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Media Health Images of Africa and the Politics of Representation: A South African AIDS Choir Counter-Narrative


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This paper is an ethnomusicological and media studies collaborative study that discusses the politics of representation on media health images, especially HIV/AIDS in Africa, and how a South African AIDS support group and choral ensemble offers a counter-narrative to the images that are seen in the Western media. Using ethnographic data on the group’s organization, music events, and interviews with choir members, we argue that Siphithemba Choir’s story is a narrative of self-representation that subverts the appropriation of their story by the scientific community, and counters the helpless image of HIV-infected individuals that often comprise the face of HIV/AIDS in Africa in the mainstream media.
" The perils of pregnancy: one woman's tale of dying to give birth. " Source: Time magazine Monday, 14 June 2010. Objectification/Reductionist Approach. Some scholars however assert that Africa is no longer represented in negative light in mainstream media (see de Beer, 2010) despite blatant headlines like the May 13, 2000 cover story of The Economist: " The hopeless continent, " and Charlayne Hunter-Gault's description of Africa with four D's, namely " death, disaster, disease, and despair " (2006: 107). The counter-argument maintains that such representation is no longer the case. But our findings of specific examples from the same year (2010) when de Beer published his study shows otherwise. African news stories still lack the extensive coverage that encompasses some history and life of individuals in the news other than the zeroed-in event. Equally and often, Africans infected with HIV/AIDS are presented in the news with little or no human dignity. They are nameless, have no life except their life with AIDS or other ailments as depicted in the story – basically reduced to mere objects. For example, Time magazine's 14 June 2010 coverage of a woman dying in child birth in Sierra Leone was accompanied by a naked picture of the woman with both breasts clearly exposed – a picture that would seem obscene for an American woman but nevertheless, acceptable for an African woman. Another example is the CNN's 10 September 2010 report on Kenya by Kevin McKenzie, which focused on child labor with the caption " Boy earns 1 cent a goat in slaughter trade. " ( This story was accompanied by a three-minute video that isolated eight-year-old and six-yearold boys transporting goats to a market square. Whilst these examples may be construed as laudable investigative journalism that unearths child labor and a lack of basic needs for pregnant mothers, they are typical of the brand of stories that are covered for Africa. It is in light of this type of reportage that Columbia Journalism Review writer Karen Rothmyer (2011) reported a study that
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Corresponding author:
Austin C Okigbo, Ethnomusicology and Africana Studies, University of Colorado, 301 UCB, Boulder, CO 80309,
Media Health Images of Africa and
the Politics of Representation: A
South African AIDS Choir Counter-
Link to published version
Austin C Okigbo
Ethnomusicology and Africana Studies, University of Colorado, USA
Bellarmine A Ezumah
Journalism and Mass Communications, Murray State University, KY, USA
This paper is an ethnomusicological and media studies collaborative study that discusses the politics
of representation on media health images, especially HIV/AIDS in Africa, and how a South African AIDS
support group and choral ensemble offers a counter-narrative to the images that are seen in the
Western media. Using ethnographic data on the group’s organization, music events, and interviews
with choir members, we argue that Siphithemba Choir’s story is a narrative of self-representation that
subverts the appropriation of their story by the scientific community, and counters the helpless image
of HIV-infected individuals that often comprise the face of HIV/AIDS in Africa in the mainstream media.
HIV/AIDS, images, Africa, media politics, music, representation
At the start of the writing of this paper, there was a media-driven ebola panic across the United
States. In the reporting on the outbreak of the virus on several cable networks, motion pictures of
sick Africans and the interment of black bodies in West African countries by health workers in
hazmat suits were juxtaposed on the screen with the still and healthy image of a white American
doctor in New York. The doctor and two other missionaries before him had contracted the disease
Journal of Asian and African Studies
© The Author(s) 2015
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DOI: 10.1177/0021909615608208
while on a humanitarian mission to Liberia. The media-driven panic made well for political rhetoric
and campaign, complicating and vitiating thus the badly needed education on the public health
situation at the time in the US. Ebola does not constitute an epidemic in the US compared with
enterovirus D68 that hit up to 48 states in the US with over 1,100 cases by November 2014.
Kimberly Leonard, a health reporter with the US News and World Report warned “enterovirus, not
ebola, is the disease worth worrying about [for Americans]” (2 October 2014). Searching for
reporting on enterovirus D68, one finds the image of a black boy in a Denver, Colorado hospital
taken on 8 September 2014, reused by both the New York Times (25 September 2014) (Saint Louis,
2014) and the US News and World Report (2 October 2014) (Leonard, 2014) to depict the impact
of the virus.1 The question then is: why is Africa and the black body often equated with global
disease epidemics?
The media images referenced above are not unprecedented. Rather it has been a centuries-long
practice, even in instances where diseases have been introduced into the African continent from
Europe: for instance, smallpox (Theal, 1899), and the Spanish influenza of 1918 (Philips, 1990;
Ranger, 1988). Mainstream media accounts tend to present reductionist views whereby African
bodies become equated with disease and helplessness. A similar reductionist approach to reporting
would characterize African images of HIV/AIDS in Western media especially since the early
1990s, when suddenly the attention shifted from North America, where initially HIV/AIDS was
associated with white homosexuals, to Africa as the epicenter of the global AIDS pandemic. The
representations are characterized by what health sociologist Paula Treichler described as
“Eurocentric, biased, doomsday Western AIDS coverage” (1999: 209). In this media coverage,
Africans at large are cast in the light as passive recipients of external aid; too ignorant, too poor
and so unsophisticated to understand how to deal with the HIV/AIDS and other epidemics. They
echo thus “The White Man’s Burden” theme of Rudyard Kipling’s 1899 poem, which has been
widely interpreted as depicting Africans and other non-Europeans as lacking in intellectual
capacity, who therefore need the enlightened Europeans to lift them out of their social and cultural
sorry states. The implication is that Westerners maintain a National Geographic image of their
African counterparts and which in turn shape public policies and Western response to disease
epidemic in Africa (Schraeder and Endless, 1998: 29).
