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In Africa, HIV/AIDS Awareness Through Performance*
Using traditional arts to in raise awareness about HIV/AIDS is more than a local phenomenon. The following article centers around a festival held in 2003 in a village in Guinea, West Africa, yet it deals broadly with the benefits as well as the potential risks of disseminating health information through the arts. Here organizers and health experts in Guinea reveal that while performance can be a vital tool for conveying messages, it can also be a liability if artists aren’t well informed.
A village in Guinea may seem worlds away. However, given that Africa is home to 60% of the global population living with HIV/AIDS, any larger perspective on the disease must inevitably look to the continent. And since Transdiaspora Network’s interventions employ Afro-Caribbean traditions such as storytelling and dance, this article’s sojourn could also be conceived as a return.
Friguiagbe, Guinea, September 2003:
Under a florescent floodlight, some 2,000 people—mostly residents of this town in Guinea’s coastal region—gather until the wee hours of morning for a festival of music, theater and dance. While the traditional melodies performed here are centuries old, their lyrics are decidedly modern.
“Use a condom!” chants one ensemble. “Or else stay celibate!”
The Ballet Wassasso from the capital city of Conakry sings the message in French and Susu, the local language, before regaling the audience with a dance of flailing limbs, an explosion of drums, and a shower of prophylactics.
As the number of Africans living with HIV/AIDS approaches 30 million, this event, the Festival of African and Guinean Folklore (FESTAFOLG), has joined an Africa-wide trend integrating AIDS education and traditional culture. The Festival’s theme: “Stigmatization and discrimination associated with HIV/AIDS, the cultural context.”
“Folkloric culture is an important platform for relaying messages,” said Alfred Houlemou, a Guinean television journalist and the Festival’s principal organizer. Houlemou explained that the West African singer/historian, the griot, traditionally plays a social role not only as a traveling artist but also as a conveyor of practical information from village to village.
“Will you say to the people of Friguiabe, ‘Hey, I’m going to send you an e-mail with information on preventing AIDS?’ No—the medium is wrong,” said Papa Fadiara Cissokho, who organizes a festival each year in Louga, Senegal. Even drumming, which he says replicates spoken language in many traditional African cultures, is being used to further AIDS awareness. “Rhythm is the best vector of communication in Africa,” he said.
The Paris-based International Council of Organizations of Festivals and Folklore says FESTAFOLG is one of many African festivals that have used folk culture as a platform for addressing societal concerns, ranging from ethnic conflict to sustainable development. Africa Alive!, a network of media-savvy youth organizations that have become one of the continent’s largest AIDS prevention groups, also uses music festivals to relay educational messages in eight countries. And in Cameroon, the John Hopkins University School of Public Health has collaborated with Cameroonian folk artist Paul Kengmo to produce cultural events about AIDS in rural villages known as Project Ah Ta-Ah.
In Guinea, the government’s Department of Culture provided most of the $50,000 needed to produce FESTAFOLG, which featured two-dozen ensembles from Guinea, Ivory Coast and Benin. Meanwhile, a group called PRISM sponsors 10 traveling theater troupes in Upper Guinea as part of its HIV/AIDS education program. On the day of a performance, the group organizes a Mamaya—a dance for members of a particular age group—or commissions a konden—a masked dancer—to parade around the village with drummers to attract villagers to watch interactive theater performances about HIV/AIDS.
The idea of integrating traditional West African arts and HIV/AIDS education dates to at least 1993, when Antonio Francesco, a U.S. Peace Corps volunteer in Diourbel, Senegal, assembled a troupe to bring health education with support from doctors to rural villages. The group toured for several months, performing with permission of village leaders and holding seminars after each show. Two months later, a health team was sent to conduct random interviews in each village, and found that villagers both remembered and understood the message.
PRISM has seen similar results. A survey conducted a year into its program found that compared to the population of Beyla—a control province in Guinea’s forest region which received no HIV/AIDS intervention—Upper Guinean men were twice as likely to use a condom.
But some HIV/AIDS workers warn that purveying health facts through the arts can be risky. “Theater and music and traditional ballets are good for attracting big audiences and presenting basic information,” said Kimberly Ross, HIV/AIDS adviser in Guinea for the U.S. Agency for International Development. “But they haven’t been effective in addressing myths and misconceptions.”
At the Friguiagbe festival, a group called Ballet Saamato performed a scene in which a comb and razor used by an unhygienic barber were said to be contaminated with the HIV virus. Such an infection “is possible,” said Mackenzie Dabo, former coordinator for the Peace Corps’ HIV/AIDS programs in Guinea, “but the chances are slim.”
