HIV in overview
The continuing rise in population together with the modernization of life in Malaysia shows that many people are not aware of the influences of lifestyle choices. The first case of AIDS (Acquired Immune Deficiency Syndrome) was recorded in the UK among injecting drug users suffering from the rare lung infection Pneumocystis Carinii Pneumonia (PCP). AIDS is now found everywhere in the world. According to the Joint United Nations Programme HIV/AIDS (UNAIDS) report on the Global AIDS Epidemic 2010, there were 2.6 million people infected with HIV in 2009. This figure is 19 percent fewer than the 3.1 million (2.9million-3.4 million) people newly infected in 1999, and 21 percent fewer than the estimated 3.2 million (3.0 million-3.5 million) in 1997. Does this mean that HIV/AIDS has been controlled effectively-(Figure 1) Despite the prevalence of AIDS around the world, it must not be suggested that people nowadays are knowledgeable about the epidemic per se. People have been dismissed from workplaces and rejected by society due to their disclosure of this health condition to their employers because they wish to obtain social support services. Prejudice, stereotyping, and misconceptions are still directed at people living with HIV.
Figure 1: Number of people newly infected with HIV
Source: UNAIDS, 2010
In Indonesia, Vietnam, and Malaysia, HIV prevalence in the prison population exceeds 10%. Ironically, HIV-related information is not available in prison systems in these countries. Furthermore, access to antiretroviral therapies (ARVs) or harm reduction services are also limited in most prisons in the region.
HIV in Malaysia
Malaysia detected its first case of HIV in Federal territory of Kuala Lumpur in December 1986. Since then, all states have reported HIV cases. As of December 2009, Malaysia has recorded a cumulative number of 87,710 people infected with HIV (Table 1), and an estimated 105 439 people are currently living with HIV.
Table 1: Overview of the Malaysian HIV Epidemic
Source: UNGASS 2010
Each day, there are 9 new cases of HIV reported; two female and the rest male. From that figure, 6 were infected by sharing contaminated needles, while 3 were infected by sexual intercourse. This show that Malaysia’s epidemic may be attributed largely to Injecting Drug Users (IDU) and heterosexual transmission. As heterosexual transmission is implicated in an increasing number of new HIV infections, the World Health Organization (WHO) currently classifies that Malaysia as having a concentrated HIV epidemic.
This research examines the importance of media roles in response to HIV/AIDS. As mentioned, media is a very influential tool in providing information and influencing public attitudes. In Malaysia, it is common that the government often takes action based on public opinion. By analyzing print media coverage on HIV-related issues, this study sought to find out how media present HIV events/items and social marketing programmes to the public. Existing perception, and misconception, stigmatization, discrimination, and ostracism against people living with HIV should be rectified in order to help the public recognize PLHIV. This study is intended to change public perception of PLHIV. Generally, negative attitudes towards PLHIV exist everywhere in Malaysia. This study examine media coverage of HIVrelated issues in order to create public awareness and understanding of social marketing programs to help integrate people with HIV/AIDS into the community.
Definitions of agenda setting theory
Agenda setting theory was advanced by Maxwell McCombs and Donald Shaw in 1972. Their study indicated that there is a relationship between the way news media (newspapers, news magazines, and network television) positions stories and the attribution of importance of those issues reviewed by their audiences.
Agenda setting theory helps in understanding three important aspects of mass communication and their functions in society: to understand the complex relationship among news media treatment of issues, public belief about those issues, and the policy concerns of leaders regarding those same issues. The elite and policy makers execute a policy regarding an issue/item. Once the public reviews an issue via media (media agenda), they will voice their opinions because these people are active audiences (public agenda).
Individuals determine what sort of information they want to perceive or receive. As policy makers are the executers of a policy or event, public opinion is very important in drafting solutions for a particular event or issue in order to fulfil the public’s needs (policy agenda).
