm than good. - Ricky Hunt

The National Arts Festival in Grahamstown took place between the 28 th of June and the 6 th of July and provided both established and green artists alike a forum to showcase their art. Visual and performance art have been important in making HIV/AIDS visible and allow for an engagement with the complex issues that the mainstream media largely ignores.

Positive 2007 , a touring exhibition of visual arts in Grahamstown during the festival, focuses on the use of art as a tool to better understand and face the issues around HIV and AIDS. The focus is also on living with AIDS, not dying of it. But along with this is a strong focus on death as being a part of life and on coming to terms with death.

“The global proliferation of art about AIDS is unprecedented in the history of art, as no other epidemic has spawned so much artistic creation. The reason for this has not been extensively researched but it could be due to the fact that the epidemic, being closely allied to sexuality, politics and the structures of society, has made it subject to artistic expression,” says Carol Brown, curator of Positive 2007 .

There is a deep sense of irony in the title of this exhibition. The artwork by Dineo Seshee Bopape, titled Love Conquers All , which consists of red string lights luridly spelling out the title, is obviously steeped in irony. But there is another layer to this which radiates positivity as connected to a potential healing force.

Some of the art deals with unveiling death and moves it from the periphery into the center, in order to address the fear and taboo set up around it. This is evident in The Bereaved a series of photographs by Pieter Hugo , who won the prestigious Standard Bank Young Artist award for 2007 in the photography category. This collection of photographs depicts people in full frontal view, reminiscent of the traditional portrait photograph or painting. However, these people are the recently deceased, and were photographed in the morgue while being prepared for burial. The photographs were taken with consent from the families concerned and are an effort to naturalize death, as well as to explore mourning and bereaved families South Africa .

Another display in the exhibition was the Long Life Body Map project. This project uses the methodology of drawn on body-mapping on life size reams of paper and provides a way for people living with HIV and AIDS to represent themselves. The AIDS 2000 Ribbon is another important community project, displayed in photographs in the Positive 2007 exhibition. The project involved 1000 people drawn from the larger community, including AIDS orphans, school children, art students and community groups.

Other heavy weight artists such as William Kentridge and David Goldblatt participate in this careful, thoughtful and clever exhibition aimed at a new and under-explored area of the AIDS epidemic and the role of art within it.

Apart from Positive 2007, there have also been other initiatives to engage with HIV/AIDS through art and performance in South Africa . DramAidE is an HIV/AIDS awareness and prevention project that uses drama methodologies to work with young people. Another newly launched creative initiative is Drama for Life , a programme spanning over 14 SADC countries that looks to educate, inform and entertain by using theatre as a forum to discuss HIV/AIDS related issues. The programme, run through the Department of Dramatic Arts at the University of the Witwatersrand , is offering 28 scholarships in both performance and teaching capacities.

It is encouraging to see people engaging with these issues in creative and interesting ways, as creative interventions raise critical questions about how we see and respond to the epidemic and also provides a forum for marginalized voices to be heard.

It’s a sultry summer evening in 2002 in Johannesburg , South Africa ’s sprawling metropolis. The South African Broadcasting Corporation’s (SABC) 8 pm news bulletin is about to be broadcast. The service’s health correspondent has filed a story on the exorbitant prices of anti-retrovirals in the country. The report’s main focus is upon a woman with HIV who can’t afford the life prolonging medication.

The journalist has written a note in the corporation’s news filing system that the subtitle to appear on the TV screen when the woman begins speaking should read: “Person living with HIV/AIDS (PLWHA)” and not “AIDS sufferer” or “victim”.

But there are murmurs of dissatisfaction amongst the news team about the reporter’s request.

Technical staff say it simply isn’t feasible; that the subtitle suggested by the health correspondent - which they’d be required to scroll across the screen during the live broadcast of the bulletin – is too lengthy. Some editors say the acronym “makes no sense”. Pressure builds as the deadline rapidly approaches.

To add to the palpable tension in the studio, the medical journalist has chosen to be present during the news broadcast, in an effort to ensure that her request that t he woman she has interviewed be labeled a PLWHA – or, at the very least, “Person with HIV” - is fulfilled…. After all, if the woman is branded “victim” or “sufferer” by South Africa’s national broadcaster, it is she – the reporter – who will be bombarded by calls from furious AIDS activists, not the editors or the technical staff members.

The journalist knows this from experience…. This isn’t the first time she’s found herself on this precipice, straddling this gossamer line between dedication to reportage and respect for human rights.

She is constantly, and deeply, aware of the activist’s argument, that HIV-positive people can live long and healthy lives, and that referring to them as “sufferers” or “victims” is disempowering and even discriminatory towards them, and creates the impression that everyone with HIV is decaying in bed, shells pathetically succumbing to death, with no control whatsoever over the situation.

I was the health correspondent described above. Scenarios like the one above took place more than a few times between the years of 1994 to 2002, when I was employed by South Africa ’s public broadcaster to report on health issues in the country.

