Twenty years ago, in the relatively early days of a global response to the AIDS epidemic, the UNICEF report Children on the Brink (1997) introduced a new definition of orphanhood—any child under the age of eighteen who lost one or both parents—along with the dire prediction that the number of AIDS orphans worldwide would continue to rise over the next decade. To varying degrees both Ann Swidler and Susan Cotts Watkins, in A Fraught Embrace: The Romance and Reality of AIDS Altruism in Africa, and Kristen Cheney, in Crying For Our Elders: African Orphanhood in the Age of HIV and AIDS, draw upon this conceptual image of the “African AIDS orphan” to frame their arguments about the current era (in Malawi and Uganda, respectively) of what they consider a global AIDS enterprise.

Swidler and Watkins attempt to add new vocabulary to the lexicon of what may be considered the AIDS-industrial-development complex. For example, their classification of the roles of “altruist,” “broker,” and “villager” in low-resource settings serves as a useful taxonomy to inform the reading of many other AIDS ethnographies (including Cheney’s). The authors attempt to frame AIDS prevention programs as a “romance” between “altruists” (Westerners sending money from afar, whether philanthropic individuals or large international aid and development agencies), “brokers” (educated and/or entrepreneurial Africans who mediate between foreign altruists and locals), and “villagers” (the materially poor objects of altruists’ benevolence and brokers’ efforts). Swidler and Watkins draw extensively on what they call “motel ethnographies” (16) conducted over nearly twenty years, seemingly ad hoc while they were conducting other research in Malawi from 1998 to 2010 for the University of Pennsylvania’s Longitudinal Study of Families and Health. These were boom years for the proliferation of both multinational NGOs and local AIDS organizations. Malawi was quickly flooded with large- and small-scale altruists and brokers, ranging from internationally educated workers for large-scale NGOs to district-level operatives providing necessary and at times informal links between elites and the villagers. Supplementing the authors’ informal interviews over the years with visiting altruists, local AIDS workers, and entrepreneurial brokers were the more than twelve hundred diaries “written . . . by local ethnographers” (17), field journals which provide on-the-ground insight regarding AIDS programming in Malawi. These various sources lend an intimately detailed perspective to the work.

A Fraught Embrace begins with this thesis:

The book proposes to reveal what the romance of AIDS altruism is like from the brokers’ perspective, as opposed to recapitulating the altruists’ side of the story. The authors largely achieve this, but conversely, they pay little attention to the villagers, whose reality may be misinterpreted by foreign altruists and cosmopolitan brokers alike.

As in most romances, there are multiple examples of the fantasy gone awry between altruists and brokers. The case of a high-profile female broker who beats a maid for allegedly sleeping with her husband illustrates conflicting concepts (140): a “vulnerable woman” (in the eyes of global donors who believe that “African cultural norms” stifle women’s agency and thus contribute to the AIDS crisis) versus a “mercenary woman” (as seen by brokers on the ground who restrain women’s behavior, more concerned with suppressing vice and reducing the temptation of “seductive” women threatening health and the moral order). Or similarly, donors’ intention to reduce the AIDS stigma doesn’t much serve brokers trying to resolve a dispute within an agricultural coop whose members won’t let an ill man join, afraid he will succumb to AIDS before repaying his share at harvest time. In addition, Swidler and Watkins address the images of institutionalized “AIDS orphans” that “loom large in the donor imagination of those looking at Africa from afar” (133)—even though most of the afflicted, in fact, remain in their own villages cared for by relatives. The compelling ethnographic detail and richly layered history they provide enliven their exploration of the “intersecting fantasies that lock donors, brokers, and villagers together in a fraught embrace” (19). Their focus on the broker is incisive and illuminating, so much so that any reader well-versed in the AIDS–humanitarian complex (say, a biomedical HIV researcher) may find herself wincing in painful self-recognition at the vaguely cynical description of the ubiquitous donor-mandated “trainings”: cheap, ritualized mainstays intended to ensure the “sustainability” of AIDS programs and favored by brokers because training confers financial gain and status. Swidler and Watkins state that their intent is not cynically to condemn all altruists, and they conclude with a relatively circumspect series of recommendations for altruists, tempered by the practical realities on the ground. A Fraught Embrace is an extremely readable and deeply informative exploration of the international AIDS enterprise, essential reading for anyone interested in AIDS and the larger machinations of the international development system.

