• Malawi;
  • political economy;
  • post-structuralism;
  • risk

The emergence of new diseases and the re-emergence of ‘old’ diseases necessitates a relook at what shapes vulnerability to ill health. A framework is proposed that combines a realist approach to mapping vulnerability with feminist and post-structural approaches that focus more attention upon the role of social identities and cultural framings of disease. Too often investigations of disease focus either upon structural determinants of risk such as political policy and the economy, or on discursive definitions of disease that impact its experience. A combination of these approaches would result in a more effective framework for evaluating vulnerability, and subsequently for generating effective disease prevention strategies. The social, economic, political, and cultural context of HIV/AIDS in Malawi is given as an illustration of this framework.