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Music as an educational tool for HIV/AIDS : a comparative study MacKinnon, Emily Margaret 2008

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MUSIC AS AN EDUCATIONAL TOOL FOR HIV/AIDS: A COMPARATIVE STUDY by Emily Margaret MacKinnon BMus, The University of Ottawa, 2005 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Music) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) August 2008 © Emily Margaret MacKinnon, 2008 ii ABSTRACT This thesis is a critical comparative study of the ways in which music is being used as an educational tool for HIV/AIDS in Sub-Saharan Africa, Brazil, India, China, the U.S., and Canada. Music for education is an aspect of a number of academic disciplines. I introduce the principles of Entertainment-Education and Participatory Communication, which are two methods of conveying education through entertainment. Music cognition, music philosophy, ethnomusicology, sociomusicology, and communication theory offer perspectives on why music is persuasive, emotive, and mnemonic. I present analyses of music HIV/AIDS education efforts from many different regions that employ different methods of music transmission and different musical genres. Some are grassroots interventions, whereas others are large-scale, mass media efforts. I identify a number of high-level themes that emerge from the case studies: music involves the audience, music engages the emotions, music is culturally relevant, music is therapeutic and empowering, and music enhances memory. The case studies highlight a number of specific elements that significantly enhance HIV/AIDS education efforts, elements that should be applied to Canadian efforts. The initiatives that are currently taking place are remarkable, but more efforts are needed to effectively combat the AIDS pandemic. iii TABLE OF CONTENTS Abstract ........................................................................................................................................... ii Table of Contents........................................................................................................................... iii List of Acronyms ............................................................................................................................ v Acknowledgments.......................................................................................................................... vi Chapter 1: Introduction ................................................................................................................... 1 Opening Thoughts............................................................................................................... 1 Laying the Foundation ........................................................................................................ 2 Ethical Concerns ............................................................................................................... 10 Themes.............................................................................................................................. 12 Chapter 2: Regions of Africa, South America, and Asia.............................................................. 16 Sub-Saharan Africa........................................................................................................... 16 Uganda: Hope CBO .............................................................................................. 17 South Africa: Bush Radio ..................................................................................... 23 Brazil................................................................................................................................. 27 São Paolo: Fique Vivo .......................................................................................... 27 India .................................................................................................................................. 30 Mumbai: The Humsafar Trust .............................................................................. 31 Doordarshan TV: Haath Se Haath Milaa .............................................................. 34 China ................................................................................................................................. 37 Chapter 3: Discussion of Hip Hop................................................................................................ 38 Hip Hop and AIDS............................................................................................................ 41 Chapter 4: Regions of North America .......................................................................................... 44 The United States.............................................................................................................. 44 Artists Speak Out .................................................................................................. 46 The Red Hot Organization .................................................................................... 51 Hip Hop and African Americans .......................................................................... 53 Connecticut: Hip Hop and Urban Youth .............................................................. 57 Rent ....................................................................................................................... 60 Canada............................................................................................................................... 63 The 411 Initiative for Change ............................................................................... 64 iv Vancouver: Circle of Song.................................................................................... 67 Chapter 5: Conclusions ................................................................................................................. 73 Lessons Learned................................................................................................................ 73 Final Thoughts .................................................................................................................. 75 Works Cited .................................................................................................................................. 76 Appendix A: Songs from Africa ................................................................................................... 86 Uganda .............................................................................................................................. 86 South Africa ...................................................................................................................... 86 Appendix B: Songs from India and China.................................................................................... 92 Mumbai ............................................................................................................................. 92 China ................................................................................................................................. 92 Appendix C: Songs from the U.S. ................................................................................................ 94 Hip hop and African Americans ....................................................................................... 94 Hip hop and Urban Youth................................................................................................. 94 Appendix D: Songs from Canada ................................................................................................. 97 The 411 Initiative for Change ........................................................................................... 97 Circle of Song ................................................................................................................... 99 Appendix E: UBC Research Ethics Board Certificate of Approval ........................................... 100 vLIST OF ACRONYMS ACTS ........................................................................ Africa Community Technical Service AIDS ...........................................................................Auto-Immune Deficiency Syndrome CBO .................................................................................. Community-Based Organization GDP................................................................................................ Gross Domestic Product HIV ...................................................................................Human Immunodeficiency Virus JHU .............................................................................................. Johns Hopkins University NGO................................................................................. Non-Governmental Organization PLWHA .................................................................................People living with HIV/AIDS U.S. .................................................................................................................. United States UN................................................................................................................. United Nations UNAIDS ............................................The Joint United Nations Programme on HIV/AIDS USAID ..............................................United States Agency for International Development vi ACKNOWLEDGMENTS In the preparation of this thesis, I benefitted from the guidance and support of many people. Thanks first of all to my supervisor, Michael Tenzer. You challenge my brain to make new connections every time I talk to you. Thanks also to Nathan Hesselink, whose thought-provoking analyses of writing style make me reconsider all my adjectives. I am lucky to have been immersed in the invigorating atmosphere at the UBC Ethnomusicology Division for the last two years. I gratefully acknowledge the financial support of the Social Sciences and Humanities Research Council of Canada. Thank you to Katie Jeffrey, Keem Leong, Elizabeth Smith, and Jeff Smith, who spent valuable time to share their expertise with me. Your thoughtful comments were inspiring. To those who went out of their way to send me materials, and often from the far corners of the globe, I couldn’t have done this without you: Tamara Dawit of the 411 Initiative for Change, Ana Garcia of the New Heights Community Health Centre, James Clark, Anthony F. Lemieux, the Kaiser Family Foundation, MTV, Emilian Papadopoulos, and Laura Devries. To Bill and Peggy Tyson: thanks for believing in me, even when you thought I was probably crazy. And finally, to Donald MacKinnon: thank you for doing the dishes, making me breakfast, and being interested in why white kids like hip hop. This wouldn’t be half as much fun without you. 1CHAPTER 1 INTRODUCTION Opening Thoughts I undertook this thesis between April and August of 2008 in order to examine how music is being used for HIV/AIDS education in different regions of the world, and to determine what lessons could be learned and applied to HIV/AIDS education in Canada. The topic was inspired by Stephen Lewis, a Canadian social scientist and diplomat who served as the UN Special Envoy for HIV/AIDS in Africa from 2001-2006. I was once lucky enough to hear him speak in person. By the end of his speech about the challenges presented by HIV/AIDS in Africa, both he and his audience were in tears, and I was resolved to do something. The jumping-off point for this thesis was Gregory Barz’s work; Barz has written extensively about HIV/AIDS prevention music in Uganda. His research made me curious to find out what was going on in other parts of the world, and what implications that might have for Canada. One of the things I discovered is that although people use music frequently for health education, they rarely write about that aspect of their work. Songs are often only mentioned elliptically in health communication reports, and it is only through personal contacts that I have any information at all about the interventions in some regions. Therefore, much more is happening than I have been able to describe. The 2008 International AIDS Conference, taking place in Mexico City as I write this, has an entire Cultural Programme dedicated to arts efforts to address AIDS, which I am sure will reveal many more programs. More scholarly attention to this area is necessary to facilitate the sharing of methodologies, lessons learned, and best practices. Although these programs take place in 2diverse regions with different cultures, there are universal commonalities that can be applied. I hope this thesis helps to spur such information sharing. This thesis contains a broad scan of the HIV/AIDS music initiatives taking place in a number of diverse regions. For each geographic region, I will set the context by providing the status of the AIDS epidemic, and I will then include brief overviews of some of the initiatives taking place for which I was only able to glean limited information. Where possible, this will be followed by more detailed analyses of particular programs. I chose which programs to analyse based on a number of criteria. I wanted to include programs that did not make use of academic theory as well as those that did; however, if they were not academically based, they were often not described in adequate detail to be meaningfully analysed. I sought to include a broad range of initiatives, to show both the diversity of efforts and the similarities that exist between them. Thus, I chose programs from different geographic areas within each region and that used different methods of music transmission. Because the purpose of this thesis was to provide a broad scan of worldwide efforts, the analyses are not exhaustive, but rather highlight areas of interest. Many of these efforts could benefit from more detailed musical analysis, which I hope will be undertaken in future research. Laying the Foundation It is easy to sound melodramatic when talking about AIDS, because it is a pandemic of staggering proportions. Over 30 million people around the world are currently living with HIV. In 2007, 370,000 children under age 15 were infected worldwide, and 45% of all new adult HIV infections are in people aged 15-24. The pandemic affects minority groups disproportionately, including African Americans, and Canadian Aboriginals, and these populations face significant barriers to treatment. In 2007 alone, 2 million people died of AIDS-related causes (UNAIDS 2008, 15-16, 33). 3Cross-culturally, women are at disproportionately high risk of contracting HIV, for many reasons including sexual vulnerability, high illiteracy rates, and economic dependency on men. Within minority groups that are already over-represented in the pandemic, women contract the virus in even higher numbers. Not only do socioeconomic disadvantages increase women’s risk of encountering the virus, but they are biologically more likely than men to contract HIV from unprotected sex (UNAIDS 2006). Promoting women’s empowerment is a critical element in righting this gender inequality. To achieve the UN’s Millennium Development Goal of reversing the pandemic by 2015, which some fear is already impossible (CBC News 2008), HIV/AIDS awareness must increase: people must be given the knowledge to protect themselves (UNAIDS 2008, 65). This thesis will examine how music can contribute to this goal. The concepts that underlie my thesis go back to the academic roots of ethnomusicology. In The Anthropology of Music, Alan P. Merriam listed communication, emotional expression, and entertainment as three of the ten “major and over-all functions . . . of music” (1964, 218). These three functions are particularly applicable to health communication, and when combined, can significantly amplify educational efforts. In the same work, Merriam made an important distinction between function and use. “Use” refers to how music is employed, while “function” refers to the purpose it fulfills: thus, “music is used in certain situations . . . but it may or may not also have a deeper function” (210). While different uses of music will be appropriate in different scenarios, the underlying functions of music can enable the goal of health education. Answering calls for “integrative, cross-disciplinary thinking” in “the social study of music” (Brown and Volgsten 2006, xvii), this thesis will draw from fields including cognition, communication theory, and music philosophy. To provide the groundwork, I will introduce the principles of Entertainment-Education and Participatory Communication, and I will provide an overview of research examining music’s ability to persuade, convey emotion, and serve as a 4memory aid. These elements provide the academic foundation on which musical HIV/AIDS education initiatives are based. Entertainment-Education versus Participatory Communication “Entertainment-Education” is a strategy that has provided the theoretical foundation for a number of development communication efforts, notably by Johns Hopkins University (JHU) in the U.S. According to Singhal and Rogers, “although combining entertainment with education is not new, Entertainment-Education is a relatively new concept” (1999, 14). The Entertainment- Education strategy that is “dominant in most entertainment-education projects throughout the world” (Singhal and Rogers 1999, 14) was developed in the early 1970s “by Miguel Sabido of Mexico’s television network as a formal, reproducible set of design and production techniques for the construction of persuasive messages” (Singhal and Rogers 1999, xi). The definition of Entertainment-Education has not remained stable since the 1970s. In 1999, Singhal and Rogers defined Entertainment-Education as “the process of purposely designing and implementing a media message to both entertain and educate, in order to increase audience knowledge about an educational issue, create favourable attitudes, and change overt behaviour” (xii). They repeat this definition almost verbatim in 2004: “the process of purposely designing and implementing a media message to both entertain and educate, in order to increase audience members’ knowledge about an educational issue, create favourable attitudes, shift social norms, and change overt behaviour” (5) (my boldface). Including the goal of shifting social norms is important for HIV/AIDS educational efforts: there are many complex social contexts that give rise to HIV risk behaviours, and they must be addressed for awareness efforts to be effective. JHU, which contributes extensively to health communication efforts worldwide, offers a different definition. Its January 2008 information bulletin defines Entertainment-Education as the 5use of “drama, music, or other communication formats that engage the emotions to inform audiences and change attitudes, behaviour, and social norms” (de Fossard and Lande 2008, 1). These two definitions clearly agree on the goals of Entertainment-Education, but they differ in emphasis on the method of delivery. Singhal and Rogers talk about entertaining media formats, whereas JHU refers to communication that engages the emotions. The difference is really one of scale. Singhal and Rogers were primarily interested in describing large-scale, mass media Entertainment-Education. In contrast, JHU is involved in many small-scale, community- based Entertainment-Education projects. The two definitions actually support each other: both entertaining media formats and emotional appeals are important elements of a successful health communication intervention. The JHU model, however, more readily incorporates the concept of audience participation. This is consistent with proponents of Participatory Communication, another education program design theory that prefers intimate, small-scale projects. Participatory communication has long been the vanguard of development communication. It is grounded in the work of Paulo Freire (1970), who said that “through dialogue and reflection the most marginalized in society would be better able to comprehend and analyze their situation, find their voice, and effect necessary, contextually appropriate and sustainable social change” (Howson and Witte 2008, 408). The concept of dialogue is thus central. Although efforts to define Participatory Communication have not reached a consensus (Jacobson 2003, 87), “the main elements that characterise Participatory Communication are related to its capacity to involve the human subjects of social change in the process of communicating” (Dagron 2001, 34). Participatory Communication focuses on interacting with the target audience. Many proponents of Participatory Communication laud its effectiveness by contrasting it with mass media Entertainment-Education programs. Dagron’s report for the Rockefeller Foundation assumes that only grassroots initiatives qualify as Participatory Communication 6(2001, 5). But Participatory Communication and Entertainment-Education do not need to be mutually exclusive. Many participatory approaches are entertaining, and Entertainment- Education is becoming more participatory. In his overview of global Participatory Communication initiatives, Dagron describes a number of radio programs that qualify as participatory because the community is involved in the design of the programs. Although the programs are delivered through a one-way media channel, Dagron includes them because of the emphasis placed on community involvement during the design process. This kind of community involvement has been identified as a criterion for the success of Entertainment-Education campaigns (Singhal and Rogers 1999, 206). Because such involvement was not part of the roots of Entertainment-Education, it has