STIGMA: RECEIVED CATEGORY AND ANALYTICAL CONCEPT

The magistrate did not refer directly to stigma in his judgement. However, by invoking fear of disclosure, the need for protection, and his duty to deter behaviour like Mayeso's, he voiced widespread assumptions about stigma as a defining feature of the HIV/AIDS epidemic. By referring to health as a ‘private matter’ he also signalled his affinity with human rights-based approaches to health care as a ‘right/freedom’ (ufulu) that accrues to the individual.Footnote ⁸ The magistrate's focus on individual behaviour as the engine of stigma, and individual fear as its consequence, chimes with the emphasis of much research and a great many policy statements on HIV risk, prevention and treatment (see, for example, Bryceson and Fonseca Reference Bryceson and Fonseca2006; Kaler Reference Kaler2004b; Poulin Reference Poulin2007; Rankin et al. Reference Rankin, Brennan, Schell, Laviwa and Rankin2005).Footnote ⁹ Not only does the stress on individual behaviour depoliticize HIV, but – as several commentators have suggested – by highlighting the association of HIV with illicit sex, and promoting a discourse of personal blame for infection, it also contributes to the creation of stigma. Thus, for Peters et al. (Reference Peters, Kambewa and Walker2010: 279), ‘public stigmatization of AIDS by agencies and media’ is an important part of the explanation for why rural Malawians rarely identify AIDS as the cause of the illness or death of their close relatives, friends and neighbours.

Sociologist Erving Goffman, the widely acknowledged pioneer of work on stigma in the social sciences, defined it as ‘spoiled identity’: ‘the situation of the individual who is disqualified from full social acceptance’ (1963: 9). Goffman stated that to theorize stigma, ‘a language of relationships, not attributes is really needed’ (ibid.: 13). Nevertheless, many have bemoaned the fact that Goffman's work has inspired studies that conceive of stigma as something that takes its form and has its effects at the level of the individual (see, for example,Yang et al. Reference Yang, Kleinman, Link, Phelan, Lee and Good2007).Footnote ¹⁰ Efforts to remedy this have included the incorporation of Foucauldian theories of power to examine how ‘stigma plays a key role in producing and reproducing relations of power and control’ (Parker and Aggleton Reference Parker and Aggleton2003: 16). Others have employed the concept of ‘structural violence’, which ‘predisposes the human body to pathogenic vulnerability … determines who has access to counselling, diagnostics, and effective therapy’ and prescribes, ‘in large part, who suffers from AIDS-related stigma and discrimination’ (Castro and Farmer Reference Castro and Farmer2005: 55).Footnote ¹¹ An alternative approach is advocated in The Secret (Hirsch et al. Reference Hirsch, Wardlow, Smith, Phinney, Parikh and Nathanson2009b), a recent volume that foregrounds ‘sexual geographies’ and ‘extramarital opportunity structures’ to argue that ‘thinking about the spaces that produce risk rather than approaching risk as a category integral to individuals might be a way out of the dead-end of identity’ (Hirsch et al. Reference Hirsch, Wardlow, Smith, Phinney, Parikh, Nathanson, Hirsch and Wardlow2009a: 215). The contributors' more ethnographic approach might go some way to addressing the concerns expressed by Janes and Corbett (Reference Janes and Corbett2009: 171), who criticize Farmer and his colleagues for ‘juxtapos[ing] stories of individual suffering with political economic givens, offering sometimes thin analyses of intervening processes and structures’.