Definitions of social marketing
“Social marketing is the use of marketing principles and techniques to influence a target audience to voluntarily accept, reject, modify, or abandon a behavior for the benefit of individuals, groups, or society as a whole.”
Social marketing is slightly different from conventional marketing. Philip Kotler, Ned Roberto, Nancy Lee (2002) argues that social marketing is used to influence an audience to change their behavior on certain issues for their own sake. The key concept of marketing is “exchange”. Marketers asks the consumer to take an action (say buying McDonald’s) and in exchange, the marketer gives the benefit (McDonald’s burger). This is what we call commercial marketing. Commercial marketers sell products and services, whereas social marketers “sell” ideas and behavior change to their target audiences. Social marketing is used to influence the public to change their attitudes, behaviors and even perceptions about HIV/AIDS and people with HIV. Such behavior change is very dependent on target audiences. Thus, social marketing is using “soft power”–voluntary-rather than “hard power” which means using legal or economic means to address issues.
Research question
The only weapons for the prevention of the spread of HIV infection are education and social marketing programmes. We may not stop the spread of HIV 100%, but we might prevent its prevalence by effective use of marketing programmes. What is the status of social marketing programmes and media perception of HIV/AIDS-related issues in Malaysia? This paper examines media perception in reporting HIV/AIDS-related issues and social marketing programmes in selected Malaysia media.
Methods
Newspaper selection
Three Malaysian newspapers were selected: Utusan Malaysia, The Star, and Sin Chew Jit Poh. Utusan Malaysia and Sin Chew Jit Poh. are poadsheet newspapers, while The Star is a “serious” newspaper. These are national newspapers especially for the three majority ethnic groups (Malays, Chinese, and India).
Search strategy
The period of analyzing the newspapers was from 1 st January 2011 to 31 st March 2011. The University of Malaya’s main lipary provided the three newspapers. Each issue was reviewed thoroughly to identify whether the content included references to HIV/AIDS-related issues/events or any social marketing programmes. For the three month period, 26 articles were found on HIV/AIDS-related issues and social marketing programmes.
Data coding
Data collected from the articles were classified into four categories: (i) basic information, (ii) framing, (iii) discourse analysis, and (iv) social marketing. The basic information category consisted of background data: date, name of newspaper, total pages, headlines, page, and focus of domesticity, character of news, section, and journalistic genre. The framing category identified the use of framing an issue/event in media coverage. That included social frame, health frame, religion frame, and government frame. The discourse analysis category examined form of reporting, credibility, main actor, heading perception, and article review perception in reporting HIV-related issues in selected newspapers. The social marketing category identified the amount of social marketing progrrammes, type of social marketing programnes, and the exclusivity and inclusivity in media coverage of HIV-related issues/events. Coding was completed for all examined articles.
Results
i) Basic information
Monthly distribution
The number of monthly distribution for all media from 1st January 2011 till 31st March 2011on HIV-related issues in selected Malaysian print media was consistent for the three month period (Figure 2). For Utusan Malaysia, the frequency of reporting HIV-related issues for January and March was the same. Only 3 items each month were identified, while in Fepuary, there were no items found. For The Star, there were three items reporting HIV-related issues each month. Sin Chew Jit Poh, however, showed inconsistency in monthly distribution on news of HIV-related issues. Only two items were identified in January, and no items in Fepuary, but there were nine items in March.
Figure 2: Number of monthly distribution for all media, from 1st January 2011 - 31st March 2011, on HIV-related issues in all selected Malaysian print media (N=26)
Focus of domesticity
15 articles out of 26 articles for all selected Malaysian print media in reporting HIV-related issues were national news (Figure 3). Sin Chew Jit Poh recorded the highest news (eight articles) in national reporting on HIV-related issues followed by Utusan Malaysia (four articles), and The Star (three articles). In the domestic news category, The Star reported four HIVrelated articles, while Utusan Malaysia and Sin Chew Jit Poh reported two articles. There were also three articles focused news from outside of Malaysia (South Africa and India). Sin Chew Jit Poh reported on a 66-year-old person from German who abused 400 underage prostitutes in Thailand for revenge and two articles in The Star reported on South. African school kids being tested for HIV and an HIV woman having sex with 100 for revenge in India.
