Languages of Sex and AIDS in Nepal:

Notes on the Social Production of

Commensurability
Stacy Leigh Pigg
Simon Fraser University

There is little current information available on HIV prevalence in Nepal.

—UN AIDS, Nepal: Epidemiological Fact Sheet on HIV/AIDS and Sexually
Transmitted Diseases. 1998.

AIDS does not exist apart from the practices that conceptualize it. represent it, re-
spond to it. We know AIDS only in and through those practices.
—Douglas Crimp, i4/D5. Cultural Analysis, Cultural Activism

AIDS has been experienced in Nepal mostly as an expected epidemic. When

epidemiologists in the late 1980s began warning that South Asia would soon
be hit by an exponential increase in the rate of HIV infections, international do-
nors moved to put prevention programs in place. The result in Nepal was a dis-
tinctive burst of relatively well-funded, concentrated AIDS awareness pro-
grams. The accompanying rise in publicity about AIDS far outstripped any
collective, public awareness that anyone in Nepal might actually be suffering
from AIDS. The publicity surrounding a few individuals with AIDS did little
to challenge a pervasive sense of the remoteness of AIDS from Nepali life.1
This relative invisibility of AIDS as illness in Nepal makes the visibility of or-
ganized prevention efforts of the 1990s remarkable.
Public knowledge about AIDS in Nepal in the 1990s was being created, to
an extraordinary degree, out of an already formed template of accepted facts
about HIV, and the public health wisdom about AIDS prevention that accom-
panied that information, as set out by powerful international organizations.
This means that Nepali health planners and activists, together with the public
at large, encounter AIDS—as an idea, and for some, a physical reality—
through the mediation of an AIDS expertise that is already firmly consoli-
dated.2 This creates a situation that differs from the experience in the 1980s in
places such as Haiti or East'Africa, when scientific knowledge was evolving
rapidly. In the first decade of AIDS, the effects of AIDS on bodies and lives

Cultural Anthropology 16(4)481-541. Copyright © 2001. American Anthropological Association

481
4X2 CULTURAL ANTHROPOLOGY

was already being felt even as the earliest cpidemiological, clinical, and vi-
rological research was beginning to describe and define the phenomenon. In
contrast. Nepal's experience in the second decade of the AIDS epidemic in Ne-
pal is of a now well-established set of medical and policy frameworks being
applied in an attempt to forestall a predicted (and, no doubt, likely) health dis-
aster that has not yet hit. What happens when this internationally standardized
set of facts and policy wisdom hit the ground, so to speak, in Nepal? What are
the processes through which Nepalis come to recognize the existence of some-
thing called AIDS, learn what it is. form ideas about who should be concerned,
and judge whether or not they should care?
In this article I attend to the communicative difficulties that arise as a tem-
plate of internationally established knowledge acquires a local life through the
efforts of Nepali AIDS workers to bend it, mold it, or force it to accommodate
the contours of the Nepali social ground. These efforts are a site where transna-
tional circulations of western scientific knowledge and its allied areas of ap-
plied management expertise (such as public health) enter into and intersect
with other knowledges and mass-mediated public consciousness. The traffic in
facts, explanations, and technologies of science is an important, but under-
examined, site where the distinctions between local and global forms of con-
sciousness and identity is produced. I thus want to consider how the knowledge
generated by science travels to the so-called underdeveloped peripheries in or-
der to connect its movements to questions about emergent global modernities
and the social positions and material possibilities these create (on the concep-
tualization of global circulations, see Tsing 2000).4 These processes are im-
plicit in the task of teaching people in Nepal about AIDS.
The issue of translation looms large in the everyday work of fostering
what is called "AIDS awareness." for Nepali AIDS workers routinely move be-
tween ideas formulated in English and their expression in Nepali. The linguis-
tic labor of Nepali AIDS workers is. I argue here, an important practice that
creates routes of movement and nodes of connection through which science
travels. In the ethnographic sections that follow. I focus more closely on
Nepali AIDS workers1 views of the expressive capabilities of Knglish and
Nepali. I take seriously their sense that AIDS education requires switching be-
tween English and Nepali, and I look at the different valence the use of Knglish
has in the explanation of AIDS and in the discussion of sex. At issue is the way
specific choices of language organi/e the movement of knowledge, especially
knowledge that gains international acceptance as factual as a result of scientific
research. What comes to count as a translation of a concept, and at \shat points
docs translation fail?
AIDS education in Nepal thus provides a case study that sharpens our lo-
cus on what I call the soefal production of conimensurabilitv. This concept is
useful for helping us think about the actual presence o\ technoscience. includ-
ing medicine, in out-of-the-way parts of the world, for it takes us beyond dis-
cussions of systems of knowledge that tend to come to rest in an overly static,
binary and implicitly hierarchical vocabulary of difference (Abu-Lughod
 LANGUAGES OF SFX AND AIDS IN NhPAL 4S7

«
1991).^ Knowledge is more dynamic than that: If we merel\ envision different
knowledge systems bumping into each other, or supplanting one another, we
risk oversimplifying the already syncretic, hybrid, polyglot conditions with
which most people contend. Much work in science studies has focused on the
stabilization of facts through social exchanges that produce consensus on how
to read the evidence and see the world. From this work we have learned about
the social milieu in which controversies are resolved and scientific knowledge
is produced, and, moving outside the laboratory, about the meaning this knowl-
edge acquires in the public imagination and the cultural metaphors that in turn
seem to shape how scientists envision their objects of investigation. One ap-
proach in medical anthropology traces the ways knowledge about the body is
formulated, represented, legitimated, and used in a given context (Lindenbaum
and Lock 1993; Lock and Kaufert 1998; Lock and Scheper-Hughes 1990;
Rhodes 1990; Young 1982). A l t c n t i ° n t o t n e production of knowledge as it oc-
curs in specific contexts opens up for examination the relation among hetero-
geneous, overlapping, and perhaps contradictory means of knowing and ma-
nipulating the body in health and illness. The knowledge production approach
can be enhanced to take translocal and global processes into account by a
greater attention to how certain practices bring forth new potentialities for con-
nection and stabilize them institutionally. It is necessary to take the investiga-
tion of knowledge production in science beyond the center comprised of North
American and European laboratories, clinical expertise, public health policy
and activism. Attention to the social production of commensurability raises the
following questions: What are the practices through which actors forge, provi-
sionally or lastingly, common measures, standards, and frames?'1 How are per-
ceived differences bridged or mediated? What are the consequences of the
routini/.ation of certain conceptual paths of connection? What links the social
production of facts in one site to the acceptance of them in another? And what,
in the context of an epidemic, might the consequences of these patterns of link-
age be? These questions point toward analysis of the ways science moves both
outside the laboratory and outside the West.
The concept of language ideologies—that is. the beliefs and assumptions
people hold about the nature of their own and others' languages—is useful for
understanding what occurs in the translation and communication of knowledge
about AIDS.7 International health programs exhibit a language ideolog) in the
common sense assumptions of their approach to communication. Reflecting an
underlying notion that languages are sets of labels (Good 1994). international
health programming rests on the idea that truth is independent of language and
that knowledge is merely contained in the packages that are words. The task in
international health education, then, is to move bits of information from one
social location to another by finding the right words in another language in
which to package it.
AIDS awareness education consists of the communication of basic
biomedical understandings of HIV transmission and AIDS, on the one hand,
and a sex education component, on the other. Nepali AIDS workers charged
4X4 CULTURAL ANTHROPOLOGY

with imparting this education say their job is "very difficult." "We can't talk
about SXA in our society,"! n} they say, and they see this as both a source of op-
position to AIDS programs in general as well as a barrier to the communication
of the AIDS "message." (Here and throughout this article I use underlining to
indicate English words used within Nepali utterances. To show the primary
language of the utterances I have quoted. I use {n} to indicate Nepali and {e}
to indicate English.) AIDS workers comment much less on the fact that, in
practice, they also find it quite hard to explain AIDS in Nepali. Perhaps even
harder, for while sexual organs, acts, and feelings are within the realm of peo-
ple's experience, AIDS is (for a Nepali audience) only a concept involving an
imprecise set of possible afflictions coming after an indeterminate period in
which invisible organisms do something to microscopic particles in a part of
your body (the immune system) that you don't even know you have. Nepali
AIDS workers' sense of the "difficulties" in AIDS education, and the language
ideology this reflects, greatly influences the practices through which they im-
plement strategies of AIDS education that are encouraged by the international
experts who fund their work. This has real effects with implications lor equita-
ble access to knowledge.
International health wisdom sees issues around communication about sex
as a problem of culture, while issues around communication about AIDS are
seen as a problem of knowledge. Beliefs in international development about
knowledge and translation are inflected by the content of the knowledge to be
transmitted. In AIDS education efforts, the reasoning goes something like the
following. If it is a bit tricky to explain AIDS in Nepali, it is because the Nepali
population, as a whole, has not yet been sufficiently saturated with correct
biomedical information about the body. Raising awareness of AIDS is a matter
of replacing misconceptions with the facts. Once the Nepali public knows "the
facts." this line of reasoning assumes, they will naturally and easily think about
them in their mother tongue. The problem of translation is a problem of con-
ceptual disparities, to be solved by information. It it is hard to talk about sex in
Nepali, on the other hand, it is because the "culture" prevents Nepalis from
talking about it with the transparency and frankness that is required. It is em-
barrassment that gets in the way of communication about sex. not conceptual
problems, because after all (this line of reasoning presumes) sex is a universal
human preoccupation. Sexuality is assumed to exist, independent of culture, as
a bedrock on which culture imposes rules and restrictions (as Vance 19^1
notes). Of course (it is assumed). Nepalis are already thinking about sex. in
Nepali, and the only task is to overcome the culturally imposed inhibitions on
speech. So goes the standard thinking in mainstream AIDS prevention dis-
course. The facts ol AIDS are merely to be made evident and explained.
A closer look at language choices in actual communication about AIDS
and .sex shows that internationally established truths -about AIDS and about
sex—do not convert into local languages as readily as the referential concept
of language presumes. My ethnographic project on the production of public
knowledge about AIDS in Nepal quickly became an effort to trace on the
 LANGUAGES OF SKX AND AIDS IN NhPAL 48.S

ground just what is involved in actually making evident and explaining: to un-
derstand when, how, and why communication is and is not a problem. For
seven months in 1997, I followed the work of Kathmandu-based nongovern-
mental organizations (NGOs) involved in AIDS prevention activities.*" 1 talked
to many NGO leaders and outreach workers about their activities, their ideas
about what their fellow citizens need to know and how that information should
be conveyed to them, and their personal feelings about their work. I partici-
pated in workshops held for targeted audiences as diverse as film actresses,
college students, and teenage women who had returned to Nepal from sex work
in India, and I sat in on (and contributed to) meetings in which educational ma-
terials were designed and discussed. AIDS workers (an umbrella term I use to
refer broadly to outreach workers, NGO leaders, and officials with a role in
AIDS-related policy) were preoccupied with issues of communication, in part
because several major international donors had been, up until that time, stress-
ing what are called IEC (Information, Education, and Communication) strate-
gies. Teaching people about AIDS—creating "awareness"—through mass me-
dia campaigns, educational materials, and sex education remains the focus of
most NGO efforts, and this is why I focus here on communication even though
the circulation of international expert knowledge clearly has many nondiscur-
sivc dimensions.
Before turning to the analysis of Nepali AIDS workers* efforts to make
AIDS known, I address, in the next section, some of the politics of theory in
the international context. It is a tricky business to use theories of language to
look at AIDS. Debates emanating from science studies rub against debates
about the politics of strategies of AIDS prevention, and both point up some un-
resolved tensions between anthropology's relativist and humanitarian commit-
ments. I sketch these issues as a necessary precursor to the ethnographic dis-
cussion of language in AIDS and sex education in order to open up larger
questions about the public understanding of science on the peripheries. In the
conclusion of this article I offer a vision, albeit preliminary, that might bring to
science studies a closer consideration of the development practices through
which so much of science extends itself into the out-of-the-way places that
have so persistently figured as the ground against which the progress of mod-
ern scientific knowledge is measured.

One World, One Hope?

As the international conference on AIDS opened yesterday under the slogan "One
world, one hope." it became clear that there are two worlds when it conies to fight-
ing the deadly disease. In one. the rich can bn\ pills and optimism. In the other, the
poor can only hope for prevention to save them from despair.9
—The (ilohe and Mail. July X. 1996

So began the front page article on the XI International Conference on AIDS in

Vancouver in Canada's leading daily newspaper. This major scientific confer-
ence was the actual starting point of m> ethnographic research and the question
486 CULTURAL ANTHROPOLOGY

posed by its theme neatly encapsulates the larger context in which AIDS pre-
vention efforts in Nepal are embedded. Much of the "hope" for AIDS around
the world is pinned on science. This is as true of the mild hope resting in educa-
tion as a step toward prevention as it is of the more energetic hope vested in
overcoming the stark inequality in the distribution of state-of-the-art drugs.
Both these hopes point to a further question: How is "one world" of AIDS
knowledge, political action, and treatment created?
Communication is one means (though certainly not the only means) by
which a stable, internationally unified world of AIDS knowledge/intervention
comes into being. International health activities based on "AIDS" (as it is
known and described by science) work at the cusps where this consolidation
cannot be taken for granted and must, instead, be made to happen. To approach
world-unifying truths, it is necessary to begin by situating knowledge, and the
processes by which that knowledge is achieved and made to matter, in the
world, in specific social and historical contexts.10 This analytical move is
sometimes seen as discrediting knowledge gained through scientific research
or dismissing the utility of its insights into nature. But Latour (1999) has
pointed out that work in science studies addresses the social not in order to de-
base science (though it does dethrone certain kinds of legitimating claims), but
in order to support what he calls a more realistic realism." Far from undermin-
ing our grip on reality, the aim is to see more clearly the dynamics and organi-
zation of interactions between people and the world.
Science does not simply find and uncover the secrets of nature. It recon-
figures our relationship to nature through an active engagement that is itself
productive and not simply descriptive (Haraway 1997; Latour 1987, 1999).
Scientific standards vary through time and across areas of inquiry; controver-
sies among scientists themselves produce differing accounts of the objects they
seek to explain; and stability and reliability of any account is produced through
scientific work. Rather than thinking about this in terms of the abstract relativ-
ism of knowledge, according to Latour (1999:174-215), we should conceptu-
alize this as a process through which intimate relations between nonhumans
and humans become folded into the everyday fabric of collective life. This ap-
proach, far from adopting a radical skepticism toward science, takes .scientifi-
cally-generated knowledge very seriously by asking about how

complex objects like pi. oncogenes. neutrinos, gravity waves. . . airplanes [and I
would add HIV. AIDS, and the AIDS epidemic! emerge, stabilize, and then pro-
duce a wide variety of real effects in our technosociocultural world. [Fujimura
1998:357. emphasis addedl

Looking at Nepal, one could'argue that in an important sense, communication

about AIDS "is" AIDS. A complex set of relations and processes (among pro-
teins, cells, and so on) can only become "AIDS" for human actors in Nepal be-
cause of the relations that link the thinking of people who conduct research on
HIV/AIDS in clinics and laboratories to ordinary Nepalis.
 LANGUAGES OF SHX AND AIDS IN NHPAL 487

