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ROLE OF MEDIA IN CREATING AWARENESS ABOUT INFECTIOUS DISEASES IN PAKISTAN: A CASE STUDY OF TELEVISION HIV/AIDS COMMERCIALS AND MESSAGES.

Byline: A. Zia

ABSTRACT: Media plays a role of significant ally in any state of public health by disseminating timely and important information regarding deadly diseases. Due to the growth of private television and FM radio channels in Pakistan, such issues, which were considered taboo subjects are now getting attention. This research explored the role of Pakistani television channels in creating HIV/AIDS awareness. The study was carried out through interview and survey methods. Primarily related messages were reviewed for questionnaire design and data was collected to investigate the role of media in HIV/AIDS awareness. Random sampling technique was used to collect the data from individuals (both males and females) aged 16-40 years from Lahore. The results showed gender wise insignificant association between television messages and awareness about HIV and AIDS.

However the findings of the study revealed that despite accessibility; television messages were ineffective in creating awareness and eliminating misconceptions about this deadly disease. On the basis of the results, recommendations were also made for the health policy makers and media organizations in Pakistan.

Key Words: HIV/AIDS, Survey, Media Massages, Infectious Diseases, Pakistan, Television Commercials.

INTRODUCTION

Education and communication are key domains of the human endeavor that are closely linked. Mass media enlightens and safeguards the rights of the public by assuming the role of a watchdog, along with enhancing knowledge about a healthy life. Effective use of media plays a significant role in community development and health communication. A need always exists to study the role performed by the mass media in developmental processes including agriculture, business, housing, health, education, industry and technology, etc. Research studies have proved that media is more likely to change the behavior of the specific audience, when the information comes from the credible source, and presents relevant, appealing and vital messages. A significant empirical evidence also shows that media is being used to change attitude and behavior of the public towards HIV/AIDS (Bertrand et al., 2006).

Now a days as the world is facing the danger of emerging fatal diseases; Acquired Immune Deficiency Syndrome (AIDS) as one of the major challenge. It is not only a big public health issue but also a developmental dilemma of this century that starts with simple smoke signal and sweeps across the world like wild fire. Currently AIDS is amongst the main and foremost causes of death worldwide (Singh, 2006). It is also essential to understand that AIDS has economic and social consequences; political and ethical implications as well thus crucial to control. The world over, most of the studies conducted on AIDS awareness and education were focused to overcome the cultural, religious, gender and economic factors that prevent public from gaining knowledge about HIV/ AIDS to reduce the risk.

In developed world, media is used as an effective tool to fight against HIV/AIDS (Liskin, 1990; and Myhre and Flora, 2000). During 1990s the media of mass communication targeted the behavioral change, which encouraged safer sex and limit the risk of HIV/AIDS. Recently the media has expanded the intervention program to concentrate on the full range of issues related to HIV/AIDS, staring from impediment to treatment, from care to support (McKee et al., 2004; Gold and Brass, 1985). These campaigns targeted the general public, particularly the youth (Bertrand et al., 2006). Like other means of communication, Television has the potential to effectively increase awareness and educate the public, regarding this disease. Previous research has determined that "television has been used to raise its awareness significantly, routes of transmission, and prevention methods throughout the world" (Myhre and Flora, 2000; Oakley et al., 1995).

It has been reported that mass communication and media are potential to educate public at large, remove misconceptions, create and maintain encouraging environment for the prevention of HIV/AID" (Choudhary, 2007). For this purpose utilization of television appears as a cost effective medium because television reach majority and diversified population in shortest possible time. In view of the above mentioned fact, the present research study was focused only on the mass approach of communication (television). Television has an edge over other means of mass communication due to its unique combination of voice and picture, thus is capable to create awareness on any issue. There is an adage "education is the vaccine against AIDS". It is, therefore assumed that television can be very supportive in promoting the affirmative approach towards people living with this epidemic.

It can play an important role in combating AIDS by persuading public to change their high risk behavior which is vulnerable to this disease. Therefore the present study scrutinizes the HIV/AIDS awareness massages delivered by television channels in Pakistan.

Global AIDS Response Progress Report (2014) tells that "currently Pakistan reports low prevalence of HIV/AIDS". But due to social taboos and religious constraints along with the disgrace attached to this disease it is hard to educate people from its prevention. Pakistan is a fertile land for the AIDS because of stumpy social indicators, economic conditions, and epidemiological transition situation (Hyder; and Khan, 1998). Parents also do not provide sex education to their children when they need (Qidwai, 1996). Thus the fear of HIV outspread prevails in Pakistan mainly due to lack of knowledge about the epidemic, the unconscious engagement of people in high-risk practices, careless blood transfusion and inoculation practices etc. There is an apprehension that spread of this disease at large scale can harm socio-cultural framework of the society.

