The 2nd Annual
GMAI/ AMAI/ UNAIDS Regional Seminar
on HIV and AIDS

25 May 2009
Macao, China

A Report
Prepared by
David Barlow

The 2nd Annual GMAI/ AMAI/ UNAIDS Regional Seminar on HIV and AIDS
25 May 2009, Macao, China

What follows is a summary of the main points made in each presentation.
In most cases the full text or the PowerPoint presentation are available from AIBD.

Inaugural session

David Astley, General Secretary of the ABU began the proceedings by welcoming all the delegates to the workshop. During the last 25 years, 60 million people had been infected with HIV; 25 million have died. The mass media possessed great power both to prevent the spread of HIV and to help those who had to live with it.

There was no sign of the disease abating - the numbers remained frightening -- and in these circumstances the media had a unique role.

HIV was preventable. The media could give out life saving messages. There were a number of key goals:
1: there needed to be a structural framework to deal with the issue across Asia and the Pacific,
2: there needed also to be an increase in the number of companies involved,
3: the media needed to support best practice. They also needed to promote a co-ordinated response and finally,
4: they needed to promote the integration of HIV messages across all platforms.

In all this the ABU and AIBD needed to work together.

The keynote address of Dr Prasado Rao, Director Regional Support Team at Asia and the Pacific, UNAIDS Bangkok was presented by Dr Jinglin He:

Dr Rao?s presentation quoted some startling statistics. AIDS and its level in Asia and the Pacific was determined largely by the extent of paid sex by young and adult Asian men. Between 2 and 20% of men in Asia visited sex workers. But most women have only one sex partner -- which is a limiting factor within the Asian epidemic. Around 75 million men visit sex workers; 10 million women are involved in the sex trade; 50 million women are married to men who have visited sex workers.

UNAIDS regional targets were that 80% of those at risk were reached by the program designed for them. The media were essential to its success and essential also in the creation and development of awareness among those most are likely to be involved.

There were however, many barriers which prevented messages reaching those they should reach or in limiting the effectiveness of the message even though it got through -- these included political and legal barriers, perceptions, beliefs, stigma , resources, oversight, capacity and civil society engagement.

Dr Rao?s presentation included country by country analysis of the barriers involved -- these are available from copies of the power point presentation.

Stigma and discrimination were major factors for both those living with the disease and those living with people who had either HIV or aids. The effects of such stigma and discrimination could be devastating and could include abandonment by spouse or family, social ostracism, loss of job, expulsion from school, denial of medical care, lack of care and support. All these disproportionately affected women and girls.
In all of this the role of the media was crucial. The coverage of AIDS and HIV was often concentrated around World AIDS Day; coverage still tended to be sensational and HIV and AIDS stories are not always perceived to be newsworthy by some media channels. Dr Rao suggested a number of possible roles for the media -- they could address fears and misconceptions through accurate information; they could humanise the infected and affected persons and perhaps above all they could keep the AIDS issue alive. AIDS is not going to go away soon. The presentation ended by quoting Dr. Piot who had said ?journalists save more lives than doctors? .

Session 1:

Chairman Ken Clarke and group CEO Media Niugini.GM Commercial Fiji Television
First speaker: Ms Nguyen Thu Ha, Deputy General Director.O2 Television in Vietnam:

Ms Thu Ha said that the media had strong support from the government of Vietnam in their treatment of HIV and AIDS. There had been substantial and positive reaction from their audience. However, when the situation was analysed more closely it was clear that there was a great deal of wrong information being circulated, that this came from unreliable sources, and that old stereotypes had taken root. HIV and AIDS were seen as social evils more than a disease. Journalists needed more training on health assumes to help combat this.

The solutions to some of these problems lay in a focus on the quality of communication, stressing that HIV and AIDS were health issues, not primarily a social evil and to bring this about the media needed training in the way they presented HIV and AIDS -- to escape from images of death and so forth to images of love and desire.

There was a need for videos of positive image; for example of how the O2 television station had focused on love skills for young people. It might not work everywhere but it had had a positive impact in Vietnam.

Second speaker: Ms Moneeza Hashmi, General Manager HUM Television Pakistan:

Ms Hashmi said that it was difficult to define either quantity or quality of HIV communication. Equally what applies in one country may not always apply elsewhere -- for reasons of culture, society and religion.

