Utilizing historical and field research methods, this dissertation addresses two research questions: (1) How did particular Western norms, in this case HIV testing practices, become a global standard?; and (2) Have HIV testing practices been transformed from their Western design in the process of their cultural diffusion in sub-Saharan Africa, and if so, by whom and in what ways? The site of the African case study for this project is Malawi: a poor, largely rural, country of sub-Saharan Africa, where HIV prevalence is eighth highest in the world. This research addresses questions with broad significance for social science and global health policy. First, while much research has documented that the institutionalization of global norms does occur, little research has addressed how it occurs. Second, most studies of HIV testing have evaluated it solely in terms of its efficacy as a public health intervention. No research, however, has focused on the multiple interpretations of HIV testing norms from among the various institutional and social actors who inform the HIV testing encounter (international and national policy makers, HIV health providers, and the clients they serve), differences that invariably affect the way in which testing is provided. Findings from this research will be disseminated to the academic community via publications and professional conferences, as well as to Malawian health officials and providers, and the local, national and international organizations that assist them.