While this style of media coverage of Africa has received broad scholarly criticism, what has
been missing in the discourse is Africans’ ways of engaging in the conversations on global health.
Using the case study of the Siphithemba Choir, a HIV/AIDS support and choir group at the McCord
Hospital in Durban, South Africa, we suggest that the choir provides a counter-narrative that
dispels the doomsday, coffin-bound health representations of Africa in Western media. We
examine the group’s operation of income-generating projects, their use of music and dance, and
the nature of the choir’s interaction with the Western biomedical scientists in on-going research on
AIDS treatment. Drawing equally from interviews with choir members, we argue that Siphithemba
Choir’s story is a narrative of self-representation, aimed at first subverting the appropriation of
their story by the scientific community who showcase them as their (medical scientists)
accomplishment, and second, countering the helpless image of them that is often misrepresented
in mainstream media using the platform of music and performances. Furthermore, a brief
examination of the contextual encounters of the choir with American audiences also suggests that
the members have a consciousness of themselves as engaging in the campaign of counter-narrative
to the often one-directional HIV/AIDS discourse.
Towards Media Politics and African News Reportage
Several inter-related paradigms provided theoretical guidance for this work. We employed the
agenda setting theory and framing, as well as the concepts of representation and stereotype as the
bedrock for this paper. We equally highlighted the global news ownership, production, and
dissemination as forces that shape international news. This is vital because the political economy
of contemporary news production may be construed as having become an oligopolistic venture,
dominated by three global news agencies (Reuters, Associated Press, and Agence France Presse)
also known as “The Big Three” who produce the majority of international news consumed in the
entire world (McPhail, 2006). Located in the global core countries and megacities New York,
London, and Paris the corporate structure, nature of services, and location of these news agencies
have dominated the international news flow discourse since the 1960s including the New World
Information and Communication Order (NWICO) debate. To date, peripheral nations are not able
to withstand the competition posed by these core-based news agencies nor have the news agencies
changed their style of reportage on the peripheral or developing nations. Therefore, international
news production is grossly influenced by underlying cultural and historical factors that stem from
the electronic colonialism ideology. McPhail (2006) noted the global news agencies’ reportage of
African (and Latin American) news stories is often negative and has a one-way slant that does not
equalize the EastWest and North–South balance. Even Roberto Savio’s Inter Press Service (IPS)
agency attempts to mitigate the negative news about developing countries by encouraging liaisons
between civil societies, non-governmental agencies, and policy makers in developing countries in
recognizing the poor and oppressed has proven insignificant in the face of fierce competition from
The Big Three. The ownership of news agencies therefore reflects the interest of newsmakers.
Since Africa does not partake in major news production, news about Africa is often presented from
a Western perspective, albeit in a predigested and romanticized fashion.
Equally as important as the political economy of news ownership and production, is how news
stories are selected and presented. Whereas media are successful in informing the general public
on matters of importance, they are capable of influencing how those “important” facts are viewed,
digested, and acted upon. The agenda setting theory provides a clear framework for examining
what news producers choose to present as newsworthy and how those events are framed. The
standard agenda setting (McCombs and Shaw, 1973) description has always been news media
may not be successful at telling us what to think but stunningly successful in telling us what to
think about. This has been furthered to entail how to think about it and, perhaps, what to do about
it (McCombs, 1997). In essence, and considering that citizens of the West view the broadcast
networks and newspapers as their sole sources of information, the selected African news stories
form the basis upon which they construct their meaning of Africa (Pew Research Center, 2013). In
line with our argument, the function of the press media in this manner then serves as a dysfunction
of displayed negative imagery of Africa.
Akin to agenda setting is the framing technique and subsequent priming effect. Framing is a
technique that allows press media producers to focus on particular issues while situating them
within a field of their own meaning a meaning that they consider dominant. James Tankard
(1999), as cited in Sparks (2010), defined framing as the “central organizing idea for news content
that supplies a context and suggests what the issue is through the use of selection, emphasis,
exclusion, and elaboration” (2010: 182). Framing serves a hegemonic purpose of influencing news
audience’s reception of the story, i.e. it influences a particular interpretation that can be attributed
to a story in this case, a negative interpretation of news about Africa. The accompanying priming
effect then facilitates and reinforces the impact by creating an association of those stories and any
other stories or thoughts about Africa. Sadly, news media have been incorporating this technique
for decades in their presentation of African news. The idea of organizing stories about Africa as
different and deviant draws a dichotomy of “us” versus “them”. Ibelema considers this practice as
eliciting realities for Africa that are “inconsistent with modernity or at variance with standard
contemporary practices” (2014: 164) because “Western identity is, in effect, the definition of
modernity. Deviation from it, therefore, constituted otherness” (2014: 165). In this case, therefore,
reportage such as relates to health and HIV/AIDS in particular, the standard contemporary practice
or reality for infected patients in the US presents a healthy and successful person(s) with a name,
a face and other qualifications, while the polarity for Africa is a nameless, disheveled, poor woman
or child lacking agency.
The political economy of news production and the process of agenda setting and framing in turn
shapes the dynamics of representation, and in the case of developing countries generates
stereotypical modes of representation in the mainstream media. The concept of representation as
an ideology for interpreting meaning was furthered by Stuart Hall. For Hall (2003), representation
allows for the production and dissemination of meaning through the use of language, signs, and
images. He deconstructs the vulnerability that continuous (mis)representation might induce on
people in their quest of making meaning with the signs and symbols (language) that media present.
Hall’s view draws inference from the semiotic and discursive ideas of the Swiss linguist Ferdinand
de Saussure (1960) and the language/power of French philosopher Michel Foucault (1980),
respectively. De Saussure posits that language is a system of signs; we merge the idea or concept
in our head with a particular form or text. He described this as having two elements: one being a
signifier and the other, the signified. For example, the first element could be an image, the second,
a concept as in a shape of a heart being an image and the concept will be love (de Saussure, 1916).
