This paper was delivered at a workshop on Caribbean media coverage of the HIV/AIDS epidemic in December 2006
Introduction
Not unlike media elsewhere in the developed
and developing world, the Caribbean mass media
have been recognised for what is believed to be their considerable potential to
deliver direct information, influence attitudes and behaviour and affect public
policy on a range of developmental issues. Researchers however claim that the
very characteristics that render mass media a powerful ally can also have
severely negative impacts on agendas to promote positive change.
Knowledge is power in the struggle to cope with and contain
HIV. People who are well-informed about the epidemic are able to assess the
threat posed by the virus and to know how best to avoid infection, or, if they
are HIV-positive, how to look after themselves and their partners and families.
But for individuals to be able to act effectively on what they know, they need an enlightened environment. The mass media have a huge contribution to make on both fronts. Besides delivering direct information, they have the potential to influence attitudes, behaviour and even policy-making in a myriad of ways through their coverage of the epidemic in news, drama, documentary and discussion.
But for individuals to be able to act effectively on what they know, they need an enlightened environment. The mass media have a huge contribution to make on both fronts. Besides delivering direct information, they have the potential to influence attitudes, behaviour and even policy-making in a myriad of ways through their coverage of the epidemic in news, drama, documentary and discussion.
However, this is a double-edged sword. The media reflect as
well as shape culture and social norms. Ensuring that the messages conveyed
assist people to cope with and resist HIV rather than inadvertently falling
victim to the epidemic requires wisdom, sensitivity and clarity of purpose.
Recent events inJamaica
Recent events in
Such ambiguity has generated concern that
while mass media can serve as an important tool in the process of health
promotion, they can also present the process with some of its sternest challenges.
Relative relief is found in the recognition that the media are but one element
of a range of interventions to promote behaviour change and that literacy,
interpersonal communication and explicit programmes of media advocacy are
important factors that both complement and counter the presumed impacts of
media content.
It has also been recognised that prior
notions of behaviour change through individualistic models of mass media
messaging on the HIV/AIDS question are challenged by other processes that
impact on community action and social change.
In 2002, Nancy Coulson noted in her discourse on developments
in the use of the mass media at the national level for HIV/AIDS prevention in South Africa
there exists “a plethora of models and
schools of thought that public health specialists can use to inform the
development of public health communication campaigns. These models include the
founding vision for health promotion captured in the 1986 Ottawa
In this context, communication experts appear
now to be turning full circle on the question of mass impacts versus individual
behaviourial transformation.
Media
Mainstreaming
The “mainstreaming” of HIV/AIDS information
in the media is related to the belief that integration of the subject into
routine media content will attract to it a greater level of credibility as
“earned” media output while reflecting its multi-faceted character. This, it is
presumed rewards such interventions with mass appeal.
The Bridgetown Declaration on the
Caribbean Media Response to HIV/AIDS acts on this very
assumption. Regional broadcast executives declared:
“We, the leaders of
the Caribbean broadcast media, gathered in Bridgetown on this 10th day of May
2006, inspired by the UN Secretary General’s call to action under the Global
Media AIDS Initiative, acknowledge that the HIV/AIDS epidemic is a threat to
humankind and an urgent impediment to the future prospects and wellbeing of all
our nations, undermining our efforts to build social capital and strong
economic systems in our countries.
Convinced that media
have a critical role to play in the fight against HIV/AIDS and that Caribbean
broadcasters can make a unique and important contribution to HIV/AIDS
information dissemination, awareness, behaviour change, and care and support in
our countries and communities …”
Silvio
Waisbord’s Family Tree of Theories, Methodologies and Strategies in Development
Communication however cites Flay
& Burton 1990 and Hornik 1989 in concluding that “much of the current thinking is that
successful interventions combine media channels and interpersonal communication. Against
arguments of powerful media effects that dominated development communication in the past, recent
conclusions suggest that blending
media and interpersonal channels is fundamental for effective interventions.”
Additionally, the mass media are being
recognised for functions including the independent verification of specific
health promotion interventions and the sourcing of mass communication skills
outside the direct ambit of journalistic practice.
It is clear the shifting bases of mass media
theory on the question of development communication have embraced the notion of
behaviour change as a function of a process that owes much less to previously
held positions on the effects of mass media than it embraces a wide range of
socio-economic factors.
