http://www.butterfieldfoundation.org/WhoWeAre/MissionandVision.aspx. Accessed, December 2013.
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message is stylistically punctuated at the end of the film in a wedding celebration as an American band The Newsboys sings ‘Something Beautiful’ to a jubilant Ugandan crowd.
Scenes from mass weddings, which have gained popularity in Uganda, are also structured into the film to intone the importance of the marriage institution and indeed the Christian church. The film leaves no doubt that heterosexual monogamous relationship is the only lasting and effective prevention against the HIV virus. It also urges people to learn from Uganda and make better sexual choices because ‘the worst of the AIDS pandemic is only beginning in the rest of the world’ [1:08:33- 1:09:12]. The overall message is that HIV will keep spreading as long as sexual restraint is not practiced. To show the long-term consequence of ARV treatment if sexual behavior remains un-changed, an animated illustration displays how the HIV virus multiplies: ‘For each new person treated for HIV, about 10 become infected’.
Miss HIV boldly credits Uganda as originator of the ‘ABC approach’ (abstain, be faithful or use condom) that is widely used around the world. In inset news footage
President Yoweni Museveni is seen and heard, talking from a podium about ABC and the importance of only A and B. His wife, First Lady Janeth Museveni, supports him in a lengthy interview where she passionately promotes sexual restraint and praises the church:
I believe that the churches are the primary organization that has a burden to get the truth to the people and we wanted to mobilize everybody who can speak to our population to tell them about this enemy. We believed the church would truly do this best because they already had the burden of speaking to our people and telling them the truth [ 42:52-43:20].
Miss HIV highlights the fact that people working with HIV/AIDS prevention often disagree over the application of the ABC approach. Conservative faith-based donors sponsoring Abstinence and Be faithful, (behaviour change first) occupy one camp, whereas liberal donors taking a human-rights approach promote Condoms (safety first) and other technological solutions that allow individuals to experience sexual pleasure. Most UN and major donor organizations support the human rights approach, whereas some, like The United States President’s Emergency Plan for AIDS Relief (PEPFAR), show more conservative tendencies. PEPFAR may claim to support a comprehensive approach,86 but its programmes are faith-based-friendly, favour behavior change and are considered intrusive to individual expression of sexuality by the human-rights camp. Miss HIV hints at these dynamics by including demonstration slogans on billboards telling President Bush that ‘we need condoms to have sex’ thus placing him on the conservative camp [1:03:00-18]. Former President Bill Clinton (discussed in chapter 3) on the other hand is positioned on the liberal
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PEPFAR, which was initiated by President Gorge W. Bush in 2003, favours a ‘combination
of evidence-based, mutually reinforcing biomedical, behavioral, and structural interventions’ source: http://www.pepfar.gov/about/strategy/document/133244.htm. Accessed, December 2013.human-rights approach camp. At the AIDS conference Clinton receives loud applause for defending women’s empowerment in the HIV/AIDS fight:
Empowering women to protect themselves seems so elemental and yet when I hear people pontificating about AIDS and acting as if we can do everything through abstinence. I think they don’t know what most women are up against in too many parts of the world face today [30:58-31:19].
Clinton’s comment is further emphasized with a still from a newspaper about what he had said in this particular conference. The image lingers on long enough to give the viewer enough time to read the heading: Former U.S president blasts abstinence- only AIDS programs, backs needle exchange. Inclusion of these scenes signify: Clinton Foundation’s liberalism (promoting casual sex, which kills) vs PEPFAR’s conservatism (demanding sexual restraint, which saves lives).
The film shows support for the Uganda’s approach, which prioritizes A and B first and stigmatizes casual sex, whereas Botswana’s ‘condom first’ approach is depicted as a way forward for those already living with the virus, and thus the pageant plays a significant role in this juxtaposition. Excerpts from the AIDS conferences where HIV- infected activists demand their rights to have sex are usually undercut. For example, an HIV-positive Beatrice Were is seen at the podium saying proudly: ‘We know that we are living a long time. We are living healthy, we are living as beautiful people. Look at me. I am not dying, I am not feeble, I am not filthy. I think we need to begin to change the picture to change the new trends. We need to begin to bring hope. We need to say what it is, we are looking good’ [22:31-23:12]. (But this is superimposed on grave digging in an African location.)
