On International Human Solidarity Day 2016 a blog post by Brenda Bartelink. Recently, the Dutch Aidsfonds stopped a confrontational campaign on the rise of HIV-infections and deaths worldwide after a complaint by a prominent Dutch lawyer that this campaign unduly stigmatized people living with HIV and AIDS. In today’s post Brenda Bartelink argues that there is more at stake than the stigmatization of people living with HIV in the Netherlands. To broaden the discussion, she compares the Aidsfonds campaign to a campaign that was developed by religious leaders in Sub Saharan Africa -now implemented worldwide- as an example of how the usual dilemma’s surrounding such campaigns can be overcome.

The controversy
On World AIDS Day, December first of this year, the Dutch organization Aidsfonds (Aids Fund) launched its new campaign ‘The virus threatens to win’ (Het virus dreigt te winnen). In the week after people in the Netherlands could listen to radio spots and watch TV ads in which HIV had a voice that said: ‘I don’t discriminate, I am a lady killer’ and ‘I kill over 300 children each day in an instance’. Despite the originality of the campaign- making the HIV virus an actor- in the following days the campaign was fiercely criticized. Prominent lawyer Oscar Hammerstein, who is living with HIV himself, argued that a campaign that sounds like a horror film stigmatizes people living with HIV in the Netherlands; the interest group for people living with HIV in the Netherlands, HVN (HIV Vereniging Nederland), coined it a ‘horror campaign’ which was quickly picked up in social and other media. Aidsfonds subsequently decided to terminate the campaign.

In a widely viewed late night news show, Oscar Hammerstein provided further explanation to the critiques of the campaign made by himself and HVN. He explained how hard he and others had fought to tackle the stigma related to HIV and AIDS in the Netherlands, while this campaign linked HIV directly with murder. “Because the virus is transmitted through people and not through the air, this campaign suggests that people living with HIV are killers of others”. He continued that the campaign erroneously suggests that HIV and AIDS is only killing people, while over the past decades huge steps have been made in the treatment of HIV. People now do not die of the virus but have a life expectancy similar to those who live without the virus. In response, Aidsfonds argued that HIV and AIDS continue to be such a huge problem to people around the world that continued attention is needed. In fact, the very reason for Aidsfonds to start their campaign is that there is a rise in numbers of infections around the world, while funds for tackling HIV and AIDS are decreasing.[1] With a strong and confrontational campaign, Aidsfonds hoped to challenge people and motivate them to continue to support programmes and organizations that fight the disease. Because HVN and Hammerstein were seen to be part of the constituency of Aidsfonds, the organisation took the critique seriously and terminated the campaign.

HIV and AIDS and stigma
While ‘AIDS does not discriminate,’ HIV and AIDS are linked to discrimination in various ways. The argument of the stigmatizing effects of communication on HIV and AIDS is not a novel reflection in Dutch approaches to HIV and AIDS. In fact, since HIV and AIDS were ‘discovered’ in the 1980s, people living with HIV and AIDS in the Netherlands have played crucial roles in developing programmes and prevention campaigns that do not stigmatize. However, the argument of stigmatization, as it came across in the media included some serious blind spots that were not brought into the conversation. In a powerful essay entitled ‘Beyond Bare Life’ (2007) anthropologist Jean Comaroff discusses how discourses on HIV and AIDS have been produced along the lines of an orientalist perception of sexuality in Africa. [2] Referring to the work of Cameroonian philosopher Achilles Mbembe, Comaroff argues that Western depictions of HIV and AIDS have reaffirmed the ‘absolute otherness’ of Africa. Comaroff particularly critiqued the constructions of Africa as a horrific, deteriorating continent while ignoring how HIV and AIDS is impacting people’s everyday lives. Others have argued along similar lines, demonstrating that colonial images of a sexualised African other have been revived in the response to HIV and AIDS.[3] Comaroff particularly criticized the pre-occupation with terrorism in US foreign policy after 11 September 2001, while the tremendous impact of HIV and AIDS in Sub Saharan Africa was neglected. Sub Saharan Africa, she concludes, is an ‘axis of irrelevance’ in international policy.

While the focus in the discussion around the campaign was not on Sub Saharan Africa but on ‘the world’, with particular mentioning of Russia and the Ukraine, the perspective put forward by Comaroff is nonetheless relevant to the argument I am making here. In the critiques from the HVN and Hammerstein, no matter how relevant and true, we can see the logic of irrelevance at work. Their argument is based on how the campaign stigmatizes people living with HIV in the Netherlands, but neglects the fact that people around the world are still very much affected by HIV and AIDS and often lack the means to properly protect themselves against the virus and the disease. However, while the Aidsfonds campaign intended to make the Dutch general public aware that HIV and AIDS is not an issue of ‘irrelevance’, they did not have the power to debunk this critique. This lack of power reveals another logic is at work in these discussions.

