So­cial me­dia

A new book on SA’s HIV/AIDS epi­demic con­tains con­tri­bu­tions from sci­en­tific ex­perts such as Olive Shisana along­side politi­cians such as Barack Obama and celebri­ties such as El­ton John. In this edited ex­tract of the in­tro­duc­tion, re­flects on the progress m

CityPress - - Voices - Africa In­sti­tute of SA 540 pages R270 (or­der from pub­lish@hsrc.ac.za)

Si­zon­qoba! Out­liv­ing AIDS in South­ern Africa, edited by Bu­sani Ng­caweni

The nar­ra­tive of the AIDS epi­demic shifted over the past decade to be­come the story of how a na­tion clawed its way out from un­der the un­bear­able weight of death from the dis­ease. What is the real story of this mon­u­men­tal tran­si­tion? Was it due to po­lit­i­cal change, phe­nom­e­nal ad­vance­ments in science, or the de­vel­op­ment of drugs and di­ag­nos­tics? Or did the ground-level pres­sure of the ac­tivists, clin­i­cians and the non­govern­men­tal or­gan­i­sa­tions – those that bat­tled daily with the virus – even­tu­ally break through? Can we claim to be win­ning the war against AIDS with al­most 400 000 new HIV in­fec­tions in the past year alone, and with­out any de­cline in the ab­so­lute num­ber of new in­fec­tions be­tween 2010 and 2015?

The 1994 demo­cratic break­through marked a sig­nif­i­cant turn for those who had suf­fered for cen­turies un­der racial seg­re­ga­tion in all facets of so­cial, po­lit­i­cal and eco­nomic life. For its part, the lib­er­a­tion move­ment pre­sented a hu­man­ist and in­clu­sive vi­sion of a new so­ci­ety char­ac­terised as demo­cratic, non­ra­cial, non­sex­ist, united and pros­per­ous. By build­ing the big­gest in­ter­na­tional sol­i­dar­ity move­ment in mod­ern his­tory, the lib­er­a­tion move­ment suc­cess­fully mo­bilised the in­ter­na­tional com­mu­nity to take a moral stand by iso­lat­ing the apartheid regime.

In the fol­low­ing years, this tri­umph of the hu­man spirit and in­ter­na­tional sol­idary would re­turn to save South Africa from yet an­other ex­is­ten­tial threat: the AIDS epi­demic. By and large, this epi­demic was present but not mak­ing head­lines un­til af­ter the 1994 demo­cratic or­der.

Soon there­after, his­tor­i­cal im­ages of apartheid mas­sacres, the iconog­ra­phy of town­ship life and ru­ral poverty were re­placed by im­ages of suf­fer­ing or­phans and fu­ner­als. This would pro­ceed to change the tone for a new govern­ment en­gaged in trans­for­ma­tive mid­wifery, giv­ing the coun­try the odi­ous crown of cap­i­tal of the world, along­side its emer­gence as the world’s new­est and most mirac­u­lous democ­racy.

Had HIV been purely a bio­med­i­cal is­sue, it may have been a dif­fer­ent chal­lenge to con­front as the so­lu­tion would have been largely sci­en­tific – en­gi­neered in a lab­o­ra­tory. It be­came ap­par­ent that it is as much a so­cial and eco­nomic is­sue, the man­age­ment of which de­pends on po­lit­i­cal will and bold lead­er­ship. The virus had “con­tam­i­nated” our so­cial fab­ric too, thriv­ing in the threads and weaves of moral judg­ment, re­li­gious and cul­tural prej­u­dice and the broad fab­ric of stigma aris­ing from fear, ig­no­rance and the nar­row fo­cus on het­ero­sex­ual trans­mis­sion.

The na­tional turn­around – in terms of pub­lic pol­icy, part­ner­ships and re­source mo­bil­i­sa­tion – has, in the past decade or so, shifted the coun­try’s fo­cus from those early days of crowded ceme­tery pro­ces­sions to the hope, relief and dig­nity se­cured for mil­lions of South Africans by the big­gest re­sponse pro­gramme in the world. Many mor­tu­ar­ies have since closed shop as fewer peo­ple die of HIV/AIDS.

This paradigm of life is a prod­uct of col­lec­tive ef­fort na­tion­ally, re­gion­ally and in­ter­na­tion­ally. It bor­rowed from the best tra­di­tions of the an­ti­a­partheid strug­gle: re­sis­tance, so­cial mo­bil­i­sa­tion and unity. It ben­e­fited from the best tra­di­tions of the an­ti­a­partheid strug­gle – in­ter­na­tional sol­i­dar­ity – made up of in­di­vid­u­als, gov­ern­ments, com­mu­ni­ties and or­gan­i­sa­tions, in­spired by the idea that life and dig­nity are a univer­sal hu­man right to be en­joyed by all, ir­re­spec­tive of eco­nomic sta­tus.

It is for this rea­son, there­fore, that re­searchers are ex­pend­ing ef­fort and re­sources study­ing the so­cial de­ter­mi­nants of the epi­demic. This is more ur­gent, given the shift­ing po­lit­i­cal econ­omy of HIV in­fec­tions.

