Priming HIV Messages in Kenyan Print Media

This paper is an investigation into the role of the print media in combating the HIV epidemic in Kenya. A critical analysis of how this information is covered is necessary to determine whether there is need for change of style in the presentation of this information . This is so because till date, there exists a gap in literature on how preventive knowledge on HIV is presented in the Kenyan print media. The data for this paper was gathered using both quantitative and qualitative designs. The paper relied mainly on the content analysis methodology in which the Daily Nation newspapers were searched for articles on HIV. The Daily Nation was purposively studied for this paper because it has the largest selling publication with the highest circulation and therefore, can adequately represent Kenya’s newspapers. All the issues of the year 2010 were purposively studied and this yielded a total of 365 copies for this paper. Findings of this paper indicate that the print media in Kenya lack consistency in the coverage of HIV issues. They also lack a clear editorial policy on the coverage of the epidemic that could guide in a sustained and effective method of coverage of the epidemic. Prominence of the HIV articles, which is a very crucial aspect in coverage, is also found to be lacking. This paper recommends that the print media should focus on consistency in their coverage… It is The print media should involve the general public, including people living with HIV in the discussion of the epidemic.


Background
Like many other African countries, Kenya has struggled in the past two decades to get the best, most effective, and responsive programs, strategies, policies, and approaches for combating the menacing HIV pandemic. The disease has not spared any country. It has affected both rich and poor countries (Ndambuki, McCretton, Rider, Gichuru, & Wildish, 2006).
The first AIDS case in Kenya was diagnosed in 1984. In 1985, the government established the National AIDS Committee to advise the Ministry of Health in Kenya (MOH) on matters related to HIV control. In 1986, the MOH formulated policy statements and guidelines on safe blood supply. The First Medium Term Plan was developed in 1987. Although the highest rates of infection were initially concentrated in marginalized and special risk groups, for more than a decade Kenya has faced a mixed HIV epidemic; new infections occurred in the general population and vulnerable, high-risk groups. In 1999, the Government of Kenya (GOK) declared the HIV epidemic a national disaster and established the National AIDS Control Council (NACC) to coordinate the multisectoral response to HIV.
The GOK responded by publishing informative articles in the press and launching a poster campaign urging people to use condoms and avoid indiscriminate sex. Since then, HIV prevalence has been found to be highest among a number of groups, such as sex workers, injecting drug users (IDUs), men who have sex with men (MSM), truck drivers, and cross-border mobile populations. Up to one third of new infections in 2008 were within these "key populations at higher risk."

Prevalence Rates and HIV Knowledge and Behavior
According to the Kenya AIDS Indicator Survey (KAIS;2008/2009), HIV prevalence rates among the general population aged 15 to 49 years was 7.4%, whereas the Kenya Demographic Health Survey (KDHS; 2009) estimated prevalence in the same population at 6.2%. The findings show that Kenya's epidemic has stabilized in the past few years. The estimated number of people living with HIV (PLWHIV) is 1.3 million to 1.6 million. New infections were estimated 504935S GOXXX10.1177 1 University of Nairobi, Nairobi, Kenya 2 Multimedia University, Nairobi, Kenya at 100,000 in 2009 for adults (15 years and above). The HIV prevention Response and Modes of Transmission Analysis (2009) found that the largest new infections (44%) occur among men and women who are in a union or in regular partnerships, MSM and prisoners contribute about 15% of new infections, and IDUs account for 3.8%.
HIV prevalence rates are generally higher in urban areas, with an average of 16% to 17%, than in rural areas that had an average of 11% to 12% . HIV and AIDS education is an essential part of HIV prevention. In Kenya, HIV education is part of the curriculum in both primary and secondary schools, and for a number of years, Kenya has delivered educational campaigns to raise nationwide awareness of the issue. As a result, awareness about HIV and AIDS in Kenya is high.
The KDHS 2008KDHS /2009 shows that knowledge of HIV prevention methods is high: 75% of women and 81% of men aged 15 to 49 know that use of condoms can reduce the risk of getting AIDS virus, and 92% of women and 93% of men know that abstinence or limiting sexual intercourse to only one uninfected partner reduces chance of getting HIV. A significant reduction in HIV stigma has also been noted. In 2003, 26.5% of women and 39.5% of men indicated accepting attitudes toward people with HIV. This percentage increased to 47.5% for men and 32.6% for women.
Research shows that the media is a very powerful tool in the formation of opinion in any society. It is, therefore, of greatest essence for journalists to exercise the power of their profession judiciously in the dissemination of information on HIV and AIDS.

The Socioeconomic Impact of HIV
HIV has a profound effect on the national development of any country. This is particularly so because the most affected are the economically productive young people. It also causes hardships in families by increasing expenditure in health care. Furthermore, the loss of skilled uniformed officers poses security challenges.
According to the Kenya National HIV and Aids Strategic Plan 2005-2010, HIV has major economic and social impact on individuals, families, communities, and society as a whole. Research across more severely affected, low-income countries clearly demonstrates that HIV is the most serious impediment to economic growth and development in such countries; there is no reason to expect Kenya to be an exception (Kenya National Aids strategic Plan [KNASP] 2005[KNASP] /2006[KNASP] -2009[KNASP] /2010).