been slower to attain recognition in this field, but it is no less necessary for its success. Recently, scholars have examined how Entertainment-Education could encompass participatory methods (Storey and Jacobson 2004) and have identified participation as a critical element for effecting change (Sood 2002). Furthermore, health communication theory suggests that the “slogan” of Entertainment- Education is inherently participatory: “sing and the world sings with you. Lecture and you lecture alone” (Piotrow, et al. 1997, 78). As this slogan suggests, audience participation is particularly facilitated by music (Barrett 2005, 276). Even when broadcast on a one-way media delivery system, music invites participation. People in all cultures sing along with their favourite songs, be they listening to the radio or in a karaoke bar. And when songs with first-person lyrics are sung, the person singing takes on the role described by the text. Music’s persuasive qualities Music is useful for health education because it has a powerful ability to affect behaviour. Music for behaviour modification has long been an element of ethnomusicological study. Brown 7posits that within ethnomusicology, music has been seen as a cohesive force within small societies, and within sociomusicology, music has been seen as a divisive force within larger societies. In both of these perspectives, there is an element of behaviour control. Societies use music in different ways, but behavioural control is “a major mechanism of its action” (S. Brown 2006, 2-5). In fact, Brown says, “music is usually used to influence behaviour” (2006, 22). (This statement, of course, is not unproblematic. The ethical concerns it raises will be addressed later.) But why is music so persuasive? “Music has become an integral component of most modern-day forms of persuasive communication because it is highly engaging, highly repeatable, and participatory” (Lemieux 2003, 14). Drawing on the “elaboration likelihood model” of persuasion, Brown calls music an “associative enhancer of communication”: linguistic and non- linguistic elements of a message are processed in separate but mutually reinforcing ways, and while the linguistic message is usually central, the non-linguistic message is peripheral (2006, 20). This is supported by Welch, who suggests that in vocal music, the lyrics are processed centrally, while the accompanying music forms peripheral support for the lyrical message (2005, 243). This peripheral message is decoded by listeners through association and emotional stimulation. Association is described by semiotic theories, which state that musical structures represent cultural objects (S. Brown 2006, 19-21). It is also described by cognitive studies as the process whereby music stimulates long-term memory, which “provides the context that gives [the music] meaning, by relating the moment to a larger framework of ongoing experience and previous knowledge” (Snyder 2000, 15). These associations are contained in music along with emotionally stimulating information, which is conveyed in countless ways including temporal and tonal variances (Dissanayake 2006, 38-43). The listener’s emotions and cultural foundations are stimulated in a way that enhances the linguistic message (Patel 2008, 343). It is thus important that the musical message reinforces the linguistic one. 8Persuasion research has generalized that “deeply felt attitudes are quite resistant to change” and “only unfamiliar, lightly felt, peripheral issues that do not matter much or are not tied to personal predispositions are subject to change” (S. Brown 2006, 23). Some behaviours that place people at risk of acquiring HIV are linked to religious attitudes, such as refusal to use contraceptives; and as religious attitudes are firmly embedded, they are likely to resist change, even by musical persuasion. Music has much to contribute to HIV/AIDS prevention education, but it is an uphill battle. Music can communicate more than mere text Bruno Nettl addressed the importance of the “relationship of language and music as communications systems” and “the relationship of music and words in vocal music” (1993, 109) to the field of ethnomusicology. The secret to this relationship likely lies in emotion. The idea of a link between emotion and musical and linguistic elements has a long history (Patel 2008, 344). Artists and scholars have reflected that music is a highly effective method of communicating emotion. Aldous Huxley wrote that “after silence, that which comes nearest to expressing the inexpressible is music” (1931, 17). Recall that emotional expression was one of the functions of music identified by Merriam. Music psychologists observe that “music is particularly useful in providing a medium for dealing with the complex emotional responses that are primary attributes of humanity” (Hodges 1996, 52). This ability to both express and appeal to the emotions is a central reason for the use of music in HIV/AIDS education. It is also a reason for carefully examining such use, as emotional manipulation should not be undertaken lightly or uncritically. Emotional, or affective, influence is an important concept in Entertainment-Education. “Affective responses are primary – they occur before, and influence subsequent, cognitive processing” (Sood, Menard and Witte 2004, 144). Health communication also makes use of 9emotional response theories, which posit that “emotional response precedes and conditions cognitive and attitudinal effects.” Thus, “highly emotional messages in entertainment would be more likely to influence behaviour than messages low in emotional content” (Piotrow, et al. 1997, 22). Health education should therefore be delivered in a medium that can effectively communicate emotional material. Besides being an important element for effecting behaviour change, music’s ability to communicate emotion means that music provides an ideal medium for addressing the deeply-felt emotional issues surrounding AIDS that are resistant to change. Stigma is an extremely damaging, deeply-felt, emotional response to HIV. It is “the most important social and psychological issue of the HIV experience” (Rintamaki and Weaver 2008, 67). Stigma actively contributes to the spread of the virus: fearing stigma, people are unwilling to be tested and so unknowingly transmit the virus; those who know their HIV status are afraid to seek support, both medical and social; and those living openly with HIV are rejected by their community. Not only is stigma damaging to quality of life, but it has also been shown to have negative medical health impacts (Rintamaki and Weaver 2008, 76). Stigma arises from many sources: for instance, it may be a fear-based response (Rintamaki and Weaver 2008, 73), or rooted in religious morality (Barz 2006, 158). It is not limited to any single geographic area. “Large portions of the U.S. public . . . express fear and disgust toward those infected with the virus” (Rintamaki and Weaver 2008, 67). It appears in Africa, where it “is on par with presenting medical issues” (Barz 2006, 55), and  “if countries like China and India are to be successful [in addressing HIV] they must address the underlying stigma” (Mandel and Rutherford 2006, S2). By conveying emotionally what it is like to be stigmatised, music can stimulate empathy in those who discriminate against AIDS sufferers. 10 Music enhances recall of accompanying text Music’s ability to influence behaviour change is enhanced by the fact that “musical devices . . . increase the meaning and memorability of linguistic messages” (S. Brown 2006, 4). A significant body of research demonstrates that “recall of verbal material . . . in conjunction with songs [is] greater than recall of spoken words alone” (Bartlett 1996, 189). One scholar has questioned this by suggesting that, for children, music only enhances verbatim recall and does not improve comprehension (Calvert 2001); however, verbatim recall has also been shown to lead to improved comprehension (Butterworth, Campbell and Howard 1986, 710). The debate in this area has moved from a discussion of whether music improves recall to how: cognitive science has begun making use of new technology to show how the brain uses music to enhance memory  (e.g. Peterson and Thaut 2007, Hickok, et al. 2003). Therefore, music is an extremely effective mnemonic device. But music does not only convey verbal material; as discussed above, it also carries a wealth of affective information. Thus, music enables the retention of “not just facts, but the feelings that accompany the facts as well” (Hodges 1996, 53). Music is the ideal medium to encourage the retention of the emotional message it conveys, precisely because it is emotional: “the sound of music itself can uncannily re-create in memory a time, place, and emotional state, with surprising emotional strength” (Dissanayake 2006, 50). Ethical Concerns Using music to persuade people to change their behaviour is not ethically uncomplicated. The goal of effecting behaviour change raises immediate ethical questions. Controlling the behaviour of others is accepted when parents influence their children, but outside of that relationship, it raises ethical questions of the autonomy of the individual, a prized concept in many societies. Freedom of the individual is an important element of the United Nations’ 11 Universal Declaration of Human Rights (1948). Societies have long struggled to balance individual rights with the common good. When the goal is to change societal norms and popular behaviour, the justification to make this change must be examined carefully. Who wants to make the change and why must be critically considered. Using music to effect behaviour change further complicates the ethical situation. Music is an affective, peripheral persuader. It can be used to change people’s minds in subversive and manipulative ways, and it has been used for corrupt purposes. The twentieth century saw music used in Nazi Germany to promote anti-Semitism (Korpe, Reitov and Cloonan 2006, 252-254) and to encourage genocide (Moreno 1999). In the U.S., fears of hidden messages in music have led as far as the courts; in 1992, Judas Priest was accused of including subliminal messages in their music and causing teenage suicide (Garofalo 1994). Using music to encourage HIV prevention behaviour thus raises the question of if it is ever ethically acceptable to use subversive methods of persuasion. Singhal and Rogers state that Entertainment-Education “uses the universal appeal of entertainment to show individuals how they can live safer, healthier, and happier lives” (1999, xii), a notably benign description. Singhal and Rogers contend that the message of HIV prevention is “of unquestionable value”; “who would want individuals to contract HIV/AIDS?” they ask (1999, 219). But the methods of HIV prevention are not uncomplicated. The promotion of condom use is considered immoral by the Catholic Church (Gamson 1990), and safe injection facilities and needle exchange programs are widely unpopular (Strathdee and Pollini 2007). The design of HIV/AIDS music education efforts can raise other ethical concerns. Celebrity appeal is often used to capitalize on a pre-existing fan base; but the celebrity’s image, which is the cause for their popularity, may conflict with some prevention messages. In Brazil, for instance, popular singer Kelly Key was chosen as the face of a governmental initiative promoting condom use, but her selection was opposed by NGOs who said her image “proposes a 12 pseudo sexual freedom … and a way of life based on consumption and banality” (Porto 2007, 123). HIV/AIDS music education programs sometimes take place within religious contexts, especially as music often has strong religious associations. Some religious organizations have made addressing AIDS a priority: the report from the Interfaith AIDS Conference states “as religious communities, we believe that HIV/AIDS is . . . an opportunity for us to serve the sufferer” (Christian Conference of Asia et al. 2003), and music provides an effective vehicle for this service. Including religion in educational efforts can be an advantage, as spirituality has been shown to decrease risk behaviours (Boyce, et al. 2003, 28). However, religious beliefs have also been shown to be a major source of stigma, as many HIV/AIDS risk behaviours are considered immoral (Barz 2006, 152). Thus, involving religion may help prevent people from getting HIV but make things worse for those who already have it. I regret that there is not room in this thesis to address these issues more thoroughly, but I hope that the reader will bear them in mind throughout. Themes Recall that Merriam’s musical functions of communication, emotional expression, and entertainment help music contribute to educational efforts. These functions were identified in all the music HIV/AIDS education initiatives I researched. From those initiatives, specific themes emerged that show how program designers made use of both Merriam’s functions and the academic foundational research outlined above. I will use those themes, which are described below, to analyse select music HIV/AIDS education initiatives. Music involves the audience. Music involves the audience by functioning as communication and entertainment, and this is a key advantage of its use in health 13 communication. Both Participatory Communication and Entertainment-Education have identified audience involvement and participation as an important element. “Audience involvement is the degree to which audience members engage in reflection upon, and parasocial interaction with, certain media programs”; this can contribute to overt behaviour change (Sood 2002, 156). In addition, by involving the audience, the issue being discussed can be made personally relevant to the audience, another key step in encouraging behaviour change (Sood 2002, 155). From traditional musicians in Uganda who say “no one will listen to us unless we bring our drums” (Barz 2006, 81) to North American awareness concerts that use music as “a kind of Trojan Horse way of getting the AIDS epidemic noticed” (Baker 1994, 89), HIV/AIDS musical education initiatives worldwide discuss the importance of using music to draw people in to their cause. Music engages the emotions. Central to its ability to involve the audience is the ability for music to function as emotional expression: it conveys the performers’ emotions and stimulates the audience’s. Because it can engage the emotions so effectively, music is a powerful persuasive element. Program designers can weave informational health messages into an emotional context, making them more likely to be received and retained (Singhal and Rogers 1999, 211). Musical HIV/AIDS education programs use emotional music and lyrics to reach their audiences. Music is culturally relevant. It is critical that health communication efforts be culturally sensitive and relevant (Geary, et al. 2008). Using music, which is an important aspect of culture, is one way to achieve this. Logically, health messages that seek to effect behaviour change are external to the target population (for if they were internal, no behaviour change would be necessary). By embedding these external messages in culturally relevant music, they can be made more familiar to listeners. 14 Many aspects of music are tied to culture. Musical performers, who are vehicles for culture, can be powerful champions for health messages (Brown and Fraser 2004, 97-99). Program designers have noted that song lyrics can include colloquialisms, thus grounding the message in the local culture (Barz 2006, 111). Music’s association with religion (Hodges 1996, 38) can be used to associate a health message with spirituality, which can both ground the message and help to reconcile conflicts between religion and HIV/AIDS (although this can also be problematic, as discussed earlier). The type of musical delivery is powerfully linked to culture, as cultures use music differently despite similar functions: many cultures have traditional musical channels of information passage, and other cultures have strong musical mass media cultures. Depending on the culture of the target population, a mass media or a face-to-face initiative may be more appropriate. Brown identifies mass media as a feature of a large-scale society. An intervention in a large-scale society will likely meet an economic need, such as selling records, that will not exist in a small-scale society, but both interventions are driven by the same concern of influencing behaviour (S. Brown 2006, 13). Many program designers have noted that AIDS is more than a medical issue; it is a social crisis, and as a social element, music has a powerful role in addressing the social context. Music is therapeutic and empowering. Those working with music for HIV/AIDS often discuss how their audiences are empowered by music. Such empowerment is therapeutic: it can help those who experience discrimination to overcome it or demonstrate another option to those who engage in HIV risk behaviours. If musical messages are positive and empowering, they can deliver self-confidence which enables people to live healthier lives. The concept that musical communication is inherently therapeutic and empowering is fundamental to the field of music therapy: “‘music as communication’ is … perhaps the key theme used by contemporary music 15 therapists to describe and legitimate their work” (Ansdell and Pavlicevic 2005, 194). This is a feature that HIV/AIDS educators worldwide take advantage of. A key element of music therapy is engaging with the audience in “musicing,” a participatory process defined as “’musicianship- in-action,’ music as lived experience, as well as music as a social and cultural phenomenon” (Ansdell and Pavlicevic 2005, 194).1 Because of its inherent participatory nature, music has specific health benefits related to empowerment and therapy that make it particularly appropriate for HIV/AIDS education. Music enhances memory. HIV/AIDS outreach program designers know that music can help their audience remember – be it health facts, emotional information, or community history. Music cognition has shown that music is a useful mnemonic tool. But music can also act as part of the social process of creating memory (Barz 2006, 177). In Singing for Life, Barz draws together multi-disciplinary research examining the performative creation of communal memory. Memory is recalled, conveyed, and sustained through performance (Connerton 1989); traumatic memories in particular are performed as a healing measure (Bal 1999, viii). Barz calls this process of “understanding memory as a purposeful social activity” “re-memorying” (2006, 177). Individuals form memory through exposure to the memories of others (Shils 1981, 51). By singing the words of a song, performers are adopting the events described into their societal memory. Songs are effective time capsules that can be brought out and re-lived. This can have important impacts for African AIDS orphans who have lost their generational link with the past, or for North American teenagers who did not witness the explosion of AIDS in the 1980s. Music in HIV/AIDS education can help them to understand the past.  1 Christopher Small proposes this complementary definition of “musicking”: “to music is to take part, in any capacity, in a musical performance, whether by performing, by listening, by rehearsing or practicing, by providing material for performance (what is called composing), or by dancing” (1998, 9). 