Preface I came upon the idea of this book sometime during the afternoon of April 9, 2005, while reading Edwin Cameron's book,Witness to AIDS.In that book, Cameron tells a ghastly story one does not easily forget.Knowing that up to a third of its population had HIV or AIDS, and that about one hundred thousand people were in urgent need of drugs, the government of Botswana announced in 2001 that it would offer free antiretroviral treatment to every citizen with AIDS. It was a dramatic declaration of intent, unprecedented in sub-Saharan Africa. By the time the drugs had hit the shelves and health personnel were ready to administer treatment, just about every soul in Botswana knew of it.And yet, on the last day of 2003, more than two years after the launch of the program, only about fifteen thousand people had come forward for treatment. The rest -- over eighty-five thousand people -- had stayed at home. The majority would now be dead.Why did they not go to get the drugs?"Stigma," is Cameron's answer. "People are too scared -- too ashamed -- to come forward and claim what their government is now affording them:...the right to stay alive...In some horrifically constrained sense, they are 'choosing' to die, rather than face the stigma of AIDS and find treatment."Does this foreshadow an entire region's response to AIDS? When the history of this great epidemic is written, will it be said that an untold number of people died, not because the plague was unstoppable, but because they were mortally ashamed? Will it be said that several successive generations of southern Africans were decimated by a sense of disgrace?About 2.1 million people died of AIDS in sub-Saharan Africa in 2006. Another 25 million are living with HIV. In South Africa, where I was born and bred, nearly 6 million in a population of 46 million are HIV-positive: more than one in eight people. Some eight hundred South Africans die of AIDS on an average day. And the epidemic is spreading at a rate of more than a thousand new infections a day in South Africa. That death could keep accumulating on this scale despite the presence of lifesaving medicines is chilling beyond description.A certain intellectual temperament greets such spectacles with excited fascination. The moral of Cameron's story, it may be tempting to conclude, is that human lives are not sunny and progressive projects, but the sites of blunt, blind tragedy. Not just the world, but even our own natures are indifferent to our programs of betterment.I am not one of those fascinated souls. When I read a story like Cameron's, my gut response is that something is wrong, something that might be fixed. This is not to say I subscribe to the proposition that, at core, our natures are healing and life-giving. There is a surfeit of shame and envy and destruction within us, quite enough to go around. But it seems to me that what becomes of this darkness is not a question of fate but of politics. When people die en masse within walking distance of treatment, my inclination is to believe that there must be a mistake somewhere, a miscalibration between institutions and people. This book is a quest to discover whether I am right.When I finished reading Cameron's book I began to look for the most successful antiretroviral treatment program in South Africa. I wanted to find a place where poor villagers lived within walking distance of well- administered drugs, and where nobody need die for lack of medical care. I wanted to go there and find people who were staying at home and dying, and I wanted to know why they were doing so.The closest thing I found to what I was looking for was the rural district of Lusikisiki in Eastern Cape province. It is not quite true that everybody there lives within walking distance of antiretroviral (ARV) treatment, or that nobody need die for lack of medical care. It is a chronically poor place, where people have been dyinSteinberg, Jonny is the author of 'Sizwe's Test', published 2008 under ISBN 9781416552697 and ISBN 1416552693.