BULAWAYO, ZIMBABWE — There are long lines in Zimbabwe for everything from food to money, but the queue that defeated Alexander Mudewe and his wife, Perpetual, could end up killing them: the one for HIV drugs at the government hospital here.
When Alexander became ill three months ago, the couple decided to get tested; both were HIV-positive.
So they went to Mpilo Hospital. After five hours in the line for antiretroviral drugs, they were told that the hospital wasn't registering any new HIV-positive patients.
"I actually cried," said Perpetual, 47. "I was not feeling well. They just tell you to come back tomorrow. You come back tomorrow and there's another long queue again."
"You end up giving up," Alexander said as a rat scuttled across the floor of the couple's small house. "You end up going home."
Zimbabwe's financial crisis has seen the near collapse of its health system. Hit by foreign currency shortages and hyperinflation, the government stopped taking new AIDS patients in October 2006. Many people die of AIDS complications before they can get antiretroviral medicine.
In Zimbabwe, 321,000 people need antiretroviral medicines, or ARVs, according to the World Health Organization, and only 91,000 have access to them.
An April report by WHO and two other U.N. agencies says about 6% of children in need of treatment were getting it. The government says more than 2,200 Zimbabweans die every week of AIDS complications.
Zimbabwe's delivery of ARVs is below average for low- and middle-income countries, according to the agencies' report. In sub-Saharan Africa, an average 28% of those in need of the drugs get them. For Zimbabwe, the percentage is about 24%.
As access to government treatment has become impossible for most, the private market is out of reach too. A December report by International Treatment Preparedness Coalition, an international advocacy group, says the number of private HIV/AIDS patients dropped from 10,000 in July to 6,000 because government policies and inflation had caused the cost of treatment to soar.
Ahmed Leher, 52, cannot bear to call his illness by its name. To him it's "this thing" or "this rubbish."
His weight has dropped by 50 pounds in a few months. He is angry knowing that there's a medicine out there that could save him, but the hospital system won't give it to him.
"I don't want to die young," he said, his face anguished. "I know there's still life. I know that with ARVs I can live for years.
"I've seen my friends die. I've watched the stages they go through. This thing can just twist overnight. I'll be in hospital. Tonight this thing can just change me and when you look at me again, I'll be a skeleton."
Nokuthula Zulu, 28, who has a 9-year-old daughter, tested HIV-positive 18 months ago. When she tried to register for treatment, she was told to come back later, but she has not yet been accepted for treatment.
Every Wednesday evening, she participates in a support group, sharing her experiences and praying with others who have been denied treatment.
She wears clothes she inherited from her sister, who became more and more ill and died, but Zulu doesn't know whether it was AIDS. Zulu has never had a formal job, but sold peanuts on the street before she became ill five months ago.
In the absence of any diagnostic test, the only available measure of her decline is her weight: In five months, she lost more than half her body weight, dropping from 132 pounds to 61.
"I don't know what to do or what to think anymore," she said. "I pray a lot. I ask God to look after me and my child."
With no access to medicines, people often turn to herbal remedies and traditional healers.
Alexander Mudewe spent a dollar on five tablets from a quack on the street that were supposed to cure AIDS.
"They said I'd get better. I bought a couple. When you are desperate, you just buy anything."
Tapson Dhliwayo has been a nganga (pronounced nun-ga), or traditional healer, for 43 years. In his top-floor apartment under a baking metal roof, he has watched a steady trickle of patients grow to a flood of desperate people.
In his consulting room, a vinyl disc is suspended from the roof amid feathers, his red traditional robes and a horse-tail brush. The power that he says these objects confer is the last hope for most of his patients. His main treatment is an herbal remedy made from plants he collects in the bush.
"In the past couple of months, a lot more people are coming because there's no medicine in the hospitals," he said, adding that if people could afford the transportation to visit him, he would be overwhelmed with patients.
Taking a pinch of snuff from an animal horn, he explained his theory on AIDS.
"This is a punishment from the Lord for the way we live today.
"It's the same as when Noah was instructed to build the Ark and people didn't listen and they drowned in the flood."
Most people who sought his help had waited too long, he said.
"There's a lot of people I try to help and they end up dying."
Leher, who watched dying friends pass through various stages of desperation, has not yet reached the point of looking to traditional remedies. But he feels his illness catching up with him. When he walks a block from his house, it feels like five miles. He struggles for the words to express his pain.
"It's very tight inside. It's very hard to . . . it's a very stiff situation. I can sit and look at a picture of my wife and I'll just drop in tears. She sits and cries too."
Dixon recently was on assignment in Zimbabwe.
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Zimbabweans who need antiretroviral medicines
Zimbabweans who have access to them
Zimbabweans who die every week of AIDS complications, according to the government
Source: World Health Organization