16 CHAPTER 2 REGIONS OF AFRICA, SOUTH AMERICA, AND ASIA This section surveys HIV/AIDS music initiatives taking place in Sub-Saharan Africa, Brazil, India, and China. Each geographic region is introduced by an epidemiological summary of the AIDS epidemic, followed by brief overviews of some of the initiatives for which I was only able to find limited information. In all regions except China, this is followed by more detailed analyses of particular programs. Musical analysis is included if a recording was available. From among the programs for which I could obtain adequate information, I chose to analyse efforts that took place in different geographic areas, that used different methods of musical transmission, that targeted different audiences, and that used different musical genres. I use the themes identified above (music involves the audience, music engages the emotions, music is culturally relevant, music is therapeutic and empowering, and music enhances memory) to compare these diverse initiatives. Sub-Saharan Africa In 2006, one of the top results yielded by a Google search for “music and AIDS” was Gregory Barz’s newly-released book Singing for Life about HIV/AIDS music education in Uganda. This was indicative of a trend: the majority of academic work examining music in HIV/AIDS initiatives is taking place in Africa. This may be in part due to what was until recently an almost exclusive focus on Sub-Saharan Africa as the hardest-hit region in the AIDS 17 pandemic. In addition, scholars have proposed that because of the traditional educational uses of music throughout Africa, it was natural to include HIV/AIDS messages in music. “The integration of music into all aspects of life in Africa, including into commercial and educational campaigns, is not new” (Van Buren 2007, 304). Characteristics of African music such as repetition and call and response may enhance this educational function (Van Buren 2007, 305). Implemented by JHU and the Ghana Social Marketing Foundation in 2000 with funding from USAID, “Stop AIDS: Love Life” was a multi-faceted campaign in Ghana that included a music video produced by Ghanaian hip-life, highlife, and gospel musicians. The video includes explicit messages about safe sex. The campaign was intended to be emotional as well as educational: “the main purposes of the campaign are to increase awareness about HIV/AIDS in Ghana, to increase the adoption of safe sex behavior among Ghanaians, to de-stigmatize HIV/AIDS, and to encourage compassion, care and support for people living with HIV/AIDS” (Johns Hopkins University 2005). In Tanzania, hip hop artists are using their medium to tell youth about HIV/AIDS by investing their rhymes with HIV/AIDS information. Many of these artists grew up in the urban slums, giving them a cultural understanding of their audience’s world. For the many youth who grow up in urban slums, where a criminal lifestyle and HIV risk behaviours are de facto, hip hop artists empower them to look to music as a way out (Vergeer 2006). Uganda: Hope CBO More than two thirds (68%) of all HIV-positive people live in Sub-Saharan Africa. Against this debilitating backdrop, Uganda has achieved remarkable success. Prevalence rates in Uganda began to drop in 1992, largely due to behaviour change. This decline has since stabilized, however, and as UNAIDS notes, in a country with rapid population growth such as 18 Uganda, a stable incidence rate actually indicates that more people acquire HIV each year (UNAIDS 2007, 17). Despite Uganda’s early success against the AIDS pandemic, there is no room for complacency. Evidence has been emerging of a rise in risky sexual behaviours in Uganda, and “there is an urgent need to revive and adapt the kind of prevention efforts that helped bring Uganda’s HIV epidemic under control in the 1990s” (UNAIDS 2007, 17-18). Barz’s ethnography Singing for Life “demonstrate[s] the link between the recent decline in Uganda’s infection rate and the introduction of grassroots interventions . . . Only when supported and encouraged by performances drawing on localized musical traditions have medical initiatives taken root and flourished” (2006, 3). The advantage of using music to educate is acknowledged by grassroots workers in Uganda. “Music, according to Rev. Jackson, can be cleverly disguised as entertainment, and this is critical in the attraction of the largest possible audiences” (Barz 2006, 216). The Africa Community Technical Service (ACTS) is a Canadian non-profit organization that identifies itself on its website as a “Christian technical mission.” They support a community- based organization (CBO) called the “Rubingo Twinematsiko People Living with HIV/AIDS under ACTS,” or, more informally, “Hope CBO.” This group travels to small towns in rural areas and gives performances to educate people about AIDS. Music involves the audience. Katie Jeffrey was the HIV/AIDS Education and Health Sanitation Officer with ACTS from 2006-2007. She witnessed the audience’s involvement in Hope CBO’s performances: “when the drums are beating, people clap along, for sure. And if there’s dancing, especially, they clap along” (Jeffrey 2008). As is widely acknowledged, music is a integral part of life in Uganda. Music frames gatherings in Rubingo; groups start every gathering with a song (Jeffrey 2008). Music is used to attract and involve people in an event 19 (Van Buren 2007, 308). Hope CBO uses music to involve their audiences from the outset by beginning every performance with the “Welcome Song” (Jeffrey 2008): We thank God very much for your presence We welcome you, our dear visitors People from Bugamba, you are highly welcome to this function Settle down and feel at home (Hope CBO 2007). Music engages the emotions. Barz’s descriptions of Ugandan HIV/AIDS education performances are inherently emotional. He relates many discussions with Ugandans who have great faith in music’s emotional communication. Hajji Ssentamu, a Ugandan traditional healer, “holds strong the view that music has the ability to communicate the disadvantages of AIDS” (Barz 2006, 27). Fear can also be induced through music: singer Aida Namulinda aims to “induce fear among those who do not yet fully understand these issues and thus affect (sic) behavioural changes” (Barz 2006, 84). The Hope CBO performance addresses stigma with a message that is common in many areas of the world. Often called “positive living,” this theme is a rephrasing of the heavily stigmatized denotation “HIV positive” (Barz 2006, 52), and it conveys a message of hope. In the Hope CBO presentation, performers say that the only way to deal with the disease is to acknowledge it, “don’t fear and don’t panic,” and “accept it and look for wisdom” (Hope CBO 2007). At the heart of these emotionally appealing messages is the theme that there is life after an HIV-positive diagnosis. Encouraging this emotionally positive response will help to minimize the restrictive effects of stigma. The songs communicate excitement, encouragement, and togetherness: Cooperate, let’s develop our nation! Those who are hating each other, leave it alone, cooperate and develop the nation! Hatred and jealousy, let’s leave that and build our nation! Cooperate with love and we will build our lives. People of Bugamba, let’s tell you this, that with cooperation and love we can build our lives. (Bemereire 2007) 20 The music supports this positive message, building gradually throughout the song. The call and response format stirs up energy and excitement (Nelson 1996, 380). The pitch gradually climbs to support the song’s positive message, so that the melody ends the equivalent of a full tone above where it started. At the beginning, the call and response format is clear and separated. By the end of the song, the soloist’s lines overlap the chorus’ significantly. Through these musical mechanisms, Hope CBO’s music conveys an emotional message in tandem with the lyrics. Music is culturally relevant. In Uganda, “Doctors and health-care workers often recognize music as a more localized and thus more affective medical intervention than outreach efforts taking the form of lectures and seminars” (Barz 2006, 27). As discussed earlier, different cultures require different media channels. “Africanist scholars have emphasized the benefits of using indigenous media rather than Western-influenced media for communication and development purposes in Africa” (Van Buren 2007, 305). Hope CBO uses traditional music genres and instruments to spread its HIV/AIDS messages. Thus, Hope CBO’s grassroots intervention is culturally relevant and effective. Music’s ability to affect behaviour change is a deeply rooted concept in Uganda. “Indigenous conceptualizations of music in Uganda often describe the ability of performances to both communicate information and affect social behaviour” (Barz 2006, 3). If music is culturally expected to be used to influence behaviour, this may in part answer ethical concerns. Colloquial terms for AIDS are common in Sub-Saharan Africa. When the disease first emerged, it was called “Slim” because infected people became very thin before they died (Barz 2006, 109). Such local terms are not merely a naming convention, but reflect a “deep, localized enculturation of the disease” and “reference the history and the cultural rootedness of the AIDS pandemic” (Barz 2006, 109, 111). Hope CBO uses two colloquial terms: Slim (or ‘Silimu’) and 21 munywengye, which is a translation of the English word “Slim” into Runyankole (Bemereire 2007). Understanding local terms in Africa, Barz suggests, can help to frame a culturally-based understanding of AIDS and generate a culturally-appropriate response (2006, 111). In the Hope CBO performance, the use of “Slim” is multi-functional: it is a familiar, approachable term, rather than the medicinal, Westernized “AIDS”; it evokes an image of the physical impacts of the disease; and it serves to ground the disease in the local culture. In December 2003, at the World AIDS Day celebration, Ugandan President Yoweri Museveni criticised religious organizations for conflating religious morality with prevention (Barz 2006, 151). ACTS is a religious interdenominational organization that includes as its mission statement, “we carry out our mission under the authority of scripture seeking in all we do to glorify our Lord Jesus Christ” (Africa Community Technical Service n.d.). God is mentioned frequently during Hope CBO performances. The “Welcome Song” establishes a Christian foundation for their presentations. The performances emphasize that Christianity is the answer to the many impacts of the AIDS epidemic: holding a Bible, a soloist tells the audience to find God in their hearts, and that God will carry their burdens for them. This is notable because when AIDS first emerged in the 1980s, it was believed to be a form of divine punishment. It was only when officials of the church began contracting the disease that churches began to get involved in AIDS prevention initiatives (Barz 2006, 154). This too is mentioned in the performance; a soloist says, “AIDS came to Uganda and it doesn’t distinguish. It reached the end, and it has said ‘let me go to the churches’.  It has affected the lay leaders, the priests, and the Christians too” (Hope CBO 2007). This approach is an important part of culturally-relevant religious efforts in the fight against HIV/AIDS. The message that anyone can get AIDS, including religious officials, is an 22 essential step in de-stigmatizing the disease. This is especially important for religious organizations because so much of the stigma is based on religious morality. It is interesting to note that condoms are not mentioned in the songs. This is not because the subject is taboo, but may be part of the effort to make the prevention messages understandable and relevant: most villagers do not know what condoms are (Jeffrey 2008). It may be, however, that this lack of knowledge could give Hope CBO even more reason to sing about condoms. Critical though cultural relevance is, it should be balanced with the dissemination of necessary information. Music is therapeutic and empowering. Faced with a disproportionately high risk of contracting HIV, women in Uganda sing to become empowered (Barz 2006, 80). The high participation of women in prevention initiatives is evidenced by the Hope CBO performers, who are almost all women. Jeffrey suggests that women are “more outgoing and open to helping their communities than men would be; they want to actually do something to help change and help people” (Jeffrey 2008). Helping others and forming a community with other HIV-positive women is a therapeutic endeavour for these women. “They bond over music, for sure,” (Jeffrey 2008). Hope CBO dramatizes women’s gossip as an effective method of spreading a public health message. In Hope CBO performances, women gossip about how often an HIV-positive man, who has since died of AIDS, tried to initiate sexual relations with other women (Hope CBO 2007). Women’s gossip is not only didactic: it is also a reproach to men. Through gossip, sexually powerless women can gain the power to communicate to their exploiters (Epstein 2004, 56; Barz 16). By advocating gossip, Hope CBO encourages women not to be silent. 23 Music enhances memory. Barz reports that Ssentamu, a Ugandan traditional healer, “believes in the power of music to ‘pound the message home,’ as he suggests, that is, music is able to confirm for him that critical health-care information ‘lasts in the brain’” (Barz 2006, 27). This aspect of music is a reason why Hope CBO instinctively uses songs to educate its listeners. An individual’s active performance of the past entrenches the past event in the community memory. Instances of this type of storytelling occur a number of times during the Hope CBO performance. Intertwined with didactic, practical messages are personal stories of the impact of the pandemic: Solo: You people, I am sad. Response: You are sad, you are sad, because all your children have died. Solo: I had two children, a girl and a boy. I buried the father first; he has died of AIDS. What can I do with this disease? I am also infected. (Hope CBO 2007) This kind of performance of memory entrenches the social consequences of the disease in the common awareness. By performing individual stories of the impact of AIDS, Hope CBO makes these tragedies a part of the village’s communal memory. South Africa: Bush Radio The South African HIV epidemic is the largest in the world. HIV prevalence has stabilized at an astonishing level, in excess of 15%. Furthermore, HIV risk behaviour does not appear to be changing. (UNAIDS 2008, 39-40). Here, too, the answer lies in education: a recent study found that each additional year of education reduced an individuals’ risk of acquiring HIV by 7% (Bärnighausen 2007). The programming for Bush Radio in Cape Town, South Africa, is produced by community volunteers, and aims to encourage dialogue between communities previously 24 segregated during apartheid. In 2000, the station ran a campaign called Youth Against AIDS that “embedded socially conscious lyrics in popular hip-hop music” (Bosch 2006, 28). This is particularly notable because the economic functions affecting the production of music discussed by Brown have restrained musicians from writing music about AIDS in South Africa. In 2004, The Economist reported that few South African artists “actually put the disease at the centre of their creative efforts,” explaining that “the subject does not sell” (The Economist 2004). Music involves the audience. From the outset, Youth Against AIDS was participatory. Preliminary consultations were conducted with the audience to encourage audience participation in the program design. During the on-air component of the initiative, cleverly named HIV Hop, youth called in to the radio show with their own verses about AIDS, demonstrating their engagement with the music. “Open phone lines and competitions (rap/poetry and graffiti) were used to encourage further participation” (Bush Radio 2005). A number of the songs attained enormous popularity, reflecting youths’ involvement in the music (Bosch 2003, 204). Music engages the emotions. Listeners’ emotions were engaged by the hip hop songs in a few ways. Humour was used as an emotional appeal (Bush Radio 2005). Efforts to increase empathy for people living with HIV/AIDS described the emotionally damaging effects of stigma: You think you’re different coz this virus didn’t show up on your test I’m seen as evil by people who know I’m depressed I’m already lying on the ground and they’re kicking me in the chest I’m walking around fighting for dignity in distress Is it ignorance or prejudice leaving the people vexed (Bosch 2003, 195) This emotional impact was acknowledged by the audience; as one listener called in to say, “music brings over a message be it positive or negative” (Bosch 2006, 36). Hip hop lyrics are usually aggressive and revolutionary (McNair and Powles 2005, 354), but some of the songs on HIV Hop include remarkably emotive lyrics: 25 This tune in my head is slowly killing my nerves On top of that my friends left me in the lurch I sit and drink and I curse Sit and think and a burst in to tears (Bosch 2006, 195) This glimpse of vulnerability makes the emotional message that much more striking and meaningful. Hip hop initiatives elsewhere, which tend not to convey vulnerability, could benefit from including such revealing, emotional lyrics. Music is culturally relevant. In South Africa, hip hop has long been used to address social problems. This genre provided a way for people to speak out against apartheid. It was a logical step, then, for Bush Radio to turn to hip hop for its HIV prevention efforts. “Hip Hop as an educational tool went beyond traditional boundaries of print in that it engaged youth in a language and a medium that they could all relate to” (Bush Radio 2005). Bush Radio grounded HIV Hop in the local culture in many ways. In an effort to respond to the complex societal and cultural context of AIDS, the program “took the cultural context of hip-hop music in Cape Town into account” (Bosch 2006, 33). Local musicians were asked to write songs. “The usage of slang, humour and other methods that young people can relate to were also utilised” (Bush Radio 2005). The song “Ek is wyn” makes references to an infamous South African criminal (Bosch 2006, 42). A listener even identified the need for localized terminology: A lot of people don’t know what AIDS is about. So if you talk in a slang that they understand then you will approach them in a better way and they will understand better. (Bosch 2006, 28)  The song by Mr. Devious uses localized language in a different way. In his song, he first describes the many myths about AIDS and then debunks them. Mr. Devious both grounds the message in the local culture and indicates the changes that must be made to that cultural way of thinking about the virus. 26 The songs often addressed social factors that contribute to the pandemic, answering the common call to treat AIDS as more than a medical disease. “Awareness around HIV and AIDS is not limited to ‘what the virus is,’ ‘how is it contracted’ or ‘safer sex and the protection of oneself.’ What HIV Hop is trying to achieve is education on some of the broader issues in a social context” (Bush Radio 2005). Music is therapeutic and empowering. Bush Radio witnessed the empowerment of youth as a result of HIV Hop. “We saw youth actively participating and in essence, taking ownership of an issue that affects them” (Bush Radio 2005). To take advantage of the momentum generated by HIV Hop, a new program was created called “Positive Living” to encourage empowerment in the face of AIDS (Bosch 2006, 35). Note the similarity between this and the anti-stigma message conveyed by Hope CBO in Uganda. Music enhances memory. The accurate information contained in the verses that listeners called in to contribute indicates the successful absorption and comprehension of the knowledge that was being disseminated through the HIV Hop program (Bosch 2003, 189). Bush Radio recognized that by grounding educational information in a socio-historical context, they could educate the youth about a past they are unaware of. By addressing the sociocultural context of the disease, Bush Radio enabled the social process of memory creation. Describing the importance of the past, Bush Radio says “we cannot look at the lack of education and not examine the complex social hierarchy that existed during apartheid” (Bush Radio 2005). In effect, Bush Radio was participating in re-memorying the roots of the AIDS pandemic: placing it in the collective memory of youth who do not remember the context in which the disease emerged (Bosch 2003, 161-162). 27 Brazil Brazil is often cited as a success story in the fight against HIV/AIDS (Oliveira-Cruz and McPake 2004, Berkman, et al. 2005). Brazil is particularly celebrated for having maintained high spending levels and institutional focus on the HIV/AIDS epidemic when it first emerged, despite severe financial challenges including the collapse of the national currency. HIV prevalence in Brazil is currently estimated at 0.6% of the adult population, or 640,000 people, and has remained stable since 2001. An additional 90,000 children are estimated to have the virus. The Brazilian government has launched initiatives to eliminate stigma and discrimination, and has achieved some success. Brazil has reached out to marginalized populations with inventive placements of prevention initiatives; for instance, truck drivers were targeted by HIV prevention services at border crossings. Brazil is “the leader of global efforts to expand treatment access”; however, the prevalence of HIV drug resistance is now increasing as a result, and the budget for this access to treatment is rising to alarming levels (UNAIDS 2008, 85, 114, 141, 153, 194, 229- 230). Brazil was successful in its HIV/AIDS response in part because the initiatives were concerted, comprehensive, and wide-ranging, addressing both prevention and treatment, and reaching a broad spectrum of the population. A major segment of the response has been media initiatives which have resulted in lower levels of HIV risk behaviours (Kowalski, McPake and Oliveira-Cruz 2004, 293-294). São Paolo: Fique Vivo In 1998, in response to the increasing vulnerability of urban adolescents, Peres et al instituted an HIV/AIDS prevention program for incarcerated adolescents in São Paolo. Called “Fique Vivo” (“Stay Alive!”), the program used pop music to encourage participation. The 28 program was so successful that it was expanded to other institutions and received governmental funding. Music involves the audience. At first, Peres et al attempted an information-only approach, but it did not generate significant participation; it “was not really relevant to these boys’ lives” (2002, 41). Seeking another method, the program designers  “found that the best communication channel with these adolescents was through art and music” (Peres, et al. 2002, 41). Accordingly, an approach inspired by the work of Paulo Freire was adopted. Peres et al “facilitat[ed] a process through which the participants developed their own intervention” (Peres, et al. 2002, 38), placing the program within the sphere of Participatory Communication. By structuring HIV/AIDS prevention sessions around rap music, significant numbers of adolescents were engaged and participated in the project. The participatory approach generated “enthusiasm” among the adolescents (Peres, et al. 2002, 41-43). Music engages the emotions. The program designers recognized that interventions must go beyond knowledge transmission. “High levels of knowledge do not necessarily lead to changes in behaviour” (Peres, et al. 2002, 43). The ability of music to connect with the adolescents’ culture in an affective way made the messages of behaviour change acceptable. Unfortunately, no recording of the group or lyrics from the songs were available to demonstrate how emotions were involved. Music is culturally relevant. Peres et al found that to encourage behaviour change, interventions must be “integrated into the social and cultural context of people’s lives” (2002, 43). Through consultations with the adolescents, Peres et al identified music as an important element of their culture and a meaningful mode of communication (2002, 41). 