Condom use and the age old battle of the sexes by Cassy Novick

Two comments about the articles:

One of the results of the “Making Sense of Condoms” really caught my attention:

“As a rule, female authors tend to place greater emphasis on the agency and vulnerabilities of female characters by means of plots in which they avoid infection by refusing to have unprotected sex or are infected as a consequence of their failure or inability to negotiate condom use. Male authors tend to focus more on their e primarily male e characters becoming infected when they refuse to believe in HIV or to heed the advice of friends” (Winskell 2011)

This observation is representative of greater trend in the “battle of the sexes” if you will. Women are more likely to ask a man to use a condom than a Man is to initiate condom use on his own. This difference in a behavior I believe to be a result of difference in cost and benefit. Getting pregnant comes at a higher cost to women than it does to men. Assuming that a woman has a hard time communicating her preference to use a condom (which is often the case) we have a situation that is well represented by a coordination problem referred to as “the battle of the sexes” in public choice theory (see utility diagram below)

 

Battle of the Sexes

Woman

 

Man

 

Condom

No Condom

Condom

1, 2

0, 0

No Condom

0, 0

2, 1

According to public choice theory, this is a coordination problem in that the man and the woman get more benefit out of coordinating than not (both choosing a condom or not choosing a condom), but the woman has a higher utility for wearing a condom than a man and vice versa. In attempt to maximize utility, the two end up not coordinating because the woman will choose/prefer condom and the man will choose/prefer no condom resulting in less benefit than if they have coordinating. This coordination problem can be resolved by communicating one’s preferences.

One other thing i meant to post, but apparently it didn’t make it through the cut and paste process is the following (might be a good addition to your comments)….

What I found interesting in relation to the article “Scenarios in Africa” was the role that cinema in relation to our own reality. Cinema, TV, Video Games, and all other types of screen entertainment have been proven to impact our everyday lives in many ways ranging from prevalence of violence in children who watch too much violence to Robert Putnam’s analysis of the affect of TV on Social Capital. With what we see on the silver screen becoming increasingly realistic with digital effects, 3D, and surround sound promoting the illusion of reality. Taking this into account and Robert Putnam’s theory on social capital I feel like the following could be true:

According to Putnam, the rise of TV has resulted in a decrease of social capital (aka people join less teams and social organizations and more often “bowl alone”). This lack of social capital is naturally connected to less connectivity and less healthy/numerous physical social relationships (no how many friends you have on facebook is not a gauge of how many social relationships you have). With less healthy social relationships, we communicate more poorly, which could explain why the preferences over condoms are not communicated. Furthermore (this may be a stretch but here it goes) less healthy social relationships encourage more ideas of “friends with benefits”, one night stands, and even prostitution. In these arguably unhealthy relationships the necessary dialouge about condom use is likely to not take place. So the lack of communication over condom use is not just an archaic form of paternalism, but a modern disregard for substantial, healthy social relationships. So I pose the question: Does facebook help or hurt or social structure? we may reach more people, but do we reach these people with more shallow interactions and connections?

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Week 11: Winskell & Von Mueller

This week Kate Winskell from the School of Public Health and Eddy Von Mueller from Film Studies talked about representations of HIV/AIDS in film.

Winskell talked about her project her film project Scenarios from Africa which “gives children and young adults an exciting opportunity to educate themselves and others about HIV/AIDS by inviting them to participate with internationally acclaimed directors in the production of a growing collection of short films.” My favorite that we watched is called Tiger, Tigress. You can watch it here: http://www.youtube.com/watch?v=XE5BKU9aJCg

Von Mueller juxtaposed two movies released in 1993 that center on the lives of HIV+ gay men: Philadelphia starring Tom Hanks and Denzel Washington and directed by Jonathan Demme and Silverlake Life: The View from Here a documentary directed by Peter Friedman that follows the lives of Tom Joslin and Mark Massi as they are living with and dying from HIV/AIDS.

Reading:

  • Cante, Richard C. “HIV, Multiculturalism, and Popular Narrativity in the United States: Afterthoughts on ‘Philadelphia’ (And Beyond).” Narrative, Vol. 7, No. 3 (Oct. 1999), p 239-258.
  • Mathijs, Ernest. “AIDS References in the Critical Reception of David Cronenberg: ‘It May Not Be Such a Bad Disease After All’.” Cinema Journal, Vol. 42. No. 4 (Summer, 2003) p. 29-45.
  • Winskell, Kate and Daniel Enger, “Young Voices Travel Far: A Case Study of Scenarios from Africa”, chapter in: Hemer, Oscar and Thomas Tufte (eds.), Media and Global Change: Rethinking Communication for Development, Buenas Aires: Clasco, 2005
  • Winskell, Kate, Oby Obyerodhyambo, Rob Stephenson, “Making sense of condoms: social representations in young Africans’ HIV-related narratives from six countries,” Social Science & Medicine, 72 (2011) 953-961

