Keywords

Introduction

Currently, over 38 million people globally are living with HIV and AIDS (UNAIDS, 2020). More than forty years after its discovery, HIV and AIDS is still among the world’s worst health challenges, not only because of its multifaceted nature but because since its discovery in the early 1980s, no guaranteed medical measures have been found to contain it. The disease has transcended boundaries, affecting all people irrespective of age, color, or social status. HIV and AIDS has infected about 76 million people since it was discovered in the early 1980s, claiming about 36 million lives by 2019 and about 38 million people lived with HIV and AIDS worldwide in the same year (UNAIDS 2020; WHO, 2020). At the close of 2020, about 38.6 million people worldwide lived with HIV and AIDS.

Although HIV and AIDS prevalence and burden vary amongst regions, Sub-Saharan Africa is the most affected with roughly 28.9 million infections; accounting for approximately 76% of the infection worldwide (UNAIDS, 2020; WHO, 2020). Uganda is among countries worst hit by HIV/AIDS in the sub-Saharan region with a current rate of about 6.2% (UNAIDS, 2020); a great decline from about 18% in the early 1990s.

Prevention has remained the best mechanism to limit the spread of HIV and AIDS. The government of Uganda embarked on HIV and AIDS prevention since the late 1980s. Different educative and awareness campaigns were and are still being developed and circulated by government to curb the spread of HIV and AIDS. To be more effective in reaching the public, government engaged the media from the initial epochs of HIV and AIDS disease. Media outlets including broadcast, radio, and print became the main sources of HIV and AIDS information. Indeed, open discussion of HIV and AIDS related issues in the media was encouraged since such discussions were considered learning points.

The majority of people depend on the media for up-front, current, and comprehensive reporting. This is especially true of HIV and AIDS (Napakol 2011; Swain, 2005). The knowledge that most people have about HIV and AIDS is from radio, television, Internet, or newspapers. Scholarly research about the scope and focus of news coverage of HIV/AIDS worldwide is extensive, with researchers such as Stevens and Hull, (2013); Swain (1997; 2005); Mollyann Brodie et al., (2004); Nilanjana (2001); Kannick et al. (1996); Lupton et al. (1993); and Everett et al. (1991) noticing a great decline in and change in content of coverage of HIV and AIDS in press from the late 1980s to the early 1990s. This study however, looks at how HIV and AIDS discourse has been framed in Uganda’s print media focusing specifically on use of official and non-official (In this paper, official, non-official and authority, non-authority sources will be used interchangeably) sources of HIV/AIDS stories.

Due to journalistic norms and values that encourage objectivity, together with practical constraints surrounding journalistic daily work, journalists are heavily reliant on official sources for collection and validation of information (Shehata 2007; Miller and Williams 2001; Molotch and Lester, 1974; Schlesinger, 1977; Tuchman, 1978; 1974). This gives official sources unvarying access to the media which consequently translates into influence of it (Campbell, 2004, p.86; Pamer, 2000; Powers and Fico, 1994). Research has shown that journalists tend to be prejudiced in favor of official news sources such as high-level politicians, government officials, scientific research and publications, or medical experts because such sources are readily available and considered credible (see Sigal 1973; Schlesinger and Tumbler 1994; Shehata 2007; 2010; Hall et al. 1978), a blind dependence that inadvertently disadvantages those that are not considered authority sources. This paper, however, argues for a redefinition of official or authority sources especially in HIV and AIDS discourse and makes a case for inclusion of affected populations and their experiences as these can be powerful in shaping the HIV and AIDS narrative. Experiences that evoke emotion have been known to be powerful influences in social and behavioral change (Baljeet 2017).