29 The music genres integrated into the program represented the popular styles in São Paolo poor neighbourhoods: rap, funk, samba, and regional music. The lyrics were about crime life, drugs, religion, violence, and AIDS, grounding HIV/AIDS prevention in the culturally-relevant social context (Silveira, et al. 2000). The program meetings included themes beyond HIV/AIDS, reflecting the social situations that give rise to risky behaviours. “Successful interventions will have to be based on a clear understanding of the specific social and cultural context that puts them at such high risk for HIV” (Peres, et al. 2002, 37). The program designers emphasized that “the most important lesson from our experience [is] before launching an AIDS prevention intervention, especially one directed toward a group with special needs, one must truly listen to the group’s beliefs, wishes, and culture” (Peres, et al. 2002, 43). Music is therapeutic and empowering. The program administrators found that the adolescents believed they had no alternative but a criminal lifestyle. Although they were afraid of being killed as a result, “the criminal life was the only option they could see” (Peres, et al. 2002, 41). To help demonstrate that alternatives exist, the program “brought in people from the community of origin of these adolescents, especially the hip-hop movement that offers poor adolescents from slums a music and poetry that focuses on human rights” (Peres, et al. 2002, 41). The adolescents identified with the hip hop artists; witnessing the success of people who came from similar socioeconomic backgrounds was an empowering experience. The program directors realized that the artistic materials being produced by the incarcerated adolescents could help other poor adolescents. Accordingly, they arranged to produce a CD. The recording process cemented the idea that there were options besides criminality (Peres, et al. 2002, 42). 30 The overriding prevention message adopted by the program was also empowering: “Stay alive! Stay alive to tell your story, to mark your territory, and to fight against social inequality” (Peres, et al. 2002, 41). Music enhances memory. The CD, which included songs discussing AIDS prevention, has been used by other educators as well as played on Brazilian radio. The songs were also available online (Peres, et al. 2002, 42). By embedding HIV prevention messages in popular music styles, the adolescents were able to reach out to a large segment of the population and ensure their messages were retained. Creating the CD resulted in an indelible record of the process the adolescents went through. The creation of such an artefact ensures the program a tangible place in communal memory. By creating a CD, the program extended its effects beyond the prison walls; other programs that used these songs made the adolescents’ experience part of their collective memory. India It is estimated that 2.5 million people are living with HIV in India. Unlike countries that have an identifiable primary mode of transmission, there are multiple modes in India; the overlap of sex workers and injection drug users may give cause for worry. Marginalized groups are particularly at risk; up to half of the sex-trafficked women and girls in Mumbai were found to have HIV (UNAIDS 2008, 50, 204). The social impacts of HIV/AIDS are significant. “The financial burden associated with HIV for the poorest households in India represents 82% of annual income, while the comparable burden for the wealthiest families is slightly more than 20%” (UNAIDS 2008, 162). Although India only spends 0.9% of its GDP on health, India has been making some progress. By 31 pressuring the pharmaceutical industry, India has increased the range of affordable treatments. Condom use among sex workers has been increasing. Anti-stigma programs were effectively implemented in three major hospitals. And in a novel approach, in 2008 Indian Railways announced a 50% fare discount for those travelling to receive HIV treatment (UNAIDS 2008, 51, 80, 152, 157, 204). The importance of music for outreach is formally recognized in India, where the government of India’s Ministry of Information and Broadcasting has a Song and Drama Division, which “has been involved in rural outreach programs to increase AIDS awareness” (Solomon, Chakraborty and Yepthomi 2004, 161). “In India, the wide variety of folk forms which have a traditional familiarity with the masses, makes the live performances an important vehicle of communication” (Song and Drama Division 2007). The Division makes use of these traditional channels and brings the message of HIV/AIDS prevention to rural communities in culturally relevant ways. Mumbai: The Humsafar Trust The Humsafar Trust, a network for homosexuals in Mumbai and the surrounding area, was created in 1994 by an Indian gay activist (The Humsafar Trust 2007). The mission statement of the organization is “a holistic approach to the rights and health of sexual minorities and promoting rational attitudes to sexuality” (The Humsafar Trust 2006). The Humsafar Trust’s focus on HIV/AIDS emerged in response to the needs of those who were attending its drop-in centre. In December 2002, The Humsafar Trust launched Messengers on the Local. For this innovative project, outreach workers singing about HIV/AIDS travelled on local commuter trains (UNESCAP 2003, 46-47). 32 Music involves the audience. When presented live, music “has the advantage of instant rapport with the people” (Song and Drama Division 2007). To catch the attention of commuters, outreach workers chose to write new lyrics to the tune of “Jhooth Bole Kauwa Kaate” from the movie Bobby. Released in 1973, the movie generated a public “frenzy” at the time; it is now considered a classic, and the film is still popular today (Joshi 2002, 128). The new lyrics combined with the popular tune caught the attention of the travellers: The train was full, like it was every day, every week. People from all walks of life and all ages thronged the doors, and the aisles. Bored and tense, their ears perked up as the sound of a popular song wafted through the air. Tambourines jangled in the air. As the sound grew louder, the commuters strained their ears to hear the lyrics. They were not the lyrics they were used to, but they were sung so well it could not be a singing beggar. (UNESCAP 2003, 46) The audience reactions, which included applause and appreciation, indicate that music was successful in engaging the travelers. As many researchers have discussed, music that has become associated with exciting events creates excitement when it is replayed (Dissanayake 2006, 41). Using the Bollywood tune took advantage of the listeners’ previously-established associations with the music, thus involving them in the HIV/AIDS outreach effort. Music engages the emotions. In India, “the traditional media of live, face to face performance … has a quality of warmth and personal touch which create (sic) a deep emotional impact” (Song and Drama Division 2007). By bringing live music on to the commuter trains, the performers involved their audience emotionally in their message. The movie Bobby, which featured  “Jhooth Bole Kauwa Kaate,” “launched a thousand emotions” (Joshi 2002, 128). By using the popular Bollywood tune but writing new lyrics, the outreach workers were taking advantage of the public’s positive emotional association with the music. The message contained in the new lyrics thus benefitted from this emotional, peripheral enhancement. 33 Music is culturally relevant. A wide range of people commute on Mumbai’s trains: “the travellers included executives, housewives, middle-class workers, labourers, salesmen and students” (UNESCAP 2003, 46). For such a diverse target population, mass media – in this case, Bollywood music - is a  uniting cultural factor. Because “Jhooth Bole Kauwa Kaate” was influenced by the style of Goan fisher folk music, a common tactic in Hindi films set in Mumbai (Joshi 2002, 57), using this song referenced both folk and popular culture. The outreach workers also drew on another cultural tradition: the traveling musician. In India, traveling musicians are “the stuff of legend” (Allen 1998, 38). The outreach workers were trained in this style (UNESCAP 2003, 47). Thus, in this single outreach program, many different cultural elements were referenced, enabling the outreach workers to appeal to the wide variety of people on the train. Music is therapeutic and empowering. Discussion of sexual lifestyle is taboo in India, a factor that severely inhibits outreach efforts (Solomon, Chakraborty and Yepthomi 2004, 162). Breaking taboos is a difficult process, but until sex can be discussed in India, HIV prevention efforts will continue to be hampered. Music may be able to help by normalizing sexual dialogue. By using song, outreach workers were able to empower travelers to seek information: “as the song ended in the tightly-packed compartment, some people started to ask questions, a few pushed their way to the young man to talk to him” (UNESCAP 2003, 46). The lyrics encouraged the audience to be empowered about their health: We have a small message, beware of AIDS, Together we’ll get rid of it, you can say When you go to the doctor, you let him check you When you want to have sex, let us tell you You can save yourself from this disease (UNESCAP 2003, 47) 34 Music enhances memory. Given the brevity of the contact the outreach workers were able to make with commuters, the use of music was important to ensure the message was retained by the audience. The use of a popular tune that the audience would likely encounter again contributed to the message’s memorability. When a single piece is heard in different contexts, multiple associations are formed, and when that music is heard again, the associations are recalled as well (Snyder 2000, 71). New associations were created between the HIV prevention message and “Jhooth Bole Kauwa Kaate,” so that the prevention message would be recalled when the tune was heard again. Doordarshan TV: Haath Se Haath Milaa Haath Se Haath Milaa (Let’s Join Hands) is a traveling reality television show for youth, created by the BBC World Service Trust with the Indian National AIDS Control Organisation and Doordarshan TV. In the original format, broadcast in 2003, two tour buses traveling around North India invited youth to board the bus and participate in challenges to increase their HIV/AIDS awareness (Sood, Shefner-Rogers and Sengupta 2006, 235). The show was re- conceived in 2006; each episode now features a top film star and a “Yuva Star,” or young achiever, whose work centers around HIV/AIDS (BBC World Service Trust “Shilpa Shetty” 2007). Music was an element of both iterations of Haath Se Haath Milaa. The original episodes always included popular music segments that addressed HIV/AIDS. The musicians involved in creating the theme song for the new version are some of India’s finest. The music was composed by “the triumvirate” of Shankar, Ehsaan, and Loy, who are celebrated film music directors (Tyrrell and Dudrah 2006, 197). The lyrics were written by the “renowned” Javed Akhtar, “arguably the best Urdu poet among the younger generation of poets today” (Joshi 2002, 55, 35 182), and “Haath Se Haath Milaa” was performed by Sonu Nigam and Shreya Ghoshal, “two of the Indian industry’s finest singers” (BBC World Service Trust “Shilpa Shetty” 2007). Music involves the audience. Music is a common way of involving an audience in a television show: it attracts attention and announces that the show is beginning. Significant excitement was generated by the theme song in part because it involved so many well-known celebrities (BBC World Service Trust “Shilpa Shetty” 2007). Because of this appeal, it likely reached a wider audience beyond those who would be drawn to reality television or interested in a song about AIDS. The single made it into the top ten of the music charts in five major Indian cities, and a videorecording of the music video and the “making of” the music video were released in 2006 (BBC World Service Trust “Fighting discrimination” 2007). But the real element of audience participation here is in the television show, not the music. The show could likely benefit from a participatory music segment. Music engages the emotions. Emotional appeal was an important part of the design of “Haath Se Haath Milaa.” The song is described as “evocative” and “goose-bumpy” by the producers (Haath Se Haath Milaa, Theme Song 2006). The music builds gradual emotional involvement and excitement through intensification (Dissanayake 2006, 42). The song begins with very little percussion, no melody instruments and a solo female voice. Gradually, male voices are added, then percussion instruments and melody instruments are also added. These elements are removed and added a number of times, allowing for satisfying emotional releases. The additive elements slowly increase towards the song finale, providing a gradual increase of excitement over the course of the song. 36 Music is culturally relevant. This is an example of a large-scale society with a culture of indirect transmission. For the target audience, televised segments and a music video are culturally appropriate. Involving film stars takes advantage of their status as carriers of culture to make the song’s message relevant. In addition, using “Haath Se Haath Milaa” as the theme for a reality show grounded the message in popular culture. Reality television has been steadily gaining popularity in India and is an important component of youth culture (Singhal and Rogers 2004, 10-11). Furthermore, the music itself is in the popular style. Music is therapeutic and empowering. The television show Haath Se Haath Milaa discusses the power of music. In one series of episodes, the Yuva Star organizes a rock concert as a vehicle to discuss HIV/AIDS. In another, the Yuva Star reveals that through singing, she was able to overcome her natural shyness and conduct HIV/AIDS outreach (Haath Se Haath Milaa, Episodes 2006). The lack of direct audience participation in the music lessens its therapeutic effect, although the message conveyed by the theme, to hold hands together against AIDS, is empowering and therapeutic: anti-stigma messages are therapeutic for those with HIV, and the idea that AIDS can be confronted together is empowering. Music enhances memory. The central message conveyed by the theme song is a simple, emotional one. By bringing together so many high-profile artists, the theme song was made remarkable and memorable. The combined impact of the celebrity endorsements and the emotional song content will enhance the absorption of the message. The creation of a CD separate from the reality show enhances the song’s ability to impact memory. The song can be replayed long after the show ends, and in contexts apart from the 37 television. It can reach audiences that do not own televisions. And as a cultural artefact, it can trigger memory. China In China, new HIV infections are on the rise. In 2007, there were an estimated 700,000 people living with HIV. Fewer than 25% of those living with HIV are currently receiving antiretroviral therapy, although this has increased significantly from 7% in 2001. In 2007, 39,000 people died of AIDS-related causes (UNAIDS 2008, 48, 191, 222, 264). China has started to increase funding for AIDS-related efforts, but more is needed (UNAIDS 2008, 193). I had great difficulty finding information about HIV prevention interventions in China. This could be because the efforts are not being written about, or, more likely, because they are not happening. Brian and Keem Leong are working with the Hani people, an ethnic minority found largely in the Yunnan province, in a community development project called “Community Health Programme.” The project formed a team of six Hani people, who were then educated about AIDS by a medical doctor. A team member who is a singer and a composer wrote lyrics for an “AIDS song,” using traditional idioms, and gave it “a Hani melody.” The song encourages preventative measures. Using localized terminology, it compares AIDS to tigers and leopards to arouse fear in the audience. It also encourages “fidelity with one life partner.” By appealing to both fear and love, the song runs the gamut of the emotional spectrum (Leong 2008). The Leongs taught the AIDS song to women at a summer camp in early August 2008. The song was popular “because it is in their heart-felt melody and idioms” and, since then, “every now and then they sing it” (Leong 2008). 38 CHAPTER 3 DISCUSSION OF HIP HOP Hip hop is a genre that has emerged frequently in my research and is represented in a number of the case studies, but its use for HIV/AIDS education raises a number of concerns. In North America, Hip hop stood out as the one genre that addressed HIV/AIDS directly and explicitly in its songs. But hip hop lyrics have often been considered offensive and frequently convey messages of behavioural freedom that may be incompatible with HIV prevention. Because hip hop is the music of youth and of African Americans, two groups that are in need of targeted HIV/AIDS outreach efforts, it cannot be ignored as an important vehicle for education. This section examines the issues raised by using hip hop for HIV/AIDS prevention. Hip hop is usually said to have originated in the South Bronx area of New York City in the 1970s (McNair and Powles 2005, 350, Keyes 1996, 223), where it was “forged in the crucible of the street” by “African American youth” (Keyes 1996, 224). Hip hop is much more than an entertainment product of African American culture; “hip-hop and rap music originated as a cultural response from working class African-American youth to their economic and social stigmatisation” (Bosch 2006, 31). Although the terms “hip hop” and “rap” are used interchangeably, “hip hop” also includes the concept of an entire culture, whereas “rap” refers only to the music (McNair and Powles 2005, 350). Rap has a history of being controversial. The Parents’ Music Resource Center (PMRC), formed in 1985 in the U.S., accused rap of causing “social problems such as the increase in rape, teenage suicide or teen pregnancies” (Chastagner 1999, 181). The PMRC was part of a concerted “war against rap music” waged in the 1990s (Chastagner 1999, 190). Violent rap was likened to 39 hate speech, said to incite violence, and accused of provoking and sustaining gang wars in urban communities (Johnson 1993-1994, 26). Songs with titles like “Fuck tha Police” (N.W.A. 1989), “Cop Killer” (Ice T 1990), and “Lyrical Gangbang” (Dr. Dre 1992) provided plenty of fuel for the fire. Chastagner has questioned the honesty of these accusations, suggesting that the opposition to rap music is too mired in Christian religious conservatism and racism to be altruistic. “While black music had been directed at the black market, no one had really objected; it was only when white youth began to be attracted that the attacks really began” (1999, 183, 189), he suggests. These accusations have also been called “a reactionary strategy adopted by a largely mainstream conservative American press to undermine subversive or challenging transcripts” (McNair and Powles 2005, 355). Recently, a more moderate criticism of rap has come from the legal community. Some suggest that rap counters the deterrent effect of the justice system by making it cool to have a criminal record: Impressionable young people who are heavily exposed to the negative and criminal- related images in Hip-Hop music and videos, instead of developing realistic measures of societal norms of right and wrong, develop a criminal-minded value system that praises confrontation, aggressiveness and crime and shuns humility, kindness and legality. (Rutherford 2005, 305-306) Legal scholars have also suggested that hip hop may actually perpetuate the racial inequality it rails against by justifying a criminal lifestyle (Nisker 2007, 181): “hip-hop culture discounts responsibility when criminal conduct has been shaped by a substandard environment” (Butler 2004, 1005). These more moderate viewpoints acknowledge the artistic merit of hip hop, however, and suggest that with socially constructive lyrics, it could be a powerful tool for positive change. McNair and Powles downplay the violence in rap lyrics as merely reflective of the grim reality of life in the urban ghetto (2005, 356). Revenge fantasies, they argue, are an important 40 and peaceful form of rebellion against mainstream, suppressive stereotypes (2005, 355). They also point out the fallacy of drawing a causal link between an increase in violence and violent lyrics that has not been supported by research (2005, 356, see also Chastagner 1999, 190). Other research agrees that violent lyrics often reflect urban realities, but points out that many lyrics contain “fabricated fantasies about urban street life” (Diamond, Bermudez and Schensul 2006). Hip hop has often been vilified as a homogenous genre, but within hip hop there are important distinctions: “various classifications such as East Coast, West Coast, teen rap, party rap, gangsta rap, Southern rap, acid rap, dance-centered rap, dirty South, and political rap are used to differentiate the genre” (McNair and Powles 2005, 351). Gagsta rap lies at the centre of the controversy over rap lyrics. Political rap, on the other hand, may have a “potentially positive impact” as “a display of cultural values, a vehicle for self-expression, and a political forum for the disenfranchised” (McNair and Powles 2005, 355).  