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Additional articles in this series.
INSIZA DISTRICT, ZIMBABWEWilson was the hardest. He had been such a charmer, a flirt even, but then AIDS dulled his sparkle and confined him to his bed. That's when Sibongile Ndlovu increased her visits to every day, bringing him food and caring for his bedsores, which had bloomed into an affliction worthy of Job. 'The whole skin on his side was coming off,' she says, and it filled his hut with the smell of sickness. She convinced the clinic to give her medicine, and she rubbed the ointment on his raw bedsores every day for the two months until he died.
Four years have passed, but despite that ordeal Ndlovu is still caring for patients. How many has she assisted? "Forty-two," she says, checking a tattered ledger with neat, handscripted notes. How many have died? "Sixteen."
Ndlovu is not a nurse or health-care professional of any kind. She is a peasant farmer who volunteers with the Insiza Godlwayo AIDS Council (IGAC). Her family income is about 300 Zimbabwe dollars a month, not even 10 U.S. dollars. Three days a weekmore if one of her patients is severely illshe stops by the homes of the sick, washing their bedclothes, fetching water, tilling the little plots of land on which these villagers all survive, even parting with some of her meager income to purchase things her patients need. Wilson had a craving for oranges, which are luxury items here. But she bought them.
Africa's response to AIDS is often depicted to be as dysfunctional as its economy, just another example of what some AIDS workers call "Afro-pessimism"only bad news coming out of Africa. It is true that just a handful of African governments have mobilized a response remotely commensurate with the magnitude of the epidemic, which has already slashed life expectancy by as much as 20 years in some countries. AIDS stigma has also made many ordinary people shy away from dealing with the epidemic. "I have found the most unacceptable denial and apathy in Africa," says Elhadj Sy, who heads the southern and eastern Africa team for UNAIDS. "But on the other hand, the most incredible responses to HIV have been developed here. We live in this contradiction of extremes."
Nowhere are these extremes more pronounced than in Zimbabwe, the former Rhodesia, which whites ruled until 1980. When it finally gained independence, Zimbabwe was the South Africa of its dayrelatively prosperous, with no foreign debt, and a currency stronger than the U.S. dollar. Now, the economy is in free-fall, and a quarter of adults in the prime of life, aged 15 to 49, are infected with HIV. The virus is killing more than 65,000 people a year.
Yet the director of Zimbabwe's National AIDS Coordination Programme, Everisto Marowa, says that government spending on AIDS prevention has, in real terms, "certainly not increased and probably declined" over the last five years. Last month, the government announced a special AIDS tax, but even AIDS workers criticized the idea because the government provided no plans on how it would spend the money. Corruption and mismanagement are rife in Zimbabwe, and previous special levies have disappeared with no accounting.
Meanwhile, the government admits it is spending more than 70 times the budget of the AIDS Programme on its unpopular military intervention in the Democratic Republic of the Congo, though independent observers estimate the war costs many times more than that. Few citizens understand why a third of the army has been deployed in the civil war of a country that does not even border their own, especially when inflation and unemployment in Zimbabwe both exceed 50 percent. But many suspect a few may be profiteering: The head of Zimbabwe's army is a director of one company that has mining rights to the mineral-rich Congo and of another that has trucking rights.
Yet below the radar of government, in individual communities there are astonishingly vigorous responses to AIDS. "In every province we have member organizations," says Thembeni Mahlangu, director of the Zimbabwe AIDS Network. "They were often started by a church or NGO [nongovernmental organization] and sometimes just by individuals." For example, Auxilia Chimusoro founded Zimbabwe's first AIDS support group, and then tirelessly traveled the country launching more. By the time she died in 1998, Chimusoro had started more than 50 support groups, most in poor rural communities. In the capital, Harare, the Musasa Project works with battered women, helping them break free of partners who often force them to have sex, almost always without a condom.
IGAC, the group that helped Wilson, specializes in home-based care and orphan support, and it has recently launched a youth prevention campaign. The leadership of most AIDS programs "is composed of professionals," says Lucia Malemane, a nurse with Zimbabwe's Matabeleland AIDS Council, who taught Insiza about AIDS. "But with IGAC, it's just ordinary peasant farmers."
Heroic as these efforts may be, they are tinged with poignancyand not just because the government, which could knit these isolated efforts into a powerful national response, has shirked its duty. Most community programs lack any but the most basic medicines. Certainly they cannot afford the expensive regimens that have reduced the AIDS death rate in wealthy countries. Without effective drugs, home-based care can seem like little more than home-based death. With the disease mowing down so many people, and with poverty making volunteering so burdensome, it remains to be seen whether such homespun efforts can endure for the decades that may well pass before an AIDS vaccine is developed.
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