Unlike de Saussure, Foucault emphasizes discourse as a system of representation. Similar to de
Saussure’s signs, Foucault explains that a group of statements can equally produce meaning
through language. Hall (2003) explains that for Foucault, the discursive events may not necessarily
happen at the same point in time. Rather, over time certain discourse could form a powerful
meaning just as signs are equally capable of evoking meaning. Applying this to our current study,
Africa and its stories have been attributed a negative concept by mainstream media through signs,
photographs, and discursive news endeavors, etc. The problem though, as de Saussure and Hall
assert, is that meaning should not be fixed; meaning should float and change. Unfortunately, the
mainstream media still renders the signifier and the signified as a fixed concept with an immutable
meaning as concerns Africa, thus perpetuating anachronistic interpretations of Africa when, in
essence, other variant interpretations have emerged.
Africa in Western Media
The African continent, especially, the sub-Saharan region has been continuously framed in a
negative light since the inception of the news media. Ibelema (2014) traced this history to the
Traveler’s Tale whose main purpose is to entertain and present an imagery that represents the
Other, the Strange, the Unknown, sometimes with conscious effort to paint a picture that is directly
contrary to the Known. David Spurr (1993: 3) succinctly asks: “how does the Western writer
construct a coherent representation out of a strange and (to the writer) often incomprehensible
reality confronted in the non-Western world?” While traveler’s tales may be centuries old, their
impact still persist and powerfully so that they still remain the frame of reference and ultimately
have constituted the template by which news and stories from Africa are reported. Evidence of this
abounds especially in news reports on public health, and we discuss this under five categories.
Commodification of African News Stories
. The commoditization of news in a digitized world
has ensured that news is increasingly no longer a mere presentation of current events but has
equally incorporated the notion of entertainment. “If it bleeds, it leads” has become the dominant
guiding principle for the selection and presentation of news and this is particularly evident in the
coverage of African news. Therefore, in their quest for ratings and increased readership and
viewership, news editors and reporters strive to present their audience with deviant stories that
entertain as much as, if not more than, they inform (Ibelema, 2014; Okigbo, 1995). This argument
has continuously dominated the international news flow discourse that it sometimes is disregarded
and likened to a broken record. Mody (2010) observed that the “news frames of media of different
countries reflected not just their national interests but also what they deemed to be expectations of
their particular audiences” (2014: 171). Such expectations include negative developments and
events including crisis, disease, disaster, corruption, among others (Mellese and Muller, 2012).
Figure 1. “The perils of pregnancy: one woman’s tale of dying to give birth.” Source:
Monday, 14 June 2010.
Objectification/Reductionist Approach.
Some scholars however assert that Africa is no longer
represented in negative light in mainstream media (see de Beer, 2010) despite blatant headlines
like the May 13, 2000 cover story of The Economist: “The hopeless continent,” and Charlayne
Hunter-Gault’s description of Africa with four D’s, namely “death, disaster, disease, and despair”
(2006: 107). The counter-argument maintains that such representation is no longer the case. But
our findings of specific examples from the same year (2010) when de Beer published his study
shows otherwise. African news stories still lack the extensive coverage that encompasses some
history and life of individuals in the news other than the zeroed-in event. Equally and often,
Africans infected with HIV/AIDS are presented in the news with little or no human dignity. They
are nameless, have no life except their life with AIDS or other ailments as depicted in the story
basically reduced to mere objects. For example, Time magazine’s 14 June 2010 coverage of a
woman dying in child birth in Sierra Leone was accompanied by a naked picture of the woman
with both breasts clearly exposed a picture that would seem obscene for an American woman but
nevertheless, acceptable for an African woman.
Another example is the CNN’s 10 September 2010 report on Kenya by Kevin McKenzie, which
focused on child labor with the caption “Boy earns 1 cent a goat in slaughter trade.”
This story was accompanied by a three-minute video that isolated eight-year-old and six-year-
old boys transporting goats to a market square. Whilst these examples may be construed as laudable
investigative journalism that unearths child labor and a lack of basic needs for pregnant mothers,
they are typical of the brand of stories that are covered for Africa. It is in light of this type of
reportage that Columbia Journalism Review writer Karen Rothmyer (2011) reported a study that
reviewed African news coverage by the 10 most read US newspapers and magazines between May
and September 2010. Results show that of the 250 stories about Africa that were portrayed in the
selected newspapers and magazines, 245 of the stories were about poverty in Africa while only
five stories covered the Gross Domestic Product (GDP) growth in Africa which is one of the most
current news events on the continent.
Binary Oppositional Views.
Historically, the coverage of HIV/AIDS by the Western, especially
US media, always assumes binary oppositional views. Early in the 1980s, the news then was
framed in what Gilman (1988) referred to as the “healthy us and the diseased other” (1988: 4).
Similarly, Albert (1986) noted that readers of newspapers and magazines in the 1980s were
fascinated by AIDS stories not because of the disease but because of the deviant character of the
victims. Initially, the binary oppositions are depicted by the labels of homosexuals versus
heterosexuals, then the black community versus the white community, and people with low socio-
economic status and those with high socio-economic status. Later that label is transferred to Africa
and other developing regions of the world versus the developed countries of the world. Bardhan’s
(2009) study reviewed AIDS stories coverage by the three major news agencies, the Associated
Press, Reuter, and Agence France Presse. Results show that HIV/AIDS was framed as “a problem
of the lesser-developed world” (2009: 300). In other words, AIDS in the United States is different
from the African AIDS. An example of this rhetoric of Otherness is the stark difference between
the faces of AIDS for the US and the African countries. The faces of AIDS in the USA include
sports celebrities, rock stars and entertainers who are successful in their various fields. According
to the list collated by Brian Krans of Healthline (2013), famous faces or poster personalities of
HIV/AIDS in the US over several decades include: NBA champion Earvin “Magic” Johnson; actor
Rock Hudson; summer Olympics gold medalist (diver) Greg Louganis; rock musician Freddie
Mercury; visual artist Keith Haring; Robert Reed of The Brady Bunch; winner of the Triple Grand
Slam tennis titles Arthur Ashe, among many others. They serve as spokespersons, writers of
bestselling books and philanthropists. In contrast, the faces of AIDS in Africa are nameless and are
often represented by women and children who lack agency. Descriptively, they are poor, live in
very rural communities with no basic sanitary amenities. They are often extremely thin, and exude
the imagery of severe suffering and abject poverty as evidenced in the February 2003 TED video
by a US journalist Kristen Ashburn
With no intents to trivialize the impact of AIDS in Africa or to negate that some AIDS infected
people in Africa bore the likeness of the depiction provided by mainstream media and independent
journalists, we contend that such presentation is skewed, incomplete, misleading, and lacks
objectivity. It therefore, falls within the oft-criticized realm of stereotype, otherness, and tribal
fixation (Ibelema, 2014).