Many of the festival’s scenes portraying death from AIDS included a sexually promiscuous female character, usually a prostitute. Such depictions are common in educational theater “because they’re funny and easy to represent, but they reinforce the stereotype that only prostitutes and promiscuous people can get AIDS,” Ross said.
Without consultation from knowledgeable AIDS workers, cultural performances may even reinforce misconceptions and add to the societal stigma suffered by many AIDS victims, Ross said. However, most health workers add that simply by addressing the topic of sex openly, folk performances can break through the fundamental taboo about discussing sexuality that is one of the biggest barriers to AIDS education in Guinea and elsewhere in Africa. They say traditional culture is a powerful awareness-raising tool when coupled with accurate information, thoughtful production, and discussions following each performance.
*Written by Joshua Cohen, a PhD student at Columbia University’s Art History Department, who aims to change western framings of African arts.
On the Verge: The Local Other (II Part)*
“Is this the medical clinic?” asks one man, to which a middle-aged woman responds, “I think so,” pointing to a picture of an AIDS ribbon visible through an open first floor window.
The building, as well as the entire city block, is occupied by Via Libre, a non-governmental organization founded in 1990, which, at the time of its creation, operated out of a cramped office and existed only through the volunteer efforts of a small group of healthcare professionals. Since its inception, Via Libre has provided counseling and mental health services to the HIV-positive population of Lima. Over the past 19 years, Via Libre has grown exponentially to provide free comprehensive medical services to persons living with HIV/AIDS, create a drug bank for those who cannot afford expensive antiretroviral medication, and engage in creative educational campaigns aimed at preventing the spread of HIV among Lima´s youth and other high-risk populations. In recent years, Via Libre has created a laboratory dedicated to the development of an HIV vaccine.
When Via Libre was founded, there were no useful statistics about the number of Peruvians living with HIV, and worse, thousands were unaware that they had been infected. As recently as September 2007, a number of population-based surveys, including surveys by the Peruvian Ministry of Health and the United States Agency for International Development (USAID), reported that there were over 50,000 known cases of HIV or AIDS in Peru, with the capital region accounting for approximately 72% of these. Significantly, the United Nations Joint Programme on HIV/AIDS (UNAIDS) estimates that approximately 35,000 additional Peruvians are HIV positive but unaware of their status. According to the USAID, sexual transmission accounts for 97% of HIV/AIDS cases in Peru.
In the 1990s, the AIDS epidemic quickly became a burden on Lima´s then-collapsing healthcare system, and private citizens met the challenge of raising awareness about HIV/AIDS.
“Civil society is most responsible for HIV prevention in this country,” says Marcela Coronado, a director at Via Libre. Ms. Coronado, a psychologist who works closely with at-risk youth ages 14-18, believes that there is no organized education in Peruvian schools concerning HIV/AIDS but there is a “growing recognition that [HIV/AIDS] is major public health crisis.”
Coronado explains that Via Libre has gained inroads into at-risk populations by working with community groups, sports clubs, discotecas, and other public spaces frequented by young Peruvians.
“When we work with youth, it is imperative to work with their parents and communities, otherwise parents rightfully will be suspicious of our activities,” said Coronado.
In Coronado´s view, a major challenge is “gaining the respect and friendship of the various communities we work with…our approach differs with each target community.” While Via Libre uses its mobile unit to disseminate information to large groups of people at street fairs, it utilizes a more personal approach when working with teens. “We play games with the youth and get them to loosen up,” said Coronado.
One such game involves asking teens to write anonymously on a small piece of paper the first words that come to mind when they hear certain words, such as “sexuality,” then taping their notes onto a giant ball. The facilitator then passes around the ball, and each teen reads aloud one comment for the group to discuss. “There is a lot of laughing, but the kids are really put at ease and feel comfortable talking about serious issues.” recalls Coronado with a broad smile across her face.
Via Libre´s vision and many innovative approaches to HIV prevention have gained the organization national and international attention, including much-needed funding from the European Union and other international sources.
Many of Via Libre´s youth participants have already gone on to become peer educators and form an integral part of Peru´s fight against HIV/AIDS. As part of Via Libre´s “Communidad Saludable” (Healthy Community) campaign, which is in its second year, some youth participants now work with community leaders and health professionals to organize prevention activities in and around Lima. Ms. Coronado reports that youth have helped organize HIV awareness fairs, created HIV-prevention brochures, and are presently working with medical clinics around Lima to create spaces where the general public can obtain HIV-prevention materials and find support groups. Ultimately, Coronado explains, “Via Libre wants to create a culture of prevention. We want to start a dialogue that will continue even after our work in a particular community is complete.”