Media and HIV Prevention
The media has the social responsibility to ensure that information relating to HIV is on the public domain. To achieve this responsibility, journalists should strive to write clearly and objectively on the subject.
The choice of the print media and particularly the Daily Nation for this paper was informed by the fact that portable media can be carried away and used later. This enables the audience to repeat and review the messages, hence, reinforcing their behavior change. Behavioral models in the print media may become more influential by virtue of the media themselves, which appear to have a status-conferred function for information sources in popular news and entertainment (McAlister, 1991).
According to the KDHS (2009KDHS ( -2010, the future course of Kenya's AIDS epidemic depends on a number of factors, which include HIV-related knowledge among the general population, social stigmatization, risk behavior modification, access to quality health care and services for sexually transmitted infections, provision and uptake of HIV counseling and testing, and access to care and antiretroviral therapy, including prevention and treatment of opportunistic infections. In collaboration with various stakeholders, the Kenya NACC developed the 2009/2010 to 2012/2013 Kenya National Aids Strategic Plan III (KNASP III), which was launched in January 2010. Although HIV prevalence seems to have stabilized, new HIV infections have been estimated at 166,000 annually. The plan was therefore focused on prevention of new infections, reduction of HIV-related illnesses and death, and mitigation of the effects of the epidemic on households and communities.
The awareness of HIV is universal with 99% of women and 100% of men in the 15 to 49 years age bracket. The only group for which the level of awareness of AIDS falls below 98% is women and men with the lowest wealth quintile. The prevalence of knowledge was already high in 2003 (99% of women and men having heard of AIDS; KDHS 2009KDHS -2010. The success of AIDS prevention and control programs worldwide depends on the ability of information, education, and communication (IEC) interventions to address this issue and establish norms of safe sex that are acceptable to (and feasible for) sexually active populations. Therefore, one of the prerequisites to the development of effective interventions will be a sound understanding of the dominant patterns of sexuality around the world and in different cultures and subcultures (Carballo, Cleland, Carael, & Albretch, 1989).
Knowledge and information are the first lines of defense for the young people (UNAIDS, 2004). The use of the media is driven by the recognition that the media can help in reaching those whose status is negative and encourage them to retain this status, to support those whose status is positive and urge them to be careful so as not to spread the virus and to maintain hope through positive living, and in general, to educate society as a whole to develop sustainable structures that will contribute to the prevention and effective management of HIV.
A key strength of the media in this sense is their agenda setting capacity. They can sustain a topic for long in the public arena and therefore, extensive discussion that supports some action in a given topic (Kiai, 2000). Other functions of the media with regard to HIV include providing accurate and factual information on HIV on a regular basis, humanizing the statistics and demystifying the epidemic, presenting the public opinion of the disease, educating the public on the need for community-based structures in HIV prevention and management, and presenting a holistic picture of HIV as well as advocating for accountability and responsibility in the HIV prevention and management sector.
This paper sought to investigate the role that the mass media and particularly the print media have played in the dissemination of information concerning HIV in Kenya. In doing so, the paper also sought to determine the prominence given to this information by one of Kenya's mainstream newspapers (Daily Nation) in terms of coverage.

Newspaper Readership in Kenya
According to a survey carried out by the Nation Media Group (NMG) in 2006, about 7.6 million Kenyans read newspapers. Since 2000, a slight improvement has been noted for those who read newspapers daily. The research revealed that daily newspaper sales increased from 211,437 copies to 215,232 between 2000 and 2005. A recent survey concluded that most people (75%) consider the media as a source of credible information.

The Daily Nation Newspaper
The Daily Nation newspaper is seen as the most influential of all the newspapers in Kenya. "It is widely regarded as being independent and balanced". It is the largest newspaper not only in Kenya but in the whole of East Africa. Its circulation is above 200,000 copies per day but as copies are often read by many people, the actual readership is much higher. It has a market share of about 75%. The biggest competitor of the Daily Nation is The Standard, published by the Standard Group.
The Daily Nation is a morning newspaper published on all 7 days of the week, available in all major cities in East Africa. The Saturday version is called Saturday Nation while the Sunday version is known as Sunday Nation. Its offices are located at Kimathi Street in the Nairobi Central Business District.
The Daily Nation also maintains a website, nation.co.ke, which publishes many articles from the newspaper and has more than three million daily page viewers. The website and its archives are accessible free of charge.

Use of Media Messages in Combating HIV in Kenya
Since the early 1990s, surveys have indicated that in many areas of the African continent, widespread awareness of HIV coexists along with highly skewed detailed knowledge. The demographic and health surveys conducted during the 1990s in Tanzania, Kenya, and Zambia showed that knowledge of the disease was almost universal, but very few people were aware of or believed in the protection offered by condoms (Caldwell, 1999). This paper therefore looks into the possible reasons for the lack of effectiveness in the media messages in disseminating information on HIV.
Scholars have increasingly documented the need to increase awareness on HIV among people. Ndeti (2004Ndeti ( , 2012 posits that adolescents require more information on all aspects of HIV, including skills of protecting themselves from infection, resisting peer pressure, being assertive and negotiating for safer sex. Although this paper focuses on the kind of information that needs to be included by the media in the fight against the epidemic, it does not address the equally important issue of how this information should be presented to the target audience to ensure its effectiveness.