For the authors of The Secret, discourses that place the onus for the spread of HIV, as well as for its prevention, on individuals, constitute a ‘neo-liberal approach to public health’, downplaying ‘the responsibility and potential for governments and institutions to create the conditions that facilitate health’ (Hirsch et al. Reference Hirsch, Wardlow, Smith, Phinney, Parikh, Nathanson, Hirsch and Wardlow2009a: 211). This is particularly problematic because ‘it is neo-liberal capitalism working as it is intended to that produces sexual risk’ (ibid.: 210). While attention to neo-liberalism occurs relatively recently in the literature, historical studies of sexually transmitted diseases (STDs) in colonial Africa similarly cite ‘connections between the capitalist economy and its creation of STD-vulnerable cohort groups’ (Chirwa Reference Chirwa, Setel and Lewis1999: 143). While my concern in this article is not to offer an analysis of the role of political, economic and social forces in shaping the HIV/AIDS epidemic as we find it in Malawi today, my focus upon the particular experiences of HIV-positive individuals in Chiradzulu is by no means an endorsement of a neo-liberal approach to public health. Rather, I hope it will be apparent in what follows that any separation of ‘lived realities’ from wider structural and historical forces and policy interventions can only serve to distort (Dilger Reference Dilger2003; Fassin Reference Fassin2007; Nguyen Reference Nguyen2010).

That stigma is dominant in contemporary understandings of the HIV epidemic is a given, but that it characterizes the experiences of HIV-positive Malawians in rural areas should not be taken for granted. Lwanda (Reference Lwanda and Englund2002: 154) notes that during the early years of the epidemic in rural Malawi, ‘the initial “segregationist” discourse prevalent in urban areas was not important’ and, among kin in the villages, ‘HIV/AIDS victims received good care’. As the epidemic has progressed, scholars have continued to raise doubts about the relevance of ideas about stigma to rural sufferers of HIV in Malawi. In their extensive research in Zomba District, which borders Chiradzulu to the north, Peters et al. (Reference Peters, Kambewa and Walker2010: 283) ‘found little evidence of stigma in people's multiple reactions to HIV/AIDS’. They argue that the term ‘does injustice to the complex ways in which many Malawians are seeking to come to terms with the accelerating rates of illness and death’ (ibid.).

FROM DEATH TO LIFE

Within the last five years or so, much has changed. The Malawi government began providing free ARV therapies in 2004, and figures indicate that by June 2010 more than 225,000 Malawians were receiving ARV treatment (The Global Fund Reference Fund2011). Malawi recently topped a Médecins Sans Frontières (MSF) comparison of eight sub-Saharan countries for ‘People on [ARVs] as a percentage of country needs' (Médecins Sans Frontières 2010: 11).Footnote ¹² However, much of the most recent anthropological literature dealing with HIV in Africa has focused on the horrific reality of a fatal disease without cure, or the particular, devastating decisions that individuals and families have faced when ARVs have appeared on the scene at prices that put them either completely out of reach or just within the realm of possibility (Mogensen Reference Mogensen, Dilger and Luig2010; Whyte et al. Reference Whyte, Whyte, Meinart, Kyaddondo, Petryna and Lakoff2006). Moreover, some of the most sophisticated anthropological work on HIV stigma has argued that ‘the association of AIDS with death, rather than sexual promiscuity, is the main source of its stigma’ (Niehaus Reference Niehaus2007: 848),Footnote ¹³ and thus that ‘the availability – perhaps even the mere perception of availability – of treatments may have a dramatic effect by redefining the nature of AIDS as a death sentence and, hence, a potential source of pollution’ (Ashforth Reference Ashforth, Dilger and Luig2010: 57).Footnote ¹⁴

The altered landscape of HIV treatment allows, requires even, a shift in analytical focus away from death and towards life. How are HIV-positive people living with the disease today? How do they think about and understand their lives as HIV-positive members of families and communities? How do they manage their relationships with other HIV-positive and -negative friends, relatives, neighbours, potential partners, and so on? The ‘life’ I refer to here is ‘beyond bare life’ (Comaroff Reference Comaroff2007); these women are no longer ‘left untreated in an era of pharmacological salvation’ (Ibid.: 207). Rather, they are beneficiaries of campaigns for treatment access that, for the most part, played out beyond Malawi's borders (see, for example, Robins Reference Robins2004; Reference Robins2006). Having witnessed the deaths of many, and perhaps also having experienced dramatic transformations in their own health, how are their decisions, and the strategies they adopt as they live and nurture the lives of their children, affected by the realization that ‘medicine is your entire life’, as a friend of mine in a Chiradzulu village put it, that their current good health is dependent upon access to medication (as well as adequate nutrition and treatment for opportunistic infections) and is, therefore, something towards which care must be directed?

