Singing For Life

HIV/AIDS and Music in Uganda

Gregory Barz

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781136733246
• Edition: 1
• Topic: Médias et arts de la scène
• Subtopic: Musique

Efforts within the past decade to address the HIV/AIDS pandemic in sub-Saharan Africa have dealt with HIV/AIDS principally as a medical concern—despite the fact that doctors continue to be confronted with the complex relationship of the disease to broader social issues. When medical and governmental institutions fail, artists step in. Contemporary performances in Uganda often focus on gender and health-related issues specific to women and youths, in which song texts warn against risky sexual environments or unprotected sexual behavior. Music, dance, and drama are principal tools of local initiatives that disseminate information, mobilize resources, and raise societal consciousness regarding issues related to HIV/AIDS.

Through case studies, song texts, interviews, and testimonies, Singing for Life: HIV/AIDS and Music in Uganda examines the links between the decline in Uganda's infection rate and grassroots efforts that make use of music, dance, and drama. Only when supported and encouraged by such performances drawing on localized musical traditions have medical initiatives taken root and flourished in local healthcare systems. Gregory Barz shows how music can be both a mode of promoting health and a force for personal therapy, presenting a cultural analysis of hope and healing.

1

HIV/AIDS, JACKFRUIT, AND BANANA WEEVILS

Music and Medical Interventions in Uganda

I can hear wailing and people crying for help

We are all in danger, Ugandans

Let us pull up our socks—those who are still alive

Let us fight the disease that wants to destroy us

Many diseases have come to torture and mercilessly kill both the old and the young

Now is the time for those of us who can see into the future to stand and fight our hunters

Woe to us, woe to parents who bury their offspring

Our heads drip with pain

Who will bury us?

Who will help us when we are old, in the future when our bones are brittle?

Ah, wasteland, those villages that used to be inhabited

—Song performed at Meeting Point Kampala, Uganda

AT THE TIME OF THIS WRITING, 38 million people are infected with the HIV virus worldwide. Of this figure, over two-thirds, nearly 67 percent—or roughly 25.3 million children and adults—live in sub-Saharan Africa. Moving beyond the charts and diagrams that map global HIV infection rates, many more are affected by the HIV virus in African countries such as Uganda, where orphaned children, spouses, and entire communities suffer the affects of this deadly disease. According to a recent United Nations report, the best statistics among African nations reflect only a stabilization of overall infection rates. Such data are often eclipsed, however, by the staggering rise of HIV infections rates in countries such as South Africa, Namibia, Zimbabwe, Swaziland, and Botswana.⁶ HIV prevalence rates in sub-Saharan Africa confound any reasonable attempt to comprehend infection rates. As recent UNAIDS (Joint United Nations Program on HIV/AIDS) statistics demonstrate, the majority of Africans live in a world grossly out of sync with global infection rates. By the end of 2003, the UNAIDS 2004 Report on the Global AIDS Epidemic issued the following estimates for HIV and AIDS prevalence by geographic area:

North America	1,000,000
Caribbean	430,000
Latin America	1,600,000
Western Europe	580,000
North Africa and Middle East	480,000
Eastern Europe and Central Asia	900,000
East Asia	900,000
South and South-East Asia	6,500,000
Oceania	32,000
Sub-Saharan Africa	25,000,000

One country, however, continues to stand out since its initial, alarming infection rates were first documented—Uganda. The Republic of Uganda in East Africa, bordering Lake Victoria, stands outside all attempts to confound HIV infection rates. It is the single sub-Saharan African country that has successfully demonstrated a remarkable, constant decline in overall infection rates over the past years (see Table 1.1).

What makes Uganda unique in this regard? There are many ways to respond to this question due to the fact that many factors have contributed to the remarkable decline experienced in Uganda. Singing for Life focuses on a comprehensive, critical contribution that has developed as a significant response since start—music. Men, women, and children, traditional healers, witch doctors, and herbalists, as well as urban and rural residents alike all sing their response to AIDS, and have done so for quite some time. From the start, many Ugandans adopted the task of spreading information about the virus and disease within contexts of indigenous and newer popular forms of music, dance, and drama. Singing and dancing have, therefore, been among the earliest medical interventions introduced in the country concerning HIV. Within songs and dramas, Ugandans educate, care for, and console one another through music, and they have done so for decades.

Most studies of prevention programmes in low and middle-income countries indicate that effective behaviour-change projects include educational and communications components, using a range of media, from traditional theatre and music, to global television and radio networks (Merson et al. 2000). Countries that have significantly reduced rates of new infections have typically invested heavily in AIDS education and awareness initiatives. (quoted in UNAIDS 2004 Report on the Global AIDS Epidemic, 14)

