Grace Mathanga, shoe seller

She is just 30 and has already lost her husband and child to HIV. The virus will slowly take her life too. But she could survive if she was given modern drugs

Grace has a little place in the suburbs. It's not much, perhaps - the whitewash is coming off the walls, the red-baked ground is stoney and the persistently cheerful rhythms thumping from the bar round the corner look set to go on all night - but it's impossible to be lonely in her one-room house in a block of four, surrounded by friends and their children, and it's a short walk to work across the fields.

She says she's happy. She's just 30, she's single and she has a good job selling luxury shoes from a shuttered wooden kiosk in the Central Market, the exuberant commercial hub of Lilongwe. All her life should be spreading out before her, but a glance into the future shows death staring back, just a few years on.

Like every fourth young man or woman in Malawi's towns and every sixth in the villages, Grace Matnanga has the HIV virus running like a slow and silent poison in her veins. You can't tell who most of them are. They teach children, they police the streets, they work in hotel receptions and bring up children. They laugh and smile like every other Malawian. For months or years, they appear well. Then the downward spiral begins. Maybe next year, maybe in five years time, depending on how well she eats and how healthy she keeps herself, Grace will begin to lose weight. She will get an infection - it might be just a minor one - but after that she will get another, more serious. It could be pneumonia, it could be TB or it could be meningitis. There are drugs in Malawi's hospitals to treat all three successfully, but each time she recovers, her immune system will be that little bit more battered, her weight lower and her chances of surviving diminished. The curves of healthy flesh will disappear. She will begin to look wasted and everybody she knows will understand why. Eventually her body will give up the fight, the pain and fever will engulf her and Grace will become just another Aids statistic.

She doesn't think about it, she says, with a smile and a slight shrug, as she looks out of her kiosk at the vitality and the colour of the market, where brightly dressed women sit among their sacks of mint leaves, tomatoes and red aduki beans, tailors peddle sewing machines and heat flat irons on open fires to repair old clothes and everything from door handles to dried fish to pineapples is for sale. But she knows too well what is in store. Her freedom and independence were wished on her like a curse. Once she had a husband. Once she had a child. Both are dead.

"I was married for eight years," she says. "My husband passed away in 1998. He collapsed and was taken to the Central Hospital and put on oxygen." Like most of the young people who die, he had not been tested for HIV, but there's little doubt that Aids killed him.

He survived longer than their little daughter. Tiyajane was born in 1993, the longed-for fulfilment of marrriage in Malawian society, where almost every young woman has a baby strapped to her back. Tiyajane appeared to be healthy at first, but then the weight gain slowed. She stopped thriving. She began to get sick. She picked up infections. When she died, aged three, she was a pitiful, wasted scrap, the ulcers in her throat and mouth making the pain of swallowing more vicious than the pangs of hunger.

Grace will never marry again, she says. "I have got HIV so I will not get married or have any more children. I would adopt some, but I will never have any of my own."

So she lives alone, with a small radio and her friends, and says she is content. She eats as well as she can afford to, which is not as well as she should, but better than many Malawians in the year after massive crop failure, exacerbated by the permanent absence of so many young women and men who should be working in the fields. Grace knows that nutrition is important to staving off illness. She buys vegetables, eggs, soya beans and milk to supplement the inevitable Nsima, a meal of maize flour which is the nation's staple diet. As long as she keeps her job she can afford the 650 kwacha ($7.38 or £4.67) rent each month on her house and her food because - unusually in Malawi, where extended families are the norm - she has nobody else to support. If she becomes sick, she will lose her job and her home, her diet will deteriorate and so will her health.

If she were living in a bedsit in Clapham on the fringes of central London instead of a bedsit in Mwenyekondo, just outside the old town of Malawi's capital, Grace would not have to face this imminent downhill dance to death. She would see her GP, who would send her to a consultant, who would put her on antiretroviral drugs (ARVs). Three drugs in combination, taken every day for the rest of her life or until such time as the scientists find a cure for Aids, would keep her alive, active, healthy and working. There are lots of people in the UK with HIV. They teach children, they police the streets, they work in hotel receptions, they bring up children. You wouldn't know who they were, and you won't, because they are on ARVs.