Philanthropic View: Helpless and Lacking Agency.
Similar to the binary oppositional frame of
health news about Africa is the subsequent need to help the needy and helpless of Africa. The
majority of health coverage in Africa, even when the theme is not about transnational relations,
will ultimately include assistance from the United States or other Western countries. Mwiinga
(1993) noted that AIDS stories about Zambia in the 1990s were mostly focused on political
donations. Equally, Kalyango and Onyebadi’s (2012) study show political and health issues to be
prominent themes in the international news coverage about Africa and most often the health crises
is presented alongside attempts from the United States to provide aid to those countries.
We did a simple search on The New York Times website for “AIDS in Africa” and reviewed
three random stories to determine to what extent political donations and philanthropic themes
surface in the story. Just a few examples: The first article, “AIDS Progress in South Africa is in
Peril” which showcases a print advertising for tombstones “Buy One, Get One Free” recounts
improvements that the South African government have made in controlling the spread of AIDS.
Shortly after recounting this effort, this paragraph was interjected:
Though few Americans or even South Africans realize it, the nation owes much of its success to a single
United States program, the President’s Emergency Plan for AIDS Relief, or PEPFAR, started in 2003
under President George W Bush. It has poured more than $3 billion into South Africa, largely for training
doctors, building clinics and laboratories, and buying drugs. (New York Times, 25 August 2013).
The second article, “Three Approaches to Beating the AIDS Epidemic in South Africa”
introduced the story with an indication that the AIDS epidemic is at its worst in high-risk subgroups
such as gay men, prostitutes, truckers, prisoners, miners, etc. The very next paragraph adds: “To
have any hope of beating the epidemic, it must focus on such groups, experts say. Many pilot
projects to do that have been started with aid from the United States government program called
PEPFAR.” (New York Times, 25 August 2013). The third article, “Where AIDS Steals Life by the
Millions: ‘Fire in the Blood’ Spotlights AIDS in Africa” was supposed to be a review of the movie
“Fire in the Blood.Also, the second paragraph expressed: “Former President Bill Clinton, the
intellectual property lawyer James Love, the journalist Donald G McNeil Jr of The New York
Times and others offer perspectives on this situation and also on the concern that pharmaceutical
companies value profits over lives” (New York Times, 5 September 2013).
Distorted Content.
African news stories are not accorded the time, space, and talent that are
needed to produce a cohesive and comprehensive report. This results in diminution of information
in the coverage of events. Often sound bites gathered from parachute journalism are presented.
Prior to the internet, satellite and other instantaneous and less expensive communication systems,
the price for supporting a single foreign correspondence for one year is about US$300,000
(McPhail, 2006); it is understandable then if Western media were unable to maintain
correspondents who will spend enough time to gather substantive information on a news story.
One wonders why even today when information is easily accessible, international news coverage
is still much distorted and decontextualized. This resonates with Ibelema’s assertion that “making
an increasingly complex world comprehensible to the American populace necessitates the situating
of news within familiar reference points or stereotypes” (2014: 170). Referencing a study by
Bleiker and Kay (2007), it is evident that not only are Western media incapable (or maybe refuse)
to understand this “foreign” culture, they may have a preconceived lens through which stories from
Africa should be viewed.
Bleiker and Kay (2007) reviewed how AIDS in Africa is represented through photography by
Western photographers and Africans living within the same community with HIV/AIDS infected
patients. They used two frameworks: the pluralist and the humanist perspectives of studying
photography and they encompass several tenets including the difference or distance between the
photographer and the photographed. As with many creative endeavors, the art of photography is
subjective and could therefore be influenced by many factors including social factors.
Undoubtedly, the photographer enjoys the autonomy of choosing what image to capture among
many choices. Similarly, the photographer decides on the lens angle, the choice of focus and lack
of focus, wide versus close-up shots, black and white versus color, and other techniques and
aesthetics inherent in the art of photography and that is how he or she tells a story and showcases
the intended meaning that each photograph exhibits. As mentioned earlier, a photographer’s
decision is influenced by many factors: socio-economic, political, economic, race, gender, religion,
etc. The distance between the photographer and the photographed therefore is determined by to
what extent the above factors influence the gap either by narrowing it or widening it a gap that
Godeau, as cited in Hayes (2015: 173), referred to as “double-distance.” Bringing in the pluralist
and humanist perspectives mentioned earlier, the pluralist presents a heterogeneous perspective
due to the close affinity of the photographer and the photographed. Put differently, the pluralist
photographer knows more about the photographed he or she is aware of other factors that shape
the existence of his or her object or person and so could bring in other perspectives that are beyond
the prism of a humanist who may confine his or her art to just the obvious. Bringing this argument
to our topic, the pluralist is aware that an AIDS patient has a lot of other things happening in his
or her life and so will not fixate all shots on the person and AIDS while the humanist is oblivious
of other activities in and around the life of an AIDS patient; therefore, all pictures tell the story of
the person and AIDS. In describing the humanist perspective, Bleiker and Kay noted, “humanist
photographic engagements, well meant as they are, contain residues of colonial values. They are
more likely to invoke pity, rather than compassion. They reflect how Western and thus very often
universalizedaccounts of HIV/AIDS in Africa are based on very specific assumptions, even
stigma, revolving around the portrayal of people affected by HIV/AIDS as passive victims,
removed from the everyday realities of the Western world” (2007: 141). They contend the skewed
humanistic view and endorsed pluralistic viewpoint in representing HIV/AIDS in Africa. They
consider pluralist photography as capable of providing different perspectives of the object other
than the established Western standpoint; thus, it “seeks to validate local photographic practices in
an attempt to create multiple sites for representing and understanding the psychological, social,
and political issues at stake” (2007: 141). Their preference does not necessarily exonerate
pluralistic view from some stereotypical assumptions since there will always be some level of
subjective insinuations inherent in every photograph especially if examined at a later time than the
moment the photograph was taken. Moreover, photographs are incapable of depicting precisely the
natural state of the object, which is photographed because every angle could tell a different story.
