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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


Draft Paper

Gendered representations of HIV/AIDS and the reproduction of hegemonic discourses on femininity in media images



Tamara Shefer

Women's and Gender Studies, University of the Western Cape

September 2004


The last decade and a half has seen much international and local South African research and interventions in the realm of gender and sexuality, some of them stimulated by the imperatives of the HIV pandemic. In particular, there has been much work (both academic and popular) that has highlighted the way in which women are particularly vulnerable to HIV infection and the role that male dominance and hegemonic masculinity and femininity play in unsafe and abusive sexual practices. Contemporary research has further highlighted the widespread nature of gender violence and the way in which this intersects with dominant practices of heterosex and the dynamics of HIV/AIDS.

In the South African context, the media has tended to seize on the most sensational moments of this focus and often reproduced (albeit inadvertently), as the academic literature itself has, problematic representations of women. The following paper draws on visual representations of HIV/AIDS and violence against women, over 5 months of the Mail and Guardian, a progressive weekly newspaper in South Africa, as a snapshot of how HIV/AIDS is currently represented, particularly with respect to women and gender relations. The pictures utilised in this presentation aim to demonstrate the way in which popular representations not only reproduce traditional constructions of women as passive, helpless victims in the realm of HIV, violence and sexual relations, but also highlight the way in which women are inadvertently stigmatised and blamed for the epidemic. Furthermore, the images illustrate the continued processes of 'othering' which also reflects racist and classist discourses in the construction of HIV/AIDS.

Gendered responses to the HIV/AIDS pandemic

There is no doubt that the HIV/AIDS pandemic, disastrous as it is, has opened up certain windows of opportunity for those seeking to challenge gender inequality. The foregrounding and problematising of normative practices of heterosex and the focus on power relations between men and women in negotiating heterosex has allowed for much critical work to emerge. Moreover, it has become commonplace for those working at a practical level of education and care, to acknowledge the centrality of gender relations in both prevention of the spread of the virus as well as in mitigating the impact of the virus on communities.

On the other hand, there is also little doubt that the massive focus on the virus has served to not only reflect, but also actively in some cases reproduce, many areas of inequality and discrimination in international and local contexts. One key example of this is the way in which both the popular and the academic, research-based literature has focused on women and their role in the spread of the virus. While initial sexist practices were quickly challenged, such as the different messages given to men and women (see the inserted advert for example), it has equally been evident that the predominant focus has been on women, arguably inadvertently facilitating a 'blaming' discourse in which women become viewed as both responsible for the spread (because it is assumed they are responsible for halting it). Inadvertently, the focus on women, both in the academic literature and the educational programmes, served to reproduce a picture of the illness as a woman's illness, and therefore 'women's fault'.  

Similar, but slightly more insidious processes that reproduce the status quo of gender are also evident in the way in which both academic and popular literature have theorised women's vulnerability to HIV/AIDS. Given the high rate of infection of HIV in sub-Saharan Africa and the fact that heterosexual relations are the primary mode of infection in these countries, research on (hetero)sexuality and women's vulnerability has accelerated over the last decade in South Africa (Shefer, 2003). As a consequence we now know quite a lot about the gender power inequalities that manifest in heterosexual relationships in local South African contexts. This has obviously been incredibly helpful at multiple levels in addressing both HIV and women's inequality.

The proliferation of research and the educational emphasis on heterosexual relationships and women's vulnerability is extremely important. On the other hand, there are also problems and potential concerns with the way in which women have been constructed in these research agendas. It is arguable that while it is important to highlight women's lack of negotiation in heterosex, the dominant picture of women emerging is that of an inevitable and passive (almost 'asking for it') victim of male power.  Nobody would argue against the significance of acknowledging women's lack of power in heterosex, but it is also a concern that that we appear to be inadvertently reproducing the dominant stereotype of women's passivity. Contemporary feminist writers have begun challenging the way in which feminist theories on heterosexuality have historically constructed power as the inherent preserve of (all) men, and women as inevitably disempowered victims of male power (Hollway, 1995; Jackson, 1996; Smart, 1996). Smart for example (1996) speaks of a conflation of the penis with the phallus, in which she maintains all power is seen as male, and all males are seen as having access to power. She argues that both of these are problematic assumptions, given a post-modern understanding of the multiple, contextual and fluid nature of power. In this way, while most feminists distance themselves from biological determinism, she argues that power and gender are inadvertently essentialised, globalised and decontextualised.