For example, recent social marketing models embrace
the view that “while media can be an
important aspect of social marketing, other components, including rigorous
planning and consumer research, channel-specific strategy development, and
formative evaluation are equally important. Likewise, other types of
interventions, such as training programs, community activities, and materials
development, are equally as valuable as media campaigns, if not more.” (Bellamy,
H., Salit, R. Bell, L. Social Marketing Resource Manual: A Guide for State
Nutrition Education Networks, 1997).
One activity that has assisted in
the mainstreaming of HIV/AIDS issues in the Caribbean
media is the annual Media Awards programme of the Pan American Health
Organization Office of Caribbean Programme Coordination. In 2004, the
institution introduced the new category of HIV/AIDS in response to a
recommendation from its Panel of Judges that this be done to help keep the
public up to date on information and approaches to the treatment and management
of the disease.
Since then, there have been awards
for coverage of HIV/AIDS Prevention; the CAREC Award for an Alternative Media
Story on HIV/AIDS and the CARICOM Award for Coverage of HIV/AIDS.
The PAHO Media Awards programme is
the leading media awards scheme in any sphere in the region. It has developed
into an operation that covers a wide portion of the Caribbean
area and has assisted in generating greater awareness by media professionals of
their role in properly covering the subject.
PAHO says it sees the programme as being designed “to promote higher
standards in regional health journalism and stimulate quality reporting on a
regular basis in all the media.”
The
Caribbean Media
It is important, as well, to discuss the
nature of Caribbean media and the social,
cultural and economic antecedents that drive their development. There is little
doubt that the media have played a historical role in affecting public policy
discourse and action.
Understanding the Media in the
Caribbean states: “Newspapers were first established
in the English-speaking territories as far back as the mid 18th Century at a
time when primary production for export to European markets, under conditions
of colonialism, dominated the socio-economic landscape. Mediated information
flows thus engaged domestic developments primarily at the level of their
impacts on the relationship between Caribbean
production and the state of a market itself in the throes of dramatic change.
Newspapers were a way of
reinforcing a status quo which, by and large, co-existed well with the changing
circumstances, serving as efficient advertising vehicles for new products and
ensuring the smooth flow of information between the colonial homelands and
their overseas operatives. So important was this role that by the mid 1800s,
there were more than 100 newspapers in the colonies.” (Gibbings, 2004)
It is also indicated that the relative upsurge in
socio-economic crises that have accompanied Caribbean societies into a new era of
international stringency and interaction have been met by a string of
corresponding social policy initiatives that have brought the media into
sharper focus. Many Caribbean societies are,
for example, debating cultural policies and new directions in training and
education. New policy frameworks are also being devised to attend to issues
such as conflict and the disintegration of Caribbean
societies.
These
initiatives have not been having a neutral impact on the free press. Cultural
policies to counter the impact of what is described as the penetration of
non-Caribbean cultural value systems have led to the proposed imposition of
measures such as broadcast content quotas and other such threats to the free
operation of media enterprises.
Matters
of social cohesion also, for example, led in Trinidad and Tobago Jamaica
The
region has also recently been characterised by a new era of politics with an
unprecedented string of changes in government and, in some instances, a
rotating of roles between government and opposition. Exposure to this dramatic
degree of political vulnerability is partly responsible for what can only be
described as a new wave of subtle but dangerous threats to free expression and
the free press in the Caribbean .
There are also distinct but not unrelated
concerns linked to perceptions of media and cultural imperialism. Such concerns
have often led to policy initiatives to promote cultural protectionism.
Bilali Camara et al, for example suggested in
a paper to the first Champions for Change workshop in 2004: “An issue is that Caribbean states have
little control of the content, cultural
framing and sheer volume of the foreign media. At the start of the
epidemic, there was little data
and information on the regional expression of the disease and most of the media reports were from North America . A number of issues raised by the disease, particularly as they relate
to sexuality, condom use, and sex work, were foisted on the Caribbean
publics. The range of responses of the health educators and information, education and communication (IEC) material
developers in the region ranged
from clarity, to ambivalence, to denial. This, therefore, is the challenge the region faces.
