Ensnared by AIDS. David K. Beine

subject to its laws. Nepal, the last remaining Hindu kingdom in the world, was now officially declared the Federal Democratic Republic of Nepal.

      Over the next four years the elected Constituent Assembly would itself be caught in a constant quagmire of political in-fighting, positioning and bickering, and more prime ministers would come and go. Girija Prasad Koirala continued in the role as prime minister of the new Federal Democratic Republic of Nepal from May to August 2008 before being forced to resign. Then Maoist strong-man Prachanda was elected as prime minister by the Constituent Assembly in August of that same year and was expected to oversee the transition from monarchy to republic but he was forced to resign in May 2009 after his controversial sacking of a Nepali army general. He was followed by Madhav Kumar Nepal of the Communist Party of Nepal (Unified Marxist-Leninist), who resigned in 2011 amidst further serious political deadlock.12 He was followed by Jhala Nath Kanal (February 2011–August 2011), and finally Maoist second-in-command Baburam Bhattarai (August 2011–March 2013). After its failure to draft a new constitution (having been given two years and two more one-year extensions to do so), the Constituent Assembly was finally dissolved on May 28, 2012. New elections were called for, and the date of November 2012 was set, in hopes of electing new members to a new Constituent Assembly that all hoped could get the job done.13 In the interim, Baburam Bhattarai stayed on as head of a “caretaker government,” the elections were again postponed, and on March 14, 2013, Chief Justice Khil Raj Regmi was sworn in as the head of a new “interim election government” tasked with carrying out the election process. This is where the process sits as of the publication of this book.

      One of the most devastating effects of all of this political turmoil is a loss of hope for the future of Nepal. The general public is very frustrated with the gamesmanship being played at a time when the politicians should be engaged in nation building. One commentator accuses the Constituent Assembly of “procedural maneuvers instead of being honestly involved in drafting a proper constitution of the country and building the nation for which they were elected” and Nepal’s political process of “’forever recycling leaders’ [the same old politicians] that haunts the house of Nepal from the fifties” (NACSS 2009). Reflecting on the implications to healthcare, another commentator concludes that “the superficial changes in political structure have not brought about any changes in the life of ordinary people” and that “the state of health service development is no way different now than it was during the active [civil war] conflict period” (Ghimire 2011). What happens next will ultimately be the domain of the historians. One thing is universally accepted, however, namely that further political instability will only further detour the prevention and treatment of HIV and AIDS in Nepal.

1.2 General cultural features

      Many aspects of Nepal’s current-day cultural features have been shaped by elements of her past history. And many of these same general features play a role in shaping and promoting the HIV and AIDS epidemic in Nepal. In the remainder of this chapter I will discuss many contemporary aspects of Nepal’s culture, focusing cursorily on the resultant impact on the spread of HIV and AIDS in the former Himalayan kingdom. Some of these factors will be taken up again more at length in subsequent chapters.

1.3 Population demographics

      David Seddon (1995:4) has commented that many of the demographic characteristics of Nepal play an important role in determining the pattern of development of the HIV and AIDS epidemic in the country. According to the latest figures available, Nepal’s population is now 26.6 million, of which 33 percent are under the age of fourteen, 62 percent are between age fifteen and sixty-four, and only 5 percent are over age sixty-five. The population growth rate is 1.35 percent and the sex ratio for the total population is 0.94 male/1 female (NPHC 2011). The latest estimated birth rate is 21.85 births/1,000 population and the death rate is 6.75 deaths/1,000 population. Infant mortality is listed at 43.13 deaths/1,000 live births and life expectancy is 66.51 years for the total population. The total fertility rate is 2.41 children born per woman (CIA 2013). Later in this book we will see how these population demographics combine with other key characteristics (such as the amount of arable land), to “push” people to migrate, which increases their risk factor for contracting HIV and AIDS, further facilitating the spread of HIV and AIDS in Nepal.

