The social construction of AIDS during a time of evolving access to antiretroviral therapy in rural Malawi

This paper draws upon a set of conversational journals collected over the past decade in rural Malawi, to understand how perceptions of AIDS are constructed as talk of antiretroviral therapy (ART) filters through social networks. Three distinct treatment eras frame our analysis: the early ART era (2001–2003), the ART expansion era (2004–2006) and the later ART era (2007–2009). We find that the early ART era was characterised by widespread fatalism as people recalled experiences with dying family and friends from what was perceived as an incurable and deadly disease. During the ART expansion era, AIDS fatalism was gradually replaced with a sense of uncertainty as rural Malawians became faced with two opposing realities: death from AIDS and prolonged life after ART. In the later ART era, the journals chart the rise of more optimistic beliefs about AIDS as rural Malawians slowly became convinced of ART's therapeutic payoffs. We conclude with an example of how ART created difficulties for rural Malawians to socially diagnose the disease and determine who was a safe sexual partner.