CATHERINE'S STORY

Catherine's immediate response to Mayeso's sentence was positive: ‘Azikaphunzira,’ she said, ‘he must go and learn [a lesson].’ A few weeks later, I visited her at the rural home she shared with her husband and son and she remained hopeful that her brother would be reformed. From our four brief encounters at court, I had developed a certain affection and admiration for Catherine: she was young, determined, and spoke with a strength that belied her fragile body; she had always seemed interested to talk to me, and she did not hesitate that morning when I called to ask if we could meet.

During my visit, Catherine described her difficulties with her brother at greater length than she had in court. As she did so, I began to see that ‘use of insulting language’ was only one way in which her complaint against Mayeso could be framed. Catherine's account of the nkhani (story, dispute, case) was chronological, beginning earlier in the day when the Village Headman (henceforth headman) had come to the compound to discuss a land sale that Mayeso had initiated. Mayeso needed the consent of his matrilineal relatives, principally Catherine and their grandmothers.Footnote ¹⁵ Catherine, who currently farms the land he was referring to, refused on the basis that ‘it's not a good thing to sell land. I have a child, and there's my younger sister, too, she will also want a garden.’

Later the same day, as Catherine and their younger grandmother were leaving the headman's court where they had been listening to cases, Catherine began to explain Mayeso's plan to sell the land. It was at this point that Mayeso appeared:

That afternoon, Catherine went to harvest sweet potatoes in her garden with her husband and a young male relative. But she was agitated – ‘I still hadn't calmed my heart’ – so she decided to call her senior maternal uncle on her mobile phone and ask him to come to see her. Her uncle had just started a new job in town but he sent his younger brother in his place, who arrived the next day to find that Mayeso had demolished part of the front wall of Catherine's house during the night. The headman came to the compound to talk to him and told the uncle that his nephew ‘is a bad person’ (ndi munthu woipa). He explained, too, that Mayeso had another case pending against him concerning the Group Village Headman, whom he had also insulted and threatened.Footnote ¹⁷ According to Catherine, the headman suggested that it would be difficult to pursue this new case with the other still unresolved, adding:

The headman counselled Catherine's uncle to report Mayeso's behaviour to the police. The uncle did not pursue the matter, however, and Catherine understood this to be a result of Mayeso's threat to beat him up if he did.Footnote ¹⁹ Before long, Mayeso resumed insulting her: ‘He started again. If I met him on the road, maybe I was going to the grocery store and he was coming towards me from that direction, he would say things like, “You'll feel it, you're in the shit with your AIDS.”’

Eventually, on the headman's advice, Catherine went alone to the police station, about ninety minutes' walk from her home. There, she was issued with a letter summoning her brother to the station, which she was to leave with the headman. The following day, Catherine repeated her complaint at the police station, this time in the presence of Mayeso, who told the police that Catherine had made the story up. Catherine described how her brother provoked the police when they asked him how he and Catherine were related by responding: ‘I don't know her, she is not my relative.’ The police then asked Catherine if she had witnesses, and when she replied that she did, she was told: ‘We're arresting him because he is denying the complaint. If he had admitted the truth of the matter it would have been different, we usually resolve issues between relatives by simply discussing them.’