Bleiker and Kay compared the iconographic photographs (humanist) of AIDS patients in Uganda
with photographs of Ethiopian children affected by AIDS (pluralist). The construction of meaning
through each prism of this typology provided a different perspective and thus different meaning
about people infected with HIV/AIDS in sub-Saharan Africa.
Below are two photographs “Florence and Ssengabi” by Hooper and “My Favorite Things”
featuring Tananesh by Eric Gottesman taken from humanist and pluralist perspectives respectively.
The humanist perspective focused only on the disease, so Bleiker and Kay described the first
picture in these words:
Both Florence and Ssengabi were visibly ill. Taken during the early period of Western public awareness
about HIV/AIDS, the Hooper photograph provided a “face” that could symbolize the AIDS crisis in Africa.
It was published widely in the international media, including Newsweek and the Washington Post… The
photograph is very confronting in its direct visualization of illness, suffering, and death (2007: 147).
They also highlighted stark inequality of power between the photographer and the photographed
a trait among many Western journalists and photographers which often compromises the dignity
of the person being photographed. This is a staple for many Western journalists covering health
stories in Africa because “any Western photographer, no matter how well meant and sensitive his
or her artistic and political engagement is, operates at a certain distance from poverty, conflict, and
disaster.” (2007: 148). In contrast, a different representation through the pluralist prism provides a
picture where Tananesh tells a story that does not have AIDS as the center of her narrative. Granted
she is infected with HIV/AIDS, but her life does not revolve around the disease, there are other
interesting events happening in her life. Bleiker and Kay described her photograph in these words:
Her pictures do not represent suffering. They place her existence in a larger personal and social context.
As opposed to the Hooper photograph, these pictures do not portray a decontextualized world of darkness
and gloom. Instead, Tenanesh captures the dailyness of her life, its ups and downs, her determination to
lead a relatively normal childhood… Tenanesh is not a passive victim in the way Hooper portrays Florence
and Ssengabi… We are inevitably confronted with the life of a single person, rather than an abstract image
of a disease (2007: 155156).
Figure 2. “Florence and Ssengabi.” Source: Hooper. “My Favorite Things.” Source: Eric Gottesman.
Clearly the likes of Tananesh’s photo image and story do not form the frame of reference on
health reportage on Africa. In contrast to the photo narrative on Florence and Ssengabi, Tananesh
in her own personal photo narrative shows her as having agency and power, and her life means a
lot more than the virus that inhabits her body. It is in light of the above, that we introduce The
Siphithemba Choir and their story as a counter-narrative to Western media representation of AIDS
infected persons in Africa.
Towards a Performative Counter-Narrative: Siphithemba Choir in the
Politics of Representation
The Siphithemba Choir (see Okigbo, 2011) came out of the HIV/AIDS support group that was
founded in 1997 at the McCord Mission Hospital in Durban. Its founding was as a source of
alternative care in the form of spiritual counseling, prayers, and social support network for HIV
positive individuals at the time when, due to slow dissemination of antiretroviral drugs, doctors
and caregivers had little medical help that they could render to patients. The support group was
initiated by Mrs Nonhlanhla Mhlongo, a medical social worker, whose primary responsibility was
to coordinate the medical social services and to administer pre- and post-HIV/AIDS diagnosis
counseling. She was trained at the University of Zululand between 1975 and 1980, an institution
that comprised one of the major centers of the South African Students’ Organization, the platform
for propagating the black-consciousness movement (BCM), led by Steve Biko. Through her
training as a social worker at this university, and her experience of the BCM, she followed the
philosophy of self-reliance, social networking, and support system as critical forms of intervention
in struggle experience, a philosophy that would shape her work at McCord Hospital, and which
she inculcated into the members of the support group and choral ensemble.
As a group of individuals who live the experience of being HIV-positive, the choir members
show clear understanding about the global health politics, especially the politics of HIV/AIDS, and
how that highlights the NorthSouth power disparities in the spheres of economics, culture, and
politics. Their aim from the moment of their formation, therefore, has been to counter the
dehumanizing images and narratives on different levels, first and foremost through healthy
lifestyles realized by engaging in work and industry in order to earn a living for themselves rather
than relying on donor handouts from foreign NGOs; second by using the platform of their musical
performances to show physical strength and thus to dispel the wrong notion about them as people
who are coffin-bound and facing imminent death; and third by seizing every opportunity to subvert
the message of Western bio-medical research scientists who like to showcase the choir as evidence
of the success of their work.
Alternative Narrative Through Work and Industry
One of the burdens of the stigma of HIV/AIDS in South Africa, especially in Black townships
in KwaZulu-Natal where this study was conducted, is that many infected people are jobless.
Zinhle Thabethe, a member of the Siphithemba Choir, described how she lost her job when a
fellow employee accessed her office cabinet without her permission, read her diagnosis result,
and revealed her status to her employers, who immediately fired her (Hainsworth, 200 5). In
fact, the majority of members of the support group had never been gainfully employed, some
for lack of skills. The lack of a strong financial base resulted in deficient nutritional habits
making them vulnerable to opportunistic infections. For Mrs Mhlongo, however, this did not
have to be. She believed that HIV-positive individuals could still be productive, and should
be able to earn a living. Hence she encouraged participants in the support group to use the
talents and skills they have to better their economic conditions. According to her, “We’ve got
people who are HIV-positive, and who have no income... they shouldn’t go around begging
(personal interview).