 

Media and Public Perception by Meg Lacy

I found the Kalichman and Hunter article on “Magic” Johnson a fabulous analysis of the influence celebrity disclosure has on public attitudes and perception of HIV. I also thought this article provided a helpful framework for understanding the way other media, such as music, shape public perspectives on HIV and social change at large. Of all of the assignments for this week’s discussion, I found the two songs from the 80’s (“It’s Christmas Time” and “We Are The World”) the most compelling content for analysis. These songs, devised to raise money for Africa, strike me as interesting for two reasons (besides, of course, the plethora of mullets). First,
I’m interested in these pieces of media because of the way they seamlessly employ religious language and imagery as an impetus for secular social change. And second, these pieces of media “mediate” particular (and diverging) understandings of the relationship between Africa and the United States, shaping public attitudes concerning the role America/Americans play(s) in global change, similar to the way celebrity disclosure shapes public attitudes of HIV in the US. 

Religion and Media
As a theology student, I find it interesting that the lyrics of both “It’s Christmas Time” and “We Are The World” employ religious language and imagery in secular media. At the risk of stating the obvious, “It’s Christmas Time” is secular media embedded in the language of a Christian Holiday, Christmas. While many might argue that Christmas is now a secular holiday, the lyrics of this song make explicit spiritual claims. Rather than mentioning gifts and Santa, they define Christmas as a time “we let in light and we banish shade.” Prayer is also states explicitly in this song as a means to a better world. Likewise, “We Are The World,” makes two fascinating religious references. The first locates our shared humanity in our shared identity as a part of a religious family—“We’re all apart of God’s big family.” This is followed by an explicit claim on truth, “you know the truth, love is all we need.” While religion has no monopoly on love, the use of a truth claim to advocate for love seems a very religious thing to do! I find religious language and imagery in these songs interesting because of the assumed association of religion/justice/care/love. That is, for these lyricists, religion seems to be the obvious framework for compelling people to love and care for others (ie, those with AIDS in Africa). Now a quarter of a century later, I wonder if this religious language would be rendered ineffective, or even counterproductive. While secularization theory would certainly suggest that religion was on its way out the door in the 80s, it is arguable that religion had more clout in the public sphere in the 80s than now. Would the use of religion in media now be a useful tool for shaping public attitudes, or a detrimental/irrelevant one?

Media and Articulations of Social Change
While both songs share a common notion of religion as pertinent to care/social change (rather consciously or unconsciously), they diverge in their conceptions of what this change looks like. Each song envisions a different relationship between America and Africa, and each vision has the capacity to influence public perception and discourse on HIV and America’s role in foreign aid. “It’s Christmas Time” sets up a clear us/them dichotomy. Nearly every stanza makes an us/them claim. That is, “pray for the other ones” (Africans), “here’s to you [Americans], here’s to them [Africans], “thank God it’s them instead of you.” I appreciate the sentiment of this song but must take issue with its emphasis on charity rather than justice. This song sets up an us/them discourse that envisions a world in with wealthy westerners should offer charity to those less fortunate by “feeing the world,” a largely destructive and rejected conception of social change. On the other hand, “We Are The World” offers a much more mutually beneficial conception of change. The lyrics of this piece hold in tension the responsibility one has as a privileged westerner and one’s intrinsic connection to those experiencing injustice—“it’s time to lend a hand…change is gonna’ come when we stand together as one…we’re saving our own selves.” This conception of change reminds me of Dr. Martin Luther King, Jr.’s insistence that “Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality tied in a single garment of destiny. What affects one directly, affects all indirectly.”  (Letter from the Birmingham City Jail).

It is important to note these diverging conceptions of social change because they contribute to public attitudes and conceptions of change—particularly America’s role in global discourse and aid for HIV. As I consider these two diverging conceptions of change, a more recent lyrical articulation of injustice comes to mind. The Raise Hope for Congo Campaign (a sector of the Enough Project at the Center for American Progress) recently released a compilation album assembled to raise awareness concerning women and children who have experiences extreme violence in the ongoing conflict in Congo. Although this justice issue is in many ways different from that of HIV, it is similarly an international issue, which requires response and accountability from the West (and, likewise, other nations). The concept of partnership in this album strikes me—it articulates a new way of conceptualizing the role of the West in global politics and aid. Partnership can be seen merely in taking a look at the artists who contributed to the project. Among American artists such as Norah Jones, Sheryl Crow, and Damien Rice are Congolese women and men who have chosen to partner with Western artists in order to raise awareness concerning their country’s plight. Partnership is also reflected in the lyrics of many of the songs. Below I have provided some of the words for the album’s title work, “Raise Hope” (written by Omekongo Didinga & Shahin Shahida).  The idea of “partnership” may not have been possible 30 years ago, but it is now, and I am encouraged by this clear articulation of new conceptions of global change.
 