After Mayeso's arrest, Catherine gave a statement explaining ‘everything’ (ndinalongosola zonse), and she returned to the station the same day with her grandmother, who also recorded a statement. Catherine recalled her grandmother's reaction when the police suggested that Mayeso might go to prison: ‘He should go to prison, because even me, there was no part of my body left that he didn't insult, his sister too, he insulted every part of her body.’ Asked the same question by another police officer outside court on the first day of the trial, she replied: ‘He should go. We want him to learn, he should know how to live with people.’

Although the court case was drawn out, Catherine and her grandmother were in the witness stand for a combined total of just fifteen minutes during which they answered questions posed by a police prosecutor. Both told the court that Mayeso had insulted Catherine by referring to her ARV drugs, explaining that he was angered by her refusal to agree to a land sale. Catherine confirmed that she receives ARV treatment. When asked if she had anything to add, Catherine's grandmother described how she had gone to check on Catherine the following morning only to find that her house had been knocked down. Catherine had carefully responded only to the questions put to her by the police officer and had not mentioned the demolition. In the second court session, a police investigator testified, reading out Mayeso's caution statement, in which he described first a disagreement with his sister over some bricks and then an altercation on the road after she refused to remove her dog. He did not mention the land sale, or the headman's court, and he made no reference to HIV or ARVs.

At the third hearing, Mayeso elected neither to give evidence nor to call witnesses and the case was adjourned for judgement. As we saw above, Mayeso was found guilty of insulting his sister and sentenced to two months in prison. The question remains, however: why was Catherine's complaint framed by the charge ‘use of insulting language’? Her story, as she described it to me, at least, is one of threatened physical violence, intimidation and the destruction of property, for which a range of alternative charges would have been available to the police. Although Catherine told me that she considered her case to have been well handled, she was nevertheless surprised, and somewhat disgruntled, that only some of what she had complained about had been taken up in court. In the account of her story she gave to me, we heard her uncle and the headman discussing Catherine's predicament: Catherine's illness, ‘the way her body is’, and the violence against her, are the key elements, rather than the verbal abuse. Catherine's grandmother, too, attempted to bring the damage to Catherine's house into her evidence in court. The issue of the land sale and Mayeso's counter-accusations concerning bricks and Catherine's dog also suggest a broader, more complicated set of disputes. One puzzle, then, is why the police chose to concentrate on this aspect of Catherine's complaint, rather than other, more obviously ‘criminal’, aspects of Mayeso's behaviour, and at the expense of a more comprehensive investigation.

During my fieldwork, I regularly attended the police station to observe sessions at the Victim Support Unit (VSU). The police officers in the VSU were aware of Mayeso's case, and they told me that they were keeping an eye on it to see how it fared in court. For them, it was something of a ‘test case’ from which they would learn in order to better advise complainants in their office; although Catherine had not come to the VSU, disputes between relatives are the mainstay of VSU work and it is not uncommon for HIV/ARVs to feature in these disputes.Footnote ²⁰ A court clerk also explained what he perceived to be the benefit of the claim ‘use of insulting language’: in a case like Catherine's, it would be possible to employ the similar charge of ‘defamation’, but that would have to be dealt with by the High Court, which requires lawyers, and then, ‘people from the villages don't get proper access to justice’.Footnote ²¹

The magistrates' court is no more than a five-minute walk from the police station along a tarred road. Yet this physical proximity did not translate into a close working relationship or open communication. The fragility of the relationship was most strikingly revealed at a meeting of the Court Users' Association, attended by staff from the court, police station and hospital, as well as officials from the various government offices located at the District headquarters. A court administrator raised an issue that was not on the agenda: she had received complaints from defendants that they had been charged for police bail. The implication was that police officers were taking bribes and the suggestion enraged a senior police officer who raised her voice as she insisted that if these meetings were to become a forum for accusing the police, police members would no longer attend. Her outburst shut down discussion of the issue, prompting the more senior of the two magistrates to restore order by reverting to English and asserting: ‘It's not an issue, it's just what people allege without basis.’ The episode exposed the precarious nature of the working relationship between the police and the magistrates' court and the limits to productive dialogue.

