Published on N-IUSSP.ORG November 14, 2016

Demography vs ethnography (or Understanding AIDS in Malawi)
Démographie ou ethnographie (pour comprendre le sida au Malawi)


Susan Cotts Watkins

Daniel Scott Smith, a historical demographer, said it well: demography has all the ingredients of the best novels, sex and death, but they hide the pleasure of the former under the term “fertility curves” and the terror of the latter under the term “life tables.” Ethnography lets us look under the blanket.

Demographers have been deeply engaged with two global efforts implemented in far-away poor countries: to reduce fertility rates through the use of modern family planning and to prevent HIV infection through abstinence, fidelity and the consistent use of condoms. To do this, global actors such as USAID  and DFID created huge bureaucracies to reach those whose lives they aim to transform. For example, USAID sets a policy, then subcontracts its implementation to international Non-Governmental Organizations (NGOs), which in turn subcontract to NGOs in capitals of the targeted countries, which in turn subcontract to smaller NGOs. These bureaucracies produced a lot of numbers: numbers using family planning, numbers with AIDS, but also stacks of paperwork to monitor and evaluate their projects (policies, strategies, work plans, reports—annual, monthly, and how much was spent on each activity. reports, etc.). What we don’t learn from the paperwork, however, is what ordinary people in poor countries say to their relatives, friends and neighbors, rather than what they say to a survey interviewer.

From demography to ethnography

A 1998 survey in rural Malawi on responses to the AIDS epidemic asked men the number of sexual partners they currently had. Many denied having any, which seemed implausible, given what we heard from supervisors and interviewers at our evening meetings to go over the day’s work as well as the figures collected by the government on HIV prevalence (at the time, Malawi ranked 10th highest in the world). We thus asked several of our survey interviewers to return to respondents who had said “no extramarital partners” on the survey. In their informal chats while drinking a Fanta or chewing sugar-cane, it turned out that about half of them said they did have partners. We thus commissioned and trained 22 local participant observers to write journals on what they heard people say about AIDS in informal settings such as on a mini-bus, in a bar, waiting to draw water from a bore-hole. There are now about 1300 journals, from 1999 to the present. They are handwritten in English (the official language) in common school notebooks; each journal is about 20 typed pages, each with many conversational episodes. The journals present a vivid picture of how rural Malawians attempted to make sense of the epidemic and their home-grown strategies for preventing themselves from dying a miserable death.

Early in the global AIDS enterprise, led by UNAIDS , the prevention messages focused on the ABC’s: Abstinence, Fidelity, and consistent Condom use. Many surveys told the global and national organizations how many respondents said they abstained (not many), were faithful (very many) and/or used condoms at all (not many). But what did people in rural Malawi say to each other about the ABCs?

Abstinence: simply impossible.

One said indeed there is no loop to escape from Aids and if people are saying that INA BWELERA ANTHU OSATI MITENGO NDI ZOONA. (meaning: IT CAME FOR PEOPLE & NOT ANIMALS ITS TRUE). He continued saying that indeed ILI MUUFA EDZI. (Chichewa) Meaning that indeed this Aids is found in the flour (we use cooking Nsima). And he said that if it is found in the flour we use in cooking Nsima that everyone is supposed to eat in order to be alive how can then one be abstain from it or prevent from catching it (1999, male speaker)

“AIDS came for people not animals” is repeated over and over again in the journals: it is quintessentially human to want, and have, sex. Although this was a male speaker, in another conversation among women, they discussed whether it was men or women who could endure abstinence longer.

Fidelity: possible, but difficult.

The injunction to be faithful is common in conversations. Parents strongly advise fidelity, as do religious leaders. Some people, it was said, are faithful: it’s just their nature, or they were raised well by their parents. But day-to-day, being faithful means foregoing the joys of sex—a common phrase again refers to Nsima, the staple of the diet in rural Malawi. Being faithful to one’s spouse also means a diminution of the joys of sex, it is compared to eating the same meal day after day. Moreover, it is not perfect. One’s spouse must also be faithful (and uninfected), so what’s the point of resisting temptation?

Condoms: possible, but completely unsatisfactory.

In Malawi, the most common metaphor for the sexual act is “sweetness”. A paper by Iddo Tavory and Ann Swidler (2009) draws on the journals to compare Africa with the West.   In the West, individuals focus on friction and movement leading to orgasm; in Africa, it depends on the release of fluids from both men and women during sex. While condoms only diminish the sensuality of friction in the Western context, in Africa they affect its sweetness. A condom might be used, for example with a sex worker, but it signals distrust and, perhaps worse, it isn’t really proper sex—a common phrase in the journals is that “One Does Not Eat Sweets in a Wrapper.”   Although it is mostly men who talk about the sweetness of sex, some women use this metaphor too—they also want to enjoy sex.

A traditional concern of demographers: generalization

Some might say (and some have said): “You have a sample of 22, how can you generalize from that?”
The response should be to go on the offensive: “You have a survey sample of 4,000 – but they lie.” And follow up with some numbers: “We have more than 1,300 journals with a total of 6,104 named participants.¹ And you still don’t know what’s under the blanket.”

References

SWIDLER, Ann & WATKINS, Susan Cotts. Forthcoming February 2017. A Fraught Embrace: The Romance and Reality of AIDS Altruism in Africa. Princeton University Press.

TAVORY, Iddo & SWIDLER, Ann. 2009. “Condom Semiotics: Meaning and Condom Use in Rural Malawi.” American Sociological Review 74:171-189.

WATKINS, Susan Cotts & SWIDLER, Ann. 2009. “Hearsay Ethnography: Conversational Journals as a Method for Studying Culture in Action.” Poetics 37: 162-184.

Footnote

¹ All proper names in the journals were anonymized. Some names appeared frequently: the communities are small, and the journalists interact frequently with the same people. On the other hand, there are conversations that the journalist heard, such as those on a bus, where the journalist wrote only ‘a man said…’ or ‘the women were saying…..’, so the number of participants would be even greater than 6,104. The journals are available for public use at  deepblue.lib.umich.edu