Ensnared by AIDS. David K. Beine

in Nepal in particular, including the statistics and prognosis for impact upon the tiny country, and examine the various types of research that have been conducted in Nepal in respect to AIDS. I also introduce the major discourses on AIDS that have been presented by NGOs, the media and others, as well as discuss the various approaches being taken by international aid agencies and local authorities to help with the growing problem. Finally, I introduce the major components of a newly emerging cultural model of HIV and AIDS.

      In chapter four, I examine the theoretical frameworks upon which this research is based. I introduce the “cultural model” concept and examine cultural models as both product of and producer of culture. I also introduce the idea of schema theory, examining the various kinds of schemata, discussing what they are and how they are proposed to work, and I introduce recent modifications to the schema concept that inform this research. I also examine the cognitive methodologies employed in two different studies, focusing attention on the value of combining multiple methods in this type of social research.

      The background information provided in part one will facilitate a better understanding of the findings (and the implications) of the projects presented in part two.

The projects

      In part two, I present the findings of two different studies, which were conducted in tandem, in order to discover the different meanings attributed to HIV and AIDS by various groups in Nepal. The goal of these studies was to discover if there are any widely shared meanings (dominant cultural model) associated with HIV and AIDS as well as to discover underlying illness schemata associated with HIV and AIDS.

      The use of multiple methods of analysis in ethnomedical research has been suggested as a way to increase the validity of such research (Browner et al.1988; Stone and Campbell 1984; Viney 1991; Van Gelder 1996). Hence, the methodology followed during this research, approaching the meaning of AIDS in Nepal, included both a cognitive ethnomedical approach as well as a discourse analysis approach. Two major studies, using the two different approaches, were conducted in order to study the emergence of various cultural models of AIDS in Nepal and their constituent elements.

      In chapter five, I present the findings of an ethnosemantic study designed to elicit the conceptions regarding HIV and AIDS among a rural Nepali community. The investigation of rural conceptions of AIDS took place within the larger context of a study on conceptions of illness in a Nepali village. I present the full study here as elements of wider illness schemata are identified, which transfer to HIV and AIDS as well. Through this study we can see how traditional concepts have influenced understanding of the new illness known as “AIDS rog.” This study, using primarily an ethnomedical cognitive approach, ultimately sought to determine whether a salient cultural model of HIV and AIDS still exists among the people of a rural Nepali village. The village of Saano Dumre in Gorkha District was selected as the study site. Besides illuminating cultural models of HIV and AIDS, this study also examines the apparent changes that have taken place in regard to health beliefs over the past twenty-five years. Using the methods of cognitive anthropology, I explore several health-related topics including categories of illness, treatment-seeking order, factors influencing health, perceived causes of illness (including factors which facilitate a greater susceptibility to illness), ideas about transmission of illness, villagers’ perceptions about what has changed over the past twenty-five years, and ideas regarding the efficacy of traditional and Western medicines.

      Chapter six presents the findings of a narrative discourse analysis project conducted among HIV-positive persons in Nepal. Thirty texts were collected from HIV-positive persons in both urban and rural settings. Besides illuminating elements of the dominant cultural model that have emerged as a result of the various governmental prevention campaigns, these narratives also express common themes of shared meanings of HIV and AIDS not held by members of the wider culture. Furthermore, the texts demonstrate that a slightly different understanding of HIV and AIDS is held between rural and urban dwellers regarding the disease and between urban males and females. These common themes, as well as the illness schemata that underlie these narratives, are the focus of the chapter.

      In chapter seven, I examine the emerging cultural models intimated by the two studies. We will see several sub-group cultural models being expressed by various communities in Nepal, but we will also see the emergence of a dominant cultural model of HIV and AIDS. I will also further examine the underlying illness schemata that are made evident through the findings of both studies. An understanding of the various cultural models (and their constituent schemata) is essential because it is these cultural models that people employ to make sense of AIDS and it is these same cultural models that people use to determine appropriate behavior to exhibit toward those who have HIV and AIDS.

The findings

      In chapter eight, I examine the making of the dominant cultural model of HIV and AIDS in Nepal. I will focus mainly on the creation of this model, since it is being disseminated widely and seems to be having the greatest impact in shaping people’s understandings of HIV and AIDS, and I expect this cultural model will continue to do so in the coming years. We will see the strong influence of Western cultural models (and schemata) upon the dominant cultural model. However, we will discover that cultural models are also influenced by biology. I will examine the role of NGOs, doctors, policy makers and the media, as well as underlying biologically based schemata in the making of a dominant cognitive model of HIV and AIDS in Nepal. We will see that the resultant dominant cultural model of HIV and AIDS in Nepal is a type of hybrid based on the combination of the traditional and the new (especially when traditional ideas reinforce the new ideas) as well as a product of universal biology.

      Chapter nine will conclude the analytical portion of this book by summarizing the findings, examining the implications of the findings, and introducing a few remaining issues that intrigue me. In particular, I will address the issue of the negative impact of current foreign aid projects, make some recommendations for future prevention efforts and discuss why I encountered less depression than expected among AIDS sufferers.

In their own words

      I reserve the last chapter of this book, chapter ten, for those struggling with AIDS in Nepal to tell their own stories. Quite often in this type of social research the voices of the research participants are never heard. Their stories are real. And they are tragic. These people’s stories often left me empty and saddened at the hard circumstances of their lives. It is my hope that these stories from their own mouths will compel readers to consider what part they can play in helping to curb the growing HIV and AIDS pandemic. These stories represent only thirty struggling voices. There are thousands more like them in Nepal alone. And millions more like them around the world.

Acknowledgements

      I would be remiss if I did not thank the many that helped me bring this book to completion. First of all I would like to thank Mr. Dwarika Shrestha for his friendship and hard work on this project. Without his able assistance during the research phase, this project would not have been remotely possible. Next, I would like to thank Dr. Ganesh Gurung and the Department of Anthropology at Tribhuvan University for their sponsorship of this project. I would also like to thank Dr. Nirmal Man Tuladhar and the Center for Nepali and Asian Studies for their most gracious help in many areas. I would also like to thank the entire membership at Prerana for their most gracious cooperation. Further, I would like to thank Rajendra Shrestha at Freedom Center; Mrs. Amina Lama at Maiti Nepal; Mrs. Shanta Sapkota at Peace Rehabilitation Center [the entire staff at ABC Nepal; Dr. Bhadra at B. P. Memorial; Dr. Bal K. Suvedi and Dr. Bhoj Raj Joshi of the Nepal Medical Council; Shiba Hari Maharjan of LALS; Dr. Vijaya Lal Gurubacharya and Dr. B. B. Karki of the National Center; Sally Smith of the United Mission to Nepal; Ms. Prakriti K. C. and Dr. Mark Zimmerman at Patan Hospital; all the staff at Amp Pipal Hospital, Gorkha District and all of the residents of Saano Dumre, Gorkha District. I am indebted to the above individuals for their assistance. Without their help many of the goals of this project could never have been realized.

      I would also like to thank the members of my doctoral committee, Dr. Linda Stone, Dr. Barry Hewlett, and Dr. John Bodley for their help in improving this manuscript. I would also like to thank my wife and children for supporting me through the long grueling process.

      Finally, I wish to thank those