Grace knows about ARVs. She knows that they could save her. And she knows that they cost 2,500 kwacha a month - around $28 or £18. That's almost twice the $170 per capita income in Malawi for a year's supply. It's an unimaginable sum of money, even for a single, working girl with no dependents.

It's an even more fantastic sum for Dessa Chidhedza, who is 29, just a year younger than Grace and in very much more urgent need of the drugs. Dessa is Grace in a few years time, if not before. She lives in a bungalow in Kawali 1, a pleasant, tree-fringed area a few miles outside of the city centre. A cane fence separates the garden from the neighbours and the hard red earth road. It's Dessa's mother's house and there are 16 mouths to feed - 11 of them children. Two of Dessa's own three children have been sent to cousins in Blantyre, 360 km away, since she fell ill and lost her job as a cashier in an Indian shop and the family had to face its financial inability to cope. It's hard to imagine she will see them again.

Dessa sits on the edge of a large wooden double bed, where at night she sleeps with her remaining daughter, 12-year-old Chirinde. It's the best room, hung with paintings of Christ and children and crowded with furniture from a more hopeful time - a dresser, a dining table with six chairs and a red three-piece suite hung with fancifully embroidered cloths to hide the holes and rips in the arms. Dessa is slight and fragile against the heavy darkness of the room and moves with slow pain.

"I'm not well," she says quietly, but it doesn't need to be said. Her husband died in 1997. Suspecting it was Aids, Dessa went for a test and found she was HIV positive. She has had many infections in the four years since then, treated in the hospital. Now, however, she is weak and frail and there is little they can do.

"I have no hope of ARVs," she says. That doesn't need to be said either. Her mother, Rose, in better times brewed the local Chibuku beer from maize and sugar out at the back of the house. Today there is no Chibuku because they can't afford the maize flour or the sugar. There's very little out at the back of the house. Only a single small supper pot bubbles on a tiny fire as Dessa's brothers sit in the shade hammering out a discordant song as they reshape an old metal hub cap in hopes of bringing in some money.

Most people in Dessa's weak state are reluctant to talk about their impending death for superstitious fear of hastening it. She looks at the floor for a while. "I'm not sure how long I can go on because my immune system is declining," she says finally. She, too, understands what is happening to her body and is only too aware that the sole chance of thwarting the virus lies out of her reach. "We have no money to spend on ARVs."

This is not only the story of Grace and Dessa but the story of every Malawian. Everybody knows someone who has lost several members of their family. Everybody wonders who in their own family will be next. Aids has brought average life expectancy down from 53 to just 39. The whole of sub-Saharan Africa shares Malawi's tragedy. There are 29.4 million infected with HIV, 60% of whom are women. Last year alone 2.4 million died. Four million are in urgent need of drugs, but less than 50,000 are getting them.

The most thriving businesses in Lilongwe are those of the coffin makers - you see them everywhere, the bright metal handles and plaques on the boxes catching the sunlight to call out of the workshop gloom. A short distance down the road from Dessa's mother's bungalow, hundreds of people are sitting on the ground, lining the courtyard of a house and the road in front of it. An achingly melodic Gospel chant rises from their ranks. It is the funeral of a 14-year-old boy. Nobody ever told him, says a local man, that he was HIV positive, even though he was tested in hospital. How would it help him to know there was no hope?

