Originally published in Section Culture: Newsletter of the ASA Culture Section. Fall 2018. Vol. 30 Issue 3.

Review of Ann Swidler and Susan Cotts Watkins. A Fraught Embrace: The Romance and Reality of AIDS Altruism in Africa  (Princeton UP, 2017)

Reviewed by:
Shai Dromi,
Harvard Univ

One of the most challenging barriers for humanitarian organizations is the lack of direct access to populations in need. In places like Syria and Yemen, armed conflict and uncooperative local governments, along with a lack of infrastructure for travel and mobilization of aid supplies, may stand in the way of humanitarians. But even in more peaceful surroundings, aid organizations work in conditions of considerable uncertainty as they attempt to identify a target population, evaluate its needs, decide on an effective intervention strategy, and determine whether or not said intervention is successful. As a result, humanitarian aid often fails to reach the communities that need it most, and when it does it achieves, at times, only partial success due to a lack of fit with local needs and expectations. The burgeoning literature on development and humanitarian organizations has shed considerable light on the challenges donors and aid organizations face as they seek to do good in the developing world. However, the long networks that carry international donors’ good intentions to the African villages that need their help—and the ways mediators within those networks shape the aid that is ultimately dispensed—remain poorly understood.

In A Fraught Embrace: The Romance & Reality of AIDS Altruism in Africa, Ann Swidler and Susan Cotts Watkins provide a compelling look into these networks by investigating the inner workings of the humanitarian and development community in Malawi. Although HIV remains a significant health problem in the country, infection rates have dropped considerably over the past twenty years as local knowledge about the virus increased in the early 2000s. And yet, despite the already-ongoing decline in infection rates, Malawi has been flooded with international actors—donors, NGOs, church groups, and other altruists—intent on providing relief to suffering Africans. Malawi is a particularly attractive location for international altruists because of its developed roads that allow travel and supply mobilization, its relatively sparse ethnic conflicts, and its weak government that allows NGOs to act independently. The influx of international donors and NGOs created an expanding job market where educated Malawians can make a career and earn a decent living.

Swidler and Watkins bring a unique perspective to this site by focusing on the brokers of altruism—those Malawians who link donors, NGOs, and potential beneficiaries, whether as NGO employees, as impromptu informants, or as volunteers in villages. Such brokers “provide the crucial channel-or, as it sometimes turns out, form the critical bottleneck” (p. 5): while altruists may believe brokers are direct representatives of populations in need, brokers often have very different understandings of the type of help needed and the ways to achieve it. In order to grasp these dynamics, Swidler and Watkins rely on an unusually rich and diverse set of data, collected over the past two decades through annual month-long ethnographic visits to rural Malawi. The authors, along with students and colleagues, conducted countless interviews with actors on all levels of Malawi’s AIDS altruism world, observed trainings and public events, collected survey data, and examined documents produced by organizations large and small. The analysis also innovates methodologically by drawing on a dataset of diaries written by local ethnographers recruited for this project—namely villagers who observed and recorded conversations about AIDS in their surroundings.

The book first outlines the multilayered organizational landscape of AIDS altruism in Malawi, from large-scale multilateral organizations like the World Health Organization and International Nongovernmental Organizations (INGOs) like Doctors without Borders, through more focused academic institutions, bilateral agencies, for-profit organizations, and local nongovernmental organizations (NGOs), to very local community-based organizations. In each of these organizational facets, actors work with particular aims, strategies, and organizational culture. To add to this mix, international “butterfly altruists”—namely those who travel to Malawi independently to offer direct assistance—work in Malawi free of accountability constraints and pursue their own visions of humanitarian aid. Swidler and Watkins demonstrate how brokers tie together the various levels of the Malawi AIDS altruism map. Brokers range from cosmopolitan elite brokers, who are often the only ones to interact at length with international donors, to national-level brokers who primarily work in NGO and INGO offices in Lilongwe, to regional brokers who work in field offices and are tasked with reaching target populations and reporting back to the head office. Two additional types of brokers are “interstitial” brokers, who volunteer in local villages in the hope to be hired one day at an NGO, and freelance brokers, who may come across visiting altruists as service providers (such as taxi drivers) and guide them to sites where they are encouraged to contribute.

The heart of the book lays in the chapters that demonstrate the mismatches between altruist intentions, broker agendas, and beneficiary needs, along with the strategies actors develop to address or circumvent these gaps. While ideals about fighting HIV stigma and helping orphans appeal to Western altruists, these goals carry very different meanings in Malawi that make them hard to implement as intended. For example, campaigns that aim to fight AIDS stigma work only insofar as they resonate with local conceptions of assisting others and loving one another, and the more Western practice of “coming out” as HIV positive makes little sense to many Malawians. Many Malawian elite members – brokers included – believe that “mercenary women” are in part responsible for HIV infections, since they seduce and infect men, and thus a successful intervention should restrain them. Various Malawian cultural practices are similarly stigmatized, but donors have difficulties with goals that explicitly work against local culture, believing this to be insensitive and imperialist. Many donors believe that empowering women would help reduce HIV infections, whereas brokers believe that stopping immoral behavior will achieve this goal. Brokers thus have to translate their goals into human rights language in order for them to resonate with donors’ sensibilities about cultural sensitivity. Rather than talking about restraining women, their discussions turn to addressing women’s poverty, and rather than discussing “negative” cultural practices, brokers adopt the language of universal human rights when they communicate with donors.

