Even in South Africa, which has been widely criticized for its sluggish response to AIDS, antiretrovirals are reaching 7 percent of those who need the drugs. In major South African cities such as Johannesburg and Cape Town, the waiting list for government-subsidized AIDS medicines has virtually disappeared, doctors there said.
While the governments of most countries hit hardest by AIDS have cooperated with international donors, Mugabe's government has grown increasingly belligerent toward the West, especially the United States and Britain, which he regularly attacks with caustic rhetoric.
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)
Mugabe has won some international praise for his willingness to discuss AIDS publicly, in contrast to South African President Thabo Mbeki. He revealed in a speech last year that members of his family had contracted the disease, and the government also instituted a tax supposedly intended to generate resources to fight AIDS.
But many Zimbabweans express doubt that the money raised by the levy has gone to treating or preventing AIDS. There are few public health messages about HIV anywhere in the country, aside from a handful of vaguely worded billboards promoting condom use.
The reputation of Mugabe and his ruling party for siphoning public funds for private gain, meanwhile, has made the major international donors even more reluctant to deal with him. And the parliament passed a law last year to bring independent aid groups, which might provide an alternative for delivering international health assistance, under government control.
The victims in this standoff between Mugabe and Western donors are Zimbabweans with AIDS, activists here said.
"You can't win this battle by fighting the government, because they control the resources," said Lynde Francis, an AIDS activist in nearby Bulawayo. "It doesn't matter how much you whine and moan about the government. It doesn't get you anywhere to withdraw help."
One of the few international donors to make a significant commitment to fighting AIDS in Zimbabwe is the studiously non-partisan French medical group Doctors Without Borders, which has managed to make Bulawayo the only city in Zimbabwe where antiretrovirals are widely available. A Zimbabwean company is also beginning to make a generic version of a popular combination of antiretroviral drugs, which might improve access.
But here in Zhulube, a dusty, destitute village in a gold-mining region, the public health system has trouble handling even comparatively simple maladies such as pneumonia or infected wounds.
Mataruse has walked to the clinic almost monthly in the past two years, complaining of coughs, headaches, fever, diarrhea and night sweats. Her health records show she was routinely given nothing more than painkillers.
The slide in Mataruse's health has been accompanied by other troubles. Weight loss is one symptom that even those with little education in southern Africa have learned to spot. As her weight fell from 136 pounds to 99, Mataruse said her husband decided to find another wife because she could no longer clean the house or carry water on her head.
Her husband's family, which reluctantly took over her care, has insisted she use her own dishes and blankets in the mistaken belief that sharing them could spread the virus. Last month, Mataruse was told that she must also prepare all her own meals, an increasingly difficult task as her strength wanes.
Once, several months back, she considered moving to her parents' home in a nearby city. But she relented, she said, after her husband objected.
"Why are you going?" she recalled him saying. "You are dead already."