Summer 2004

Fighting AIDS with pictures and words

South African health campaigns dominate the political landscape

The words on the T-shirts are unambiguous. ‘HIV positive’ reads the simple sans-serif legend on the white tops worn by members of the South African HIV / AIDS lobby group: the Treatment Action Campaign (TAC). Inelegant as the design is – its concept borrowed from Benetton’s 1993 HIV Positive campaign – the cumulative package clearly articulates the burden confronting South Africa’s emergent democracy. The burden being that 5.3 million South Africans, or nearly ten per cent of the population, are infected with HIV / AIDS. ‘Sort it out’, the T-shirt demands.

Sadly, the graphic design interventions aimed at confronting the challenges of the country’s HIV / AIDS problem have not always contributed much to the greater objective: a reduced incidence of HIV. A look at the short history of such work demonstrates the difficult, often circuitous, journey travelled by designers searching for coherent visual strategies aimed at curbing the upward march of the statistical barometer: 4.7 million infected by late last year; 5.3 million by the nation’s tenth birthday on April 2004; 8 million projected by 2010.

Learning Through Stories
With nearly 25 per cent of South Africa’s economically active individuals HIV-positive, the socio-political impact of the disease is clear. This has led to a variety of macro-level initiatives aimed at encouraging behavioural changes in sex and hygiene among a broad range of South Africans.

One of the most prominent of these initiatives is the social change project initiated by the Soul City Institute for Health and Development Communication. It’s a scheme that aims to ‘impact on society at the individual, community and socio-political levels’. A non-governmental organisation established in 1992, Soul City uses an extensive multimedia strategy that combines television, radio and print, with branding focused on one core identity.

Soul City’s printed HIV / AIDS Action Pack includes materials aimed at a broad range of people involved in education or training. The two comic books in the pack, for instance, talk about issues ranging from transmission, prevention, stigma and discrimination to the HIV test, care and support. There is a strong narrative content to all these materials – Soul City’s credo being that ‘human beings have always learnt through stories’.

Branded Strategies
Taking its cue from the integrated branded strategies initiated by Soul City, loveLife also aims for a multi-pronged media plan. Launched in September 1999, loveLife is South Africa’s largest and most visible national HIV / AIDS prevention programme. It has brought together a broad-based coalition that includes international foundations working in HIV / AIDS prevention, the South African government, significant South African media organisations and private corporations, and leading South African non-government organisations. The foundation’s stated goal is to ‘substantially reduce the HIV infection rate among young South Africans’.

The target audience of loveLife’s campaign are pre- and newly sexually active adolescents aged twelve to seventeen. This age group is about to enter a dangerous period of their lives. A recent study showed HIV prevalence among fifteen- to 24-year-old South Africans to be 10.2 per cent. Prevalence was significantly higher among women (15.5 per cent) than among men (4.8 per cent), and in the 20- to 24-year-old age group (16.5 per cent) as compared to the 15- to 19-year-old age group (2.5 per cent).

HIV has disproportionately affected young women. Among the 10.2 per cent of South African youth who are HIV positive, 77 per cent are women. Nearly one in four women aged 20-24 are HIV positive, as compared to 1 in 14 men of the same age. The greater susceptibility to HIV infection among women is attributable to both biological and social factors.

Among its many media strategies, loveLife has embarked on a massive billboard campaign. There are over 1000 billboards and signs on water towers proclaiming loveLife’s message along the country’s main arterial routes: these have become a familiar part of the South African visual landscape.

Since first staking their claim to the public consciousness five years ago, the creative content of these billboards has been the subject of heated debate. The mishmash graphic style of the early campaigns, such as ‘Foreplay’ and ‘The future ain’t what it used to be’, now look naive. The early campaigns appear to have been more concerned with proclaiming that it was good to be young, black and proud than actually challenging the viewer to think about changing their sexual habits.

The Big Ad Spend
It was only in 2002 that loveLife’s billboard campaigns acquired coherence, with a campaign formed around a series of abrupt quotes discussing real-life scenarios. LoveLife’s somewhat unruly coming of age in the public view has earnt it many detractors. In addition to outraged callers to radio talk shows, media critics have been vocal in labelling the billboard campaign as ‘extravagant’ (for its £1.3 million ad-spend per annum) and ‘subliminally racist’ (because of its early focus on black subjects). Its aspirational images have also been accused of promoting ‘conspicuous consumption’.

Yet the campaign is partially protected from criticism by a ‘gagging clause’ that prohibits three partner newspapers from publishing ‘material that will harm the loveLife images’. Journalist Chris Barron, writing in The Media, an upmarket monthly offering astute analyses of the South African media, has argued that loveLife is cynically leveraging its ad spend (roughly £2 million per annum) in a way that elevates the campaign above the vicissitudes of public criticism.

