French television has been broadcasting health magazines since the 1950s, that is from the beginnings of television in France. Health magazines can be defined by their topics, exclusively related to health, and their regular broadcasting, on a daily, weekly, monthly basis.1 These health programmes generally tend to invite doctors and to promote medical power and discourse, leaving a limited role to patients or their representative associations.2 One health magazine however intended to provide both non-medical and medical discourses. The producers were hoping for a change from the usual paradigm, by giving more voice (and time) to patients and witnesses.3Sidamag, as it was called, was broadcasted in the mid-1990s and talked exclusively about AIDS, with an emphasis on preventive measures. In 1995, French public television programme directors asked Emmanuel Hirsch (a radio producer at France Culture at that time) to create a magazine that would talk about AIDS to a young public. Sidamag objectives were thus very unusual for a health magazine: to valorize non-medical perspectives, address only one illness and ways to prevent it, and speak to one specific target group.4 Not only did the Sidamag producers hope to give more agency to witnesses and patients in a health show, but they also believed that television might positively influence youth behaviour.
The Sidamag experiment was however short-lived and the magazine lasted less than two years. No other health magazine has since been designed for a given public and for a given illness in France. The present study assesses Sidamag content in terms of non-professional versus professional discourses on prevention and to analyse if and how the Sidamag objectives were achieved.
Extensive studies of French television programmes are possible due to the consistent archiving of television by the National Audiovisual Archives (Institut National Audiovisuel, INA). As for Sidamag, all episodes are fully available in the INA digital archive database, the Inathèque, and thus may be used to assess how the producers wanted to maximize messages of preventive measures, alongside the AIDS prevention campaigns regularly broadcasted in the 1990s. These archival sources have been complemented with an interview with Emmanuel Hirsch, the main producer of Sidamag, that I conducted in May 2020. In the following, no images featuring a witness will be provided. For ethical reasons and respect for those appearing on the programme the descriptions here are largely limited to textual description.
2 Before Sidamag: AIDS on Television in the 1980s and early 1990s
The first AIDS cases were reported in 1981, at first in the USA, several months later in Europe. In the 1980s, France was the European country with the highest rate of HIV-contamination. Although fully aware that all people with AIDS are HIV-positive, but not everyone HIV-positive has or ever develops AIDS, I’ll use these two expressions as synonyms in the present study, for no other reason than reading fluency. French television addressed AIDS in news programmes, talk shows, political shows, medical shows, prevention campaigns and fiction productions, initially somewhat shyly in the 1980s at the time of the epidemic onset, then more overtly later on.5 However, television magazines did not play a privileged role in AIDS communication:6 in fact, television began to regularly talk about the acquired immunodeficiency syndrome more than 3 years after the printed press. The medical press was the first to engage in AIDS communication and later on, the most important French daily national newspapers of the 1980s (Le Figaro, Le Monde, Libération, La Croix) were also very active, but more on the political and societal aspects of the issues.
Concurrent to this devastating and worldwide health issue, the AIDS epidemic was the subject of two major debates in France. One was tied to a furious battle between a French lab and an American lab for research supremacy, a debate that would eventually involve both France and USA political leaders. Indeed, many reports on AIDS on television in the 1980s talked of the dispute over the AIDS virus discovery between Robert Gallo in USA and Luc Montagnier in France.7 In the 1980s, the battle was extremely fierce and found communication relays both in newspapers and television.8
The second debate in France was related to the scandal of HIV tainted blood, first revealed in 1991 by Anne-Marie Casteret,9 a journalist from L’évènement du jeudi, a weekly print magazine. In short, “the case stirred outrage in France after an official investigation showed that senior health officials had ordered the continued use of the blood-clotting factor that haemophiliacs need even though the officials knew it to be contaminated at a time when procedures to detect and eliminate the virus were already available.”10 It was a public health scandal with tremendous consequences at a political level and it received wide press and television coverage. In reaction to these political and societal debates, French television shows in the 1980 and 1990s were extensively modifying their content and giving more voice and visibility to so-called ‘regular people’, talking of their life struggles (divorce, handicap, death, etc.).11 In the 1970s, television health magazines would probably have mostly used medical expertise and advice to talk about this new epidemic. But in the 1990s, television was addressing medical subjects more and more outside health magazines, and AIDS victims were mostly seen in non-medical magazines. Such shows indirectly contributed to AIDS communication to the main public, through reports presented individual lives and not information about HIV infection and prevention per se. One show in particular, called Mea culpa broadcasted on TF1 on 11 March 1992, received tremendous press coverage; the printed press journalists expressed discomfort towards a programme based on intimacy exposed on television, however the show had high viewership. It featured locals from a French village and the parents of a 9-year-old boy, who died of AIDS after being infected by contaminated blood, who had been refused admittance to his local school.
