Sunday, May 22, 2011

HIV/AIDS Activism: Lost in Translation

After dedicating two years of my life to the cause of sustainable development in the Republic of Mali, I came to loathe so-called "aid" projects which are unnecessarily expensive, relatively ineffective, and either achieve their intended goals at an obscenely high ratio of costs to benefits or they accomplish absolutely nothing at all. Perhaps the greatest potential for stupid, wasteful “aid” projects lies in the sub-field of HIV/AIDS education. Part of it is because HIV/AIDS is such a relatively trendy cause and there is simply such a volume of Western aid dollars allocated to HIV/AIDS projects that there is so much more potential for waste. Part of it is because HIV/AIDS is such an ideologically-loaded subject that Western do-gooders are wont to apply their own belief systems onto poor, unwitting Africans. And part of it is that benevolent do-gooders are so completely ignorant of their host country’s culture that when they try to intervene in matters of sexuality they are simply doomed to failure.

Imagine a couple of humanitarian aid professionals – one has a Masters in African Studies from Yale, another went to Princeton to get their Ph.D. in International Relations. A well-meaning NGO just raised $200,000 to send them to do something about AIDS in some poor West African country, say, Niger. So they are sitting around the air-conditioned boardroom of their NGO in the expatriate quarter of Niamey, brain-storming ways to raise the Nigerien people’s awareness about HIV transmission and prevention.

“What if we made a sign to raise awareness about HIV/AIDS?”

“Great idea! Let’s draw up a hundred of them and put them up along heavily-trafficked roads!”

So they will spend about $10,000 to hire a graphic designer in San Francisco who will email his design to a factory in Lyons which will manufacture a hundred or so signs for $20,000. And it will cost another $30,000 to ship the posts from Lyons to the port at Marseilles to the port at Lagos and overland to their NGO headquarters in Niamey. Another $15,000 will be lost to bribing the customs agents. And they will pay the local contractor some grossly inflated price, say, $25,000 to drive around the country, hammer posts in the ground and put up billboards along one lane-roads leading into various cities and towns in Niger.

So when everything is said and done, the perfectly benevolent NGO will have plopped down 100 billboards for a price of around $1,000 each to the grand total of $100,000. Take a hard look at this sign, scrutinize it for about a minute and try to understand why it is such a stupid, festering piece of garbage.

Every piece of information that could possibly be conveyed by this sign can only be understood by those who can read French. Officially, Niger is a Francophone country, there are indeed some people in this country who can speak French – a miniscule minority of teachers, doctors and police officers. But the overwhelming majority of the people only speak their native Hausa, Songraï, Peulh or Tamashek – it is not unfair to assume your typical market lady does not know any “White People Language” beyond “Bozu le Blanc sava sava byen”. Also, the vast majority of people in this country are absolutely illiterate; 71.3 percent of the population, according to the CIA World Factbook – and even that figure is padded by an extremely liberal definition of “literacy” which recognizes anyone who can scrawl their name as “literate”. To 9 out of 10 pedestrians who might be walking down the street in Niamey, that public service announcement might as well be written in ancient Greek.

Likewise, this billboard on the road to the Malian city of Koutiala is also a festering piece of garbage. Imagine you are an illiterate Minianka millet farmer riding your donkey cart to sell your goats at the Koutiala market – what useful lesson in disease prevention could you possibly gain from viewing this $1,000 sign?

This billboard was placed by the Christian NGO World Vision in my former home of Sanadougou. I will give them due credit for writing their public health message in Bambara – Mali’s vernacular lingua franca. It reads “Hey! Be careful, AIDS is here! There is no cure for it.”

Indeed, writing a public health message in Bambara is certainly more sensitive to the local culture compared to writing it in French. But this World Vision billboard is still fatally flawed by the fact that their message was written in any language at all; instead of writing their AIDS-prevention message in ancient Greek, they decided to write it in the equivalent of modern Greek.

To pass the time, I asked scores of my illiterate neighbors for their interpretations of this billboard on the road leading to town. Not a single person I asked was able to tell me that it had anything to do with HIV/AIDS. The closest thing to a logical response I ever heard was “don’t leave razor blades in your bed – they will cut you.”

Sometimes I wonder what part of “illiteracy ” these well-meaning Christian aid-givers don’t understand. To refer to someone as “illiterate” doesn’t me that they can’t fully appreciate the works of Proust; “illiterate” refers to an individual or a group of persons who cannot read or write anything at all. To refer to these cultures as “predominantly illiterate” is not at all a judgment of intelligence or character – it is simply a statement of fact. Likewise, one cannot mount an effective public health campaign in a country like Mali, Niger, Mauritania or Burkina Faso without taking into consideration that the vast majority of your intended audience in these countries is completely and utterly illiterate.

One time I met a World Vision missionary/humanitarian agent in Bamako and took issue with their billboard campaign. She accused me of “insulting the Malian people’s intelligence”; “I work with a number of local staff who are all very capable of reading and writing – one of my colleagues was educated at the Sorbonne and he can read English, French and German!”

