Cover

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Title Page, Copyright

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pp. i-iv

Contents

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pp. v-vi

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Preface

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pp. vii-xviii

Beginning in the late 1980s, the horror of the AIDS epidemic in Africa called forth an outpouring of compassion—and of romantic imagination. Governments in wealthy countries created global organizations to fight the disease; church groups sent volunteers; ordinary people sent checks. There was a ferment of altruism in the Western world inspired by a desire to help others in far-away places. We focus on AIDS as the key motivator of the global altruism we study. But altruists also target other issues, such as poverty and women’s empowerment, and embrace other...

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CHAPTER 1. Introduction: Altruism from Afar

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pp. 1-18

Altruism from afar—the flows of money and help from wealthy countries to poor ones—has become an enormous and enormously significant enterprise.1 We describe the efforts of altruists to turn the tide of new HIV infections in Malawi, to alleviate the suffering of the already infected, and to assist the orphans of those who have died. We focus on AIDS prevention rather than treatment, since preventing HIV transmission has been the ultimate goal of the AIDS enterprise. Some altruists are vast international organizations, such as USAID, Save the Children, and Britain’s...

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CHAPTER 2. Fevered Imaginations

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pp. 19-35

Donors, like the brokers upon whom the success or failure of donor projects depends, are moved by powerful fantasies. The term “fantasy,” of course, can carry a negative connotation, implying wishes totally divorced from reality, or a positive one, an image of a desired future state. Fantasy can impair effective action, but ambitious plans often begin as fantasies. Here we wish to retain precisely this ambiguity: “fantasy” and “imagination” are critical elements of all human endeavors, and they can also get us into trouble. Exploring the fantasies that both motivate and entangle the...

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CHAPTER 3. Lumbering Behemoths and Fluttering Butterflies: Altruists in the Global AIDS Enterprise

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pp. 36-56

In the previous chapter, we described the alluring promise that the AIDS effort has created. Here we describe the innards, the messy and convoluted routes by which money and programs move through the global AIDS system.

What does it take to create the encounters between altruists and brokers that we described in the previous chapter? The short answer is “a lot of money for AIDS.” This chapter is a longer answer: it takes the huge, chaotic, and frenetic organization of the global AIDS enterprise and, for those who come in person to help, a commitment of significant time and...

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CHAPTER 4. Cultural Production: A Riot of Color

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pp. 57-77

Once the premise was accepted that AIDS was an emergency and that prevention was central, there was the question of just what the organizations described in the previous chapters could do.1 Institutional altruists supported technical approaches, such as screening the blood supply for the HIV virus, providing antiretroviral drugs to HIV+ pregnant women so as to prevent transmission to their babies, and voluntary counseling and testing. Donors also spent heavily on information, education, and communication about the ABCs—abstain, be faithful, and condomize—since...

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CHAPTER 5. Getting to Know Brokers

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pp. 78-105

In the romance of AIDS altruism, brokers must bridge the distance between the imaginations and aspirations of the altruists and those of the people they aim to help. For some brokers, this is simply a job that puts food on the table and pays children’s school fees; for others, it is also a mission to bring development to their countrymen; and for still others, it is an occasional gig—when an opportunity arises, they offer their services.

Brokers do not get much attention from the altruists; it is the beneficiaries who captivate the altruists’ imagination. But it is the brokers who ultimately...

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CHAPTER 6. Brokers’ Careers: Merit, Miracles, and Malice

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pp. 106-122

Malawian brokers tell their career histories by drawing on three narratives: that of Merit, emphasizing their objective achievements and the ways their hard work, intelligence, and honesty are rewarded; that of Miracles, emphasizing the remarkable coincidences or the unexpected help from relatives or strangers that make success possible, which they almost universally attribute to God’s help; and Malice, or simply misfortune, when anyone from capricious donors to envious co-workers can undermine or sabotage a career. To fully understand brokers’ aspirations and...

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CHAPTER 7. Themes That Make Everyone Happy: Fighting Stigma and Helping Orphans

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pp. 123-137

How do brokers and donors manage to work together? There are conflicting motives and complex misunderstandings between donors and brokers, and between both of these and villagers. Each arouses fantasies in the others that cannot be fulfilled. Nonetheless, because it is in the interest of each to do so, brokers and donors, and sometimes villagers, fumble toward “working misunderstandings”—ways of accommodating one another that allow them, however uncomfortably, to get along.1 In this chapter, we examine themes on which the two parties have worked well together; in...

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CHAPTER 8. Themes That Make Everyone Anxious: Vulnerable Women and Harmful Cultural Practices

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pp. 138-165

Unlike images of vulnerable orphans and stigmatized AIDS sufferers that rally donors, elite brokers, and even villagers to the same cause, images of vulnerable women and harmful cultural practices fascinate and disturb both brokers and donors, but leave them working at cross purposes. Donors and brokers agree that “vulnerable women” and “harmful cultural practices” contribute to the spread of AIDS, but underneath this surface agreement, the anxieties these issues arouse are very different for the two groups. The two themes are similar in that both brokers and donors...

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CHAPTER 9. A Practice That Makes Everyone Happy: Training

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pp. 166-182

Why do development projects, such as those to prevent or mitigate the effects of AIDS, take the forms they do? We have described “themes,” basically words (categories, slogans, and buzzwords) that allow altruists and brokers to imagine themselves joined in a common enterprise. The ability of donors, brokers, and villagers to develop working misunderstandings at the level of verbal formulas, however, provides only one answer to the puzzle of how they manage to get along. The deeper answer isn’t about words, but about practices—the routinized activities that allow people to...

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CHAPTER 10. Creating Succes

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pp. 183-197

At the beginning of this book, we wrote that the foreign aid efforts against AIDS are motivated by compassion, by a passion for doing good, by an urgent need to connect with others very different from ourselves—and by fantasies of transforming the behavior of those at risk of HIV infection. But how do donors know whether their efforts were successful? In this chapter we examine another set of practices that bind donors and brokers together: the varied practices through which they assure their funders and themselves that their efforts have...

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CHAPTER 11. Conclusions: Doing Good Better

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pp. 198-214

We have had many skeptical things to say about the AIDS enterprise. Our message, however, is not that the task is easy and those who do not get it right are fools. Just the opposite. We are constantly aware how hard it is to do good at long distance. It is difficult because the visions that inspire the romance of altruism are often at odds with the visions of the brokers on whom the donors depend and with the visions of those living in villages or slums who long for help that will permit them to survive from day to day. It is particularly difficult for the giant institutional altruists such as...

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Acknowledgments

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pp. 215-218

We begin, as is conventional, by thanking the many visiting altruists, development workers and volunteers, and especially the Malawians, who shared their lives with us. In our case, we mean it. Malawi’s national motto is “The Warm Heart of Africa,” and indeed, Malawians are remarkably open, warm, generous, and eager to talk with outsiders. As we walk in local markets, people who speak English want to chat about everything from American politics (a source of particular fascination during the Obama era), to soccer, to their curiosity about us—where we “go to church,” our...

Notes

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pp. 219-246

References

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pp. 247-268

Index

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pp. 269-280