We have come to three countries abutting one another at the bottom of Africa - Botswana, South Africa, Zimbabwe - the heart of the heart of the epidemic. For nearly a decade, these nations suffered a hidden invasion of infection that concealed the dimension of the coming calamity. Now the omnipresent dying reveals the shocking scale of the devastation.

AIDS in Africa bears little resemblance to the American epidemic, limited to specific high-risk groups and brought under control through intensive education, vigorous political action and expensive drug therapy. Here the disease has bred a Darwinian perversion. Society's fittest, not its frailest, are the ones who die - adults spirited away, leaving the old and the children behind. You cannot define risk groups: everyone who is sexually active is at risk. Babies too, unwittingly infected by mothers. Barely a single family remains untouched. Most do not know how or when they caught the virus, many never know they have it, many who do know don't tell anyone as they lie dying. Africa can provide no treatment for those with AIDS.

They will all die, of tuberculosis, pneumonia, meningitis, diarrhea, whatever overcomes their ruined immune systems first. And the statistics, grim as they are, may be too low. There is no broad-scale AIDS testing: infection rates are calculated mainly from the presence of HIV in pregnant women. Death certificates in these countries do not record AIDS as the cause. "Whatever stats we have are not reliable," warns Mary Crewe of the University of Pretoria's Center for the Study of AIDS. "Everybody's guessing."

The TB Patient
Case no. 309 in the Tugela Ferry home-care program shivers violently on the wooden planks someone has knocked into a bed, a frayed blanket pulled right up to his nose. He has the flushed skin, overbright eyes and careful breathing of the tubercular. He is alone, and it is chilly within the crumbling mud walls of his hut at Msinga Top, a windswept outcrop high above the Tugela River in South Africa's KwaZulu-Natal province. The spectacular view of hills and veld would gladden a well man, but the 22-year-old we will call Fundisi Khumalo, though he does not know it, has AIDS, and his eyes seem to focus inward on his simple fear.

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.