Global health experts are optimistic that the end of AIDS is within reach. Yet while programs to combat HIV/AIDS have been essential, they exist alongside public healthcare systems that have struggled to gain donor attention and support. Unequal Worlds of Care examines how policymakers, providers, and patients in Malawi navigate a healthcare system transformed unevenly by foreign aid. Whether through engaging in political resistance, refusing treatment, or leveraging the opportunities available to them, people contend with global health programs that only partially recognize their healthcare realities. Ultimately, overlooking fundamental aspects of healthcare limits even the best-intentioned efforts to improve people's health and well-being. Amy Zhou provides a comprehensive portrait of the human costs of institutional constraints—as well as the ingenuity and dignity of the people continuing to pursue care along these uncertain pathways.