Miss HIV is 88 minutes long and employs various stylistic devices to offer a
compelling overview of the pandemic. Through the didactic voice-over commentary by the African American actress Della Reese and the interviews with Harvard
medical anthropologist Edward Green, Miss HIV presents a chilling story. It suggests that sub-Saharan Africa is in the middle of an AIDS genocide, caused by
ethnocentrism and pride on part of Western AIDS experts. The choice of on-screen white experts such as Green to defend African sexual conservatism and way of knowing is significant because Green is outspoken about racial thinking in HIV/AIDS discourse and claims it has caused some Western experts to fall back onto the 19th century adventurers ‘lurid tales’ about the hyper sexuality of African people.
According to Green’s 2003 book, one of the several reasons Uganda developed a distinctive and different response to AIDS prevention is because the ‘zero grazing’ (be faithful) programme was developed before outside experts showed up in significant numbers and enforced the condom-first approach which undermined personal responsibility (Green, 2003:172). Hanon’s personal bias is also ‘personal responsibility,’ and although he claims that he wasn’t ‘constructing an argument for the jury in order to swing them to a client’s position’ (Hanon Interview, 2012:5), Miss HIV’s support for the behaviour change approach is not disguised; this reveals the gaze of the Christian donors and of Hanon as the filmmaker.
Miss HIV is an ambitious project featuring scenes from the 2006 international AIDS conference in Toronto, various locations from Uganda and Botswana, archive images from other identified sub-Saharan Africa places, off-screen filmed footage etc, to provide a coherent picture of the scale of the AIDS machinery. Opinions from high profile individuals such as Bill and Melinda Gates, Bill Clinton, Peter Piot (UNAIDS) President Yoweri Museveni of Uganda, epidemiologists and medical anthropologists are juxtaposed with grave digging, burials, tearful women, cheerful wedding
marches, abstinence celebration dances and other communicative devices. Hanon randomly subtitles comments from black African contributors although they speak fluently and articulately in English. The most striking stylistic device is the voice-over narration by Della Reese, the African American actress and gospel singer whose distinctive voice carries the central theme of the film.
The first part of the film offers the non-informed viewer a well-detailed background regarding the origins of HIV/AIDS. Right from the beginning, before the opening credits, the controversy pertaining to the very nature of the HIV virus is presented audio-visually. The sequence opens with a young black African girl standing near a redbrick wall shyly staring into the camera, and then fades into an iconic African sunrise over green fields superimposed on sound from a solo traditional string instrument, then slowly pans into a yard with clothes hanging to dry. Two mud huts are panned in and a different little girl is shown sitting down painting with mud on stacks of compressed boxes. [This nameless ‘mud painting girl’ is one of the
continuous cutaways built into the film, showcasing progressive stages of her
painting.] More images that visually depict an authentic African location are shown in succession before Della Reese’s voice comes in: ‘There is controversy over nearly everything having to do with HIV/AIDS, even its origin. Most of the world’s leading epidemiologists believe that a strain of HIV evolved from the simian immunity deficiency virus found in certain monkeys’ [00:36-01:02]. A dry mud painting of a brown coloured monkey brandishing sharp pointy teeth is then panned in as the nameless mud-painting girl in medium close up squeezes the excess mud from her hands.
Reese’s voice explaining how the virus entered humans is now superimposed on a close-up of the girl’s hands as she continues to squeeze out the excess mud, and we assume she drew the painting of the monkey:
The cut on a person’s hand while preparing monkey meat is all it would have taken for the virus to enter a human. Because it can take ten years for symptoms to appear, HIV was already established among some general populations in Africa well before the virus was discovered among the first patients in the United States. It would be several years before the children of Africa knew the real reason why their young parents were dying. This
shrouded the disease in fear, superstition and stigma beyond the experience of any Western culture [01:02-02:02].