Catherine's ‘test case’, then, can be seen as an episode in the ongoing negotiation of that relationship as the police watched to see whether such a claim would be a successful way of dealing with disputes in which the complainant's HIV-positive status was part of the mix. From Catherine's account of their encounter with the police, we might also deduce that Mayeso's defiant, uncooperative attitude hardened officers towards him, inviting formal charges where ‘simply discussing’ might have sufficed.

The police focus on the insults concerning HIV and ARVs, and the solemnity with which the magistrate dealt with the case, can also be understood in the context of the official discourse surrounding HIV/AIDS, vulnerability and stigma. Stigma has attained such prominence in understandings of HIV/AIDS that its existence can be declared without recourse to evidence – it is simply assumed to characterize the experience of HIV-positive people in Malawi, as in sub-Saharan Africa more generally. In invocations of stigma by government, donor and NGO representatives, as well as in media coverage, the concept is rarely given any content and the impression is of a static condition or attribute, much in the same vein as the less subtle academic analyses referred to above.Footnote ²² Thus, Nicola Ndovi, acting programme manager of the Centre for Human Rights and Rehabilitation, expressed her organization's ‘concern that attitudes that stigmatize and discriminate against people living with HIV and AIDS continue to remain high in the country’; Footnote ²³ and a spokesman for the National Association of People Living with HIV/AIDS in Malawi recently stated that its members ‘perpetually face mounting stigma’.Footnote ²⁴ These representations colour the landscape in which professionals, including police officers and magistrates, operate. By handing Mayeso a sentence that he intended to act as a deterrent to others, the magistrate made explicit his contribution towards efforts to curb the stigmatization of HIV-positive citizens.

KUTSALA, TO LEAVE BEHIND

To what extent, though, does such stigma characterize the experiences of Catherine and other HIV-positive women in rural southern Malawi? The Chichewa verb most commonly called upon to describe negative attitudes and behaviour towards people with HIV, and which comes closest to capturing the meaning of the English ‘stigmatize’, is kutsala, ‘to leave behind’. When she talked about kutsala, Catherine located her experiences firmly within her matrilineal family group, and in this she was not unique. In addition to her brother, she named her younger sister and the elder of her two grandmothers, all of whom, she said, failed to take proper care of her when she fell ill, did not like to share food with her, and would tell her not to sit and chat with them because she was HIV-positive. It wasn't the case that Catherine felt ‘left behind’ by all members of her family; she told me she could rely on her husband, her younger grandmother, and her two maternal uncles. She also described how a young male relative, who had formerly allied himself with Mayeso, had become more sympathetic towards her recently, extending his public support by accompanying her to court on the first day of Mayeso's trial. Catherine contrasted the way certain of her relatives treated her with a cast of local non-kin who were kind to her and came to her defence when they saw or heard her family members mistreating her. She spoke with particular affection, for example, of a female friend who visited her at home to encourage her when she was having a difficult time and who had come to support her during the night when Mayeso was shouting insults and demolishing the wall of her house.

As is suggested by Catherine's reference to the headman's assessment that Mayeso was ‘a bad person’, and the pending case for threatening the Group Village Headman, Mayeso had long been known as troublesome in the area. Indeed, his reputation traversed several villages to reach the compound in which I was living in the area of a different GVH. Catherine's latest difficulties with Mayeso surprised nobody there. Whether we interpret his behaviour as symptomatic of a ‘crisis of masculinity’ in a context of high unemployment and acute poverty (McNeill and Niehaus Reference Niehaus, Becker and Geissler2009; Ngwani Reference Ngwani2001), or frame his intention to sell Catherine's land as an episode in the as-yet-incomplete rupturing of a matrilineage, the effect of which would be to transform kin into ‘strangers’ with no claim to family land (Peters Reference Peters2002),Footnote ²⁵ what is certain is that Catherine's relationship with Mayeso was more complicated, more longitudinal, and more particular, than simple invocations of stigma suggest.

