Meanwhile, the untreated pandemic of the 1980s and '90s has acted like a generational neutron bomb, killing many in the prime of life. Visiting the "compounds" of Lusaka -- dense slums of small houses, dirt streets and beer halls -- it is common to find households composed entirely of grandparents and grandchildren. A generation is missing.
In these places, it is possible to see an immense drama in a small room. During one visit, I met a grandmother, Maidaka, and her granddaughter Enelesi. Enelesi had been born in the sitting room where we talked. Her father and aunt had died of AIDS in the bedroom behind a curtain. Enelesi sleeps in the sitting area, because a room in which relatives have died is traditionally kept empty. From the age of 15, she took care of her grandmother, but then came down with AIDS herself. Her breathing rattles with tuberculosis. She shows a sore on the side of her breast that could be cancer. Food comes only from friends and well-wishers.
America and other wealthy nations have responded to this kind of suffering with medicine, and Enelesi is now on AIDS treatment. But African society has responded with a hopeful social movement. Enelesi is visited twice a week by a caregiver from a small faith-based group called God Our Hope. These volunteers -- uniformly poor themselves -- bathe patients, sweep the floors, provide fresh linen, distribute food and malaria nets, and bring patients to the hospital on the back of bicycles. They also pray and read the Bible with people in need of comfort. The founder of God Our Hope, a pastor's wife of boundless energy named Lister Chingangu, explains, "When we say we live by faith, it is not a joke."
More than 15,000 volunteers in groups such as God Our Hope -- trained and organized in a network called RAPIDS -- reach 200,000 homes across Zambia. Not even the miracles of medicine are more impressive than the generosity of the poor.
And by supporting this movement, PEPFAR is making an important statement: that the next step in the AIDS crisis is not only to provide healing medicine but to help wounded communities heal themselves.