After receiving contaminated blood-clotting factor in the 1980s, many haemophiliac children were HIV-positive.12 AIDS was, however, more commonly portrayed as a sexually transmitted disease on television, although it was most commonly associated with homosexuality despite governmental prevention spots stating the necessity for everyone to take preventive measures. HIV-infected homosexuals were interviewed on French television, in non-medical programmes. To give two examples, Jean-Paul Aron was a well-known philosopher who was exposed publicly as being HIV positive in October 1987 in Express,13 an influential printed magazine and on television on 21 June 1988.14 Hervé Guibert was a young writer whose book sales went from marginal to phenomenal after his interviews in television literature shows15 for his autobiographical books on his HIV infection published between 1990 and 1992.16 His autobiographical non-fiction film titled Pudeur et Impudeur [Modesty and Immodesty] that related his physical deterioration was broadcast on TF1 in 1992 after his death.17
In the mid-1980s, producers believed television could play a role in preventive health and individual healthy practices. This was mainly measured by audience participation. Take, for example, a show produced by TF1 to promote organ donation in June 1988.18 The popularity of this show helped its producer Martine Allain-Regnault to convince the TF1 managers to take part in the first worldwide World Health Organisation (WHO) AIDS event on 1 December 1988.19 In the press kit for the WHO event called To live with HIV Martine Allain-Regnault emphasized the key role of television in promoting the right information at the right time and in the fight against ignorance by offering knowledge, emotion and entertainment.20 Another exceptional show called Sidaction was produced in 1994, using the telethon fund-raising format, with the ambitious goal to be broadcast by all French channels simultaneously, instead of one as for the AFM-Téléthon, the most renowned telethon in France launched in 1987.21 It was during the first edition of Sidaction, in 1994, that a condom would first be seen on television;22 it must be kept in mind that advertising condoms was prohibited in France until 1987.23
In addition to these one-shot shows, television news and magazines regularly presented AIDS-related information. A quantitative analysis of the INA archives for the present study reveals that the number of reports mentioning AIDS in television news or magazines (excluding health programmes) were highest in the period between 1994 to 1996. Qualitatively, television news spoke extensively about the tainted blood scandal, as well as the Sidaction telethon in this period and very little about prevention or medical information. In contrast, the majority of magazine programmes (including talk shows, political shows, reports magazines, etc.) focused on individual cases and only minimally addressed general medical information. A preliminary screening of these shows was helpful to categorize the type of information related to AIDS: prevention, medical information, research information and everyday life of HIV-positive people. These categories were then used for the extensive analysis of all Sidamag episodes, which I describe below.