She remained convinced that not enough was being done by the media to raise awareness of the problems involved. But it was important to keep numbers in perspective. In Pakistan 100,000 people were infected by HIV and even the numbers of those who died of diarrhoea were greater and two out of three people in Southeast Asia were without access to drinkable water. Context was important when allocating resources and determining priority.

In Pakistan HIV media attention had run into many difficulties; discussion was often taboo for religious reasons and indeed some NGOs had been attacked for working in this area.

Solutions to these problems were not always easy to come by. There was a need for increased coverage and for that coverage to be proactive. There was also need for the media to be creative in overcoming the difficulties they encountered. She reiterated that one size did not fit all -- each country would require its own solution.
The media pattern within a country could also help determine the best approach. There were for instance 91 million mobile phone users in Pakistan -- sadly these phones were often used for hate --; there were 106 FM stations, 76 television channels and 12 million Internet users. This was the media background against which any planning to deal with the AIDS HIV issue needed to be made. Each of these platforms had their role to play.

Third speaker: Mr Ole Hanson Advocacy Adviser, UNAIDS China:

Mr Hanson described the approach of the UNAIDS agency which brought together 10 United Nations system organisations to work for a global AIDS response. Mr. Hanson reminded the seminar that prevention was the only way of dealing with HIV. There was no cure and no vaccine. So behaviour change was the only way ahead. UNAIDS saw the media as an essential part of this process. AIBD was crucial to this approach.

They were inviting advice about how the draft in his paper (available from AIBD) should move ahead and then sought for assistance with its implementation. There were a number of areas in which journalists could clearly help. At present, as just one example, journalists often reported HIV stories about those who were infected without having met them or talked to them; this needed to change.

UNAIDS had a process of introducing products with quality messages about HIV and AIDS prevention. Mr. Hanson invited comments on the process as outlined in his paper so that those involved could learn and then feed the results into the process which at the end of the day would aim to change behaviour as the only sure route to success.

In questions and answers for this session one delegate asked how general reporters could be trained to handle HIV AIDS sensitively and thus positively. Mr. Hanson replied that this was a real problem, which needed to be addressed as part of an overall organisational response to the need for general reporters to handle specialist stories. However some delegates felt that in reality many reporters, especially in outlying areas, would continue to do their best with little or no specialist training.

A further question was raised as to how companies could buy into the process that had been described. Company participation might well be essential to the success of any campaign.

Session 2:

Chair: Mr Nasimui Quadir Chowdhury Deputy Director-General, News, Bangladesh Betar
First speaker: Cosmalinda Simanjuntak from TVRI.

Ms Simanjuntak confessed to the participants of the seminar that in TVRI at present, they did nothing about HIV AIDS. Within Indonesia, with a population of 230 million, there were 270,000 cases of HIV. That amounts to 0.03% of the population.

It is therefore understandable that media people do not care much about HIV. News covers it rarely, as does current affairs. Within youth programming, entertainment and education there is no coverage at all.

TVRI in fact had no medical programs of any sort although there were some on the commercial television channels. However TVRI had only been a public service broadcaster for three years and they had a limited budget from the government for production. Moreover, this year was an election year so the concentration of programming output was on that.
The problem was not a lack of information about HIV AIDS; the first and necessary step was to create a relevant strand of programming in their schedule. Medical programs have been proposed before but the proposals have made no progress.

There are now plans in 2010 to deal with HIV AIDS in the current affairs strand. It might be possible to support this with coproductions, rebroadcast of other program output from elsewhere, and by looking again at the possibilities in the entertainment sector.

For the moment the priorities within TVRI lay elsewhere. HIV was seen as a relatively minor issue. There was, moreover, the cultural issue. Discussion of sex and condoms etc was not welcome with the majority of the audience. Given the amount of sex before marriage it might well be a context of some hypocrisy but with a mixture of culture and religion it was difficult to deal openly with many of the issues involved.

The speaker's final point was the need to empower women in all areas so that they played their role in coping with HIV AIDS.

Second speaker: Mr Savyasaachi Jain, Thomson foundation:

The speaker remarked on the huge impact of HIV especially in Asia. More people got their information about HIV aids from the media than from their doctor. He quoted figures from Iran in 2002 where 84% got information about HIV AIDS from television, 66% from doctors, and 27% from parents. This gave the media a huge responsibility. This applied in many areas -- which included placing stories in context and their ethical treatment.

And this had undoubtedly been a problem in the media coverage of this issue. There was a feeling in some circles that the media normalised deviant behaviour. The responsibility that lay with journalists was a heavy one. It was not that there was a lack of information -- there were a huge range of sources available -- but there were issues with all those sources, the government, websites, even the mutual misunderstanding that frequently occurred between scientists and experts and journalists.