Addressing issues of major concern such as racist approaches within law enforcement (Nisker 2007, 179) and economic marginalization (McNair and Powles 2005, 353), rap provides a way for a marginalized population to increase public awareness of these problems. It also provides an avenue to educate “the black community” and “raise consciousness … as an impetus to the overthrow of the existing balance of power” (McNair and Powles 2005, 357). Thus, political rap is frequently “revolutionary” in nature (McNair and Powles 2005, 354, 358). Although much of the discourse about hip hop still refers to it as African American culture, rap music has for many years not been solely the realm of marginalized African Americans. In 1991, the music industry discovered that “white suburban teenage males” were buying hip hop in record numbers (a phenomenon which remains, to some, “mysterious” (Watkins 2005, 96) ). In 1999, white rapper Eminem debuted on a major label, having spent his career defending his right to sing “black music” by emphasizing the authenticity provided by his 41 lower-class background (Watkins 2005, 87-92). At this stage, white rappers were accepted only if they were also marginalized and poor. Almost a decade later, rappers and their messages can be both white and middle-class. This is hotly contested, however. Some argue that “to say you love [hip hop] is to say you love Black things” (Kitwana 2005, 152). Others point out that hip hop “prides itself on its multicultural appeal” (Kitwana 2005, 153). White Canadian female rapper Eternia talks about challenging the stereotypes: When I first started putting out singles leading up to my debut album I did feel like a lot of the press I was getting was because I’m looked at as being ‘different’ … So in that sense I guess the whole ‘white female rapper’ tag worked in my favor. But to be honest with you . . . it’s only been as I’ve gotten older, done more interviews and traveled that my gender and race have become things I really have to think about based on questions that I sometimes have to answer. In Canada it was never really that much of a big deal because it’s a very multi-cultural place, so everyone hung together and it was just a case of if you’re dope, you’re dope. But since moving to New York it’s definitely been made very apparent to me that my gender and race can be an issue for some people and others are just shocked to learn that someone like me even exists, a half-white, half-middle-eastern female who loves hip-hop and is good at it. (Eternia, Eternia - Real Testament 2007) Many of these new, non-marginalized artists continue in the vein of using rap to raise political awareness, but their choice of subject matter is different. Canadian rapper Rochester explains: The situation in Canada is different. Sure some people are living that kind of life, but why rap about busting guns when you’re not? I come from a proud Dominican and Jamaican household, grew up with my two parents, and I didn’t live that kind of life… so why am I going to rap about something that I don’t live? … Music is expression of self. If that’s not you, don’t express it. (The 411 Initiative for Change 2005) Hip Hop and AIDS What does all this mean for the use of hip hop music for HIV/AIDS education? In 1996, The Red Hot Organization released a hip hop record called America Is Dying Slowly as part of its series of records drawing attention to the U.S. HIV/AIDS epidemic. Some authors expressed concern that using existing hip hop music without new lyrics to raise awareness about HIV/AIDS sends conflicting messages: 42 The primary means of transmitting the HIV virus … are through sexual contact with an infected person and by sharing needles and/or syringes (primarily for drug injection) with someone who is infected. One of hip hop culture’s dominant modes of communication is sex and drug-related imagery. … [There is a] parallel rise in the global market influence of hip hop culture and rates of HIV/AIDS infection among black American men, women, and youth throughout the 1990s and into the 21st century. (Lewis 2008) In fact, it has long been a concern of those combining entertainment and education that the popular singers who convey HIV/AIDS prevention messages may send different messages in their other work (Lemieux 2003, 100, Singhal and Rogers 1999, 114). But such conflicting messages reflect the healthy reality of public debate. For behaviour change to be effective, it should be discussed and debated in the public realm (Singhal and Rogers 2004, 422-424, Piotrow, et al. 1997, 18). HIV/AIDS prevention messages are not necessarily incompatible with the sexual and drug-related imagery in many rap lyrics. Having multiple sexual partners, after all, is not what transmits HIV, but rather having multiple sexual partners without using a condom. And injecting drugs does not give a person HIV, but sharing needles might. Until such precautionary behaviours become a part of rap’s sexual and drug-related discourse, however, the messages of prevention and behavioural freedom will continue to appear conflicting. As discussed earlier, rap has traditionally been used to instil a revolutionary spirit and encourage “a collective challenge against authority” (McNair and Powles 2005, 359). AIDS has not become a common subject for hip hop artists, and I suspect this may be in part because there is no authority to rebel against. Vilifying a disease is not nearly as sexy as vilifying a ruling elite. Even worse, preventing the disease means adopting behaviours that are supported by the authority otherwise rebelled against. Perhaps hip hop may find solace in the knowledge that condom use and safe injection drug use still constitutes a rebellion against those who promote abstinence from sex and drugs as the only solution. Hip hop stands apart in my case studies both as the only genre in the U.S. and Canada to tackle AIDS explicitly, and as the genre of choice to address youth in South Africa, Brazil, the 43 U.S., and Canada. The issues discussed above deserve consideration, but they must be weighed with an awareness of the awesome potential of hip hop to disseminate HIV/AIDS education. 44 CHAPTER 4 REGIONS OF NORTH AMERICA This section surveys HIV/AIDS music initiatives taking place in the U.S. and Canada. As before, each country is introduced by an epidemiological summary of the AIDS epidemic. This is followed by brief overviews of some initiatives and detailed analyses of particular programs. The U.S. initiatives I analyse include commercial efforts that also happen to provide a didactic message about HIV/AIDS, demonstrating how individual musicians have chosen AIDS as their subject matter without the impetus of aid organizations. This is not only a phenomenon in the U.S.; as mentioned in the section on Sub-Saharan Africa, Kenyan hip hop artists choose to invest many of their songs with HIV/AIDS prevention lyrics. Because of the quantity and quality of information available, however, I am only able to discuss this aspect of HIV/AIDS education in the U.S. The United States In 2007, an estimated 1.2 million people in the U.S. were living with HIV. Annual numbers of new diagnoses have remained relatively stable for the last few years, but as new treatments enable people to live longer, the total number of PLWHA has risen. Although the epidemic is diverse, men who have sex with men are at the highest risk of acquiring HIV (UNAIDS 2008, 57-59). Unique challenges for educational efforts are presented by multi-cultural societies. In order to remain culturally relevant, each sub-group must be addressed individually, but sub- 45 cultures are not divided along clear-cut lines. Identifying the most culturally relevant avenue becomes complex. In the U.S. and Canada, most HIV/AIDS educational initiatives have used music to attract attention rather than to impart knowledge. Music that explicitly addresses the AIDS epidemic is rare. “To date, one of the primary methods of incorporating music into HIV prevention intervention has been through ‘benefit’ and ‘awareness’ concerts, and through the release of songs that are purportedly about prevention and safety, but do not necessarily directly address prevention and HIV related issues” (Lemieux 2003, 100). In 1994, Rob Baker challenged that “pop music still could, and should, do a great deal more than it is currently doing to get the message out about AIDS, for pop music is a special universal language to which the young around the world respond” (1994, 93). Hip hop has of late begun to answer this challenge. The popular music efforts to address HIV/AIDS, however, have not made it into mainstream pop culture; artists who write songs about AIDS typically do not include them on their albums but release them, if at all, as singles. It has been speculated that AIDS does not sell (The Economist 2004), or that DJs are reluctant to give such songs airtime (Morris 2004). But until pop culture is willing to embrace AIDS as a subject of importance and relevance, musical efforts to address the epidemic will remain on the sidelines, where they can only have minimal impact. Researchers have found that those who are already engaging in high- risk activities are less likely to listen to music identified as HIV/AIDS prevention education. “This is consistent with the idea that if people are engaging in behaviour that they know may pose a risk, they may be more likely to avoid such information” (Lemieux 2003, 78). This is what being culturally relevant really means; not merely that the musical genre should be appropriate, but that the message should be immersed in the culture. 46 Artists Speak Out Artists in a few popular genres have felt compelled to write music about AIDS, usually with the goal of raising awareness or as an artistic expression of the impact of the disease that they have witnessed. The female R&B trio TLC’s album CrazySexyCool, released in 1994, included the hit song “Waterfalls,” which addresses drug use and AIDS. Country artist Reba McEntire’s album Read My Mind, also released in 1994, included the song “She Thinks His Name Was John,” about a woman dying from AIDS that she contracted during one night of spontaneous, anonymous sex (Morris 2004). As Ambassadors for Nelson Mandela’s 46664 HIV/AIDS campaign, the rock band Queen and Paul Rodgers2 re-worked the song “Say It’s Not True” (originally composed by Queen drummer Roger Taylor for the 46664 concert in 2003) for World AIDS Day 2007, and released it for free on their website. The song was subsequently re-released commercially as a single (Queen and Paul Rodgers 2008) and will be included on their upcoming album, to be released on 15 September 2008. These artists took it upon themselves to express their dismay at the AIDS crisis through their music. None of these songs are explicit, which minimized their didactic impact. The artists were walking the fine line between artistic expression and commercial viability. Music involves the audience. In large-scale societies, music is often driven by economics (S. Brown 2006, 9). The albums of popular artists sell. This is a fact of the music industry, and it is this aspect that TLC, McEntire, and Queen and Paul Rodgers took advantage of in releasing songs about HIV/AIDS. They could count on their music to attract their audience. But there is some doubt that music about AIDS without a major celebrity behind it can attract an audience,  2 Queen and Paul Rodgers are British. They are included here because they have a large American audience and because their song about AIDS achieved significant popularity in the U.S. 47 which may explain the small number of artists who have tackled the subject, despite the severe impact the epidemic has had on the artistic community (Baker 1994, 87). McEntire is one of a very small number of country artists who have addressed this issue, and there has been speculation that “it may be the fear of getting little or no lucrative airplay – as much as it is timidity or aversion – that keeps country writers and performers at such a distance from AIDS” (Morris 2004). Even McEntire’s effort never made it above number 15 on the charts, while most of her other singles were in the top five (Morris 2004). The economic function served by music in a large-scale society both allows its use to disseminate HIV/AIDS information and prevents such use. These kinds of initiatives involve the audience in a more passive way, as listeners with no path for interaction. The effectiveness of these songs in encouraging behaviour change is likely lowered as a result. Music engages the emotions. The lyrics of McEntire’s “She Thinks His Name Was John” are not explicit, but they are emotional. McEntire describes the deathbed of a woman with AIDS: And all her friends say what a pity what a loss And in the end when she was barely hanging on All she could say is she thinks his name was John (McEntire, 1994) She creates a melancholic atmosphere with a very slow tempo and simple piano accompaniment. The melody line sits largely around the tonic, with frequent leaps up to the dominant. This use of the fifths creates a sad, regretful atmosphere without becoming tragic. Songs like this instruct on a purely emotional level, attempting to convey what it is like to live with AIDS. This is perhaps the most common approach to be found in North American songs that address HIV/AIDS. In a twist on the traditional emotional description of what it is like to suffer from AIDS, in “Waterfalls” TLC describes the impact on others of the high risk lifestyles that lead to HIV contraction: 48 A lonely mother gazing out of the window Staring at a son that she just can't touch If at any time he’s in a jam she’ll be by his side But he doesn't realize he hurts her so much (TLC 1994) The music of “Waterfalls” is remarkably upbeat. The tempo is relaxed but not slow, and the harmonies do not create a gloomy mood. The melody does sit quite low, however, and there are a large number of downward motions, which go some way to conveying the seriousness of the topic. Roger Taylor, the drummer of the rock band Queen, said “Say It’s Not True” describes “the impact of the shock of realisation you are HIV positive and the urgent need for cheaper drugs for all with the disease” (46664 Concerts 2007). The lyrics discuss very little outside the emotional response to an HIV-positive diagnosis. Freddie Mercury, the band’s celebrated lead singer, died of AIDS-related causes in 1991 (46664 Concerts 2007), so Taylor has an emotional connection with the subject matter than is revealed in the lyrics: Say it ain't true Say it today When I open my eyes Will it all go away (Queen and Paul Rodgers 2008) Queen and Paul Rodgers’ music takes the audience on a marvellous emotional trajectory. The song opens with a poignant mood created in ways similar to McEntire’s, with a slow tempo and similar chord progressions. The music builds intensity gradually by adding instruments. The song opens with simple synthesizer chord washes, then adds a simple guitar line and doubles the vocal line. Midway through, a short drum solo introduces an exciting explosion of sound as the volume dramatically increases and the chorus is repeated. This changes the meaning of the phrase “say it’s not true,” which in the first iteration was a plea, but with the dramatic musical backdrop becomes an outraged cry. An exciting guitar solo follows, before the song finishes quietly with a solo voice. 49 Music is culturally relevant. TLC, Reba McEntire, and Queen and Paul Rodgers are all cultural icons. These three popular artists each represent different cultural groups within the U.S. When Queen originally emerged in the 1970s glam rock scene, music was central to youth culture, and glam rock was responsible for articulating classless issues like sexuality (Stratton 1986, 36). Queen represented the emergence of questioning one’s sexuality “with their not-so-subtle name” (Stratton 1986, 35). But as their audience has grown up, Queen has moved beyond the borders of glam rock. Their music is now considered classic; “We Will Rock You” (1977) can be heard on sports fields across the continent. TLC, a “particularly unconventional and sexually aggressive trio” (Goodall 1994, 85), was an important part of the female rap scene. This made them particularly culturally appropriate to address HIV/AIDS, as both women and African Americans are disproportionately affected by the epidemic (Ferguson, et al. 2006). Their genre, “a mixture between rap and ‘pop’,” ensures that they “reach a large and varied audience” (Goodall 1994, 91). Reba McEntire is both seen as an example of country music traditionalism and as a crossover musician who has experimented with R&B sounds (Neal 2003, 124). As with TLC, this may serve to widen McEntire’s appeal. The fact that McEntire has a television show indicates that she is considered marketable to a wider audience. Country music has been identified as a genre that “attracts older people, with low educational qualifications, and has a high ethnic minority representation” (Savage 2006, 169). McEntire’s “She Thinks His Name Was John” is firmly grounded in the traditional country female culture, wherein “women are defined by their relationships to men” (Pruitt 2006, 63). Music is therapeutic and empowering. As with “Haath Se Haath Milaa”, the lack of active audience involvement likely lowers the therapeutic effect of these songs. 50 McEntire was part of the shift that took place in country music in the 1990s toward increasingly positive, empowering themes (Pruitt 2006, 65-66). This may explain her willingness to tackle the thorny subject of AIDS. The fact that she spoke out about it is an empowering message to others. The lyrics of TLC’s song serve as a call to action, urging those engaging in risky behaviours to stop: “don't go chasing waterfalls / please stick to the rivers and the lakes that you're used to” (TLC 1994). In “Waterfalls”, TLC breaks from the female rap tradition of portraying women as suffering from sexual activity (Goodall 1994, 88), and instead describes a man acquiring HIV from unprotected sex. TLC come from a middle-class background, which in part explains their willingness to confront sexism: “as middle-class women, they undoubtedly have greater access and options with regard to both birth control and pregnancy termination” (Goodall 1994, 91). This enables them to in turn deliver an important message of empowerment to their female fans. The only issue discussed in Queen and Paul Rodgers’ “Say It’s Not True” besides the emotional stress of being diagnosed with HIV is the unaffordability of treatment: “magic cocktails for lives / people just can't afford” (Queen and Paul Rodgers 2008). This is intended to bring attention to the policies that perpetuate high drug prices. This is a major stumbling block for developing countries’ efforts to address HIV. Using music would be an excellent way to place pressure on the decision-makers or empower governments to take other actions to resolve the problem, which could include generating their own patents, but Queen and Paul Rodgers’ message falls short of this. Music enhances memory. The fact that people are still talking about these songs is evidence that music has helped to entrench these messages. I learned about a number of these songs by simply asking my friends and family if they knew of any songs about AIDS. Because 51 these songs are simply artists’ responses to the crisis, they are evidence of the role that music can play in the creation of social memory. They become part of the fabric of their listeners’ history, and for those who did not live through the initial explosion of the AIDS crisis, they serve to make real the important elements of that past. I hope that artists who sing about AIDS in the future will be more explicit and braver about their subject matter. These songs could have had a greater impact had they been less ambiguous. The Red Hot Organization As mentioned above, a common aspect of music’s response to the HIV/AIDS crisis in North America is the use of unrelated popular music to draw attention to HIV/AIDS awareness efforts. The Red Hot organization was established in 1990 with the release of Red Hot + Blue, an album of Cole Porter music in contemporary arrangements, sung by major pop artists including U2 and Sinéad O’Connor. Since that first project, Red Hot has produced fourteen albums, embracing musical genres from Latin to country to dance. With the exception of hip hop, however, these albums have not explicitly addressed AIDS, which will limit their impact. Music involves the audience. The aim of the Red Hot CD was to capitalize on music as an attention-grabbing device. John Carlin, the mastermind of The Red Hot Organization, explained that he conceived it as “a kind of Trojan Horse way of getting the AIDS epidemic noticed in popular culture” (qtd. in Baker 1994, 89). Carlin was taking advantage of pop music’s ability to involve a wide audience, although the involvement encouraged is very passive. 