In this, brokers devise ways to communicate to donors that their projects succeeded. An economy of information and cultural representations between different organizational levels exists, as brokers learn to communicate humanitarian needs and operational successes through carefully curated testimonials, monitoring and evaluation reports, and matrixes that break down a broad intervention project into checklists of activities and anticipated results (the omnipresent “logframe”, in NGO-speak). Activities like educational campaigns, for example, draw on donor beliefs that eye-catching, playful awareness drives will be more effective (and often fall on deaf ears among villagers). But regardless of whether they directly help reduce AIDS incidence, they provide brokers with feasible ways to demonstrate that the funds invested were put to use in the field. Conducting trainings of various sorts is another activity that appeases all sides and bears little potential risk. Even though training often offers very little in concrete help, it speaks to donor ideals about sustainability and can be easily sold by brokers as a concrete, doable intervention. Brokers thus develop cultural competencies in the language and experiences that appease donors, while at the same time further their own goals of material payment, local prestige, and community moralizing.

Throughout the analysis, Swidler and Watkins highlight the role of imagination in AIDS altruism, specifically as it gives rise to very different fantasies among different actors. Donors imagine powerless beneficiaries in need of help, and develop fantasies about empowering them into self-sustenance. Such donors often find local social and cultural structures illegitimate and seek to change or circumvent them (or are unaware of them altogether). Conversely, like many other African societies, Malawians value dependence and client-patron relations rather than the independence international altruists would like to give them. Villagers develop fantasies about patronage that would help relieve their material needs, in ways that Western donors are often not comfortable with. In fact, Western altruists’ emphasis on building local self-reliance allows them to move from project to project without building long-lasting relations with specific communities—a practice at odds with the dependency ethic that locals harbor. And brokers also fantasize about achieving status and wealth through their position, becoming a success story, and—at times—policing the morality of their community through the channeling of outside aid. In short, fantasy motivates altruistic behavior, but also stands in the way of effective interventions.

By highlighting the link between helping behavior and fantasy, A Fraught Embrace makes an important contribution toward a cultural sociology of altruism that can help make sense of other cases as well. Historically, other sites of social suffering have served as loci for fantasies of all sorts, and have given rise to corresponding types of altruistic work. The burgeoning mid-nineteenth-century Red Cross movement, for example, attracted many European women by emulating their romanticized views of the battlefield as an exciting site where the most noble human virtues could be expressed (and, where a volunteer nurse position could serve as an alternate socially acceptable trajectory for unwed women). In the 1970s, numerous French volunteers left their safe jobs and joined the emerging Doctors Without Borders movement’s work in war- and disaster-ridden countries. Many of them recounted their excitement by the prospect of affecting true social change abroad, compared to their mundane workplaces in France. In these and other places, the thought of distant suffering intersected with culturally-specific ideas about altruism to generate fantasies that, in turn, translated into concrete mobilization. A Fraught Embrace provides a fruitful framework and model to analyze such sites, and will certainly inform future work on collective mobilization.

The book is also relevant for several timely questions in the sociology of development and humanitarianism. First, recent conversations on humanitarian aid have raised concepts like rights-based humanitarianism as possible alternative to the existing top-down relief model, in which NGOs primarily provide supplies and human services. Given situations in Haiti, Mozambique, and elsewhere where influxes of expatriate aid workers and NGOs effectively override the few functioning state health and welfare systems (rather than partner with them and strengthen them), scholars and policy makers have been proposing ways to work toward sustainable local solutions. A Fraught Embrace demonstrates that Malawians tend to expect patronage, rather than such sustainability, but says little about what the long-term effects of reliance on international funding to generate jobs and support for locals might be. Further exploration of the potential implications here would be particularly useful for developing policies based on the findings of the book. Second, the book makes only brief mention of churches, mosques and faith-based organizations as part of the AIDS altruism landscape. But in a high religiosity country like Malawi, one would expect that religious organizations would figure strongly when it comes to addressing AIDS, as regulators of intimate life or as hubs for social activism. In some cases, for example, U.S. churches partner with African churches in their denominations in an attempt to channel aid through religious networks and circumvent some of the obstacles the book describes. While the book certainly mentions churches and faith-based organizations, more concerted discussion of the extent to which religious organizations facilitate or hinder efforts at aid – either on a practical level or as key cultural institutions in Malawi – would have expanded the scope of the book further still.A Fraught Embrace is a must-read for any scholar interested in long-distance development projects. While the book focuses on Malawi, its findings are illuminating for a wide range of cases, and can inform abstract discussions of intervention ethics as well as concrete conversations of humanitarian best practices in the field. For cultural sociologists and for ethnographers, the use of ethnographic diaries along with the wide array of data sources should serve as an extraordinary model of rigorous empirical examination of meanings in social action. The book is compellingly written and will be of interest to senior scholars and undergraduates alike.