IEC
Research has shown that IEC approaches are highly effective in increasing knowledge on HIV but they have minimal impacts on behavior changes (Wyss, 2001). Based on this and the fact that the mass media effects in developing countries is not well documented, this paper examined the print media messages in combating HIV in Kenya with a view of looking at how they are presented, the prominence given to them, and the frequency with which they occur in the dailies.
The impact of IEC on behavioral changes may be less strong, and experiences from several industrialized countries have shown improvements in levels of HIV-related knowledge following mass media campaigns, but limited effect on behavior. This paper therefore sought to find out if journalists use IEC messages in the print media and the limitations that they have. It also sought to suggest ways in which these limitations, if any, could be addressed to make them effective in causing behavior change among the audience.

Effects of Mass Media Health Campaigns in Developing Countries
Kenya is one of the developing countries in which print media campaigns in the fight against HIV has not been well documented. The media have a pivotal role to play in combating HIV. It is often said that education is the vaccine against HIV. Research shows that some countries have been using the media in combating HIV. It has also been observed that the mass media messages are an important source of knowledge regarding HIV, but that this knowledge is inadequate, and often contains misconceptions (Wyss, 2001). Salmon and Atkins (2003) argue that health campaigns have a long, well-established, and respected heritage as an apparatus for promoting public health and welfare. This phenomenon has, however, not been witnessed in Kenya despite the presence of print media, which can be effectively used to influence behavior changes. The Daily Nation newspaper for instance can be effectively used in HIV prevention campaign owing to its national outlook in terms of coverage and readership.
According to World Health Organization (WHO; 2006), most governments have turned to the mass media as a means of informing their population, shaping social norms and influencing behavior associated with the transmission of HIV. Torwell and Rodney (2010) affirm that the mass media play a central role in informing the public about health and medical issues. They further say that the print media, particularly newspapers, have been found to be an effective media for influencing the general public as well as opinion leaders on issues of public health.
It is also acknowledged that newspapers are best suited for explanations and in-depth analysis because of the length allowed for in print and the relative ease of access. Collins, Abelson, Pyman, and Lavis (2006) recognized print news as an integral source of public policy information as well as a medium to persuade public opinion, depending on selection and presentation of issues (Torwell & Rodney, 2010).

Presentation of HIV Information in the Print Media
The way in which information on HIV is presented in print media to the audience matters a lot if it has to be effective in behavior change. Doak, Doak, Fredel, and Meade (1998) suggested a number of strategies for effectively presenting printed information to people with low health literacy. These strategies are as follows: only give advice that is immediately essential, divide the information into easy-to-understand parts, include visual images with each information part, put all information in the appropriate context, make instructions interactive, offer visual examples, use testimonials, use active voice and conversational style, use bullets to organize information, and use friendly content that is appealing and culturally appropriate. If these strategies are adopted by the print media in Kenya, many positive changes will be brought about in combating HIV. This paper therefore sought to find out the way in which information on HIV is presented and suggest ways in which journalists can improve in the presentation of this information.
Some of the ways in which information can be presented to the audience in the print media is through using entertainment columns. In this way, audience will find it more interesting. Singh (2011) argues that media is capable of preventing HIV with an ultimate goal to cure it through its capabilities to impart education through entertainment. This can be effectively used by the Daily Nation Newspaper in its entertainment columns.

Contribution by Other Stakeholders
To complement the work of journalists in their work of reporting on HIV and AIDS, other stakeholders, such as scientists, physicians, public officials, and nongovernmental organizations (NGOs) are also important. By increasing public awareness, it may also elicit the support that is essential to bring risks under control (Jha et al., 2001).

Prevention Efforts
Although better ways of keeping people with HIV infection alive and well were sought, efforts must be intensified to prevent any further spread of the virus. Prevention is the key to curtailing the ultimate impact of AIDS. Perhaps, the main lesson learned so far during this pandemic is that sexual behavior change is an achievable goal. There is growing evidence that people from striking diverse cultures on different continents have managed to adopt safer behaviors, such as having fewer sex partners, choosing nonpenetrative forms of sex, and, the best documented, using condoms (Merson, 1993).
Carefully crafted messages by the print media need to reach the general public so as to ensure truly universal education about HIV. However, these behavioral interventions have hardly been implemented in Kenya, and where they have been, they are on far too limited a scale to make a real impact on the pandemic.