Together with the Congolese
We can change this direction
If you decide to raise your conscience
And each one teach one
Reach one in your grasp
We can make an army of change
An army of conscious consumers
Not soldiers of the same old sympathetic solution
For political and profitable prostitution
The true resolution is the empowering of our women
The center of our land must be made whole again
The backbone of our nation must be realigned
When our women can stand proudly
Our country will once again have its spine
The heart of our future
Lies in our young girls
The pride of our lives
Lies in our young boys
Congo’s future lies in our hands
If you can just understand
That we’re all in this together
So lets raise hope
And take a stand for our land

Here is a link to the album, for anyone who is interested: http://raisehopeforcongomusic.org/

Über-celebrities: Bill Gates by Lydia Karch

Noland, Marshall, Goodale, and Schlecht (2009) identify three generations of celebrity involvement with HIV/AIDS in their article entitled “An Exploration of the Impact of Celebrity on the HIV/AIDS Pandemic.” [1] Generation 1 held sway in the early years of the epidemic, from 1981-1999, and consisted primarily of Elizabeth Taylor and Elton John. Generation 2 had a significantly greater membership, as it became cool for celebrities to raise awareness around HIV/AIDS from 2000-2006. Finally, Generation 3 is composed of “über-celebrities” who chair foundations, attend G8 summits, and pour billions of dollars into vaccine research. Generation 3 membership is much harder to come by; Bill Clinton, Angelina Jolie, Bono, and Bill Gates are the current leaders of the pack. The enormous difference between Generations 2 and 3 is that Generation 3 celebrities do not merely advocate for a cause; they have the power to create actual change, both in terms of public perceptions of the disease and policy priorities. Of the aforementioned leaders, I will focus on Bill Gates in this post, as (to me at least) the odd member out of the group.

In 2008, Bill Gates walked away from Microsoft the richest man in the world. He left the company not to go into retirement, but to focus on his philanthropic efforts with the Bill and Melinda Gates Foundation. [2] For such a young organization (founded in 1994), the Gates Foundation is a major player in the global health world, pouring over $15 billion into global health programs during the Foundation’s lifetime, including $2.2 billion in HIV grants. [3] [4] In early 2011, Bill Gates lost his position as the richest man in the world, almost entirely due to the amount of money (one-third of his wealth) that he has donated to the Foundation. [5] Gates now occupies a somewhat Robin Hood-like position in American culture, taking from the rich (himself) to give to the poor. He has become an advocate (as well as an exemplar) for philanthropy and combatting global inequalities, admonishing the Harvard graduating class of 2007 to “take on the big inequities.” [6] In contrast, another man who made billions in Silicon Valley, Steve Jobs, did not engage in such public displays of philanthropy, and was consistently berated by the media for his perceived (relative) callousness. [7] If Bill Gates could do it, why not everyone else?

Why not everyone else? Therein lies the mystery of Bill Gates’ über-celebrity status. As Kalichman and Hunter (1992) explain, “identification with a target celebrity results in personal relevance,” which in turn triggers identification with the celebrity’s pet causes or concerns. [8] And while it might seem like Angelina Jolie and Bill Gates are equally difficult to identify with (both so removed from the American norm), there is something about extreme intelligence that is repulsive to the public. Bill Clinton, an undeniably intelligent man, famously appeared on the Arsenio Hall while campaigning to play the saxophone, an act that made him more “relatable.” Bill Gates may be equally talented at playing the guitar, but his public persona does not reveal it. He packages himself (or is packaged?) as the genius who made billions off of Microsoft, and is now turning his intellect and fortune to the challenge of eradicating global inequalities.  He is undeniably “known and talked about,” but this is definitely not his primary purpose; he is first and foremost an intellect and innovator. His celebrity is a secondary function, the byproduct of being so rich in such a capitalist country. So does he really belong with the other Generation 3 celebrities, people who make a living (through the entertainment industry or politics) off of “being known and talked about”? Or is Gates something else, an entity to himself? Perhaps, more optimistically, the first member of a new celebrity Generation of people who gain fame for service work, and then use that fame to drive even more progress and innovation in a positive feedback loop?