Questioning problematizing approaches in development
Aidsfonds states on their website that the campaign has been tested among a selection of people in their constituency and the general public in the Netherlands, according to the rules for marketing campaigns in the Netherlands. However they also argue that it was a campaign particularly focussed on addressing the impact of HIV and AIDS worldwide (and not in the Netherlands). This raises the question, however, whether the campaign would have been critiqued for being stigmatizing if HIV and AIDS did not directly affecting people in the Netherlands. What would have happened if Aidsfonds had tested this campaign with the people for whom they are campaigning? What are the views from Russia, from Ukraine, from African countries? How would people living with HIV and AIDS living in societies where the health system in not as good as in the Netherlands respond to the argument put forward by Hammerstein and the HVN that the life expectancy of people living with HIV and AIDS is similar to those living without? Most development campaigns focus on concerns that do not affect people in the Netherlands directly. This regularly results in campaigns that can be coined as ‘poverty porn’ (a recent example of such a campaign by Save the Children can be seen here). Through the controversy around the Aidsfonds campaign, it becomes apparent that in the context of international development, issues such as HIV and AIDS can be framed in ways that are unacceptable in the Netherlands. The question is of course why we represent people living with HIV and AIDS outside the Netherlands in ways that we would never dream of representing the Dutch (or the English, Australian or American for that matter)? Is this only because the views of those who are directly affected remain unheard (which is in itself problematic as it is), or is it perhaps also because people from outside of Europe or what is generally seen as the ‘west’ are somehow seen as having less dignity?

Global power relations
Arturo Escobar argued back in 1995 that development cooperation had divided the world into categories of the ‘developed’ and the ‘less developed’, ‘rich’ and ‘poor’, ‘North’ and ‘South’. [4] Critical research by Escobar and others has demonstrated that development often includes stigmatization and therefore might hinder finding a solution to the very problem it claims to address (i.e. turning around growing inequalities in the world).[5] While scholars, practitioners, activists and policymakers are all aware of this paradox (many development professionals in the Netherlands have been trained in institutions that have integrated critical theory in their curriculum, for example), it has proven difficult to tackle the dichotomies according to which the field of development is organized and sustained by capital flows. In addition, in societies such as the Netherlands, the rather generous support for development has been crumbling, influenced by government budget-cuts for development, nativist tendencies in politics and among the general public, coupled with an increasing cynical reception of development as ineffective and corrupt.[6] Within this context of diminishing public and private support bases, some development organisations choose to communicate based on strong and often stereotypical images.

While stigmatisation and stereotyping in development marketing has been critiqued by platforms such as ID-leaks and the World’s Best News in the Netherlands, and Radi-AID, Africa is a Country, CIHA-bloginternationally, organisations continue to fall for the temptation of the short-term support the shock effect of poverty porn creates.[7] The Aidsfonds campaign, for example, did not include critical information on the successes that have been achieved in the response to HIV and AIDS over the past decades, as journalist Ralf Bodelier has argued.[8]While HIV infections still occur and might be rising, there are successes in halting the disease and preventing people that live with HIV from dying of AIDS, achieved by the tremendous efforts of local, national and international organisations, including Aidsfonds. This in turn plays right into the cynicism about international development and its inability to solve problems effectively. Therefore, while Aidsfonds could have taken the opportunity to debunk the critique of its campaign by pointing out how the critics failed to address the realities of people living with HIV and AIDS referred to by the campaign, I suggest that their own problematizing approach made them powerless to do so. Is it possible that the reaction of Aidsfonds would have been different if Aidsfonds had indeed generated broad support for their fundraising campaign by engaging relevant people and organisational partners in the countries where they work? Instead, the campaign and the discussion afterwards ended up confirming invisible (but very real) boundaries between the axis of relevance and irrelevance, which are in turn firmly rooted in the power relations between developed and underdeveloped, North and South, rich and poor.

Suffering and hope
How do we raise awareness of HIV and AIDS, centralizing the dignity of people with the aim of transforming unequal power relations? Awareness of how structural inequalities are entangled with various forms of stigmatization, even within the institutions that aim to overcome these, apparently is not enough. Perhaps this has to do with the focus of public health campaigns (whether in the context of development or not) on preventing or relieving human suffering. Anthropologist Joel Robbins offers two approaches that have the potential to shift the ‘development frame’ that centralizes a suffering other.[9] He first of all suggests that when problems are addressed it should be done in such a way that ‘we do not primarily provide cultural context so as to offer lessons in how lives are lived differently elsewhere, but in which we offer accounts of trauma that make us and our readers feel in our bones the vulnerability we as human beings all share’. Secondly, he advocates for a more explicit focus ‘on how people living in different societies strive to create the good in their lives’. This focus on the good can include devoting attention to empathy, care, ethics and hope.