Sources of Information on HIV
Sources from which information on HIV are obtained is an important factor to be considered by the journalists when they cover stories. It has been argued by different scholars that because of the complexities surrounding the HIV issues, journalists require a wide array of information sources to provide quotes, background information, explanation of complex aspects or technical details, useful suggestions and leads, new findings or other news, and even contact with other sources (Miller & Williams, 1998).
Different sources bring different values to the news on HIV. One of the most important sources of information is PLWHIV. This is because they are in an advantaged position to tell their HIV stories. Therefore, involving PLWHIV as the sources of stories would help make the information more pragmatic in fighting the epidemic. This will increase the effectiveness of the messages in influencing behavior change in the targeted audiences. Lule, Seifman, andDavid (2007-2011) argue that the critical need to address the HIV problem is reflected in the Sixth Millenium development Goals (MDG), which seeks to halt and begin to reverse the spread of HIV by 2015, and to make access to treatment for HIV universal for all those who need it. This fundamental goal can be best achieved by increasing awareness of HIV issues such as prevention ways, in which it can be transmitted among other issues through the print media. Barnett and Whiteside (2006) argue that the relative role of information, observation, and instruction are important for HIV prevention programs, their design, and understanding of why they have succeeded or failed. They further say that information-based decisions are grounded on messages and the theory of reasoned action and planned behavior rather than experience or observation.

Use of Different Media in Carrying Information on HIV
A few countries have been successful in the use of media in the dissemination of information on HIV. Uganda is often held up as a model for Africa in the fight against the epidemic. This success can be attributed to several factors, which include strong government leadership, broad-based partnerships, and effective public education campaigns. Ugandan experts believe that the simple act of talking has made profound difference to the course of the country's epidemic. The fact that Ugandan President Yoweri Museveni allowed a free discussion on HIV in the media, among organizations and the civil society is cited as a key element of the country's success in reversing the epidemic (UNAIDS, 2004). Other countries such as Kenya can also adopt the same strategy of increasing the role of the print media. This is because the print media has the potential of providing a platform for important discussions by media personalities, medical experts, public officials, and the public.
Thailand is another country which has recorded declining trends of HIV infection. This is a demonstration that the pandemic beats a retreat in the face of determined and sustained massive efforts in generating awareness among people and empowering people with information to combat it effectively. Visibility in the media, and informed and sympathetic visibility at that, is an effective step toward creating greater awareness. Leaders of the media, in cooperation with other segments of the society, can play a significant role in educating public opinion.
In the United States of America, the media has been used successfully to dispel myths which had long been held about the epidemic. It was, for instance, believed that Aids was a disease for the gays. When studies began to suggest that heterosexual transmission could take place through sex workers, the press responded by increasing coverage (Nelkin, 1991). The Kaiser's National Surveys have also confirmed that the media in the United States are one of the most important resources for information for Americans on HIV-the media are named more often than health care providers or schools (Henry J. Kaiser Foundation, 2004) In Russia, the Russian Media Partnership to combat HIV (RMP)-a group of more than 30 media and communications partners, including TV networks, print partners, radio networks, and online companies was formed. The partnership launched Russia's first coordinated public education campaign, STOPSPID (Stop AIDS), on World AIDS Day, 2004(Transatlantic Partners against Aids, 2005. In Tanzania, the Radio Tanzania soap opera Twende na Wakati (Let's Go With the Times), which was first broadcast in 1993, greatly increased listeners' willingness to discuss issues related to the virus. After the program had been aired for several seasons a survey reported that 65% of the respondents said they had spoken to someone about Twende na Wakati and more than 8 in 10 reported having adopted a HIV prevention measure as a result of listening to the show (UNAIDS, 2004). Benefo (2004) concurs with the argument that mass media can be effective in combating HIV. He states that conveying HIV information in the mass media has done a great deal to teach Ghanaians about the disease. He goes on to say that it has raised awareness of the importance of using condoms and partner fidelity and has made fidelity in sexual relations and condom use to be seen as feasible and likely behavioral responses to the epidemic.
What this means is that the print media in Kenya can, therefore, be used effectively in the fight against the epidemic if it forms partnerships and come up with programs designed to prevent transmission of the HIV virus.

Issues
From the review of literature, this paper found out several issues which need to be addressed. First, most of the scholars concur that the print media is an invaluable tool in the dissemination of information on HIV (Doak et al., 1998;Singh, 2011;WHO, 2006). However, the stakeholders in the fight against HIV do not seem to have taken the role of the print media seriously in the fight against HIV. Instead, they have focused more on areas such as Voluntary Counseling and Testing (VCT), provision and distribution of condoms, and provision of antiretroviral treatment for persons living with AIDS, among other interventions. Despite the fact that all these measures are important, the government, NGOs, and other stakeholders in the fight against the AIDS pandemic should also incorporate the use of print media in the dissemination of HIV information to the public. This is because the media is capable of preventing HIV transmission through its capabilities to impart education through entertainment.
A review of literature also showed that in areas where the government and other stakeholders have made an attempt to use the mass media in the fight against the pandemic, very little regard is given to the way in which this information is covered. This has a lot of implications on the efforts to combat the epidemic as it touches on several issues among them being the credibility of the sources of information on HIV in the print media, the amount of information on HIV covered the frequency of coverage, as well as the style of presentation of this information in the newspapers.