[1] Noland, C.M., Marshall, P.D., Goodale, G., & Schlecht, H.P. (2009). An Exploration of the Impact of Celebrity on the HIV/AIDS Pandemic. Journal of Health & Mass Communication, 1(3/4); 194-210.

[2] http://topics.nytimes.com/top/reference/timestopics/people/g/bill_gates/index.html

[3] http://www.gatesfoundation.org/about/Pages/foundation-fact-sheet.aspx

[4] http://www.gatesfoundation.org/hivaids/Documents/hiv-strategy-overview.pdf

[5] http://www.reuters.com/article/2011/03/08/us-wealth-gates-philanthropy-idUSTRE72668V20110308

[6] http://news.harvard.edu/gazette/story/2007/06/remarks-of-bill-gates-harvard-commencement-2007/

[7] http://dealbook.nytimes.com/2011/08/29/the-mystery-of-steve-jobss-public-giving/

[8] Kalichman, S.C., and Hunter, T.L. (1992). The Disclosure of Celebrity HIV Infection: Its Effects on Public Attitudes. American Journal of Public Health, 82(10): 1374-1376.

Courage in the Face of Stigma: The Story of Gugu Dlamini by Dan Hougendobler

Reading Prof. Niehaus’s article about the stigma of HIV/AIDS in the South African Lowveld reminded me of another story I heard while in South Africa.  It highlights the tremendous suffering and horrific violence that can result from the stigma and fear surrounding HIV/AIDS.  However, I wanted to share the story not because it confirms something we all know (stigma and hatred are bad), but rather because it demonstrates how courageous people who stand up in the face of stigma can become catalysts for changing an entire culture.  The story is taken primarily from interviews conducted by Beat It!, which are available here.

The story took place in 1998.  Gugu Dlamini was an HIV-positive young mother who lived in the Province of KwaZulu-Natal.  When interviewed by a local Zulu-language radio station, she bravely confirmed her HIV-status.  As a result of her disclosure, she endured a great deal of overt harassment.  Her mother reported, “She’d keep on phoning and coming to tell me [about the threats]; she cried.  She said the people they come, they threaten me.”  Her boyfriend confirmed the stigmatization, recalling that some people did not even “want her to touch them or to drink together with them.”

On December 12, 1998, what had been verbal harassment, and other forms of stigmatization, became even more serious.  After a campaign workshop, a man came up to her and punched her and threatened to return.  The assault was reported to the police, but they apparently did nothing to help her. 

Later that night, she was attacked again.  This time she was beaten, stoned, and stabbed until she lost consciousness.  One of her attackers then sent her boyfriend a text message which said, “you can come and fetch your dog; we are done with her.”  She was taken to a hospital where she died.  She left behind a 13-year old daughter.

However, Ms. Dlamini’s story didn’t end with her death.  News of her brutal murder swept through South Africa, inspiring protests and bringing the scourge of discrimination to the forefront in the minds of many living in South Africa and around the world.  The Treatment Action Campaign’s famous “HIV Positive” slogan, seen on activists’ t-shirts, was developed as a response to Ms. Dlamini’s death. 

News of her death also moved Edwin Cameron, a South African judge, to become the first South African official to publicly declare his HIV-positive status.  Mr. Cameron now sits on the Constitutional Court of South Africa, arguably the most prestigious judicial position in the country.

I would draw several lessons from this tragic story.  First, stigma and harassment are not “just” psychological afflictions for those living with HIV/AIDS.  The line between verbal and psychological abuse and outright assault and even murder is much too fine.  Increasing understanding of those living with HIV/AIDS is therefore a critically important public safety issue.  Second, and most importantly, I think Ms. Dlamini’s story demonstrates the power that a single individual has to shake a society out of its complacency and bring underlying issues of stigma and discrimination to the fore.  Much of our reading for this week deals with the power of celebrity disclosure, but Ms. Dlamini was not a celebrity before her death.  She was simply an ordinary worker, mother, and daughter who happened to be HIV-positive.  What made her extraordinary was her courage in the face of stigma and the tragic results of her decision to stand up in the face of a hostile society and declare that she wasn’t ashamed.

Week Ten: Nilsson-Stutz & Troka

This week Liv Nilsson-Stutz talked about her anthropological research on death and dying while Donna Troka talked about how celebrity shapes and impacts HIV/AIDS discourse.

After giving a historical context of the study of death and dying, Nilsson-Stutz talked about a South African context where the “othering” of HIV+ people is less about sexuality and morality and more about how the disease is intimately connected to death. In this instance, HIV+ people are seen as living corpses who are dangerous because they are polluting. Furthermore, the terminally ill are seen as “noisy ancestors.”

