Reading A Fraught Embrace: The Romance and Reality of AIDS Altruism in Africa, one cannot but agree with the authors (Ann Swindler and Susan Cotts Watkins) that “the development community would benefit enormously from an accumulation of ‘collective wisdom’ […] about how HIV-prevention and other development initiatives actually work on the ground” (196, my italics). The ground covered in the book is the arena of three groups of players: altruists, brokers, and villagers, who—each in their own way—attempt to mold humanitarian missions, money, and resources into sustainable progress for villagers in their battle against AIDS. The adjective “sustainable” points at the (often illusionary) expectation that the village volunteers will carry on the good work after the project has ended. This arena is carefully dissected and vividly described from the perspectives of the players involved, “who all are moved by the fantasies they have about one other” (201).

The stage is set in Malawi, but the patron-client relationships, infrastructural constraints, and cultural misunderstandings the authors describe are not typical of Malawi. Likewise, the “AIDS enterprise” does not structurally differ from other development “enterprises.” What has made the AIDS enterprise special, however, is its scale and urgency, along with the cultural complexities involved. Because the primary goal of HIV prevention entails addressing people’s most private behaviors and affairs, cultural dissonance lurks at every corner. Culture indeed looms large in the book, and rightly so.

This book derives its strength both from the grounded compassion of the authors and from the variety and quantity of materials they collected from 1998 onward. These comprise their own ethnographic notes on events, meetings, and interviews (called “motel ethnography”), fieldwork contributed by students and scholars from foreign universities, and the field journals of “local ethnographers” whom the researchers tasked with writing down what they learned about AIDS (interventions) in their villages.

The arena is structured by the three groups of players and the narratives and practices through which they interact. The altruists range from the behemoths in AIDS aid—UN organizations, WHO, INGOs, big bilateral donors—to individuals gripped by the AIDS drama who are mobilizing resources on their own. In between, there are national institutes and NGOs. The altruists share a common need for intermediaries to help them achieve their goals. Because of the pivotal role of these intermediaries, the authors zoom in on these brokers. They distinguish the white-collar, highly educated, cosmopolitan, office-based brokers who have to screen proposals and identify other brokers for further implementation; the district elites who may work at a local INGO office or for an individual altruist and may include local politicians or religious leaders; and the “brokers without offices,” with one foot in the village and the other in town. Although brokers at all levels have to deal with the capriciousness of development funding and the finality of projects, the last group is particularly vulnerable. They have to navigate daily between the aspirations of their employers and the expectations of the villagers, including their own kin, and when the project has ended, the organization considers them expendable.

Training is a key practice through which the three parties interact. It is an appealing practice in a context where education is cherished as the path out of village poverty. Additionally, training provides a concrete intermediate objective—more measurable than HIV prevention—and through it one can reach the villagers (recruited volunteers). Narratives can “make everybody happy” or “make everybody anxious.” One example of the second category is “vulnerable women,” a pet theme of donors. But in the AIDS context, rather than viewing women as vulnerable, the villagers see dangerous women who are morally compromised, entice sexual encounters, and spread the virus. The interfaces on the ground reveal many more of such clashing moral and cultural frames, though the brokers also (at least) pay lip service to the AIDS and development mantras.

Given the manner in which the AIDS enterprise unfolds on the ground, the authors consider attaining the primary objective of HIV prevention to be largely elusive. Other factors influence the decline of HIV incidence (personal experiences) and mitigate AIDS impacts (antiretroviral medicine). Hence, in the final chapter the authors offer a plea for “tempered modesty.”

This book will be particularly useful for persons working in AIDS programs of development organizations in Africa, from those designing policies to those shaping interventions. However, the issues of the structurally different positions of the actors involved and the inevitable cultural misunderstandings are embedded in the development enterprise as a whole. Although this can never be completely resolved, understanding creates sensitivity and can result in better practices. Finally, the book provides a powerful read for development scholars and Africanists.