To
suggest that non-regional media were capable of foisting undesirable material
on unsuspecting Caribbean media audiences to an undetermined and undefined
degree would be to ignore current thinking on mass media effects as outlined
above and to invite policy interventions that have increasingly tended to
prescribe regulatory control over media content.
In any event, as noted in the PAHO 2005 study
on Coverage of Health in the Media of St Vincent and the Grenadines, “Many
studies on HIV/AIDS have found that initial coverage includes mostly foreign
stories which become localized over time as local governments start to address the
issue within their own country.”
The Association of Caribbean MediaWorkers
(ACM) has led efforts to resist policy and regulatory interventions related to
foreign content in the regional mass media. Current debates over broadcast
content quotas to promote greater domestic content have, in my view, distracted
from the urgent imperative of action to develop indigenous broadcast content
through direct support for the enhancement of specific production skills.
Broadcast
content quotas contravene basic principles of free expression and fair business
practice and vainly attempt to legislate taste. In their place, regimes of
fiscal support and promotion of higher technical standards in domestic
broadcast media production can go a long way in addressing perceived
shortcomings.
The ACM has also argued in favour of professional
development strategies in the field of journalism to better reflect the
Caribbean experience and to instill an ethic and aesthetic reflective of the
needs of Caribbean society.
Sir George Alleyne,
United Nations Special Envoy for HIV/AIDS in the Caribbean
suggests “there are basically two
approaches to the reduction of stigma and discrimination that are worth
considering. The first is how to reduce the level of stigma and consequent
discrimination against persons living with HIV/AIDS and those perceived or
suspected of having a life-style that increases their vulnerability to HIV/AIDS.
The second is to accept that stigma and discrimination currently exist and find
measures to protect persons against them.”
A media study conducted by Internews Network’s Local Voices
project, in collaboration with two of the leading international networks on
HIV/AIDS, the Global Network of People Living with HIV/AIDS (GNP+), and the
International Council of AIDS Service Organizations (ICASO) entitled Frontline
perspectives on how the global news media reports on HIV/AIDS was launched on
World AIDS Day 2006.
The report analyses views from more than 130 PLWHA leaders
and 200 HIV/AIDS programme managers from more than 44 countries. In one section
on Inaccurate and Stigmatising Language, there is the contention that “discriminatory, stigmatising and inaccurate
language used by local news media about HIV/AIDS remains a serious concern and
continues to undermine effective coverage of HIV news, according to PLHIV respondents.
They link this failure to a weakness in research and knowledge of HIV/AIDS by
local journalists as well as a lack of interest by their editors and publishers.”
According
to the report, respondents to a survey conducted by the project “agreed across the board that the biggest
failure of media coverage is in the portrayal of PLHIV, while acknowledging
some improvement as activists engage more proactively with journalists. Ninety-six
percent of PLHIV respondents said that stories opposing stigma and discrimination
need more coverage, such as reporting on internalised stigma of PLHIV and the
effect of homophobia on national strategies to combat HIV and AIDS.”
This statement can be said to be largely true of the Caribbean situation and interventions are clearly
required to address these shortcomings.
Journalists’ Views
Media outputs are recognised as contributory factors in both
the promotion and mitigation of stigma and discrimination against PLWHA.
A survey conducted for this workshop solicited the views of 10
senior journalists in Grenada ,
Guyana , Jamaica , St Lucia ,
St Vincent & the Grenadines, St Maarten and Trinidad and Tobago on the question
of media mainstreaming of HIV/AIDS issues, stigma and discrimination and
perceived shortcomings in media coverage of such issues.
Six respondents said they did not believe that their media institution
had sufficiently mainstreamed HIV/AIDS issues. Mainstreaming is here defined as
the integration of HIV/AIDS issues into
routine media content.
When asked what
changes had been recognised in the treatment of HIV/AIDS material in their
media over the past five years, the responses included:
i.
“Inappropriate”
language is now generally not included in news stories;
ii.
Greater care is
taken to report HIV/AIDS news “responsibly”.
St Vincent & the
Grenadines
i.
The
issue is now covered seasonally on occasions such as World AIDS Day;
ii.
There are more
workshops and conferences to cover.
i.
The
issue has gained greater prominence in the news (maybe because more people are
dying);
ii.
It however
faces the danger of being “overplayed” and therefore be eventually accorded
less attention.
Trinidad & Tobago
i.