3 The Sidamag Years
3.1 The Sidamag Producer and Editorial Board
Apart from the programmes mentioned above, official prevention campaigns were launched on French television from 1987. It was understood that they must be tailored to a specific population – youth, homosexuals, heterosexuals, etc. – and not to the general population.24 The managers of France3 (France3 is one of the French public channels) asked Emmanuel Hirsch to create a medical programme for young people.25 He seemed to be the right guy at the right time. Since 1983, Emmanuel Hirsch, a philosopher by training, had been producing a radio show entitled Les Chemins de la Connaissance [The Pathways to Knowledge] that questioned how knowledge was acquired and diffused. As a philosopher, he has been very much involved in ethics in the medical field and still is today.26 He has been an active member of the Arcat-Sida association, which aims to support AIDS research and promote close relationships between AIDS researchers and HIV-infected patients, since 1986.27 Hirsch’s implication in Arcat-Sida allowed him to see first-hand how the pandemic was challenging the medical power that was firmly held by medical professionals. In the 1980s and 1990s, with the limited understanding of AIDS, the inability to find a cure and the lethal consequences of a HIV infection, patients created efficient patient associations, avidly read any research reports and participated in international research meetings. This implication would result in the patients’ recognition as legitimate and full partners in the health sector. At the time television, however, only showed the development of AIDS associations to a mild degree.28 Emmanuel Hirsch recalls that he felt strongly that television health programmes should adapt their content to offer less professional medical knowledge and more witnesses’ insights and suggested a health magazine on AIDS.29 From September 1995 to February 1997, France3 broadcast a new magazine, Sidamag, a weekly health magazine, entirely dedicated to AIDS, whose objectives were to inform, to explain and to prevent. Dedicating a health magazine to a single illness was very unusual and Sidamag is indeed the only case for French television. Hirsch has claimed, during an interview for the present study, that it is the only worldwide audiovisual example of such a programme, but the present study has not been able to fully confirm such statement and after an overview of the international research literature.
Also unique to Sidamag was the presence of nine medical doctors and researchers on its editorial board:30 Dr Didier Jayle (in charge of the AIDS information and prevention Ile-de-France center, Broussais Hospital, Paris ); Dr Françoise Linard (psychiatrist in charge of HIV-infected patients, Bichat Hospital, Paris); Professor Jonathan M. Mann (public health professor, first director of the World Health Organization’s Global Program on AIDS), Dr Christophe Michon (Louis Mourier Hospital, Paris), Dr Gilles Pialoux (Vaccine researcher, Pasteur Institute, Paris), Claude Schneeberger (director of Fontainebleau Hospital), Yves Souteyrand (economist, Paris) Professor Didier Sicard (Cochin Hospital, Paris) and Isabelle Vincenzi (epidemiologist, Saint Maurice Hospital). Their names were given in the opening credits to reinforce the scientific legitimacy of Sidamag, in contrast to most health magazines for which medical credits if any are stated at the end of the programmes.
At the time of Sidamag broadcast, all the editorial board members were actively doing research on AIDS and/or treating HIV-infected people and/or AIDS associations’ members. Hirsch remembers the editorial boards members would suggest patients’ names during the editorial meeting on the Tuesdays, enabling the Sidamag audiovisual professionals to film and edit reports for the following Saturday broadcast.31
3.2 The Sidamag Hosts
It was France3 management that suggested Pascal Sanchez would be the perfect host for Sidamag.32 Since Pascal Sanchez was unreachable for the present study, statements found in the Sidamag press release or written press contents during the 1990s were used to assess his role as a Sidamag host.
Although Sanchez was called a co-producer in the credit lists at the beginning and the end of each Sidamag episode, Hirsch states Sanchez was not involved in the reports and guest choices. However, according the France 3 directors as said by Hirsch, Sanchez was the best presenter for a young public.33
Prior to Sidamag, Sanchez was the main host of a television magazine targeting 15-25-year olds. Lasting 30 minutes, and filmed live, the magazine entitled Une pêche d’enfer [A Burst of Energy] was broadcast from December 1987 to June 1995. The pêche d’enfer programmes were extremely well perceived by young people, who appreciated to be talked to as young adults. Mostly filled with fun and light information,34 Sanchez decided to broadcast several episodes exclusively about AIDS with the objective to improve medical knowledge and prevention among youth. To give two examples, Dr Willy Rosenbaum, doctor at Claude Bernard Hospital, Paris and researcher in Montagnier’s laboratory, was the main guest for the episode broadcast 28 June 1993 and Philippe Douste-Blazy, Health Minister from 30 March 1993 to 11 May 1995, was a guest on 15 September 1994.