«
But does not HIV exist whether or not some Nepalis know about it? La-
tour (1999:145-173) has argued that a scientific fact never emerges solely out
of the singular event of discovery, but requires continued institutional upkeep,
action, and work to remain true. Pasteur's microbes exist not because Pasteur
once convincingly said so, but because we "live inside the Pasteunan network,
every time [we] eat pasteun/ed yogurt, drink pasteurized milk, or swallow an-
tibiotics" (Latour 1999:168). Latour further argues that this is not simply a
matter of changing frameworks of understanding on our part; when people be-
gin to think and behave differently in relation to attributes and processes they
perceive in the world, this is also an event in the history of the nonhuman ac-
tors involved. New scientific findings replace old ones and the world changes
as a result, not because there is a substratum of independent, ahistorical nonhu-
man substances behind all that happens but because the actual wa\s nonhuman
actors are brought into human history makes things happen in the way they do.
This is not an either/or proposition (either microbes have always existed or
they have never existed until they were imagined as such by people); it is an as-
sertion that takes seriously the historicity of the interaction between the forces,
properties, and attributes of nonhuman actors and people engaged in specific
practices, and the capacity ol these interactions to affect both the world and hu-
man understandings. One of Latour's main theoretical concerns has been to re-
place the all-or-nothing terms ol truth and reality in which questions of the re-
lation between representations and things are so often posed with a vision of
gradients, continuums, linkages, that are established and maintained via locat-
able material practices. 12 The "reality" of HIV can be seen in this light. HIV
"exists" whether or not some Nepalis know about it because there are other
people in the world, organized in powerful institutions, for whom knowledge
about HIV and the AIDS pandemic is the basis for a series of actions, sonic of
which have apparent results for peoples health, as well as lor the ability of the
thing we call HIV to reproduce and survive. The issue of communication about
AIDS in Nepal raises a question about how we might understand the place of
Nepal, and other places similarly on the periphery, as part of "our technosocio-
cultural world." Nepalis are implicated in AIDS science not simply as poten-
tial, but largely passive, beneficiaries (Clarke and Montini 1993) but also as
teachers, translators, outreach workers, and peer educators whose actions help
bring HIV/AIDS into existence in new contexts.
Some AIDS activists and cultural critics in the industrialized West have
worked with savvy theories of language, power, and the social construction of
science to continually question the stability and effects of knowledge about
AIDS as it is produced by researchers and clinicians and then taken up b\ poli-
ticians, policy makers, service organizations, and people in various life situ-
ations. No other health condition has had the process of its discover), investi-
gation, and management so thoroughly scrutinized even as the science was
very much in the making (Epstein 1996; Patton 1990; Ireichler 1999). Activ-
ist-experts have raised questions not only about access to the latest knowledge
and treatments, but also about the processes through which the priorities and
AHH CULTURAL ANTHROPOLOGY

procedures of scientific research on AIDS have been set and treatment proto-
cols established. Most of the intervention-oriented thinking about AIDS pro-
grams in the Third World has been largely simplistic in comparison. Fixated as
most international AIDS programs are on identifying the constraining "be-
liefs" of the cultural other," little thought is given to the politics of know ledge
about AIDS in these other locations. Paradigms lor intervention are hotly de-
bated, to be sure, but there is little reflection on the ways the implementation of
a given paradigm involves communication practices that themselves establish
the contextual "reality" of AIDS.13 The emphasis is on imparting information
in order to reduce risk.
Here it is important to understand a debate within international AIDS cir-
cles. AIDS research and program design has been guided overwhelming by a
behavior change model that emphasizes cognitive processes. Proponents of a
social vulnerability paradigm <Farmer et al. 1996; Mann and Tarantola 1996;
Parker 1996) argue that attention should be directed at the social and political
context that creates conditions of vulnerability. Instead of focusing on defi-
ciencies in people's "awareness," or states of mind, as the reason why people
fail to protect themselves from HIV infection, we should be attending to how
life conditions rooted in economic inequality become manifest in conditions of
health, dynamics of relationships, and sexuality. Whereas the behavior change
model medicalizes both sexuality and AIDS, the social vulnerabiliu model
politicizes them.
It is important that an analysis of AIDS prevention education avoid fur-
thering what Farmer et al. (1996) call "immodest claims of causality" and "ex-
aggeration" of the effects of education on risk reduction. One way to begin is
by noting that reactions to AIDS are very much a part of what AIDS is. and that
we never encounter "AIDS" in the abstract, apart from some matrix of knowl-
edge about it. Without falling into simplistic truisms about AIDS education,
we must recognize that information and modes of communicating, more
broadly, are of real social value to Nepalis. Without it. how is there to be a po-
litical debate—let alone political mobilization—within Nepal about responses
to AIDS?
It could be argued that a preoccupation with communication on the part of
Nepali AIDS workers—as manifest in the time and energy devoted to wran-
gling over word choice, the phrasing of messages, the illustrations on posters,
and the known or imagined reception of their AIDS education efforts—served
as a comfortable diversion from a more politically incisive engagement with
the social inequalities linked both to HIV transmission itself and the choice of
intervention strategies. I think this is the case, but it is not an adequate account
of what is going on. It is necessary to pay attention to the series of .small ac-
tions and apparently reasonable choices that accumulate into a political effect.
There is something to be learned from lollowing the communication practices
that count as AIDS education in Nepal and from considering the concerns of
the workers who produce and disseminate AIDS messages to other Nepalis.
There are important questions here about the exclusions and possibilities created
 LANGUAGES OF SEX AND AIDS IN NKPAL 489

by modes of communicating information about AIDS. Who is able to under-

stand, or listen to, what kinds of explanations? This is a question about the lo-
cal distribution of information—a particular stabilized understanding of the
complex objects HIV and AIDS—that is valorized international!) for a variety
of reasons.14 It is necessary to tie questions about the formation and stabiliza-
tion of scientific know ledge more firmly to questions about the circulation of
this knowledge and to consider local distributions of knowledge in relation to
international distributions of knowledge.
It has been hard for anthropologists to take up this challenge, perhaps be-
cause our relativist and humanist commitments seem to collide on this point.
On the one hand, many voices are asking whether the knowledge produced by
science is as pure, value-free, and universal as it presents itself to be.!S Such
questions are born of relativist considerations about systems that make sense in
their own terms and of multiple measures of truth, value, and legitimacy that
people might apply. This line of thinking encourages us to think about systems
of knowledge as incommensurable. On the other hand, most responsible crit-
ics, however much they question over-generalized claims to objectivity and
universality in science, still insist that there are benefits of science and medi-
cine to which everyone in the world should have access (Harding 1994:322;
Lock and Scheper-Hughes 1990:49). These are humanist claims that give the
efforts of science, technology, and medicine a place in struggles for improved
conditions of living in the name of social justice (Farmer 1999 makes this case
with great passion). Such claims generate a new set of pressing questions about
which benefits of science and medicine would serve this cause, who decides,
and how access to these benefits would be organized.
HIV/AIDS is one of those problems of human life for which the claim that
everyone ought to have the benefit of the best information, prevention strate-
gies, and treatments has been especially compelling, albeit poorly realized in
practice. Moreover, what is "best" in addressing HIV/AIDS remains a subject
of intense debate in most areas of AIDS-related research and activism. M> at-
tention to language is intended as an exploration of the question of access as it
is made possible at the level of consciousness, and this, admittedly, is but one
dimension of the problem. This is the question of how information gets to peo-
ple, how people come to participate in the gold standard that is the germ thcorv
of disease, how (hey might begin to think about actions in the name of disease
prevention.

"They Don't Even Know What HIV Is"

It is hard for Nepali AIDS prevention workers to imagine a form of useful
AIDS education that is not firmly tethered to the (simplified) biomedical idea
that there is a distinct condition known as AIDS and that it is caused by infec-
tion with HIV. Nepali AIDS workers tend to measure what they call "igno-
rance" about AIDS in terms of people "not even knowing about HIV." Impart-
ing this information in Nepali is a linguistic chore.
490 CULTURAL ANTHROPOLOGY

Talal Asad has insisted that "the process of 'cultural translation" is inevi-
tably enmeshed in conditions of power" (1986:163). His insight can be ex-
tended to apply to the mundane, practical communication activities of interna-
tional health. Asad, following Walter Benjamin, reminds us that translation is
transformation, and that the hybrid forms it generates are produced under his-
torical conditions of inequality:

because the languages of Third World societies . . . are "weaker" in relation to

Western languages (and today, especially to English), they are more likely to sub-
mit to forcible transformation in the translation process than the other way around
. . . Western languages produce and deploy desired knowledge more readily than
Third World languages do. [ 1986:157-158]

The convolutions required to explain the terms HIV and AIDS in Nepali
in various educational sessions was for me a vivid illustration of Asad's point.
Explanation of the acronym AIDS and the abbreviation HIV is the standard
starting point for most AIDS awareness education. The word "AIDS." being
easily pronounceable in Nepali, quickly entered colloquial language and is ren-
dered in print in the phonetic devanagri script as "^r. To explain the acronym
thus requires converting this Nepalicized AIDS back into AIDS, roman alpha-
bet. English acronym (see Figure 1). Then the English word lor which each let-
ter stands is provided. The next step is to translate these especially technical
English words into Nepali. This can quickly devolve into a wordy endeavor re-
quiring more and more explanation, given that the dictionary-defined technical
words in Nepali for "acquired." "immune system." "syndrome." and even "\ i-
rus" are not necessarily easily intelligible to even rather well-educated Nepalis.
who sometimes need the English definition to understand the Nepali equiva-
lent. No wonder "explain the full form of AIDS" was a stock question in the
ever popular quiz contests for school children.
Why is it so hard? Our tendency, of course, is to sec it as a problem rooted
in Nepali language and culture: It is because the Nepali language lacks a word
for immune system, we say. or because many Nepalis do not grasp the germ
theory of disease that it is hard to explain what HIV and AIDS are. We could,
however, look through the other end of the telescope, so to speak. It is just as
true that due to some historical quirks in the way clinicians, epidemiologists,
and basic scientists began to investigate what we now call AIDS, it has conic to
pass that everyone else in the world, down to a perplexed Nepali villager, is
stuck with this cumbersome terminology. All disease names are artifacts that
bear the traces of the history of attempts to know them, but in the case of AIDS
this history is both fresh and remarkably open to scrutiny. We have the term
AIDS, after several other labels were discarded, because epidemiologists at the
Centers for Disease Control "'had to define what constituted a ease" in order to
investigate this "fatal disorder of unknown origin and indefinite proportions"
(Oppenheimer 1988:272. 270). It is because it took three long years to discover
a retrovirus that appeared to be the causal link, because a law suit over the pat-
ent rights to the antibody test became an international diplomatic incident, and
 L A N C l A ( . l S O h S I X A M ) A l l S IN N K P A I

^=Ti

jft ?

HIV

ir
try. * T ^tTf^r-j A I D S ^

A Acquired

I Immune 7^
D Deficiency
S Syndrome <]*]?* i

F ignre 1
Phe acronym ' MDs" unpacked and translated into Nepali. Detail of poster produced
bv \K< VNi p. il with support from \mF \R ca.

because the dispute between Robert Ciallo and I uc Montagnicr over its discov
er> and naming had to be adjudicated bj the International Committee on the
axonom) of \ iruses that we have the term HI\ (Epstein 1996:77 Oppenheimer
1988). The distinction between infection with HIV and the condition ol full-
blown AIDS is emphasized because of institutional needs to standardize clinical
ease definitions and orsani/e insurance, disabihu leave and other entitlements.
492 CULTURAL ANTHROPOLOGY

and for activists an emphasis on this distinction was a semantic way to focus
attention on the needs and quality of life of "people living with HIV" and to
counter the "death sentence" imagery AIDS quickly acquired."1 l.very time a
Nepali AIDS worker becomes embroiled in contorted explanations of "what
HIV and AIDS stand for." he is implicated without realizing it in the recent
history of "science in the making" (as Latour 1987 puts it) in distant centers of
sophisticated scientific research, as well as in the distant contexts in which this
distinction matters.
Asad rightly saw in acts of translation a question of power relations, as
manifested in a global hierarchy of value attributed to different knowledges.
As we will see, the desirability of knowledge about AIDS is very much at issue
in AIDS prevention communication. What counts as knowledge about AIDS?
Who has that knowledge? Who wants it, who needs it, and why?

From Development Donors to Public Culture:

The Formation of an AIDS Discourse
Although HIV is a very cosmopolitan microbe.AIDSdiscour.se . . . has always been
provincial.
—Paul Farmer, AIDS and Aci-u.sation

Nowadays when your marriage is being arranged your family should demand an
HIV test along with the horoscope!
—quip among young middle-class women in Kathmandu

In 1992, the number of HIV infections ever identified in Nepal was 1 I4.17
That same year, the American Foundation for AIDS Research (AmFAR) re-
ceived over 80 applications from Nepali NGOs wishing to be funded to carry
out AIDS prevention activities. Interest in AIDS intervention work has been
donor-driven, part of a general shift of attention toward AIDS in Asia. Be-
tween 1990 and 1993, The World Bank, the United Nations Development Pro-
gram (UNDP), the European Economic Union (KFU). the United States
Agency for International Development (USAID), and several other smaller do-
nors specifically commissioned preliminary studies or started active AIDS pro-
grams in Nepal.1H By one estimate, international AIDS-related funding in-
creased by 99 percent between 1992 and 1993 (Mann and Tarantola 1996:530).
A 1996 inventory showed that 21 separate government offices. 12 multi- and
bilateral organizations. 2S International NGOs (INGO), and 45 Nepali NGOs
involved in AIDS-related activities. Two initiatives were highly publicized.
AIDSCAP (AIDS Control and Prevention Project). USAIDs worldwide
"AIDS strategy." set up a Nepal program in 1993. the same year AmFAR de-
cided to focus its small international program in a single country as a sort of
"laboratory" of AIDS prevention (Haniium 1997; Pigg 2001). Both AIDSCAP
and AmFAR programs were to be carried out by local NGOs (in the case of
AIDSCAP, each doing a different job in the overall program; in the case of
AmFAR. each working independently with its targeted community with initial
 LANGUAGES OF SEX AND AIDS IN NhPAL -N}

»
technical assistance and support from Save the Children Fund-U.S.). These
programs, initially budgeted at approximately 2 million and 3 million dollars,
respectively, were launched precisely at the time that the number of NGOs in
Nepal burgeoned (by some reports, tenfold) after the restoration of multiparty
democracy in 1991. AIDS intervention work took form in Nepal at a particular
moment in its history of national development bureaucracy. Critics in Nepal
have suggested that all AIDS work is merely a way of chasing the donor dollar in
an era when development-oriented NGOs are (they say) an entrepreneurial form.
This view, whatever its kernel of truth, overlooks the reasons to worry
about an HIV epidemic in Nepal, even in the absence of reliable epidemiologi-
cal data.|y HIV/AIDS has in many places become a disease of poverty, follow-
ing, in Paul Farmer's words "steep grades of inequality" (Farmer et al. 1996;
for Nepal. Seddon 1997).20 There is a dearth of empirical data on the pattern of
the epidemic in Nepal, and most expert representations of patterns of HIV
transmission (including my own, here) must rely on extrapolations from
epidemiological patterns discerned from research elsewhere. International do-
nor concerns based on international, not Nepal-specific, knowledge of the epi-
demic was the catalyst that formed a vision of a potential AIDS problem in Ne-
pal. International knowledge gave Nepal both a formulation of the problem and
a path toward solutions.
The push to launch AIDS prevention programs in Nepal has driven, and
indeed legitimated, new forms of institutional attention to sex. "Sex 1 appears
in the institutional worlds of health development through three main efforts:
(1) a focus on the prevalence and management of sexually transmitted dis-
eases; (2) attempts to research sexual behaviors, including the incidence of
prostitution; and (3) promotion of sex education as an aspect of health educa-
tion.21 That these are the priority areas reflects not only the centrality of sexual
transmission in the epidemic but also certain orthodoxies of international
AIDS prevention.22
Attention to AIDS therefore has come to mean, in a very practical sense,
an attention to the sexual activities and sexual consciousness of Nepalis in the
name of disease prevention. That is what AIDS prevention work is understood
to be all about. Indeed, the idea that AIDS is "about* sex in a unique way could
only be underscored for people seeing unprecedented public displays such as a
made-for-TV movie in which Santosh Pant, one of the country's most famous
comedic actors is depicted having sex with a prostitute (he is unable to find a
condom and becomes infected with HIV). Girl-trafficking featured as a sub-
plot in a weekly TV serial drama aired in 1997; AIDS was invariably men-
tioned in the frequent newspaper stories about arrests of prostitutes and raids
on the new "massage parlors" that had sprung up in the tourist district and were
assumed to be a cover for bqpthel-like activity. Unlike other ubiquitous fea-
tures of the urban public landscape that people saw as putting sex in the public
eye—blue films, soft pornography magazines, the eroticism of Hindi films, the
sex scenes in TV shows and films made in the West, and posters of scantily clad
white women in alluring poses—AIDS intervention had an official imprimatur
4^4 CULTURAL ANTHROPOLOGY