While Catherine's situation is extreme, my point about stigma's embeddedness in social life is a general one. For another HIV-positive woman I knew, it was her relationship with her mother that was most strained: ‘These days,’ she explained, ‘there's no one [else] whom I can say leaves me behind in any way.’ Another woman described how her elder sister used to gossip about her at the borehole, ‘telling people there that I am dying and I'll leave my children behind for her to raise’. In these cases, and others, such problematic relationships predate the women's HIV tests, and what looks like or finds expression as ‘stigma’ is an aspect of an ongoing and complex situation. In any discussion of the experiences of HIV-positive members of families and communities it must be understood that they are located within such ‘imperfect’ circumstances, where new information about a person is folded into pre-existing and often complicated social relations. Quite apart from its insensitivity to local idioms, then, the term stigma, applied in the absence of an appreciation of the texture of such multidimensional, unfinished relationships, can do little to illuminate the challenges that HIV-positive people must surmount and the interactions that they negotiate as kins(wo)men, friends and neighbours.

These experiences are far from static. A woman named Edith echoed many when she described recent changes in her relatives' behaviour:

Edith's own attitude had changed, too. Whereas previously she would get very upset about the things people said to her, ‘these days I don't worry, because they too are in the same group [they are also HIV-positive], those people who gossip about me, they are in there too’. It is no doubt true that, with the expansion of HIV testing, more and more of the people who were unkind to their HIV-positive kin and neighbours have themselves been diagnosed with HIV. However, other HIV-positive women, too, expressed a similar belief that HIV prevalence was significantly higher than official estimates of 11–15 per cent, stating, for example, that ‘perhaps three quarters of the people in this village are positive’. By considering that many of the people who speak disparagingly of them are themselves HIV-positive, they are able to distance themselves from their ignorant remarks. And for many, this sense of significant temporal shifts in their experiences is compounded by the transformative effects of ARVs, as one woman explained:

Proponents of the view that it is HIV/AIDS' intimate connection with death that produces stigma rightly question assumptions about the link between stigma and associations of HIV with illicit sex, pointing out that there is little to suggest the general stigmatization of illicit sex per se. However, it seems more accurate to understand attitudes towards HIV as being influenced by both factors. While ARVs may sever the bonds that have so powerfully bound AIDS to death, they leave the spectre of illicit sex untouched. Among my HIV-positive informants, even the most outspoken generally found it necessary to impress upon me that there are various ways (njira zosiyanasiyana) in which an individual might become infected. In this way, much like the relatives of the sick Zomba villagers whom Peters et al. describe carefully avoiding mention of AIDS, HIV-positive women distanced themselves from assumptions of sexual impropriety so as to position themselves ‘as fully moral, fully social beings just like any other sick person’ (2010: 298).Footnote ²⁷

At the same time that dominant discourses emanating from the media, government, donors and NGOs generate stigma by emphasizing the role of illicit sex in the spread of HIV, and elicit concern about the effects of stigma, they leave the concept unexamined and, therefore, stable and content-less. The experiences discussed here suggest the need for its interrogation, and for greater attention to local idioms, if the terms of these debates are to have any utility as descriptors of life with HIV. Chiradzulu women's depictions of kutsalidwa, being left behind, are inflected by the texture of pre-existing relationships and feed upon ongoing antagonisms. There is also a crucial temporal dimension to these women's experiences. Their own attitudes and behaviour, and those of their kin and fellow villagers, have shifted. The role of ARV therapies as a catalyst for such transformations ought not to be underestimated, but Catherine's case cautions against a view of ARVs as a simple cure-all for discrimination against HIV-positive villagers.Footnote ²⁸ The particularity of Catherine's experience was seemingly lost on the professionals who drew upon available understandings of stigma in their efforts to assist her. In Catherine's case, her HIV-positive status was simultaneously a resource that helped her find an audience for her complaints, and a burden that served to obscure other aspects of her complex relationship with her brother. While Mayeso was prosecuted for his stigmatizing behaviour, Catherine was left with a sense that only part of her nkhani (story, dispute, case) had reached the court.