On the Verge: The Local Other*
“Can you get HIV from living with someone who has HIV?” “Will you get HIV from a mosquito bite?” “How about from kissing?” Sandesh Mahadik, an HIV counselor by day and aspiring actor by night, asked these questions to a crowd at Mumbai’s Juhu Beach on a balmy December evening. They had gathered around Mr. Mahadik as he and his fellow volunteers put on a street theater performance. Earlier in the evening, informational health literature and condoms had been disseminated among beach-goers by members of Sanmitra Trust, a non-profit organization founded in 1999 that runs several projects for HIV prevention and for the care, support and empowerment of people living with HIV/AIDS.
Mr. Mahadik, who has a bachelors degree in counseling and works at an AIDS hospital by day, believes that Indians are “dangerously” uninformed about HIV/AIDS and lack access to accurate information about prevention and treatment. “In a country that is struggling to educate its youth and to achieve 100% literacy, HIV prevention is not viewed as a top priority. But it must be.” Mr. Mahadik explains that the desire to inform fellow Indians has driven him to volunteer with the Sanmitra Trust, which, among other things, sponsors street theater relating to HIV/AIDS issues. “We try to break down stereotypes and societal stigma associated with HIV/AIDS,” says Mr. Mahadik.
One of Sanmitra Trust’s street theater pieces tells the story of a carefree Indian youth who finds out that he has contracted HIV. Faced with this news, he is confronted by his brother who tells the young man that he should leave their family’s home and live on his own. “I’m not sharing a toilet with you,” exclaims the brother. When their father gets wind of these developments, he is understanding; he sits the boys down and explains that HIV cannot be spread this way. “Does anyone know how HIV is spread?” the father asks the growing crowd.
Mahadik explains that the public has been receptive to Sanmitra Trust’s street theater performances, although noting that in Mumbai, the center of India’s film industry, “everyone’s a critic.” He believes that there is still a great deal of denial in India about HIV/AIDS; however, people are beginning to recognize that the virus “is killing millions of our countrymen.” Mr. Mahadik is hopeful that through the work of Sanmitra Trust and other local grassroots organizations and charities, India will be able to overcome the greatest public health crisis in its history. (View Pictures)
*Written by Ameet Kabrawala, TDN Board Chairman, from Mumbai, India
Let’s Build Something Together
In early June, The Archives of Internal Medicine published an article concluding that our health care system fails minority patients because of what the study’s author, Dr. Thomas D. Sequist, an assistant professor of health care policy at Harvard Medical School, called “a systemic failure to tailor treatments to patients’ cultural norms.” According to Dr. Sequist, “it isn’t that providers are doing different things for different patients. It’s that we’re doing the same thing for every patient and not accounting for individual needs. Our one-size-fits-all approach may leave minority patients with needs that aren’t being met.” To address these gaps, Sequist suggested that health care providers learn more about minority communities so they might better understand cultural barriers to treatment compliance.
As many of you know, Transdiaspora Network recently conducted a health survey in the Crown Heights community. After analyzing the survey results with Gretchen Maneval, Lorna Mason*, and Naomi Braine at the Center for the Study of Brooklyn at Brooklyn College, we found that knowledge and impact of HIV/AIDS varied widely among survey participants, a diverse group ranging in ethnicity, age, and gender.
More than 60% of those surveyed reported that they had not participated in HIV prevention education, and 67% reported that they discussed ways to protect themselves only once per year or even less frequently.
Not surprisingly, an overwhelming majority of those surveyed (79%) reported that their HIV prevention education had not incorporated cultural elements at all.
But most interestingly, we found that 50% of those whose education had incorporated cultural heritage described their knowledge of HIV prevention as “excellent” compared to 27.7% of those whose education did not incorporate cultural heritage at all.
So what does this all mean? Sequist is right, but he is also quite wrong. While his study sheds light on the shocking lack of cultural sensitivity among most health care providers, an even more ambitious approach is needed. We must go beyond simple cultural sensitivity or even competency and demand cultural proficiency. Cultural differences need not be a limiting factor merely to be accommodated or referenced, as Sequist’s study suggests. Let’s not just consider culture. Let’s use it. Our rich cultural heritage can provide many of the tools we need to address our most intractable health challenges such as effective HIV prevention. Setting the bar higher – aiming for cultural proficiency – will allow organizations to develop more sustainable prevention programs within a community that improve the capability of its own residents. Let’s take a closer look at everything that our own community has to offer. Harnessing the full potential of our own very powerful cultural resources may well provide the more lasting, more comprehensive, and ultimately more sustainable approach to HIV prevention that we urgently need.
*TDN would like to give a special thank you to Lorna Mason for creating the beautiful graphs you see here.