Documenting PMTCT

During my time working as a photographer in sub-Saharan Africa, a recurring theme has been the documentation of HIV/AIDS. Initially much of this work told the stories of the virus’ devastation in communities and it’s effects on their societies. Many of these stories told of the challenges of accepting one’s HIV-positive status and the implications of denial.

As the reality of HIV/AIDS in sub-Saharan Africa began to change, I became aware that the nature of my documentation needed to change too. As long as health services are available, HIV/AIDS is changing from a literal death sentence to a more managed situation that offers up hope and possibility of a longer life, enabling people with HIV to plan for their own and their children’s futures. More and more, people are living with HIV rather than dying with HIV. There are still many challenges facing those living with HIV, of which stigma and access to health services and drugs are the biggest, in my opinion.

My concerns about representation in the documentation of HIV/AIDS lead to a desire to present another face of HIV/AIDS not normally seen in the mainstream media in the western world. While not wanting to minimise the challenges of HIV/AIDS faced in sub-Saharan Africa, I also wanted create documentation that would cross the barrier of Othering to inform and advocate for continuing HIV/AIDS funding. This became very much a consideration in my short term work on HIV/AIDS but what I found lacking was the continuity of a person’s story, the sense of a life lived rather than a moment in time.

The ideal opportunity to contribute significantly to the body of HIV/AIDS representation presented itself when UNICEF Senior Photography Editor Ellen Tolmie proposed a collaboration documenting the lives of several women with HIV as they undertook a process to prevent passing on the HIV virus to their unborn children. The documentation was to go beyond the usual representations of women and children accessing health care to an in-depth two year long documentation of the women and their children, extending to many facets of their lives, both outside and inside the healthcare setting.

Reflexivity was key in the documentation. Many ethical concerns presented themselves as I became friends with the subjects of my coverage, and interacted with their families and communities. With many of the women in the coverage, I was the only person present at the births of their babies, aside from health care workers, leading to strong personal ties between us.  I was trusted with personal information and points of view as the lines between photographer/subject and being friends blurred. Relations of power as an outsider in the community of another race was an ever present concern. My motivations and actions had to be considered carefully, the most important outcome of the project was the well-being of the subjects of the documentation and that the documentation doesn’t change their lives in a negative way.

It is my hope that this work stands as a tribute to the strength and love these women show for their children, and other women like them, as they deal with the challenges of living positively.

The project was managed and produced by myself, an independent photographer and directed by UNICEF Senior Photography Editor Ellen Tolmie, with support from Zambia’s Ministry of Health and UNICEF Zambia.