Those attentive to the rhetoric of stigma, not least Malawian magistrates and police officers, might be forgiven for assuming the passivity of HIV-positive people. However, the dynamism and determination of the women whose experiences are recounted here challenge such depictions and draw our attention to their future-oriented actions and intentions – be they to educate an unruly brother or, as we shall see, to care for themselves and their children, and to make watchful decisions regarding marriage and reproduction.

TENTATIVE HOPE IN A MATRILINEAL SETTING

Matrilineality and matrilocality have profoundly shaped the experiences of HIV-positive women in Chiradzulu. For many, the experience of being left behind has been most keenly felt within their home compounds, at the heart of the matrilineal family (cf. Peters et al. Reference Peters, Walker and Kambewa2008: 668). But in the era of ARVs, it is largely through their achievements as farmers, working land that they acquired through matrilineal inheritance to feed and provide for themselves and their children, that they have reconstituted themselves as confident members of their village communities. Alongside their attempts to unsettle associations between HIV and illicit sex, their invocations of agricultural labour and care for their children can be understood as efforts to demonstrate their moral worth as productive participants in local social and economic processes. Of no small importance here is the fact that they are once more capable of contributing maize for communal ‘traditional’ and religious feasts.Footnote ²⁹ Active involvement in agricultural production marks a radical break with their past experiences of AIDS, and their re-establishment as able subsistence farmers sows the seeds of hope, as it were, for the future. The centrality of agriculture to sociality (Englund Reference Englund1999), as well as to survival, also gives some indication of what was at stake in Catherine's dispute with Mayeso over the sale of her garden.

Many of the women I got to know well were not currently married – a situation that is not uncommon in this part of Malawi (Kaler Reference Kaler2001).Footnote ³⁰ Single women (divorced or widowed), living separately from the fathers of their children (female-headed households), constitute by no means a small minority of households in these villages. They are recognized as ‘owners’Footnote ³¹ of the gardens they farm and their circumstances are deemed thoroughly unremarkable. The situation in southern Malawi cannot be taken as representative of the country as a whole, just as it is not representative of Africa as a whole. It offers a stark contrast to south-eastern Nigeria, as described by Smith (Reference Smith, Cole and Thomas2009: 178), for example, ‘where being (and staying) married remains a reputational requirement’.Footnote ³² Understanding the efforts of women in Chiradzulu to live well with HIV requires attention to the texture of their lives as relatively independent subsistence farmers in a matrilineal setting.

Now in her late forties, Lucy is twice divorced with one adult daughter and two young grandchildren. She left her HIV-positive second husband in 2006 when she became ill with an opportunistic infection and he did not take care of her. Lucy's description of her daily routine as a single woman is characterized by the celebration of ‘freedom’ (ufulu):

Like most villagers, Lucy farms to feed herself and strives to produce surplus maize and vegetables to generate a small cash income. During the dry season (May to September), she also hires casual workers (ganyu) to mould bricks on her land, which she sells. She hopes eventually to use the revenue to build herself a new house and to roof it with iron sheets, something she had once expected her husband to do for her. Lucy's ambition is to build a house that will remain after her own passing and that her grandchildren will point to with pride and say: ‘This is the house my grandmother built.’

Lucy made a direct connection between her ability to farm for herself, to feed herself and produce a surplus, and her decision to remain single, and she evaluated that decision in relation to her health:

At other points in our conversations she was more equivocal, expressing a tacit recognition of the sexual advantages of marriage: ‘I can say that I will marry because, what, can I say that I am elderly? I haven't aged! (laughs) I haven't aged, I'll accept [a proposal], but I'll be very vigilant (-yang'anitsa), asking myself will this help me?’