1.4 Economy

      Although Nepal has seen some statistical improvement in its economic condition since the first edition of this book was published a decade ago, the country remains one of the world’s least developed nations. Nepal is listed as 157/187 (30th poorest) in the Human Development Index Rankings (UNDP 2013), with a Gross Domestic Product (GDP) per capita income of $1,300 and approximately one quarter of its population still living below the poverty line (CIA 2013). Nepal is mainly an agrarian society where nearly 75 percent of the population is economically dependent upon agriculture, which makes up over one-third of Nepal’s GDP (CIA 2013). Given the declining ability for Nepalese to meet their own basic agricultural needs due to the growing population and land degradation, future economic prospects are poor. Nepal is an underdeveloped nation with strong economic ties to India as a result of Nepal’s geographic proximity, historical relationships, and landlocked status. Also, Nepal has historically relied heavily upon foreign aid to meet her needs. Foreign aid (as a percentage of the GNP) had grown from 8 percent in 1984 to nearly 13 percent in 1987 (latest figures available, Savada 1991). Likewise, foreign aid accounted for 64 percent of the development expenditures between 1956 and 1990 (latest figures available, Savada 1991). And latest figures estimate foreign aid to make up 5–6 percent of the GDP, 55 percent of Nepal’s capital expenditure and 25 percent of its total expenditure (Dahal 2008).

      To understand Nepal’s present economic condition it is necessary to understand its economic past. Nepal, under the despotic leadership of the rogue prime minister’s hereditary line (the Ranas), practiced a protectionist policy of isolationism and was cut off from the rest of the world for over a hundred years (1846–1950). Karan and Ishii (1994) observe:

      Nepal’s chaotic political development in the first half of the nineteenth century precluded any real attention to the economic needs of its people. When autocratic stability was imposed by the prime ministers of the Rana regime after 1846, the administrative structure was reinforced to provide economic aggrandizement for the extensive Rana family, to the extent that Nepal’s revenues, land ownership, and economic opportunities were almost totally the prerogatives of the ruling family. (Karan and Ishii 1994:1)

      Prior to this period Nepal had also suffered under the consequences of a two-year war (1814–1816) with the British (Anderson 1987:20–23), which had been preceded by the consolidation (through warfare) in 1769 of several tiny hilltop kingdoms into the Kingdom of Nepal under the leadership of Prithvi Narayan Shah (EIU 1996:71). It was King Prithvi Narayan Shah who first established the modern nation-state known today as Nepal (Savada 1991:15–19). Nepal, therefore, had suffered the consequences of underdevelopment (as a result of political instability and despotic rule) for nearly two hundred years. Blaikie, Cameron, and Seddon (1979:25) observe that “Nepal had no economic planning of any kind prior to 1951.”

      The year 1951 saw the overthrow of the Rana government and the return of the rightful royal monarch to the throne. King Mahendra Shah took control of Nepal in 1951, ending its “virtual economic seclusion” (Johnson 1983:155) and marking Nepal’s emergence into the modern world. Shah threw Nepal’s doors open to the outside world and attempted to lift Nepal from its poverty by guiding the revitalization of the country through its introduction into the global community as a fully functioning economic member (Bista 1991:1). Nepal’s economy, however, was still “rooted in the medieval past” (Karan and Ishii 1994:1).

      Since 1951, Nepal has pursued various economic strategies with limited success (Bista 1991:1; Savada 1991:107). In 1955 the government announced the first of several five-year economic development plans (Uppal 1977:17; Lohani 1984:181; Karan and Ishii 1994:1) designed to facilitate economic and social development. However, by the mid 1990s “the development strategies introduced in the 1950s and 1960s had not had the results predicted by their advocates” (Schloss 1983) and Nepal “had not advanced economically in the last 45 years” (EICU 1996:79). Although the last decade has certainly seen some statistical economic improvement, many would contend that the civil war actually set Nepal’s economic development