Thanks to Mhlongo’s good guidance, the support group became a space of work and economic
activity. These included the making of Zulu beads which were marketed locally and overseas, and
from which individuals earned income as well as saved some money in a common account that
was used to support the treatment of sick members. The beadwork project grew over time, drawing
hundreds of new members to the support group thus prompting the hospital management to add
different types of skill acquisition to the program for members including sewing and knitting, the
making of mosaics, computer literacy, and even health counseling. Today most of the members of
the group are gainfully employed in private businesses, as counselors in local clinics, and in the IT
sector. This, in combination with their overseas performance tours, and record sales contributed to
majority of them now having a standard of living that is above South Africa’s poverty index.
Much has been documented and written about the use of music to accompany work in African
communities (Bebey, 1975: 11; Nketia, 1974: 2829; Weman, 1960: 8082), to lighten the burden
of work, facilitate productivity, and “to share the burdens and pleasures of the work” as a
communal experience (Biko, 2004: 46). Thus singing comprised an integral part of the work
activities of the Sinikithemba Support Group, and it was in the context of the income-generating
projects that the Sinikithemba Choir was born. According to a choir member, Phakamile Shabane,
“We used to sing all the time, and everyone can sing any part they like. But it always sounded
good” (personal interview). According to Mrs Mhlongo, “the group sang so well, and sometimes
we even shed tears” (personal interview). Another member, Nomusa Mpanza, testified about times
when passersby on the street would stop to listen to the sonorities of the group as its members
worked at their tasks. The environment of work performed to the accompaniment of song thus
created musical consciousness for members, and it was a consciousness that would permanently
alter the dynamics of the group. Nomusa said the day that changed everything was sometime in
early 1998, when the group had finished its work for the day and spent several more hours singing
and dancing. “It was like we all went crazy that day,
Figure 3. Beadworks and other artworks by the Siphithemba group. Photo by authors.
and everybody was watching us. So Nonhlanhla [Mrs Mhlongo] suggested maybe we should form
a choir” (personal interview). Thus, at Mrs Mhlongo’s suggestion, the support group formally
became a choir, and it soon began performing at events in the hospital. The formation of the choir
transformed the support group into a trifunctional entity an HIV/AIDS support group, a
microeconomic project, and a choral ensemble.
A Musical Counter-Narrative
The Siphithemba Choir’s performance is usually an integration of song and dance. Its repertoire is
comprised largely of gospel music, including pre-existing songs they adapted and their own
compositions. In South Africa, two recognizable forms of singing are commonly called gospel music.
The first is the gospel chorus (in Zulu, amakhorasi). Amakhorasi are songs of simple, repetitive refrains.
The style is performed in dialogic call and response between the choir and a soloist who improvises on
a few verses by simply manipulating the theme and existing texts of the song while cueing the choir and
congregation into the refrain. The style of singing is generally accompanied with handclapping and
dance. Based on an indigenous style of singing in its melodic and rhythmic patterns, the theme often
speaks to individual and community experiences in the spheres of faith, economics, love and family. A
second form of gospel music draws heavily from Black American gospel tradition fused with
indigenous amakhorasi style. They equally articulate individual experiences within the harsh economic,
social, and political history of South Africa, and performers reformulate them as characteristic
experiences of their communities and the society at large. The predominance of gospel music in
Siphithemba’s repertory is partly in keeping with their association with McCord, which is a mission
hospital. Dr James McCord, a medical missionary of the American Congregational Church
Figure 4. Ncamisile Yengwa demonstrates the
dance with vigor at a concert in Durban. Photo
by authors.
founded McCord Hospital in Durban, 1909 (see McCord and Douglass (1946) for more on the
missionary history of the hospital). But the choir members also see themselves as engaged in the mission
of preaching the gospel through their music which encapsulates the spirituality of hope in the presence
of HIV and AIDS. Their preference for gospel music notwithstanding, the choir conductor, Phumulani
Kunene and other members interviewed, revealed that they also incorporate traditional Zulu songs
because of their amenability to integration with dance. The dance rationale has several implications as
it pertains to the experience of Siphithemba members. First, traditional songs and dance comprise an
important medium that is recognizable to their local audiences. They also provide an opportunity for the
audience to actively participate, such as when they join the choir in individual soloing in the ngoma
dance, the traditional Zulu high kick and foot stomp dance. Secondly, Phumulani and Nomusa Mpanza
explained that the choir’s decision to perform traditional songs was to provide more opportunities for
dance as a form of exercise. Exercise is recognized as a key component of “positive living, an
expression that conveys the idea of having a positive physical, emotional, and spiritual attitude toward
and about the reality of HIV/AIDS (O’Loughlin, 2008). According to Phumlani, Zulu traditional songs,
with their accompanying vigorous dance movements (see Figure 4) provided regular exercise for
members. Dance is also the choir’s way of projecting distinctive African identity in the context of
performance, especially in the presence of foreign audiences. Ultimately, dance, for the choir, is a means
of maintaining physical health as well as an explicit rejection of the typical depiction of the faces of
AIDS in Africa as hopeless and helpless.
Who’s Story Anyway? In Contention with Research Scientists
Since the beginning of their collaboration with American research scientists who began using
McCord Hospital as the test site for the CD4/Viral Load research project, the choir has received
several invitations to perform in the USA and Europe including appearances at the annual
Conference on Retroviruses and Opportunistic Infections and a show in London with Sir Elton
John. Whereas these overseas tours enabled the choir to forge closer ties with the scientific
community, boosted their economic wellbeing, as well as raised their profile back home in South
Africa, the new relationship with the scientific community also revealed some degree of contention
about who gets the credit for the achievements of the choir and the member’s physical healthiness
manifest in the exuberant music and dance performances. This contention is evidenced in some
scientists demand during one of the conferences in Boston that the choir must not perform any
song about God on the stage. The demand was made irrespective of the fact that the choir is part
of a mission hospital, was founded first and foremost as a support group with prayer and spiritual
counseling at the center of their activities, and that gospel songs predominate in their repertoires.