when it made sex publie. The message was clear. Unlike the illicit pleasures of
pornography. AIDS information was supposed to be good for you and good for
your society. Disease prevention is loosely associated with national develop-
ment, if only because disease prevention campaigns come through the deep
channels carved by the movement of funds through the development infra-
structure.
From the perspective of workers in the development industry. AIDS pro-
grams introduced new, odd, and decidedly awkward problems by forcing sex-
ual matters into a new idiom of official attention.23 Suddenly matters like pros-
titution, STDs, and patterns of sexual behavior were brought into the work
place. The need to discuss sex-related topics as part of one's professional work
created contradictory situations in which the lines between professionalism,
prurience, and personal moral propriety often blurred. There was a widespread
sense of nervousness around AIDS prevention activities. Some people reacted
by pushing for direct and frank discussions of sexual matters in the name of
public health, while others demurred with arguments that such approaches
were unnecessary, premature, or inappropriate in Nepal.
Of course, given that population control efforts have been a cornerstone of
health development since the 1960s, sexuality has, in a sense, long been a de-
velopment concern. But from the perspective of development workers, the
AIDS intervention work sponsored by donors was different. One communica-
tions official I interviewed insisted that "Family Planning just isn't about SJLX.
the way AIDS is"{n}. He went on to explain that family planning can be ap-
proached as a problem of population growth, and therefore discussed in rela-
tion to environmental degradation, the national economy, and the household
budget. But AIDS, he said, "touches directly on ^eji.. AIDS, prostitution, con-
doms, these are all about §jix"{n}. By 1997, tensions between busmess-as-
usual on the family planning circuits of development and the more experimen-
tal work of AIDS prevention were evident. These two wings of health
development work were being brought together under the rubric of reproduc-
tive health, in keeping with views that it is counterproductive to single AIDS
out in educational efforts. Many in the family planning field felt that the new
AIDS orthodoxy of condom promotion was in conflict with the family plan-
ning orthodoxies that emphasize sterilization and depo-provera. Accustomed
to denying contraceptive access to the unmarried, some family planning work-
ers outraged certain AIDS workers by refusing to give information on HIV risk
and the use of condoms to unmarried young people. Where family planning
was understood to deal with socially sanctioned sexual relations (making it
possible to deal with sex indirectly through references to "husband and "wile
and "children"), the AIDS issue draws attention to all the ways in which the
ideal of premarital chastity ;md marital monogamy are violated in real life.
Thus the very task of promoting AIDS awareness seemed to many people,
both inside and outside development circles, to be out of synch with Nepali
culture and society. In many nations, AIDS has been viewed as a foreign dis-
ease, a danger to citizens only to the extent that national borders are penetrated
 LANGUAGES OF SEX AND AIDS IN NhPAL -W

by diseased outsiders (lor the example of Japan, see Buckley 1997). AIDS car-
ries these connotations in Nepal as well. Yet in contrast to the many govern-
ments that have blocked internationally sponsored AIDS intervention agendas,
the Nepali state—while not particularly enthusiastic, and certainly not without
qualms about being seen to violate public morality—has proven remarkably
open to internationally sponsored AIDS intervention activities (carried out
mostly by NGOs). This apparent openness is undoubtedly due to the state's
weak position vis-a-vis development donors, in general. The interesting result
is that in Nepal, it is not only AIDS that is marked as foreign, but the practices
of AIDS intervention themselves. Ambivalence about the foreign values, pri-
orities, and sensibilities embedded in international AIDS intervention tem-
plates is played out subtly in the actual communication and reception of
knowledge about AIDS.

Communicating AIDS: A Brief History of "The Message"

They thought it was like doing AIDS education in the L'S. except in a different lan-
guage.
—wry criticism made by a former employee of the
AmFAR AIDS prevention initiative in Nepal.

Why would there be any problems of translation? All the programs have Nepali
staff producing the material.
—comment of a USA1D official on my research question.

When workers involved in giving form and substance to the idea of AIDS
described their work as "very difficult." they mostly meant the difficulty of
talking publicly about sexual matters. But they also saw it as the difficulty of
trying to make people care about something that seems irrelevant, distasteful,
or ungrounded. The question of how to talk about sex and AIDS, indeed the
question of what it means to talk about sex and AIDS, was not merek an ab-
stract issue of public health for AIDS workers, for they felt the implications
themselves, as individuals, in the choices their organizations made. "Go say
these things to your own sister!" was not an uncommon insult hurled at male
AIDS workers by the supposed beneficiaries of their information campaigns.
They felt people whispered about them "unlharulai pani txastai holat" (they
must be one of those [afflicted with AIDS because of their unregulated sexual-
ity]).
Nepalis are not unique, of course, in their struggles to find ways to ad-
dress AIDS and sex (see. for instance, Crimp 1988b on controversies within
and around North American urban gay communities; Brandt 1987; damson
1990; Pliskin 1997 on STDsi Nor do I mean to imply that Nepali society is
weighted down somehow by a higher quantum of moralism. or shame, or re-
pression, or conservatism, or anything else that is usually seen as a barrier to
the smooth communication of "the facts" about AIDS. The point is not whether
the situation in Nepal is unique, but rather how Nepali actors understand it as
496 CULTURAL ANTHROPOLOGY

their situation. Within AIDS prevention circles, the difficulty of talking about
sex and AIDS tends to be viewed as a problem of "our Nepali society."
Workers views are thus consonant with the dominant perspective in inter-
national health practice, a perspective that consistently pits its commitment to
scientific truths that can save lives against the cultural beliefs that impede peo-
ple from accessing them. International health programs are dominated by be-
havior change models, and within these models culture is treated as "a set of
beliefs, values, and individual goals that pattern behavior . . . individuals are
constrained by their image of normative action as they seek to conform to the
values of their society" (Yoder 1997:135). This conceptual scaffolding leads to
a practice in health education campaigns whereby information is sought about
"local idioms of expression in order to better communicate health messages"
(Yoder 1997:138). Yoder clearly points out the isomorphism between the sci-
ence/culture split and the modus operandi of international health programs:

Setting up belief and knowledge as clearly contrastive has certain advantages tor
health educators, since the task of health education then becomes teaching
biomedical knowledge to a population unaware of its implications. This approach
fits well with our own commonsense tradition, which conceives of lay knowledge
as a faulty derivative of biomedical knowledge. It assumes that as knowledge im-
proves in accuracy, healthier practices will follow. When they do not. this m.i\ be
explained by citing local cultural beliefs [1997:138]

Nepali AIDS workers follow this line of reasoning. 24

The earliest public information messages on AIDS in Nepal used images
of death to instill fear. Donors and technical advisors (both expatriate and
Nepali) quickly put a stop to that. They introduced the now established wisdom
of positive AIDS communication to NGO personnel who. as a result, devel-
oped a philosophy of AIDS communication often at odds with the approach
coming from the National Centre for AIDS and STD Control [NCASC]. A con-
sortium of the AmFAR-funded AIDS NGOs began meeting in the Information.
Education, and Communication Committee (IECC) to "peer review" proposed
posters, jingles, and pamphlets (Frey and Pyakuryal 1995). The IECC (whose
membership was later expanded to include representatives from NCASC and
AIDSCAP, as well as other organizations such as United Missions to Nepal)
eventually became one of the few nodes of coordination of dispersed efforts to
develop AIDS education materials. Guided by a set of principles of health
communication that had been laid out in a workshop led by technical advisors,
the IECC established, over time, the method and approach I discuss here.
By 1994. under AIDSCAP and AmFAR funding, fear-based messages
were replaced with a spate of materials presenting "how HIV is transmitted
fkasarl sarchaT as th c information about what AIDS is. Encapsulating the
HIV-causes-AIDS message, the electron micrograph image of HIV was a fa-
vorite motif in pamphlets (see Figures 2 and 3). Anticipating possible miscon-
ceptions, these messages about HIV/AIDS typically balanced every point about
HIV transmission with a parallel fact about "how HIV is not transmitted" jkaxarl
 LANGUAGES Oh SbX AND AIDS IN NEPAL 497

Figure 2
Electron micrograph as icon. Detail of poster produced In VIU/Nepul uith supporl
from \mh VR,ca. IW4.

tardainaj, for instance through mosquito bites sharing a cup. sneezing and
so on (see Figure 4). These misconceptions could onlj be anticipated, since the
\er\ function of the messages was to introduce the idea oi \1DS and HIV
transmission to Nepali people B) 1997. an astonishing range of people
would quote this information in the parrotlike voice of school rote learning a
testament to the degree to which it had drilled its waj into public conscious
ness (Of course understanding or even acting on this information is anothei
matter all together). Later versions of the "kasarl sarcka kasarl sardaina
498 (VLTtRAL AN'IHROPOLOGY

i o

Figure 3
From an educational Hip-chart produced In Save the ChildrenA .S. ca. IW6. "Whul
does HIV mean'" The arrow indicates an elapsed "five to ten years. I he caption
underneath reads: ' When the \tr> small HI\ \iruses enter I he hod\ it causes MDS.
I his virus destroys the hod\ \s immune system. It has hten found that M1)S de\elops
five to ten years after I he virus enters the hoclv.

message replaced "how HIV is not transmitted" with the more practical "how
you can protect yourself from HIV" [e(Jsh&[a kasarf hanchnef.
This message required the invention of verbal and graphic cocks for refer-
ence to sexiul intercourse A certain struggle over Inns to balance truth with
ttiste I.icts with morals is evident. SOUK- versions speak o\ "hodilj contact
/sarir xamparka/ others refer to "having sexual contact with man) people
(dherai janSsanga youn sarnparka t,w/(/j/to 'unsafe sexual contact' [asurak
chit Y'lim samparkal or even sexual relations with prostitutes //'< sxihritimll
Liifcku hvaktilnnitsa/i^ii \oitn .sanihaiulhii/. Prevention, conconiitantK ranged
from use a condom to 'onl\ have sexual relations between husband and
v> lie ' Illustrators relied on certain conventions to code sexual passion (silhou-
ettes ol embracing couples flames; see Figures 5 and 6). Sexual transmission
ol HIV was equated with seVul relations outside marriage and visuall) coded
through certain symbols associated with modernization (a woman in western
clothes, booze bottles cigarettes physical touching between male and female
figures removal of ctothing see Figure 7). whereas 'protection from HI\
was conflated with sexual relations inside marriage visually coded In s\mbols
 LANGUAGES OF SEX AND AIDS IN NEPAL 49s)

f ijiure 4
Modes of transmission. I ppcr picture [clockwise]: "It is transmitted: when a woman
has VIMS is pregnant; from pntstitulinn; from the I)1IKHI of a |HTsi»n with VIDS; when one
needle is userl hj m.ii» people.' I.imtr piiluie. "It is not transmitted: In mosquito hiti-s
I»\ shaking hands through f(MKl; In lathnc*, b\ hugging. ITiis is the beek page of an
MDS education comic b«M>k culled Samayakn Vw^j.Second Edition l)-s. 2051 (L996). IVo-
ducd In the IN(.() P \ I ft \N ritten h> Vshesh Malla, illustrations In Y karam Maharjan.
5(H) ( T L T I R A I . ANIHROPOLOGY

ftrwr X »ni*H

Hsurt 5
Fhe tnndom is saying: "Don't forget to use nit1, OK'' I In1 caption readl " I el'l he
s;ili- from VIDS l i \ always usinjj a condom when having sexual contact." Mk ker pro-
duced b) IC H, with siip|)«rt from \ m l \ K ca, 1995, K.iilili Nepal.

of family (presence ot children, domestic scenes woman in a sari, eating to-

gether, couple full} clothed; sec \ i Hire S). These codes were and still
•ire the sub|ect ol discussion in re\ie\vs In the Information, l.dueation. and
( oiiinuinication ( omrniuce Should married couples be shown in bed to-
gether? Would this be meaningful to the Nepali ullagers who sleep on the
floor? Does it make sense to indicate nudit\ to allude to se\ when villager]
generally have sex u i t l i their clothes on? The "kii\<ui sarcha kasari sardaimi
messages cast AILXS as an abstract question ol microbral transmission, a move
which displaces but does not eliminate the fundamentally social lorm of sexual
 LANGUAGES Oh Sf-..\ AND AIDS IN" M I'AL

Figure 6
( over of pamphlel produced bj \V K OM. with support from \iiih \R ca. 1995

intercourse Ostensibh the posters in which the images shown in Figure*,

and X appear simply report information about transmission routes hut thej do
so. implicitly or explicit!) bj using J male actor s poinl ol view to differentiate
between two distinct kinds of female partners the s.ile wife and the diseased
prostitute
An entire!) different strateg) was pursued b) AIDSCAP the USAID
lunded program In keeping with I SAlD's free enterprise philosoph)
MDSCAP took the route of. . essive social marketing private advertising
agene) developed a campaign around a jaunt) cartoon character condom logo
whose slogan w.is "let's wear a condom to drive awa> \1DS. a slogan slightl)
catchier in N'e|i.ili than in English (see Figure 9). Named Dhale) Dai (dai
means older brother and Dhal— shield' —is a brand of condoms marketed b\
;(P CL'I l l ' R A L ANIHKOPOl.OdY

Iigure7
Details of illustrations depicting ways HIN is transmitted, lop: "from unsafe sexual
contacts (from Suvedl ll>('7); Bottom left: "from sexual contacts: with someone other
thun husband or wife poster on HI\ tranmission, NCAS< ca. I99i~96>; Bottom
rifjlit: "froin se\u>il intercourse with a person infected with III\ (poster produced I>*
\IU /Nepal with support from VniP \R ca. 1994).

U. AID supported ag ), the character was designed as ,i "friendi) and

"lun image that also had associations of strength and protection. The Dhale)
Dai campaign was multipronged: posters radio jingles, and a IV commercial
lor the general public a comic hook to be distributed to AIDSCAP's target
group of truck d n \ e r s and a humorous educational film. (It featured a truck
 LAM'I AGhS Oh ShX AND AIDS IN NEPAL 50?

Details of illustrations depicting «;i>s to protrct yourself from VIDS. l o p : " b \ limit-
ing sexual relations to onl> those between husband and wife (from Suvedi I*>*>7>:
Bottom left: "only h a \ e lexual contact between husband and wife (poster on H I \
transinissiun. N( VS( , ca. 1993-961; Bottom right (caption not shown): ' In not hav-
ing sexual intercourse wilh strangers or with man> people (poster produced by U K
Nepal with support from \ m F \ R ca. 1994).

drucr giving AIDS prevention advice to his goof) assistant, who tnuls (h.it.
among other things condoms are useful lor carrying water for an overheated
engine and can serve in a pinch tor an alternator belt). One advantage of an ani-
mated cartoon condom giving instructions on how he should be used is that he-
can unroll himself onto thin air. He did so on prime-time TV evei \ evening.
 (VLTURAL ANTHROPOLOGY

Figure 9
"Let's wear a condom to drive awaj MDS.' Dhalcv Dal, created bj Stimulus Velvet
tisinjjfor \II)S( VIVNipaUa. 1994.

There was of course a backlash to these informational campaigns Not a

tew workers in AIDS organizations confided to me that the) had personal res-
ervations about condom promotion strategies and moral!) neutral messages
about sale and risky sexual activit) l'he\ like a number of urban middle class
people I spoke to. felt th.it to promote condoms was to erase moral distinctions
between appropriate and inappropriate sexual relations guest editorial in an
English language newspaper argued that the onh thing people need to know
about AIDS is that the> should tear it and that the) will be sociallx ostracized
if the) get it (Malla 1997). The public health wisdom behind the informational
campaigns was not alwa s appreciated b\ the public Io many at the receiving
 LANGUAGES OF SEX AND AIDS IN NEPAL 505

end, AIDS messages like the Dhaley Dai campaign evinced an unnecessary at-
tention to unseemly topics. Even some AIDS workers felt that the message
ought to be more specifically about disease transmission. They wanted a mes-
sage that stuck to the facts of AIDS without bringing certain possibilities for
sexual activity to mind.

