HARARE, Dec 2 (IPS) - Martha* knows that her two young sisters and her need medicine. She also knows where to get it - a clinic a few yards away from her home in Glen Norah, a high-density suburb in the Zimbabwean capital.
But she cannot get the life-prolonging anti-retroviral drugs (ARVs). At 15, the law prevents her from doing so. She can only access the drugs in the company of an adult.
"When my mother died in 2007, my aunt used to collect the drugs for us. She has since relocated to South Africa, and our other relatives say they are too embarrassed to be seen collecting the drugs, people will think they are now sick," said Martha.
Martha is among the estimated 158,798 children who are infected with HIV in Zimbabwe.
On November 24, the United Nations Children's Fund (UNICEF) released a report that 100 children under 5 years of age die every day in Zimbabwe. Most of these children die from HIV/AIDS related illnesses.
"Today and everyday in Zimbabwe 100 children below five years of age are dying of mostly preventable diseases," said Dr Peter Salama, the UNICEF country representative.
According to the National Aids Council (NAC) 39,809 children die every year due to AIDS-related ailments. The children are dying not because there are no drugs. The drugs are there, but youngsters just cannot access them.
"The drugs are there, everything is there, the only challenge is who (will) take the children for anti-retroviral treatment, because they cannot go on their own," said Orirando Manwere, a spokesperson for NAC.
A 2008 study on the factors contributing to the low uptake to paediatric ART in Zimbabwe showed that one of the challenges was that few officials were trained in the field, and among those trained, the staff turnover was very high because of low salaries. But this was not the main challenge children faced in accessing treatment.
The obstacle to treatment for many children living with HIV in Zimbabwe is that they cannot access ARVs on their own. The law requires them to do so in the company of parents and guardians.
"The main challenge is the laws, they are not conducive at all," said Bekezela Mapanda, the chairperson of a committee that organised this year's commemorations for World Aids Day.
"There is need for a review of the policy framework to address issues of HIV and AIDS among children. The state should ensure that these children are able to access treatment and prevention without any prejudice. The law should be clear on how we handle issues of disclosure among children."
A draft report of the 'Zimbabwe National HIV and AIDS Estimates 2009', produced by the ministry of health and child welfare, shows that nearly 10 percent (107 388) of people living with HIV in Zimbabwe are children below the age of 14.
The ministry of health and child welfare estimates for 2009 that 35,190 children are in urgent need of ART. Of these, only less than half, about 16,000 children, were receiving ART by the end of August 2009.
Accessing treatment is a challenge for most of these children, who either live without adults in child-headed households or stay with relatives.
Speaking to IPS on condition of anonymity, a Harare pharmacist said in some cases, drugs meant for children were actually expiring due to low uptake.
"The painful part is that while you have the drugs even expiring, they are not accessible to many children who need them. We should re-look into our legal framework regarding children's access to treatment.
"Look at South Africa, they are currently debating to allow anyone above the age of 12 to access treatment. We also need such debates in Zimbabwe, this will certainly change the way we approach some of these issues," he said.
In some cases, activists have resorted to door-to-door campaigns to identify children who need ART but are not on treatment. A home-based care group in Seke, a rural community near Harare, conducted a pilot project and managed to place 83 children on ART.
In May 2009, UNICEF collaborated with the government in carrying out the Multiple Indicator and Monitoring Survey (MIMS). The results of that survey indicate that children were most affected by the deterioration in the provision of social services.
According to the figures, there has been a 20 percent increase in mortality of children under five since 1990, the baseline year for the Millennium Development Goals. Children in rural areas, and those among the poorest one-fifth of the population, were the most vulnerable.
The government report also indicates that: "The number of children living with HIV and AIDS initially peaked at 114,316 in 2003 and declined to 107,388 children in 2008 and 105,740 in 2008.The upward trend is estimated to start again in 2014. The increase could be a reflection of the survival of children on cotrimoxazole and ART."
The plan aimed to expand the number of patients on ART ensuring equity by gender, age (among the youth and children) and disability. It specifically sought to increase the number of children accessing ART by updating ART guidelines and training materials to adequately cover the paediatric component.
According to the country director of the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), Agnes Mahomva, the inadequate access to treatment is a result of the harsh economic situation that prevailed in Zimbabwe over the last few years. EGPAF is an international organisation that seeks to prevent paediatric HIV infection among children, and improve their access to treatment.
"The crisis caused a high staff vacancy rate (of such skilled personnel like counsellors)," said Mahomva. "There is a need to address staff retention and motivation issues including strengthening of community-based health care cadres... There is poor identification of HIV-exposed and infected children."
Mahomva added that there were currently "weak linkages between ART clinics and the community".
"There are inadequate diagnostic services for children under 18 months. There is a need to expand early infant diagnosis (EID) and sensitise communities on its importance," she said.
The government has, however, started moving towards improving paediatric ART uptake. A revised Child Health card, which captures HIV status, has been developed. Every child who produces this card at a health service centre will be allowed to access treatment without an adult. The card certifies that the child is positive and should be given treatment.
At a meeting on children's rights in September, social services minister, Paurina Mpariwa, said they were working towards reviewing the policy framework on children's access to social services like ART.
At the moment, Martha and her siblings will continue to hope for an early resolution of the legal impediments to their access to ART.
*Not her real name.