Official Dominance Model, Journalistic Norms, and News Coverage

Research has shown immense support for claims that official actors influence how issues are framed in the news media. The official dominance model (Bennet 2007; Bennet and Livingston 2003; Hallin, 1986; Campbell 2004; Bennet 1990; Hall et al. 1978, Shehata 2007) argues that a symbiotic relationship exists between journalists and official sources where official sources offer information needed by journalists while journalists afford a vital platform for such sources to influence a mass audience (Shehata 2007). These actors and sources within established institutions in society hold a level of leverage with reference to defining societal problems and subsequently influencing the stipulations of policy debates (Shehata 2010). The model basically proposes that news coverage of issues concentrates on undertakings in government or reputable political institutions. For example, Bennet (2007) and Shehata (2010) argue that news coverage in politics is typically goaded by reporter’s assessment of authority ranks in government. In other words, news reporters’ attention on official sources goes beyond an issue of dependence to include consequence of general journalistic tendency to follow and report on actions of those in powerful positions (Shehata 2010, p. 125). Despite bias in choice of information sources however, several studies have suggested that critical voices may, under certain conditions, enter news coverage (Entman, 2004, Lawrence 2000; Shehata 2007). Sporadically, the routine pattern is broken, altering journalistic news criteria concerning who to include in news reports on a given topic. Though such changes might open a window of opportunity for unofficial voices (Shehata 2007, p.132), it is not enough to successfully challenge the dominant stance unless sustained over a longer period of coverage. These media waves, as they are popularly called, create an opportunity for none authority sources to shape and define beliefs and definition of social issues (Shehata 2007). The official dominance model is most commonly referenced in political communication, but it has relevance in health communication as well, particularly to the issue of HIV and AIDS which has long been politicized. HIV and AIDS assumes different facets and its discussion therefore traverses numerous spaces including political, medical and research, social and economic. Representation of other voices in HIV and AIDS reports therefore needs to be much more systematic. Oftentimes, the official sources’ have been associated with knowledge, power, position, and authority (Sholle 1988)—the understanding that for a story to be credible, it must have authority or official voices as sources of information. There is need however, to redefine what powerful, credible, and authoritative sources are. Having facts and knowledge about an issue such as HIV and AIDS is as powerful as having lived experiences of the same (Baljeet 2017). The ability to exemplify and bring to life effects of diseases such as HIV and AIDS through using the so-called none official sources could be as effective as letting people know about policies and decisions and the prevalence of the disease.

News Sources and Journalistic Norms/Routines

A source can be a person, document, record, or publication that contains, is involved with, or is affected by an issue. Oftentimes, such sources provide information that would aid a journalist to report or explain an issue to his/her audience. News gathering by journalists has for long been criticized for being unbalanced, involving a battle to control information flow (Davis, 2005, p. 24). Manning (2001) asserts that resources, both material and symbolic, are employed in an attempt to influence and control information flows supporting news production. In other words, sources with limited material and/or symbolic resources are sidelined in the shaping, control, and production of news, leaving the powerful sources with sizeable capability to set agendas and influence the narrative for most topics. Davis (2005) has argued that such power has been intensified by new technologies and introduction of free market conditions to public service broadcasting. As financial anxieties have supplanted public service standards, the will to resource overpriced news programs and reflective quality newspaper press have diminished. As a result, journalists have time and again been compelled to upsurge output without an equivalent upsurge in resources. In the end, the impression is that there is a deterioration in investigative reporting and in editorial standards, yet there is augmented dependence on authority sources.

Corporate and state sources have enormous government and economic resource advantages that independent, low power actors cannot match (Davis, 2005). In Sigal’s (1973) study, for instance, American and foreign government officials accounted for 75% of all news sources. The state will always have the political, legal, and financial means with which to supply pressure to journalists, influence their movements, and/or court them. In Uganda, the leading newspaper, the New Vision is government owned (enjoined by the act of parliament to act “independent”) thus the level of government influence is clearly evident. The Daily Monitor newspaper, despite being privately owned, also dependents on powerful sources—that is politically, economically, and academically—to gain information.

Also, one of the common factors in choice of sources is their legitimacy and credibility (Becker 1967). Some sources such as government and corporate institutions enjoy de facto legitimacy. Such sources also include politicians and are often easy to contact and considered more informed and credible. The discussion of “official or authority sources” has been ongoing for long with various researchers calling for recognition of experiences of affected and/or infected people (Paletz and Entman 1981; Sigal 1973; Becker 1967; Traquina 2004); Davis, 2000; Manning, 2001; Semujju 2015).

Tuchman (1978) emphasizes that the custom of news organizations establishing a routine of deploying reporters at different places and organizations engenders news workers partial to official sources. This practice, which Tuchman calls the “news net” referring to the “netlike formation of the dispersion of reporters” influences the way of life on the social world since it permits news events to transpire at selected places while ignoring “other” places thus a continuous marginalization of non-official news sources. In essence, such practice and reliance on routines, the news making procedures turn into bureaucratic tendencies of selecting affected news pieces from agents of a different bureaucracy: demonstrating that social actors are not equal in their access to journalists (p. 81). Traquina and Schudson echoed what Philip Schlesinger stated in 1978 that sources are by no means equal, both in status and in their access to journalists. The powerful, the economically and politically endowed can gain effortless access to and/or are pursued by journalists yet those who are less powerful cannot easily be contacted by journalists and their views are not pursued till their actions or behavior engender a social malady (Gans 1979, p. 81).