Shortcomings of the Print Media in Combating HIV
Despite their potentially effective role in combating HIV, the print media in Kenya have some shortcomings. These include the profit orientation of most media houses, which lead them to focus on sensationalism, even in health topics, to increase sales. Real public health issues therefore get very little coverage. There is also lack of in-depth analysis that can help communities to act on their health concerns as most stories tend to give only general information to people. Journalists should analyze health issues rather than just reporting them routinely. There also exists a huge gap between health officials, researchers, and the print media. Some media houses, for instance, are accused of relying more on politicians rather than health officials who would provide them with accurate, comprehensible, and credible information on HIV.
Reporters were also found to lack specialization and clear understanding of issues relating to HIV, which causes them to distort information sometimes with catastrophic results. For example, it is argued that Kenyan journalists still refer to PLWHIV as victims (African Woman and Child Feature Service). The media could therefore address this issue by hiring professional science editors who can report competently on the subject of HIV.
It also emerged that the print media in Kenya still lacks innovativeness in developing stories that can lead to behavior change. They simply provide information, which does not necessarily target specific populations at greater risk of infection such as the youth, women, commercial sex workers (CSWs) among others.
Other factors external to the workings of the media which nevertheless negatively affect the media in combating HIV are denial, stigma, and discrimination. In addition to strengthening the stigma, discrimination keeps many from seeking information or help if they are infected, these beliefs promote denial, allowing many in society to distance themselves from the realities of the epidemic, and therefore, to be lulled into a false sense of security.

Sampling Procedures
All newspapers for the period under review were searched for articles on HIV. The reviewed newspaper has daily and weekend editions. There was no categorization in this sense because all the newspapers within this period were searched, irrespective of the day on which they were published. Using this method, therefore, the researchers searched all the newspapers in the year under the paper for information on HIV. This information was in the form of news items, opinions, editorials, features, letters to the editor, magazines, and research reports among others that had subjects touching on HIV. The subjects of this information included but were not limited to new medical discoveries, government policies regarding HIV, financial assistance toward fight against HIV, views of PLWHIV, religious perspectives, and any other issue concerning HIV. Any daily or weekend edition of the newspaper with information on HIV was included in the sample. Those which did not have information on HIV were also part of the count. The editorial policy of the newspaper was analyzed to give an idea of the influence it might have on the writing on the subject. Senior editors and writers explained about editorial policy of the newspaper on such issues like HIV and effects on writing about the subject, which illuminated on the data collected quantitatively.

Data Analysis and Presentation
This research sought to analyze articles on HIV issues during the specified period (January 1st to December 31st) in Kenya appearing in the Daily Nation newspaper. In this respect the following aspects were analyzed and coded accordingly. The unit of analysis was an individual story (news story, feature, and editorial, letter to editor or commentary) whose content was be examined in terms of The table (the main research instrument) was designed in such a way as to ensure flawless entry of the data into a microcomputer for analysis. The subsequent data aggregation and analysis was done using the SPSS computer software and involved mainly charts to indicate associations and differences in the treatment of HIV stories by the Daily Nation newspaper.

Findings
The researchers used content analysis to collect data for this paper. First, the process involved selecting a sample of 365 copies of Daily Nation newspapers. Once the researchers selected a representative sample from the population, he embarked on perusing them while looking for stories on HIV. The process involved identifying the story; classifying them into their respective categories, for example, a news item, a feature story, an editorial, an advertising feature, news in brief, opinion, letter to the editor, among others; measuring the amount of space allocated for them in cubic centimeters; and determining the source of the story, the placement of the story in the newspaper, the number of stories in the newspaper, the main event, the intention of the story, and the origin, that is, whether local or international.
After collecting the data the researchers presented it in different ways based on the type of interpretation that is intended to the audience. The researchers made use of tables and pie charts to present the data from the research. To meet the objectives of this paper, the researchers focused on some of the aspects from the findings in the process of analysis. The aspects which the researchers analyzed include: number and size of articles published every month of the year under the paper, type of article and its frequency of coverage during the year under the paper placement of the article in the newspaper, themes covered in the article, and sources of the stories in the articles.