Dr. Troka talked about how celebrities (musicians, movie stars, athletes) have impacted AIDS discourse in different ways over the last three decades. Looking at both HIV positive celebrities like Magic Johnson and (presumably) HIV negative celebrities like Bono, we discussed how they can impact social norms, health communication, and whether or not the folding in of consumerism (Bono’s “Project Red” or Kenneth Cole’s “We All Have AIDS”) makes a difference.

Reading:

  • Kalichman, Seth C. “The Disclosure of Celebrity HIV Infection: Its Effects on Public Attitudes.” American Journal of Public Health. October 1992, Vol. 82, No. 10.
  • Niehaus, Isak. “Death Before Dying: Understanding AIDS Stigma in the South African Lowveld.” Journal of South African Studies, Volume 33, Number 4, December 2007. 845-860.
  • Noland, Carey M. “An Exploration of the Impact of Celebrity on the HIV/AIDS Pandemic.” Journal of Health and Mass Communication. Vol 1. Nos 3/4 (Summer/Fall 2009).

 

Couples’ Voluntary Counseling and Testing: From Heterosexuals in Sub-Saharan Africa to MSM in the United States by Megan Murphy

Dr. Susan Allen is one of my scientific heroes. Spending mere minutes with or listening to her yields full understanding of the inspiring passion and tenacity she brings to HIV-1 issues in public health. Dr. Allen established two heterosexual HIV-discordant couple cohorts (meaning one partner is HIV positive, one partner is HIV negative) in sub-Saharan Africa several decades ago: Projet San Francisco (PSF) in Kigali, Rwanda in 1986 and the Zambia-Emory HIV Research Project (ZEHRP) in Lusaka, Zambia in 1994 [1]. Samples from patients seen at the PSF and ZEHRP cohorts fuel my current graduate research. Two additional cohorts, with which I am only minimally familiar, are located in the Copperbelt region of Zambia in the villages of Ndola and Kitwe. All of these mentioned cohorts target heterosexual couples because this is the most significantly affected population in the geographical context of sub-Saharan Africa.

The approach employed at the PSF and ZEHRP cohorts is called couples’ voluntary counseling and testing or CVCT. Heterosexual, typically cohabiting and monogamous, couples are given condoms, HIV tested, and counseled about the risk of transmission to the negative partner as a dyad. This preventative strategy focuses on the unit of a relationship rather than the individual. Research supports the efficacy of this methodology where “targeting couples in HIV prevention efforts—in particular couples-based HIV counseling and testing—has been shown to be effective in reducing transmission between sero-discordant couples, increasing condom use, and reducing sexual risk-taking” [2].

As you might remember, I forwarded a CBS article link [3] to class members near the beginning of February. It was, in fact, the first time that I had heard about the CVCT approach migrating to the United States, and I was excited. In that piece, one of this week’s speakers (Rob Stephenson) commented on a program recently launched in Chicago and Atlanta called “Testing Together” that is financed by the MAC AIDS Fund and that “hopes to test 400 [MSM] couples by the end of the year.” Stephenson said, “The idea is to bring honesty to sexual relationships…Relationships offer only ‘mythical protection’ from HIV…Some couples may have avoided talking about each other’s HIV status, thinking, ‘If he were HIV positive he would have told me,’ or ‘If he wanted to know, he would have asked’” [3]. Program efforts target MSM because, unlike Africa, this population represents the majority of new infections in the United States.

Stephenson and colleagues flesh out the foundation for programs such as “Testing Together” in one of this week’s readings [2]. Initially, it was important to understand what changes would have to be made in order to adapt the heterosexual CVCT approach in Africa to appropriately target US MSM. Interviewing of focus groups in three US cities (Atlanta, Chicago, and Seattle), composed of 39 Caucasian or African American MSM, found that “CVCT was seen as a sign of commitment within a relationship and was reported to be more appropriate for men in longer-term relationships. CVCT was also seen as providing a forum for the discussion of risk-taking within the relationship” [2]. The study ultimately supports the idea that, with some alteration, the CVCT approach could prove effective as a preventative/educational strategy to combat HIV-1 transmission in the United States.

References:

1. http://www.rzhrg.org/

2.Stephenson, R., P. S. Sullivan, L. F. Salazar, B. Gratzer, S. Allen, E. Seelbach. “Attitudes Towards Couples-Based HIV Testing Among MSM in Three US Cities.” AIDS Behav (2011) 15:S80-S87.

3. http://www.cbsnews.com/8301-501367_162-57361265/testing-for-hiv-together-hearing-results-together/