Journalist needed to know their territory. They needed to use medical terminology which was easy to understand and statistics which were contextualised and relevant.

Some of this was necessarily an issue for management but there was also an information overload. Given the importance of the media as a source of information the responsibility and role of the journalists was crucial. He finally noted that one neglected source of information in this entire field as far as the media was concerned with those people living with HIV.

From the chair Mr Chowdhury noted that in Bangladesh many people were in denial. It was difficult to get real figures. But it was thought they were small. The lack of information coupled with cultural problems made this a difficult topic to deal with.

Special address: Mr Henrikas Iouchkiavitchious Vice President of Eurasian Academy of television and radio.

Mr Iouchkiavitchious in his address noted the importance of information and example in this field. Changes of attitude were badly needed. Good quality sex education could be helpful and the evidence was that it did not increase the number of sexual partnerships.

Given this the school and the media were the most potent tools in this fight. He noted that health messages in popular television shows had considerable effect. The present situation was the result of decades of controversy and discussion but the key to a successful outcome lay with health education and he repeated his view that the media had a crucial role to play.

Session 3: children at women and HIV

Chairman: Director-General Pakistan radio:
First speaker: Dr Sadhanna Raut, Additional Director-General All India Radio India.

Dr Raut spoke mainly about children and women and the AIDS issue. First HIV AIDS is a gender issue; secondly it was a human rights issue; and thirdly it was a development issue. She noted that more than half of those with HIV where women. Young women are two or three times more likely to be HIV-positive than men. This underlines women's vulnerability.

In the government sponsored testing program only 36% of women had information as to where to go for testing as against 52% of men. Out of 5 million people tested under this program, 18,094 tested positive and only 10,494 when the treatment.

The impact on children was incalculable. It affected children in many ways. Some were born with HIV; some were living with parents who were sick; many eventually ended up being orphaned; and the communities within which these children lived were frequently unsympathetic. 70,000 children below the age of 15 were infected; half of all AIDS cases fell within the group 15 to 29.

There was therefore urgent need of help for children and families. Although the media had the potential to compound the vulnerability of children on the whole it's impact had broadly been positive. Accurate reporting was vital; with it went the need to avoid value laden words. It was also desirable for those with HIV to be able to participate in discussion of matters that concern them.

Second speaker : Ms Nuntawun, Lecturer in Health Communication Department, Faculty of Communication Arts,Hua Chiew University, Thailand

Ms Nuntawun spoke of the need to bridge the gap between health and media. She believed that in Thailand too little money was spent on prevention and too much on care. Within Thailand there were 1 million infected people; 25,000 had died. 20% had access to care but there were substantial regional differences. In some villages in the north for example were only old people left.

The good news was that new infections had declined by 90%. There had been an excellent programme of condom promotion among sex workers but equally many young people did not use condoms, believing that they could trust each other. The use of condoms within Thailand produced some interesting statistics -- 50% of the general population used them, 96% of sex workers did, 28% of males having sex with males and only 35% of drug users. 13% of those who had sex before the age of 15 did so without using condoms. Indeed many in the younger generation were asking whether AIDS was still around.

Many things remain to be done -- it was in many ways like a jigsaw which required a number of interlocking pieces. For example to attract the support of business the slogan had been coined ?sick staff can't work; and the dead customers can't buy.?

They had also introduced the ABCD of how to avoid AIDS: A was for abstinence (and it was accepted that this might go with masturbation); B: faithfulness; C: always use condoms: D: always have an HIV test before marriage or pregnancy.
In Thailand 200,000 children were affected by HIV. There was an acceptance that in many countries women did not like to discuss sex; the speaker believed that in Thailand people were realistic and an appropriate response had been provided. Prevention with treatment had reduced the risk to children to 3%. A small percentage perhaps but what happens to that 3%? Will they be orphaned? Will they have to be looked after by grandparents? In these circumstances children frequently blamed their parents for a problem not of their making.

Third speaker:Ms Ma Jing Deputy Dir, CCTV9.China

Ms Jing also emphasised the importance of media. It was crucial to share and discuss the issues of stigma and discrimination. 700,000 people were living with HIV in China. 50% did not know they were infected. There were 40,000 clinics to help.

There was no question but that those who were infected were stigmatised. Most people associated HIV with sex and drugs and did not wish to talk about it. This made it difficult for the journalist to handle the issue.

