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Network-based strategies and competencies are probably even more important in poor societies with limited means of communication and less effective formal structures than in developed economies. And they often deal with life and death matters. This paper presents lessons from and insights about the nature of and the impacts of informal social networks in reducing fertility and coping with HIV/AIDS in Kenya and Malawi based on analyses of quantitative longitudinal data and qualitative data that the authors and their collaborators have been collecting and analyzing for over a decade. Specific lessons include the relevance of social networks and informal interactions for many different domains related to health – and thus life and death – in developing countries, the importance of accounting for the endogeneity of network partners in analyzing network effects, that networks are important even with control for endogeneity, that network effects may be nonlinear, that there may be multiple equilibria, that which networks may either reinforce the status quo or help diffuse new options and behaviors, that both the context (e.g., the degree of market development) and the density of networks matter (possibly interactively), and that multiple approaches, including both qualitative and quantitative analyses, can be informative in providing more in-depth understanding of what networks do and how they function.

Objective: To examine the acceptance of repeat population-based voluntary counselingand testing (VCT) for HIV in rural Malawi.Methods: Behavioral and biomarker data were collected in 2004 and 2006 fromapproximately 3,000 adult respondents. In 2004, oral swab specimens were collected andanalyzed using enzyme-linked immunosorbent assay (ELISA) and confirmatory Westernblot tests while finger-prick rapid testing was done in 2006. We use cross-tabulationswith chi-square tests and significance tests of proportions to determine the statisticalsignificance of differences in acceptance of VCT by year, individual characteristics andHIV risk.Results: First, over 90% of respondents in each round accepted HIV test, despitevariations in testing protocols. Second, the percentage of individuals who obtained theirtest results significantly increased from 67% in 2004 when the results were provided inrandomly selected locations several weeks after the specimens were collected, to 98% in2006 when they were made available immediately within the home. Third, whereas therewere significant variations in the socio-demographic and behavioral profiles of those whowere successfully contacted for a second HIV test, this was not the case for those whoaccepted repeat VCT. This suggests that variations in the success of repeat testing mightcome from contacting the individuals rather than from accepting the test or knowing theresults.Conclusions: Repeat HIV testing at home by trained health care workers from outsidethe local area, and with either saliva or blood, is almost universally acceptable in ruralMalawi, and thus likely to be acceptable in similar contexts.

As part of a study that tested individuals for sexually transmitted infections in rural Malawi, we examine the reactions to the provision of voluntary counseling and testing (VCT). This paper presents response rates as well as summarizing qualitative data on community comments. Our primary substantive conclusion is that despite mixed community opinions about the value of VCT, there was unexpectedly high participation in VCT. This has important implications for current methods of assessing the acceptability of VCT based on research that poses hypothetical questions rather than measuring actual behavior.

Network-based strategies and competencies are probably even more important in poor societies with limited means of communication and less effective formal structures than in developed economies. And they often deal with life and death matters. This paper presents lessons from and insights about the nature of and the impacts of informal social networks in reducing fertility and coping with HIV/AIDS in Kenya and Malawi based on analyses of quantitative longitudinal data and qualitative data that the authors and their collaborators have been collecting and analyzing for over a decade. Specific lessons include the relevance of social networks and informal interactions for many different domains related to health – and thus life and death – in developing countries, the importance of accounting for the endogeneity of network partners in analyzing network effects, that networks are important even with control for endogeneity, that network effects may be nonlinear, that there may be multiple equilibria, that which networks may either reinforce the status quo or help diffuse new options and behaviors, that both the context (e.g., the degree of market development) and the density of networks matter (possibly interactively), and that multiple approaches, including both qualitative and quantitative analyses, can be informative in providing more in-depth understanding of what networks do and how they function.

Patron-client ties and a moral obligation to support the needy are central to African social life, and are usually understood as operating in a very different realm than the exchange of sex for material support that Western observers have labeled “transactional sex.” Claimed by some to be a major driver of the AIDS epidemic in sub-Saharan Africa, transactional sex is described as akin to prostitution, a degraded form of sexual expression forced on vulnerable women by economic desperation. Based on evidence from rural Malawi, we argue that the exchange of sex for money is better understood as one of the many ties of unequal exchange in which Malawians and other Africans engage, an exchange in which the patrons are as important as the clients.

In this paper we seek to gain an understanding of local epistemology--how Malawians themselves understand the epidemiology of HIV (kachirombo, or ?little wild beast?, from the Chichwa chirombo, for wild beast). We approach this by analyzing occasions when several villagers are trying to diagnose the illness or death of someone they know. What information is considered relevant for concluding that an illness or death was due to AIDS? What sources of information are considered authoritative? On what facts do both rural Malawians and the international research community agree, and where do they disagree? And is it likely that these differences might militate against effective reactions to the epidemic?

Sociology has long struggled to develop methods adequate to its theoretical understanding of society as a reality sui generis (Durkheim, 1982). While culture is widely understood as the most collective aspect of societies, the methods sociologists use keep pulling us back toward an image of culture as produced by the interaction of individual minds. To try to capture more effectively what is genuinely collective about culture, we focus here on conversational interactions—the voices and actions that constitute the relational space among actors. Conversational journals provide us with a method: the analysis of texts produced by cultural insiders who keep journals of who-said-what-to-whom in conversations they overhear or events they participate in during the course of their daily lives. We describe the method, distinguishing it from other approaches and noting its drawbacks. We then explore the ways and settings in which participants in conversational interactions use culture, illustrating the methodological advantages of conversational journals with examples from our texts. We end with a discussion of what we have learned about culture in action and the method’s potential in our setting as well as in other places and times.

Patron-client ties and a moral obligation to support needy kin are central to African social life, and are usually understood as operating in a very different realm than the exchange of sex for material support that Western observers have labeled “transactional sex.” Believed to be a major driver of the AIDS epidemic in sub-Saharan Africa, transactional sex is usually seen as akin to prostitution, a degraded form of sexual expression forced on vulnerable women by economic desperation. Based on evidence from rural Malawi, we argue that the exchange of sex for money is better understood as one of the many ties of unequal exchange in which Malawians and other Africans engage.

Sociology has long struggled to develop methods adequate to its theoretical understanding of society as a reality sui generis (Durkheim, 1982). While culture is widely understood as the most collective aspect of societies, the methods sociologists use keep pulling us back toward an image of culture as produced by the interaction of individual minds. To try to capture more effectively what is genuinely collective about culture, we focus here on conversational interactions—the voices and actions that constitute the relational space among actors. Hearsay ethnography provides us with a method: the analysis of texts produced by cultural insiders who keep journals of who-said-what-to-whom in conversations they overhear or events they participate in during the course of their daily lives. We describe the method, distinguishing it from other approaches and noting its drawbacks. We then explore the ways and settings in which participants in conversational interactions use culture, illustrating the methodological advantages of hearsay ethnography with examples from our texts. We end with a discussion of what we have learned about culture in action and the method’s potential in our setting as well as in other places and times.