Upon completion of a transnational medical research project in Lusaka in 2008, outreach workers received a certificate of participation that stated: ‘Your contributions help pave the way for women in your community and all over the world to one day have a safe and effective way of preventing HIV transmission.’

The text invoked a link between a particular kind of contribution and notions of solidarity, if not altruism, that embraced women in one's own community and also women far beyond it. Voluntaristic contributions to the progress of health based on solidarity and altruism are at the very core of medical research ethics, but for people in Lusaka other kinds of hopes and possibilities emerged in relation to such research projects. In a part of the city where small medical research projects had only been implemented sporadically until the early 2000s, when the HIV and AIDS epidemic completely changed the landscape of interventions, lay people who engaged in transnational medical research projects were well aware of the long-term purposes and products of these research projects, but their involvement was often a matter of more immediate concerns, relations and responsibilities in a precarious day-to-day life.

This chapter explores the diversity of positions that lay people in urban Lusaka took up when they volunteered in transnational medical research projects as study subjects, recruiters, peer educators and outreach workers in 2008–2009. The chapter suggests how their volunteering can be understood as a variety of practices that shift with the positions that people learn to take in relation to the projects. These practices and positions unfold in unequal relations in attempts to open a variety of often vague, ambiguous and fickle connections and possibilities in research projects, which include access to care and the chance to learn something, temporary contributions to livelihoods, and maintaining or adding to status and identity by sharing these possibilities with others, which may again open the way to new connections and possibilities (cf. Prince 2015).

This exploration of different volunteering positions offers an alternative starting point for understanding volunteering in medical research that has otherwise been dominated by two different frames highlighting volunteers’ individual motives and wider structural inequalities. Both frames invoke an underlying concern with material rewards as problematic in the way that the voluntaristic altruism assumed to be necessary to freely participate in medical research can be undermined by forms of undue inducement.