Pascal Sanchez was the host for the first fifty Sidamag episodes. He later hosted televisual sports magazines, then disappeared from television in the 2000s. Sanchez was replaced by Carole Gaessler for the next twenty Sidamag episodes. Gaessler had been an anchorwoman for the France3 weekend news magazine since 1996. The reason for Sanchez’s replacement by a young female host was never addressed during the Sidamag broadcast. When questioned about the host change, Emmanuel Hirsch answered that Carole Gaessler was a recognized journalist.35 His short answer suggested possible professional tensions, but any analysis of this is beyond the goal of the present study.
3.3 Overall Features of Sidamag
The Sidamag episodes all shared the following features. Lasting 15 to 16 minutes, they were hosted by Pascal Sanchez for the first 1-50 episodes and Carole Gaessler for the subsequent 51-70 episodes, broadcast on a weekly basis every Saturday morning at 10:05 am (for the 1-64 episodes) and at 2:30 pm on Tuesday for the last six episodes. Pascal Sanchez believed that his name known to many young people from Une pêche d’enfer would attract these viewers even at the early morning time. Furthermore, the Sidamag episodes were broadcast a second time on Tuesday evenings, possibly attracting a different public. However, the Sidamag audience was fairly low, with at the highest with an 11.3 per cent audience share on 10 February 1996 and at the lowest with only a 2.4 per cent audience share on 14 September 1996.36
Sanchez opened each episode with the following words: “Every Saturday morning, we have an appointment with AIDS current news, to inform, to explain and to understand for a better prevention and most of all, for solidarity. We will take a different look, a closer one, a more empathic one, a truer one, a more human one. Sidamag, because we are all concerned”. Carole Gaessler skipped the introduction and preferred to briefly outline the content of the episode.
Since the producers were very keen to emphasize that AIDS had become part of the viewers’ everyday life, Sanchez, then Gaessler were filmed strolling in Paris streets (when appropriate) (See Figures 3 and 4) and he or she would briefly introduce two edited reports per episodes. These reports lasted 2 to 4 minutes each and the witnesses were briefly presented before the reports (a HIV-infected person, a member of the family of a HIV-infected person, a prisoner, etc.). During the reports, the journalist’s voice was very rarely heard, leaving space for the witness’ words. The witnesses were usually shown in their everyday life, in their intimate or professional environment. In addition to these edited reports, the Sidamag hosts extensively interviewed for 5 to 8 minutes one guest in a friendly relaxed situation, in a coffee-bar or a park.
After 70 episodes without any major changes in the Sidamag format apart from the introduction, Carole Gaessler started the next episode with the following words:
“AIDS has now become a chronic disease and no longer a deadly one thanks to triple antiretroviral therapies. Therefore the editorial board has decided to stop exclusively addressing AIDS and to talk about other chronic illnesses. The magazine will from now on also change its name to Vivre avec [To live with…].”37
Hirsch explained that it was time to offer the same space for witnesses living with other chronic and life altering illnesses.38 Acting on this change, the first Vivre avec… episode addressed Alzheimer’s disease and was clearly no longer intended for a young public.39 For the present study, the Vivre avec…. episodes were not studied, due to the major changes in the magazine objectives.
3.4 Sidamag Contents Analyses for Prevention Content, Non-Professional Voice
As explained above, four categories were used for the Sidamag contents firstly for the reports and secondly for the interviews. The 70 episodes included 143 reports: with 57 (40 per cent) addressing prevention, 33 medical information, 3 purely research and 50 everyday life. In coherence with the Sidamag objectives, prevention was very much present through all the 70 episodes. The prevention content category was next subdivided in the following subcategories: prevention campaigns, prevention for specific adult publics, prevention for young public and prevention for health professionals. The relative weight for the four subcategories is given in Table 1.