The journalistic routines and therefore; the day-to-day effort to navigate the professional exigencies of news production creates a painstakingly planned excessive access to the media by individuals in power and authority advantaged institutions thus almost single handedly shaping the discourse for most social issues including HIV and AIDS.

Sources, Dominance, and Coverage of HIV and AIDS

Chapman and Lupton (1994) argue that coverage of health and medical knowledge including that of HIV/AIDS is frequently piecemeal, overgeneralized, and reliant upon a limited number of powerful sources (Chapman and Lupton, 1994; Manning 2001, p.1). However, the most expert sources may not be powerful individuals and policy makers. Depending on the topic, some of the experts whose views need to be made known to the public may be of powerless individuals who simply have inside experience with the issue. When it comes to HIV and AIDS discourse in Uganda, such “experts” would include groups at high risk for infections such as women, children and the youths, fishermen, truck drivers, sex workers among others. Lived experiences and challenges of the people living with or affected by an issue lend a multilayered perspective to the knowledge of and prevention strategies to a multifaceted disease such as HIV/AIDS.

Building on Shehata (2010), this paper draws from the official dominance model and journalistic routines and practices to discuss the ascendency of official sources in HIV and AIDS print media in Uganda, the marginalization of the sources with less political, social, economic, or educational power, and potential impact of skewed HIV and AIDS narrative. In this paper, official actors include government officials, medical personal, researchers, and international organizations such as the World Health Organization, the United Nations, and other international agencies concerned with health.

Research Questions

RQ1: How common are official vs. non-official sources of information in HIV and AIDS related articles?

RQ2: How does the pattern of official vs. non-official sources vary over time?

RQ3: What international sources are most common among HIV and AIDS related articles?

RQ4: How does the pattern of international sources vary over time?

RQ5: Is there a difference in use of official vs. non-official sources of information for HIV/AIDS stories in the government-owned vs. private newspaper?

Research Method

This paper is part of a larger research that studied HIV and AIDS coverage in Uganda over a 20-year period. The study used quantitative content analysis methodology although qualitative analysis was used to establish categories for the coding scheme. The study period considered years from 1992 to 2011. Although data collection stopped in 2011, this being a historical as well as longitudinal study, it remains relevant because it is important to systematically evoke significant nuances of coverage of HIV and AIDS and their meanings so as to analyze how these have shaped and continue to shape the present discourse and policies on the HIV and AIDS epidemic.

The year 1992 is when the private newspaper The Daily Monitor started its operation in the country. Comparison about how ownership of the newspapers influences content was one of the objectives of the study, therefore analysis of earlier years when Uganda had just one daily newspaper, the government-run New Vision, was not useful. Also, many structural, social, and economic reforms related to HIV and AIDS were instituted in Uganda around 1992. Also, the study was divided into four phases to enable comparison of coverage among them. Phase 1 was from 1992 to 1994, Phase 2 from 1995 to 2000, phase 3 from 2001 to 2006 while phase 4 was from 2007 to 2011.

TheNew Vision daily newspaper was established in 1986. It has grown into a multimedia business focusing on newspapers, magazines, television, Internet publishing, and radio broadcasting (The New Vision Annual report, 2017). The paper has a daily circulation of over 38,000 copies countrywide. Although it is owned by government, the newspaper is enjoined by the act of parliament to remain independent. As such, The New Vision claims that it runs balanced information and reports all facts while leaving the opinion of the matter to the readers (Napakol, 2011; Khamalwa, 2006).

The Daily Monitor was established in 1992 as an independent daily newspaper but was renamed in June 2005 as The Daily Monitor. The Daily Monitor has a daily nationwide circulation of over 32, 000 copies (The Daily Monitor Annual report, 2017). The paper refers to itself as “Uganda’s favorite and only independent paper” (Vergaelen, 2001). It is highly critical of government and the president, resulting in its being labeled on occasion as an enemy of the state (Khamalwa, 2006). The two newspapers were chosen for the study because they are the main daily print media in the country and command the largest readership.

New Vision and The Daily Monitor archives were searched for issues that were published between January 1992 and December 2011. Two days a week were considered per publication and all articles about HIV and AIDS that were more than 200 words long were included for coding. Three research assistants were employed for article identification and coding. Overall, 1510 articles were drawn from the entire period of study for both newspapers.

Fourteen percent of the sample was randomly selected for the calculation of inter-coder reliability test. Krippendorff (2013; 2004) recommends coding between 10 and 15% of the sample for inter-coder reliability. Wimmer and Dominick (2011) also recommend coding at least 10–25% of the sample to test for inter-coder reliability. A total of 200 articles out of 1510 were coded for inter-coder reliability test. Overall reliability was kappa = 0.91.