Coding the Facts of HIV/AIDS: English as Arbiter of Truth

Yes, I remember the first time I heard about AIDS. It was in a quiz contest in school.
They asked "what is the full form of AlDS?"{n)
—A Nepali AIDS worker in her mid-twenties

The development workers involved in AIDS intervention had to learn

about AIDS themselves before they could do their job. Most of the workers I
met described themselves as having "heard of AIDS" but as not having given it
much thought prior to being hired. Because of this, the first phase of donor-
funded AIDS programs was capacity building (the term used) accomplished by
teaching workers in the NGOs what AIDS is, how it is transmitted, the social
issues that make it a concern for Nepal, what the main AIDS awareness mes-
sages are, and the best strategies of communication.
English is the appropriate medium for this information, in the perceptions
of AIDS workers. The concepts that distinctively define AIDS, from virus to
immune system to safe sex, are seen as transparently represented in English.
Expressed in Nepali, these concepts can only be conveyed in explanations of
one or more sentences or in translations that require neologisms constructed
out of Sanskrit roots.26 Workers have to first learn the technical vocabulary in
which the facts of AIDS are expressed in order to become AIDS educators.
These English terms thus pepper communication about AIDS, despite workers'
explicit efforts to render AIDS information in Nepali. It is as if AIDS (and
AIDS intervention more generally) is an object that can only be seen through
one particular lens, and the lens through which AIDS is discernible is English.
For workers, an immune system is somehow more an immune system
when stated in English than when explained as a concept in Nepali. It seems
more concrete, more solid and precise. The Nepali term pratirakcha pranull is
so technical and abstract few can understand it, while the more colloquial
phrase bibhinna rogko kitSpu lacjne $akti (the [body's] power to fight the
germs of various diseases) does not necessarily resonate with many people's
implicit images of disease processes. The implicit idea that germs cause dis-
eases will be meaningful, at different levels of precision, to some Nepalis, and
entirely meaningless to others. How are these germs fought? What is the sakti,
or power, of the body? The notion that the body fights off germs that cause dis-
ease has its own social history.in Nepal, a history that ties the notion itself to
the West and to the forms through which Nepalis with differing degrees of
privilege might encounter it. Some Nepalis learn about immune systems and
viruses in elite English-medium schools, some memorize the term pratirakcha
prapall as part of the rote learning science lessons in their village school, some
506 CULTURAL ANTHROPOLOGY

hear about kitapu (germs, bugs) from health workers trying to convince them to
build latrines. Concepts of germs, viruses and the body's immune system are
no longer alien to Nepal, but they have an uneven presence and are elaborated
with varying degrees of precision. They are held, moreover, along with other
everyday concepts of the body and illness deriving from humoral, religious,
and moral-supernatural frameworks.
Take the word syndrome, usually translated in the AIDS literature as bib-
hinna rogko lakchanharu (the symptoms of various diseases) or lakchaa sa-
muha (a cluster of symptoms). A simpler alternative term might be betha. a
word used commonly, especially in rural areas, to refer to the condition of be-
ing ill, a word, moreover, that rather precisely suggests the notion of a condi-
tion of clustered afflictions that do not necessarily have a single cause. BethH
never appears in English-Nepali dictionaries as a conceivable translation for
syndrome, however. I remarked on this one day in a conversation with Dr.
Bhadra, the leader of an NGO involved in AIDS education and a man who
shared my interest in these problems of language. We had decided to organize
a series of workshops with a handful of experienced AIDS workers to tr\ to
produce a glossary of AIDS terminology for Nepali speakers, and my comment
about the aptness of the word betha spurred Dr. Bhadra to use the workshops to
widen what would count as a good Nepali translation of the technical vocabu-
lary of AIDS. 27
In the first workshop, we laboriously worked our way through acquired,
immune, and deficiency and had finally arrived at syndrome. Tea and biscuits
had been served. Somewhat mischievously, Bhadra wrote syndrome on the
board, writing betha next to it as if it were the obvious translation. With a bland
look on his face, he turned to face the group. The participants were at first sur-
prised, then uneasy. They shifted for a moment in their seats, then burst into
discussion. Betha just doesn't fit (mildaina), one participant argued, because
syndrome specifically means a consistent grouping of symptoms, whether or
not the sufferer recogni/es them, while betha refers to the feeling of pathos and
suffering that is part of being sick; it is a subjective view.2* Bhadra replied. "11
we're talking about AIDS and we have to use words that are hard to explain,
then those words seem like they fit [milncjasto lwP'[n). He had put his finger
on the crux of the matter: that AIDS workers have developed a sense that the
foreignness of AIDS, as a disease, requires explanations that themselves con-
vey an alien feeling. The others still felt that "it doesn't sound right" fsuhaun-
dainaf. "When you say syndrome one kind of feeling comes into your head." a
participant blurted out. "and when you say betha the feeling is different"!n}.
Bhadra countered, "it doesn't sound right to us because we are immersed in in-
formation about AIDS. But if u e are talking to people who have never heard of
AIDS, and never heard of 'syndrome' the question is. what do we say to make
them understand"(n}7
Betha really did not sound right, as the exchange above makes clear, to
these AIDS workers. One reason some of the workshop participants gave is
that, as such a vernacular and very "authentically Nepali" word, it feels too
 LANGUAGKS OF SHX AND AIDS IN NKPAL 507

emotionally compelling. In a strictly technical sense, it is no more nor less ac-

curate than lakchap samuha as a translation lor the clinical term syndrome.
When a group of AIDS workers insist that their gut feeling, as native speakers,
is that bethd simply 'does not fit" the idea of syndrome, they are revealing the
logic governing the translation choices that link Nepali and English, the domi-
nant language of international knowledge. There is a language ideology at
work here. It does not feel right to these speakers to place such a folksy Nepali
word right next to a technical word in English. When English terms are trans-
lated into Nepali (thereby forming the terms in which most Nepali speakers
will become familiar with concepts and vocabulary), the choice in Nepali is al-
ways for the more complex and literate forms. Rather than bending colloquial
knowledge toward the authoritative language, a move that would make the dis-
tance between ordinary Nepali life and the world of international knowledges
bridgeable, a literate form of Nepali is inserted as the necessary intermediary
between colloquial "folk" language and international language.
It is not surprising that a technical vocabulary developed in one language
is borrowed by speakers of another language to express concepts for which
they lack a lexicon. English in AIDS work seems, at first glance, like a simple
case of borrowing: why would there be a word in Nepali for retrovirusi Sociol-
inguists distinguish between this kind of lexical borrowing and code-switch-
ing, where a shift between two languages in the speech of bilingual speakers is
triggered by features of the communicative context (such as the nature i)\' the
relationship between speakers, the institutional domain of communication) or
where the switch itself can be a performative tool that manipulates the meaning
of the communicative context (by indicating a level of formality, expressing
social solidarity, or conveying emotion, for instance).29 These insights into
lexical borrowing and code switching only take us part way toward under-
standing the significance of the language issue in AIDS education.
More recent thinking has come to question whether languages are best
conceptualized as codes with distinct boundaries separating them unequivo-
cally from other languages (Irvine and Gal 2000). Shifts of register within the
same code, the borrowing of terms, and switching between codes can all be
seen as part of a continuum of linguistic practices through which identities and
the boundaries of communities are experienced and marked. Thinking about
language in this way challenges the idea that talk simply "takes place" in the
already fixed array of communicative settings in a larger context. It suggests a
more dynamic relation between text and context.Vl Linguistic practices can
both express the tensions created b\ social difference and stratification and
serve, potentially, as a meaningful tool for retiguring the understanding of so-
cial positions. More than that, context must be understood not merely as the
immediate situation in which speakers interact, but the larger political-economic
structures that organize national and international relations (Gal 1989; Kroskntv
2000; Silverstein 1998). "Languages." writes Michael Silverstein. "are only
relatively stable . . . outcomes of dialectical valorizing processes among popula-
tions of people" (1998:402). Languages are caught up in institutional projects
508 CULTURAL ANTHROPOLOGY

of political orders on scales ranging from regional and national to the global,
and the "locality" of any language community is the product of a eontrastive
understanding of what it means to participate in a language community, given
that linguistic usage is inevitably ideologically charged as an index of social
identity. As Silverstein puts it, "languages and their locally recognized variants
become emblems (iconically essentiali/ed indexes) of their users' positions in
a shifting field of identities" (1998:411). Code-switching is a social practice
that "must be seen as the socioculturally meaningful creation and transforma-
tion of interactional context through the use of entextualized forms"
(1998:413). The question we must ask, according to Silverstein, is how does a
group constitute its cultural mode of allegiance to particular linguistic forms?
AIDS awareness education and the sex education that so often goes with it are
particular "entextualized forms." They are, in practice, communicative events
that actually aim to transform "interactional contexts" by creating news forms
of awareness. Recognizing this, we can better appreciate the social complexi-
ties of word choice.
The use of English has important social implications in Nepal. Nepali is
preferred in most situations, even by Nepali speakers who are fluent in Eng-
lish.31 Nonetheless, in the speech of the most educated urbanites code switch-
ing into English is very common, and at least some English words or phrases
figure in the ordinary speech of a range of people. Some code switching feels
right. But to code switch into English "unnecessarily/' as people put it, when
speaking to another Nepali speaker is interpreted as an arrogant move to dem-
onstrate superiority. This is because command of English is strongly linked to
social privilege, indexing as it does an educational background that only
money can buy. Code switching also occurs because English is associated with
certain domains of experience: world popular culture, technical and scientific
knowledge, modern forms of administration, school-based information. Ac-
cess to these domains is also organized by social privilege.
The development-related work of Nepali officials, planners, and staff is
pulled toward English not only because the goals, activities, and concepts are
named in English but also because English is the language of accountability to
donors. Poster slogans, training manuals, pamphlets are frequentK designed
first in English, only later to be worked up in Nepali, because it is ,ilwa\s nec-
essary to be able to show the donor agency what the organization is doing.
Proof o\' accomplishment to non-Nepali speaking donor consultants and deci-
sion makers always overrides the work of formulating texts in Nepali or minor-
ity languages in Nepal.
In this context. AIDS' workers are more than just diglossic individuals
who move between languages as they shuttle between speaking to the people
they educate and the donors who determine their programs. Rather, they ac-
tively mediate multiple contexts by mediating languages. In doing so. they are
establishing the sociolinguistic pathways that will convey information.
 LANGUAGES OF SEX AND AIDS IN NEPAL 509

Learning AIDS to Teach Prevention

In no other health education initiative is the public asked to pay so much
attention to the scientific and medical terms of explanation. Posters laying out
"how HIV is transmitted" begin the job, but it is in training workshops that the
full body of AIDS information comes to life in the interaction between facilita-
tors and participants. In these training sessions, people such as community
health workers, family planning motivators, local Red Cross volunteers, stu-
dents, and members of the police and military are brought together to be taught
about AIDS and STDs so that they can raise awareness among others/12 Such
programs offer a socially acceptable—and arguably, necessary—displacement
of the potential stigma of receiving AIDS information by framing the partici-
pants as teachers of others, not as people themselves at risk. That these training
sessions must devote much time to both basic health and sex education under-
scores how much even "simple'-' AIDS information rests on the assumption of a
particular background frame of reference. In these workshops, a standard rep-
ertoire of topics and participatory exercises is adapted and pitched to each
audience, depending on their presumed level of education and social back-
ground. This repertoire includes the following elements. (1) explanation of the
acronyms AIDS/HIV and of the distinction between HIV infection and AIDS:
(2) definitions of antibodies, immune system, and opportunistic infection
(sometimes preceded by an explanation of "germs" and the concept of disease
caused by microorganisms); (3) explanation of the "test* for HIV and the "win-
dow period" before seroconversion when the test may not be accurate; (4) how
HIV can and cannot be transmitted; and (5) introduction of the concept of
sexually transmitted diseases, their symptoms, and their treatment.33 Some-
times the social causes and consequences of an AIDS epidemic in Nepal are
addressed. The remainder of the time in the training workshops is devoted to
issues related indirectly to the sexual transmission of HIV. The problem, as the
programs conceive it, is how to get people thinking and talking about sex so
that they will be able to talk to others about sex. The platform most often cho-
sen (and this is the sixth standard element) is a discussion of body changes dur-
ing puberty, which leads to (7) an account of the physiology of reproduction
using diagrammatic line drawings of the male and female reproductive organs
and, often, an account of the menstrual cycle and conception. This sets the
stage for (8) discussion exercises designed to explore values and feelings
around sexuality. In training sessions I observed, many participants were learn-
ing for the first time about fertilization, the physiology of the menstrual cycle.
and a category of diseases known as "sexually transmitted."u HIV and sperm—
two things described in Nepali as "so small the eye cannot sec them"—were
often conflated by trainees, as were descriptions of fertilization and infection.
For many people it was hard to take all this in and remember it clearly after-
ward, a problem of which the people who organized these training workshops
were quite aware.
The touchstone of AIDS education is the unpacking of the English words
the letters in AIDS and HIV stand for, and the translation of these English
510 CULTURAL ANTHROPOLOGY
«

terms into Nepali. One of the points of these tangled unwindings is to inform
people of the distinction between AIDS and HIV, presumably so that people
can grasp the difference between being infected and being sick. Yet it is pre-
cisely the HIV/AIDS distinction that makes their communicative task harder
than it need be. "After all, when we teach about TB," Bhadra mused in one of
our dictionary workshops, "we don't teach people the Latin name of the bacil-
lus. It would be easier if we could just talk about the AIDS germ Jaid.sko ki-
tanm]." Why, then, do AIDS workers insist on teaching the HIV-AIDS dis-
tinction? For one thing, the technical competence that qualifies one to carry out
AIDS work must be demonstrated by continually marking the HIV/AIDS dis-
tinction. NGO teachings are actually policed. Their upstream accountability to
the international donors who sponsor their work requires that they be factually
accurate by the measures of accuracy set elsewhere.
Looking downstream, as it were, to the people they are supposed to reach.
AIDS workers correctly perceive that the tcchno-medical terms in English are
what AIDS "is." To collapse AIDS information completely into colloquial
Nepali would erase most of the concepts they are told define AIDS. Moreover,
though it would smooth many immediate difficulties of communication, it
would do so by creating an unbridgeable chasm between the internationally es-
tablished facts of AIDS and Nepali vocabularies for knowing it. It is by hang-
ing onto the vocabulary of technoscience that Nepalis variously positioned
along a steep grade of inequality can rappel themselves up this cliff face to
stand, as it were, on the flat plains of internationally established truth and fact.
Much AIDS awareness work that has taken place in Nepal could be criti-
cized for spending too much energy producing complex, overly technical
medical explanations of HIV transmission and AIDS, materials that provide a
kind of knowledge about AIDS that few can connect to their own real condi-
tions of vulnerability to HIV infection. It could further be argued that this
shows just how out of touch urban elite N(>() personnel are with their less
privileged compatriots (many of whom use languages other than Nepali, any-
way). I wish to place alongside these valid criticisms a somewhat different
point, not as an apology, but as an insight into the processes that structure the
context in which any AIDS education in Nepal must do its job. Science and all
other modern epistemologies organi/e immense arenas of life and thereby de-
mand recognition and invite emulation, Nepalis at all levels are well aware of
the asymmetries that govern which knowledges and values are. in effect, suit-
able currency in global circulations. This is the definition o\' marginality: to be
positioned as the exception, the deviate, the parochial, the remnant, or the
merely local in the face of the universal.As The knowledge of science is the
magnetic north toward which all compasses are now compelled to point, no
matter which forests of meaning people may be dwelling in.
This magnetic pull might help account for the evident delight those re-
ceiving lessons about AIDS find in eagerly asking how long HIV can live in a
drop of blood outside the body, whether HIV originated in green monkeys,
what the precise period o\ time between infection and seroconversion is. and
 L A N G U A G E S O F S h X A N D A I D S IN N h P A L 511

«
whether it is true that the cure has actually been found. The enthusiastic appe-
tite for this kind of information, and the precision with which such questions
are asked, is remarkable, and although it surely is driven by the desire to avoid
another set of questions about AIDS (like, What about my risk in my sexual re-
lationships?), the pleasures of engaging the obscure facts of a science-for-its-
own-sake should not be underestimated.™ The questions themselves indicate
that the askers already know that these arc askable questions.
From the perspective of AIDS workers, there are several reasons why it is
difficult to draw the line at the minimal necessary information. One mundane
reason is that the most efficient thing for an understaffed, underskilled, and un-
derfunded organization to do is translate existing English-language materials
on AIDS directly into Nepali. But the principles of health education are also in-
volved. To follow the health education guideline of using terms people can un-
derstand is to violate the mandate to provide accurate information. In training
workshops I observed, more detailed information was presented as a response
to real or potential misunderstandings of basic points.
Even more fundamentally, it seems that much of the information only
makes sense as a whole package. As we have already seen, once you begin try-
ing to explain what HIV and AIDS "are," you are on a slippery slope from pub-
lic health messages to molecular biology's understanding of T-cells and
retroviruses. The simple metonymic relations that make it possible to condense
AIDS information in the first world do not work well in Nepal, where a part,
such as a word like immune system, does not stand so easily for the whole idea
of health (as Martin 1994 argues it does in the United States). If the truth of
AIDS is contained within the language of science and medicine, then is not this
language necessary for any kind of understanding?
Workers themselves have to struggle to assimilate the technical informa-
tion that defines AIDS in much the same way that participants in their training
sessions do. Dr. Bhadra. for instance, complained that many AIDS workers are
under the impression that seroconversion is a phenomenon unique to
HIV/AIDS, and that a single exposure to HIV will immediately and :ilwa\s in-
fect a person. AIDS communication is a catch-22: to actually translate the in-
formation on what AIDS "is** is to provide information that is hard for Nepalis
lacking specific training in biology or medicine to understand; to bracket this
information and the terminology which is its vehicle off from public view is to
ghettoi/e these same people in a restricted prison of limited understanding.
AIDS workers experience this dilemma as much in their own training as in
their educational practice. Indeed, the line between an AIDS educator and the
public to be educated is always tu//y because, as noted earlier, most work-
shops and sessions on AIDS arc teaching AIDS to people—be the\ family
planning motivators, community health workers, or peer educators—who are
then supposed to educate others. Every student of AIDS is also positioned as a
teacher ol AIDS.
The effect is that, far from sharpening the dichotomy between the know-
ers and the believers, AIDS education creates gradations of knowledge, good
512 CULTURAL ANTHROPOLOGY
«

enough knowledge, semi-useful knowledge, incomplete knowledge, fragment-

ed knowledge across shifting layers of communication. Through practices ot
word choice, translation, and explanation people actively mediate relations be-
tween knowledges along this continuum.
I have dealt thus far with information about disease, the part of the AIDS
awareness message where the problem of communication is assumed to be
only a matter of getting the facts to people. I have shown that it is not so easy to
package "the facts" of AIDS in Nepali. Efforts to do so require translations and
code-switchings that set up socially charged nodes of connection that bring
some people in Nepal closer to the facts than others. This is the process
through which a set of facts about the body that have stabilized in one context
of knowledge production become meaningful to people in another context.
Through this process the possibilities for communsurability become organized
social realities. Next let us turn to the sex education component of AIDS
awareness messages. Here the mediations between knowledges of the body
have a different tenor. When it comes to sex education, it is an even more diffi-
cult job to graft knowledge about sexuality in Nepal to the international lan-
guage in which the official facts of "sex" come packaged. This is commonly
thought of as a matter of competing value systems, not competing truth claims
about the body. I will suggest that the problems of sex education are actually
much like the problems of AIDS education I have just discussed.