The strategy of remaining single for a number of years before remarrying was not new to Lucy, nor was it specific to her life with HIV. After ending her marriage to her first husband because ‘he was cruel to me: I realized that his behaviour was not helping me’, she was single for four or five years before marrying her second husband. Other divorced or widowed women, too, HIV-positive or not, sometimes asserted that they were single by preference and that they may or may not marry again, depending on their assessment of their situation and the suitability of available partners. While single HIV-negative women tended to argue that they were getting by all right alone with their gardens and livestock and that pregnancy would limit their ability to provide for the children they already had, other HIV-positive women offered similar reasoning to that of Lucy: their health was more secure while they were unmarried and in full command of their medication, diet, workload and sexuality. As one woman so succinctly put it, ‘if I marry, I'll die sooner’ (ndikakwatibwa, ndifa mwamsanga). Another did not rule out remarriage, but she was adamant that she could only marry an HIV-positive man: ‘As far as I'm concerned, I can't take a man who hasn't tested [positive], how am I supposed to take my medicine? How can I sleep with him? It's problematic.’Footnote ³³

There has been much discussion of rural Malawians' strategies for HIV prevention, which are said to include attentive partner selection, a reduction in extra-marital partners and, where a husband's behaviour is deemed to be putting his wife at risk, divorce (Kaler Reference Kaler2004a; Schatz Reference Schatz2005; Tawfik and Watkins Reference Tawfik and Watkins2007; Watkins Reference Watkins2004). In this case, however, strategies of spouse selection and the (perhaps temporary) rejection of marriage, are discussed and employed not by villagers who hope thereby to limit their chances of contracting HIV, but by HIV-positive women navigating their new circumstances, living with HIV. Kaler, reflecting on the relatively high rates of divorce and remarriage in matrilineal southern Malawi, which for her are indicative of ‘bad marriages and bad behavior’, concludes that we should ‘define marriage and heterosexuality as permanently beleaguered, shaky institutions’ (2001: 547).Footnote ³⁴ Seen from another perspective, we might understand the agency these women practise as they initiate divorce, choose their partners, and/or live independently with their children among their matrilineal kin, somewhat differently. Drawing upon longstanding, ‘traditional’ strategies, HIV-positive women are being vigilant (kuyang'anitsa), taking stock of the fact that, with the help of ARV medication, they are not dying, their bodies are strong and they face new challenges that were unimaginable just five years earlier. The question for these women today is how best to live, as HIV-positive women, villagers, wives and mothers. Their responses are profoundly shaped by their matrilineal context, not least by the social acceptability of female-headed households, and the relative independence afforded by land ownership.

In this context, kuyang'anitsa, being vigilant, is a future-oriented activity that captures well the sense of cautious hope expressed by HIV-positive women in Chiradzulu. It was perhaps best illustrated by one unmarried woman, when she described how she felt the day she brought her ARVs home for the first time. Terrified, she sat on the edge of her bed, tossing the tablets up and down gently in her hands. She was afraid of the effects the pills might have on her body – would her illness begin to show on her skin? That night she took the medicine as instructed and the next morning she inspected her skin for signs of change. She repeated this routine every day for months before eventually allowing herself to relax. But, she explained, she would continue to monitor herself for another three years. If she is still healthy then, she will try for a child. Although she is bringing up two young daughters of her late sisters, ‘it's not the same as having your own child’.

The vigilance that HIV-positive women in Chiradzulu employ in relation to marital or sexual relationships is emphatically not a rejection of sociality, atrophied through stigma. Rather it is a creative, hopeful, approach to re-establishing themselves in their core relational roles, as mothers, grandmothers and productive members of their extended matrilineal family groups. If being left behind by intimate others is the epitome of stigma, hope that centres on new possibilities for belonging constitutes its ultimate reversal.