MANGALSEN, Nepal—Most locals walk here, journeying hours or days to reach a smattering of tea shops and convenience stores or an ammonia-washed health clinic. Outsiders access the western Nepali district of Achham either by helicopter or the single road clinging precariously to the rocky corners of the Himalayan Mountains. People in Achham have no choice but to eat the little that sprouts from their stubborn land. Here, many know HIV only as “Bombay disease,” a seemingly mysterious illness that began to weaken and kill in Achham when men started migrating to India for short-term, low-wage jobs more than a decade ago.

Two women fix their eyes on their small children when they speak with a visitor outside a local health clinic for people living with HIV/AIDS. Even one and two years after their diagnoses, they say it’s difficult to accept their...

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