The recent expansion of free access to antiretroviral therapy (ART) in many sub-Saharan countries has the potential to transform the meaning of HIV/AIDS in the region. Despite findings that the availability of ART influenced risk perceptions and behaviors among men who have sex with the men in the West, few studies have examined the implications of ART for the generalized epidemics of sub-Saharan Africa. The Young Adults'Responses to ART (YARA) study will collect timely and innovative data to examine how improved access to ART influences the meaning and consequences of HIV/AIDS for rural Malawians entering the peak ages of infection. We situate the study in Balaka, Malawi to take advantage of Tsogolo la Thanzi (TLT), an ongoing panel study (2009- 2012) of 2500 young men and women, and because ART has been available at the local district hospital for four years. YARA will use a sequential mixed-method design that includes four focus group discussions, two waves of TLT longitudinal survey data, and eighty in-depth interviews with a nested subsample of TLT respondents and their infected household members. Using these data, we address critical questions of how exposure to ART and the possible existence of HIV treatment optimism influence young adults'risk perceptions, risk behavior, day-to-day lives, and future aspirations. The proposed project is strengthened by a close relationship with an existing panel study, more than five years of research in rural Malawi, and good relations with local district and health officials. PUBLIC HEALTH RELEVANCE: This project examines how the recent spread of antiretroviral therapy (ART) is changing the meaning of HIV/AIDS for young adults in sub-Saharan Africa. The main goals of the project are to understand how ART is transforming the way that young adults perceive the threat of HIV and to examine evidence for increased risk taking as a potential consequence.