What is probably most problematic about the continued emphasis on women's vulnerability, passivity and powerlessness, is that this emphasis serves to silence the many times that women do resist male power and do challenge men. Furthermore, the stereotyped image of women is ultimately reproduced, with no space given to alternative images and discourses of women as strong, assertive and powerful agents. Importantly, as mentioned, the predominant picture of woman remains one of asexual victim of male desires, and women's own sexual desires and a positive female sexuality is seldom represented in the literature.

The flipside of women being constructed as inevitable victims, is the reproduction of the stereotype of men as inevitably powerful and controlling in relation to women in heterosexual relationships. While some authors have pointed out the salience of the 'male sexual drive' discourse in talk on heterosex, the literature itself appears to reproduce this stereotype. Clearly there is a silence around alternative ways of being men. There is no literature which highlights men's resistance to traditional masculinity, or speaks of men's vulnerability to women and their difficulties with hegemonic masculinity. In some research, fragments of male vulnerability and the pressure on men to conform to hegemonic masculinity, are beginning to emerge (see for example, Shefer & Ruiters, 1998). Nonetheless, there is still little work that gives a voice to the different ways of being men, and offers alternative and more equitable versions of maleness in heterosexual relationships. Moreover, there has been little work that explores in a more complex and critical way the role masculinity plays in the spread of HIV, other than to present a unidimensional, homogenous picture of men as controlling and dominant in heterosexual negotiations. While a focus on masculinities is emerging strongly in the current South African context, and partly in response to the concerns raised here, it may be argued that popular representations of HIV/AIDS continue to position women as central to and responsible for the illness as illustrated further in what follows.

Stigmatising discourses and images of HIV/AIDS

AIDS has become the symbolic bearer of a host of meanings about our contemporary culture: about its social composition, its racial boundaries, its attitudes to social marginality; and above all, its moral configurations and its sexual mores. A number of different histories intersect in and are condensed by AIDS discourse (Weeks, 1989, p. 2).

Many authors over the decades have highlighted the way in which certain illnesses have served particular roles as representation of certain social markers, generally tending to reinforce problematic images and stigmatisation of particular groups of people, usually those subordinated or marginalised in a culture. Susan Sontag's (1977) ground-breaking work 'Illness as Metaphor' set the tone for an understanding of the way in which illnesses are socially constructed and play particular roles in social systems. Foucault (1973) had suggested that for every age there is an illness that reflects the conditions of that time, that serves to capture some of the broader social issues and concerns, and play a political role in constructing dominant meanings of the time. A range of authors have spent much time deconstructing the ways in which HIV has been socially represented and the problematic, stigmatising. 'othering' effects of such representations (see for example, Plummer, 1988; Aggleton, Hart & Davies, 1989; Patton, 1990; Seidel, 1993; Kopelman, 2002).  In particular, it has become clear that AIDS powerfully reflects dominant aspects of norms and constraints with respect to sexuality. Plummer (1988) describes two central discourses operating in the construction of AIDS, one that is overtly medical and scientific, and one that is characterised by social and moral meanings. The medicalising discourse is overlaid by pathologising notions of AIDS as representing disease, plague and death. Central also are military metaphors, with the virus constructed in terms of invasion and battle (cf. Brandt, 1988; Sontag, 1988). The second central means of stigmatising HIV/AIDS relies on other more social discourses, historically familiar within the construction of STDs, which centre around 'moralistic and punitive social constructions of sexuality' (Ratele & Shefer, 2002, p.186). As with syphilis, AIDS has been seen 'othered' as the preserve of sexually deviant individuals, and powerfully associated with sexual excess and moral deviant behaviours and lifestyles.

In the early days of HIV, we saw the way in social representations served to reflect and legitimise the homophobia of the western world, constructed by many in moralistic and religious terms as 'punishment' for deviant sexual and social practices (Aggleton and Homans, 1988; Weeks, 1988; Crewe, 1992). Besides for gay men, HIV stigma was grafted over a range of other stigmatised identities, in particular IV drug users and sexworkers (Gilman, 1988; Holland et al., 1990). The very use of the term 'risk groups' which became widely used in the HIV/AIDS context as a way of highlighting those most vulnerable to infection, merely served to reinforce existing stereotypes and stigmatisation of existing marginal groups in societies and 'resulted in their further harassment, control and medicalisation' (Seidel, 1993, p. 176).  While there is now widespread, criticism of the notion of 'risk group' and a move to talking about 'risk behaviours', arguably this has taken longer to shift in the South and to shift the existing constructions of those living with HIV/AIDS.

