“They are looking just the same”: Antiretroviral treatment as social danger in rural Malawi

- Antiretroviral treatment for AIDS is widely accepted in Malawi.
- Yet the increasing availability of treatment creates concerns about new forms of risk.
- The concerns are strongly gendered.
- Men speculate that they may be at risk from sexual encounters with women on treatment.
- Availability of treatment complicates men's strategies for seeking potential partners.

Research on the social impact of ART pivots on questions of individual adherence and community acceptability of treatment programmes. In this paper we examine unexpected and unintended consequences of the scale-up of treatment in rural Malawi, using a unique dataset of more than 150 observational journals from three sites, spanning 2010 to 2013, focusing on men's everyday conversations. Through thematic content analysis, we explore the emerging perception that the widespread availability of ART constitutes a form of social danger, as treatment makes it difficult to tell who does or does not have AIDS. This ambiguity introduced through ART is interpreted as putting individuals at risk, because it is no longer possible to tell who might be infected - indeed, the sick now look healthier and “plumper” than the well. This ambivalence over the social impact of ART co-exists with individual demand for and appreciation of the benefits of treatment.