News media present such stories with a greater sense of
its human interest nature;
ii.
PLWHA are now viewed in a more favourable light in the
media;
iii.
More informational material is now published in the media.
i.
AIDS is no longer a “taboo” topic in the media;
ii.
It is present in the media more in terms of its
educational value
St Maarten
i.
HIV/AIDS news and information is viewed mainly as
material for special supplements.
i.
The disease is reported less as a “doomsday” story;
ii.
More informational material is now published in the
media.
The survey also sought to determine whether these
journalists viewed coverage of HIV/AIDS issues as “multi-sectoral” in nature. All
respondents agreed the HIV/AIDS story was cross-cutting in nature and was
eligible for coverage under the following headings:
- Economy/Finance
- Tourism
- Social
Affairs
- Education
- Child
Welfare
- Culture/Entertainment
- Crime
- Lifestyle
- Politics
- Population
- Labour
Significantly, 7 respondents thought that “media attention
is being paid to HIV/AIDS to the detriment of coverage of diseases such as
diabetes and heart disease.” There was one journalist who said reporting on
these diseases was, in any event, “seasonal”.
On the question of whether the media have been helpful in
promoting responsible sexual behaviour in their countries, 6 of the journalists
said “yes”, one person said “not as much as we should” while 3 said “no”. Some
who said “yes” had provisos such as: “we have tried but no one pays much
attention”, “there is room for improvement”, “there is less shame in reporting
these things now.”
Asked whether they believed PLWHA are discriminated against
in their countries, the respondent from St Maarten said “no”, another said
“somewhat” while the rest said “yes”. The ways in which PLWHA are discriminated
against included: denial of employment opportunities, school places, services
and stereotyping based on sexual orientation.
The journalists were however divided on the question of
whether the media “play a role in promoting negative images of persons infected
with the virus.” Two respondents said the media were “somewhat” responsible.
Asked to rate their level of HIV/AIDS awareness of their
journalistic colleagues seven described it as “medium” and three said levels of
awareness were “high”.
Asked whether they believed they knew enough about the
disease, all responded they would like to know more.
The journalists then suggested ways of promoting “greater
awareness of the disease and its impact among media workers”. These included:
i.
More regular seminars and workshops
ii.
More media-friendly information from the experts
iii.
A regular media-focused HIV/AIDS newsletter
iv.
The use of more graphic images of impact of the disease
v.
More direct access to PLWHA
Development of journalistic skills in health reporting and
the re-directing of editorial policies are recommended as effective strategies
in addressing the multi-faceted phenomenon.
In a survey among a wider group of
regional journalists conducted by the ACM in collaboration with the Population
Reference Bureau of the U.S, in May 2005, coverage of HIV/AIDS is among the
five major areas of concern of journalists engaged in environment and health
reporting.
The survey attempted to gauge the
most important sources of news and information that advised reporting on
population, health and environmental issues. Person-to-personal interviews were
the major source (82%); the Internet (73%) and Press releases (55%).
Ninety-five percent of respondents
said they consulted regularly with experts and government offices on such
issues. Sixty-eight percent consulted regularly with Non-Governmental
Organisations while 63% relied heavily on Press Conferences.
When asked what were the most
important professional needs to enable them to perform their duties at a higher
level, the following were identified:
-
Training in
investigative techniques (79%)
-
Lists of experts to
contact (68%)
-
Tips for interpreting
and citing data (63%)
-
Training in how to
effectively use internet (47%)
A follow-up workshop was hosted by
the PRB together with the Caribbean Environmental Health Institute and the ACM
in Barbados
on May 30-31, 2006. The workshop, recognising the needs identified, focused on:
-
How to frame issues
-
Some contact with
experts
-
Some exposure to
investigative techniques
-
Some tips for
reporting using population data and internet sources
These kinds of efforts have been replicated through
activities involving the Pan American Health Organisation, the United Nations
Education, Scientific and Cultural Organisation (UNESC) and Caribbean Community
Climate Change Centre (CCCCC) over recent years.
The Panos Institute of the Caribbean
has also led several direct journalistic interventions on the coverage of
HIV/AIDS issues. One of its more innovative efforts has been the use of “child
journalists” to tell the story of Haiti through the eyes of children.
It is advisable that follow-up activity involving PANCAP
proceed on the basis of clearly identified needs as described by the
journalistic community.
