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An Epidemic of Uncertainty

Navigating HIV and Young Adulthood in Malawi

A decade-long study of young adulthood in Malawi that demonstrates the impact of widespread HIV status uncertainty, laying bare the sociological implications of what is not known.

An Epidemic of Uncertainty advances a new framework for studying social life by emphasizing something social scientists routinely omit from their theories, models, and measures–what people know they don’t know. Taking Malawi’s ongoing AIDS epidemic as an entry point, Jenny Trinitapoli shows that despite admirable declines in new HIV infections and AIDS-related mortality, an epidemic of uncertainty persists; at any given point in time, fully half of Malawian young adults don’t know their HIV status. Reckoning with the impact of this uncertainty within the bustling trading town of Balaka, Trinitapoli argues that HIV-related uncertainty is measurable, pervasive, and impervious to biomedical solutions, with consequences that expand into multiple domains of life, including relationship stability, fertility, and health. Over the duration of a groundbreaking decade-long longitudinal study, rich survey data and poignant ethnographic vignettes vividly depict how individual lives and population patterns unfold against the backdrop of an ever-evolving epidemic. Even as HIV is transformed from a progressive, fatal disease to a chronic and manageable condition, the accompanying epidemic of uncertainty remains fundamental to understanding social life in this part of the world.

Insisting that known unknowns can and should be integrated into social-scientific models of human behavior, An Epidemic of Uncertainty treats uncertainty as an enduring aspect, a central feature, and a powerful force in everyday life.


"The philosophy and history of mathematical probability and its applications have recently, and very evocatively, described it as ‘the taming of chance’. Trinitapoli reminds us that this is certainly not the case. The calculus of risk, however impressive its achievements, cannot dispel the uncertainty of life events as people actually experience them. In the course of her analysis, she builds a simple and powerful explanatory framework attentive not only to the findings of her own superb ethnography, but to other demographers’, anthropologists’, and sociologists’, contributions."

Philip Kreager, Somerville College, Oxford University

"Trinitapoli, with her storytelling, has successfully opened a window for the reader to look into village life in Balaka district in Malawi, and she has at the same time, addressed demographic phenomena of fertility, migration, and mortality in a context of rapidly changing local HIV epidemic. The sensitive and accurate portrayal of village life and its chatter, interwoven with uncertainty in decision-making over partnerships, parenthood, and divorce has given me a fresh perspective on how I will read HIV and demographic statistics in the future."

Nyovani Madise, Director of Research and Sustainable Development Policies and Head of the Malawi office of the African Institute for Development Policy

Table of Contents

List of Abbreviations

1 Introduction: Surveying the Shadows of Uncertainty
2 Ten Years in Balaka: The Excellent and Imperfect Data of Longitudinal Studies
3 Uncertainty Demography
4 The Scope of HIV Uncertainty
5 HIV Uncertainty and the Limits of Testing
6 Relationship Uncertainty and Marriage Instability
7 Call the Ankhoswe
8 Ultimate Uncertainties and the Mortality Landscape
9 Conclusion: Varieties of Uncertainty in Balaka

Appendix: Mortality Trends in Malawi, 1990–2020
Glossary of Chichewa and Technical Terms

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