Data Collection: Sample Selection and Procedure

Categories were generated by a qualitative analysis of a few news texts gathered during the preliminary study and then coded as all-inclusive variables in manual content analysis (Akhavan-Majid & Ramaprasad, 1998; Meyer, 1995; Simon & Xenos, 2000; Sergic, 2005). In the preliminary step, an in-depth analysis was carried out so as to produce possible operational categories that make up the coding scheme.

Coding Scheme

For an article to be included in the study, its content had to be at least 50% about HIV and AIDS. Articles included for analysis were either in the news, features, science/health features, editorials, opinion, commentary, or in the regular column. Only hard news and editorial comments showing the position of the two newspapers were considered. Letters to the editor, photo features, cartoons, and news analysis were not included in the research. The entire story was read to determine the usage/reference of different sources.

Sources were divided into local and international. Under local sources the sub-categories were coded as follows; (1) HIV and AIDS experts (These included, for example, medical experts, NGO workers-specializing in HIV and AIDS issues within the country); (2) Government (These included anyone that was part of government, e.g. politicians, government/ministry spoke’s persons, etc.); (3) People living with HIV and AIDS (When article indicated its source as an HIV+ person); (4)Women (When a woman infected or affected by HIV and AIDS was cited as the source of information); (5) Children (This group included youths, both infected and/or affected by HIV and AIDS); (6) People with disability (This when an article sought or considered views of persons with disabilities); (7) Scientific Research (An article was coded thus if the information therein was sourced from a scientific study within the bounds of the country); (8) Married people (This also included people in long-term relationships/cohabiting couples); (9) N/A (An article was coded so if it had not mention of any of the above sources).

International sources were divided into the following sub-categories: (1) international organizations (e.g., WHO, UNICEF, UNAIDS, or HIV and AIDS experts); (2) scientific research (any research study conducted outside of Uganda); (3) Associated Press (AP); (4) United Press International (UPI); (5) Reuters; (6) Press Association (PA); (7) Agence France-Presse (AFP); (8) African news agencies; (9) N/A (An article was coded as N/A if it had none of the international news sources above).

Data Analysis and Interpretation of Results

Simple frequencies of categories were analyzed with the assumption that frequency can be interpreted as a measure of importance or value (Keyton, 2006, p. 240). Chi-square tests were done to establish if differences were significant.

Results

A total of 1510 stories were realized for the period studied and the year 2008 had the highest number of stories, see Fig. 1. New Vision had the highest number of stories about HIV and AIDS throughout the 20 years under study, with n = 867, while The Daily Monitor covered a total of n = 642 (Fig. 2). Fluctuation of coverage was common throughout the period of study and to both newspapers.

Research question one asked how common official sources were compared to non-official sources among HIV and AIDS related articles. Overall, official sources were used more (n = 2423) as information sources for HIV and AIDS news stories compared to non-official sources who were used n = 260 times.

Among official sources, HIV and AIDS experts were most referred to (n = 868) followed by international sources (n = 794) then government (n = 566). Use of non-official sources was generally poor, leading with people living with HIV and AIDS (n = 171) while married/couples in long-term relationships (n = 4) with n = 1 were the least used as sources. See Table 1 for the summary.

Research question two asked how the pattern of official versus non-official sources varied over time. Official sources were used more during all the four phases under study, with a steady increase in frequency after each phase except in phase four where a slight decrease was noticed (see Fig. 3). The leading sources through the four phases were still medical experts, international sources and research at the tail of official sources; however, in phase four, the use of People Living with HIV and AIDS surpassed scientific research (n = 77 and n = 64, respectively) (See Table 2).

Research question three and four asked what international sources were most used among HIV/AIDS related articles and what was the trend of usage during the four phases of the study. In general, international sources, which were also considered part of formal sources were used more than the total none official sources. Table 1 shows that the total international sources’ usage was n = 794 compared to the total non-official sources’ usage which was n = 260. In fact, international sources were used even more than government of Uganda sources (n = 566). Table 3 shows details of international sources’ usage.

Among the most used international sources were international organizations such as World Health Organization (n = 360) followed by scientific research (n = 227) while the least used were African News Agency (n = 14) times in all the twenty years of study. The New Vision newspaper used more international sources compared to Daily Monitor, see Table 3 for details. Chi-square tests indicated a significant difference of x2(7) = 43.32, p ≤ 0.000.

There was not much noticeable variance in usage of international sources through the phases other than in phase four (see Table 4) where a decline in all sub-categories except African News Agency, which registered a slight increase, was realized.