Although commercial sex is not legal in China many of those working in karaoke bars have become infected. There has been a successful campaign to use peer education in this field to spread messages about HIV. What people living with HIV needed and wanted was to be treated with respect and normality.

But the stigma did not stop with those who were infected. There was also stigma for the doctors who treated them. She believed that the Chinese media had on the whole done a good job but prejudice was still there; for example some 55% of adults were unwilling to live in the same household as someone with HIV.

The official support for programs in China had helped. Both the President and Prime Minister had been involved in the AIDS Day support. All of this helped to create a culture where people would accept HIV-positive people. She reported on a workshop for journalists and HIV sufferers in a week-long seminar. Those suffering from the syndrome had been critical of the stigma they believed they received from the media.

There needed to be more to cross border cooperation -- public health issues are international. Equally HIV AIDS is only one issue in a field of similar problems; it might well be possible to transfer the experience and role of the media in dealing with other problems that raised similar issues such as TB, diabetes, cancer etc to this field.

The chairman at this point noted, on the point of cross border cooperation, that Gulf States expelled people from the subcontinent who were working there but found to have HIV; however they did not report the fact to the authorities in the countries concerned.

In the question and answers that followed the figures given for HIV sufferers in China were questioned; UNAIDS confirmed that they were genuine and had been estimated from sound statistical sources.

Session 4: culture traditions and language

Chair: Rajendra Sharma, Deputy Executive Director, Radio Nepal
First speaker: Asoka Dias Dir station,MTV channel(Pvt) Ltd, Sri Lanka.

Mr Dias suggested that much that we have heard was negative. The question was how to get people's attention and communicate directly with them. There was a need to think out of the box -- we were not dealing with a shampoo or a kind of cake. No slick communication was needed to communicate about AIDS. The message was not complicated. He therefore, suggested that the media needed to adopt an approach that was different and simple.

There was also an issue with local language and translation. Translation was not always necessary -- he cited the tsunami story as an example- and could sometimes be positively mystifying. Tsunami was not a Sri Lankan word, but people knew what it meant and any attempt to translate it would have been confusing.

Sri Lanka had 1099 HIV reported cases but the estimate was that the real figure was around 4000 out of a population of 20 million.

There was an urgent need for the media to work closely with those with whom they were trying to communicate. Those in the media needed to ensure that their agenda matched the agenda of the audience. Simplicity and directness coupled with honesty were of the essence.

Second speaker: Ken Clarke Group CEO media Niugini, GM Commercial Fiji Television

Ken Clarke outlined the cultural and linguistic context within which he worked in Papua New Guinea - there were 850 different languages and cultures. Although his organisation was a commercial broadcaster, they were committed to dealing with the HIV issue. The government initiatives in this field had so far been modest. He had asked himself not just what companies could do but what individuals could do as well. He told the story of the background to the introduction of a condom dispenser within his organisation. There had been initial resistance but eventual warm support. How had this warm support come about? It had been done with the support of a body called BAHA and the approach it had adopted in dealing with his organisation. He gave the seminar a questionnaire which dealt with the policy of an organisation towards disability, and issues like HIV. The questionnaire helps to indicate how far both individuals and companies understood their responsibilities in this area and had forced people and organisations to question their practices and outlook.

It was important for all to understand the effect of HIV both on individuals and on the companies involved.

Ken Clarke finally remarked that it was extraordinary that it was possible to have discussions of the frank kind we have had today. Even five years ago it would probably have not been possible. There was a new frankness and openness around which augured well for real progress in this area.

Third speaker: Mr K P Madhu, Programme Manager, AIBD.

Mr Madhu discussed issues of culture and tradition. Within these are many important influences -- the mythologies and stories with which children lay foundations, the reprimands and encouragement that children receive and the peer group pressure to which they are subject.

HIV will also in turn influence tradition; he cited the case of a society where a widow was inherited by her dead husband's brother; this allowed property to remain in the family. But this tradition was now, given HIV AIDS, being challenged.

It was very important for broadcasters to use appropriate language in dealing with this issue; they needed to be comprehensible, accessible and to avoid jargon.

They also needed to be acceptable. This required precision, comprehensible and fair reporting. Coverage also needed to be culturally appropriate. Words and language had different connotations in different places.

The language used needed to be non-discriminatory, gender sensitive, to avoid negatives and avoid sensationalism.

There needed to be a code of practice and benchmarking to enable all this to occur.