As I grew into the job, I naturally formed close ties with members of SA’s vocal - and sometimes downright militant - AIDS activist community. In the face of a president (Thabo Mbeki) who denied the very existence of the virus present in many of their bodies, and communities which often attacked, viciously assaulted and sometimes murdered those found to be HIV-positive, these advocacy groups exuded pure strength and bitter determination. They could not have survived otherwise. It was upon their instruction – and often their brutal insistence – that I learned to avoid the use of terms they considered stigmatizing and insulting when I reported on AIDS.

But, at the time, many of my editors argued that – because they didn’t have access to the necessary drugs, most South Africans infected with HIV were indeed “suffering victims”, and would eventually fall sick with AIDS-related illnesses and die. They pointed out that the media referred to people with other chronic illnesses, such as diabetes and cancer, as “sufferers” and “victims”, and asked why AIDS should be treated “differently” and “specially”.

The difference is, of course, that the HIV epidemic is the most politicized and stigmatized disease the world has ever seen. And the manifestation of this is especially prevalent in a country like South Africa . The mere fact that there are AIDS activists - and not cancer or malaria activists - is incontrovertible proof thereof. And language and politics are intertwined; language shapes beliefs and influences behavior.

When AIDS interest groups put pressure on journalists to use certain terms surrounding HIV, and to avoid others, they exercise great and unprecedented influence over the media…. In so doing, influencing the way that members of the public talk about the epidemic.

In the case of AIDS, insensitive language and inaccurate medical terms can foment stigma and discrimination.

Anton Harber, the head of the Journalism Programme , that hosts the HIV/AIDS and the Media Program at the University of the Witwatersrand in South Africa, says: “Journalists have a fundamental responsibility to use language accurately and appropriately” and should strive to minimize any harm they may cause through usage of certain terms.

But the task of language usage when reporting on AIDS and the people it affects is sometimes more daunting than it sounds.

The latest list of the UNAIDS Terminology Guidelines contains 14 pages of terms that reporters are often expected to use – many of them politically correct NGO jargon, such as “orphans and vulnerable children”, “opportunistic infections” and “client-initiated testing” that many newspaper readers, radio listeners and TV viewers are unlikely to understand.

To the ears of seasoned media practitioners, many of these terms also sound boring and colorless.

And the list of “politically correct” AIDS terms continues to lengthen, with activists becoming increasingly prescriptive and pushy when attempting to compel journalists to use their preferred terminology.

“I’ve often bristled when told by public health colleagues that I can’t or shouldn’t use certain words because they ‘carry a different meaning’ in the context of HIV/AIDS,” says John Pitman, a former VOA journalist now working as a blood safety technical advisor for a United States government HIV program.

Pitman believes that journalists should be aware of the “risks attached to certain words” - like “sufferer” or “victim” - but that “they should not be forced to use the dissembling jargon of global health, if it undermines their ability to tell a story truthfully and honestly.”

Professor Harber echoes this, arguing that reporters should not allow anyone to prescribe to them.

“We should use our judgment to select the appropriate words and phrases, but keep a keen ear for suggestions that the language we choose may be harmful or inaccurate. In other words, we should listen to activists - but not allow them to decide (what language reporters use). Activists, after all, may have special interests, or a narrow view - or they may be just plain wrong.”

A study conducted by the University of the Northwest in SA in 2005 found that the country’s print media regularly portrayed people with HIV as “victims”, and that such language usage negatively influenced the way in which readers talked about the disease. But, the research also argued that the many terms that activists demand that people use when describing the epidemic, were sometimes unrealistic.

“What is HIV/AIDS other than a ‘dreaded disease’?” the researchers asked. “It is to some extent necessary to tell people how ravaging AIDS is, to make sure they do not become unconcerned, without falling into the trap of sensationalism.”

It’s not only the South African media that sometimes uses words that AIDS activists and experts don’t approve of…. Many US newspapers and broadcasters do the same. A search of the Washington Post and CNN archives from the past year shows that terms such as “fight” or “war” against AIDS, AIDS “victim”, “patient” and “AIDS virus” – terms that AIDS activists disapprove of for various reasons – remain common.

But, many in the media say there are good reasons for this. Some media professionals argue that a blanket ban of certain terms is not constructive.

“It’s about using a term responsibly and sensitively,” says one of South Africa ’s leading health journalists, Anso Thom. “I think when you use ‘sufferer’ within context, it says more than a million words could ever say. But then you have to understand that you need to communicate the context within which you are using it.”

John Pitman agrees. He argues that many people still die as a result of HIV-related illnesses - despite the fact that ARV’s are becoming increasingly accessible.

“(The term) ‘living with’ has its place to describe the courage and humanity of people struggling to survive – but suffering’ remains a reality across the world. It shouldn’t be banished from stories about the pandemic,” he emphasizes.