In its defence, loveLife points out that its billboards are but one element of a targeted multimedia campaign that is actively supported by grass roots initiatives. Research has also shown a two-thirds (65 per cent) awareness of at least four loveLife programmes or products among all South African youth. The same study also reported a high level of awareness across all geographic areas. More than three-quarters of young people living in rural areas reported awareness of loveLife, while in urban areas this rose to 93 per cent. This begs the question as to whether awareness and visibility automatically imply success. For instance, many of us are aware of Coca-Cola’s marketing campaigns without actually drinking Coke.

Tackling Government and Industry
If one accepts visibility as a marker of success, then the Treatment Action Campaign (TAC) certainly comes across as a huge success. Whereas loveLife and similar organisations are focused on pro-active campaigning, with success predicated on a fall in HIV statistics, the TAC is a vocal lobbying group. It consists of an association of organisations and individuals, all operating independently of both the government and the pharmaceutical industry, who have pitted themselves against the slow response of President Thabo Mbeki’s government to the treatment of the virus.

Launched on 10 December 1998 (International Human Rights Day), the TAC has vociferously campaigned for the affordable treatment of people affected by HIV / AIDS. It famously challenged the pricing of AIDS drugs set by multinational pharmaceutical companies in court, and influenced a policy turnaround with regards to the national roll-out of anti-retroviral drugs such as AZT. On 8 August 2003 the South African cabinet approved the provision of anti-AIDS drugs for HIV-positive people through the public health system. (In addition to denying a causal link between HIV infection and AIDS, the government of President Mbeki had previously denounced anti-retroviral drugs as an attempt to poison black people.) For his singular efforts, Zackie Achmat, a leading activist with the TAC, has been shortlisted for the 2004 Nobel Peace Prize.

Echoes of the Old Struggle
The TAC’s graphic activism is interesting for a number of reasons. Foremost among these is its confrontational placard-and-protest style. This has direct historical antecedents in the techniques and values espoused during the struggle against apartheid. Indeed, there is little to differentiate the grass-roots activism that has mushroomed around the ‘HIV Positive’ banner from that which took shape around the twin slogans of ‘Free Nelson Mandela’ and ‘Stop Apartheid’. The message is also urgent enough to excuse the TAC’s poor stock of graphic visual material.

However, the TAC’s activism is more than simply throwback politics – it is of the age. During the short period of its existence, the TAC has been vocal in linking a regional health concern with the drift of the new global activism. ‘Through mass mobilisation, civil disobedience, legal action, extraordinary personal sacrifice and visionary leadership, Zackie Achmat and the TAC have helped to galvanise a global movement to provide hope and gain access to treatment for those with HIV / AIDS,’ the American Friends Service Committee, a US-based Quaker organisation, observed in their written statement nominating the TAC for the Nobel Prize.

The success of the TAC’s activism bears out a point made by Tony Barnett and Alan Whiteside – authors of AIDS in the Twenty-First Century: Disease and Globalisation (Palgrave Macmillan, 2003) – that ‘HIV / AIDS is a problem that is not handled easily by the mechanisms and methods of the nation state’. Barnett and Whiteside go on to state in their book that HIV / AIDS has ‘drawn out from the world community a response that depends of fluidity rather than extreme bureaucracy’.

This statement acknowledges the vital role that activist groups, collectives and individuals have played in defining how the HIV / AIDS problem is visualised. This is particularly true in South Africa. Beyond the highly visible, often contested, campaigns initiated by both government and non-government organisations, there exists a vast panoply of creative resistance and graphic activism. This is shaping a new visual language that expresses the HIV / AIDS issue.

Community Voices on the Street
One relatively recent phenomenon is the community mural. South Africa has a long tradition of mural advertisements, particularly in the townships, executed by sign writers, graphic artists, and painters. Mural art, though, is much newer. Before the 1990s it was practised on a small scale due to political repression and a rigidly regulated conservative bureaucracy. Art historian Sabine Marschall links its rise as a popular graphic form to the country’s gradual socio-political liberation.

Usually collaborative by nature and dominated by male artists in black communities, mural art is characterised by the suppression of individual self-expression in favour of a mutual style. Remarking on the general content of these murals, Marschall says: ‘Murals are about asserting identity and resistance; they create a sense of place and ownership; they “talk” in a specific language targeted at a local community audience.’

Largely overlooked by the art establishment, owing to its perceived inadequacies in terms of technical and conceptual sophistication, mural art has also been criticised for confirming rather than challenging the prevailing stereotypes of race and gender identity. Nevertheless mural art offers a fascinating parallel narrative in a visual landscape where branding, not message, is regarded as the key virtue of the country’s signature

HIV / AIDS campaigns.
A similarly ignored narrative is discernible in the story of glass beadwork projects. Glass beadwork has a rich cultural history among the diverse ethnic groups inhabiting South Africa. The geometric precision of Ndebele beadwork, for instance, is reminiscent of the linearity of De Stijl. Older examples of glass beadwork are highly sought-after and collectable.