Programmes of professional, journalistic development also
need to take into account the changing face of the work environment for Caribbean media workers. In a paper presented to The World
Commission on the Social Dimension of Globalisation, Caribbean Dialogue in Barbados
“The
introduction of new information technologies to the communications industry has
significantly changed the media workplace. It can be observed that in many
instances, a shrinking share of financial resources is being devoted to the
remuneration of media workers engaged in newsgathering.
There is now a greater degree of
multi-tasking in the mass media with the resulting elimination of some human
tasks in both electronic and print operations. The implications for journalism
are recognisable through the non-moderated nature of much more easily accessed
foreign news inputs and the negative impact of multi-skilling in the production
of both print and broadcast media products.
There is also growing concern about
authors' rights, especially in the case of the growing number of freelance
journalists. The efficiency with which news outputs can now move beyond national
boundaries has both increased the range of benefits linked to the practice of
freelance journalism and presented it with its sternest challenge.”
Media Studies
There have also been a few attempts at more closely
examining media content and coverage of HIV/AIDS issues. In 1995, a content
study on Reporting on HIV/AIDS in Trinidad (1992 – 1994) was executed by the
Caribbean Institute for Media and Communication (CARIMAC) at the University of
the West Indies, Mona following a similar study in 1994 which looked at Reporting
on HIV/AIDS in Jamaica
during the course of 1992.
The results of these studies are not easily accessible and do
not appear to have been widely circulated at the time. However, a rather
comprehensive investigation of The Coverage of Health in the Media of St.
Vincent and the Grenadines was commissioned by
PAHO in 2005 under the leadership of CARIMAC lecturer Livingston White.
This
report concluded that “the coverage and treatment of the HRC
(health-related content) was described and the findings suggest that there is
room for improvement in the area of health journalism especially in the way
journalists explore the health implications present within stories which on the
surface do not seem to have any potential for a health focus. The study showed
that there were 164 missed opportunities where journalists could have explore
more fully the health implications of certain stories.”
This finding suggests the existence of gaps between coverage
of otherwise unrelated events and their potential to emerge as HRC. This is an
area that can be addressed both through a revision in the approach of agencies
concerned with coverage of health issues and via a process of systematic
orientation of journalists. It can be argued that the gap emerges largely from
the failure of agencies concerned with health promotion to identify essential
links between otherwise mundane information and news and the implications for
health.
The study is being replicated in six other countries and an
audience response component is being included.
Over the past 10-15 years the Caribbean
media have made great strides in reversing the tendency to propagate
misconceptions about the nature and scope of the disease which led to pervasive
social disapproval of PLWHA and persistent discriminatory practices in the
labour market. But, media reportage of conspiracy theories and misinformation
regarding the means of transmission have served to validate unsubstantiated
views and information, some of which still exist.
It
has also been found elsewhere, and confirmed in the St Vincent and the Grenadines
study, that the use of “negative terminology” in reporting on HIV/AIDS has been
readily associated with popular descriptions of the virus and the disease. In
the Caribbean , media research on this subject
has been largely confined to limited analyses of media production (the form and
source of the media coverage) while considerably more attention has been paid
to media content (the information being conveyed). There has meanwhile been
little or no attention paid to the impact of production and content on media
audiences.
Hopefully,
the PAHO/CARIMAC study will begin to fill this information void.
The
WHO’s Technical Report Series No 938 cites the findings of a study which looked
at the influence of media interventions on HIV/AIDS through the findings of 15
studies that evaluated such programmes between 1990 and 2004.
These
findings do not examine the effects of non HIV/AIDS specific material but,
importantly, notes, some of the influences observed. The studies were however confined
to three main types of mass media interventions including: radio only; radio
with supporting media and radio and television with supporting media.
The
outcomes measured included: knowledge, skills (self-efficacy in terms of
abstinence or condom use), sexual behaviour (condom use, numbers of partners,
abstinence), communication (parents, others), social norms, awareness and use
of health services.
The findings
of the studies supported the effectiveness of mass media interventions in
increasing knowledge of HIV transmission, improving self-efficacy in condom
use, influencing some social norms, increasing the amount of interpersonal
communication, increasing condom use and boosting awareness of health
providers.