Discussion and Conclusion

Results of the study indicated that official or authority sources far outnumbered non-official sources in HIV and AIDS news reports in Uganda. This should not come as a surprise because most research about news sources on different topics has arrived at similar inference (see Lacy et al. 2013; Schlesinger and Tumber 1994; Shehata 2007; Semujju 2015 etc.). However, for health news, especially for multifaceted issues such as HIV/AIDS, the apprehension is about the representation of content and whether such content, obtained mainly from authority figures, affects policy and social and behavioral change efforts in a way that causes actual positive impact on those that need services. As explained early in the text, official/authority sources in this paper include government officials, scientists, research publications, medical experts, and international organizations. Non-official sources included people living with HIV and AIDS, women, children, and youths, and people with disabilities, married/cohabiting persons, all of who are listed among the risky groups. The leading sources of information for all twenty years were medical experts, international sources, and government officials. The gap between the least used formal/authority source and the most used non-official sources is 25.65%. The difference is substantial and worrying especially at a time when complacency to HIV and AIDS is still high. Despite advancement in medication, affordability of ART, and assurance of a prolonged life, people need to understand the intricacies and difficulties of living with HIV/AIDS including economic and social complications that can only be illuminated by people living with or people directly affected by the disease.

One would argue that most official sources carry knowledge intended to educate and create awareness, which cannot be comfortably got from ordinary information sources however, scholars such as argue that knowledge, power, and authority are mutually reinforcing and that he that has power also tends to have the knowledge. Unfortunately, for health news, especially HIV and AIDS news, which is covered with hope to change behavior, powerful and authority information sources tend to reinforce a single narrative which, albeit good, can benefit from inclusion of other actors, with a varying knowledge but equally compelling (Sholle 1988).

Results also showed that married and/or cohabiting people and women were consistently the least used sources for information for HIV and AIDS stories. In 2010 and 2015, the Uganda MDG report recorded increase in HIV infection among married and cohabiting persons and they accounted for 43% of new infections. At the same time, women have been consistently recorded as bearing the brunt of HIV and AIDS, not only in Uganda but Africa as a whole. They are the most infected compared to men but most importantly, they are the caretakers of relatives, siblings, or children thus the importance of their voices in the HIV and AIDS discourse at an international and national level. International sources, although part of official sources, were studied specifically to understand their influence on HIV and AIDS narrative in Uganda over the twenty years studied. As results showed, international sources were the second most used sources in all the four phases, with marked increase after each phase except for phase four. These sources were even preferred to Uganda government officials. In his study about transnational signification, for instance, Karnik (2001), who studied diffusion of knowledge about risk groups found that Indian news outlets, “borrowed” knowledge about HIV and AIDS from international agencies without, in most cases, paying attention to context. He used an example of Haitians being listed among risk groups in India yet India had never had Haitian immigrants. Karnik emphasized that there was need to look inwards, and communicate HIV and AIDS from a context of people that one is communicating to if worthwhile coverage is to be realized. It cannot be concluded from this study what information Ugandan journalists sourced from international organizations and news outlets but it has shown that the narrative we have or have had about HIV and AIDS is profoundly shaped by external forces.

There were some differences in use of sources by the government-owned and privately-owned newspapers. Sources such as HIV and AIDS experts were almost equally consulted by both newspapers, as was the case with People Living with HIV and AIDS and scientific research. However, government was used more by New Vision (n = 348, 40.1%) than The Daily Monitor (n = 218, 33.9%). The results are not surprising given that New Vision is government owned and has been involved as a government mouth piece in the fight against HIV and AIDS. On the other hand, The Daily Monitor accessed more women and children sources, albeit on low scale, compared to the New Vision. Sources such as people with disabilities and married people were hardly included for HIV and AIDS information during the period under study. As argued before, these unofficial sources of information are sometimes only required in case of extraordinary circumstances or event that include them and their voices cannot be ignored. However, much as it is important to get accurate and credible information from authority and “knowledgeable” people the voices of those experiencing the brunt of HIV and AIDS need a mouth piece that can usher the rest of the population, including HIV and AIDS prevention experts and policy makers into their daily encounters and challenges and ultimately effectively affect behavior change and policies that concern them. Instead of quoting the affected people as victims, they should be given a platform, as sources, to espouse the HIV and AIDS issue as well shape the public belief and perceptions about its spread, treatment, prevention among others. An example is the promotion of Antiretroviral Therapy (ART). Government sources and scientific/prevention experts have given precedence to the importance of ART and positive living but do not highlight the daily challenges that people who depend on ART for survival face. Inclusion of “other” voices to bring such perspectives to the fore is paramount because HIV and AIDS is a multifaceted disease that needs to be tackled from different positions in society, including perspectives that frame its discourse.