My Fulbright fellowship ended with a dissemination of preliminary findings to “key stakeholders” in Lilongwe, Malawi's capital city, where most government offices are located and many international NGOs base their country headquarters. The people shaping Malawi's national response to AIDS – technocrats from government ministries and program officers representing bilateral partners (e.g., the US Department of State) or major international NGOs (e.g., Save The Children) – gathered in a conference room at the US Embassy in late 2008. I went through slides with interview quotes and histograms of survey data documenting what I learned during my fellowship. The bulk of that presentation drew from early analysis of what now makes up Chapters 5 and 6 – results showing that among Malawian villagers and their headmen, AIDS is a relatively low priority. The participants were surprised at my findings. I was, in turn, surprised at their surprise: I expected these highly educated, locally posted specialists to have already known AIDS was a low priority among citizens and to be annoyed to have sat through another dull powerpoint presentation by an academic only in Malawi for a few months. Instead, after registering their surprise, they asked questions akin to “Now what?” With that, my cynical view of the bureaucratic world of AIDS intervention in Africa shifted.

Powerful decision-makers – at least in one African capital – wanted to reconfigure their response to reflect the priorities of their intended beneficiaries. Questions they asked reflected an intuition that matching interventions to local policy priorities would increase the likelihood that an intervention would succeed. One program officer asked my opinion on whether an AIDS program “bundled” with a water well initiative would increase the AIDS program's potential for success. Their questions demonstrated how they were constrained: the higher-ups in their North American and European headquarters would continue to prioritize AIDS programs and the locally posted expatriates were not seeking strategies to change those minds.