52 Music engages the emotions. Carlin explained that he chose Cole Porter’s music for this initial project because of its emotional content. I listened intently to the lyrics. They resonated with new meaning in the context of the AIDS crisis. . . . It was even more resonant that Porter was a homosexual who hid that fact in the repressive era of mid-20th century America. (Carlin 2005) Because the lyrics were not explicitly about AIDS, it was even more important that the songs convey the intended message emotionally. These emotional messages included a “chilling articulation of the rhizomatic connectivity of the global AIDS body” and made “both illness and the care for the ill, in a word, sexy” (Nyong'o 2007, 54). Music is culturally relevant. By releasing records in many different musical styles, the Red Hot Organization reached out to diverse populations. Still, few albums actually include original songs that directly address the disease. Interestingly, an attempt to change this was made in order to make the alternative album more culturally relevant: [Because] Generation X is tired of tribute albums and packaged concept material . . . [on No Alternative] there are one or two cuts where the artists go beyond the music and address the issue . . . maybe not directly, but symbolically. (Baker 1994, 91). Furthermore, by including a broad range of music, the Red Hot albums recognized the diverse populations affected by the disease (Nyong'o 2007, 53). Music is therapeutic and empowering. The Red Hot CDs are an example of how music can be an empowering medium, even if the lyrics do not express explicit empowering messages. Carlin explained his goal: To use music to help modify people’s behavior. I wanted to make records that people would buy: pop culture with a conscience. I’ve always been a big fan of popular culture – using the arts to effect change… I was very interested in how art can relate to politics, how it can force people to not be so simplistic, to look at things they wanted to avoid. (qtd. in Baker 1994, 93). 53 Thus, the goal of empowerment was directed towards encouraging people to examine their society critically. Carlin also disseminated the empowering message that in the face of the epidemic, prevention can still make a difference. Music enhances memory. The Red Hot + Blue album is an example of the role music can serve in reminding and reconstructing the past. At the time the album was issued, AIDS imagery was rare in the mainstream media. The early fight against AIDS was fraught with discrimination, denial, and revulsion. Red Hot + Blue has been recently re-released, and this anniversary edition “provides an occasion to reflect upon the archive of feelings that lay dormant in a history much more radical than we are often permitted or encouraged to believe” (Nyong'o 2007, 52). Hip Hop and African Americans Hip hop is one of the few genres that has addressed the HIV/AIDS epidemic explicitly, potentially in part because hip hop culture experienced the effects of the epidemic: rapper Eazy- E died of AIDS-related causes in 1995 (Lewis 2008). The willingness of hip hop artists to speak explicitly about the disease is fortunate, as the African American population is overrepresented among those with HIV. Plain-speaking efforts include a song by Canibus called “AIDS is Gold, HIV is Platinum,” written for an AIDS benefit concert. Specifically directed at the African American community, it discusses the disproportionate number of African Americans with the disease. He uses culturally relevant terminology like “nigger” and phrases like “raunchy ass parties” (Canibus 2001). His song was merited on its own, outside the context of AIDS: it has been described on an online blog as one of the “best concepts in hip hop” (k-fLiP 2005) and highly recommended to other hip hop fans (IKon 2007). 54 Another example of a direct approach in song was taken by Salt’N Pepa, who have been called “undoubtedly the most historically and continually progressive female rap group in terms of addressing female sexuality” (Goodall 1994, 87). In keeping with this empowering stance, Salt’N Pepa’s rewrote their hit song “Let’s Talk About Sex” to create “Let’s Talk About AIDS” in 1992 (Keyes 2000, 261). “Salt’N Pepa had proven themselves to be leaders in the movement, both within and without the industry, to get female independence and sexuality openly discussed” (Goodall 1994, 87). In February 2008, in collaboration with the Kaiser Family Foundation and the Common Ground Foundation, MTV sponsored the A Minute Contest, in which hip hop artist Common invited youth to compose lyrics about the importance of getting tested for HIV. This was part of MTV’s “It’s Your (Sex) Life” campaign, which raises awareness of sexual health issues. The winning lyrics, written by Jose Rivera, were performed by Common and aired both on MTV television and online throughout the summer of 2008 (Henry J. Kaiser Family Foundation, A Minute Contest 2008). Music involves the audience. The goal of the A Minute Contest was to involve the audience in creating an HIV/AIDS prevention message. The A Minute Contest inspired over 2500 youth to submit lyrics, indicating a high rate of audience participation. “The intent was to facilitate conversations by contest participants with their peers to help spread awareness about HIV and HIV testing,” the Kaiser Family Foundation explains (Henry J. Kaiser Family Foundation, Grammy Winner Common and Nebraska Teen 2008). Although there was no face- to-face component of the contest, the audience was still enabled to participate actively, enhancing the effectiveness of this initiative. 55 Music engages the emotions. A significant amount of hip hop’s appeal lies in its ability to make an “emotional connection” with its audience, which is grounded in its image as “real” and “meaningful” music (Watkins 2005, 105). Thus, even as hip hop addresses the AIDS epidemic in explicitly educational ways, many songs also use emotion. The hip hop culture is aggressive and proactive, so self-pitying, emotive lyrics would not be appropriate here. This can be seen in how Common mentions the emotional damage of losing someone to AIDS without describing the emotional effects: “I had an uncle succumb to HIV, so I’ve personally felt the impact of the disease” (Henry J. Kaiser Family Foundation, Grammy Winner Common and Nebraska Teen 2008). In hip hop, the emotion that is conveyed is one of battle; recalling the “revolutionary” stance of hip hop (McNair and Powles 2005, 354), HIV/AIDS is set up as an opponent against which the African American community needs to rally. “I went from killing them softly, to killing them harshly / minorities from twenty to forty can’t afford to ignore me” (Canibus 2001). Music is culturally relevant. Prather et al report emphasize the importance of culturally- relevant HIV prevention interventions targeting African Americans. “Within an Afrocentric approach,” they explain, “the inclusion of cultural heritage is used as a strategy to instill pride and empowerment for people of African descent” (2006, 150). Research has found that among African Americans, higher levels of ethnic identity are associated with less risky sexual attitudes (Belgrave, Maris and Chambers 2000). “Ethnic identity is considered a protective factor that should facilitate general well-being” (Belgrave, Maris and Chambers 2000, 313). Ethnic identity has also been linked with lower levels of drug use; “africentric values are associated with attitudes and behaviours that are intolerant of drug use” (Belgrave, Townsend, et al. 1997, 432). Thus, for this ethnic group in particular, culturally relevant approaches may reduce behaviours that place individuals at high risk of contracting HIV. 56 Hip hop is an ideal medium to raise awareness among the African American community. This is especially true in the U.S.; although hip hop is no longer solely African American music, many African Americans still view it as theirs. “It must be stated unequivocally that hip-hop is a subculture of Black American youth culture – period” (Kitwana 2005, 150). African American musicians can ground the crisis in their own culture, and emphasize to their peers the importance of avoiding risk behaviours. As Canibus says, “forty percent of the AIDS patients is Afro- Americans / and we only twelve percent of the population / that statement is a fact, Latinos and Blacks face it / it came straight from the World Health Organization” (Canibus 2001). Hip hop also uses terminology that is appropriate for those within the African American community. Canibus uses words like “nigger” (Canibus 2001) that ground his message in African American culture but would be inappropriate for an outsider to use. “That word is not even in my vocabulary,” Eminem has said (qtd. in Watkins 2005, 87). Using hip hop in a mass media approach is further culturally relevant: MTV is an important part of the culture of American adolescents. Much of youth culture relies on indirect transmission, so it was an appropriate method for delivery of the A Minute Contest. Music is therapeutic and empowering. In its HIV prevention program targeting African American women, the Sisters Informing Sisters About Topics on AIDS (SISTA) use “an HIV Prevention CD . . . in the form of rap music”. The program designers purposely use a cultural focus to empower the women who take part by encouraging their active musical participation (Prather, et al. 2006, 155). Many hip hop lyrics are empowering and encourage listeners to take steps to protect themselves, from Canibus’ “ ‘cause the only way I can be detected, is by getting tested / and most people don’t question the person they having sex with” (Canibus 2001) to Common and Jose Rivera’s “so go get check dont make it so complex / and always remember to have safe sex” 57 (Henry J. Kaiser Family Foundation, A Minute Contest 2008). There is stigma associated with HIV testing, and by addressing its importance frankly, hip hop can help to break that stigma. Music enhances memory. In an interview for the A Minute Contest, Common explained why he thinks music is a powerful vehicle for HIV/AIDS prevention: People don’t see how AIDS is affecting us. I say that in a lyric in one of my songs, and I feel that … to be able to say that in a lyric is something that somebody is going to repeat; I’ve learned from just repeating songs, you know; when I hear them later, I get the message when something’s brought up about it, I get the message, and I feel like a lot of messages can be delivered in lyrics and songs, that I feel that everybody from the youth to the elders would get. It’s sometimes subconscious but it eventually becomes conscious to you, that’s what I want to happen with puttin’ these messages in the lyrics. (Henry J. Kaiser Family Foundation, Interview w. Common 2008) Common knows instinctively what researchers have found: music aids memory. Connecticut: Hip Hop and Urban Youth One of the groups who have been targeted most frequently by music initiatives is adolescents, perhaps because youth are such voracious consumers of music; studies have shown that listening to music is the “number-one non-school activity” of most American youth (Roberts, Henriksen and Christenson 1999). In 2001, Anthony F. Lemieux instituted an HIV prevention intervention in a Hartford, Connecticut high school that used HIV prevention-themed hip hop music created by students at the school. The students adopted the name “SWAAT” (Students Working Against AIDS Together). The song, called “Life Is Too Short,” was recorded and disseminated by the students who wrote it. They made presentations in classrooms and held information sessions in the hallways (Lemieux, Fisher and Pratto 2008, 352). The program was found to be fairly effective, although “there is room for expansion and improvement” (Lemieux 2003, 96). 58 Music involves the audience. As a small-scale intervention, this program incorporated the ideas of Participatory Communication. Students were encouraged to be involved in every aspect of the song creation, and indicated a high degree of ownership and pride in the music. Significant interest and excitement was also generated in the general student body; students even asked for autographs from those involved in making the CD (Lemieux 2003, 98). High schools provide one avenue of access to adolescents where music could help to involve students in HIV prevention education. “Since most school-based HIV prevention education is information-only, it is therefore unlikely to change HIV preventive behaviour” (Lemieux 2003, 18). Music-based programs can provide youth with the motivation to adopt preventative behaviours, especially when they are involved in musicing (Lemieux 2003, 89). Music engages the emotions. In keeping with hip hop’s “revolutionary” theme, the emotions conveyed by hip hop music are usually aggressive and exciting. Some of the emotional appeals in “Life Is Too Short” are similar to that found in the hip hop music discussed earlier: warnings that HIV/AIDS is a serious enemy, and that steps must be taken to counter its impact. Killing off millions and counting Men, women, and children are drowning But SWAAT is on patrol now, the alarm is sounding (Lemieux 2003, 116) The lyrics are more fear-based than revolutionary, however; they lean towards describing AIDS as a powerful enemy with terrible impacts and do not include many collective calls to action. Unlike many hip hop songs, “Life Is Too Short” encourages a lot of individual action: Make right decisions and ask yourself a question Do you wanna die? How can you live with that reflection? (Lemieux 2003, 116) This lyric also contains an element of personal responsibility, which is somewhat unusual. 59 Music is culturally relevant. As rapper KRS-One has said, “what goes around comes around I figure / now we got white kids callin themselves ‘nigger’” (1995). Hip hop is not only the music of African Americans:  it is now the popular culture of most American youth (Kitwana 2005). Although the school was multi-racial, hip hop was “culturally relevant and popular in the school and local community” (Lemieux 2003, 34). In addition, because the message senders were from the same group that was being targeted, the messages were grounded in adolescent, high school reality, and were more likely to effect behaviour change. “The direct involvement of students . . . engenders interest and increases the potential for a music-based HIV prevention intervention to be well-received, widely implemented, and most importantly – effective – among urban adolescents” (Lemieux, Fisher and Pratto 2008, 355). Music is therapeutic and empowering. In an attempt to influence the social conditions that reinforce risky sexual behaviour, the song lyrics encouraged social support for HIV preventative behaviours. Lemieux stressed “motivational factors including attitudes, social norms, and perceptions of vulnerability” in the lyrical design process (2003, 33). The students involved were empowered throughout the process. Crafting the campaign gave them the self-confidence to believe they could effect change. They were fully immersed in the therapeutic process of musicing. Furthermore, not only were they able to participate in the process of recording and mixing a CD, but they also had their photographs and biographies placed in the liner notes – heady stuff for any adolescent. Music enhances memory. This intervention was specifically designed to be memorable by carefully crafting lyrics and music. It is interesting to note that “information was not among the focal points of the intervention” (Lemieux 2003, 67); rather, the intervention targeted 60 “attitudes, perceived social normative support, and perceived vulnerability to HIV” (Lemieux 2003, 73). Music enhanced the memorability of these efforts to change social norms. As has been seen before, the creation of the CD ensured that the message was delivered frequently, expanded the campaign’s impact beyond school walls, and contributed a cultural artefact to the community. Rent Premiered in New York in 1996, Rent is a rock musical about love confronted with HIV/AIDS. It is described by its creator, Jonathan Larson, as follows: “Rent is about a community celebrating life, in the face of death and AIDS, at the turn of the century” (Titrington 2007, 64). It swept the Tony awards in 1996, achieved staggering international success, and in 2005, a movie version was released (Titrington 2007, 3, 68). The primary message in Rent is about living fully despite the disease, a theme that resonates with the Ugandan and South African emphasis on “positive living.” Music involves the audience. The music of Rent became popular in its own right, and many people, myself included, heard the music before they saw the show. “Larson’s strongest skill in writing for theatre was his ability to craft original, relevant, and memorable music” (Titrington 2007, 57). The popularity of the songs attracted listeners to the musical before they were aware of its subject matter. Elizabeth Smith, a fan of the musical referred to the author through snowball sampling, was in high school in Ottawa when the musical emerged. She remembers how she first became a fan: I became a fan of Rent through the soundtrack, long before I saw the original musical; a friend of mine had it with her on a cottage weekend. As for what pulled me in; well, I liked the melodies, almost all of them. I think what I liked most was the gleeful, rebellious exuberance. “La Vie Boheme” was always my favourite number, by far. Once 61 I was into it I became fond of the quieter songs as well; once I got into the storyline I found it really compelling. (E. Smith 2008) Larson’s music also managed to attract an unusual audience. “Thanks to its rock influenced score and relevant themes, Rent attracted more of a youth audience than did other musicals of the eighties and nineties” (Titrington 2007, 3). Music engages the emotions. As with most musicals, in Rent the characters burst into song whenever they are given strong emotional impetus. In this way, the form of a musical takes advantage of music’s ability to engage the audience’s emotions. Larson specifically sought performers who could sing in various rock styles (Titrington 2007, 63). Vocal timbre conveys emotion (Patel 2008, 345), and in the case of Rent, helps to define the characters. Liz Phair’s low, vibrato-less voice defined the sound for Maureen’s character, and Bruce Springsteen’s heartland rock defined Mark (Titrington 2007, 62). The rock genres chosen for different characters also conveyed specific musical, emotional messages. “Musically, the contemporary ‘grunge’ style defines Roger’s lost, angry character. . . . The deliberately distorted rhythmic elements reflect the dreamy feeling of attraction and/or being doped up” (Titrington 2007, 63). Rent as a whole communicated to the audience the emotional impact of living with HIV/AIDS. “It put a human face on the disease,” Smith says (E. Smith 2008). Music is culturally relevant. By integrating rock music into musical theatre, Larson “consciously sought to incorporate current musical styles” in order to “marry the MTV generation with theatre” (Titrington 2007, 63, 3). Rock music was the culturally relevant genre, given the musical’s subject matter. The characters would have listened to rock, and the audience that needed to hear the message Rent delivers listened to rock. Smith describes the cultural 62 appeal of the genre: “I've always loved musicals, and Rent came just as I was starting to listen to more and more rock, so the combination of the two appealed” (E. Smith 2008). Rock was a difficult genre choice for a musical, as “once you start putting in the backbeat, it evens everything out, and there is nothing dramatic in that” (Titrington 2007, 60), but “it is the necessary language for the show’s controversial, contemporary topics and themes” (Titrington 2007, 2). One of the show’s primary message about HIV/AIDS is provided by the cultural context. Larson counters the stereotyped AIDS “victim” (Titrington 2007, 33) by placing his characters in a cultural context that was familiar to the audience. This sent the clear message that AIDS is a part of your culture, and anyone can get it. Titrington outlines how Rent grew directly out of the society Larson lived in (2007, 28). Larson was immersed in the culture that surrounded PLWHA, as many of his friends were HIV positive (Titrington 2007, 25). Music is therapeutic and empowering. The main HIV/AIDS message Rent communicates is an empowering one. Based on what he witnessed his friends experience, Larson sought to emphasize the potential for PLWHA to live fully. “Rent portrays some of the difficulties of life with HIV and AIDS, but it also delivers a strong positive message about accepting and living with disease. ‘No Day But Today’ [from “Another Day”] has become almost a motto for the show, and Larson stressed that philosophy throughout all the many revisions” (Titrington 2007, 32). This message is similar to the “positive living” theme: there is life after an HIV diagnosis. Music enhances memory. Rent managed to convey the emotional impact of HIV/AIDS, and it made the messages meaningful and memorable. At the time, public education was already providing a great deal of information about HIV/AIDS, but in order for the message to be 63 memorable, it needed to be delivered in a different context. Over a decade later, Smith still remembers the educational impact of the musical: I think what I mostly got out of it in terms of learning about AIDS was an actual awareness of what it means to live with the disease. I mean, everyone gets the basics of it in sex ed and, well, through the ether, however kids learn about things, but I'd never put a lot of thought into the detailed AZT schedule, or the constant uncertainty and fear, and watching how it affects your relationships with people. But these were interesting, intelligent people for whom AIDS was an every day reality, rather than just something that happens to other people. I suppose even before Rent I knew that most of the superstitions aren't true - I knew I wasn't going to get AIDS by shaking hands with someone, or whatever. I guess it may have re-inforced at a human level what I already knew at a scientific level, and would stop me from acting negatively towards someone with AIDS. (E. Smith 2008) Rent can now be re-experienced at whim on CD or DVD. The making of the movie a decade after the show opened is a testament to its impact. Rent has firmly established itself in the collective memory. Canada In 2007, an estimated 73,000 people in Canada were living with HIV. The situation is similar to that in the U.S., except that a high number of new infections in Canada occurred in people who were born in countries with high HIV prevalence (UNAIDS 2008, 57-59, 229). Globally, half of all new HIV infections are in youth aged 15-24. In Canada, 1.5% of new HIV infections are in youth. There is cause for concern, however, as youth are likely to engage in high risk behaviours (Public Health Agency of Canada 2007). Hip hop has been frequently used in Canada, as in the U.S., to address HIV/AIDS. In 2005-2006, the Lawrence Heights Community Health Centre in Toronto funded a project to “create 20 Hip-Hop or spoken word pieces that include HIV, healthy sexuality and community issues” and “compile the hip-hop and spoken word pieces for distribution to radio stations, HIV/AIDS education venues and other interested parties” (Falconer 2005, 22). The songs were 64 composed and recorded by a youth group from the Centre’s program “Words 2 Live By” (Garcia 2008). The 411 Initiative for Change The 411 Initiative for Change is a non-profit organization that aims to use the arts to educate Canadian youth about “common global issues” (The 411 Initiative for Change 2007). In 2006, they created a travelling show called “The Corner” that brings HIV prevention music education to high schools across Canada. Unlike many HIV/AIDS education initiatives, the 411 not only tells youth how to protect themselves, but also tells them how to help youth suffering from AIDS in Africa. Music involves the audience. The 411 initiative “leverages [young peoples’] interest in contemporary musicians to engage them in global issues” (The 411 Initiative for Change 2007). Canadian hip hop artists Eternia and Rochester, who have both achieved significant commercial success, tour with “The Corner” and are able to engage adolescents in their message. Youth become visibly involved in the musical presentations, moving their bodies to the music and responding to the hip hop artists. The performances are interactive, inviting audiences to respond and clap or sing along. The 411 also involves the audience by encouraging youth to write HIV/AIDS prevention song lyrics and submit them to the 411, which in turn will present them to the Prime Minister and other Members of Parliament. Music engages the emotions. Hip hop artist Rochester describes the situation faced by PLWHA in Africa in emotional ways that appeal to the audience. 