According to the choir director Phumulani Kunene, this demand by the scientists was
condescending, patronizing, and amounted to utter disregard of the fact that their music is a means
of telling their own story and not the story of the scientists.
The truth is that medical research on AIDS did not give birth to the Siphithemba Choir; rather,
the member’s desire to support one another in their struggles with the virus, their determination to
beat the odds of being HIV-positive, and their effort to bring the message of hope and educate their
community in the same vein account for the formation of the ensemble. Hence, although the
members have benefitted in their relationship with the medical researchers, they still desire to
control the message so that their story becomes paramount in the circumstances of that relationship.
It is therefore arguable that the story of the relationship of the Siphithemba Choir with the scientists
is symptomatic when viewed at least from the perspective of choir members of the West’s
patronizing relationship with Africa. There is a seeming assumption perhaps unconscious by
Westerners who embark on humanitarian and research efforts in Africa that Africans are, as
previously stated, helpless and incapable of finding solutions to their problems. Hence Africa
becomes the critical space for vaccine experimentations and drug testing. When these experiments
fail however, Africans, who comprise the majority of the subjects, suffer. An example is the
reported case of a microbicide gel manufactured by an American pharmaceutical company, a
potential treatment that failed in KwaZuluNatal in 2007 and infected many young Zulu women
with HIV (Skoler-Karpoff, 2008: 19771987, see also Howden, 2009). When success has been
recorded, however, the rules of patents and costs have made it extremely difficult for Africans to
gain access to the drugs. At other times, Western scientists instigate doubts about African’s ability
to handle complicated drug regimens such as the ARV because of “ignorance” about the use of
drugs. Choir member Zinhle Thabethe, who gave the keynote during the tenth annual Conference
on Retroviruses and Opportunistic Infections in Boston rebutted this argument: she offered herself
as a living example of the success of antiretrovirals in an African environment, thanks to her
diligence and ability to manage the complexity of the regimen. Given Zinhle’s ability to use the
platform of the concert stage to respond to Western scientists’ patronizing attitudes, it seems the
choir can still meet its objective of raising its voice and telling their own story without necessarily
letting them be subsumed in that of the scientific community who want to showcase the choir as
evidence of the success of their research endeavors.
“We Are Positive Too”: Acknowledging HIV Status by Americans
Besides performing at AIDS-related conferences in the United States, the Siphithemba Choir also
visited churches and local schools, where they addressed issues related to their individual
experiences and those of their communities back home through performance. In conversation with
Professor Bruce Walker of Harvard Medical School who made the initial pitch of bringing the
choir to the conferences, he revealed that the choir’s school visits had prompted students in some
schools in the Boston area to start their own AIDS-awareness campaign projects. According to
him, it is important to put a human face on a disease that has often been reduced to statistics. He
related how the choir’s performances are constantly received with standing ovations and deep
The emotionality of the responses in the churches could have been for different reasons. It is
often easy for AIDS to be discussed in North America as an African or developing-world problem.
Some people who are infected or affected by HIV and AIDS in America tend to live in denial of
their individual experience of AIDS. While most of the reporting and commentaries on the choir’s
tours reiterate the increased awareness that the group brings about the AIDS crisis in Africa, the
choir members on the other hand made observations about Americans who are HIV-positive but
have difficulty disclosing their status. In a conversation with Zinhle Thabethe, a female member
of the choir in 2012, she commented on how several individuals in the USA have opened up to her
to discuss their HIV status on several occasions following some of her talks during different trips
to the United States. Her comments are consistent with a report in the Church World Service
newsletter of spring 2003, where an unnamed choir member remarked during one of their tours in
the United States:
We notice that Americans who are HIV+ were very shy about telling others they had AIDS. We would be
just about to leave and then someone would come forward and quickly tell us that they were HIV+. We
think that perhaps we were role models for Americans living with AIDS and that maybe we helped some
of them to think about being more open about their status. We hope we have given them confidence. (2003:
It appears from the nature of these interactions, that some Americans who are HIV-positive are still
less likely to reveal that fact than in South Africa. A few years ago, it was reported on National Public
Radio that about half the Americans who ought to submit to HIV testing refuse to do so, suggesting that
the actual number of Americans living with HIV and AIDS may never be known. This is further
evidenced in the November 2014 supplemental report issued by the Centers for Disease Control which
stated: “Over the past decade, the number of people living with HIV has increased, while the annual
number of new HIV infections has remained relatively stable. Still, the pace of new infections continues
at far too high a level.” A similar report by John Tozzi (2015) of Bloomberg News published on 23
February 2015 also reiterated the fact that “patients diagnosed with the virus that causes AIDS but not
getting care account for most new transmissions, estimates show.” According to these reports, of the
number of people living with HIV infection, one in seven are unaware of their status. This lack of
awareness is compounded by the refusal of individuals to submit to testing, thanks to the stigmatization
of HIV/AIDS, which is still high and strong in the United States. The reality of the stigma is captured
in the testimony of an anonymous young female:
By now you’d think people would know a lot about HIV, but they don’t. I would never tell someone I was not
close to. Even when I do feel close enough to someone to tell them, I wonder. Are they going to say, ‘Get away
from me! Don’t touch me!’ The truth is that people really do look at you differently when they know you are
HIV positive... It is hard. But I know people’s ignorance is not going to go away. I still think people are going to
hate me or not want to be my friend when they learn I have HIV. (DeNoon, 2009).
