How to tell a positive HIV story in Africa

It is a brutal truth that some topics, no matter how important, struggle to engage the public. One such, as reported in the western media, is HIV in sub- Saharan Africa: both the subject and location seem so distant from us in every sense.

But what does the HIV story look like as reported from the place where it is a daily reality? Last month my photographer colleague Frank Miller and I travelled to Zambia, 15 per cent of whose 14 million people are HIV positive, to try to find out.

What you cannot avoid noticing in Lusaka, the country’s capital, are the billboards that line all the main roads. Then you notice the hand-painted adverts and slogans on the walls. Their messages are stark.

“Beating. Rape. Defilement” – referring to men, often HIV positive, who have sex with their daughters, stepdaughters and granddaughters – “Men!!! Don’t just watch. Stop the violence.”

“When pregnant, get tested and treated for HIV.”

“Child sexual abuse. Stop it now.”

Although these notices are highly visible, the people affected by HIV are not. In parts of Lusaka 27 per cent of people have the virus. You would never know. People have been managing HIV for years with free anti-retroviral drugs (ARVs) and living lives that are close to normal.

What it does mean is that the challenge for Zambian media in covering the HIV story is the same as that faced in the West: readers’ fatigue with a topic that has been around for close to three decades.

Unlike in the West, however, the local media have an essential role in helping to save lives, raise awareness of the need to go for testing, and reduce the stigma of a diagnosis. The Zambian media, whether privately or state owned, recognise how crucial their role is in keeping readers engaged with the biggest public-health story in Africa of the past century.

“The newspapers speak with one voice on this topic,” says Richard Mulonga, who reported for the state-owned Times of Zambia for 14 years.

“They are united on the subject, unlike politics. There is no agenda in the reporting. HIV coverage is above politics, because even the government itself is challenged about how to tackle it.”

George Chomba is chief editorial editor at the Zambia Daily Mail. “We are not talking about people dying any more,” he says. “Fifteen years ago, the stories were about statistics. Now we try to explain why the figures are still so high. I think we have become tired of the story, but it is not because stigma has reduced around HIV. There is still stigma. For instance, people usually go outside their communities to be tested.”

Chomba would like to see investigations in which reporters follow the money that comes into the country in the form of foreign aid, not all of which goes where it is meant to.

“In Nigeria, ARVs are not free,” he says. “A Zambian government official with a suitcase of ARVs was arrested at Lusaka as he was about to get on a flight to Nigeria. He was going to sell them. But that story has died a death.”

Chomba doesn’t need to explain why his paper didn’t follow up the story of a corrupt government official: like the Times of Zambia, the Zambia Daily Mail is state owned.

Troubled and angry

Manasseh Phiri is a doctor who has been writing a weekly column for the Post, reflecting on Aids for the past eight years. The Post is privately owned. On the day we meet at his pig farm, an hour outside Lusaka, he is troubled and angry.

The previous Sunday, for the first time, his editor refused to run his Aids column. It had been headed, “As long as homosexuality is criminal, ‘zero new infections’ will not be achievable.”

“Men having sex with men is a key driver of the epidemic here,” says Phiri. “We know, for instance, there is high prevalence in prisons. But the numbers are totally unrecorded, and it’s all undercover because it is illegal. Without data we can’t get infection levels down.”

The reason he was given for his column not being published was that “there was a problem with the content”.

Phiri says he is “alarmed and surprised. It’s censorship.”

He is worried about coverage in general of the HIV story in the Zambian media. “That shock element of seeing people get very ill and die is gone. There is a level of complacency now. But it continues to be a story as long as people continue to get infected and die.”

Like Chomba, he also wants to see HIV stories focusing on aid money. “Nobody is looking at where the money is going. This year Zambia has received $380 million alone from US aid. The people on treatment in this country are alive because of the kindness of aid. If it is withdrawn, our people will die.

“People in the Zambian government should be losing sleep over this. We need to raise this money ourselves, from our own resources, over time. Depending on aid means the government is not in control of its own health programme.”