Number and Size of Articles Published
One of the objectives of this paper was to examine the amount of space allocated to articles on HIV to determine the prominence given to them in the print media. The number and size of articles covered in a topic are some of the aspects of the agenda setting theory of the mass media. It is evident that if a topic is perceived by a news media as important, it will frequently cover that topic as well as allocate substantial amounts of space for them. In this way, the mass medium will find a way to present to the public their views and how they feel about the topic. It also plays a role in establishing a platform to illustrate, discuss, or even debate an issue that a paper wants to focus on creating, thus, a mass of public discussion.
From Charts 1 and 2, it is evident that December accounted for the largest number of articles on HIV covered during the year under this paper (27). The amount of space allocated to the articles in this month was 15,912. This represented 30% of all the space allocated to articles on HIV during the period under review. This is mainly because the first day of December of every year is World Aids Day and therefore the Daily Nation dedicates a lot of their spaces to stories on HIV. The Daily Nation had 27 articles on HIV on this particular day during that year.
It emerged from the reviewed literature that most researchers are more concerned with the dissemination of information on HIV to the targeted audience, without regard to how this information is presented for it to be more effective in behavior change. Examining the amount of space allocated to articles on the epidemic as well as the frequency with which these articles are published was therefore important in this paper.
The other phenomenon which is clear from Charts 1 and 2 is that the month of August accounts for only 1% of the number of articles covered during the year under the paper. This is mainly because the newspaper was preoccupied with covering stories on the referendum as this was the month in which Kenyans were to go on referendum over a new constitution. It is also important to note that apart from the first day of December, stories on HIV were covered on only 7 other days within the month. On average, each of the other months (apart from December and August) had an average of 7.8% of the total number of articles covering HIV.
From this pattern of coverage, it is clear that the print media in Kenya lacks consistency in the coverage of HIV issues. The extreme variation in the frequency of coverage as well as the space allocated to articles on HIV during the period under the paper is an indication that the print media organizations in Kenya lack a clear editorial policy on the coverage of information on the epidemic.

Types of Articles
Journalists distinguish between hard news and soft news (Curran, Douglas, & Whannel, 1980). Soft news generally deals with the less serious news, such as news about personalities or celebrities, human interest, or gossip. Hard news generally concerns the more serious news with such salient foci as those of high rank in government or other institutional hierarchies, news of events which affect large numbers of people, or news which possesses national or international significance for the past or future.
From this paper, it appeared that the majority of the articles were in the soft news category. This is because most of them were not accorded much salience in terms of placement, size, and frequency with which they occurred during the period under the paper.
The articles on HIV were categorized into six groups. These included news, editorials, opinions and letters to the editor, brief news, and special reports (features [news features and advertisement features] and reports). The number of each of the categories was represented in Table 1.
The majority of articles from the content analysis were news items which accounted for 44% of all the sampled articles. This is significant as it shows that the journalists in the media house strove to publish as many news items as possible during the year under the paper. It is also an indication of the importance with which the media house regards issues on HIV. It was also important that the news items be examined closely for aspects such as adherence to journalistic ethics and codes.
This was followed by special reports, which accounted for 35% of all the sampled articles. In this research special reports included reports from research, news features, advertisement features, and magazines. Special reports are a significant category of articles in a newspaper in that they not only give an in-depth analysis of issues but they also allocate big amounts of space to the articles.
Opinion articles represented 7% of the sampled articles. Articles in this category included analyses by writers of the Daily Nation as well as commentaries by guest writers. Although it may be argued that guest commentators' views do not represent those of the media house, it is also acceptable to argue that by sanctioning a publication, the editor, by implication, indicates that she or he agrees with it, and consequently, takes responsibility of the contents thereof. Brief news accounted for 6% of all the articles sampled.
Finally, editorials and letters accounted for 5% and 3%, respectively. Editorials are also effective in the agenda setting theory of the mass media in that they are articles written or approved by the editor, which gives a newspaper's views on a current topic. With only 5% of the articles being editorials during the year under the paper, it is evidently clear that the media house has not done enough in giving its views and position on the issue of HIV. It is also an indication that other issues are given salience over HIV by the print media.
Letters to the editor also play an important role in the fight against HIV in that it offers a platform for the general public to air their views to the media house on issues regarding the epidemic. From the paper, it was found out that letters to the editor accounted for only 3% of all the articles on HIV. This is considered too little because the public views on the epidemic are also important if the war on the epidemic is to be won. The small percentage of the letters to the editor could also be an indication that the readers of the print media do not find articles on HIV interesting, and consequently, they are not motivated to respond to the articles on HIV in the newspaper.

Placement of Articles
Placement is another very important aspect in the agenda setting function of the mass media. Placement refers to the position of an article in the newspaper. The aspect of placement is important in that it is an indication of the importance of the topic in the article. Some of the most important positions in a newspaper are considered to be the first, second, third, and the back page of the newspaper. When an article is placed in these pages, it facilitates rapid reading as it helps the reader to get a glance of what he wants to know. Placement of articles in these pages has the potential of attracting the readers' attention. Buckler and Travis (2005) argue that newspaper editors, in their agenda setting role, consider the front page stories the most important ones of the day and therefore the ones that entice the largest audience. From the content analysis carried out on the Daily Nation newspaper, the writer found the placement of stories on HIV as shown in Table 2.
From the above table, it is evident that articles on HIV were not placed as much as possible in the pages considered to be prominent in the newspaper during the period under paper. This was a serious omission on the part of the newspaper given the importance of the subject under discussion. From the paper, the researchers found out that only one story appeared in the front page of the Daily Nation newspaper in the period reviewed. Only one story also appeared in the back page of the newspaper during the year under the paper. Placement in the second and third place was, however, much better, with six articles appearing in these pages in the period under the paper.
Apart from the most prominent pages mentioned above, placement of articles in magazines, special report pages, and pullouts and features is also important as it shows the seriousness with which the newspaper treats the topics in the articles. This is because the articles are treated not only exclusively in most of these publications but are also accorded substantial amounts of space. In this respect, the Daily Nation newspaper scored highly in that most articles on HIV were covered in form of news features, special reports, advertisement features as well as magazines such as "Living Magazine" among others.