This well-meaning church lady’s response was quite telling. When practitioners of “humanitarian aid” and “economic development” live in the expatriate Green Zones of their respective African capitols, they can manage to go months at a time interacting with only the extremely-Westernized, French- or even English-speaking, literate elite, completely sheltered from the social and economic realities of the other 99.999 percent of the population. Such an experience establishes an absurdly rose-tinted perspective of a country’s predominant living conditions – and it allows these naïve, bumbling do-gooders to waste all of their funds on projects which could only benefit the 0.001 percent of the indigenous population with whom they interact at official state functions and the American Club racquetball courts.

Here is another one of my favorite signs posted in the city of Koutiala. If you were a simple unlettered shepherd who speaks the hyper-literal Bambara language completely devoid of metaphor or simile, what would you interpret it to mean?

If I were an illiterate goat-herder, I would think that this billboard meant that AIDS is an anthropomorphic fire demon with a face and arms and legs. In a society where grown men are genuinely afraid of witches, warlocks, hairy field demons, mischievous forest demons and dwarf spirits with backwards feet, it makes perfect sense that benevolent Tubabs would seek to warn the Malian people about the anthropomorphic fire demons which have been wreaking havoc upon America. Likewise, I would interpret this billboard to mean that if this fire demon were to ever try to get into my house, I should push the door shut.

My all-time favorite HIV/AIDS public service announcement is the one line of billboards in Bamako which actually dares to show the image of a condom. Take a look at this public health campaign and try your best to imagine its unintended consequences.

Hardly any Malian men in Bamako ever buy condoms to wear while engaging in sexual intercourse, but – thanks to this fiasco of a public service announcement – when they do buy a condom they are likely to wear it on their two fingers. So they go to the brothel, they fuck a prostitute for 500 francs (~$1), they wear a 100 franc (~20¢) condom on their fingers, and – big surprise – they still contract HIV! So now if any of men or women ever get tested and discover that they are HIV+, they are going to go around telling everyone that either condoms don’t work or that it was the condom itself that transmitted HIV, and any lesson that the well-meaning NGOs might wish to convey will be thoroughly discredited in the public mind.

A ham-handed public health campaign like the infamous “finger bang” billboard is not merely ineffective in combating the transmission of HIV/AIDS – it actually makes the problem worse. Partly thanks to this train wreck of a public health campaign, many young men in Mali think that AIDS is just a hoax. Some have concluded that since people have followed the “finger condom” billboard’s instructions and contracted HIV, The White People are telling Black Africans to wear condoms because we want them to stop reproducing. Others think that AIDS is real, that it was concocted by the CIA to decimate the black population of Africa. Word on the street is that it’s the reservoir tip of the condom which contains the deadly virus; so some people actually buy condoms and cut off the very part of the prophylactic which makes it functional. Since these Western public health campaigns have crashed and burned so egregiously, it figures that polygamous young men resort to “traditional” i.e. witch doctor-prescribed methods like drinking snake oils, herbal teas and having unprotected sex with virgins.

So if these billboards are such absolutely ineffective pieces of garbage, why on Earth do humanitarian aid organizations waste their money on them? Part of the reason is surely that some of the individuals implementing these humanitarian aid campaigns simply don’t get it. But these professional aid-givers with their Ivy League graduate degrees are generally intelligent people – I can’t imagine that all of them are so dense that they don’t understand the folly of expressing public health messages with the written word in a thoroughly illiterate culture.

A more rational explanation for this embarrassing waste might be that Foreign Service Officers and professional development agents are often so lazy that they can’t be bothered to learn the local tribal language(s) of the culture they’re working in – the vernacular tongues without which they can’t possibly engage in any meaningful health education campaign. But they need to demonstrate to their superiors that they did something, anything constructive with their time in Namibia other than gallivanting around on the taxpayers’ dime. Constructing 100 undecipherable billboards – though they might be utterly useless for the Namibian people – at least makes for a solid bullet point on a professional aid-giver’s résumé.

But an even more rational explanation might lie in the political/economic interests of the rent-seeking aid agencies, private aid contractors and NGOs themselves. The unfortunate metric by which they all measure success is not the number of HIV infections averted or the number of Africans educated but the sheer volume of funds dispersed – the more money they spend, the more “successful” they can claim to be; e.g. “This year we spent $100,000 on a campaign to raise awareness about HIV/AIDS”. It doesn’t matter if that $100,000 was spent on a particularly ineffective awareness-raising campaign, or if it didn’t reap any positive health-related results. All that matters on the bottom line is how much money they spent, because the more funds they spend one year, they more funds they can justify raising from donor agencies, banks and private donors the next year.

