We will see several cultural models being expressed by various communities in Nepal, but we will also see the emergence of a dominant cultural model of AIDS formed through the weaving together of Western models and schemata with traditional Nepali cultural models of illness and traditional illness schemata. An understanding of these models is crucial as it is these cultural models that people are employing 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. And a cursory re-examination of some of these same factors ten years after the first edition of this book was published will reveal that some elements of the cultural model are slowly shifting while others remain the same.
The purpose of this book is to examine the HIV and AIDS situation in Nepal in depth. Although a thorough coverage of the subject necessitates an investigation of the structural factors contributing to the spread of the disease, I will focus primarily on the social side of AIDS in Nepal—in particular, upon the newly emerging cultural models of AIDS and their underlying illness schemata.
Format of the book
This book is divided into four main parts: (1) “Background and theoretical underpinnings,” (2) “The projects,” (3) “The findings,” and (4) “In their own words.” These parts are described below.
Background and theoretical underpinnings
The purpose of part one is to (1) introduce the reader to Nepal (the context in which this study takes place), (2) explore in general the concept of AIDS as both fact and social construction, (3) examine in particular the current AIDS situation in Nepal, (4) introduce the theoretical concepts of cultural models and illness schemata, and (5) introduce the cognitive methodology on which the findings of this book are based.
In chapter one, I briefly introduce the country of Nepal. Many of the facts about her history, economy, educational system and religion have played an important part in fostering the current AIDS situation. Many of these same cultural features have also been influential in the production of cultural models that I will discuss at length in subsequent chapters.
In chapter two, I look at AIDS in particular. AIDS is a biomedical fact. It is also a socially constructed disease. In addition, other factors are making it a socioeconomic disease. The result of the mixing of biomedical fact and social construction is that different meanings are attributed to AIDS from culture to culture. The resultant cultural models are also malleable as the nature of the disease (the biomedical facts) itself changes, or as our socially determined understanding of the disease changes.
In chapter three, I discuss the current AIDS “crisis” 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