Figure 3: Focus of domesticity for all selected Malaysian Print media (N=26)
Character of news
The category of news character consisted of two attributes: conflict and prominence/important in reporting HIV-related issues. The result showed that there were 12 conflict items identified in three newspapers, and a total of 14 prominence/important items in all newspapers. Sin Chew Jit Poh had more conflict items in reporting HIV-related issues compared to the other newspapers (Figure 4). Utusan Malaysia, however, contained the fewest conflict items on HIV-related issues. The Star and Sin Chew Jit Poh had the same number of prominence/important artcles for HIV-related issues.
Figure 4: Character of news for all selected Malaysian Print media (N=26)
Types of media reports
The study result showed that most of the HIV-related issues were reported in the form of interviews and news-in-pief items (eight items for each) (Figure 5). Feature writing on HIVrelated issues was seen only in The Star paper, which published three articles. The Star showed consistency in the number of features, interviews, and news-in-pief items in reporting HIV-related issues. Only Sin Chew Jit Poh included any conference reports (one article). In Utusan Malaysia, interview was the most popular form in reporting HIV-related issues, and Sin Chew Jit Poh used of a significant number of news-in-pief items in reporting HIVrelated issues.
Figure 5: Journalistic of items about HIV-related issues in all selected Malaysian print media (N=26)
ii) Framing
Most of the HIV-related news was framed as social issue reporting(Figure 6). Both The Star and Sin Chew Jit Poh recorded the highest number of articles in social frame. It was interesting that only one article was framed in religious terms (Buddhist and Christian) in Sin Chew Jit Poh. Government frame showed a consistency in number of framing on HIV-related news for the three newspapers.
Figure 6: Framing for all selected Malaysian print media (N=26)
iii) Discourse analysis
Among the total of 26 headings, 11 were positive, 11 were negative, and four were neutral. Among the total of 26 articles, 15 were positive, eight were negative, and three neutral in reporting HIV-related issues (Figure 7).
Figure 7: News perceptions about HIV-related issues in all selected Malaysia print media (N=26)
iv) Social marketing
Amount of social marketing programmes
Among 26 articles in the three newspapers, there were 15 social marketing programmes identified (Figure 8). Each newspaper reported on five social marketing programmes, while 11 articles were not related to any social marketing programmes.
Figure 8: Amounts of social marketing programmes about HIV-related issues in all selected Malaysia print media (N=26)
Exclusivity of items
Among the total of 26 articles, 42 percent reflected exclusivity of items about HV-related issues, and 50 percent showed inclusivity in reporting HIV issues. However, eight percent were non-related to social marketing articles (Figure 9).
Figure 9: Exclusivity of items about HIV-related issues in all selected Malaysia print media (N=26)
Types of social marketing programmes
Most of the social marketing programmes were awareness messages to the public about HIV-related issues in order to achieve behaviour changes in HIV/AIDS-related negative perceptions. Both The Star and Sin Chew Jit Poh recorded three awareness messages in reporting of HIV-related issues (Figure 10). However, many items were not applicable. There was one in Utusan Malaysia; four in The Star; and six in Sin Chew Jit Poh. These items were just reporting HIV-related issues, but not promoting an idea or a program to gain behaviour change among the public about HIV-related problems.
Figure 10: Types of social marketing programmes about HIV-related issues in all selected Malaysia print media (N=26)
Discussion
Media has an influential role in influencing public perception. It is often suggested that media shapes our notions of social phenomenon through the way they represent and report on news and social experiences. In short, the media that we consume often helps us to understand society and even ourselves. Stella Babalola, et al. (2009) strongly suggested that HIV-related programmes in media coverage are able to reduce HIV/AIDS-related stigma effectively [8]. This research, however, found that Malaysian media reported insufficient HIV-related issues for educating people about HIV and social marketing programmes that help PLHIV. Therefore, media should provide more HIV-related items and promote more social marketing programmes in order to achieve reduce HIV/AIDS-related stigma in Malaysia.