The world media is being effectively, utilized by the organizations that lead HIV/AIDS awareness program; it was, therefore essential to determine if Pakistani television awareness messages are being understood by the viewers or not. It also tries to spot the factors which hamper the efficacy of these campaigns and provide recommendations to improve people's understanding of this killing epidemic disease.

MATERIALS AND METHODS

Based on the notion that media plays a powerful role in creating awareness about HIV/AIDS among the viewers this research explores how television projected HIV/AIDS awareness messages and advertisements in Pakistan. The study consisted of two parts.

In the first part HIV/AIDS television commercials and massages were being used for awareness were studied. The focused messages were collected and reviewed to identify their strengths and gaps. Further producers of targeted messages were interviewed to understand the construction process and their limitations. The study of the television massages helped in designing the questionnaire for investigating the role of media in HIV/AIDS awareness through survey method.

In the second part of research, role of television massages in creating awareness about HIV/AIDS were examined. Target audiences of this research were general public from two areas of Lahore, including SherPao Bridge Colony and Makkah Colony. Lahore city was divided into six Divisions by the "Punjab Aids Control Program'. This research focused on one of the main Divisions where cases of HIV/AIDS were found and selected two of the areas included SherPao Bridge Colony, and Makkah Colony. Random sampling method was applied and every third house was taken from every street as a sample. A sample size of 60 male and female was set from these two different areas of Lahore. These 60 volunteered participants' included 40 males and 20 females between 30 to 50 years of age.

The scope of the present research is to recognize the various factors that were effective or reduced the efficiency of television messages related to HIV/AIDS. However, the sensitivity of this issue in Pakistan itself caused a limitation to the research. It was not easy to mold people including youth, parents and grandparents to talk about sex, condom and AIDS openly.

RESULTS AND DISCUSSION

Review of HIV/AIDS Television Messages and In-depth Interviews: Findings reveal that first advertisement and message against AIDS control was initiated by the television in Pakistan in early 1990s, but copy writers did not use the word "AIDS" in the commercial due to the social and religious limitations in Pakistan, as mentioned by the producers. It was hard to address the issue openly but gradually a message was finally formed that says: "AIDS is a dangerous disease, prevention is must". Afterwards this slogan was improved to "HIV is dangerous, Protect yourself" the focus of above mentioned messages was only blood and blood products as the major means of transmission. This public service message did not mention careless sex as one of the causes and how one could protect oneself, because media was not allowed to use the word "condom".

In 2002 a commercial was developed that was demonstrated and encouraged male contraception. The Pakistani censor board approved this commercial but suggested some of the modifications. However when the advertisement was modified and presented to the state television (PTV) for broadcasting, it was opposed to be telecasted. The concerned officials of PTV were of the point of view that it should not go on air as such and suggested that it should be "qurbat k taaluqaat mein ehtyat kijye" while using the picture of condom. It did not even use the word Condom. The message of this commercial was prepared by National AIDS control program.

Interviews with producers of commercials revealed that after 2002 all the means of HIV and AIDS transmission between the sexes were elucidated in concerned messages and media discussed the issue in other programs too. Later a condom advertisement with the song "suno zara khushi ki aahat" was aired on PTV (Pakistan television) and private television channels with the collaboration of Green Star (family planning organization) in 2003. This advertisement was a song based story in which a happy newly married family with a new born baby was shown. Although the song did not clearly convey that it's about the safe sex and use of condom, but at the end of the song after 5-6 second, a logo of the condom was shown. Finally a public service massage in 2004 including care and precautions for HIV/AIDS was presented on private and state television channels. It was, however, comparatively a more clear message and provided information and little guidance to the audience about this deadly disease.

Survey Results and Discussion: The study also explored the impact of the HIV/AIDS television messages/commercials on the viewers through a survey consisting of 60 volunteer participants, including 40 males and 20 females between 16 to 40 years of age. As shown in Fig-1, majority of respondents i.e. 68.5% were literate and their level of education varied from primary to metric. However maximum respondents had received primary education only. The respondents comprised of mostly workers, housewives and maximum self employed class i.e. 46 %. Majority of respondents were married i.e. 53.3%.

During survey it was found that majority of the respondents could not properly recall the media projections (advertisement and messages) of HIV/AIDS except the condom company's advertisement which was broadcasted by some TV channels those days with a slogan "suno zara khushi ki aahat'. Thereafter the respondents were given published brochures of National Aids Control Program (NACP) along with questionnaire so that they could recall the messages before responding to the questionnaire.