The framework of A Fraught Embrace aligns almost seamlessly with Kristen Cheney’s Crying for Our Elders. The book records the author’s returns to Uganda, where Cheney previously had chronicled the life histories of children affected by AIDS (Pillars of a Nation, University of Chicago Press, 2007). In preparation for the latest monograph she reconnected with some of the same child informants, now much older, and trained them to serve as youth research assistants for her ethnographic studies. Cheney details her methodology extensively in a lengthy chapter describing her youth-centered participatory approach and its connections to her earlier discussion of children’s rights and empowerment. Here her reengagement with her brokers, the young research assistants, is her own enactment of altruism : “I thus relinquished much of my authority as the PI [principal investigator] to privilege the children’s and youth RAs’ knowledge as the ‘experts’ on their own lives” (69). Like all good brokers, “the youth RAs inadvertently became proxies for me as PI, as well as outsiders within; the caregivers perceived them as having an elevated status—but one they could still manipulate by virtue of being elders dealing with young people whom they expected to be subservient to them” (77). Yet while Cheney’s rights-based perspective is important for any researcher engaged in research with children, the detailed life histories of her youth RAs that inform her account of orphanhood during the AIDS era blur the distinction between the RAs as “brokers” and at the same time subjects themselves.

Cheney asserts that “orphans and vulnerable children are constructed categories, created and propagated by the development and humanitarian industrial complex, that do not ultimately hold together within the social constructs of children’s lives” (3). As the AIDS fantasy has been misconstrued, she argues, so too has the category of orphanhood: “It is not orphanhood itself but its intersections with other personal, social, and political circumstances and structural factors that adversely affect children’s life chances. Indeed, a number of scholars have written that the AIDS pandemic has been similarly misconstrued, but I wish to make a related point that a focus on AIDS has also obscured the many other causes of orphanhood” (3). This is a compelling statement (and most likely objectively true), although, except for the effects of poverty, the rest of the volume does not clearly elucidate the other causes of orphanhood, and the interaction of poverty and AIDS in the life histories Cheney recounts here is nearly impossible to disentangle in any case. Had illustrative examples from the child and household profiles that Cheney painstakingly compiles in a heartrending and meticulous appendix been more integral to the main text, she might have better supported some of her arguments, or demanded less of the reader’s capacity to make those connections independently. The rich detail obtained by the youth RAs but included only in the appendix feels somewhat secondary, divorced from passages where more ethnographic detail would have better illustrated Cheney’s provocative points.

A main theme throughout the work is that the U.N.’s definition of orphanhood does not necessarily reflect the kinship safety nets that often safeguard children in Uganda (and in Malawi). Cheney posits, however, that within the AIDS complex “the definition of orphans and vulnerable children [OVC], a catch-all phrase developed in the aid industry to recognize the vulnerabilities faced not only by orphans but also by other children lacking care . . . has reified vulnerability as an ironically privileged and empowered identity; orphanhood can ironically raise the status of a child who has lost a parent precisely because orphans are made objects for intervention” (25). Again, maybe because there is little integration of ethnographic details from the appendix and her youth RAs’ stories, it is hard to find qualitative evidence in Cheney’s volume to underpin this provocative argument: most details of the children’s and RAs’ lives don’t support a particularly privileged or empowered status. Cheney does include a well-researched discussion of tension between maternal and paternal kin of an orphaned child in terms of which side assumes the initial financial responsibility for young orphans, with the expectation of benefiting from an extra person’s contribution to household income when the person is older. The later chapters discuss the challenges of adoption by nonrelative Ugandans and the increasing abandonment and institutionalization of these children, often for economic reasons. However, this discussion seems bereft of particulars regarding HIV/AIDS, or issues affecting HIV-positive children in particular, although there is an implicit assumption that these children are all orphans due to AIDS.

A particular strength of Crying for Our Elders is that Cheney does achieve, with great precision, a concise history of the AIDS epidemic and the initial plethora of international and national responses that were employed to various effect in Uganda. Her prose is readable, and her positions are always clearly stated and deeply informed by the particulars of children’s rights, with a specific perspective on how AIDS has constructed an orphan–industrial complex. This abundantly researched work is essential to the study of international development and of orphanhood, as well as an enriching contribution to the field of children’s studies.