Paper short abstract:

Using 15 years of observational journals, we demonstrate how global guidelines concerning HIV prevention, testing and treatment have been taken up by rural Malawians in unexpected ways.

Paper long abstract:

The Malawi Journals Project is one of the longest-running observational field studies in sub-Saharan Africa, ongoing since 1999. Through the journals, rural Malawians have chronicled their individual, household and community-levels response to the evolving AIDS pandemic, from the days when AIDS was a poorly-understood death sentence, through the advent of behavior change campaigns and HIV testing, to the emergence of the treatment era as antiretroviral medications arrive. Over the same period, these communities have also been saturated by global policy prescriptions and interventions concerning HIV risk, prevention, testing and treatment, emanating from the world opinion leaders in global health and filtering down through village clinics and NGO activities. In this paper, we examine the disjunctures between global norms and local interpretations thereof, as Malawians adopt, adapt, and query these official discourses, re-interpreting them in creative and pragmatic ways adapted to local life projects and social conditions. We illustrate not only the unintended ambiguities of AIDS interventions, but also how these ambiguities move towards consensus as time goes by. We argue that this longitudinal observational journal method provides not only empirical insights but also theoretical contributions to the study of unintended consequences of global health policies.