In a study, Myhre and Flora (2000) reported that awareness was the key factor to an effective response to the disease. The findings of this study showed that maximum respondents received primary education only, attributing them not being able to understand the messages delivered through media related to HIV/AIDS. But their ignorance of such television message indicated that either the respondents did not have a chance to watch, or could not properly comprehend the theme of the messages. They may not have given any importance to these advertising campaigns thus could not understand or retain them. In Pakistan the overall literacy rate is dismally low at 40 percent. Female literacy is even more lower. The situation is worst in the rural areas. The definition of literacy in the country is "any person who can read and write a paragraph in any local language is considered as literate." Therefore it could be said that media messages would not be understood by general public.

The findings, shown in Fig-2, designated majority i.e., 58.9% of the respondents did not understand the HIV/AIDS media messages properly and a small number i.e. 41 % could understand them. They cannot comprehend the desired meanings of these commercials and public service messages. Media has the potential to contribute considerably in spreading HIV/AIDS education and prevention information if utilized significantly and professionally (Myhre and Flora, 2000). Therefore it can be said that media messages, under review, were not constructed properly and lacked in clarity. They were vague, confusing, and inappropriate thus majority could not perceive the underlying purpose behind them. These massages remained ineffective in creating awareness among the public regarding HIV/AIDS and minimizing the stigma related to it. The finding also illustrated that half of the respondents who had seen HIV/AIDS awareness media messages along with their family, showed reaction and condemned them.

These advertisements did not attract them; rather they remained uncomfortable with such messages and showed indifferent behavior.

Data reported in Fig-2 also revealed that only 8.3% discussed HIV/AIDS media messages with others and rest of them remained silent. Such (passive) attitude of the respondents showed ineffectiveness of these messages. The findings also indicated that half of the respondents agreed that these messages were culturally acceptable, and majority (59%) specified that they were not acceptable with reference to their religion, as presented in Fig-2. In Pakistan, social taboos exist based on moral judgment, religious beliefs, social and cultural norms which were less addressed or talked including Dowry, Satanic and Black magic, Honor killing (karo kari), Child marriage (Vani), Watta Satta, gender discrimination, adultery, drug abuse, diseases related to sex were a few ones which prevailed in the society. Due to taboos, cultural and the religious limitations people feel ashamed to discuss this serious issue in Pakistan.

Majority was not aware of the symptoms of HIV/AIDS and differences between HIV and AIDS which meant that they did not conceive or ready to understand the real issue as is shown in Fig-3. Majority considered these messages against their religion, and so generally were not acceptable to them. Thus most of them avoided discussion on the issue raised by the massages. While answering to the question that how they feel about people living with HIV/AIDS (PLWHA), majority of respondents accepted that they feel sorry for them but when they asked whether they will care for such person, majority's response was "no'. In contrast to this study a report by Center for Aids Development, Research and Evaluation (CADRE, 2005) on dramas series of South African television "TshaTsha" demonstrated positive impact on the respondents/viewers of this drama series.

The report concluded that the audience exposure to initial 26 episodes had changed the attitude of the viewers towards people living with HIV/AIDS (PLWHA), and also augmented the acceptance of HIV prevention behavior. On the other hand some of scholars including Gumpert and Cathcart, 1986; Reardon and Rogers, 1988 reported that "distinction between mass media and interpersonal communication as triggers to behavior change is a false dichotomy" (Sood et al., 2006).

Their responses, as given in Fig-3, made clear that a stigma and discrimination in society for the PALWAs existed due to lack of knowledge. Although people had some information but misconceptions and intolerance still existed in the society for the PALWA. This finding also indicated the failure of the media messages regarding HIV/AIDS. Result of the present study was contrary to the international studies that conclude "television media campaigns generally yield strong influence with reference to HIV/AIDS understanding, spread knowledge, interpersonal communication and change in attitude, when compared to campaigns by means of other mass communication channels, including print and radio" reported by (Chatterjee, 1999; Keating; et al. 2006).

In response to the queries regarding sexual knowledge and the use of condoms findings indicated that 45% knew what is meant by safe sex but majority were unaware. Results shown in Fig-3 indicated that 60% respondents knew that precautionary material was available in the market for safe sex but only one fourth of the respondents were using them. This authenticated their careless behavior. Unsafe sex was one of the causes of HIV/AIDS and this information was provided through public service messages, but in Pakistani society people were not allowed to talk about sex issues and neither was the media. Thus the television messages did not give the conceptual clarity to the audience.

