Deadline for Health: The Media’s Response to Covering HIV/AIDS, TB and Malaria in Africa
Country Report Summaries: Botswana

Human Development Index* rank: 125 out of a total of 175 countries.
Adult literacy rate: 78.1 percent (UNDP 2001)**
GDP per capita: $7,820 (UNDP 2001)
Life expectancy at birth: 44.7 years (UNDP 2001)
Government expenditure on health as percentage of total general government expenditure: 7.6 percent (WHO 2002)
HIV/AIDS prevalence in the adult population (15-49 years): 37.3 percent (UNAIDS 2004)
Orphans due to AIDS: 120,000 (UNAIDS 2004)
Population size: 1.7 million
Print media surveyed:
Daily News (state-owned, daily)
Mmegi (privately owned, weekly)

Botswana is a country being destroyed by HIV/AIDS. Once one of the more successful African nations, HIV/AIDS now affects more than 37 percent of its citizens. Yet despite this fact, there was no more than one health story in each issue of the newspapers studied.

The content analysis was done of articles that ran in 2002 in two newspapers, the privately owned weekly Mmegi, circulation 25,000, and the state-owned Daily News, circulation 65,000. All issues of Mmegi were studied, and 70 stories per issue were analyzed. In the 47 issues of the Daily News that were studied, 25 stories per issue were analyzed.

The overwhelming number of health stories in both publications was on HIV/AIDS (95 percent for Mmegi and 97 percent for Daily News). Malaria, which is seasonal and affects only the northern region of Botswana, does not feature prominently in the media. Malaria was covered in only 2.7 percent of Mmegi stories and 2.9 percent of the health stories in the Daily News.

Botswana’s extremely high rate of TB was an issue highlighted in the research. The high incidence of TB is a direct result of the high prevalence of HIV and its impact in weakening people’s immune systems. According to Dr. Jean Nachega of the Department of International Health at the Johns Hopkins School of Public Health, who conducted the study interviews in Botswana, people who are HIV positive are 200 times as likely to get TB as people who do not have HIV. However, reportage that linked TB and HIV was virtually absent from the content of the country’s media. In the 47 issues of the Daily News analyzed for this report, TB was not covered at all. In Mmegi, 0.7 percent of stories mentioned TB. In the focus groups and interviews, all of the respondents acknowledged the need for the media to address TB – not only to explain how it can be prevented but also that TB can be cured.

Most study participants acknowledged the dominance of state-owned media over privately owned mass media in terms of resources, easy access to information and community outreach. They also said that radio – followed by newspapers and TV – is the medium with the most impact at a community level. However, there was widespread frustration over the National Security Act, which requires journalists to apply for permission to visit health facilities or speak to medical personnel. “The National Security Act is one of the major obstacles for speedy access to reliable information by the media,” said one respondent.

Lack of resources was the main reason identified by respondents as to why most media organizations did not do a better job of covering health. Most organizations do not have specific health desks or dedicated columns or programs. They also lack trained and experienced reporters and proper equipment. Several study participants said that the government’s contributions to better health coverage should include networking and collaborating genuinely with the media, developing good communication strategies, increasing press briefings and sponsoring media training and having an open-door policy.

The vulnerable position of women in Botswana society was identified as a key factor in their high risk of exposure to HIV/AIDS. Women and girls are commonly discriminated against in terms of access to education, employment, credit, health care, and property and inheritance rights. In both the Daily News and Mmegi, stories dealing specifically with women’s health issues made up just 3 percent of total health content – this in a country where 35.4 percent of pregnant women were HIV positive in 2002.

“Relationships with men – casual or formalized through marriage – are seen by women and girls as vital opportunities for financial and social security, or for satisfying maternal aspirations,” says Dr. Nachega. “In addition, the combination of dependence and subordination of women makes it difficult in Botswana for girls and women to demand safe sex – even from a husband – or to end relationships that pose a risk of infection.”

However, despite this context, views were mixed on the question of whether women-oriented columns or programs would have the desired effect. Some informants, including women, expressed their concern that targeting women specifically in the media would create negative reactions in male partners. “We must be careful in trying to have specific health columns for women, since the majority of women in Botswana are not in control of their own sexuality,” said one respondent. Another added that “Men are the ones who need specific education when it comes to the issues of HIV/AIDS.”

Botswana is in the unique position on the African continent of providing free antiretroviral medication not only for the prevention of mother-to-child transmission, but also for the treatment of AIDS for any citizen who needs it.“Training for journalists must be multidimensional with multiple components,” said Dr. Nachega. “The media don’t know enough. Journalists need to go out and investigate – with health professionals – topics such as why there is still such stigma in a country which offers free antiretroviral treatment and why people won’t go to be tested.”

In this context, respondents had very clear ideas as to the important role the media should play. Among these was the need for the media to communicate HIV prevention messages, especially to prevent vertical transmission from mother to child; the need for good adherence to the schedule in taking antiretroviral drugs; education on when antiretroviral drugs were necessary and how to manage their side effects; and creative advertising that “went beyond” condom promotion and increased efforts to communicate messages about abstinence for boys and girls.

Study participants were unanimous in recommending that journalists needed specialized training in order to provide quality health coverage. On the issue of stigma and discrimination, respondents said that the media needed to be aggressive in promoting the acceptance of people living with AIDS. Health personnel respondents reported their willingness to work with the media and government in training sessions for journalists, as well as to volunteer to take part in designing, writing or broadcasting health messages.

*The Human Development Index is an independent composite measure calculated by the United Nations Development Programme. Figures were released in 2003 from data collected in 2001. The HDI weighs such factors as life expectancy at birth, adult literacy rate and GDP per capita, and then ranks countries from 1 (the best) to 175 (the worst). Countries ranked worse than 142 are considered to be low in factors which provide opportunities for people to develop their potential.

** UNDP figures were released in 2003 from data collected in 2001.