When it became evident that the incredibly high rate of spread of infection in Sub-saharan and the rest of Africa was predominantly through heterosexual relations, a range of other problematic discourses in this particular context began emerging. A number of authors have begun since the early 1990s to identify some of the key discourses emerging in Sub-saharan Africa, opening the way for understandings of how HIV/AIDS serves as vehicle for a reproducing power and normative practices with respect to sexuality and gender performance (Seidel, 1992; Strebel, 1993). One of the strongest discourses emerging is probably that of 'African AIDS', the way in which the focus on Africa has allowed the rest of the world to distance themselves from HIV/AIDS by seeing it as an 'African disease' (Patton, 1992; Jungar & Oinas, 2004). It has been argued that linked to this construction are racist representations of 'African sexuality' as uncontrollable and promiscuous (Jungar & Oinas, 2004).

Drawing on a Foucaultian discursive framework, Seidel, following Plummer (1988), has highlighted the salience of the medical discourse in sub-Saharan Africa, which has shaped the responses to HIV/AIDS in a way in which the person living with HIV/AIDS (PLWHA) is notably absent. This dehumanising effect of the construction of HIV/AIDS as primarily a disease has meant that many of the social dimensions of the virus and its progression have been masked. Linked to the medical discourse has been the salient medico-moral discourse which centres around the representation of AIDS as 'Gods punishment' and the calling on christian chastity as a way to prevent further infection. While some of the churches in sub-Saharan Africa initially challenged the promotion of condoms for this reason, it seems that there is now more acceptance of the necessity of promoting them, whether or not they adhere to chrisitian values. At the same time, the continued use of the ABC strategy (Abstain, be faithful, condomise) reflects some of these continued conflicts with respect to what messages should be given to young people and there is still a popular notion that 'talking too much' with young people about sex may encourage them to be more sexually active. With respect to women and gender, Seidel (1993, p. 180) called attention to the way in which women have been viewed as both 'polluted and polluting' (, highlighting how language for STDs are in some contexts translated into 'women's diseases'. She argues that generally it has been female sexworkers and women in general who are blamed for sexually transmitted diseases in both the North and South.


It is evident that a number of social-psychological processes have been central to the way in which meaning has been constructed of HIV/AIDS. Alcorn (1988) speaks of the 'individualisation of responsibility' as a key component of the mainstream response to HIV/AIDS. In South Africa, it may be argued that that this process has been particularly directed towards black, poor women who have become the repository for all negative constructions of the illness. Linked to this process is the way in which the illness has been 'othered' through processes of objectification and distancing tactics. Thus HIV/AIDS has not only been seen as the responsibility of poor, black women but has also been viewed as something which only happens to poor, black women. In this way, whites and men succeed in distancing themselves from the possibility of infection and becoming ill. The dangers of such constructions for educational efforts are more than evident.

A range of local literature has highlighted the way in which popular community beliefs and meaning construction reflect the arguments made about the social representation of HIV/AIDS. To cite a handful of empirical examples:

In a national study on STDs, involving a range of focus groups with members of diverse communities, the researchers found that 'stigmatising, pathologising and 'othering' discourses were omnipresent in the ways in which participants spoke about what it meant to have an STD, with those inflicted almost inevitably constructed as 'other' and/or deviant in some of other respect' (Ratele & Shefer, 2002, p. 188). In particular a strong association of STDs and HIV with sexual promiscuity was evident. With respect to gender, it was more than evident that women were punished far more than men for having an STD, and STDs were constructed as female illnesses with a strong component of blame. This was particularly evident in the view of men who saw women as responsible for starting and spreading STDs, and even constructed women's bodies, particularly their genitalia, as endemically pathological and prone to infect - notions of women being like 'compost' were cited. The pathologisation of women's bodies has been well documented in feminist literature and is powerfully evident in contemporary society through a range of discourses acting on the female body (see for example, Greer, 1992; Northrup, 1995; Wood, 1997).

Empirical local literature has also illuminated the way in which HIV and STDs are 'othered', represented as the preserve of black communities, and especially women. Two recent student works highlight this (Le Clezio, 2003; Van Wyck,2004). Both studies, carried out with young white South Africans show how these groups distance HIV/AIDS from their own experience, constructing it as a 'black illness', impacting only on what they view as uneducated, black communities and not therefore a concern for them. In one study the notion that women passively are infected, while men somehow have a choice when it comes to being infected, emerged as well (Le Clezio, 2003). There are of course many studies which focus on the experiences of those living with HIV/AIDS illustrating the multiple areas of stigma, including rejection by family members and communities, and many examples of the experience of both domestic and public violence following disclosure (for example, Strebel, 1992; Baleta, 1999; Bollinger, 2002; Jennings et al., 2002; POLICY Project et al., 2003; and see POLICY Project et al., 2002 for a literature review). There is currently much emphasis on the issue of stigma with many NGOs and government departments developing policy and practices to challenge discriminatory and prejudicial practices with respect to stigma and HIV/AIDS (for example, UNAIDS/HDN/SIDA, 2001; POLICY Project et al., 2003, 2004).