A decade ago, the epi­demic was driven by con­di­tions of poverty, de­pri­va­tion, mi­grancy and gen­der-based vi­o­lence. To­day, it has as­sumed or added other di­men­sions, in­clud­ing so­cial me­dia, elec­tronic me­dia, re­al­ity tele­vi­sion and inequal­ity. This challenges preven­tion strate­gies to move be­yond tra­di­tional ap­proaches of above and be­low the line mes­sag­ing and con­dom dis­tri­bu­tion. To con­sign HIV to the mu­seum of the his­tory of epi­demics, there has to be greater use of so­cial and elec­tronic me­dia, which have cre­ated so­cial bub­bles where un­pro­tected sex and mul­ti­ple con­cur­rent part­ner­ships take place. As far as de­clin­ing knowl­edge lev­els are con­cerned, a study by the Hu­man Sci­ences Re­search Coun­cil ob­served that dis­in­vest­ment in com­mu­ni­ca­tions by na­tional govern­ment has eroded ear­lier gains as trends show di­min­ish­ing knowl­edge lev­els among sig­nif­i­cant sec­tions of the youth pop­u­la­tion. (Add grow­ing gen­der, in­terand in­tra-class inequal­ity into the ma­trix, and the sit­u­a­tion de­te­ri­o­rates fur­ther.) In July 2016, South Africa hosted the bi­en­nial In­ter­na­tional Con­fer­ence in Dur­ban. This was the sec­ond time that this con­fer­ence came to South Africa, the first be­ing in July 2000. As many of the con­fer­ence pro­ceed­ings and pub­lic com­men­tary showed, the 2016 con­fer­ence took place un­der sig­nif­i­cantly al­tered con­di­tions. The im­agery was that of life and hope.

There was greater co­her­ence and co­op­er­a­tion be­tween govern­ment, civil so­ci­ety, the pri­vate sec­tor, in­ter­na­tional agen­cies and other role play­ers. The con­text in which the HIV epi­demic continues to ex­pand in coun­tries around the world is one of grow­ing po­lar­i­sa­tion be­tween rich and poor ... and in­creas­ing so­cial in­equal­i­ties that seem to be an in­te­gral part of glob­al­i­sa­tion based on ne­olib­eral eco­nomic poli­cies.

HIV continues to be a ma­jor global pub­lic health is­sue, hav­ing claimed more than 35 mil­lion lives thus far. Ac­cord­ing to the World Health Organisation, there were ap­prox­i­mately 36.7 mil­lion (34 mil­lion to 39.8 mil­lion) peo­ple liv­ing with HIV at the end of 2015 with 2.1 mil­lion (1.8 mil­lion to 2.4 mil­lion) peo­ple be­com­ing newly in­fected with HIV in 2015 glob­ally.

South Africa is home to the largest con­cen­tra­tion of peo­ple liv­ing with HIV any­where in the world. When it first emerged, few could know how the epi­demic would evolve, and fewer still could de­scribe with any cer­tainty the best way to com­bat it. The es­ti­mated over­all HIV preva­lence rate at the time of writ­ing was 11.2% of the to­tal South African pop­u­la­tion. The num­ber of peo­ple liv­ing with HIV was es­ti­mated at 6.9 mil­lion in 2015. For peo­ple be­tween the ages of 15 and 49, an es­ti­mated 16.6% are HIV pos­i­tive.

The mes­sage is clear: so­cial part­ners in south­ern Africa should in­ten­sify ef­forts to turn the tide against HIV and TB. They should move be­yond bio­med­i­cal science and in­ves­ti­gate the so­cial science, that is, re­al­life ex­pe­ri­ences that in­crease vul­ner­a­bil­ity to HIV in­fec­tion. They should ask and seek an­swers to ques­tions such as why in­fec­tion rates in­crease even among the most ed­u­cated and up­wardly mo­bile peo­ple. What so­cial pres­sures af­fect ado­les­cent girls, young women and the mid­dle class to the ex­tent that they read­ily ex­hibit risky sex­ual ten­den­cies, much like the least ed­u­cated and marginalised pop­u­la­tion groups that are ex­posed due to sex­ual vi­o­lence, poverty and in­ter­gen­er­a­tional sex? Is it some false sense of in­vin­ci­bil­ity that “this won’t hap­pen to me”, or “surely this banker can’t be HIV pos­i­tive”, or “let us just en­joy sex un­en­cum­bered by in­ter­me­di­aries like con­doms”?

So­cial and be­havioural sci­en­tists need to study this phe­nom­e­non to re­align na­tional strate­gies in re­sponse to what sta­tis­tics tell us about in­ci­dence and preva­lence trends.

Ev­i­dence-based stud­ies are ur­gently re­quired to de­velop a thor­ough un­der­stand­ing and re­sponse to challenges pre­sented by the grow­ing use of so­cial me­dia. Deeper in­sights into the dy­namic use and mis­use of so­cial and elec­tronic me­dia will help pol­icy mak­ers and stake­hold­ers turn ta­bles, ef­fect­ing pos­i­tive be­hav­iour change through the same plat­forms that are cur­rently used to pro­mote risky life­styles.

Zero in­fec­tions re­main our goal. An AIDS-free gen­er­a­tion is pos­si­ble. Bold steps need to be taken, how­ever, by in­di­vid­u­als, or­gan­i­sa­tions, com­mu­ni­ties and stake­hold­ers to spread the mes­sage – and to live by it – that safe sex is the way to go; and know­ing one’s sta­tus is a pre­req­ui­site for un­pro­tected sex, in ad­di­tion to faith­ful­ness.

PHOTO: GALLO IM­AGES / THE HER­ALD / JACKIE CLAUSEN

STAR POWER A con­trib­u­tor to the book, the mu­si­cian Sir El­ton John, is pre­sented with an award dur­ing the In­ter­na­tional AIDS Con­fer­ence in Dur­ban last year

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