For Christina Bulunga, US President George W. Bush's visit to Africa comes five years and US$15 billion too late.
Sitting on a rattan mat on the dusty doorstep of her wooden shack, Bulunga smiles nervously when asked about what is killing off the adults of eastern Swaziland.
"They just go," she said, as several of the 10 children she and her elderly mother care for sit listlessly in the winter chill, their fathers having died early deaths. "There are these terrible diseases around..."{
Bulunga's household represents the nightmarish intersection of AIDS and poverty that Bush says will be a key focus of his first official trip to Africa this week.
But while the US president brings with him the most aggressive aid plan yet to fight the disease, pledging to spend US$15 billion over five years, millions of Africans in the grip of the epidemic fear the help may come too late.
"If you look around here, it's scary," said Gcebile Ndlovu, a Swazi program officer with UNAIDS, the world body's global AIDS agency. "There are no easy answers to what is going on."
US officials say Bush's new AIDS plan represents a massive push against a disease which already infects almost 30 million people on the world's poorest continent.
But delays over disbursement and anger at what developing countries say is reluctance by giant US drug companies to cut prices of life-saving triple therapy AIDS cocktails could overshadow the visit.
There are also real fears that a "leadership gap" in Africa -- epitomized by South African President Thabo Mbeki's go-slow approach to fighting the disease -- will hobble even the best-funded AIDS assistance programme.
"Empty rhetoric and photo opportunities, like those expected to emerge from Africa during the President's upcoming visit, will not stop this holocaust," said the Washington-based Global AIDS Alliance.
"The AIDS crisis demands real dollars for real programs that swiftly reach people."
A key element would be wider provision of anti-retroviral drugs, the only treatment known to slow the disease. Bush's plan aims to bring drugs to at least two million people, but activists fear that the program will not address the high prices and infrastructural weaknesses that keep the drugs out of reach of most Africans.
"The amount [of aid] has no real bearing on the scale of the epidemic. US$15 billion over five years stretched across the continent and the Caribbean ends up being quite small amounts of money," said Mark Heywood, a spokesman for South Africa's Treatment Action Campaign (TAC), the country's largest AIDS lobby group.
"What we need with the AIDS epidemic is a systematic approach, coming also from industrialized countries, not grand gestures."
Swaziland, a small kingdom surrounded on three sides by South Africa, is not on Bush's itinerary. But the Swazi debacle shows how big the challenge will be.
Largely agricultural and with a population of about one million, Swaziland now has the second highest AIDS prevalence rate in the world after Botswana with an estimated 38 percent of people infected.
UN estimates suggest one Swazi child in five under 15 will be orphaned by 2005, while life expectancy will fall to below 30 by 2010 if the spread of AIDS is not checked.
Swazi officials concede the epidemic is spiralling out of control, threatening not only agricultural production as farm workers die but also the very underpinnings of society as more and more children are orphaned.
The difficulties are compounded by drought, which has left granaries all but bare. The country, middle-income by African standards, now grows less than half its annual required cereal supply and as much as 20 percent of the population requires emergency food aid.
Strategies to handle what amounts to the slow-motion collapse of Swazi society are hard to come by.
UNICEF has launched a program of "neighborhood care points" where vulnerable children -- often AIDS orphans -- can receive rations of a nutritionally-enhanced corn-soy porridge and an hour or two of adult company.
"The older ones are acting as parents for the younger ones, but it is not enough," said Dorothy Nxumalo, who oversees one center in Mlindazwe, which counts some 70 new orphans in a population of 6,000.
More corn-soy porridge would help, as would better medical care -- all of which could be improved with US aid.
But activists are concerned that the US legislation has not put any actual dollars in the AIDS pot, and warn that Congress could finally approve an amount that falls far short of expectations.
Bush has asked for about US$2 billion to fund the programme in the first year, about US$1 billion less than the law authorized.
"President Bush may not notice it but he's walking to a continent of mass death where life expectancy is in its 30s and 40s, said Professor Jeffrey Sachs, special adviser to UN Secretary General Kofi Annan on development.
"Millions of people are dying and the US apart from spin has basically done nothing for years," Sachs said.
Christina Bulunga smiles shyly when asked what she thinks should be done.
The children she cares for need education, she says, and above all food -- a tough proposition in a country where fields are parched and farmers are dying.
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