Sex and the Necessity of "Unnecessary Talk"

Consider the plight of a high school health teacher, who told me:

I might be able to talk easily about MLI But I can't say it in Nepali. 1 can't say it in
front of other people. 1 am educated but still 1 can't say these sorts ol things But
in English I can say anything without embarrassment. When I teach about the re-
productive system and about sex I don't use a sinulc Nepali sentence. My culture
makes it difficult forme fn}.

AIDS workers say much the same thing: "sex education" is "difficult" due to
"culture," but using English words makes it possible to overcome embarrass-
ment. They should know. Whereas teachers only have to point to ;i diagram of
the male and female reproductive organs as part of a health lesson. AIDS edu-
cators have to speak repeatedly of sexual intercourse and condoms and allude
to couplings that fall outside social approval. Recourse to a second language
always serves nicely to defuse the emotional charge of certain words in one's
mother tongue, ol course, so it is not surprising that educators find English
words less embarrassing. This observation alone, however, does not fully ac-
count for what happens in the oscillations between English and Nepali in dis-
cussions of sexual matters. Speakers are grabbing English because of its capac-
ity to distance and saniti/e. yet in doing so they are also taking possession of it
to create new possibilities for discussion.
 LANGUAGES OF SEX AND AIDS IN NEPAL 513

•
AIDS prevention templates contain unexamined assumptions about what
constitutes sex education and what purpose it should serve. The frank and open
discussion of sexual feelings, choices, and behaviors is valued along with the
provision of accurate information. What health educators mean by accurate in-
formation is a biomedical understanding of reproductive physiology (how the
body works) that is rendered through the delineation of pathology (disease)
and normalcy. What counts, nowadays, as sex education emerged out of a fu-
sion of the endrocrinological discoveries of the 1920s and 1930s, the political
agendas of social purity, eugenic, and contraceptive movements, and the crys-
tallization of sexuality as an object of a new science of sexology (Clarke 1998;
Weeks 1989). Sexual knowledge began to be made in a distinctive new way,
according to Porter and Hall, from around the 1880s. It "endeavored to escape
or avoid association with pathology, individual or social" (1995:154) and "at
least in intention, however compromised, set [. . .] out to apply the rigors of
scientific rationality to a highly emotive area" in a way Porter and Hall say
"provided a radically new way to make, unmake, and remake sexual knowl-
edge" (1995:177). Medicalized, it became possible to discuss sexual matters
with clinical detachment.
A nameable, knowable, manageable domain called "sex" began to take
shape in European and North American thinking, in part through the discourses
of sexual knowledge (Foucault 1978; Porter and Hall 1995) and in part through
the social changes associated with industrial capitalism that created conditions
for the experience of a sexualized "personal life" (Caplan 1987; D'Emilio
1997; Ross and Rapp 1997; Weeks 1989).37 Contemporary models for AIDS
education efface the historicity and cultural specificity of this understanding of
what "sex" is. "Sex" is taken as a self-evident domain of human experience
that can be addressed in the name of public health through sex education. For
Nepali AIDS workers, merely finding a culturally acceptable way to raise is-
sues and name body parts is not enough. They are involved in establishing the
ground for a public discussion of a problematic discursive object called
'sex."38
Importantly, to speak about the difficulty of talking about sex they have to
use the word sex in English, for there is no corresponding term in Nepali. AIDS
workers and others note this as a sign of the disjunction, or nonfit, between the
international (Western) framework and a sensibility they identify (somewhat
misleadingly, given Nepal's social diversity), as Nepali. "To talk about sex in
Nepali is absolutely unimaginable," I was told laughingly by a Nepali friend
here in Canada when I posed to him the questions I tackle here. "It is like
me"—an engineer—"trying to talk about geomorphology in Nepali. It simply
can't be done." His comment, like many others I heard to this effect, shows the
extent to which knowledge can appear coterminous with the language in which
it comes packaged.
AIDS workers are bending the word youn to serve increasingly as a syno-
nym for "sex" in phrases such as sex education (youn tikcha), safe sex (surak-
chit youn samparka), and sexually transmitted disease {youn rog). They have
514 CULTURAL ANTHROPOLOGY
«

debated which term for sexual intercourse would be both intelligible, clear, and
polite enough to use in public, settling in the end on xoun samparka (sexual
contact). None of these terms were common parlance, I was told, prior to AIDS
prevention efforts. Now they are increasingly familiar terms to many educated
urban speakers. More than one person insisted to me that youn does not mean
sex in the same way the English word sex means sex. Such a comment can only
come from someone who can hear and use English in a certain way. It seemed
(to me) that these speakers inflected the word youn with the meaning they at-
tributed to the word sex and, indeed, the ability to understand these AIDS-
related neologisms depended on this hybrid interpretation. What about those
Nepalis—the less educated, less cosmopolitan—who do not already know how
to talk about certain sexual matters in English? From the reports of frustrated
AIDS educators and my observations of the confusion of some of their stu-
dents, it appears that the neologisms undergo semantic slippage when the word
youn cannot reliably conjure up its "proper" translation as sex. What safe sex
(surakchit youn samparka) means to your average villager, one experienced
AIDS educator commented wryly, is finding a place to have sex where no one
can see you. Similarly, AIDS educators report people thinking that \Y>«/I rog
(literally "sex disease" or STD) must mean excessive sexual desire, or diseases
that arise from the heat of excessive sexual activity, or possibly even problems
like premature ejaculation. Many Nepali speakers do not place the boundaries
around a domain of "sex" in the way AIDS education requires.
Preoccupation with word choice has been AIDS workers' response to this
problem. In Nepal the question has been how public acceptability could be rec-
onciled with clarity of communication. The most common polite, colloquial
ways of referring to sexual intercourse are context dependent circumlocutions
about "that" [the particle u\. Other common ways of referring to coitus include
"contact" and "relations" and "the work which happens between husband and
wife." (Sex between men was not addressed in Nepali AIDS prevention ef-
forts). In the NGO review committee for educational messages, these phrases
were deemed too vague and ambiguous to be suitable for AIDS pamphlets and
posters, as was the very colloquial term laspas, which means, basically, "fool-
ing around." Early AIDS prevention messages sometimes pointedly attributed
HIV transmission to "going outside" [biihira ji'inuj or having sex with prosti-
tutes, an approach quickly squashed by Am FAR on the grounds that it is both
inaccurate and judgmental. Not surprisingly, the educated elite, mostly high-
caste Hindu leaders of AIDS programs were drawn toward formal, literate,
sanskritic terms like samhliog, youn kriyi), rati krixj. maithun even while some
workers acknowledged that such words were not readily understood by many
Nepali speakers.v' They ended up settling on youn samparka, even though they
admit it too is odd. if not entirely incomprehensible, to many of the people they
address. I was told that this word was not commonly used before the advent of
AIDS programs (that is. before the early 1990s). Nonetheless it was clear to me
that the sheer repetition of this term, not only in AIDS messages themselves,
but in a ran^e of more public discussions of sex that developed in tandem with
 L A N G U A G E S O F SEX A N D AIDS IN NKPAL 5 1 5

«
AIDS publicity—such as Dr. Bhadra's sexual advice column in Saptahik, a
popular Nepali language newspaper—was quickly making it the word for
which people exposed to these messages would reach. Again, this is the para-
dox of AIDS communication: the terminology that opens new possibilities for
speaking about sex for some speakers makes the topic obscure for others.
If, in the perceptions of AIDS workers, vocabulary is one obstacle to talk-
ing about sex, the other is what they refer to as the problem of "acceptability."
AIDS workers experience the problem of acceptability as both an external (in-
terpersonal) and internal (subjective) struggle. Their programs are rarely wel-
comed. School principals, village officials, carpet factory owners, media cen-
sors and other gatekeepers have not only resisted AIDS awareness activities,
but have sometimes been vituperative toward the workers themselves. In one
case I heard of, dogs were set on the hapless outreach worker: another man was
hit in the head with a rock during a street theater performance. But these at-
tacks aside, AIDS workers also have to struggle with their own feelings of dis-
comfort and resistance. They, after all, are the ones who have to stand in front
of groups of strangers and talk about how to put a condom on an erect penis.
One unmarried woman in her early twenties described to me the bone-chilling
mortification she felt when, soon after starting her job, she was required to dis-
cuss a list of sexual words w ith her male colleagues. Of a similar experience in
her training another young woman said, "everything inside me said, 'don't say
this.' but it was my boss asking me to say it." A middle-aged man who worked
as a planner in an INGO mused that development outreach workers want to be
seen as role models in the communities in which they work, and that speaking
about sex. AIDS, and condoms is problematic because they feel it will under-
mine the respect they feel people ought to have for them.
As men and women, workers experienced gendered dilemmas around re-
spect and respectability. These reflect what the problem of talking about sex
actually is: a problem of context rather than topic. AIDS workers themselves
sometimes pointed out that in same-sex, same-age groups, sexual matters are
more freely and easily discussed. AIDS education requires people to discuss
sex in public situations organiz.ed around differences of status. These include
classrooms, clinics, professional situations, and development outreach work.
AIDS messages always carry a flavor of the official civic legitimacy of devel-
opment. In Nepal, anything that is framed as an issue of "awareness"—as
AIDS has been—brings connotations of status differentials marked through
idioms of education, understanding, and development (Pigg 1^2). To pass on
AIDS awareness information is to be caught up in these implications, thereby
making the very act of AIDS education something that marks a communicative
context as somehow public and official.1"
In public contexts where<here is a status difference between speakers it is
especially transgressive to talk directly about sexual matters. Respect is dem-
onstrated through acts of restraint: deference is embodied in acts of holding
back and keeping silent. It is worth noting how Nepalis refer to talk of sexual-
ity when it does occur in these contexts. It is condemned as nachnhine kuril.
SI6 CULTURAL ANTHROPOLOGY

unnecessary talk, and most of all, it is chd(Ja. Chada talk is talk that \ lolates the
accepted constraints, talk that roves, as it were, in directions it should not (on
women who are labeled "chads," see Liechty 1994a:232). Thus in Nepali, not
being able to talk about sexual matters in these contexts extends to not even be-
ing able to name in Nepali that which you cannot talk about except by labeling
it as a breach of norms. Hence the problem faced by progressive AIDS workers.
There are patterns of appropriateness governing who may speak in Nepali
about sexual matters, and how, when, where and in what register they might do
it. Of course it has always been possible to speak in Nepali of coitus, fertility,
sensations, genitals and other body parts (and things you can do with
them)—the nondiscursive referents that might be indexed in a discussion of
sexual matters. There is, moreover, a discursive universe that constructs lust,
attraction, desire, erotic aesthetics, that labels sexualities, and that organizes
sexual relationships into socially resonant categories. Nepali is as rich as any
language in terms, be they euphemistic, metaphorical, vulgar, graphic, loving,
or humorous. The patterns of these ways of speaking need to be researched, for
they have received no attention in AIDS prevention circles in Nepal despite the
incessant preoccupation with how to talk about sex. In AIDS prevention dis-
course in Nepal, these nuances are erased by generalizations about stigma,
shame, and cultural prohibitions (Pigg 2002).
English enters into the patterning of Nepali languages of sexuality, dis-
rupting them but also extending them. People I spoke to saw the intensification
of public attention to sexual matters as recent, and their reflections about it
often centered on the question of the relation between a traditional Nepali soci-
ety and the modernizing influence of the West. Westerners are portrayed as
"open" in their ability to speak without embarrassment about sexual matters, a
characteristic regarded with considerable ambivalence. Nepali social norms,
and the Nepali language itself, are portrayed as deficient vehicles for sex edu-
cation by Nepali AIDS workers, for they are constantly forced to compare
what they are trying to communicate with what they know they are expected to
communicate about sex. Recall that in Nepal. AIDS and sex education modules
are adapted from resource materials in English. Despite efforts to develop and
cross-test these materials internationally, these templates often incorporate dis-
cussions of concepts like sexual identity that do not have correlates in Nepali,
or contain exercises designed to foster assertiveness skills for sexual decision
making that presume certain styles of verbal interaction that may not easily
transfer from one society to another. The information presented in these sex
education templates has an authoritative aura: These are the tacts of life, if you will.
English is felt to be more precise, sanitized, and technical, and therefore
more suited to the proper fin both senses of the word) communication of this
information. English words relating to sexual matters, including the category
term sex itself, tend to form the core vocabulary for AIDS workers, especially
when speaking among themselves. The Nepali "translations" of these terms are
for their target groups and their posters. In the practice of AIDS workers. English
 L A N G U A G E S O F SHX A N D A I D S IN NHFAL 5 1 7

«
terms are as necessary to the "necessary information" of sex education as tech-
nical/medical terms in English are to explaining the facts of AIDS.
English gives AIDS workers and their audiences words like safe sex. sex-
ual satisfaction, oral sex, anal sex, sexually transmitted disease, pedophilia,
sex worker, and homosexuality. Whether or not these concepts can be articu-
lated in Nepali, these English words are perceived to have a cool, technical
neutrality. What the English words do that the Nepali lexicon cannot is to ob-
jectify sex by turning it into something you can point to and talk about at arm's
length. English extricates sexual matters from the embedded emotional inti-
macy and moral density that can make mention of sexuality exposure of self.
Those Nepali speakers who can code switch into English understand the Eng-
lish word sex to mean precisely that possibility of direct public discussion of
acts, body parts, and feelings that could otherwise only be addressed indirectly,
if at all, in a public context. English, in this sense, is the language for talking
about sex because it provides a discourse that operates by bracketing off an ob-
ject called sex and then placing it in relation to—no longer in and of—social
relations, and, importantly, morality. Compacted in the very vocabulary of sex
in English is the sexological tradition from Ellis and Krafft-Ebbing, to Masters
and Johnson, to Dr. Ruth. Foucault would place it within a larger "incitement
to discourse" that "set out to formulate the uniform truth of sex . . . in an or-
dered system of knowledge" (1978:69). For Nepalis, this particular truth
comes in the form of English, and when it is translated into Nepali, it no longer
seems ordered in the same way.
I purposely risk an overgeneralization in saying that this is true "tor
Nepalis." The vast majority of Nepali citizens have very little exposure to Eng-
lish because their access to formal education and international media is limited
by rural isolation, poverty, or both. We social scientists know very little about
languages of sexuality across the social spectrum in Nepal, and. at this writing,
almost nothing about how people in diverse social locations hear and make use
of the AIDS and sex education messages they might hear. Exposure to and fa-
miliarity with English clearly follows the fissures of social inequality. But it is
a mistake to approach these questions of language by dividing Nepalis into
those who do use English and those who do not, and to assume that my obser-
vations about language ideologies guiding AIDS workers are irrelevant to the
rural poor. AIDS prevention work draws people into certain ways of speaking
about sex and it calls existing ways into new relations. The language practices
of elite AIDS workers are supported by a larger development apparatus that ex-
tends the mediating strategies they choose by formalizing them in institutional
practice.
Following the reflections, of the AIDS workers and others with whom I
spoke, I see English as a signpost for an emergent, but unstable discourse of
health and hygiene around sex. To explore how this discourse takes shape and
the positionings it makes possible, I turn to two extended examples of practices
of translation and code-switching in contexts organized as sex education.
518 CULTURAL ANTHROPOLOGY

