Academic journal article Contributions to Nepalese Studies

HIV/AIDS in Nepal: The Making of a Cultural Model

Academic journal article Contributions to Nepalese Studies

HIV/AIDS in Nepal: The Making of a Cultural Model

Article excerpt

Introduction

HIV/AIDS has become a prominent problem in the tiny South Asian country of Nepal. Experts have stated that the number of AIDS cases has increased fifteen-fold over a three-year period (1990-93) and the numbers were expected to reach 100,000 cases by the year 2000 (Suvedi, Baker and Thapa 1994). Although the numeric impact of HIV/AIDS has not been as dramatic as anticipated, (1) it is expected that AIDS will grow at an alarming rate over the next few years. One author proclaims AIDS as a "coming crisis" for Nepal (Seddon 1995).

The way people make sense of illness is, in part, culturally determined. Existing beliefs and presuppositions shared by a community (cultural knowledge) regarding illness plays a significant role in shaping an understanding of newly emerging illnesses in any given culture. This cultural knowledge is organized as cultural models, which are utilized to "make meaning" of new situations such as the HIV/AIDS epidemic. These cultural constructions (cultural models) of illness can also contribute to the spread of the epidemic.

In this paper I examine the various factors involved in the creation and spread of a dominant cultural model of HIV/AIDS in Nepal. This process seems to be the result of a complex combination of factors, both cultural and biological. I will introduce the dominant cultural model of HIV/AIDS and examine the role that NGOs, doctors and policy makers, the media, and underlying biologically based schemata have all played in the making of a dominant cognitive model of HIV/AIDS in Nepal. The resultant model is a type of hybrid model based on the application of traditional ideas (underlying culturally-based illness schemata), the strong influence of an imported Western model of HIV/AIDS (especially the aspects of this model that are reinforced by pre-existing cultural schemata), and universal biology.

The findings of this paper are based on a larger study of HIV/AIDS in Nepal, which included 1) an ethnomedical study (cognitive anthropology) that examined cultural models of illness and the schema which underlie these cultural models, explicitly focusing on villagers perceptions of the newly emerging phenomena of HIV/AIDS, 2) a discourse analysis (linguistic anthropoloy) study of 30 narratives of persons living with AIDS (PWAs), in-depth interviews with multiple HIV/AIDS NGO staff, a knowledge, attitudes, practices (KAP) study conducted among Nepali doctors and a six month study of the Nepali media's presentation of HIV/AIDS. The data collected was presented as a doctoral dissertation for the department of anthropology at Washington State University (Beine 2000b).

Cultural models of HIV/AIDS in Nepal

In my doctoral dissertation I explored various cultural models of HIV/AIDS that exist among different sub-groups in Nepal and examined the various schemata that inform these models. Based on the findings of my research I also proposed a dominant cultural model of HIV/AIDS that influences these various sub-group models. The three major components of this dominant model are fear, hate and blame. The research also demonstrated widely shared understandings of HIV/AIDS as a fatal, infectious, and sexually transmitted disease. The research also illuminated common themes regarding AIDS as a "bad person's" disease, AIDS as the result of bad karma, and the belief in a strong connection between worry and disease. Based on the data, I have proposed a dominant cultural model of AIDS in Nepal that encompasses these features as major elements (Figure 1). As can be seen in Figure 1, however, there are also slightly modified cognitive models held by different sub-groups (e.g. rural versus city PWAs, and urban female PWAs versus urban male PWAs). These sub-group models still encompass the major features of the wider model, but differ from one another in significant ways as well. Although these differences are of interest, I will focus here mainly on the creation of the dominant model. …

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