AMA Journal of Ethics^®

On September 30, the South African version of Sesame Street, Takalani Sesame, will introduce a character with HIV to the cast, joining the ranks of Zikwe (Cookie Monster), Moshe (Big Bird), and Neno (Elmo). The new Muppet will be the first children's show character to bring HIV and AIDS issues directly to the attention of preschool children. The Muppet's name, shape, and color will be unveiled later this month.

Harsh realities of the AIDS epidemic in South Africa prompted the Muppet's introduction. A UNAIDS 2002 report estimated that 250,000 South African children under the age of 15 years are infected with HIV, and another 70,000 to 100,000 babies are born HIV-positive each year.¹ These children often face isolation, rejection, and the grief of losing one or both parents while having to deal with the debilitating symptoms of the disease. The new Muppet will be a 5 year-old orphan girl with "high self-esteem" to encourage positive self-image among children. As a lively and integral member of the community, she will be respected and appreciated by her fellow Muppets and will be a role model for children with HIV, particularly young South African girls. Unequal gender relations, sexual customs, and socioeconomic factors combine to make women in South Africa especially vulnerable to both HIV infections and the stigma and discrimination associated with having the virus.

Takalani Sesame will teach kids, by example, how to interact with a playmate who has the human immunosuppressive virus, stressing that the individual is a member of the family community. The character will help instill positive attitudes toward people who are infected with HIV, according to Yvonne Kgame of SABC, the network that airs the show in South Africa.²

The story lines, written for children ages 3 to 7, will not mention common ways of viral transmission, such as drug abuse and sexual contact. Instead the show offers coping mechanisms for children faced with loss and isolation caused by the epidemic. In one episode, the new Muppet is sad because she misses her mother. In another, children treat her as an outcast because she is HIV-positive, but then the Muppets console her, replacing the lesson of exclusion with lessons of compassion and inclusion.³ Takalani Sesame will also instruct children in public health precautions. As Joel Schneider, vice president and senior adviser to Sesame Workshop explains, "We will be very careful to fashion our messages so they are appropriate to the age group. 'What do I do when I cut my finger? What do I do when you cut your finger?' That sort of thing."²

Takalani Sesame is intended as a prompt for initiating family discussions about HIV/AIDS. The show endeavors to dispel the widespread denial of and ignorance about the disease by creating an environment where people affected by HIV/AIDS can openly talk about their concerns. Print resources containing educational materials and suggestions on how to discuss the issues with children will be available for parents.

Takalani Sesame debuted in July 2000 as part of the South African Department of Education's Early Childhood Development effort to provide basic literacy and mathematical skills for preschool children. The program is co-produced by Kwasukasukela and Sesame Workshop with funding provided by USAID and the South African Broadcasting Corporation (SABC), among others.⁵ The show has a unique African flavor with original characters, themes, and story lines that reflect and celebrate the rich diversity of South African cultures. With the introduction of the new Muppet, the South African government takes a major step in the education of children about HIV/AIDS and the impact of the epidemic in the country.

Takalani Sesame's innovative approach to raising HIV/AIDS awareness among children is daring and commendable. Rampant in South Africa and other developing countries, AIDS remains a health issue of global concern affecting an increasingly greater scope of children each year. Introducing the show to other countries might help more children who are affected directly and indirectly by HIV/AIDS. However, some members of the US House Energy and Commerce Committee, which oversees PBS funding, have expressed the opinion that bringing the character with HIV to America's Sesame Street audience would be inappropriate. Although Sesame Workshop has no plans for introducing such a character in the US, its producers answer the Congressional objection by explaining that they have carefully developed age-appropriate content for the show. Sesame Street has a sound record of success in treating matters of diversity and prejudice in ways that are appropriate and accessible to preschoolers. It might be said without exaggeration that Sesame Street's frog-like Muppet, Kermit, with his complaint that, "It's not easy being green," has contributed to the colorblind congeniality among children of various ethnicities in daycare centers and kindergartens around the US today.

More than 10,000 children in the United States are HIV-positive. The array of aggressive treatments that prolong their lives are outward signs and harsh reminders of their illness. Fears of losing friends and respect from their community are common. As 6 year-old Tanya expressed in a recent TIME article, "It feels terrible to have AIDS . . .because if my friends found out, they wouldn't play with me anymore."⁶ Children, like Tanya, with HIV seek relief from the physical and emotional stress of their illness. Takalani Sesame offers coping mechanisms for dealing with the stress, while informing them about preventive health measures and tackling social issues of stigma and discrimination. The show presents important age-appropriate health education that may prevent new infections.

Entertaining, age-appropriate health education is an essential part of the global fight against HIV/AIDS. Caring for children with HIV is not merely about treating opportunistic infections; it also means replacing their despair with hope by teaching others to accept and support them.