Finding the Words

My first example is an exercise used worldwide in AIDS related training
programs.41 The Sexual Words Exercise is used in Nepal as a "desensiti/ation"
exercise or an "ice breaker" to help trainees overcome shyness in speaking
publicly about sex.42 A list of "sexual words" are presented to trainees. What
counts as a "sexual word"? The Sexual Words Exercise typically elicits further
vocabulary for some or all of the following terms: sexual intercourse, semen,
ejaculation, penis, vagina, masturbation, orgasm, breasts, anal intercourse, oral
sex. kissing, erection, buttocks, condom, homosexual, bisexual. When partici-
pants are given the work sheet listing these terms in Nepali, it is sometimes
necessary for the facilitator to define the Nepali words for which synonyms are
to be found, since, as we've seen, the Nepali terms chosen as the "proper"
translation of the English words are not necessarily widely understood (for in-
stance, samlihga as a term for homosexual)^ When the trainees can be pre-
sumed to know English, the list is often presented in English or English paired
with the formal Nepali translation that has sedimented as "the" word through
the process of developing educational materials.
Presented with this list, trainees are asked to list as many synonyms as
they can. Sometimes, to make this awkward task a bit easier, participants arc
asked to begin with "formal" synonyms and then move on to "slang." catego-
ries also rendered as "acceptable" and "unacceptable". This allows people to
present themselves as quoting, not really voicing, vulgar terms. Facilitators en-
courage, cajole, and goad participants into writing the words offered down on
large sheets of paper for all participants to see. Afterwards, these sheets of pa-
per are often taped to the walls and remain up as a kind of sexual wallpaper for
the remaining days of the training. The mood in the room is invariably intense
during this exercise; there is as much laughter as there are demonstrations of
shyness. To speak many of these words aloud, often in groups consisting of
both men and women, is deeply embarrassing for some, titillating or funny for
others, and for still others, just peculiar. That this exercise is conducted in the
context of a training session makes many participants, especially women, par-
ticularly uncomfortable. To be asked to call out slang terms for sexual inter-
course requires trainees to reveal themselves as a person who "knows" these
words in a context which otherwise calls for a very different presentation of
self.
Two rationales for this exercise are offered to trainees. One is that if peo-
ple are going to become peer educators, or health workers providing AIDS pre-
vention information, they need to overcome (i.e.. become "descnsiti/ed" to)
the emotional charge of these words. Being forced to say. hear, and read them
will make them mundane, or at least toughen people up enough to use them.
The other reason given is tKat educators need to be aware of the range of words
people they talk to might use. The exercise is therefore sometimes presented as
an elicitation of the slang of particular subgroups. Some NGOs took care to
collect the lists generated by trainees of different backgrounds (the police
proved to have an especially rich vocabulary). Despite this meticulous attention
 LANGUAGES O F SHX A N D AIDS IN NEPAL 5 1 9

to the overabundance of words in Nepali, I never heard an AIDS worker or

peer educator actually use any but the standardized word for which the syno-
nyms are elicited. Informal or slang terms are kept firmly out of the newly
formed linguistic repertoire for AIDS education.
The exercise presents sex as a series of decontextualizcd fragments. It of-
fers body parts, not persons; sexual acts, but not sexual relationships. Because
this exercise is arguably the most visible symbol ol "talking about sex" in
Nepali AIDS intervention circles, the clear medicalization of sex it fosters is
significant. To use these words is to "talk about sex"; to talk about love affairs.
mistresses, or marriages is not "talking about sex" in this discourse. AIDS in-
formation tends, more broadly, to be presented in this sort of abstracted, deper-
sonalized language of sex rather than in a grounded discussion of the forms of
sexual encounters and their social meanings. The legacy of Western sex sur-
veys, with their attention to acts and frequencies, is evident.
For AIDS workers who feel it is necessary to be nonjudgmental in com-
municating about sex for public health purposes, this language offers an escape
from the thoroughly moralized terms Nepali would otherwise offer for the dis-
cussion of sexual relationships. This Nepali vocabulary pertains to relation-
ships, not acts, and it systematically conveys the power relations between men
and women via the moral connotations of the positions it names. In concert
with many of their colleagues worldwide, some AIDS workers in Nepal argue
that AIDS education is socially transgressive at its very core, and that exercises
such as this one help break through the silences many opponents of AIDS edu-
cation use as an excuse for doing nothing about AIDS. But more commonly fa-
cilitators and participants ask, pointedly, "yo garda ke phaida?" (What is the
point of doing this?) Their facial expressions convey their distaste. Some AIDS
workers argue that far from being a "desensitization" exercise, as claimed, it
actually re-sensitizes people to a charged vocabulary by forcing them into an
extremely uncomfortable position of uttering and hearing words that should
not be mentioned. An exercise such as this lends itself to subtle misuse as an
excuse for men to talk dirty (although no one ever said this outright to me).
There is no way to "desensitize" these words, these AIDS workers claim.
The repetition of the Sexual Words Hxercise in training after training dan-
gles the possibility of a sanitized discussion of sexual matters for the purposes
of health. The vocabulary list, with its focus on specific words, is made to rep-
resent what a frank and open discussion of sexuality would be like. To say the
words is to be frank. To speak of sex through the apparently gender-neutral
grid of sexual acts is to be nonjudgmental. In the translation of "sexual words"
from a standard list in Hnglish into its execution as an "ice breaker" exercise in
Nepali, however, the sexological frame, with the distanciation it can create,
does not reliably survive. Nepali words do not conjure the medicalized frame
as securely as does English. The words do not lose their emotional charge, but
the exercise itself enforces an image of a saniti/ed discourse on sexual matters
that could and should exist. The image and attractions of this discourse ex-
tended beyond the closed rooms in which these specialized training sessions
520 CULTURAL ANTHROPOLOGY

were held. We see it in the mass media on a controversial radio show that al-
lowed listeners to phone or write with any question they might have about sex.
This show is my second example.

Teaching People about Their Bodies

Imagine, if you will, the stir that was caused in Kathmandu when, in 1997,
an FM radio station started airing the "Hotline" on which a suave DJ invited
listeners, in typical code-switching fashion, to write or phone "in case tap&iko
kunai pani question cha bhane, no matter how difficult, how embarrassing,
how bold it is, hamilai lekhnos post box number 8559" [In case you have any
question, no matter how difficult, how embarrassing, how bold it is, write to us
at post box number 8559]. Listeners flooded the show with calls and letters to
be answered by the guest expert. It quickly became one of the most popular
shows on radio. It also quickly became the target of vehement criticism from
many officials in broadcasting, family planning, and development education
who felt that answering listener questions about their practices of masturba-
tion, their homosexual encounters, pleasure in the marital bed, or HIV risk in
oral sex could not possibly have anything to so with the message of AIDS pre-
vention (Pigg 2002). A debate quickly formed. Was the show pornography or
education? Did the show violate standards of broadcasting decency under the
guise of AIDS prevention? Pressure mounted to ban the show; fans and de-
fenders of progressive sex education rallied to support it. Eventually its format
was modified so that there was less listener participation and more didactic
control from the studio. Too many listeners were writing in with questions
about sexual activities that gatekeepers had been claiming do not take place in
Nepal.
Begun in March 1997 as a minor experiment with the idea that AIDS pre-
vention must address sexuality in the broadest terms, the show was initially
spearheaded by AIDSCAP and sponsored by Contraceptive Retail Services
Ltd. (CRS), a previously obscure USAID-affiliated company charged with the
commercial marketing of contraceptives. The public mission of AIDS preven-
tion was mixed with commercialization and private enterprise from the start in
the Hotline. The Hotline show extended the characteristic broadcasting style of
FM radio—a style that featured lots of English from DJs, a preponderance of
western pop music, and a heavy reliance on phone banter with listeners—to a
weekly "sex education" show with an ostensible public service mandate.44 The
contrast to Radio Nepal's shows on the benefits and side-effects of family
planning methods could not have been more startling. The talk segments, with
their sometimes astonishingly explicit discussions of sexual matters, were thus
framed, somewhat incongruously, by the hip international pop music ("pretty
woman, walking down the street, pretty woman") on one side, and CRS's
stock-in-trade ads for contraceptives ("Panther condoms, for pleasure and
safety") on the other. These family planning ads were long familiar to listeners,
but the Hotline aligned them with AIDS prevention by introducing commercial
 LANGUAGES OF SEX AND AIDS IN NEPAL 521

•
breaks with aphorisms such as, "If you are about to entertain between the
thighs, remember! Condomize"{e}!
The use of English on the show became a point of discussion in itself. It
was clear that to attempt such a show exclusively in Nepali would make it im-
possible to discuss many of its topics, for to name many of these acts and de-
sires in Nepali would be to transgress, unequivocally, all bounds of taste. It
couldn't be broadcast. English, on the other hand, changed the tone, making
these acts and desires seem more legitimate as a topic of serious public atten-
tion. Unfortunately, not everyone who wanted the information could under-
stand English. The public education mandate appeared to conflict with the
clear class connotations of a certain linguistic style. On the show, therefore, the
DJ, the doctor, the callers and letter writers code-switched between English
and Nepali, as they groped for the right words. Indeed, the more nervous and
embarrassed a guest expert doctor became at a question, the more English he
used in response. As weeks passed by in the summer of 1997, the list of doctors
willing to be the guest expert shrunk, until Dr. Bhadra (whom we have already
met in the vocabulary workshops) was the only one left to field questions. Over
half the letters sent to the show in its first three months were in English, while
callers seemed to prefer Nepali. The DJ and the doctor tried to follow the lin-
guistic preference of the questioner, but often the doctor could only provide a
technically accurate answer by using English terminology. A full analysis of
this code switching would be another article. Here, I focus on how people in-
volved viewed the issue of language choice itself, as it came up during inter-
views and focus groups I conducted.45
My first stop was the offices of Radio Nepal, whose top programming of-
ficials were among the most outspoken critics of the show, with the power to
pull the FM station's broadcasting license, to boot. In presenting to me their
objections, they pointed to what they saw as the egregious mixing of English
and Nepali. (Use of English on Radio Nepal is restricted). "Who is being
served by this?" one official wondered. "The English speakers don't need the
Nepali and the Nepali speakers don't understand the English at all"{e}. The
FM broadcasters need to recall, he admonished, that their signal can be heard
outside the urban areas of the Kathmandu Valley by villagers. Calling the show
"explicit—even perverse at times," this official asked rhetorically "does each
and every person need to be informed about everything that can be called sex
education"{e}? He was referring, specifically, to rather detailed instructions
that had been given in Nepali on more than one occasion on techniques for
maximizing sexual pleasure.
The programmers at Kantipur FM, for their part, consistently presented
the show as a "health program" and they enthusiastically justified their pro-
gramming decisions by the.eagerness fans had to "know about their body"
(Pradhan 1997; Saptahik 1997). In their view, the basic message about HIV
transmission would not sustain an audience: "you have to address questions
about SCJL or no one will listen. Radio Nepal doesn't have to worry about listen-
ers, but we are a business"!n}. People do not think about HIV, so there is no
522 CU.Tl.'RAL ANTHROPOLOGY

point in talking to them about it, a programmer said. It is better to get people
talking about their problems. "They don't realize that we have put HIV aware-
ness in their minds"(n}. He accused Radio Nepal of denial: "if we won't talk
about sex., when will we start talking about HIV"{n}? Consistent with this phi-
losophy, he justified the use of English as merely reflecting the way listeners
themselves speak. Though their signal can be heard in a 35 kilometer radius, he
said, "our target is not the village and we have very few listeners there. They
don't like all the English and foreign songs and they don't tune in"(n}.
Back at Radio Nepal, however, another programmer opined that "we do
need to give sex education but there has to be a limit"{n}. In his view, people
were mostly getting "sexual feeling"{e} from the show rather than informa-
tion. When I asked him about whether the use of certain words ought to be
banned on the show, he replied that the sort of low-level words that "people in
villages use to scold" should not be used. Instead, "educational words." like
those in schoolbooks, would be preferable. Or better yet, sex should be talked
about indirectly, in a roundabout way. In his view, the Hotline was much too
direct in specifically speaking of male and female organs. None of the letter-
writers would use those words if the DJ and doctor were not broadcasting
them. "It is up to the anchor to find the clear way to say things indirect!) ."{n|
he said. And because FM, unlike Radio Nepal, is allowed to use English in its
broadcasting, they can use "English words to be indirect"!n}. The target
groups will understand. "More English," in his view, "would make the show
more educational and serious."
Fans, however, begged to differ. Although among the many hundreds of
letters the show received in its first three months of broadcasting perhaps half
were written entirely in English, the show received consistent pleas to explain
more things in Nepali because "this information is so important"!n}. Wrote
one fan, "especially when it comes to talking about genitals lyoun ahgaj and
STDs lyoun rogf it is hard for those of us with weak English to understand
what in fact is being said"{n}.
It was a common expectation among the middle-class people I spoke to
that hygenic-sexological views of sexuality would uphold moral rectitude by
emphasizing "how diseases are spread." The Hotline, in contrast, was born of
the very different philosophy of public health, one that emphasizes the provi-
sion of medical information and services over moral judgement. Whether sex
education was acceptable, or even possible, was much discussed among work-
ers in AIDS, family planning, and reproductive health fields, and when asked,
adults and youth also had much to say on the subject. What set of information
would come to count, however, as sex education was being worked out in the
mid-1990s, in part through focal events like the debate about the language in
which sex education on trie Hotline should be conducted.
Many things are happening at once with language on the Hotline, what-
ever the messages it may be conveying. The show models for listeners with
some competence in English what a mediation between the "true" (English)
language of sex and Nepali might sound like. It does so by stretching vernacular
 LANGUAGES OF SHX AND AIDS IN SKPAL 523

«
Nepali into the form of the English sexological language. The ccntrality of
English may have important consequences tor the many Nepalis who cannot
hope to understand even a few words of it, however, because it also informs the
stilted Nepali terms that have solidified as the "true" translation of the hnglish
words. The ideology of language attached to sex talk in English is transferred
onto an emergent reworking of Nepali, so that speakers begin to speak a Nepali
that can emulate the hcalth-and-hygiene discourse thought to reside in English.
What is striking about the Hotline—aside from the fact that it staved on
the air—is the way the sanitizing potential of Hnglish opens up a space for a
public discussion of sex that then invites other uses and positionings. With the
distancing effect of the discussion of sexuality in terms of health and hygiene
comes new forms of discursive identification. The for-your-own-good didacti-
cism of AIDS awareness that this medicali/.ation of sexuality is supposed to
serve gets re-appropriated wi^h an almost romantic abandon in a cosmopolitan
youth culture. The Hotline is but one piece of this wider urban, middle-class
youth culture in which media images, international sensibilities, and new prac-
tices such as body-building, fashion, modeling, and dating interweave in what
Mark Liechty (1994b) has called gendered self-fashioning. Laura Ahearn (in
press) has shown that even in (some) rural areas of Nepal, youth are making
themselves into an image of a romantic, modern self. Falling in love is associ-
ated with being modern, developed, successful, and independent. The medi-
calization of sexuality carried in the English vocabulary of sex education con-
verges with other frames for sexuality, ranging from the gendered relations of
kinship to commercial advertisings association of commodities with romantic
love. The expansion of a medicali/.ed discourse about sex, partially linked to
national development, occurs side-by-side with this increasingly se\uali/ed
commercial realm, not to mention the actual commodification of sex in por-
nography and prostitution.
This is the loose seam at which historically distinct concepts o\' sexuality
are in the process of being darned together. The AIDS prevention agenda is
tied to a certain kind of knowledge about sex. The international template for
AIDS intervention assumes that "sex** exists out there in the world as a self-
evident natural domain of experience and that the kind of information that
would constitute sex education is an equally transparent truth about the body.
The rationale behind the Hotline indicates how deeply this view structures the
terms in which Nepalis encounter both AIDS and medical knowledge about
sex. Listeners' questions suggest reasons why some people wish to enlist them-
selves in this knowledge. The mix of discomfort, outrage, curiosity, and laugh-
ing astonishment with which the Hotline was received make it clear that the
discourse of sexual health-and-hygiene sits uneasily with other ways of con-
struing discussion of sexual juatters.
Rather than trying to understand the relation between these views as an
oppositional one. in which Nepali cultural values will either hold ground or give
way to scientific knowledge and the Western values thought to be compatible with
it, it is more useful to pay attention to the sometimes awkward amalgamations
524 CULTURAL ANTHROPOLOGY

and conceptual near-misses in everyday practices. English and the possibilities

for speaking of sex or AIDS that are thought to inhere in it are woven into
Hows of communication in Nepali. Code switching in an utterance is onl> the
most conspicuous form of this intertwining. The movement between, say, the
suggestions for learning activities for training programs on sexual health pro-
vided by the International Red Cross and the actual implementation of a work-
shop for adolescent sex education is also a movement between the facts of sex
as encapsulated in English and their expression in Nepali words and through
Nepali examples.
In the actual juxtapositions of Nepali and English codes, in the transla-
tions between them, interesting new possibilities are created. If translating in-
formation—any view of what AIDS is—into locally comprehensible languages
and forms is an objective, then it is important to understand that this translation
occurs along discontinuous pathways and involves layer upon layer of code-
switching, borrowing, and revoicing. There is no line between two knowledges
or competing truth claims. What happens linguistically and conceptually in
this uneven middle-space between the facts established by international sci-
ence and the ground of Nepali discussions about them matters because that is
where people actually live. The interpenetration of languages is also a negotia-
tion of the ideologies speakers hold about those languages, an experimentation
with what they feel it is possible to say in those languages—a negotiation that
leads speakers to formulate through speech the "what" itself to which talk re-
fers. It is at these junctures that—to borrow Donna Haraway's words—"what
will count as nature and matters of fact get constituted" (1997:50).