An HIV and AIDS campaign that has integrated elements of both is the SAVE approach developed by INERELA+, the international network of religious leaders living with or personally affected by HIV. Initiated by Gideon Byamugisha, an Anglican priest from Uganda who was the first priest who publicly announced his HIV positive status, INERELA+ has tremendous experience in bringing the ‘realities of HIV and AIDS’ into conversation in societies around the world, while empowering people who live with HIV and AIDS. A key-element in the approach is that people, regardless of their background, realize their own vulnerability towards HIV. ‘HIV does not discriminate’ is the message these religious leaders convey. Their unique positions and experiences as leaders and people living with HIV and AIDS allowed them to develop prevention campaigns that were more inclusive and less stigmatizing. The SAVE approach contains an acronym that stands for Safer Practices, Access to treatment, Voluntary counselling and testing, Empowering marginalized and vulnerable groups. Embedded in the slogan ‘Together we can SAVE lives’, it also contains a message of hope towards the future.[10] While the SAVE approach is focussed on prevention, and not on communication about HIV and AIDS for fundraising purposes, it demonstrates that more sensitive and inclusive communication focussing on human suffering as well as hope is possible.

Towards a world without HIV and AIDS
INERELA+ is not the only organisation that has developed more inclusive approaches that tackles stigma on many levels. The video ‘Love a Positive Life’ from the Link Up project of the International HIV/AIDS Alliance is another example. Yet, the approach chosen by INERELA leads me to make another point: It is about time that we recognize the leadership of people living with HIV and AIDS around the world in how to communicate about vulnerability, suffering and hope in ways that empower rather than stigmatize. And while the interest in HIV and AIDS in the context of (Dutch) development policy has decreased in favour of problems such as early marriage, gender based violence and sexual health, it is more important than ever that organisations communicate about these complex and important issues in ways that affirm our common humanity, both in terms of what concerns us as well as in how we imagine our future. On December 1st, the day that Aidsfonds launched its campaign, an HIV and AIDS monument (ironically enough partially funded by Aidsfonds) was unveiled in Amsterdam.[11] The monument is a giant abacus with red glass beads, representing a ‘countdown to the moment when HIV and AIDS become a thing of the past’. According to the text on the website of the Aidsmonument, it is ‘a symbol of solidarity and a beacon of hope for everyone living with HIV today’.[12] I hope that any future campaigns to raise support for HIV and AIDS around the world will indeed appeal to our solidarity and hope for a world without HIV and AIDS.

[1] Cf. https://aidsfonds.nl/nieuws/belangrijkste-vragen-bij-het-stopzetten-van-laatste-campagne-aidsfonds

[2] Jean Comaroff. ‘Beyond Bare Life: AIDS, (Bio)Politics, and the Neoliberal Order’. Public Culture: Bulletin of the Project for Transnational Cultural Studies. Vol. 19.1. (Durham NC: Duke University Press, 2007), 197-219.

[3] Cf. Anouka H.J.M. van Eerdewijk. The ABC of unsafe sex. (Nijmegen: Radbout University, 2007), 37. Silvia Tamale ed. African sexualities a reader. (Oxford, U.K., Pambazuka Press, 2011) Signe Arnfred ed. Re-thinking Sexualities in Africa. (Uppsala: Nordiska Afrikainstitutet, 2004), 67

[4] A. Escobar. ‘Encountering development: The making and unmaking of the Third World’. (Princeton, NJ: Princeton University Press, 1995)

[5] Eriksson Baaz (2002) groups a number of quite diverse writers under the title ‘post-development’. Examples of post-development studies: Escobar (1995); J. Ferguson. ‘The anti-politics machine: “development,” depoliticization, and bureaucratic power in Lesotho’. (Cambridge UK: Cambridge University Press, 1990). Reflections on post-development studies: Jan Nederveen Pieterse. ‘After Post-Development’. Third World Quarterly. Vol. 2. ( London: Taylor & Francis Ltd., 2000), 175-191.; R.D. Grillo. ‘Discourses of Development: The view from anthropology’. Discourses of Development: anthropological perspectives. R. D. Grillo, R. L. Stirrat eds. (Oxford UK: Berg Publishers, 1997), 20; and Eriksson Baaz, (2002).

[6]http://www.rd.nl/vandaag/binnenland/nederlander-wantrouwt-internationale-goede-doelen-1.1110346

[7] This critique has also been taken up by organisations themselves. See for example the websites of development organisations Oxfamand Cordaid

[8] http://www.volkskrant.nl/opinie/aidsfonds-zou-succes-van-de-daken-moeten-schreeuwen~a4430527/

[9] Robbins, Joel. 2013. “Beyond the Suffering Subject: Toward an Anthropology of the Good.” Journal of the Royal Anthropological Institute 19 (3): 447-462.

[10] It is now being implemented by various organisations around the world, including INERELA+, Christian Aid, World Vision and CABSA.

[11] Cf. http://www.aidsmonument.nl

[12] Ibid.

Image: A CGI image of the AIDS monument unveiled in Amsterdam on World AIDS Day, 1 December, 2016 (source http://www.aidsmonument.nl)