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An understanding of…cultural influences must undergird our efforts and result in culturally appropriate education materials and methods that incorporate these features if we are to succeed in reducing stigma associated with HIV and AIDS in Nepal.
- David Beine, PhD, “Causes of HIV and AIDS Stigmatization in Nepal: a Proposed Model to Reduce Stigma,” Global Journal of Health Science, October 2011
(October 2011) As rates of HIV/AIDS infection reach alarming levels in some areas, governments and humanitarian organizations around the world have devoted vast amounts of energy, resources and personnel to prevention and treatment. The efficacy of prevention efforts is the subject of an article by SIL International Anthropology Consultant David Beine, published in the October edition of the Global Journal of Health Science. While the risk factors and means of transmission are the same for all people, Beine makes a strong case for adapting information campaigns to fit local cultural norms.
As part of an overall commitment to serving the world’s ethnolinguistic minority communities, SIL views local language development as essential to achieve the UN’s Millennium Development Goals, including Goal 6: Combat HIV/AIDS, Malaria and Other Diseases. Ethnolinguistic minority communities are particularly vulnerable to HIV/AIDS, malaria and other diseases due in part to the lack of essential information in the mother tongue.
In Nepal, current rates of HIV/AIDS infection are relatively low and mainly confined to high-risk populations. However, HIV/AIDS threatens to reinvigorate another illness that Nepal has worked tirelessly to eradicate: tuberculosis. People living with HIV/AIDS are particularly susceptible to a resistant strain of tuberculosis. Given the ease of TB transmission, this resistant strain could spread unchecked through all segments of the population. This reality makes effective prevention of HIV/AIDS in Nepal all the more urgent.
In order to communicate the message of prevention, Beine suggests refining the methods by which HIV/AIDS education is communicated. Through extensive research grounded in both linguistics and anthropology, Beine was able to gain insight into key features of how illness, specifically HIV/AIDS, is perceived in Nepali culture. He contends that the prevailing model of speaking openly and explicitly (a western model which has been replicated worldwide) is actually counterproductive in Nepal.
By speaking explicitly about promiscuity and drug use (taboo activities in Nepali culture), health educators inadvertently identify people living with HIV/AIDS with the cultural model of the randi (dirty, immoral) person. Arandi person is dealt with by isolation. Furthermore, the very act of presenting this explicit information identifies the health educators themselves as randi, causing them to be ostracized, as well. For this reason, the standard model of dealing with HIV/AIDS as a knowledge problem to be addressed by explicit information not only increases stigmatization and the potential for discrimination towards people living with HIV/AIDS, but also stigmatizes the health educators, rendering them largely ineffectual.
Another problem which has come to light relates to the language that has been used to communicate this important information. The high, formal variety of the national language has been used, resulting in low comprehension among ethnolinguistic minorities and the rural population.
In order to achieve greater effectiveness, Beine recommends that health education efforts be modified to avoid stigma and take advantage of the cultural values and models which are already in place. In fact, he points to several values in Nepali culture which directly relate to important aspects of HIV/AIDS prevention. He also advocates for communicating health information in the mother tongue.
Above: The Beine family with a friend in Nepal.