Malawi is running with children - ragged, dusty-footed children with large inquiring eyes and shy smiles. More and more of them are orphan children who have lost either both parents to Aids or just one - usually their mother, leaving a father who is unable to cope. There's never been any question over the future of a motherless child in Malawi. Grandmothers, aunts and uncles take him in, share the maize porridge and the rice, clothe him and send him to school. Until now. Aids is taking not only the mothers and fathers, but the aunts and uncles as well. It is striking down those who should be working the fields. Aids has played a dire part in the food shortages caused by crop failure last year, so that no family has enough to eat. The villages do their best to absorb the bereaved children but they are at saturation. There are officially 475,000 orphans among Malawi's 11 million population, but it's hardly an offficial census figure, and many believe there could be as many as one million. The dangers should be obvious. Those who guide children - the parents and the teachers - are dying. Those who feed these children are hungry themselves. Even the CIA has acknowledged Aids could breed a new generation of terrorists.

In Tilerane, still in the district of Lilongwe but part of the countryside, is a school set up for some of these orphans by local people. It's midday. Children of all ages are spilling out of the door of the schoolhouse, tumbling down the few steps like a waterfall. A small child in a dirty pink T-shirt is trying to pick up a toddler in an identical dirty pink T-shirt who is stuck halfway down, like the wrong shaped stick in a bend of a stream. The wave of Lilliputian humanity parts around them and forms again on the other side, until a teacher picks up the tiny one by the arms and swings him easily to the ground.

The orphan centre does what it can. There are 500 children registered at Tilerane, although not all of them come to the school. Volunteers visit the surrounding villages to help and support others. The school gives them love, care, very basic education and - fundamentally important - some food. When they arrive at around 7.30am, they get tea and rice or maize porridge which allows them to learn their ABC and do a few sums without the familiar, distracting cramps of hunger. But the children have to be sent home at midday because there is nothing more for them to eat.

"In the afternoon, if we have something, we give them maize and rice. If not, they go home but they don't eat there either," says Chitekwele Phiri, who started the centre in 1995 after his own sister and mother died and he was left looking after his little brother and his sister's two children. Three friends in similar situations, with dependent nephews and nieces, helped him get it off the ground. Two of the three are now also dead.

In Salima, near the vast and beautiful Lake Malawi, small children, big children, children carrying much smaller children, walk as far as 10 km to reach an orphan centre which opens every Saturday morning.

There's Jolam Mwale, aged 12 but as small as an eight-year-old, with the extended belly of hunger. He's twisting on the spot with shyness, wearing blue shorts and a cut-down man's faded blue striped shirt, just about held together with a safety pin. "I live with my grandmother," he says. "My mother and father have passed away." He comes, he says, to learn about HIV. Undoubtedly he also comes in order to eat.

Andrew Kayinga, 15, had polio as a baby, which affected his legs and made it a slow and arduous five kilometre pilgrimage to the Salima Aids Support Organisation until SASO organised transport for him. He lives with his aunt and her husband, who are good to him, he says. His father died when he was five, followed by his mother four years ago, coughing and in pain from the TB which infects 70% of those with HIV/Aids. He knows the future is loaded against him. "I am facing so many problems that I think if I go to school it may help me in the future to get employment," he says gravely. "I would like to be a typist or do driving. Now in Malawi jobs are scarce but you can get a job if you have trained." His faith in life is moving in the face of such short odds. Well, he explains, because of his polio, he did not walk until he was four.

"In the village, they say God is great because they thought I might never walk at all." Malawi is full of such hope, but the dice are loaded heavily against its people. Prevention efforts, such as HIV education and the use of condoms may help slow the infection rate, but only treatment with unaffordable drugs that a Londoner, Mancunian or Glaswegian would pick up for free on the NHS can check the tidal wave of death that is set to overtake so many like Grace.

As she sits among her smart sandals and a tiny mock-leopard skin handbag, doing very little business because it is the quietest time of year, when families have just scraped together every last kwacha to pay for school fees, Grace's cheerful serenity slips just for a moment. "If ARVs were available and they were here, I would take them," she says. She is no more indifferent to her life than her contemporary in an up-market shoe shop in Durham or Leeds. She's just living on the wrong side of the global divide.


Sarah Boseley

The GuardianTramp

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