Outside the Citadel, on the Periphery

science is simultaneously . . . a "particular story of how things stand" and . an im-
portant part of the institutions that are exerting particularly brutal forms o\ power
worldwide at the end of the twentieth century.
—Emily Martin. Anthropology ami the Cultural Study of Science

The relation between science and lay or public culture has recently been
re-envisioned by work in the anthropology of science that shows their mutual
interpenetration. Martin (1997). for instance, uses the metaphor of the citadel
to describe studies that examine science—the "culture of no culture" in
Traweek's (1988) famous phrase—as a set of socialK organi/ed meanings and
practices for engaging with the world. What lies over the ramparts'* Might the
walls of the citadel be permeable? Who lives outside the citadel? Martin ex-
tends the metaphor of the citadel, and proposes other metaphors, in order to
"link (he knowledge in the citadel and its manner of production, with processes
and events outside, processes that may be distant or spatially discontinuous
from it" (1997:136). As Martin puts it:

many powerful collectives and interested groups dot the landscape all around the
castle. Not only are they there, but they interact with the world inside the castle of
 LANGUAGES OF SEX AND AIDS IN NhPAI. 525

science frequently and in powerful ways It is as if we thought ot science as a me-

dieval walled town, and it turns out it is more like a bustling center ot 19th centurs
commerce, porous in everv direction. [1997:135]

This vision of "commerce" and "trade" between scientific "citadels" and

various public "settlements" helps us envision multiple sites of agency and
crisscrossing lines of influence.
But what if those settlements are on the periphery of industrialization and
populated by people speaking non-European languages? In what wa\s do the
inequalities created by conditions of economic dependency, neocolonialism,
and cultural imperialism alter the relation between the inside and the outside ot
science? The ethnographic questions about the science-in-culture and culture -
in-science look somewhat different when posed from a location such as Nepal,
about a specifically transnational dissemination of scientific knowledge, and in
relation to a practice such as AIDS intervention.
These additional questions are particularly important not solely because
science may be "part of institutions exerting particularly brutal forms of power
worldwide at the end of the twentieth century" (Martin 1997:133). Science
may also be part of quests for improved life conditions, through specific tech-
nologies, including medicine and preventive health. Much of the thinking
about science and the so-called third world has been dominated by agonistic
caricatures of science-as-life-saving-knowledge versus science-as-epistemo-
logical-colonization. Debates about science and multiculturalism—which are
often debates about whether there is something distinctively "Western" about
science—too often err by treating the knowledge produced by science as postu-
lates about the world that lend themselves to relativistic contemplation or to
absolutist claims about unmediated reality. Much of the debate is structured
around a remarkably naive and unselfconsciously colonial picture of a world
carved up into discrete, internally coherent cultures contained within definable
territories (for instance. Harding 1998). Certainly in both the practical field of
international health and in the medical anthropology associated with it. too
much is taken for granted. We are left contemplating the gap between indige-
nous frameworks and biomedically grounded public health prescriptions, a
perpetual binarism that leaves us either rescuing "indigenous knowledge" (as
technique or as meaning) or trying to rationali/c it or append it to science. In
place of these discussions of "cultures" (imagined as unproblematically uni-
fied worldviews) we need ethnographic research that considers the uneven
middle ground where things actually happen (Rapp 1993). Phis perspective re-
quires, first, a shift in how we think about the thinking of people in that vast
space we call the third world. Instead of seeing believers who are hearers of "a"
culture we would see positioned people, citizens of nation-states, negotiating
knowledges in different ways.4*1 This approach, furthermore, requires a discus-
sion of processes and relations that begins by asking how ideas and technolo-
gies travel.4
International projects of development and national projects of modern
governance are both major channels through which publics on the periphery
526 CULTURAL ANTHROPOLOGY

encounter science. Through a range of actions within identifiable institutions

that make use of varied technoscientific projects such as epidemiology, immu-
nology, molecular biology, reproductive sciences, sexology, and even public
health planning, science comes to be unmoored from its historically situated
origins to move as a truly translocal bundle of practices, meanings, and tech-
nologies. These processes of movement and localization occur through myriad
institutional practices and ordinary activities. The mundane plans and routines
through which the job gets done in international health programs contributes to
the actual building up of worlds around certain understandings of bodies. In
the case of HIV/AIDS, for instance, the current understanding of human-viral-
cellular interactions comes to make a difference first and foremost by becom-
ing the basis for a wide range of continuing institutionalized actions. Latour
has argued that the real-world efficacy of scientific discoveries—the effects
that persuade us that something new and fundamentally true about the real
physical world has been uncovered—are best explained not by assuming that
entities or processes were "really out there" all along without our know ledge,
but by truly appreciating the historicity of the intermingling of human and non-
humans. All scientific insights require upkeep, and those we regard as true ac-
counts of the world are the ones around which the most stable, enduring, and
extensive networks have been built. "What was an event," Latour (1999:168)
says of scientific discovery, "must remain a continuing event."
A growing body of work in science studies examines the public under-
standing of science and the controversies that erupt when members of the lay
public monitor, evaluate, and challenge the accounts of scientists.48 What kind
of authority does science gain, or loose, when it travels to peripheral publics
via institutions of modern governance and practices of development? Do pe-
ripheral publics encounter certain facts as the blackest and most tightly sealed
black boxes? Latour (1987) has used the concept of the black box to name the
shift that occurs when the fluidity, contingency, and open-endedness of inves-
tigation ("science in the making") is stabilized to the point where its results be-
comes the unexamined given ("ready-made science") from which new research
departs. For whom and under what circumstances are these black boxes sealed?
Alongside critiques of geographical inequalities in the production of scientific-
research, it is worth considering the global distribution of resources for public
participation in science-in-the-making.4>)
It may seem odd that I apply the term technosciencc to AIDS education
and its related discourse about sex. Clearly these arc not domains structured by
science in the first order. Haraway, though, uses the term technoscience "to
designate dense nodes of human and nonhuman actors that are brought into al-
liance by the material, social, and semiotic technologies through which what
will count as nature and as matters of fact get constituted for—and by—many
millions of people" (1997:50). "What will count as nature" is indeed what is at
stake for Nepalis. and "what counts" (as well as who deckles and how) will in-
deed have effects both on bodies and on signifiers of identity. As I have here,
Haraway explicitly aims to go beyond "a morality play about modern damnation
 LANGUAGES OF SEX AND AIDS IN NEPAL 527

•
or apocalyptic salvation" (1997:50). How, she asks, are people being interpel-
lated by technoscience? Who turns their head when technoscience calls out
"hey you!*'? This is a question we can pose to understand the science-public re-
lation on the periphery. If we see the project of AIDS prevention itself, and the
messages of AIDS awareness more particularly, as shouts of 'hey you!," who
in Nepal hears the cry, who can interpret it, and who, then turns to find their
"you" in its form?

Notes
Acknowledgments. The field research on which this article is based was made pos-
sible by a grant from the Joint Committee on South Asia of the Social Science Research
Council and the American Council of Learned Societies, with funds provided by the Na-
tional Endowment for the Humanities and the Ford Foundation. The Social Sciences and
Humanities Research Council small grants program at Simon Fraser University sup-
ported background research on public representations of AIDS. I would like to thank
Abana Onta for her invaluable research assistance and support, and the NGOs, planners,
and AIDS workers in Nepal who shared their work with me. Dr. Rajendra Bhadra and
Mrs. Renu Wagle wee especially helpful in patiently answering my linguistic questions
and sharing so many of the insights and observations about translation that I attempt to
convey here. Conversations about AIDS in Nepal with fellow researchers Kathy White
and Linnet Pike, and with Dr. Paul Janssen, sharpened my understanding of the issues
Vincanne Adams, Laura Ahearn, Don Brenneis. Leslie Butt, Dara Culhane. Kate Gilbert.
Mark Nichter, and George Hadjipavlou. Hugh Raffles, as well as Dan Segal and an
anonymous reviewer for Cultural Anthropology all provided useful suggestions,
some—but not all of which—I have been able to incorporate into this article.
1. It does seems likely—given the presence of social factors associated with HIV
transmission in Nepal, the background level of poor health and malnutrition in the popu-
lation, and the scarcity of biomedical care—that many people have already died of what
biomedicine would define as AIDS, without knowing their illness as such. The
UNAIDSAVHO Epidemiological Update on Nepal reports rising HIV prevalence among
sex workers in the Kathmandu Valley (from 0.9 percent in 1993 to 15 percent in 1998)
and a very dramatic rise in prevalence among intravenous drug users (in 1997. 50 per-
cent) (UNAIDSAVHO 2000). This information was not known among the AIDS workers
who are the subject of this article at the time of my research. Readers should realize that
this article reports the situation roughly from 1993-97.
2. Readers familiar with the numerous vociferous controversies surrounding AIDS
science and public health strategies may find my claim of standardization surprising.
Seen from the receiving end of this knowledge, however, and from the margins of its pro-
duction, knowledge about AIDS and AIDS prevention does, however, come rather
tightly packaged. The controversies are difficult to perceive and the common assump-
tions underlying various positions loom large.
3. See Farmer (1992) for a description of this relationship for Haiti.
4. This is, admittedly, a task that spills over the limits of this article, especially
since I also throw international development, sexuality, and the politics ol AIDS into the
mix. This article is part of a larger project in which ideas only signaled here will be fur-
ther explored.
5. This is the starting assumption of Harding's (1994, 1998) attempt to bring what
she calls "multicultural perspectives" to the question of the universality of science.
528 CULTURAL ANTHROPOLOGY

despite her claims to blur boundaries. She advocates a pluralist view of comparable
knowledge systems, but the "other cultures" in which these reside remain neatly separate
and geographically fixed. See Cohen (1994), Farquhar (1994), and Kuriyama (1994) for
criticisms of Harding's assumptions. Watson-Verran and Turnbull (1995) avoid the
fetishization of "other cultures" by attending to what they call "assemblages" of hetero-
geneous practices and problematizing coherence in a way Harding does not.
6. As practice-oriented research in science studies demonstrates the heterogeneity
among western scientific cultures, questions of commensurability, standardization, and
coherence arise as a problem within mainstream science itself (Watson-Verran and
Turnbull 1995:117, 127-131). For a discussion of the use of metaphors of bilingualism
and pidgins in thinking about differing epistemologies, see Fuller (1996).
7. On the concept of language ideologies, see Gal 1989; Kroskrity 2000; Silver-
stein 1998, Woolard and Schiefflin 1994.
8. The research also involved a comprehensive review of media coverage on AIDS
since the 1980s, collection of both educational materials (posters, pamphlets, videos)
and "gray literature" from NGOs and donors, and reconstruction of the recent history of
NGO involvement with AIDS intervention. The aim of the research was to follow the
production of public knowledge about AIDS as this process was organized through the
international development apparatus linking donors to NGOs.
9. This was reported by Picard (1996). The slogan became the prism through which
were seen both the announcement of the promising new treatments with protease inhibi-
tors and the critical commentary on the pervasive social inequalities underlying both
vulnerability to HIV infection and access to new drugs. Delegates from underdeveloped
countries of the South inflected the slogan with a question mark as they pointed to the
huge disparity between the actual incidence of HIV infections (predominantly in their
countries) and the preponderance of papers addressed to the narrow context of AIDS in
North America, Europe, and Australia.
10. As Hacking (1999) notes, a constructivist claim is always an intervention that
acts as a call to reconsider some taken-for-granted account of how things are. It is there-
fore a gesture that makes sense in a given context by moving against the grain of a cul-
tural silence.
11. Like Hacking (1999), Latour (1999) intervenes in the debate that pits "reality"
against "constructivism" by unwinding fundamental and long-standing philosophical
answers to questions about truth, reality, nature, relativism, and language to show the
premises that shape the terms of debate. Latour proposes that these seemingly intractable
alternatives (either science identifies "real" features of the world "out there" or it is a
form of social action) are based on notions of an inert, certain, objective, ahistorical "na-
ture" that presents a clear unified face to the people who would know it. Instead, Latour
(1999:15; 1987) proposes that what had been, under one kind of realism, regarded as in-
ert "objects" in the world might be better thought of as an array of "nonhumans" that be-
come "socialized through the laboratory" and enlisted and enrolled in various human
projects. Latour argues that we must "retrace our steps, retaining both the history of hu-
mans' involvement in the making of scientific facts and the sciences' involvement in the
making of human history" (1999:10).
Although I cannot reproduce Latour's full argumfcnt here, his reformulation of no-
tions of linguistic reference and relativism are pertinent to my discussion of communi-
cation about AIDS. Reference, Latour (1999) argues, is not a simple correspondence
between words and the world, a single act of pointing. Rather, it is a series of practices
that together can create "a quality of the chain of transformation, the viability of its
 LANGUAGES OF SEX AND AIDS IN NEPAL 529

circulation" (Latour 1999:310) or "our way of keeping something constant through a se-
ries of transformations" (1999:58). There is always a gap between form (or repre-
sentation) and matter; it is the constancy and strength of a chain that allows us the valid
sense that a scientist's account of a phenomenon refers back, reliably, to a stable set of
relations that exist somewhere other than solely within the account itself. Latour makes
these points in order to pinpoint the peculiar referential power of reductionism. Seeing
reference as a chain of transformations also opens up a way of thinking about the relation
between the scientific research on, say, HIV, and the further transformations those ref-
erential chains undergo as they are extended into public health policy and AIDS educa-
tion modules and translated into Nepali. Following Latour, 1 see this not as a single leap
from "accurate understanding" to "distorted misunderstanding" but as a series of moves,
some of which strengthen the chain and some of which weaken it.
Similarly, Latour argues for a concept of relativism and "relative existence" that re-
places all-or-nothing claims with a definition of existence as a "gradient" that "allows
for much finer differentiations" that can accommodate the tangled history of human-
nonhuman interactions, including the history of modern scientific efforts. Latour insists
on relativism, but just as he rejects an absolutist dichotomy between belief and knowl-
edge, so too does he object to conceiving of relativism as "the discussion of the incom-
mensurability of viewpoints" (1999:310). Relativism should refer, according to Latour.
"only to the mundane process by which relations are established between viewpoints
through the mediation of instruments. Thus insisting on relativism does not weaken the
connections between entities, but multiplies the paths that allow one to move from stand-
point to standpoint." My discussion of AIDS and sex education here is a study of paths
of movement.
12. Latour realizes that the politicization of the outer edges of what he sees as ex-
panding technoscientific networks is important; hence his efforts to dismantle the be-
lief/rationality dichotomy (1987:179—213; 1999) and his insistence on the way
boundary-marking of this kind creates social "others." Latour's (1999) discussion of
"relative existence" and the "spatio-temporal envelopes" in which entities exist, act. and
are known suggests some important questions for anthropologists interested in address-
ing the actual relations among knowledge systems and actual politics of access and so-
cial justice. Latour himself does not pursue these possibilities, as his discussions tend to
be located within the networks of technoscience he describes, rather than in the margins
(for a discussion of marginality as a starting point for the analysis of networks, see Star
1991). In the discussion of Pasteur's microbes I mention here. Latour makes his argu-
ment by talking about how ideas become retroactively extended through time—he ad-
dresses a single (European) history but not coeval variation in space.
13. Other anthropologists conducting research on AIDS in the 1990s have noticed
this lacuna in the scholarly literature on AIDS in nonwestern contexts and works ad-
dressing it are beginning to appear (for ethnographic examples, see Lyttleton 2000; Setel
1999; for a general discussion of this point, seeTreichler 1999:99-126).
14. These reasons might include: the explanatory and clinical power of the HIV hy-
pothesis of AIDS; the investment in research efforts in this approach to AIDS; the domi-
nance of the "AIDS knowledge" turf by molecular biologists, epidemiologists, and
behavior-change oriented socia! scientists; the political use of reductionist thinking in
shifting attention away form the social origins of disease.
15. Harding (1998) and Haraway (1997) take on this issue in different ways.
16. A distinction lhat is now giving way in Euro-American clinical practice to the
term HIV disease as way of encompassing the continuum of health consequences of HI V
530 CULTURAL ANTHROPOLOGY

