NKULAGIRIRE, Uganda — Past a smoldering pile of trash and two bleating goats, through a doorway beginning to buckle beneath the weight of the bricks above, is a darkened room where a skeletal, 70-year-old man lies on a pillowless bed above a floor littered with trash.

The lone window’s shutters are closed but enough shards of sun make it through holes in the corroded roof to see Joseph Malagho’s ribs poke at the skin of his torso and legs like twigs inside his olive green pants. As he struggles to sit up, leaves crinkle beneath him on a soiled sheet. His mattress sags. The air is thick and stale.

Malagho has no illusions about the difficulty of growing old. But the fact that he is here at all is its own miracle.

Across Africa, millions who once faced the death sentence of an HIV infecti

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