There were some conflicts in the media coverage of HIV-related issues. These conflicts involved heading perception and article perception. Some of the headings were very negative in reporting HIV-related issues. For an example, in Utusan Malaysia, there was an article titled “HIV positive jailed and caned”. Such headings lead to negative perceptions. If we go through the article itself, the HIV-positive person was jailed for possession of 484 grams of cocaine. In fact, the HIV-positive person was jobless. However, the media stressed the word “HIV positive” instead of “jobless person”. This illustrates the fact that media reports in Malaysia are not always objective.
Most of the news items were framed as social issue by media. This indicates that media do agree with the status of HIV infection as hyperendemic. However, both The Star and Sin Chew Jit Poh carried more news in social frame than Utusan Malaysia. The results showed ooor social media agenda setting when it comes to HIV-related and social marketing issues. Reporting on HIV-related issues for the first quarter of the year 2011 was rarely published on the national pages even for the month that carried the highest amount on HIV-related issues news. Most of the HIV-related news was carried on the inside pages of the newspapers. For an example. This indicates a weak identification of the importance of health issues in Malaysia. This study shows that the media is failing in its role as the gatekeeper in setting the social national agenda for HIV-related issues and social marketing programmes. The total num-ber of items, weak coverage and poor article placement in the newspapers examined shows a weakness in Malaysian reportage on HIV-related issues. The weak coverage results in a poor representation of the issues .
One article in Sin Chew Jit Poh framed HIV-related issues as a religious issue. In the headline story “Understanding AIDS and care for People Living with HIV (PLHIV)”, Sin Chew Jit Poh not only framed this as a health issue, but at the same time as religious issue by interviewing religious leaders (Buddhist and Christian) with different perspectives about HIV-related issues. Sin Chew Jit Poh also carried an article concerning a conference report and.reported this item in a very objective way, including many perspectives, opinions, and suggestions from experts (doctors, academicians, and religious leaders). However, the newspapers still excluded “victim voices” in repoting on HIV-related issues. Again, that is related to the idea of objectivity in reporting HIV-related issues by the media.
Becky L. Genberg, et al. (2009) argued that effective HIV-related prevention, treatment, information, education programmes should be implemented in a way to give some ideas about HIV/AIDS to the public [9]. However, few social marketing programmes were carried in the newspapers studied. Only 15 social marketing programmes were reported on in the first three months of 2011. Most of the social marketing programmes were meant to raise public awareness of positive messages about HIV-related issues. Furthermore, there was a successful social marketing program, carried by The Star–“Orang asli women get education on HIV. Most of the attendees at the two-day workshop were illiterate”. This social marketing program was successful because there was feedback from the public supporting the social marketing program. One participant said she now has a more accurate perception about HIV/AIDS. This social marketing program reporting achieved the objective of contributing to behaviour changes among the public.
Regarding the exclusivity of items about HIV-related issues in the three newspapers, 50 percent of the articles included “certain persons’ voices” while reporting HIV-related issues, and 42 percent of articles excluded “certain persons’ voices” in reporting HIV-related issues. Lean Mei Li (2005) asserts that including opinions from experts, government pronouncements, statistics offered by “experts”, or discussion of the “social impact” of AIDS by specialist medical or health correspondents in media coverage of AIDS leads to a high level of credibility [10]. However, some articles did not include other “voices”. For example, both Utusan Malaysia and Sin Chew Jit Poh reported “Minister of Defence: Implement in May. All NS participants will have to attend for health and sexual knowledge class”. This item only included the Minister of Defence of Malaysia, but not NS (National Service) participants in order to achieve the ideal of including many ‘voices’. Based on the results of this study, it may be stated that Malaysian media does have some measure credibility in reporting HIVrelated issues.