The background sound heightens to a dramatic pace and this sequence transition is an important stylistic devise used throughout the film, calling for a renewed attention to an even more serious and urgent message. As the opening credits roll, the editing speed changes and loud background rap music is added in so that the viewer is now assaulted by a montage of iconic and captivating images that unmistakably
communicate ‘underdeveloped Others’. Lonely children in bushes, a succession of coffins being lowered into the ground, a wedding march in a small church, sad
looking women lighting candles, an old woman rocking back and forth in bitter tears, a dead child being wrapped in a cloth, and other stages of funeral preparations.
This is contrasted with Bill Gates at a red-carpeted podium talking to a large group of well-dressed AIDS conference delegates, the majority of whom are white. After this fast-paced, breathless visual introduction, a scene from an African wedding
ceremony is faded in with a male voice (later revealed to be a seated white male, and only much later identified as Dr Edward Green) saying ‘Nicholas Kristof of The New York Times said, the two most dangerous things in Africa today are not
promiscuity or prostitution but marriage and abstinence’ [02:35-02:45]. A close-up of a white woman at the podium claiming that the Bush administration’s AIDS policy ‘is tied to an agenda to control non-orthodox expressions of sexuality’ is juxtaposed with black African men digging with spades in a field. [02:55] Reese’s narration fades on the digging men: ‘Nearly two thirds of all HIV infected people in the world live and die in sub-Saharan Africa [03:02-03:16].
After situating the HIV/AIDS pandemic in Africa, the film cuts to Bill Gates from the Toronto AIDS conference, looking and sounding confident about the new medical solutions: female condoms and anti-HIV vaginal gel that will finally protect vulnerable women and empower them from having to ask men to put on condoms. Gates informs the applauding delegates: ‘We hope and expect that this could be the next big breakthrough. It is particularly important because it will benefit women who largely have to rely on men to agree to abstinence or condom use, and that simply isn’t getting the job done. The woman should never need to ask her partner’s permission to save her own life’ [03:19-03:38]. The HIV-positive activist Beatrice Were, supporting Gate’s sex-as-human-right vision, is cut to on the podium in a medium shot: ‘In most cases people forget that we have a right to sex’ [03:49-04:09].
Throughout, Miss HIV combines metaphorical contrasts with unnerving abrupt changes in background sound, editing pace and unexpected assertions from contributors. But the most significant and conclusive stylistic strategy is the chilling warning from an epidemiologist, Rand Stoneburner, which is placed right at the end of the film as a ‘take home’ message for the viewer: ‘One of the worst abuses of the latter part of twentieth century is the failure to do AIDS prevention in ways we know that are effective.’ To many people who are conversant with the HIV/AIDS discourse Miss HIV is a groundbreaking text, and it is fair to say that the director ‘got his hands dirty’ through extensive research. The ‘take home message’ from the epidemiologist is particularly significant because Dr. Stoneburner was commissioned by the UN and his findings clearly illustrate the superiority of the Ugandan solution, which was very effective, cheap and culturally relevant. In other words it is an unexpected instance where a Western expert recommends an African perspective, although the AIDS establishment rejected it. Stoneburner asserts that:
Uganda provides the clearest example that human immunodeficiency virus (HIV) is preventable if populations are mobilized to avoid risk. Despite limited resources, Uganda has shown a 70% decline in HIV prevalence since the early 1990s, linked to a 60% reduction in casual sex. The response in Uganda appears to be distinctively associated with communication about acquired immunodeficiency syndrome (AIDS) through social networks. Despite substantial condom use and promotion of biomedical approaches, other African countries have shown neither similar behavioral responses nor HIV prevalence declines of the same scale. The Ugandan success is
equivalent to a vaccine of 80% effectiveness. Its replication will require changes in global HIV/AIDS intervention policies and their evaluation (Stoneburner and Low-Beer, 2004: 714).