infection. Nepali AIDS workers, however, are still struggling with the burdensome diag-
nostic definitions of ARC (AIDS Related Complex) and AIDS, enshrined in many of
their source materials.
17. The actual number of people in Nepal infected with HI V is unknown, and data
for estimating incidence and prevalence spotty. Statistics on AIDS in Nepal are better
seen as social artifacts than empirical measures. The number 1 report here reflect the
positive test results reported to or collected by the National Centre for AIDS and STD
Control (NC ASC). This number is always presented as a crude count, and it is this count
(rather than data on rates of incidence and prevalence) that is taken as a measure of the
seriousness of the epidemic. In 1992, the number of HIV tests conducted by private phy-
sicians would have been very small, if there were any at all. It is now more common for
HIV tests to be done privately, and it is widely felt that physicians or labs who do these
tests are not reporting results to NCASC. The numbers recorded for more recent years
are therefore more likely to under-represent the actual number of positive test results.
For 1994, WHO estimated that there were 5,000 adult HIV infections in an adult popu-
lation (ages 15-49) estimated at 9,863,000 (Mann and Tarantola 1996:495). The 1998
WHO was estimating that 26,000 people were living with HIV (UNAIDS 1998). For as-
sessments of the HIV situation in Nepal in the early 1990s, see Bhattaetal. 1994 and Su-
vedietal. 1994.
18. A comprehensive picture of all AIDS-related activities and their level of fund-
ing is not obtainable because AIDS-related activities are often integrated into other, ex-
isting programs, donors are often secretive with their budget information, and funding is
scattered across a complex field of government, international nongovernmental, and
nongovernmental agencies that is impossible to track. Comparative data on other health
expenditures is likewise unavailable, to my knowledge. Nepal reported receiving a total
of$283,651 in 1996-97 to a UNAIDS study (UNAIDS 1999).
19. See Dixit (1990) and Rana (1991) for early projections about Nepal's vulner-
ability in the Nepali media.
20. Widespread rural poverty in Nepal has, for generations, driven massive labor
migration both within Nepal and to other countries—mostly to India, but also to South-
east Asia and the Gulf states (Seddon et al. 1998). Male labor migration is associated
with HIV transmission because mobile men engaging in sexual relations with different
partners in different places create the sorts of sexual networks through which HIV can be
transmitted. Concern about AIDS in Nepal, however, has focused much more on the
other half of the equation: women in prostitution. In both public and official imagination
a single story line about AIDS has prevailed: "Prostitutes" are the source of AIDS, men
who "misbehave" sexually may pay the price, not only by contracting HIV themselves,
but by infecting their "innocent" wives and children.
Note that during this period, when sex workers and their clients were intensively tar-
geted for interventions, the prevalence of HIV infection among intravenous drug users
skyrocketed (see Note 1). Throughout the 1990s, only one NGO focused on harm reduc-
tion for intravenous drug users. Sexual transmission from sex workers was assumed in
1997 to be the main source of HI V infection in Nepal.
21. STD's have been associated with increased susceptibility to HIV infection, and
as a health problem in their own right, follow the same routes of sexual transmission as
HIV. Understandings of sexual behaviors, sexual networks, and the cultural values
around sexuality are assumed to be useful not only for ascertaining where to target inter-
ventions but also for assessing the potential epidemic scope and (as more and more
"risky" behaviors are uncovered) and designing awareness messages that would lead to
 LANGUAGES OF SEX AND AIDS IN NEPAL 531

behavior change. Sex education is thought to be an essential tool for creating the sorts of
understandings that would make people •aware" of AIDS and encourage them to alter
their behaviors in order to a\oid infection.
22. It may seem obvious that AIDS interventions must deal with sex in these ways.
and certainly at one level it is difficult to imagine an adequate AIDS intervention strat-
egy that did not. The obviousness of this three-pronged approach, however, naturalizes
many assumptions about what AIDS is. When AIDS gets framed, first and foremost, as
a sexually transmitted disease, proposals for how to prevent the virus from finding its
way into human bodies tend to focus on individual sexual behaviors rather than social re-
lations (Hammar 1999). The best way to "frame" AIDS has always been debated: should
it be understood as a medical problem, a development problem, or a human rights prob-
lem? (Fortrin 1989; Jbnsson and Sbderholm 1995; Seidel 1993). Each of these frames
leads us to think about AIDS in terms of different proximate causes and different feasible
solutions. In international AIDS work the medieal frame has encompassed certain as-
pects of the development and human rights discourse about AIDS. Hence in Nepal atten-
tion is focused on the sexual transmission of HI V and, to a lesser extent, the surrounding
social "factors."
23. It also introduces sanctioned opportunities for voyeurism and. in the phrase of
Linnet Pike, 'a soft-core public discourse" that opens "a moral space in both public
health and the public sphere which is at once prurient yet safely anesthetized and sterile"
(Pike 1999).
24. Patton (1990) articulates an alternative vision of AIDS education.
25. This approach created its own set of confusions, for the messages seemed to tell
people that AIDS is a saruwa rog, a contagious disease, but at the same time to tell them
that it does not sarnu (move from one person to another) in the ways other health mes-
sages tell them to worry about other diseases. These messages about AIDS came in the
wake of other health education campaigns that did emphasize the role o\' mosquitoes
(malaria), sharing cups (TB), and so on. in disease transmission. (My thanks to Ritu
Priya for pointing this out).
26. The ethnographic assertions here are my distillations from my conversations
with workers about language issues, my informal observations of their word choices in
different contexts, and my socially acquired sense of the "feel" of words. Some workers
were more reflective and articulate than others about these language issues.
27. In ethnographic research with development NGOs. the method of participant-
observation requires collaboration with NGOs' efforts to design and evaluate programs
and solve problems. My interest in language and communication converged with main
workers' interests in producing clear messages and handling AIDS education. In col-
laboration with Dr. Rajendra Bhadra. 1 convened a group of about a half dozen experi-
enced AIDS workers in a series of four-hour sessions to try to produce a Nepali
"dictionary" of the technical and sexual vocabulary related to AIDS. We envisioned this
dictionary as a resource for health workers, many of whom are themselves unsure of the
meanings of the many English terms in which AIDS is explained. Our goal was to push
to find the most colloquial, basic ways ot definingthe.se terms in Nepali. The final prod-
uct was never published.
28. Nepali speakers distinguish between rog and betiiH. Rog specifically refers to a
disease, however, and therefore not every bethn has a rog behind it.
29. Borrowing occurs when no other word is available to a speaker, the borrowed
words, molded to the grammatical structures of the matrix language, are used as if they
were words in the speaker's own language. Blom and Gumperz (1972) introduced the
532 CULTURAL ANTHROPOLOGY

notion of metaphorical code-switching with observations about the ways a speaker's

code choice can serve social functions. See Myers-Scotton (1997) for a review of sociol-
inguistic research on code switching. Code switching can be analyzed within the micro-
dynamics of interactions (thus generating explanations of the factors that trigger a
switch). Codes themselves have an indexical quality, and therefore a social meaning, as
signals of identity, allegiance, and social position. Code switching can therefore also be
analyzed within a wider frame that examines how code switching shapes and is shaped
by wider social and political processes.
30. Silverstein and Urban (1996) turn to a view of processes of entextualization
and contextualization.
31. Though I did not carry out rigorous sociolinguistic research these are basic ob-
servations. It should be noted that Nepal is a multilingual nation, and an analysis of this
type should be done of practices between English, Nepali, and other languages.
32. Peer-education—the idea that AIDS information is most effectively presented
by member's of a given social group—is one of the cornerstones of AIDS work world-
wide (Williams 1996; for a criticism of the exportation of this model, see Murray and Ro-
binson 1996). This model has fused with the system of "training trainers"—the idea that
a body of expertise can built up in resource-poor settings by creating a network of nested
training activities whereby the people who receive a week-long training can then go on
to provide that training to the next group.
33. The training sessions reflect what is known as the syndromic approach to
STDs, the approach currently promoted in Nepal. Health workers are taught to use a de-
cision making tree to arrive at the appropriate drug therapy on the basis of reported
symptoms. In training sessions, participants are taught to recognize certain things as
symptoms of STDs, but not to differentiate among STDs.
34. In several training sessions I observed, this information threatened to over-
shadow AIDS as the focal information. In one, the middle-class women attending bom-
barded the nurse who was presenting this material with questions about contraception,
infertility, hysterectomies, and other gynecological concerns. In others, some partici-
pants—many of whom were hearing about both diseases caused by germs and reproduc-
tive physiology for the first time—confused the "safe period" (the time in the menstrual
cycle when fertilization is most unlikely) with the "window period" (the time between
infection with HIV and the point when the test can detect it). The image of sperm fertil-
izing the egg tended to merge with the image of HIV attacking T-cells. I was struck,
when I observed training workshops, both by the eagerness with which people sought in-
formation on the physiology of reproduction and the difficulties posed by the "experi-
ence-distant" inscrutability of the decontextualized biomedical presentation of this
information in forms such as line drawings of the female reproductive system.
35. See Adams (1998) and Pigg (1995.1996) for further development of this point
in relation to medicine. Silverstein (1998) makes it in relation to language, more broadly.
Dirlik (1998) makes it in relation to globalization and social movements.
36. I came to appreciate this point when Dr. Bhadra commented that they found
that when they taught health workers the actual names of various STDs and their causa-
tive pathogens, health workers tended to retain only this arcane information (and. he
said, use it to show off) while forgetting the pragmatic training they received on syn-
dromic treatment of STDs.
37. Given this. Clark (1997) has asked whether we can then posit sexuality as a
"thing in itself to be analyzed in societies distant from this Euro-American history.
Writing of the Hull of highland New Guinea, Clark argues that "clearly 'sexuality' as an
 LANGUAGES OF SEX AND AIDS IN NEPAL 533

area of study imposes a Western framework of beliefs and analysis, which assumes that
a category exists 'out there' but does not ask whether this is also a category for non-
Western peoples like the Huli." (1997:195). To the extent that the Huli could be said to
have a concept of sexuality, Clark urges us to acknowledge "that sexuality is an undif-
ferentiated experience for the Huli" and to consider "the moral dimension of sexuality
and the way in which it is ontologically grounded in relations of power and gender." By
defining sexuality as "a framework for interpreting experience based on notions of the
body and related to sexual behaviors and attitudes" (1997:194), Clark insists that we not
inadvertently inject Western concepts of sexuality into our theoretical frameworks (a
point also made by Vance 1991). An analysis of sexuality in Nepal would therefore be a
different undertaking from that of this article.
38. The problem of talking about sex splits AIDS awareness programs into two
camps. On the one side, there are those who view this "difficulty" as inherent in "Nepali
society" and therefore attempt to provide AIDS information with as little discussion of
sex as possible. Nonsexual routes of HIV transmission are given elaborate attention,
while sexual transmission is quickly glossed over with euphemisms. Blood receives a
great deal of attention. In this camp are those who argue that every AIDS awareness
poster should depict all routes of HIV transmission. On the other side, there are those
who feel that "difficulty" is something that should and can be overcome. These are the
advocates of sex education, of direct discussion, of raising uncomfortable subjects in the
interests of public health. Both camps share a preoccupation with the nonfit between the
discussion of sex that AIDS seems to require and the possibilities for producing that dis-
cussion in a Nepali context. AIDS workers always locate this problem "in our society."
and although some workers feel Nepali society is much the better for not fostering what
they view as "Western" attitudes toward sex, it is Nepal's inability to conform to the a
model of what "talking about sex" should be like—rather than the nonfit of the model for
Nepal—that they emphasize.
39. AIDS workers (and many other development outreach workers) tend to under-
estimate the ability of villagers to understand many words and concepts when they gen-
eralize about their work. At the extreme, they portray villagers as prone to confusion,
especially by being overly literal in interpretations of what is said. In practice, most
workers fail to gear their language sufficiently to local vocabulary and styles of explana-
tion. The result is a paradoxical situation in which workers commonly theorize about
what villagers won't understand (in a criticism of word choices, for instance) but in prac-
tice stick to the more difficult language.
40. These connotations can be, and probably are. occasionally overcome in actual
practice. 1 simply wish to point out the tendency. Moreover, it is likely that over time un-
derstandings of AIDS will enter into popular consciousness, taking on new meanings,
and freeing the very mention of AIDS from this strong link to the idiom of "awareness."
41. International Red Cross (n.d.) and CEDPA and SCF/US (1997) contain exam-
ples of this exercise as recommended exercises for training sessions. See Pike (1999) and
Pigg (1999) for further comments on this exercise as it is used in Nepal.
42. My local AIDS NGO, AIDS Vancouver, uses it in orientations for volunteers
as a technique for helping people reflect on "how open they are about sex."
43. One training manual inventively proposed to get-around this difficulty by pro-
viding trainers with stylized sketches taken from religious art, such as the struts of Kath-
mandu's many tantric temples. It was thought that these depictions of deutS (divine
figures) engaged in exotic sexual acts might be more acceptable (CEDPA and SCF/US
1997). Trainers could then point rather than say.
534 CULTURAL ANTHROPOLOGY

44. When, in late July, 1997, it appeared that the Minister of Communications him-
self was on the verge of banning the show, the producers played only Nepali folk music
as a signal to listeners that something was up.
45. These were conducted (with assistance from Abana Onta) on behalf of
AIDSCAP as part of a midstream assessment of the show that 1 prepared under contract
with Family Health International in the final weeks of my research stay. Interviewees
were aware of my dual role as "consultant" and "researcher." The analysis presented
here is my own and does not reflect the views or policies of Family Health International
orAIDSCAP-Nepal.
46. Scott (1994) has usefully cautioned that we must not mistake our theoretical
proposition that cultures might be more open-ended than previous theories had allowed
for an assumption, in advance of any empirical evidence, that all cultures are actually
equally open-ended. Boundedness may indeed be a feature of people's conceptual reali-
ties. I do not mean to rule that out here. 1 suggest, however, that it may be useful to start
(both theoretically and empirically) at the points of interpenetration and feel our way to-
ward those sites of boundedness rather than the other way around. When we begin eth-
nographically at the center of boundedness everything else can only look like boundaries
dissolving.
47. Latour's (1987) criticism of diffusionist thinking is one starting point, but see
Haraway (1997:33-39) for criticisms.
48. Although Latour assumed that the public only responds to a ready made sci-
ence, we can point to many current controversies—from the antivaccination movement
to alarm over genetically altered potatoes and boycotts of BGH milk—as evidence that
some understanding of the "constructedness" of scientific knowledge has become part of
public consciousness in places like the United States. One of the most striking examples,
in fact, of the ways lay people involve themselves in science-in-the-making is that of
AIDS activism (Epstein 1996).
49. AIDS is a case in point. While most HIV infections now occur in the develop-
ing world, basic research remains concentrated in the hands of U.S.-based researchers
and a very small proportion of their work usefully addresses the problems of AIDS in re-
source-poor nations. Similarly, AIDS activism in industrialized countries has become a
major site where lay experts have not only kept a close watch on the research process but
have actively challenged its assumptions and intervened in its processes. Where AIDS
activists in North America are well-informed about the controversies around various hy-
potheses and treatment protocols, AIDS workers in Nepal are handed an authoritative
truth about AIDS and AIDS treatment.

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