Representations of HIV/AIDS in the South African media

There has been one large recent, relatively comprehensive study of the role of the media in the current construction of HIV/AIDS in South Africa (POLICY Project et al., 2003). A joint project of the POLICY Project, the Centre for the study of AIDS (University of Pretoria), USAID and the Chief Directorate: HIV/AIDS and TB, Department of Health, the study included a three month analysis of select print media, television programmes with an entertainment focus, and a community radio station. The findings from the print media, a total of 603 newspaper articles which mentioned HIV/AIDS, from 24 newspapers, were particularly instructive.

It was found that in the print media, HIV/AIDS was most often depicted as affecting people who were poor (31% of articles), black (27%) or living in developing countries (18%). In terms of sources of information, two out of three sources of information were male, and only one in three were female. Similarly those living with HIV/AIDS were not viewed as particularly instructive in offering insight on HIV/AIDS, with only one in 12 sources of information citing PLWHA (8% of articles). Contrary to this, HIV/AIDS was more likely to be represented in terms of women's experience (69% of articles) than men's experience (31%), highlighting the continued construction of the virus as women's responsibility. The study also found that women are more likely to be portrayed as victims of sexual assault or as mothers confronting concerns about infecting their unborn children. In this way, the construction of women as passive, victims and the sterotype of women as mothers is reproduced.  Interestingly, male PLWHAS who spoke to the media generally spoke as activists (36% of articles) or celebrities (18%) while female PLWHAs were given a voice as mothers (44%) or orphans (25%).

The televison programme analysis similarly suggested that portrayals in the soap operas may reinforce stereotypes of HIV/AIDS as a 'black' and female disease. In both soap operas analyses, only two individuals are seen with HIV/AIDS and they were a black woman and a coloured child. In both, they are portrayed as innocent and passive victims (contracted HIV through rape or parent-to-child transmission). In both TV programmes, the caregivers affected by HIV/AIDS are all women, reinforcing the stereotype of women as nurturers and rationalising their continued burden of care for the illness. The analysis of community radio raised similar concerns, with all of the PLWHA guests appearing on the shows during the research period being black women, inadvertently reproducing the construction of HIV/AIDS as a disease of black women.

Visual representations of people living with HIV/AIDS

The current study was concerned to look more closely at visual representations of HIV/AIDS and those living with the virus in the print media. One weekly newspaper, the Mail and Guardian, an historically progressive newspaper (emerging during apartheid days and still acting as social critic), was chosen for scrutiny. All visual representations accompanying articles on HIV/AIDS were viewed over a period of 5 months, from January to August 2005. No attempt was made to quantify the analysis, rather I was concerned to see what kinds of representations were dominant. The study found the work of Gillian Rose (2001) particularly helpful in guiding the analysis, as well as more general literature on discourse analysis (e.g. Wetherell and Potter, Parker, 1992;) which while not necessarily focusing on visual representations, served to provide a framework for critical deconstruction of the imagery within the broader ideological terrain of HIV/AIDS, gender and sexuality. Rose's methodology draws attention to the visual effects of an image, and in particular the way visual images serve to reproduce social difference and always 'intersect with the social context of its viewing and the visualities its spectators bring to their viewing' (Rose, 2001, p. 15).

A total of seven images that accompanied articles on HIV/AIDS and a further two on sexual harassment were selected for closer scrutiny (see attached images). It should be added that these were also the majority of images found over that time. A number of key effects in the images looked at were evident and in many ways they served to reproduce the stigmatising discourses flagged by the theoretical literature on HIV/AIDS. These may be outlined as follows:

1)     HIV/AIDS as a black illness: All images viewed represented black men and women. Those represented were also predominantly of African, rather than 'coloured' background (according to South African apartheid categories which are still salient in today's context). While the majority of those represented were South Africans, one image was of an Asian woman in a 'developing' or 'third world' Asian country.

2)     HIV/AIDS as an illness of the 'poor' or 'third world': All images arguably represented those of people living in poverty. This is evident through clothing, and the location of the photographs. The majority of photographs are set in public hospital or clinic settings, where issues of over-crowding and long queues for assistance are in evidence.