|Reports showing prevention campaigns||31||~ 54 %|
|Reports showing prevention for specific adult publics||12||~ 21 %|
|Reports showing prevention for young people||8||~14%|
|Reports showing prevention for health professionals||6||~ 10%|
|Total number of reports||57||100 %|
Sidamag producers clearly believed that seeing a prevention spot on television had a powerful effect, since more than half of the reports treating prevention used part of them. Sidamag included prevention spots or campaigns from France, but also, in alphabetical order, some from Brazil, Burkina Faso, Germany, India, Israel, Italy, Spain, Portugal, South Africa, Tanzania, and Vietnam. These prevention campaigns or spots were usually not commented by the presenter or his guests after they were broadcast. These health campaigns aiming to curve human behaviour may have indeed a greater effect on young people than on the general population, suggesting the young people are more receptive to prevention.40 Television AIDS prevention has a lot to do with how the public visualizes sexuality and it is known that viewers also learn sexual behaviour from fictional content. To this regard, although not based on programmes broadcast in the 1990s, a recent study may help to offer food for thought: in a recent study on sex and television, it was found that less than 1 per cent of 2578 television sex scenes (in fiction programmes) mentioned AIDS or other sexually transmitted diseases, suggesting that fictional authors do not believe they have or must have a role in AIDS prevention.41 It could be argued that health magazines would be the best programmes for learning about safe sex, albeit keeping in mind that those with potentially dangerous behaviour are the least receptive to the arguments found in a behavioural campaign.
Thus, Sidamag adopted a very classical method to talk about prevention: by broadcasting campaign spots, instead of pushing imaginative or innovative methods, as the AIDS associations were doing. Even though Sidamag had a strong relationship with AIDS associations (Hirsch and half of the members of the programme’s editorial board being members of AIDS associations), this did not provide for original prevention reports targeting a young public.
As said above, Sidamag presented reports and interviews and Sanchez and Gaessler interviewed a guest in each of the 70 episodes. It was found that 31 of the guests only had a general discourse – such as asking people to use condoms – possibly because they were not AIDS experts but musicians or singers, for example. That these laypersons were not HIV-positive was possibly because in the 1990s, societal taboos surrounding AIDS and sexuality discouraged HIV-positive guests from being interviewed on television and Sidamag privileged the report format where editing was possible. Of the remaining 39 guests having a specific AIDS subject they wished to talk about, 11 mainly exchanged about HIV prevention (28 per cent), 10 talked about research (26 per cent), 16 about medical information (41 per cent) and 2 on everyday life (less than 1 per cent), in sharp contrast with the number of the reports in relation to the everyday life of HIV-infected in the Sidamag reports. This can be easily explained by the increased presence of witnesses in Sidamag reports. As for the prevention category, its relative weight was significantly less, in accordance to the Sidamag producers’ assumption that prevention was best treated by professional prevention spots or best understood by viewing a campaign. For the 11 guests explicitly talking about prevention, they were very cautious to not stigmatize or to talk about any specific population and none talked about homosexuals or drug users.
In conclusion, the Sidamag had three main objectives: to hear non-medical points of view, to present preventive topics and to address a young public. The present analysis showed that these three goals were only partially achieved. The witnesses were very much present and each Sidamag episode gave time for non-medical words. These words were not considered less valuable than those coming from medical experts and were not questioned or analysed by doctors. As such, this represents a tremendous change in comparison to traditional medical magazines. However, the witnesses shown on Sidamag reports used mild words to describe their personal situation and no political statement was ever pronounced by these witnesses, even though many haemophiliacs were dying as a result of the tainted blood scandal. According to Arnaud Marty-Lavauzelle, French AIDES president Sidamag episodes were showing “peaceful AIDS”.42 Although imperfect to his eyes, the health magazine gave significant air time to patients.
Sidamag was tailored for a young public, however, the content analysis showed that a mere 14 per cent of the reports were specifically targeted to young people and the Sidamag evolution to Vivre avec… totally abandoned this objective with the first episode dealing with Alzheimer’s. Overall, however the Sidamag format could have been a model for television health programmes to give more place and power to health democracy, but perhaps two years were not sufficient to lead to a paradigm shift.
As for the Sidamag impact on prevention, it is impossible to evaluate. It is even harder than appreciating television reception. However, what we can draw from this is that Sidamag is a revealing example of the way television producers and managers see viewers. They strongly believed that television public is willing and ready to change their behaviour when and if the right information is given to them.