Ensnared by AIDS. David K. Beine

and never with labor. Education is traditionally the prerogative of the upper classes; to be educated is a powerful symbol of status. Education is not seen as a means of acquiring skills that can be used productively to secure economic prosperity but is seen as an end in itself which once achieved signifies higher status… To become educated is to be effectively removed from the workforce. (Bista 1991:5–6)

      Or to put it bluntly, once hands have taken up the book they should never again touch the plow. Bista concludes that such cultural features of Nepali society “are retarding and diminishing its efforts to develop” (Bista 1991:1). David Watters (2011), observing the impact of this cultural belief on the rural youths sent off for education from far-western Nepal, writes, “Many students returned home and became thugs, perfecting the criminal practices they had witnessed in the towns” and “most honest, hardworking villagers [and here he is referring to the Tibeto-Burman Kham people who are not willing to give up manual labor for the sake of an education as the Indo-Aryans are] were thus understandably wary of Nepali education and wanted no part of it.” This is a remaining cultural feature that is inhibiting Nepal’s progress and yet few have ventured to address it as it relates to education paradigms.15

      Another little-discussed (and possibly related) problem regarding education is the impact that the form of educational curriculum had upon the Maoist insurgency in Nepal. The curriculum in Nepal as noted above focuses heavily upon the three Rs (reading, writing and arithmetic) at the expense of a focus upon a more village-appropriate education (perhaps more technical or vocational in nature). Thus, rural youths were educationally trained for types of jobs that simply were not available in the rural areas of Nepal. And fewer and fewer of these types of jobs were available in the city either, as unemployment and oversupply skyrocketed. As a result, frustration rose among the well-educated rural youth toward the existing conditions. This frustration, in turn, led to sympathy for the Maoist message. And many well-educated rural youths joined the Maoist movement in response.

      The “Maoist problem” had a major impact on the spread of HIV and AIDS in Nepal in many direct and indirect ways.16 The most obvious impact was that during the conflict, many of the rural schools were forcibly closed by the Maoists as they were considered agents of imperialistic, capitalistic Nepali hegemony. These schools had been the main venue where HIV prevention was being promoted throughout the country. Likewise, many INGOs working on HIV and AIDS issues in the rural areas were targeted for the same reason and had to close their projects under threats of the Maoists. Fearing forced conscription by the Maoists or by the police, many young men, including those who normally attended school, fled the rural areas, which made them more vulnerable to the normal temptations of migrants (a high risk group). And with these young men gone and the economy in shambles, poverty increased, leading many women to turn to prostitution out of sheer necessity. Lawlessness abounded in many rural areas as police abandoned their posts, while the army, unconcerned with enforcing civil laws, allowed traffickers and women abusers free reign during the conflict. And perhaps most significantly, young people were taken away from their families (their social structure) by the Maoists and put into coed bands of warriors that traveled together for months or years. These young people, who were ripped out of school, had little formal education, particularly on the behavior risks associated with HIV and AIDS—and they were in a ripe environment for risky sexual behavior, particularly without social reinforcement against any such behavior that they would have received from their families.

      So, as demonstrated, many aspects of Nepal’s educational system have had negative repercussions upon the spread of HIV and AIDS in Nepal. And despite the progress of the past ten years, Nepal still has a long way to go.

1.7 Medical systems

      Nepali illness beliefs and practices have been influenced by many different sources throughout history. Most of the modern inhabitants of Nepal trace their ancestry to various waves of migrants, who brought with them, from their origins, many beliefs and practices regarding illness. The influence of these illness beliefs and practices is still evident in the various medical systems in use today throughout Nepal. For instance, the original Bodic-speaking peoples, of pre–fourth century Mongolian origin, brought with them central-Asian shamanistic practices that are still evident in some of the healing practices observed among shamans today (Gaenszle 1994; Streefland 1985; Watters 1975). Likewise, the Khas tribes, who started settling in Nepal around 2000 B.C., brought with them ancient Ayurvedic traditions from India that are still widely practiced today (Dhungel 1994; Streefland 1985). Waves of Muslims brought with them Greco-Arabic medical beliefs and practices that are evident in modern-day homeopathic medical practices (Blustain 1976). Later, waves of migrants from Tibet brought with them Tantric Buddhist ideas about healing (which combine elements of ancient Chinese medicine and shamanistic practices of the early Bon and Lamism religions) that are still popular today (Durkin 1984; Streefland 1985). And recently, the allopathic ideas of Western medicine have been introduced and well accepted (Dhungel 1994; Pigg 1995a; Streefland 1985). Acharya (1994), Durkin (1984) and Streefland (1985) have provided particularly good descriptions of the interface between the various medical systems in use today in urban Nepal.

      One characteristic feature of the Nepali medical system is its pluralistic or eclectic nature. Although each system might be associated (originally) with a certain group (or religion), modern Nepalis easily incorporate ideas and utilize treatments from the various medical systems. Stone (1976:77) suggests that “in several contexts of illness treatment, [Nepali] villagers easily combine Western medicine with traditional practices” and “such observations suggest that villagers have little difficulty integrating Western medicine with their own traditions on an ideological level.” Pigg (1995a) demonstrates that the way people determine which systems they will employ is dependent upon (1) their perceptions about which is most effective for particular illnesses and (2) their access to the various treatments. It seems that Nepalis have no problem integrating the ideas of the various systems into a new hybrid medical system.

      Foster and Anderson (1978:53) dualistically divide non-Western medical systems into a “personalistic” and “naturalistic” dichotomy. In a personalistic system, illnesses are believed to be caused by the intervention of a sensate agent: supernatural beings (gods or deities), other nonhuman beings (ancestors, ghosts, or evil spirits) or human beings (sorcerers or witches). Sickness is often viewed as a punishment for some wrong committed. Naturalistic systems attribute disease causation to natural, impersonal phenomena, such as the disruption of the body’s equilibrium. Disruption of the body’s equilibrium can be caused by such things as an imbalance between the various humors of the body, the improper mixing of hot and cold foods, the imbalance of yin and yang, etc. When equilibrium is disrupted, illness occurs. Disease causation in naturalistic systems is impersonal, the result of more or less natural causes rather than a sensate agent.

      Interestingly, both systems are practiced in Nepal. In many cases, demons or witches (personalistic) are believed to be the cause of illness. In other cases, sickness is interpreted as the result of the improper mixing of foods. Some individuals may consider certain classes of illness to be spiritually caused (personalistic) and others naturally caused, while another’s belief about illness causation (whether personalistic or naturalistic) may be informed by the traditional healer or astrologer and shift from illness episode to illness episode. In some cases, an individual can even attribute naturalistic and personalistic causes to the same illness episode. Again, this displays the pluralistic nature of the Nepali medical system.

      Various authors have studied different groups of Nepalis and have described diverse beliefs and medical practices among Buddhist Nepalis (Adams 1988; Holmberg 1989), Hindu Nepalis (Blustain 1976; Stone 1976; Stone 1988), Muslim Nepalis (Blustain 1976), and mainly animistic groups (Allen 1976; Gaenszle 1994; Watters 1975).17 Although the medical practices of each group may focus mainly on the specifics of a particular system, influence of the various other systems is evident as well. Again, various authors have demonstrated that medical pluralism is well utilized throughout the various groups in Nepal (Acharya 1994; Blustain 1976; Dhungel 1994; Durkin 1984; Pigg 1995a; Streefland 1985; Stone 1976). Although there are differences between the various groups, some common features emerge.18 For instance, for all of the groups listed, disease etiology can be either single factorial or multiple factorial, and disease can be either physically caused or spiritually caused. Many of the other features common to the various