Miss HIV includes this African successful initiative through the clips of the Ugandan President Yoweri Museveni, and the interview with the Ugandan First Lady, Mrs Janet Museveni: ‘We had to fight to defeat AIDS or it would defeat us. We had just gone through a war, and many of our people had died. We now saw this enemy coming in, and we just had to come together as a nation again, and fight AIDS’ [13:25]. In another book by Green, Paradigm Shift and Controversy in AIDS
Prevention (2006) he notes that ‘when Uganda began to respond to HIV/AIDS in the late 1980s and early 1990s, it was just emerging from two decades of war and extreme civil unrest’ and that ‘far from being passive victims of forces beyond their control, Ugandans mounted an effective response to HIV/AIDS in spite of the difficult situations in which they were living’ (Green and Herling, 2006:28). Furthermore, the approach is praised as ‘culturally relevant, very low cost, and very successful’ (Green and Herling, 2006: 30).
The film is a strong visual statement that despite Uganda’s success story most African countries rigidly follow the human-rights approach to their own peril, because in the long run they cannot afford the technological solutions such as condoms, HIV testing kits or indeed the expensive ARV drugs. Likewise it shows that de-
stigmatizing HIV/AIDS and treating it as any other disease is also problematic because poor countries are unable to keep up with the treatment costs for life prolonging drugs. Besides, the virus does not usually end with one patient, behavior change approaches are undermined by the liberal camp as Ssempa puts it: ‘It has become a battle for human rights. My rights to have sex anytime I want.’ [26:26-34]. To emphasize this, Bill Gates’ comment about the overall cost implications is
articulated with subtitles: ‘Right now, nearly 40 million people are living with HIV. The annual cost of getting treatment to everyone in the world who is HIV positive will be more than 13 billion US dollars a year, every year. We are now averaging 4 million new infections a year’ [56:10-56:41].
Stylistically, subtitling in this case serves to emphasize the seriousness of the statement, but it is doubtful that the same can be said about subtitling the black African contributors, particularly when they simply state their names.
Without doubt, Miss HIV ‘speaks nearby’ the beauty pageant, on the one hand to empower the contestants to articulate their human needs, and also to show the relevance of the condom-only alternative, for those already infected. Elizabeth smiles as she explains: ‘People think you can’t have sex when you are HIV positive. But
they must understand that you are always a human being. Because, sex, it’s not me who did it. It’s God. It is for every person. So when that comes, I have to have sex, enjoy it. If I don’t enjoy it I will say so. But if I enjoy it, I have to’ [39:48-40:11]. To put an emphasis on condom in such a case, a brother to the other contestant Motse Thabang adds: ‘when a person has HIV it doesn’t mean that he or she doesn’t have to have sex. As long as there is protection. If you don’t have sex with someone who is HIV positive, it will be like we are stigmatizing them. So we need to give them support. We need to have sex with them, relationship with them. Condom is the best way of having sex [40:22-41:05].
What is expressed throughout the film however is the fact that the ideological biases of donors got in the way and undermined a perfectly effective solution that originated in Africa simply because it was not ‘measurable’ and it did not necessitate expensive foreign expertize. Green says that the ‘cost of promoting ABC the way Uganda did it in the early years when they were just emerging from war and turned the epidemic around was less than 50 cents per person, per year’ [57:00-15]. He condemns the donor’s arrogance because it allows ‘experts’ to travel to Africa to help but not to listen to Africans:
We were so arrogant. We were typical Western experts. So here is this great model in Uganda. The Western experts show up. They know what is best because of what may have worked in San Francisco in a different kind of epidemic affecting gay men and drug users and hemophiliacs, and they go into Africa with no experience in Africa and tell them what to do and don’t listen and they don’t notice what is going around them [18:50-19:14].
The film foregrounds the voices of the white experts to show the relevance of the Ugandan approach, and at the end uses a long sequence with an American band (The Newsboys) to celebrate matrimony, which relegates the Miss HIV contestants into a backdrop template for a two-sided HIV/AIDS story. In this case, African subjects are demonstrated upon to show how Western-derived (human rights) solutions are failing in the fight against HIV/AIDS as Green asserts: ‘The people working with HIV/AIDS prevention are reluctant you might say to go down that path of seeming to constrain or restrain sexual behaviour. Most Africans have
conservative attitude towards sex. Most people who work with HIV program adhere