Wednesday, September 9, 2015

HIV/AIDS : The invisible voices

Increasingly, health communication scholarship has been arguing about the marginalized population to become the focus of health campaigns in reducing the health disparity between the health rich and health poor. The culture centered approach advocates participatory cultured centered research by deeper understanding of culture. It reinvigorates the health advocacy campaigns by listening to the health problems faced by the communities, and in looking for solutions that are meaningful to cultural members and not dictated by external entities (Dutta-Bergman, 2004). The culture-centered approach exemplifies the need for creating a space for greater critical dialogue (Dutta & DeSouza, 2008).
In this blog, I seek to elucidate the need for a space in Indian news media for the marginalized community, ‘high risk’ community, while addressing HIV/AIDS.
National AIDS Control Organisation (NACO), a division of the Ministry of Health and Family Welfare that provides leadership to HIV/AIDS control programme in India, refers to the population who are at high risk of HIV infections as “high risk” group. High risk group refers to Female Sex Workers- FSW, Male having Sex with Male- MSM and Injecting Drug Users- IDUs. Clearly, “high risk” is an umbrella term for a population with a diverse localized cultural and social identities.
In Mohan Dutta’s ‘The unheard voices of Santalis: Communicating about health from the margins of India’ and ‘Theory and practice in health communication campaigns: A critical interrogation’, he talks about the systematic marginalization  of poor in different realms of health, as evidenced by the erasure/absence of voices in discursive spaces. This intrigued me to do a research for news stories on HIV/AIDS. I selected World Aids Day, 1st December, 2014, to look for any narratives from the “high-risk” group in the largest selling English-language daily in India, Times of India, as well as the construction of the content.
To identify the articles, I searched LexisNexis for the term HIV/AIDS. The search resulted in 18 articles. I included all article types i.e., reports, features, editorials for my analysis. Most of the articles talked about various  initiatives by stakeholders, such as the government, international donors, and advocacy groups (e.g., nongovernmental organizations [NGOs]) , the severity of the problem, opinions of celebrities, the social stigma. Example of this can be seen in the following excerpts:
Speaking with TOI ahead of the world HIV AIDS Awareness Day, Indian Society of Haemetology and Blood Transfusion president A K Tripathi said, "FDT will soon be introduced across all ART centers across UP. In King George's Medical University it will be launched in mid-December."
Poonam Khetrapal Singh, regional director, WHO South-East Asia, said stigma, discrimination and restrictive laws continued to be barriers to accessing prevention, care and treatment services. "The HIV epidemic in our region is concentrated among populations most vulnerable to HIV: men who have sex with men, transgender people, people who inject drugs, sex workers, people in prisons and other closed settings. Although we have been successful in scaling up the health sector response for the vulnerable populations, more needs to be done. Less than 50% of these people know their HIV status," she said.

The irony is the vulnerable population i.e the high-risk group who get mentioned in most of the articles, their voices remain silenced. There is no narrative from the 'high-risk' group. It is always the expert who talks about the high-risk group and their vulnerability. It is the expert who decides what is good and bad for them. The basic idea behind this is to maintain objective distance, which gives the expert the objective knowledge about these communities, which he or she can use for health communication intervention. The high risk
community is ‘the other’ who gets mentioned in the articles in a way which makes them situate in the distant, far from the civil society. For example:

The drop in the number of fresh cases is due to the increasing awareness among the public, especially the risk-prone communities of sex workers, homosexuals and transgenders, said Bakthavatchalam A, deputy director of Association for Rural Mass India, a non-profit organization working in the health sector.
Media play a vital role in social constructions by the shaping the way in which it frames any issue. According to Airhihenbuwa & Obregon(2000), to understand the problems of HIV/AIDS, one has to understand the cultural phenomena that is constructed largely by media (DeSouza, 2007). HIV/AIDS is mostly constructed as a disease of ‘high-risk’ community (‘the other’)  instead of trying to understand the cultural and structural factors that increases the spread of this disease. Also, it is mostly narrated by the expert. Therefore, it is built upon the limited knowledge of the expert's (‘the outsider’) communication phenomena and research methodology, which lacks the knowledge of the community and its culture.(Dutta, 2007). Culture is intertwined with structures. For the high-risk group, structural factors are adequate access to condoms, STD treatment, HIV testing, and information on the diseases, as well as their economic situation.
Human health is not only dependent on the awareness of individuals and their communities. It is intertwined with the broader social-economic-political processes such as globalization and neoliberal policies (Dutta, 2008). Media, rather than stigmatizing the stigmatized population, should strive for a dialogue with the high-risk communities and not just the stakeholders.  Such construction of HIV accentuates the divide between the haves and have-nots, that in turn, manifests in increasing infections and diseases on the vulnerable population.

References:

De Souza, R. (2007): The Construction of HIV/AIDS in Indian Newspapers: A Frame Analysis, Health Communication, 21:3, 257-266
Dutta, M.J. & De Souza, R. (2008): The Past, Present, and Future of Health Development Campaigns: Reflexivity and the Critical-Cultural Approach, Health Communication, 23:4, 326-339
Dutta-Bergman, M. (2004). The unheard voices of Santalis: Communi- cating about health from the margins of India. Communication Theory, 14, 237–263.
Dutta-Bergman, M. (2005). Theory and practice in health communication campaigns: A critical interrogation. Health Communication, 18, 103–122.

Dutta, M.J. (2007): Communicating About Culture and Health: Theorizing Culture-Centered and Cultural Sensitivity Approaches

Dutta, M.J. (2008): Communicating health: A culture-centered approach 

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