65 I’ve seen mothers with AIDS Babies with AIDS People climbing mountains just to get change Just to get paid They gotta do whatever They walk with the Lord but they dance with the devil And I hope it gets better before it gets worse Went to Lalibela said a prayer in a church And said why them and why not us (Rochester, Pull Up HIV/AIDS Remix 2008) The rhythms Rochester uses in the above song, “Pull Up,” engage the emotions by creating anticipation and uncertainty (Dissanayake 2006, 42). He inserts unexpected pauses before the words “better” and “worse.” This creates suspense and then release when he resolves the syncopation. The repetition of this technique creates excitement. By such methods, Rochester involves the audience’s emotions on a level separate from the lyrics. Music is culturally relevant. Research has indicated that HIV/AIDS education programs for youth must address their culture. “The reasons for using a condom are important, but a discussion about why some adolescents will not wear a condom is equally relevant” (Boyce, et al. 2003, 136). Hip hop artist Eternia articulated the reason hip hop is an effective way to bring HIV/AIDS prevention messages to high schools: “we’re speaking to them in their language,” she said (The 411 Initiative for Change 2007). It is interesting to note that Eternia is white and female, and the other presenter for “The Corner,” Rochester, is black and male. It is possible that because of this racial and sexual diversity, more adolescents were able to identify with the performers and the message they were sending. As Rochester wrote about Saskatchewan, “obviously there ain’t that much black people” (Rochester, Edutainment Tour 2008). In a mock interview during “The Corner,” Rochester describes why HIV/AIDS is an issue that is meaningful for the hip hop community: Especially in hip hop, we lost a lot of people over HIV/AIDS. Look at artists like Eazy-E … he ended up dying of the flu. How crazy is that? …And probably at the 66 peak of his career. It just goes to show it can hit anybody, no matter where you are. (Eternia, Cross-Canada with Eternia 2008) Music is therapeutic and empowering. The 411 aims to “empower young people as agents of change” (The 411 Initiative for Change 2007). The program demonstrates that young people are drivers of change and tells them that they can make a difference in the world. As the host of “The Corner” says at the conclusion of the performance, “when it comes to HIV and you, it is completely preventable; you just have to make the right choices” (Eternia, Cross-Canada with Eternia 2008). The 411 website includes extensive advice to help anyone who wants to design a charity program to “make a difference” (The 411 Initiative for Change 2007). As with hip hop initiatives discussed above, the emotions conveyed by the songs are a call to action. The lyrics send empowering messages: “stand up and fight,” Eternia urges the students (Eternia, Cross-Canada with Eternia 2008), and “we gotta rise,” Rochester repeats (Rochester, Rise 2008). Music enhances memory. The 411 Initiative addresses misconceptions that exist among youth about HIV/AIDS, including that a cure or a vaccine exists. Surveys have indicated that these misconceptions persist despite the considerable amount of HIV/AIDS information disseminated through school health classes (Boyce, et al. 2003). By presenting this information couched within hip hop culture, the 411 is taking advantage of music as a memory aid. Once these students hear someone rap about the issues, they will be more likely to remember the facts. And in some situations, students’ health classes may not provide adequate or frequent information about HIV/AIDS (Boyce, et al. 2003, 135). Furthermore, research has indicated that youth engage in risky behaviours even if they are aware of the risks involved (Boyce, et al. 2003, 128). Ensuring that the information these youth receive is memorable is paramount, and music can help to achieve that. Of course, the information they receive must also be accurate. 67 Rochester’s song “Rise,” about the HIV/AIDS situation in Africa, includes the lyric “and they probably got a cure / but the cure cost loot” (Rochester, Rise 2008). This brings into focus a conflict between art and information. “The Corner” informs adolescents that there is no cure for AIDS; in fact, that is one of the common misconceptions that the program expressly sets out to address (The 411 Initiative for Change 2007). But Rochester’s lyric sends a conflicting message. He may have felt that “treatment” has too many syllables, or he may believe that “cure” is an acceptable and clear euphemism, and the audience is told explicitly that no cure exists for AIDS. But there is potential danger in including such contradictions, especially when misinformation about this issue already exists. Vancouver: Circle of Song The Circle of Song was a program for PLWHA in the poverty-stricken Downtown Eastside of Vancouver from 2004-2005. Run by music therapist Jeff Smith, it took place at the Vancouver Native Health Society, in partnership with the Dr. Peter Centre, and with funding from Health Canada. The Public Health Agency of Canada describes the program: In addition to music therapy and storytelling workshops for HIV-positive clients, this innovative project is providing community outreach aimed at street-involved Aboriginal youth and elders and producing an audio CD that will convey a powerful prevention message and help to build skills in this highly marginalized population. (Public Health Agency of Canada 2005, 28) This was the first music therapy program ever to receive funding from Health Canada (J. Smith 2007, 105). Music involves the audience. The premise of this program was that by using music, Jeff Smith would be able to draw people in. “Music is a great first point of contact,” he explained 68 (2008). Playing in the drop-in centre at the Vancouver Native Health Society, clients would drop in just to listen, or they would pick up a guitar, sit at the piano, or grab a drum and join in. Smith conducted outreach by spending “two hours per week with a couple of guitars in the streets, parks, churches, drop-ins, and hotels of the Downtown Eastside seeking out individuals who were slipping through the cracks of the health care system” (J. Smith 2007, 112). He described how he would go out into public spaces to perform and “allow people to come to [him]” (2008). He carried a song book and additional instruments with him, and he would invite people to choose the music or to participate in making music. The ability for music to involve strangers in a public space is a remarkable transcendence of barriers. Music engages the emotions. Participating in music-making was often an emotional experience; “participants often discussed feelings and memories related to the songs” (J. Smith 2007, 107). Smith describes making music with someone who had just spent a week injecting cocaine and heroin. The two played songs by Neil Young and improvised on themes of drugs, illness, and death. Smith describes tears pouring from this tough, homeless man’s eyes, whom most of us would have avoided, and to whom it would not occur to us to ascribe tender emotions. “But the thing is,” Smith said, “I did that often” (2008). Music allows people to connect across boundaries and open themselves up emotionally, Smith explained, “because you have to let your guard down to play music” (2008). The participants took advantage of music’s ability to express more than mere words: “The music-centered program modality enabled self-expression” (J. Smith 2007, 107). It is difficult to pin down just what precisely about music conveys emotion so readily. As Smith said, “it’s not really anything tangible, but it’s there” (2008). I found listening to the Circle of Song CD proof positive of such emotional content. The songs convey sadness, hope, and frustration beyond the content of the lyrics. The evidence of a hard life – in the true blues 69 sense of the phrase – is in the timbre of the singers’ voices. Many of the songs make use of the blues scale, associated in Western culture with genuine hard-luck stories. “Angel Eyes” by Dale Disimone and Al Gore (The Circle of Song 2005), a song about disillusionment, makes use of a number of musical devices to express emotion. A violin plays yearning interludes, mostly in its lowest register. The feeling of disillusionment is amplified by surprising, deceptive chord resolutions. The tempo doubles in the middle section for the instrumental interlude, heightening the tension with repetitive guitar motives and rising pitches. When the tempo slows to the original and the tune recapitulates, it is with a new feeling of bittersweet acceptance. Circle of Song engages the emotions in a unique way. Music is often considered a talent possessed by a select few (Dissanayake 2006, 33). But on this CD, people who are plagued by disease, poverty, and homelessness produce remarkable music. Listening to the raw emotion recorded onto these tracks is a humbling experience. It was a long time before I could listen to the CD without crying. Music is culturally relevant. As the Public Health Agency of Canada states, the Circle of Song program took place at the Vancouver Native Health Centre to help Aboriginal clients “reconnect with their native culture” (Public Health Agency of Canada 2005). Music is an important part of healing in Aboriginal culture, and is strongly linked to spirituality (Loverin 2004). In “Frank’s Tune”, written by Francis McAllister, the Aboriginal influence can be heard in the use of vocables and the background singers’ style. The lyrics articulate this link between music, spirituality, and healing: I know if my heart and my spirit are true Follow your path straight and true I can be a warrior in your plan Spreading your love, lendin’ a helpin’ hand All across your land to any man (The Circle of Song 2005) 70 But the Circle of Song was not limited to Aboriginal music or even Aboriginal people. Although the focus was “culture-specific music therapy,” Smith explains, “this musical community was comprised of the larger world music community” (2007, 106): heavy metal, Punjabi, country, and punk rock were all represented, among others. Smith explained that in keeping with the Aboriginal tradition of openness, “anyone is welcome” (2008). Accordingly, Smith called up his knowledge of “punk, jazz, hip-hop, and heavy metal genres” (J. Smith 2007, 111). He could adapt the music to suit each individual’s culture. This program was also made culturally relevant through the use of peer leaders. Individuals who expressed considerable awareness of their own issues along with a desire to help others were asked to be co-leaders of the music program. “These leaders also were to have a first hand understanding of the challenges associated with living with HIV, giving them a unique perspective not shared by non-positive economically privileged professionals” (J. Smith 2007, 110). Music is therapeutic and empowering. The Circle of Song was designed to “allow health- deprived individuals to examine their high-risk lifestyle in a culturally appropriate and non- intrusive manner” (J. Smith 2007, 103). The program enabled participants to “make music as a means of self-care” (J. Smith 2007, 106). Smith described how music enabled people to work through their personal problems. Healing takes place, Smith explained, when one’s emotions and humanity are honoured by another human being (Email to the author 2008). Musicing “enabled the therapist to reach some of the more withdrawn group members” (J. Smith 2007, 111). In his outreach sessions, Smith suggests that people were encouraged to participate because “I put myself out there – I take a risk,” so others were encouraged to “take a risk, too” (2008). 71 Music itself is empowering, Smith explained, because it allows people to reconnect with positive times in their past, and it contributes to a sense of cultural belonging. Participants would say “that’s my music, and their body language would be really proud” (J. Smith 2008). The use of peer leaders was also empowering and encouraged a sense of pride and community (J. Smith 2007, 110). Creating the final CD allowed the Circle of Song participants to “connect with professional musicians.” Removing the performers from the Downtown Eastside environment, “transcending barriers,” and placing them in the recording studio was an enabling, healthy experience (J. Smith 2008). For many, it was the achievement of a dream that they may have felt was lost (Hume 2006). Music enhances memory. Similar to the Fique Vivo program in Brazil, making the Circle of Song CD was a way for the participants to “crystallize” their experiences. After the emotionally fraught process, the “tangibility” of the CD “anchored the work they’d done and the progress they’d made” (J. Smith 2008). “Frank’s Tune,” written by Francis McAllister (The Circle of Song 2005), contributes to the creation of society’s collective memory in more ways than one. In December of 2005, McAllister died while sleeping on a sidewalk in the Downtown Eastside in sub-zero temperatures. But his song lives on, so to speak; it remains as a living testament to his memory. And by immortalizing his story in a “tough, gritty track” (Hume 2006), McAllister’s story garnered some media attention, and his experience became part of the memory of a wider society. Music has the power to wrap a memory in a context that people can relate to, and to communicate that memory beyond the borders of the people involved in its creation. Those who have never been to the Downtown Eastside can listen and feel connected with people from whom they are separated by enormous socioeconomic barriers. 72 The CD is described in news releases by the Vancouver Native Health Society and the Public Health Agency of Canada as an educational tool for HIV/AIDS. But what it really educates about is the reality of life on the streets, and the social context within which HIV/AIDS thrives. Circle of Song has given the voiceless a voice. 73 CHAPTER 5 CONCLUSIONS Lessons Learned My goal in this thesis was to provide a broad scan of music HIV/AIDS education efforts and identify elements that could be applied in Canada. The themes I have identified provide high-level elements that should be a part of any initiative: a musical HIV/AIDS education program should involve the audience, convey emotional content, be culturally relevant, offer therapy and empowerment, and be memorable. But beyond those themes, certain specific approaches emerged that significantly enhanced the efforts being made. Combating stigma must be a priority. The common “positive living” message is an effective way to de-stigmatize HIV, and it is a therapeutic and empowering message for those with HIV. It is also tied to the message that there is life after an HIV diagnosis, which is critical for encouraging people to get tested. This concept has already been embraced by the organization Positive Living North in Prince George, but it should be more widely applied. When songs are written for prevention efforts, the lyrics should be carefully crafted; accuracy is important. Even the slightest discrepancy between lyrical content and fact can cause misinformation. But this concern will never be truly addressed until popular musicians insert HIV prevention behaviours into their common dialogue. Condom use must be normalized. Being tested for HIV should also be standard practice at the beginning of any new relationship. Careful attention to lyrics within a prevention initiative is the first step in this direction, but until prevention behaviours are normalized, there will continue to be a conflict between HIV prevention songs and other popular music. 74 Furthermore, lyrics should be explicit. To be effective, songs must convey their subject matter clearly. Euphemisms or indirect allusions only propagate taboos and encourage silence. Music may be able to help erase taboos, as things can be said in song that are unacceptable in speech. But for this to happen, governments must support their artists, or artists must become brave. HIV education songs should be recorded. In the case of a small-scale, face-to-face intervention, the participants should produce a recording. And in the case of a large-scale, mass media intervention, the songs should be released commercially. Commercial releases should preferably be an entire album including other works by the artist, rather than an isolated single: research has shown that those engaging in risky behaviours are less likely to expose themselves to risk-reduction songs. Regardless of the transmission method of the intervention, a recording offers a number of advantages. The recording process is empowering and therapeutic for those involved. The recording can be disseminated in novel ways and the messages can reach an audience beyond the borders of the intervention. It can be replayed at will, further entrenching the message in long-term memory. And finally, a recording will remain for long after the program has ended, and can act as a vehicle for memory creation. Even in a large society, where indirect transmission is a cultural norm, the initiative should contain a participatory element. The A Minute Contest took place through indirect transmission: it was promoted on television and online, and the participants submitted their entries by mail, electronic or otherwise. Only the contest winner actually met rapper Common in person. But by seeking submissions, the initiative encouraged interaction and participation. Music HIV/AIDS prevention efforts require long-term commitment. The Circle of Song program was shown to be effective and meaningful, but its funding was cut after only one year (Hume 2006). As a result, much of the progress made was reversed, as marginalized populations need continuous support to avoid risk behaviours. Furthermore, funding must not only be stable, 75 it must also be sufficient. The drain on the music therapist running the Circle of Song was considerable and made the project unsustainable beyond the year. If such a program is funded again, it must be with enough resources that the program directors themselves can also receive support. A plea that emerged repeatedly in my research is that targeting HIV/AIDS is not enough. The desperate social situations that promote HIV risk behaviours must be resolved. As Jeff Smith, the music therapist who worked in Vancouver’s Downtown Eastside, said: The real issue is poverty. They’re not singing about disease. Not to diminish the role HIV plays in their lives, but there are so many other issues. When they’re just struggling to survive, struggling to get their next fix, HIV is just one more thing. It’s a social issue, with the lack of support and lack of equality. Racism is still a big problem, you don’t think you see it, but it’s there. (J. Smith 2008) Final Thoughts At the same time as it is striking that there are so many HIV/AIDS music initiatives taking place around the world, it is also remarkable that there are not more. 