The UNAIDS preferred terminology list also disapproves of referring to the “response” to AIDS as the “fight” or “war” against AIDS. The authors argue that these words are “combatant language” that can instill fear, and therefore instill negativity around HIV/AIDS in the public mind.

But, even the experts are extremely confused about the language they should use – or they simply disagree with the prescriptions forced upon them by AIDS advocacy organizations: In the March 9 edition of the Washington Blade , a weekly newspaper published in Washington D.C. with a predominantly gay readership, the US Department of Health and Human Services and National Institutes of Health advertised for HIV-positive volunteers for a clinical trial using the catch phrase: “Help in the fight against HIV/AIDS.”

And, often, the activists themselves use language that they themselves say don’t approve of. According to the UNAIDS list, it’s scientifically incorrect to say that “AIDS has killed someone” or that “someone has died of AIDS”. It should be “HIV-related” or “AIDS-related illness”, because AIDS – a syndrome – can’t lead to death. Yet, on 20 February this year, the South African Treatment Action Campaign’s (TAC) Nathan Geffen, a leading AIDS activist in SA, published an article that used the following sentence as its opener: “In 1997, Judge Edwin Cameron nearly died of AIDS.”

Most people will, of course, understand what Geffen meant with his sentence; it is, after all, written in the way that most people generally talk about AIDS. Yet, according to many activists, it’s scientifically incorrect and may even be discriminatory.

Journalists often ask: If the experts and activists themselves alternate terms about AIDS, how do they expect the media to constantly conform to their often brusque demands?

It’s doubtful whether readers, listeners and viewers are able to understand many of these “preferred” terms. Orphans and vulnerable children (OVC’s) is another politically correct term that many experts demand reporters to use. But, according to Thom, her readers can’t make sense of it.

“If I had to use ‘vulnerable children’, they would be really confused. Our job is to help readers understand the issues - not to make it more difficult. I think ‘orphans’ is a much more dignified term than OVC’s. If we use such a term, we are in danger of turning children into acronyms, and that is really unfortunate.”

NPR science correspondent, Brenda Wilson - who has frequently reported on AIDS in Africa - is of similar inclination.

“My listeners would not understand what I’m talking about if I referred to children orphaned by AIDS as ‘orphans and vulnerable children’. It’s too NGO-ish. I just use the word ‘orphan’, otherwise no one would know what I am talking about.”

For Kenyan radio journalist, Anne Waithera , the UNAIDS definition of orphan – a child who has lost one or both parents to HIV/AIDS – is equally confusing.

“In Kenya , an orphan means someone who has lost both parents. A child with one parent would be referred to as ‘a child from a single parent family’ and those are very common in Kenya . The word orphan gives the idea that the child is totally alone…. which makes the ‘orphan’ statistics that refer to all children that has lost one parent to AIDS open to misleading interpretations.”

Yet, NGOs refer to OVC’s in most of their press releases and interviews with journalists. It’s one of the biggest challenges Pitman faces, when training public health PR officers in effective media relations.

“I try to emphasize that just because they know what an OVC, VCT or PLWHA means - that does not mean they’re the right words or acronyms to use when communicating with the public. On a couple of occasions I’ve asked PR people to read their releases aloud. Then I take the paper away and ask them to describe the event or issues in their own words, as if they were describing it to an uncle or cousin. It’s sometimes a struggle, but the verbal recounting usually resonates in a way the regurgitated lingo doesn’t.”

A recent case in point is that of a television journalist in Kenya …. The reporter’s editors met with AIDS activists. After the meeting, the activists gave a list of preferred terminology to the editors. One of the activists’ recommendations was that people with HIV should never be referred to as “AIDS patients”, as, they stressed, many were able to live long and healthy lives and were therefore not “patients”. Shortly after the meeting, the journalist was sent to a hospital to cover a story about a person who was sick with HIV-related illnesses. Upon the reporter’s return, her editor refused to permit her to use the word “patient” in her script – even though the story was all about an emaciated man in a hospital bed who was – and this could very clearly be seen in the TV visuals – very ill.

“My editor says he’s been told to follow this list, or there’ll be big trouble,” says the journalist. “It’s now part of our broadcasting code and can’t be adjusted.”

Thom disagrees with the kind of “stifling prescription” that sometimes happens in the AIDS sphere. That certain terms are accorded “usage status” to the “total and dictatorial exclusion” of all others, rankles her.

“I think we have to acknowledge that there are journalists who have done a lot of damage by using terms in a derogatory manner, terms that feed AIDS-related stigma. But I think every story is different, every country is different and it is unfortunate if we expect to have one set of ‘rules’ for all AIDS-related stories.”

Thom believes the bottom line is: “As long as we do not harm people, we have to write the story in a way that makes the reader read it, and actually care about what has been written. We are not writing for the NGO community, we are writing for the man on the street. And it is often the man on the street that has the power to change the course of things.” - Mia Malan