Table 1.1 UNAIDS Estimates of Adult (15–49 years) HIV Prevalence Rates 1997–2001

Country	1997	1999	2001	Difference in Rates 1999–2001
Botswana	25.1%	35.8%	38.8%	3%
Burkina Faso	7.2	6.4	6.5	0.16
Burundi	8.3	11.3	8.3	−3
Cameroon	4.9	7.7	11.8	4.1
Central African Rep.	10.8	13.8	12.9	−0.9
Congo	7.8	6.4	9.7	3.3
Cote d’Ivoire	10.1	10.8	9.7	−1.1
Dem. Rep. of Congo	4.4	5.1	4.9	−0.2
Ethiopia	9.3	10.6	6.4	−4.2
Ghana	2.4	3.6	3	−0.6
Kenya	11.6	14	15	1
Lesotho	8.4	23.6	31	7.4
Malawi	14.9	16	15	−1
Mozambique	14.2	13.2	13	−0.2
Namibia	19.9	19.5	22.5	3
Nigeria	4.1	15.1	5.8	0.7
Rwanda	12.8	11.2	8.9	−2.3
South Africa	12.9	19.9	20.1	0.2
Swaziland	18.5	25.3	33.4	8.1
Togo	8.5	6	6	0
Uganda	9.5	8.3	5	−3.3
Tanzania	9.4	8.1	7.8	−0.3
Zambia	19.1	20	21.5	1.5
Zimbabwe	25.8	25.1	33.7	8.6

Source: UNAIDS (cited in R. Bennell 2003, 2).

The popular response to HIV in Africa—often translated in dramatic fluctuations in pie charts and statistical diagrams—confounds many in the scientific communities as more Ugandans adopt positive behavioral changes in response to the threat of the AIDS pandemic.⁷ I provide several definitions that help ground my usage of terms such as “pandemic” and “epidemic” throughout this text:

An epidemic is a rate of disease that reaches unexpectedly high levels, affecting a large number of people in a relatively short time. Epidemic is a relative concept: a small absolute number of cases of a disease is considered an epidemic if the disease incidence is usually very low. In contrast, a disease (such as malaria) is considered endemic if it is continuously present in a population but at low or moderate levels, while a pandemic describes epidemics of world-wide proportions, such as influenza in 1918 or HIV/AIDS today. (Barfield 1977, 150, quoted in Barnett and Whiteside 2002, 25, emphasis added)

UGANDA’S UNIQUE RESPONSE

A fertile, landlocked, water-rich nation of twenty-five million people, Uganda is currently governed by the National Resistance Movement—or NRM—a political organization⁸ led by President Yoweri Kaguta Museveni. Nearly one-third of the population—and well over one-half of the total female population—is undereducated. The average fertility rate is seven children per woman in Uganda. The majority of the population exists on US$60 per month. It is estimated that 1.1 million Ugandans currently live with HIV or AIDS. Each year approximately 110,000 individuals die from the disease, which is transmitted for the most part through heterosexual intercourse.⁹

President Museveni seized control of the country in a bush war ending in 1986, and he promptly sent his soldiers to Cuba for further military training. The Cuba-based soldiers underwent routine physical examinations shortly after their arrival and it was soon revealed that over one-third of the troops were in fact HIV positive. As Greg Behrman suggests, Museveni rejected the early denial of AIDS demonstrated by other African countries and embraced an open, multisectoral response:

The country’s leader, Yoweri Museveni, had only recently seized the reins of political authority via military coup in January 1986. Having replaced the notorious despot Milton Obote, Museveni’s regime was green and not yet entirely stable when he started to receive deeply disturbing reports from senior military officials. Fidel Castro, it seemed, citing incidence of mysterious, debilitating, and seemingly infectious disease, was returning Ugandan soldiers from Cuba, where for years they had gone to be trained. The reports jolted Museveni, still enormously reliant on the strength and stability of his military. It was the bulwark of his fledgling regime. Unlike almost all of his political contemporaries around the continent, Museveni did not indulge in denial. Losing little time, he launched an ambitious multisectoral—government, industry, religion, and civil society—effort aimed at combating the disease. Early acknowledgment and leadership would, over the following decade, make Uganda the archetypal success story. Museveni’s early and comprehensive response helped curb the pandemic. (2004, 43)

The Ugandan president, new to his leadership of the country, had no formal health-care training or medical expertise. Realizing that he was in the middle of a severe medical catastrophe, Museveni launched a tireless campaign—with little outside funding or support—to address the scourge of AIDS in his country. At the time, AIDS was more often referred to as Slim (a verbal truncation of Silimu), due to the wasting effects the disease had on patients. The program established by Museveni became known as “ABC,” and has subsequently been embraced by the Bush administration as the “answer” to addressing the AIDS crisis not only for Uganda, but for Africa as a whole.¹⁰ According to Behrman, the ABC program “called on people, first to abstain from non-marital sex. If they wouldn’t abstain, they must be faithful … if they wouldn’t be faithful, they must use a condom” (2004, 113).

Practice Abstinence

B e faithful¹¹

Use Condoms

The ABC program has penetrated deep into the programming and curricular initiatives of educational institutions throughout the country, through national mandates for primary and secondary school education. An excellent example of how far this program has reached can be seen in the simple drama I recorded in the western town of Ishaka at the Kashenyi Model Primary School (see Figure 1.1). The English translation is transcribed below.

Kashenyi Model Primary School, Ishaka Drama

Knock on the door

Father: Oh my children, please come in. Good evening Shira (She...