Little is easy these days for Gladys Mataruse. Walking tires her. Talking hurts. And in long, sleepless nights of coughing fits, she lacks even the comfort of her husband, who has declared her "useless" and moved away. But nothing, she explained in a hoarse whisper, is more painful than her fear that she will soon die of a mysterious disease, effectively orphaning her two school-age daughters.
Mataruse, 29, has the thin arms, slack-skinned face and glum stare of someone very ill. She said she had heard of AIDS. Yet all she knows about the disease is that it often causes the symptoms she's experiencing -- weight loss, diarrhea, coughing, fever -- and that here in rural Zimbabwe it is invariably fatal.
Gladys Mataruse has symptoms she believes mean she has AIDS, but her local clinic in rural Zimbabwe does not have HIV test kits, let alone antiretroviral drugs.
(Craig Timberg -- The Washington Post)
"I wish to be healthy again, but now I'm doubting it will happen," said Mataruse, her eyes fixed on the floor as her youngest daughter, 6-year-old Florence, sat unsmilingly beside her, wearing a white dress.
AIDS is no longer an unavoidable death sentence in most of the world. Even in much of Africa, billions of dollars in international aid has made it a chronic, controllable disease for a small but growing number of patients with access to antiretroviral medicine. But this relief is arriving in a profoundly uneven way, dividing the continent into areas where AIDS is survivable and areas where it is not.
By this measure, Mataruse could not live in a worse place. Zhulube is a remote region in southern Zimbabwe, a country whose public health system has been decimated by economic collapse and international isolation. In southern Africa, the epicenter of the global pandemic, no country is as far behind in treating AIDS, according to World Health Organization statistics.
An estimated 1.8 million Zimbabweans have HIV, the virus that causes AIDS. Of that group, 295,000 need antiretroviral treatment immediately, but only 8,000 -- less than 3 percent -- are getting it, according to a December report from WHO. The need for treatment is growing far more quickly than the capacity to provide it, the report shows.
Mataruse's local clinic, an arduous three-mile walk from her home, lacks not only antiretroviral medicine but also the kits needed to test for HIV. Even the basics of modern health care -- syringes, intravenous fluid, antibiotics and elastic bandages -- are frequently out of stock, a nurse at the clinic said.
There are no doctors there. The nurses who have chronicled Mataruse's decline have never mentioned either HIV or AIDS, she said, and neither term appears in the battered paper folder of medical records she keeps.
The surge of international funding that is beginning to prolong the lives of Africans with AIDS has bypassed Zimbabwe almost entirely. The United Nations, the World Bank and President Bush's AIDS initiative are focusing on other countries, in large part because President Robert G. Mugabe's reputation as one of the most undemocratic and anti-Western African leaders has kept donors away from Zimbabwe.
"There is tension between the international community and the government of Zimbabwe," said James Elder, a UNICEF spokesman in Harare, the capital. But he added, "Don't take it out on children. Let's move the attention a little bit away from politics and put it on people."
The average amount of international funding each year in southern Africa is $74 per person infected with HIV, according to UNICEF. In Zimbabwe, that figure is $4.
The discrepancy is even more dramatic when compared with sums received over the border in Zambia, where international donors provide $187 per infected person. And though Zimbabwe is slated to get a grant of $14 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the same agency rejected a request in December for more than $250 million, citing technical flaws in the proposal.
The results can be seen in the relative availability of medicine. In Zambia, antiretroviral drugs are reaching 13 percent of those who need them, according to WHO statistics. Zimbabwe's southwestern neighbor, Botswana, which has a much higher per capita income and receives substantial health care funding from the Bill and Melinda Gates Foundation, is getting antiretrovirals to 50 percent of those who need it.