On the contrary, several studies conducted by (Berttrand, et al. 2006; Singhal; Cangah, 2005 and Rogers, 2003; Japhet and Goldstein, 1997; Soul, 2000) reported that "literature on International health communique advocated a positive association between exposure of media awareness campaigns and behavior changes towards HIV among the users. i.e., the acceptance of condom usage, and limit to one sexual partner only" (Sood et al., 2006).

Responding to the statement about the effectiveness of media messages, majority (74%) denied their usefulness as presented in Fig-3. Accessibility of media did not change the people's attitude; rather the context and content of the message along with the language used for message construction matters a lot in this regard. Therefore it was notable that the language and the level of education of the audience enhance the comprehension of the issue among the public. Which would in turn, could decrease the infection rate and intensity of stigma and intolerance related to HIV/AIDS and PLWHA. On the other hand international studies concluded that the role of media in creating awareness about HIV/AIDS is very crucial, "as communication is the most often received from this channel instead of interpersonal sources" (Bertrand et al., 2006; Joint United Nations Program on HIV/AIDS, 2004; Ross and Carson, 1988).

Similarly a research study carried out in India advocated that "people with media exposure to HIV/AIDS information were significantly more likely to discuss HIV-related topics within social networks" (Chatterjee, 1999).

On asking how HIV/AIDS spread, the answer, as is shown in Fig-4, was surprisingly pleasant. Majority knew that it did not transfer through kissing, shaking hands and drinking in a cup of people living with HIV/AIDS (PLWHA). The findings also revealed that most of the respondents were aware that it could spread through blood transformation, sex and mother feeding.

Table 1. Showing Chi-Square Values for Gender Wise Association between TV Messages and Awareness about HIV/AIDS (n = 60)

Statements about HIV/AIDS###X2###P

awareness###value

Aware about symptoms HIV and###.039###.844

AIDS

Aware of major difference between###.448###.457

HIV and AIDS

HIV/AIDS spread through kissing.###.133###.715

HIV/AIDS spread through mosquito###.081###.776

ites.

HIV/AIDS spread through Blood###.400###.527

transfusion.

HIV/AIDS spread through mother###.036###.850

feed.

HIV/AIDS spread through handshake###.137###.711

HIV/AIDS spread through sex###.081###.776

HIV/AIDS spread through drinking in###.154###.695

a cup of PLWHA

Take care of PLWHA###.873###.375

Afraid from of PLWHA###.039###.844

Awareness of safe sex###.300###.584

Aware of safe sex precautionary###.833###.361

material

Taking precautions for safe sex###.060###.806

Effectiveness of information in media###1.936###.164

messages

The gender wise responses regarding statements of HIV and AIDS awareness and modes of spread along with the Chi-Square values displayed in Table-1 showed that gender wise association between television messages and awareness about HIV and AIDS at 5% level of significance was non significant.

Conclusion and Recommendations: Though the increase in media coverage of HIV/AIDS is very encouraging, but its awareness among the people in Pakistan is relatively much limited. Thus the stigma related to HIV/AIDS remains a severe problem in the country. Television advertisements and public service messages have shown some improvements about information of HIV transmission but could not create required awareness among the public. This is regrettable since HIV/AIDS associated stigma has been acknowledged as one of the key barriers to fight against this deadly disease. A prejudicial attitude not only hinders PLWHAs to access HIV diagnostic centers, revealing the issues to their sex partners and to access health care. These are the challenges that emphasized the immediate need to improve HIV/AIDS related media messages' production

and dissemination. While addressing such issues, one should think about the failure of the recent media campaigns used to fight against this very serious epidemic.

On the basis of results and conclusion, recommendations for the improvement and better use of the television and other media in creating awareness regarding HIV/AIDS in the society are:

-The awareness and attitude of the public are the two important and established factors to fight against the prevalence rate of HIV and AIDS. The potential of mass media in influencing perception of people towards HIV/AIDS could not be successful if other attributes like illiteracy or poor knowledge, redundancy, cultural and social prejudice are not addressed.

-It is recommended that planned and frequent HIV/AIDS awareness campaigns to educate the public needs to be prepared in relevant languages with appropriate informative material to change their attitudes towards the issue.

-It is suggested that media should be used properly by the government and NGOs in disseminating information about HIV/AIDS in the country.

-Strategies need to be devised by which public is made aware of HIV/AIDS and not alarmed.

-Radio is the most used mass medium in the rural Pakistan; thus it can also be successfully employed for running awareness campaigns of HIV/AIDS.

-It is also recommended to the health policy makers and educators to reconstruct the content and enhance the quality of HIV messages/communication and frame comprehensive HIV/AIDS awareness strategies.

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