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We will advise you. Everybody should be tested, that is the best way. Solo: AIDS does not distinguish. Even if you are a doctor, a nurse, or a government leader, it can still attack you. Response:  If you find that you are already infected, you have to accept it and look for wisdom. South Africa Artist: Mario “Mr. Devious” van Rooy Source: (Bosch 2006, 39-40) We’re caught up in a war against a chemical weapon that’s unseen There’s no escape once it enters your bloodstream There’s a killer with no prime directive to come clean Only life support system is knowledge of what seems to be Super STD, scientifically designed to wipe out you and me We not free It’s set to decrease the population of the planet But how do we stop population understanding What we’re dealing with is an articulate plan 87 Sent to destroy nations In various variations You people might think I’m making serious accusations My theory exists due to previous regulations So play close attention, receive this information There’s 4 million people infected in this country alone 33.6 million across the globe The death toll increases ten fold So I’m telling you about a crisis Because we’re dealing with human deficiency virus Attacking the immune system at a rapid pace And yo! It might be too late before we act with haste What we’re dealing with is a master plan If you’re seeing this you’re seeing past the scam The crisis is a virus created by man Most people would tend to disagree with my theory And I might be assassinated if some governments hear me But I’ll say this anyway AIDS is man made They tried killing us before with guns that’s man made Isn’t cyanide a weapon What about atomic bombs Isn’t that man made Made to harm men, women and children Isn’t this virus on the same mission to kill them Breaking down the immune system of its victim ‘til there’s nothing left except your last breath I could think of a thousand more conspiracy theories Enough to split in a series If you’ve been waiting to hear these I suggest you adjust your earpiece For the truth is While we’re pointing fingers and trying to chill There’s people out there infected and dying for real People afraid to be tested denying they’re ill People on the verge of a breakdown, relying on will Trying to deal with misinformed people’s prejudices feelings toward them If society refuses to pay attention to this problem then I’ll force them The deal is AIDS is more than what your average sexually transmitted disease is It’s evidently killing our species By the next millennium there’ll be zero population left I guess the current synonym for copulation’s death The shit we’re facing, this current situation It’s a must that I drop these stats to this misinformed nation The only way you get AIDS is by sleeping around unprotected Next thing you know you’re six feet deep in the ground come and check it You can only get AIDS from contact with blood Or the transfer of semen from a partner to another Even a baby can get infected by its mother 88 Make sure you apply the correct use of a rubber For instance when you open use your fingertips to tear the cover Don’t use it you might shred it Make sure the condom tip contains air and check the expiry date If it’s old don’t go there, oh yeah You can’t get AIDS from animals or mosquito bites You can’t get AIDS from going to the dentist or sharing the same glasses You can’t get AIDS from cutting your hair or breathing the same air Or sharing cutlery with a person with HIV hopefully I’ll make you see Having sex while standing does not prevent infection Neither does pulling out your penis before ejaculation So go ahead and laugh at this You can still get AIDS if you have sex and pee afterwards That’s my verse If you confused, rewind and go back ‘til you understand the lyrics in this rap. Get that? Artist: Mario “Mr. Devious” van Rooy Song: Don’t Front Source: (Bosch 2003, 195) The hard thing to tell me, please is this my curse This tune in my head is slowly killing my nerves On top of that my friends left me in the lurch I sit and drink and I curse Sit and think and a burst in to tears Deep in depression I think that it’s worse But I’m not ready to leave got things to achieve on this earth When I sleep I have nightmares about how my family will grieve I wake up in the morning and I look at my But this knop [lump] in my throat leaves me unable to speak AIDS is a killer this statement is deep Instead of spitting phlegm I spit blood when I cough If you’re going to front don’t front on me Rather front on this virus called HIV The cap on TV says I must hope and maintain But tell me how on earth can I cope with this strain When my friends don’t visit me It’s like I lost my dignity ‘til the very end He’s now spreading rumors They’re afraid I might spit or cough and they might catch it too They’re afraid to even hug me or walk through my avenue I can tell by my family’s attitude They’re ashamed to even say I have this virus They say I’ve got cancer an infection in my sinus It’s already a crisis to fight this virus 89 On top of that I have to deal with high prices Pharmaceutical companies When all they really want to do is make a bunch of money This is a summary of all I must endure I’m a HIV positive victim faced with a test I’ll explain my prerogative before they lay me to rest You think you’re different coz this virus didn’t show up on your test I’m seen as evil by people who know I’m depressed I’m already lying on the ground and they’re kicking me in the chest I’m walking around fighting for dignity in distress Is it ignorance or prejudice leaving the people vexed You best believe what you read take a peep at the stats One thousand six hundred people’s infected daily Not only by sex but needles injected maybe You need to take the test yourself then check your attitude Coz someone in your family even you might have it too Artist: Anonymous Song: Ek is wyn Source: (Bosch 2006, 40-41) Original text: Ek se jy, ken jy vir my? Jy, raak wys, ken jy vir my? Ek se jy, ken jy vir my? Raak wys Ek stiek uit soos ’n chameleon Ek is nou hier langs jou Dans ek soema binne in jou TV in ’n verkleremannetjie in die verkere company Ek change color soos groen bruin en blou Ek is alles waarvan jy hou Ek is die downfall van ’n bruin ou In die township is ek ’n main ou Ek is daai ding wat die working class in die werk hou Ek is die rede hoekom baie predekante kerk hou Ek is trouble, en ek lyk om te sien hoe onskuldige mense struggle Ek is die cause van die violence en hoekom it aanhou Ek is die rede hoekom prostitutes aan mans klou Ek is die rede hoekom brasse jou sal rob en skop sonder ophou En as die nood druk, dan stik ek naad soos a speld En ek is die rede vir daai bra se demise op die veld As ’n laaitjie toet jye my verloor het, het jou tannie jou hard geneek met die beld deur my want ek is geld Nou net as jy check jy’d my uitge figure se ek haaties, ek change in daai ding wat jy invat by parties Ek is daai ding wat a waai bring 90 Ek laat jou verbeel jy kan kwaai sing I can even make you cry vrind Of Engels praat en laat afbriek Ek is die rede hoekom jy daai bra wil hard steek Ek is die rede dat jy Sondag oggende laat kip En ek is die rede hoekom jy die laws wil ’n kaard skiet But dit baat nie Met daai asem sal jy dit noe maak nie Met my in jou system is jy totally reckless Ek is ’n alcoholic se supper lunch en breakfast En as jy jou motjie klap sal jy vir my blame Ek laat die pyn verdwyn want ek is wyn Ek’s a tool van oppression In die form of a chemical warfare experiment Ek is Wouter Basson se blerrie kind Ek laat jou omkap as ek jou mond vat Ek slat jou long pap en jy… jou sopnat as jy die grond vat Ek is ’n … en ek dra die ghetto se kroon Ek is ’n gangster se droom Hulle meng my met boom Ek’s a button, but I can change into a flake Ek is… Hoe lyk jy vir my … sys nie a mens nie sys net a meit. Ek is die rede hoekom jy ha wil gryp en rape Ek is geld, buttons wyn en rape … fingerprints Ek is ignorance English translation: I say, do you know me? Wise up, I stick out like a chameleon Now I’m here next to you, then I’m inside your TV A chameleon in the wrong company I change color like green brown and blue I am everything you like I am the downfall of the brown man In the township I’m the main guy I’m that thing that keeps the working class in work I am the reason many priests hold church services I am trouble, and I like to see innocent people struggle I am the cause of violence and why it persists I am the reason prostitutes cling to men I am the reason guys will rob and kick you without stopping I am the reason for the guy dying on the field As a child you lost me and your mom beat you with a belt because of me because I am money Now just as you think you’ve figured me out, I change into that thing you take to parties I am that thing that brings noise I make you imagine you can sing well 91 Friend, I can even make you cry Or speak English and break down I am the reason you want to stab that dude I am the reason you sleep late on Sunday mornings I am the reason you want to cheat the law, but it’s not worth it With that breath you’ll not make it You’re totally reckless with me in your system I’m an alcoholic’s supper, lunch and breakfast And when you beat your wife you blame me I make the pain disappear because I am wine I’m a tool of oppression In the form of a chemical warfare experiment I am Wouter Basson’s51 bloody child I make your lung collapse I wear the ghetto’s crown I am a gangster’s dream They mix me with other drugs I make you say she’s not a person, she’s a bitch I am the reason you want to grab and rape her I am money, drugs, wine and rape I am ignorance. 92 APPENDIX B SONGS FROM INDIA AND CHINA Mumbai Artist: Humsafar Trust minstrels Melody: Jooth Bole Kaua Kate (The crow bites when you lie) Source: (UNESCAP 2003, 47) We have a small message, beware of AIDS Together we’ll get rid of it, you can say When you go to the doctor, you let him check you When you want to have sex, let us tell you You can save yourself from this disease We have a small message, beware of AIDS China Artists: Community Health Programme Song: Eiqziilbif e Caldoq (艾滋病歌) Source: (Leong 2008); English translation by James Clark (Clark 2008) Aqyivq meilnaol qiq mavq ei eiq! 父老兄弟们啊 Galhhu huvqlaq laoq haqssiiq haqlaq guv. 当今社会最怕豹子老虎 Eiqziilbif nalgol mol haqssiiq hultav zeiq,haqlaq hultav zeiq. 如今艾滋病胜过豹子,老虎 Eiqziilbif nalgol mol byuqtaoq taoq nia nga, 艾滋病在潜伏期 Maq hu duv qivq meil, 看不出来的 Tyultaq laoq colqoq yaol aqzeiq dovq lal nga. 这时更容易传染 Aqyivq meilnaol ei eiq, 父老兄弟啊 Dovq leil dovq alngaoq sil ngeel naq ei eiq. 染上了艾滋病就死路一条 Meiqloq kovdul meiqciivq sevssaq hhovqma taq aol tavq. 93 别共用牙刷刮胡刀和针灸 Sivq nei dovq lal qivq, 血液能传播 Nalheiq taq taoq miaoq. 别接近伤口 Duvqzal daoqpei taq niq li jil, 远离毒品 Aqyivq meilnaol ei eiq! 父老兄弟啊 Qiq hhaq daoqpei yossil jil, 守信最重要 Qiq bol tavq a koqdovq ssivq. 夫妻互相要尊重 Miqyo naogo ceil. 男女更要守 Miqlaol maq lal laoljo jo. 预防为主 Eelziiq maq lal laolkaol seil. 预防,预防还是要预防 Yoqhhaq e laolkaol mol ssaonei diq cyuq zaq. 生命最宝贵 Elders and brothers! Present society most fears the leopard and the tiger. Today AIDS exceeds the leopard, exceeds the tiger. AIDS in its incubation period Cannot be seen, In this moment it is even easier to get infected. Elders and brothers, Having caught AIDS you right away have begun the road to ruin. Do not share toothbrush, razor and acupuncture needle. Blood can spread, Do not get close to a wound. Stay removed from drugs, Elders and brothers! Keeping promises is the most important, Husband and wife each other must honour. Man and woman still more must observe the rules. Prevention relies on Precautions, prevention still3 requires precautions Life is the most precious.  3预防 means to prevent, to take precautions against, to guard against, to protect. The phrase means that prevention requires precautions but the Chinese character version is a play on words, that "yu fang needs yu fang" with a pun of sorts on the alternate meanings of yu fang (Clark 2008). 94 APPENDIX C SONGS FROM THE U.S. Hip Hop and African Americans Artist: Common Author: Jose Rivera Album/Event: A Minute Contest Source: (Henry J. Kaiser Family Foundation, A Minute Contest 2008) get tested for HIV no need for livin blindly doubt todays the perfect timing do it for your self do it for your family do it for your friends do it for humanity afraid of needles when gettin tested now theres diffrent methods depending on your preference your afraid of what people might say but those people cant assure you you'll live another day you can go alone or go with a partner knowing can help make your relationship stronger so remember it only takes a minute to decide 3 million people infected worldwide so go get check dont make it so complex and always remember to have safe sex Reprinted with permission of Kaiser Family Foundation and MTV Networks. Hip Hop and Urban Youth Artists: SWAAT Song: “Life Is Too Short” Source: (Lemieux 2003, 116) Yo. The Millenium is here. Right here son. It has brought fear to the hearts of many. Much fear. With monsters like AIDS fighting a war for souls. Lucky for earth, SWAAT is on patrol. It’s time to fight back. This deadly disease can lead to a demise Oh, you already know cause it ain’t no surprise The acronym AIDS basically means disaster To end a young beautiful life even faster 95 No matter how you got it, from sex or transfusion There’s enough information to stop the confusion, and start the fusion Prevention is an important issue affecting people like me and you So what you gonna do? AIDS a disease of terrible nature There’s no explanation it’s killing our generation People like you and me under one nation I’m ready for war against life and death Save your breath Enough about this issue People like you don’t care about inner tissues Make right decisions and ask yourself a question Do you wanna die? How can you live with that reflection? Life is too short To throw it all away That’s why we use a shield Or we choose to wait AIDS invincible? Read the headlines Spreading to millions, killing off thousands at a time Slow death made worse by hope for life Kills without use of words, guns, slugs, or knives Feeds off the youths inability to see That AIDS has no soul and spreads aggressively The mighty monster has a flaw that can take it down And hopes no one has the gall to take away its crown Scared of us, just like we’re scared of it Use latex, stop having unprotected sex I can’t get it? My friend I recommend you think twice ‘Cause headlines and statistics prove otherwise so stay wise Killing off millions and counting Men, women, and children are drowning But SWAAT is on patrol now, the alarm is sounding AIDS is a lock and the key is the truth HIV transforms to AIDS like Clark Kent in a phone booth But not slick enough, prevention is its weakness Together we can beat this I spit this food for thought For all of y’all to eat this. Life is too short To throw it all away 96 That’s why we use a shield Or we choose to wait SWAAT without a shield is like me without these lyrics Or going to church without the presence of the holy spirit Questionable is your status when you choose to be blind you’re losing your mind AIDS will catch you straight from behind So improvise – Don’t be a victim of circumstance Make sure you wear the suit when you and AIDS choose to dance Dodging infection, SWAAT – We stay protected Grabbing protection to keep from getting infected And that’s the message The number of lost lives grows among us everyday Because of wrong decisions and the games that people play SWAAT is on patrol and we’re here to lead the way So we use a shield, or we choose to wait Put these words in your heart Think about ‘em very hard Hear them ringing in your ears and let everybody know That the SWAAT is on patrol and we’re here to show the way So we use a shield or we choose to wait. Life is too short To throw it all away That’s why we use a shield Or we choose to wait 97 APPENDIX D SONGS FROM CANADA The 411 Initiative for Change Artist: Rochester Song: Pull Up HIV/AIDS Remix Source: (Dawit 2008) I’ve seen mothers with AIDS Babies with AIDS People climbing mountains just to get change Just to get paid They gotta do whatever They walk with the lord but they dance with the devil And I hope it gets better before it gets worse Went to Lalibela said a prayer in a church And said why them and why not us They give them so little but they need so much They need more books they need more schools They need more drugs they need more food They need less crooks they need less fools They need Rochester to show yall the truth It sounds so sweet but most can’t see If we get up then together we will succeed So follow my lead Get your hands high Everybody here wave em side to side Artist: Rochester Song: Rise Source: (Dawit 2008) I wish some of ya'll could see what I've seen been where I've been then you'd understand how the other side lives we got it so good but the most don’t know it they trying to get by we trying to sip Moet champagne dreams big money schemes while the people over there ain’t got no food to eat 98 cause they trying to survive off a dollar a day when we got $6.85 as our minimum wage living in a cage locked up with AIDS that HIV be killing em slowly and they probably got a cure but the cure cost loot so buy food or use is the catch 22 put yourself in they shoes what  you gon do can't ask for help cause they just like you Cause over there its a short stop either you selling what you got or you end up in a pine box and thats just everyday life ya'll and seeing that takes me back to what i picked up the mic for It ain't right ya'll but we can change it it only takes a spark to get a fire blazing get up out the matrix maybe they can make it look at what we facing before we turn our faces face it its like the whole world needs a facelift we one race no matter what color they face is Chorus: We Gotta Rise (x8) And we calling it the motherland That ain’t right cause i would never treat my mother just like they was any other man I got love for my brother man And I ain’t trying to see em end up being 6 feet under it Now-a-days i got my eyes wide open This epidemic got the whole world choking I think its time we put the plan in motion Let operation 411 be the outcome We can’t let it take em out bra’ And desecrate all the land where every man started out from From Botswana To Uganda Senegal and all across the Sahara 60 mill sick 20 mill dead that’s a whole lot of graves they dun laid to rest if AIDS is a game I ain’t played it yet 99 cause once its game over you don’t play again but if we get up out the matrix maybe they can make it look at what we facing before we turn our faces face it its like the whole world needs a facelift we one race no matter what color they face is Chorus: We Gotta Rise (x8) Rise Up (x8) Circle of Song Artist: Francis McAllister Song: Frank’s Tune Source: (The Circle of Song 2005) There’s a fire burnin’ down deep in my soul I’m just a child that needs to grow Thirty-seven years now and nothing to show Ah, there’s gotta be a better way to go Sick and tired of lookin’ out at your world From the side of these prison walls Chorus: I know in my heart and my spirit are true Follow your path straight and true I can be a warrior in your band Spreading your love, lendin’ a helpin’ hand All across your land to any man Spent too much time in my short life Puttin’ my troubles on my brothers, mothers and others It’s time I started lookin’ in the mirror There’s only myself, can’t blame no others here Please show me the way, show me your path I’ve been long gone but I wanna come back Chorus Hey hey hey hey, etc. You’re a calm, loving creator This I come and hold to you Hey hey hey hey, etc. 100 APPENDIX E The University of British Columbia Office of Research Services Behavioural Research Ethics Board Suite 102, 6190 Agronomy Road, Vancouver, B.C. V6T 1Z3 CERTIFICATE OF APPROVAL - MINIMAL RISK PRINCIPAL INVESTIGATOR: INSTITUTION / DEPARTMENT: UBC BREB NUMBER: Michael S. Tenzer UBC/Arts/Music H08-00481 INSTITUTION(S) WHERE RESEARCH WILL BE CARRIED OUT: Institution Site UBC Vancouver (excludes UBC Hospital) Other locations where the research will be conducted: Offices of BC AIDS support organizations with musical outreach intiatives. Africa Community Technical Service offices. CO-INVESTIGATOR(S): Emily M MacKinnon SPONSORING AGENCIES: Social Sciences and Humanities Research Council of Canada (SSHRC) PROJECT TITLE: Music as an Educational Tool for HIV/AIDS - A Comparative Study. CERTIFICATE EXPIRY DATE:  April 25, 2009 DOCUMENTS INCLUDED IN THIS APPROVAL: DATE APPROVED: April 25, 2008 Document Name Version Date Protocol: Research Proposal N/A April 17, 2008 Consent Forms: Consent form 2 April 23, 2008 Letter of Initial Contact: Letter of initial contact 2 April 23, 2008 The application for ethical review and the document(s) listed above have been reviewed and the procedures were found to be acceptable on ethical grounds for research involving human subjects. Approval is issued on behalf of the Behavioural Research Ethics Board and signed electronically by one of the following: Dr. M. Judith Lynam, Chair Dr. Ken Craig, Chair Dr. Jim Rupert, Associate Chair Dr. Laurie Ford, Associate Chair Dr. Daniel Salhani, Associate Chair Dr. Anita Ho, Associate Chair

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