International efforts to combat AIDS in Nepal questioned

December 01, 2005, vol. 34, no. 7
By Howard Fluxgold

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One-size-fits-all AIDS awareness programs may work in some countries, but when transported by international agencies to places like Nepal they run into serious barriers.

“There is no simple translation for the term AIDS in the Nepali language,” explains Stacy Pigg, associate professor of anthropology and co-editor of the recently published Sex in Development. “And most educational materials were produced in English first.” In fact, when these materials were produced in the mid-1990s there wasn't even a notion of AIDS in Nepal and many Nepali health workers hadn't heard of the disease, notes Pigg, a medical anthropologist.

Yet most aid agencies used basic health education principles that demanded accuracy and clarity. While this was easy in English it wasn't as easy in Nepali.

Because of language difference, just trying to explain the acronym for acquired immune deficiency syndrome (AIDS) in Nepali was fraught with problems. Each word took several lines of text to explain, or attempt to explain. “In Nepal, terms that are accurate are not necessarily intelligible,” says Pigg.

“How do you convey the idea of germs in a culture where some believe disease is caused by spirits, especially in one hour?” Pigg asks. “Yet the explanation of the acronyms for AIDS and HIV are a common starting point for AIDS education. For Nepali AIDS educators it is a difficult task to produce a clear explanation of AIDS in Nepali.”

Further, there is a wide continuum of educational opportunities among Nepalis. It ranges from those who live in rural areas with few resources who rarely have chances to learn science, to the wealthy who have been educated in English-language private schools in Kathmandu. Using the same education program to raise awareness of AIDS will not be effective across the continuum.

Pigg found that some AIDS posters “raised unintentionally the race and class dynamics of AIDS education where elites sanctimoniously lecture others. When proper sexual conduct is the matter on which education is needed, raising awareness of AIDS has implications within power relationships organized through class, caste and ethnicity.” Internationally accepted AIDS education templates seem to have ignored this reality in Nepal, Pigg concludes.

Were the millions of dollars spent on AIDS awareness in Nepal effective in reducing the incidence of HIV/AIDS? It was impossible to know how many suffered from the disease before these programs took hold and “there is not enough epidemiological information to reliably determine infection rates in Nepal,” Pigg says. Furthermore, education campaigns have been based on the assumption that the disease would most likely be transmitted sexually, however it appears that the rates of infection have risen most dramatically among injection drug users.

Still Pigg believes “it was better to do it (educate people) than not because a lot more know about the disease.” And when she showed her research on the problems involved in raising awareness about AIDS to Nepali AIDS workers “it resonated with them. As a medical anthropologist I am able to look more broadly at the social context in which health education is carried out. I am documenting a set of constraints that intuitively, others in the field may know, but not understand.”

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