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Before he can speak, his throat clutches in gasping spasms. Sharp pains rack his chest; his breath comes in shallow gasps. The vomiting is better today. But constipation has doubled up his knees, and he is too weak to go outside to relieve himself. He can't remember when he last ate. He can't remember how long he's been sick--"a long time, maybe since six months ago." Khumalo knows he has TB, and he believes it is just TB. "I am only thinking of that," he answers when we ask why he is so ill.
But the fear never leaves his eyes. He worked in a hair salon in Johannesburg, lived in a men's hostel in one of the cheap townships, had "a few" girlfriends. He knew other young men in the hostel who were on-and-off sick. When they fell too ill to work anymore, like him, they straggled home to rural villages like Msinga Top. But where Khumalo would not go is the hospital. "Why?" he says. "You are sick there, you die there."
"He's right, you know," says Dr. Tony Moll, who has driven us up the dirt track from the 350-bed hospital he heads in Tugela Ferry. "We have no medicines for AIDS. So many hospitals tell them, 'You've got AIDS. We can't help you. Go home and die.'" No one wants to be tested either, he adds, unless treatment is available. "If the choice is to know and get nothing," he says, "they don't want to know."
Here and in scattered homesteads all over rural Africa, the dying people say the sickness afflicting their families and neighbors is just the familiar consequence of their eternal poverty. Or it is the work of witchcraft. You have done something bad and have been bewitched. Your neighbor's jealousy has invaded you. You have not appeased the spirits of your ancestors, and they have cursed you. Some in South Africa believe the disease was introduced by the white population as a way to control black Africans after the end of apartheid.
Ignorance about AIDS remains profound. But because of the funerals, southern Africans can't help seeing that something more systematic and sinister lurks out there. Every Saturday and often Sundays too, neighbors trudge to the cemeteries for costly burial rites for the young and the middle-aged who are suddenly dying so much faster than the old. Families say it was pneumonia, TB, malaria that killed their son, their wife, their baby. "But you starting to hear the truth," says Durban home-care volunteer Busi Magwazi. "In the church, in the graveyard, they saying, 'Yes, she died of AIDS.' Oh, people talking about it even if the families don't admit it."
Ignorance is the crucial reason the epidemic has run out of control. Surveys say many Africans here are becoming aware there is a sexually transmitted disease called AIDS that is incurable. But they don't think the risk applies to them. And their vague knowledge does not translate into changes in their sexual behavior. It's easy to see why so many don't yet sense the danger when few talk openly about the disease. And Africans are beset by so plentiful a roster of perils--famine, war, the violence of desperation or ethnic hatred, the regular illnesses of poverty, the dangers inside mines or on the roads--that the delayed risk of AIDS ranks low.