So do I think that we – the vanguard of humanity who genuinely care about alleviating the disease and misery which defines life in so much of the world – should just give up on teaching Africans about HIV and AIDS? Not at all. I just think that we should stop throwing our money away on such unforgivably stupid wastes of finite resources as visual media which Westerners will never be able to produce for the consumption of peoples who do not understand our system of symbols and imagery, who cannot read our language, who cannot read any language at all – not even their own.

After spending two years living amongst the Minianka tribe in Mali, one lesson I came to understand is that though a literate culture remains alien to these people that have only begun to enjoy access to books, pens and paper, the Miniankas do have a rich and vibrant oral culture. This is a culture in which farmers will dispatch their child from one village to another to rely a simple message, in which virtually all business is transacted through oral contracts, the theology of the Qur’an is disseminated from the mouth of the imam to the ears of the faithful, and where griot troubadours transmit the tribal history from one generation to another through song. If you want to get a message across in the Minianka culture, the only appropriate medium for doing so is the spoken word.

Likewise, you can’t possibly hope to impart unto the Miniankas any useful lessons about health and hygiene unless you speak Minianka. This is one area in which I believe that the Peace Corps is leaps and bounds beyond any other development agencies and NGOs in the field because we are the only organization which bothers to learn the local tribal languages and live out in the field where we can practice them to fluency. I myself did not spend a whole lot of time disseminating seeds of knowledge about HIV/AIDS – I was much more preoccupied with the more ubiquitous scourges of diarrhea, giardia and dysentery. And it took me untold months of building up my language skills, sitting around the teapot chatting with the locals, gradually gaining their trust until I could convince anyone to take even the most modest steps to treat their drinking water.

Teaching the Miniankas about HIV/AIDS is a whole lot trickier because you have to have an exceptional command of the local tongue before you can gracefully converse with the locals about their most intimate relations. And even though my language skills might have been good enough by the end of my two years, I would have never become comfortable enough to talk to conservative Muslim Minianka women about their vaginas. The only people in Sanadougou with whom I could converse about matters of the nether-regions were the teenage-to-twenty-something boys who couldn’t stop asking me about penises, vaginas, and the various other instruments with which Americans engage in sexual relations.

“So Madu, how do Americans do it? Y’know, putting the penis into the vagina?” (Amadou demonstrates by inserting his index finger in and out of a curled fist)

“Well, in America the men have to always wear a condom on our penises before we engage in any sort of hanky-panky. You have to wear a condom every single time – unless, of course, you and your wife are married, you have a lucrative career, a good health insurance plan and enough funds in your savings account to have a baby.”

“But I do not want to wear a condom on my penis. It is not natural!”

“In America you would not have a choice. You must wear a condom on your penis every time you have sex. If you have sex with anyone and you don’t wear a condom – even just once - then everyone will think that you might have AIDS and no one will want to have sex with you ever again.”

“But I am a good Muslim! American women should trust me that I do not have AIDS.”

“Just about every American woman whom you will ever meet in Africa is here to work on HIV/AIDS projects. Hate to break it to you, Amadou, but you live in Africa. You are an African. If you have ever had sex without a condom, and you are open and honest with an American woman about your sexual history, then you have zero chance of ever having sex with her.”

“Hm… maybe I should start wearing condoms - that way I could convince an American woman to sleep with me!”

“That's awful, Amadou. I have just lost a lot of respect for you as a human being. But you know what? There's no such thing as a bad reason to start wear condoms!”

In such a fashion, development agencies and NGOs should make greater efforts to utilize the mass media potential of radio and television – media which are lapped up readily by even the most illiterate Minianka. This is a culture in which an entire village will sit around the car battery-powered TV set watching the soap commercials as raptly as their dubbed Telemundo soap operas. If there is ever to be a cost-effective means to encourage Africans to practice safe sex, it would be stop selling them prophylactics the way we sell them rheumatism ointment and arthritis palliatives and to start selling them prophylactics the way we sell them beer, soda and powdered milk – by insinuating that this product will help the consumer to get laid. After all, this is how Trojan and Durex market condoms in the developed West – it’s absolutely bizarre that the one product that should be sold with sex appeal isn’t marketed in Africa as a catalyst for more frequent and more enjoyable sex.

So if there is one thing that we Tubabs should be doing in Africa to halt the spread of HIV/AIDS, I would say it would be to start aggressively marketing condoms to Africans. USAID and the World Bank should start underwriting the filming of commercials with Akon, Jay-Z and the entire Ghanaian soccer team making culture-sensitive advertisements for these wonderfully cost-effective products, perhaps even buying advertising time on the various African radio TV stations. Such a marketing strategy might be aiming for the lowest common denominator, it might be completely bereft of science, and it might not be as intellectually sound as a bona fide public health announcement. And free market fundamentalists might shudder at public subsidies to benefit certain for-profit corportions. But in consequentialist terms I can’t help but think that it would be the most cost-effective strategy to encourage Africans to practice safe and hygienic sex.

1 comment:

Hena said...

Hi. I totally agree with you as my whole research work is based on developing context specific visual communications. I shall be using your post as a reference in my PhD thesis.