In the majority-Zulu city of Pietermaritzburg, South Africa, business appears to be thriving. This winter, the Royal Show, a kind of grand modern county fair, opened to packed crowds, showcasing the fruits of local industry and agriculture alongside rides and music. On Alan Paton Road, just outside of town, a fancy new sports club offers weight training, yoga, and an indoor swimming pool, attracting not only the white clients who have enjoyed these amenities for decades, but also droves of blacks and Indians. While poverty is more evident outside the city, a visitor can ride a packed combi van through the countryside and listen to fellow riders talk for hours without hearing a word about the region’s greatest problem. The communities in and around Pietermaritzburg have been hit harder by the HIV/AIDS epidemic than any in the world.

Pietermaritzburg lies in the Eastern province of KwaZulu-Natal, where a full 37.5% of residents are HIV-positive, making it the most ravaged region of South Africa. The region directly surrounding Pietermaritzburg is called the Midlands, the worst-off section of what is already the country’s worst-off province. A 2005 study of pregnant women at a clinic in Vulindlela, a rural region near Pietermaritzburg, indicated an HIV prevalence rate exceeding 40%. Throughout South Africa, the mortality rate has doubled in the last six years; in the Midlands, the figures are even more tragic. And yet, in Pietermaritzburg, this ongoing catastrophe would not rank among a visitor’s most immediate impressions. The occasional AIDS ribbon or poster for an HIV testing center suggest the presence of AIDS but provide little sense of the magnitude of the problem. To pick up on the epidemic’s more prominent visual clues, a visitor must look beyond the city’s bustling health clubs and sugar cane fields and notice the city’s eerily large concentration of funeral homes and ads for mortuary services. In the middle of town, two intersecting streets feature block after block of funeral parlors, many garishly decorated with glittering coffins and crosses in the windows. Along the highways heading out of town, undertakers advertise their services on gargantuan billboards. The epidemic’s most visible presence is not decay but is rather a part of the prosperous bustle of Pietermaritzburg.

These macabre traces betray the ubiquity of an epidemic that might otherwise remain hidden from view, thanks to the unique biological and social features of HIV/AIDS. For a while, at least, HIV is not a difficult disease to conceal. For the first five to ten years of infection, before HIV progresses to AIDS, the virus causes few symptoms. After symptoms and sickness set in, infected people and their families (if informed at all) strive to maintain a veil of secrecy. By keeping silent, they hope to escape the stigma of sexual promiscuity that South Africans associate with AIDS. In the typical scenario, when a young, HIV-positive city-dweller in Pietermaritzburg becomes ill, he or she returns to the family’s rural home, often failing to leave notice with friends in town. Fearing the spread of rumors and gossip throughout the community, the family endeavors to keep their relative’s sickness a secret. Quietly, the family provides care in their hut or house. Even among themselves, they might never mention AIDS as the cause of sickness.

In such cases, sickness emerges into the open only at the funeral. Death confirms the whispers that have been circulating around the community, and people begin to gather at the home of the deceased. Even in rural areas, funerals routinely draw hundreds of attendees. In the Midlands, where a traditional Zulu reverence for the power of ancestors mixes with the dominant Christian faith, a funeral is a socially important event. A large and impressive funeral not only signals a family’s material wealth; it also boosts the family’s reputation by improving their relationship with both the recently deceased ancestor and those long dead. Indeed, some funerals are so extravagant that clergy have expressed concern that the ceremonies are draining funds that ought to be dedicated to providing proper care during sickness or to paying school fees for living children.