3)     HIV/AIDS as a woman's illness: As has been raised frequently, women are disproportionally represented in the pictures. Of the images found, only one is of a man and the vast majority of those featuring are women. Even in the busy hospital scenes, it is mostly women who are seated in the photograph. As emerged in the POLICY project finding, women also emerge strongly in the position of mothers. This is particularly evident in the one picture which foregrounds an exposed stomach, and succeeds in compartmentalising the subject. Her head is half cropped, her body barely visible, constructing her pregnant stomach, that is her baby, as the centre of the photo. She becomes important only in so far as she is a pregnant stomach that holds an unborn child.

4)     Medicalisation of HIV/AIDS: The dominance of a medical discourse in the construction of HIV/AIDS has been widely argued. The salience of the medical setting in many of the photos (5 out of 7 are set in medical contexts) reproduces this powerful construction of HIV/AIDS as a position of pathology, one which needs to be treated and controlled within a medical institutional context. Moreover, the patients in most pictures are lying on beds, passively receiving treatment, itself presented as a terrifying intervention and met frequently by the contorted faces of torture victims.

5)     The construction of passive, receptive, dehumanised and very ill victims: As already evident, the medical discourse creates a patient that is acted upon often in invasive ways. All of the images are turned away from the camera, their eyes shut or looking elsewhere, usually downwards or towards the edges of the picture. The majority of faces that are presented close up are pictures of misery, depressed mood and hopelessness. One close up of a woman, taken it appears in her own home, represents a woman so thin and ill that she appears close to death. The consistent representation of patients in queues, or part of a group, also serves to dehumanise the person living with HIV/AIDS and construct them as passive in their own illness and life (waiting in a queue). A similar construction of passivity emerges in the two images of sexual harassment. Both images are alongside articles talking about violence against girls and women, which also highlight vulnerability to HIV/AIDS in the articles. What is particularly striking is the disembodiment of both images, with the one cropping their  heads, while the other… In this way, these girls are presented as passive, disempowered victims who have 'things done to them', with no means to resist male power. Again the powerful image of a line, a queue of girls, as in the images of those queuing in the clinics, denotes an image of dehumanisation, in which the individual is reduced to a number, a disembodied member of a line of others.


Although, this is a handful of images, they do represent the majority of visual representations found in the Mail and Guardian over the five month period. As I did not carry out a rigorous audit, I may have missed a couple over this time. Sadly, the images appear to reproduce many of the problematic, stigmatising discourses that have been identified in the theoretical literature and as have emerged in other studies of stigma and HIV/AIDS. In particular, HIV/AIDS emerges primarily as an illness of black, poor women. In this way, such women are inadvertently blamed for the illness and the virus is distanced and 'othered' for those groups of South Africans who are not poor, black women. Moreover, throughout the representations the subjects are constructed as passive, disempowered recipients of both the illness and treatment, and a very strong medicalising discourse is evident. The overall image is one which strongly associates HIV/AIDS with illness and death, with victimhood rather than survival and resistance, and there is a glaring absence of images of a positive or healthy living with the virus.

Both the empirical and theoretical literature on HIV/AIDS and stigma in South Africa tell us that we have a long way to go in reconstructing HIV/AIDS as 'just another illness' and mitigating the additional effects of such stigma on those living with HIV/AIDS. It is disappointing that our newspapers continue to inadvertently reproduce the stereotypical, stigmatising constructions of the virus and those living with it, that ultimately serve to reinforce existing practices of racism and gender inequality. HIV/AIDS in these images continues to be constructed as 'other' to the north and west (African, and 'third world'), as 'other' to middle class people (as the preserve of the poor and uneducated), as 'other' to whites, and as 'other' to the broader group of men (but especially middle class, western, white men. The power of the visual, the picture that speaks, is more than evident as images serve to reinforce, legitimise, and rationalise existing social 'truths'. The picture out there does not only reflect the popular inner pictures, but may serve also to challenge or reinforce the popular imaginary. The media may make a strategic choice to reconstruct its dominant representation of HIV/AIDS, to ensure the proliferation of 'new' and different pictures which take us closer to a more liberating, empowering construction of the virus and its effects. In so doing, we may also be able to challenge other areas of stigma, marginalisation, exclusion and inequality, the dominant and problematic constructions of gender, women, sexuality,that the social representation of HIV/AIDS has so powerfully intersected with. We may argue that it is the imperative of the social scientist and cultural theorist to foreground such issues and lend expertise to the process of deconstructing current visual practices in the arena of HIV/AIDS.



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