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 In Rural Zimbabwe, AIDS Still Means Death
 
 By Craig Timberg
 
  ZHULUBE, Zimbabwe 
 
 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.
 
 "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.
 
 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.
 
 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."
 
   

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