The
review concluded that mass media programmes can and do influence HIV-related
outcomes among young people, although not on every variable or in every
campaign. Campaigns that include television require the highest threshold of
evidence, yet they also yield the strongest evidence of effects.
It is
evident that the paucity of media effects research in the Caribbean
context has served to undermine confidence in the interventions of the
developmental community through the almost exclusive focus on content analyses
which, though useful, do not interpret the actual impacts of such interventions
and/or the effects of general media content.
Even
so, advocates of mass media interventions should bear in mind that the evidence
strongly suggests questionable general returns in the context of fundamental
behaviour change.
M. M. Cassell et al indicated in their 1998 paper Health Communication on the Internet: An
Effective Channel for Health Behavior Change? that “within the field of public health, much attention has been devoted to
potential uses of the mass media to modify attitudes, shape behavior, and
generally persuade audiences to protect their health (Amezcua, McAllister,
Ramirez, & Espinoza, 1990; Hornik, 1989; Wallack, 1989). However, where
newspapers, magazines, radio, and television have been used to modify health
practices, research indicates that these mass media are not very compelling channels
for effecting behavior change (Backer, Rogers, & Sopory, 1992; McQuail, 1987;
Rogers, 1983; Rogers & Storey, 1987). Although mass media channels have
proven capable of reaching and informing large audiences, interpersonal
channels have been more successful in influencing attitudes and motivating
behavior change (Backer et al., 1992; Rogers & Storey, 1987). For health
educators, the practical implication of this research is that mass media
channels are appropriate for creating awareness, but interpersonal interactions
are essential for persuading individuals to adopt health-promoting behaviors.”
The
need clearly exists for greater investment in the monitoring and evaluation of
programmed mass media interventions in the Caribbean
and estimations of the impact of general media content on behaviour change.
Recommendations
Though there exists a basis to suggest favourable mass media
responses to the thrust by developmental agencies on the question of HIV/AIDS,
with particular but not exclusive attention to stigma and discrimination
against PLWHA, there appear to be gaps in the attempt to relate the presence of
more information to behaviour change.
The following recommended actions can assist in addressing
these gaps, together with concerns expressed in this paper regarding the absence
of an empirical basis for determining the efficacy of media-oriented
interventions.
i.
The need to establish a cadre of Caribbean
media professionals fully equipped to address informational shortcomings both
with their media enterprises and among media audiences is well recognised.
These professionals can benefit from the development of a Handbook for
Caribbean Journalists on HIV/AIDS.
ii.
There have been several attempts to convene lasting
online networks of Caribbean health reporters.
In 2004, the ACM, in collaboration with PAHO established Caribbean Healthnet –
a network of journalists interested in health reporting. Though the network has
become moribund, it provides the region with a model that ought to have been initially
supplemented by a further strategy to encourage production of journalistic
outputs. Such a model existed in the Caribbean Environmental Reporters’ Network
(CERN) which offered journalists the opportunity to earn freelance incomes
through such reportage while the network made use of international media alliances
to ensure broad usage of the material generated. A similar model is currently
being development by the ACM with assistance from the Inter-American Institute
for Cooperation on Agriculture (IICA) named CARN – Caribbean Agricultural
Reporters’ Network.
iii.
Resources ought to be allocated to enable the
conducting of long-term media effects research to investigate the impact of
HIV/AIDS media content on specific aspects of behaviour. CARIMAC is perhaps
best placed to partner in this exercise.
iv.
This paper, especially its accompanying survey, firmly
establishes the cross-cutting nature of the HIV/AIDS journalistic story. It
would therefore be important that journalists across a wide variety of ‘beats’
receive exposure to specific information on the disease and its impacts. The participation
of business/finance, labour and political reporters should be encouraged at HIV/AIDS
workshops to stress multi-faceted nature of the subject.
v.
Journalistic workshops should also disaggregate print
and broadcast media for specialised treatment. This should be at media
workshops and efforts should be made to identify leading figures in emerging
new media, especially online media.
vi.
Given the increasing injection of funding into media
interventions against HIV/AIDS, there should be some effort at a closer
examination of the media’s treatment and effects, specifically audience
response, that may help to better inform the effort to prevent and/or control
HIV. This is a costly undertaking but will undoubtedly build on the work
already being engaged in this area.
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December 7, 2006
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