Harare — The child squirms drowsily as it struggles to roll over on the bunk bed, eventually succumbing to sleep. The skin on its face is too taught. Wisps of hair look as if they could fall out at any minute.
"He is just from his daily ARVs (anti-retroviral drugs)," says the woman who takes care of him at Fairfield Children's Home, an orphanage in the eastern Zimbabwean city of Mutare, which houses 74 children up to the age of 14. Several of Fairfield's charges are HIV-positive.
"We try to accommodate everyone and never discriminate against babies infected with the virus. We take them on board and give them special care," says Peter Mufute, administrative officer of the home.
However, the extra needs of children infected with the AIDS virus have placed a heavy financial burden on Fairfield -- and raised questions about whether government is doing enough to care for children who face the double burden of parental loss and HIV.
According to the National Aids Council (NAC), a government body, Zimbabwe's orphan population has grown from 345,000 just under a decade ago to some 1.3 million today. About 165,000 of these children are infected with HIV - and the United Nations Children's Fund (UNICEF) estimates that just over 20,000 need ARVs. However, only 2,000 are receiving the life-prolonging medication.
"Both national HIV/AIDS plans and poverty reduction strategies (in Zimbabwe and various other nations in sub-Saharan Africa) are stronger on proposed policy actions than on budget allocations and clear statements of targets to be achieved for children, young people and HIV/AIDS," said a December 2004 report by the World Bank and UNICEF, titled 'Poverty Reduction Strategy Papers: Do they matter for young people made vulnerable by HIV/AIDS?'.
"The situation of children who have been orphaned or made vulnerable by AIDS receives little attention," added the document.
These words are echoed by Festo Kavishe, UNICEF's representative in Zimbabwe.
"There remains an urgent need to boost prevention, care and treatment programmes in Zimbabwe, ensuring the rights of orphans, while preventing HIV infection in infants and young children," he said.
The plight of HIV-positive orphans reflects the situation in society at large.
According to UNICEF, about 1.6 million of the approximately 13 million Zimbabweans have contracted HIV. Just over 340,000 require anti-retroviral treatment, but only a fraction of these persons are on ARVs.
"There is still a huge gap between those who need and those under anti-retroviral therapy (ART)," Health and Child Welfare Minister David Parirenyatwa said recently.
"By December 2005 only 26,000 were on ARVs. Of these, 20,000 were on government ART programmes, while the remainder were being taken care of by the private sector."
Latest figures from the Joint United Nations Programme on HIV/AIDS (UNAIDS) put adult prevalence in Zimbabwe at 24.6 percent. However, the 'AIDS Epidemic Update' for 2005, published by UNAIDS and the World Health Organisation, also notes a drop in HIV prevalence among pregnant women from 26 percent in 2002 to 21 percent in 2004.
John Robertsen, an economist based in the capital of Harare, says worsening economic conditions are undermining efforts to address the ARV crisis.
"Crushing poverty, high unemployment and low wages have reduced the ability of households to take care of their sick, and this has increased the burden the government has to bear in welfare interventions," he noted.
"But the government is currently trying to reduce its welfare expenditures because already it is in a fix with its economy which has the highest inflation rate, the highest unemployment rate and among the highest economic shrinkage (rates) in the world."
For several years, Zimbabwe has suffered from acute shortages of foreign exchange, fuel and food -- this in the wake of a controversial programme of farm seizures ostensibly aimed at rectifying racial imbalances in land ownership that dated back to the colonial era. Zimbabwe's involvement in the Democratic Republic of Congo's five-year civil conflict, which ended in 2002, also proved a drain on state coffers.
Although Zimbabwe launched a 'National Plan of Action for Orphans and Vulnerable Children' in 2004 in a bid to provide comprehensive care for these children, Parirenyatwa admits that much more needs to be done.
"Because a majority of our people are poor we have a big financing problem. The money allocated to us from the budget is too little to do anything much about the orphan crisis," he said.
IPS was not able to obtain figures for how much of the national budget is spent on orphans at present.
According to Parirenyatwa, however, "The most visible HIV/AIDS support programme run by government is BEAM (Basic Education Assistance Module) which is implemented by the Ministry of Public Service, Labour and Social Welfare in conjunction with the Ministry of Education. It provides school fees, uniforms and supplementary feeding for AIDS orphans."
NAC Executive Director Tapiwa Magure says government would like to phase out orphanages in favour of placing orphans in community care.
"Our thrust is to discourage institutional care. We are therefore exploring possibilities of facilitating an exit plan for institutionalised children," he noted earlier this year.
However, another NAC official who did not wished to be named told IPS that such initiatives seemed ill-advised when incidents of baby dumping, and the proliferation of child-headed households and street children suggested communities were already unable to cope with orphans.
"Community-based care may be the best rehabilitative model, but more resources will be needed in terms of mobilising community-led initiatives, paying community outreach workers and government care coordinators," said the official.
"In Zimbabwe this is wishful thinking considering that the government is perennially broke. If the government had that money, would we be having orphanages in the first place?"
NAC statistics indicate that there are about 60 registered children's homes in Zimbabwe providing care for about 800 children.