In part, this accounts for the popularity of the Monkeybiz beadwork products. Made by a collective of disadvantaged women in Cape Town townships, the glass bead products, which include wall-hung murals and red-ribbon lapel badges, articulate something of the complexity of the HIV / AIDS problem in South Africa.

Disease as Commodity
The point is best argued by way of an analogy. The essayist and critic Daniel Harris, also the author of The Rise and Fall of Gay Culture (Hyperion, 1997), attributes the proliferation of HIV / AIDS products in the US to harsh political realities. ‘My thesis is this,’ he has written, ‘in the early days of the epidemic, the Reagan and Bush administrations refused to allocate the money necessary to cover basic costs of research and treatment, with the result that movie stars, and not government officials, became the epidemic’s statesmen, its panhandlers, the ones who were forced to seek alternative sources of funding out in the open market, in charity balls, rock concerts and fashion benefits. Because of insufficient federal funds, activists were forced to turn the disease into a commodity and sell it to the public like any snack food.’

Harris further argues that charitable contributions were extorted from the public by arousing pity for the victims ‘by packaging the epidemic in sentimental clichés that reduced potential donors to a state of maximum susceptibility. The more money that was needed for the disease, the kitschier it became.’ Substitute the Reagan and Bush for Mbeki and the approach described above illustrates why so much craft art flirts with becoming sentimentalised, kitsch product.

The Zimbabwean graphic designer Chaz Maviyane-Davies has made some interesting comments about the overlapping red ribbon and its emergence as a universal HIV / AIDS solidarity symbol. [Inspired by the yellow ribbons that honoured American soldiers participating in the Persian Gulf War, the design was the outcome of a collaborative project initiated by the Artists Caucus of Visual AIDS. Conceived in the spring of 1991, the Ribbon Project was officially launched at the 45th Annual Tony Awards ceremony on 2 June 1991.]

After attending the fourteenth International AIDS Conference in Spain in 2002, Maviyane-Davies offered a report to Design for the World [].

‘Ribbons, ribbons everywhere and on everything,’ he observed in his review entitled ‘Graphic Design for AIDS: The sense of the possible’. ‘In all shapes and sizes, like lipstick, distorted, enhanced, patterned, manipulated, given a national or ethnic slant and even sold. Tag this motif on to anything and avoid the risk and challenges of communicating about this pandemic.’ Maviyane-Davies concluded his report with a concise rebuke. ‘In effect,’ he writes, ‘I found this stylised zealousness to be a classic hallmark of graphic design’s denial and laziness.’

Art Initiatives
Some of the aforementioned laziness and reductiveness has insinuated itself into the South African art world claiming to make sense of the lived experience. With the proliferation of the HIV / AIDS pandemic, South African art is increasingly engaging with AIDS as a theme. A series of local and international exhibitions highlight the trend. ‘Co-Existence’ and ‘The Memory Box Project’ are two recent examples shown in the USA, while ‘Engaging Modernities’ and ‘AIDSART’ were local projects. Common to all is the rather haphazard, sometimes even opportunistic, response of individual artists to HIV / AIDS.

Sue Williamson’s street graffiti project ‘From the inside’ offers an interesting example of work grounded in the protest genre. After interviewing a number of HIV-positive South Africans, Williamson extracted a defining quote for each subject and painted the words in a prominent public place. ‘I’m sick of Mbeki saying HIV doesn’t cause AIDS’ reads the statement by a man named Benjy. Painted on to a busy underpass wall, the work obtained further gravitas when a night stalker blacked-out the word Mbeki. (The work has subsequently been painted over in its entirety by the Cape Town council.)

The struggle to define a visual style capable of challenging the assault of HIV / AIDS in South Africa is not simply about finding the right tools and media to communicate, inform and educate, it is about overcoming a clash of competing wills. At this juncture, the lived experience of a destitute sex worker plying her trade on a busy trade route in rural KwaZulu Natal confronts the well-meaning inadequacy of a centralised, mass-marketed campaign that views this woman as a statistic and asks her to ‘love life’. Something is getting lost. As Chaz Maviyane-Davies says: ‘A quick reminder here, we are not competing for profits, we are competing for lives.’

First published in Eye no. 52 vol. 13 2004

Eye is the world’s most beautiful and collectable graphic design journal, published quarterly for professional designers, students and anyone interested in critical, informed writing about graphic design and visual culture. It is available from all good design bookshops and online at the Eye shop, where you can buy subscriptions and single issues.