Themes Covered in the Articles
Theme in this paper has been used to refer to the main subject of the article published in the articles. This may also be used to refer to the major aim of the writer of the article.
In this paper, it was found out that most of the articles had themes on discoveries made in HIV treatment, achievements which have so far been made in the fight against the HIV pandemic, government policies and legislations on HIV, IEC on HIV, appeals made by groups and individuals in the fight against HIV, activities geared toward combating the epidemic, personal views of PLWHIV, obstacles faced in the fight against Aids, issues surrounding funding for combating the epidemic, and others. The pie chart (Chart 3) is a summary of the themes covered in the articles in the year under the paper.

Lack of Detailed Knowledge
The findings of this paper concurs with the argument that in many parts of Africa, Kenya included, there is widespread awareness of HIV which coexists with highly skewed detailed knowledge (Caldwell, 1999). Most of the articles on HIV in the period under the paper revolved around government policies and legislations on HIV (15%), achievements made in the fight against HIV (14%), and views of PLWHIV (14%). Articles on IEC were a paltry 8%.

Main Actors in the News
Main actor refers to the main source of the news for the article. In communication, and in particular health communication, the source of the information to be passed across to the audience will determine how the message will be received by the audience. One of the most commonly considered source factors is source credibility. This aspect has two primary dimensions; expertise and trustworthiness (Berlo, Lemart, & Mertz, 1969).
Research shows that expert sources are generally more persuasive than those lacking expertise and the relationship between trustworthiness and persuasion is also generally positive (Eagly, Wood, & Chaiken, 1978). Furthermore, effects of source expertise and trustworthiness are often context dependent.
Research has also shown that inaccurate information can affect the success of preventive initiatives, like health campaigns. It is therefore, important to examine where journalists obtain HIV information. In this research, sources were categorized into eight groups, namely: journalists, health experts, and GOK, Unite nations, NGO, PLWHIV, guest commentators, and others. These can be represented as in the Table 3. The State The state in this research has been used to refer to the sources of news from government. These may include health ministers, Secretaries in the ministry of health, officials in the Kenya Medical Research Institute, and other government officials, who are authorized to comment on issues regarding HIV. Most of the state sources in this research gave news on issues regarding achievements, which have so far been achieved by the government in the fight against the epidemic, government policies and legislations regarding HIV, and IEC materials by the ministry of health, among other issues. In this paper, the state sources accounted for 22% of all the articles on HIV in the year under the paper.

Health Experts
The term health expert in this paper has been used to refer to individuals who are qualified to provide health care. These may include doctors, nurses, and pharmacists. It also refers to researchers in the field of medicine. One of the objectives of this paper was to examine the articles to determine the expertise of the sources of information on HIV. Previous researchers have noted that expert sources are generally more persuasive than those lacking in expertise. Therefore, the importance of using expert sources in disseminating information on HIV cannot be overemphasized. In this regard, the print media did fairly well in the use of expert sources in the dissemination of information regarding new discoveries made in the management of HIV and educating the public on prevention measures.

PLWHIV
The involvement of PLWHIV in the dissemination of information on HIV is also very important in that the media gives them a platform on which to air their views on such issues. PLWHIV are people who keep looking for solutions and require daily experience from resolving psychological and social problems associated with their HIV status. The solutions discovered by PLWHIV today can be used in future for others who face the same problem. Therefore, their full involvement and participation in design, planning, implementation, and evaluation of programs is crucial to the development of effective responses to the HIV epidemic. In this paper, however, articles whose sources are PLWHIV account for only 15% of all the articles on HIV in the year under the paper. It is also worth noting that most of the articles by PLWHIV are concentrated on one person living with the HIV virus. This is a feature in form of a diary, in which AsuntaWagura, a person living with HIV who had publicly declared her HIV positive status several years ago, writes informative articles on her experiences as a person living with HIV. In this column, she advises, educates, and counsels the general public on issues about HIV. Though this is a positive step by the Daily Nation newspaper, it would be better if journalists get the views of various PLWHIV as they have different experiences.

Journalists
In this paper, the articles by the journalists account for 18% of all the articles on HIV in the year under the paper. This is an indication of many issues surrounding the reporting of HIV information by the journalists. First, it points out to the fact that most journalists lack appropriate training in matters concerning HIV and so most of them shy away from the task of investigating and writing stories on HIV. As a result of this therefore, they rely on a wide array of sources to provide quotes, background information, explanations of complex aspects or technical details. It also implies that journalists are constrained by time and resources in most of the print media houses.