Uncomfortable

At the Post’s offices, the newspaper’s managing editor, Bivan Saluseki, looks uncomfortable when asked why Phiri’s column did not run the previous Sunday.

First he says it may have been too long and that all columns run at the editor’s discretion. There is a long silence. “This is a very political issue,” he says eventually.

Last December, Hillary Clinton announced that US aid to developing countries such as Zambia would depend on receiving countries’ recognising the rights of their gay citizens. Church organisations in particular, as well as governments, have been vocal in countering by saying that aid should not come with such moral conditions.

“If we publish stories saying homosexuality should be legal, then that has a political impact on government. We thought we would leave the topic alone for a while,” says Saluseki, who refuses to be drawn on the subject further.

Saluseki would like to see more investigative reporting, especially around aid money.

“There is a lot of NGO money in HIV-Aids, but I don’t think the money trickles down to those who need it. It’s difficult, because there isn’t any law that allows for reporters to search for documents.”

About the Post’s other HIV coverage he says, “We have moved beyond statistics. The human cost is already known. Human-interest stories work the best. We ran a story on an HIV-positive prostitute who slept with 49 people, and that was of interest to readers. We are in business. At the end of the day we need to run stories that will sell papers.”

Rosita Boland and Frank Miller travelled to Zambia with the support of the Simon Cumbers Media Fund

Campaigning for change: Pregnant and HIV positive

Connie Mudenda is a week away from having her fourth baby delivered via Caesarean when we meet at her home, outside Lusaka. She is HIV positive. Her three previous children all died from the effects of the HIV virus, one aged seven. This baby is planned and prepared for.

“There is much better care nowadays for pregnant women with HIV. There is a 99.9 per cent chance my child will be negative,” she says, referring to the fact that the Caesarean delivery reduces the chance of transmission to the baby via blood, as does using formula milk rather than breastfeeding. “HIV is a condition I live with. I’m not sick.”

Mudenda is a social worker and community activist who is passionate about HIV testing. She presents a radio show that focuses on HIV topics.

“I’ve used my situation to encourage other women to test before falling pregnant,” she says. “And we need men to test too. If men go with their partners to test, they get priority at the hospital as a result and don’t have to wait. Men usually go to clinics very late, because they are naturally more stubborn – I think that is the same the world over.”

One of the topics her radio show keeps returning to is that of pastors – some from breakaway churches, other from Pentecostal churches – who claim they can “heal” people who have HIV.

“Some people believe HIV is a punishment from God. I have a personal war against such people,” she says . “Pastors come to people’s homes – for a fee – pray over them, and tell them they don’t have to take their ARVs any more. But they don’t ask those people to go back to clinics to get retested to see if they are now negative. And then people die because they stop taking their drugs.”

Media airing: Former sex worker's World Aid's Day TV show

Last year Precious Kawinga was one of 18 sex workers who answered an advert to participate in a Zambian reality-TV show, Ready for Marriage. At the time she was making between $50 and $100 a night from clients who ranged from businessmen to politicians and civil servants.

“I was still in the industry, and I wanted to change,” she says. “The reason I went into the sex trade is that I had a broken marriage and two sons. I had to provide for them, and that is how I found myself on the streets.”

During the reality show Kawinga lived in a house for four months with the 17 other participants, who were offered training and counselling, as well as classes in deportment, first aid and art therapy. She was the only one who admitted on television that she was HIV positive – a brave admission in a country where the virus is still stigmatised.

The prize was money and a job offer. Kawinga didn’t win, but the experience was life-changing just the same: she became famous. “When I walk down the street, people come up and shake my hand and say, ‘You were very brave to say what you did.’ ”

She took up an offer to train as an HIV counsellor and has become a high-profile role-model for advocacy around HIV.

One night Kawinga takes us to a red-light district of Lusaka to meet her friend Kayosha, who dreams of getting off the streets – and would love to be a wedding planner.

Kawinga is due to become even better known in Zambia. Today, World Aids Day, she begins her television chatshow, Positively Precious. “It will run for 13 weeks, and each week I’ll be interviewing other women who are HIV positive,” she says.