Like many men from Nepal’s Accham district, Sarpa migrated to India for work only to return with HIV. Thankfully, a lessening of stigma – and a greater emphasis on treatment and testing – are making such stories less commonplace

Adarsh and Numa are the only two HIV-positive kids at their school, and everyone knows it. In this mud-and-brick village, so high up Nepal’s far-western hills that it takes two days by 4x4 to reach the nearest town, no secrets stay secret for long.



Like nearly every other man of working age here in Achham – a remote, mountainous district where many women are still banished to cowsheds when they menstruate – Adarsh and Numa’s father migrated to India for work. And like many other migrants seeking wealth and opportunity beyond Nepal’s borders, he returned home with a very different legacy to the one he anticipated: a life-threatening virus.

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No one knows this better than Adarsh and Numa’s mother Sita, 50, who discovered she too was HIV-positive after her husband fell ill five years ago.



“I know 10 other people in this village who have HIV,” she says, gesturing to the smattering of neighbours’ homes. “One is a school teacher and another one is a government health worker – we all know each other and support each other. Same story: their husbands went away to work and one day came back with HIV.”

Just 10 years ago, such honesty about this stigmatised condition would have been unthinkable – even here in Achham, the district with the country’s highest rate of poverty, HIV and Aids. But years of community-led awareness programmes, mobile blood-testing units and radio education series have helped to turn the numbers on their head: overall HIV and Aids rates have fallen 22% over the past decade, and stories like Sita’s show why.



Sita’s husband Sarpa left for India just after they married as teenagers, when she was still pregnant with their first child. Poor roads, lack of infrastructure and almost zero communications meant it was virtually impossible for the couple to stay in touch. Every two years, Sarpa, now 51, would return to Nepal, and Sita would once again fall pregnant. But it was only when Numa, their sixth and final child, was born that Sita noticed the lumps on Sarpa’s chin. It took a whole year for Sarpa to agree to testing and admit the extent of HIV’s impact on the family: Sita and the two youngest children, Adarsh, then 10, and Numa, then five, all tested positive.

Facebook Twitter Pinterest ‘It’s been an emotional journey, but we decided not to fight over it’: Sarpa, 51. Photograph: Archana Gurung/Practical Action

Like many other men interviewed in Achham, Sarpa has a well-rehearsed story that explains how he believes he contracted HIV, but it does not involve any sex workers, whom researchers believe are the primary source of migrants’ HIV infections. In 2002, the same year that Adarsh was born, HIV prevalence among Nepali migrants returning from India was believed to be as high as 8%migrants comprised almost one-third of all HIV infections (double the rate of sex workers in Kathmandu valley); in 2011, in Nepal, according to the World Bank.

“It’s been an emotional journey, but we decided not to fight over it,” says Sarpa coolly.

Sita shakes her head, indicating that she has had to accept the likelihood he visited Indian brothels. “He was very depressed and embarrassed about it – he couldn’t face it at first,” she says. “But our concern really is the kids. We just hope that we will find a cure in our generation and they can lead normal lives.”

These days, “normal” means antiretroviral medication once a day for Adarsh, 15, and his parents. His sister Numa, 10, who sits playing with a doll along the mud wall, hasn’t yet started her “medicine”; her parents fear she won’t be able to handle the side effects. Her face and neck are already dotted in long, pale scabs, but the nearest clinic is a steep hike down one mountain and up another in flip-flops on washed-out trails. Sita, who would normally accompany her daughter there, has been extremely poorly the past few weeks after a fall on the mountain. She is clearly worried about what that means for her overall health.



“I used to be strong and capable, but lately I am weak and have no appetite,” says Sita, trying to catch her breath as she speaks. “I fell down a while back on the trail and hurt my ribs, and they still haven’t healed. That’s not normal.”

For Sarpa, who is tall and lean and looks the pinnacle of health, maintaining a good diet and positive attitude is the primary focus. With the help of the NGO Practical Action, he has learned how to create an organic, seasonal garden that can feed his family while also producing enough surplus to turn a profit at market. He points to the fruits of his labours – the persimmon and pomegranate trees, and crops of tomatoes, cauliflower and bitter gourd that he has planted – as proof of how far his family has come. The income is enough to keep him in the village instead of returning back to India for work, and having Sarpa at home has meant the family can confront their reality together.

Sujan Piya, who heads Practical Action’s agriculture and nutrition programme, says fruits and vegetables are key to building immunity, but are too often substituted by cheaper food sources such as rice and grains.

“Malnutrition across Nepal is a problem, but in Achham, where there is no easy access to expensive sources of proteins like eggs and meat, malnutrition for an HIV patient is of grave concern.

“So we’ve really focused on families in remote areas to improve their livelihood and nutrition levels, teaching them ways to sustainably add nutrition to their daily diet by promoting neglected but nutritious crops, homestead gardening and home-based poultry and goat farming.”

Facebook Twitter Pinterest Sita, 50, discovered she was HIV-positive after her husband fell ill five years ago. Photograph: Archana Gurung/Practical Action

Sarpa has also found himself a job as a safe sex campaigner for the Global Fund, and travels from village to village warning about the risks of working abroad and the importance of using protection. But Nepal’s distinctly patriarchal society makes it tough for women to demand their husbands use the condoms that local and international NGOs distribute, says Sarpa, largely because the men believe the outreach programmes merely encourage the women to have affairs while they are away.



“It’s very controversial to use condoms. The husbands want to know why the NGOs are distributing condoms when they are not in Nepal. They say, ‘Are you trying to encourage our women to have sex while we are not here?’ Female condoms are not distributed here, so it is very, very tough.”



But Sarpa is confident that work like his, as well as radio announcements and visits by local NGOs, have done much to increase the education both of Achham’s women and the men who go abroad.



“I tell the migrant workers I meet with, you’ve got to get regular check-ups. You’ve got to practice safe sex, and you’ve got to keep taking your antiretrovirals if you’re on them. I know men who started their antiretrovirals at the same time I did, and some of them have since died.”

As for Adarsh, who may also seek fortune beyond his own village soon, the future remains uncertain.

“We don’t want to let him out of our sight,” says Sarpa, welling up when asked what may become of him. “He might be treated differently if he goes anywhere else and faces stigma. Here he is at home, with his family, where we can monitor his medication and his health.”

The greatest worry is the legacy these two HIV-positive children will leave themselves, the parents say. “We may have to find HIV-positive mates for them, because who will marry them otherwise?” says Sarpa. “They will need to marry soon, and have children, and pass on the family line. We just hope we find a cure. One day.”

Some names have been changed to protect identities