NGOs
In this paper, the term nongovernmental organization (NGO) has been used to refer to any nonprofit, voluntary citizens' group, which is organized on a local, national, or international level. They are task-oriented and driven by people with a common interest and perform a variety of service and humanitarian functions, bring citizen concerns to governments, advocate and monitor policies, and encourage political participation through provision of information. Some are organized around specific issues, such as human rights, environment, or health. They provide analysis and expertise, serve as early warning mechanisms and help monitor and implement international agreements. The paper only focused on those NGOs organized around health issues, and in particular HIV. In this paper, NGOs accounted for 8% of all the sources of information on HIV during the period under the paper. This was rather less given the major role played by the NGOs in the fight against the epidemic. By limiting the number of articles from these organizations, the journalists and by extension the audiences eventually miss out on important aspects, such as expertise in research and analysis of issues on HIV, which would have been provided by the NGOs.

Framing of HIV Stories
The concept of framing is related to the agenda setting tradition but expands the research by focusing on the essence of the issues at hand rather than on a particular topic. The basis of framing theory is that the media focuses attention on certain events and then places them within a field of meaning. Framing is an important topic because it can have a big influence on the interpretation of messages in articles by the audience.
In this paper, the researchers focused on how the journalists framed articles on HIV with a view of determining the effectiveness of the articles in disseminating information on HIV to the target audience. The choice of language by journalists is one of the most important elements of framing. This is because language helps us to remember information and acts to transform the way in which we view situations.
From the findings of this paper, despite the efforts that journalists put in covering information on HIV, their choice of words was not appropriate in some of the articles. This concurs with the views raised by a research done by the African Woman and Child Feature Service. They argue that journalists lack specialization in the area of HIV. For instance, the journalists seemed to have overused the term AIDS instead of HIV. From the findings, some of the titles of articles read, "Kenya misses out on AIDS drugs" (Daily Nation, Wednesday, February 17, 2010), "Cash hitch won't delay AIDS drugs" (Daily Nation, Wednesday, February 21, 2010), "Aids patients wait for verdict on drugs law" (Daily Nation, Friday, March 19, 2010). These are just a few examples of instances where journalists substituted the term HIV with AIDS.
The above examples are an indication that journalists in the Kenyan print media are not well versed in the terminology of HIV. Instead of sensitizing their target audiences with accurate information on HIV, they end up creating misconceptions on the epidemic.
Among the key findings of this paper is that print media in Kenya lacks consistency in reporting issues on HIV. It was found out that articles on HIV are at their peak during events such as World AIDS Day, government reports on the progress so far made in the fight against the epidemic, as well as sponsorships by different organizations in the fight against the epidemic. The number of articles then decline in other periods as the print media focus on issues other than the epidemic. Other findings from the paper include the fact that the print media in Kenya has not done very well in placement of articles on HIV in the newspaper. It was found out, for instance, that during the entire period under the paper, only one article on HIV made it to the front page, which is considered the most prominent page of a newspaper. This was considered as a serious lapse on the part of the newspaper editors as it is an indication that issues on HIV are not given the attention and prominence that they deserve.

Conclusion
The print media in Kenya was found to be lacking in consistency in reporting HIV issues. At times, it is flooded with articles on HIV, and then there are longer periods when it is silent on the issue. What often spurs the print media coverage of the epidemic were found to be events such as announcements by the government and other stakeholders on the achievements so far made in combating the epidemic, new discoveries made in the treatment and management of HIV as well as features revolving around PLWHIV. Articles on these themes and others were also found to be concentrated in the month of December. This is mainly because most of the coverage in December is based on sponsorships and public campaigns to mark the World AIDS Day event, which is observed on 1st of December annually. This is an indication that there is lack of drive in the print media organizations in Kenya to address the epidemic.
Though there are a fairly good number of articles on HIV in some of the months in the year under study, the amount of column space allocated to them might not be proportionate to the weight which the epidemic carries. The importance of an issue is normally judged by the amount of column space allocated to it among other aspects such as placement and the frequency with which it occurs in the newspaper. The print media can do better by allocating enough space to articles on the epidemic. It has been acknowledged through research that media managers will not give regular coverage to HIV issues if there is no reader interest. This paper found that most articles on the epidemic were poorly displayed and tucked away in the inside pages of the newspaper.
Another lapse is that there are only a very limited number of articles in form of letters to the editor. This scenario is an indication of either lack of interest on the part of the general readership to contribute on matters concerning the epidemic or the editors do not publish adequate number of letters from the general public. Involving the general public in the fight against the epidemic is very important.
The paper also found out that only a few articles on HIV (8%) contained detailed knowledge on HIV. These were in form of IEC materials. This finding concurs with then assertion that there exists a widespread awareness on HIV, but this knowledge coexists with highly skewed detailed knowledge. According to Caldwell (1999), the demographic and health surveys conducted during the 1990s in Tanzania, Kenya, and Zambia indicated that knowledge of the disease was almost universal but very few people were aware of or believed in the protection offered by condoms.
Based on the findings of this paper, it can be argued that print media in Kenya still has a generally low and temporary coverage of HIV issues on print media. This kind of coverage cannot therefore create the necessary input in terms of awareness and change in behavior in tackling HIV.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research and/or authorship of this article.