To some people who bear the burden of the stigma of AIDS in the United States therefore, the
Siphithemba Choir offers hope and courage through its music. Such individuals recognize that they
share common experiences with members of the choir, and they are moved to extend a hand of solidarity
with the group. By so doing, they gain spiritual and emotional strength to confront their fears. Thus,
Siphithemba’s music is well received for moving their American audiences to appreciate their
experience of HIV/AIDS, and to extend hands of charity toward Africans with AIDS, but equally
successful in awakening a new level of consciousness about AIDS within the American society.
Concluding Remarks
We have argued in this paper about an African counter-narrative to media health images of Africa. The
Siphithemba Choir does not possess the power of the media, and thus is incapable of producing media
narratives that can compete with those of the mainstream media. Their activities however, namely their
work and labor productivity, physical show of strength in performance contexts, and the savvy use of
the concert stage to contest the appropriation of their story by the scientific community, and to move
Americans (and Westerners) to acknowledge their HIV status are powerful enough to both their local
and international audiences as a narrative of health that runs contrary to the image of Africa being
projected to the world. They are also an example of a proactive African response to local issues that
rarely form part of mainstream media reportage on Africa.
A considerable irony is evident however in the use of music and the concert stage by the choir as a
means to offer alternative narrative to the AIDS experience in (South) Africa. African bodies, arts, and
expressive forms have been sources of curiosity for Europeans for centuries. The curiosity resulted in
what Bernth Lindfors (1999: vii) described as “ethnological show business – that is, the displaying of
foreign peoples for commercial and/or educational purposes.” Ethnological show business with African
bodies reached its apogee in the nineteenth century through early twentieth century, that era of Darwin,
when Africans’ singing and dancing were of interest most to zoologists and imperialist agents
preoccupied with the trends of human cultural gradation as justification for conquest and domination of
the “Other.” Some might argue that the choir’s multifunctional use of performance including an attempt
to project an African identity has the potential to reinforce the stereotypical images of Africa that are
rooted in the nineteenth century ethnological show business. We believe on the other hand that if any
such exotic curiosity may have been elicited by their performances to foreign audience, they have
equally been successful in letting them add their voices to the conversations on AIDS treatment as well
as helped to reveal the reality of HIV/AIDS in the American society that is often not acknowledged.
Finally, although we say that the choir does not possess the power of the mainstream media, yet
their appearances on the international stage has drawn the attention of the media and by extension
to their message, thus allowing the context of their musical performances become a space for
offering alternative narrative that challenge as well as counter the dominant health images
especially of AIDS that is witnessed in the mainstream media.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit
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Full-text available
Female-initiated HIV-prevention options, such as microbicides, are urgently needed. We assessed Carraguard, a carrageenan-based compound developed by the Population Council, for its efficacy and long-term safety in prevention of HIV infection in women. We undertook a randomised, placebo-controlled, double-blind trial in three South African sites in sexually-active, HIV-negative women, aged 16 years and older. 6202 participants, who were randomly assigned by a block randomisation scheme to Carraguard (n=3103) or placebo (methylcellulose [n=3099]), were instructed to use one applicator of gel plus a condom during each vaginal sex act. Participants were followed up for up to 2 years. Visits every 3 months included testing for HIV presence and pregnancy, pelvic examinations, risk reduction counselling, and treatment for curable sexually transmitted infections and symptomatic vaginal infections. The primary outcome was time to HIV seroconversion. Analysis was in the efficacy population (a subset of the intention-to-treat population, excluding participants for whom efficacy could not be assessed). This study is registered with, number NCT00213083. For the primary outcome (time to HIV seroconversion) we analysed 3011 women in the Carraguard group and 2994 in the placebo group. HIV incidence was 3.3 per 100 woman-years (95% CI 2.8-3.9) in the Carraguard group (134 events) and 3.8 per 100 woman-years (95% CI 3.2-4.4) in the placebo group (151 events), with no significant difference in the distribution of time to seroconversion (p=0.30). The covariate-adjusted hazard ratio was 0.87 (95% CI 0.69-1.09). Rates of self-reported gel use (96.2% Carraguard, 95.9% placebo) and condom use (64.1% in both groups) at last sex acts were similar in both groups. On the basis of applicator testing, however, gel was estimated to have been used in only 42.1% of sex acts, on average (41.1% Carraguard, 43.1% placebo). 1420 (23%) women in the intention-to-treat population had adverse events (713 Carraguard, 707 placebo), and 95 (2%) women had adverse events that were related to gel use (48 Carraguard, 47 placebo). Serious adverse events occurred in 72 (2%) women in the Carraguard group and 78 (3%) in the placebo group, only one of which was considered possibly related to gel use (placebo group). This study did not show Carraguard's efficacy in prevention of vaginal transmission of HIV. No safety concerns were recorded.
This monograph takes a qualitative, content analytical approach in examining U.S. press coverage of Africa from 2000 to 2012. The goal is to learn the degree that the press manifests ?tribal fixation? and the broader theme of otherness in the context of advanced globalization. Coverage by The New York Times and the Associated Press is the primary focus. To assess tribal fixation, this monograph examines coverage of the electoral crisis in Kenya in 2008, the Darfur conflict in Sudan, and the civil war in Congo. To assess the portrayal of otherness, the study examines the general framing of African news. While both aspects of coverage have diminished, the element of otherness seems more resilient. Drawing from notions of the ?traveler?s tale? and theories of social cognition and news frames, this monograph concludes that perceptual distance remains a factor in the coverage of Africa.
This study examines the coverage of Africa by the U.S. television networks over a 30-year period, to determine whether the evening news broadcasts pay equal attention to Africa compared to South America and Europe. Also assessed is whether incidents of wars, famine, and public health crises and the increasing importance of Africa's oil, gold, and diamonds on the international market, continue to dominate the U.S. television network evening news coverage of the continent. A content analysis of ABC World News, NBC News, and CBS Evening News shows that coverage of Africa has steadily decreased more than coverage of other regions. The majority of international stories were about Europe while coverage of Africa on all three networks was far less when compared to other regions. Also, conflicts and crises dominated Africa's coverage throughout the 3 decades and stories linked a considerable amount of the news events to a particular U.S. interest. More results and their implications are discussed in detail.