Guruve — Eleven-year-old Irene Thembo* lies curled like a foetus on a white wooden bench for outpatients at a clinic in rural Zimbabwe. The orphan, whose parents died of HIV-related illnesses, is terribly sick.
Weighing around 16 kilograms, her hair is thin and patchy, her eyes dull. Since the age of two she has regularly visited the clinic for treatment.
On her medical cards, nurses have listed the range of illnesses the child has suffered from over the years: pneumonia; tuberculosis; vomiting; skin rashes; fevers; malnutrition; and diarrhoea. But not one of the staff has recommended that she be tested for HIV, despite her being a regular visitor at the clinic and showing clear symptoms of the virus.
In the company of her grandmother, Ntombizodwa Thembo*, Irene goes into the consultation room.
She strips to her royal blue school uniform slowly, with obvious effort, revealing emaciated limbs and a torso tattooed by a blotchy rash. Her voice is so soft she could barely be heard between the gasping spasms of her coughs.
"She has been vomiting the whole night," Thembo said. "She is too weak to walk, and can't do anything. I am worried as this is getting worse by day."
The 11-year-old is most likely HIV-positive, but she does not know it. And she may not be able to ever discover her true status because the clinic does not have the facilities to test her.
Mugarakamwe Clinic is situated in one of the poorest districts in Zimbabwe's Mashonaland Central province, some 200 kilometres north of Harare. Situated in an area that has no public transport, patients have to sometimes walk 15 to 20 kilometres to reach the clinic. It also has no testing equipment and no transport to ferry Irene to hospital for HIV tests.
It also does not have the drugs to treat her ailments, is under staffed and does not have an attending doctor. The nearest one available is based at Guruve district hospital some 100 kilometres away and no doctors make visits to Mugarakamwe Clinic.
But it is not the only rural clinic in Zimbabwe ill-equipped to treat its patients. The situation at Mugarakamwe Clinic is a microcosm of most of rural Zimbabwe where children are still not getting AIDS prevention or treatment drugs.
Government-run rural clinics in these areas lack essential drugs and the most basic clinical supplies such as cleaning agents, surgical gloves, and bandages.
A medical doctor at Guruve Hospital who asked for anonymity for fear of political persecution said even though the drugs have become affordable and available, the country's health care systems to treat children and pregnant women remain weak.
"In most rural areas, children with AIDS are generally considered a lost cause," the doctor said. "Treatment, to the extent it exists, is limited to adults, for whom antiretroviral therapy is cheaper and easier."
He said specialised and costly tests are needed to determine whether a child under 18 months is infected, although treatment can begin based on symptoms alone.
"Children are also more complicated to treat, partly because their medication must be constantly adjusted as their height and weight change. And paediatric drugs cost more than adult medication until recently, up to three times as much," the doctor said.
He added that half of all untreated HIV-positive infants die before the age of two for lack of medication that can produce transformations seemingly overnight.
And until Irene can access testing and treatment, it seems as if she is destined to follow her parents, both of whom passed away in the last three years.
"She has been bewitched. I know people are jealous. Her parents suffered the same symptoms before they passed on. I am just a poor old woman widowed and don't have any other source of income," said Irene's grandmother, 68-year old Thembo.
HIV, Thembo believes, can only be contracted by adults who have sex.
But meanwhile, Irene has suffered from her symptoms because of the lack of medication at the clinic. "I quit school last year March. I couldn't walk and my body was so weak and feeling terribly hot," she told IPS.
According to UNAIDS, the country has over 1,3 million AIDS orphans. About 100,000 of them live on their own while others live with their extended families.
It estimates that between 110,000 and 140,000 children aged between 0 to 14 years are living with HIV - who mostly live in rural areas.
And the country does not have enough antiretroviral (ARV) drugs to comply with World Health Organisation recommendations on providing treatment to people with HIV. According to Dr Tapuwa Magure, CEO of the Zimbabwe National AIDS Council, the number of Zimbabweans in need of ARVs has increased to 570,000 from 350,000.
Currently about 200,000 people whose immune systems have been severely weakened are on ARVs. This number includes children, Magure said.
But Tanya Weaver of the American Foundation for Children with AIDS, said Zimbabwe receives little HIV/AIDS funding support from any of the major donor initiatives. The country receives approximately four dollars per HIV-positive person per year.
"In contrast, neighbouring Zambia, which has a similar rate of HIV prevalence, receives around 187 dollars per HIV-positive person annually from foreign donors," states Weaver. Her organisation is raising money for HIV-positive children.
But for Irene and other HIV-positive children in rural areas they can only hope that the political situation in the country will improve and they will be able to access HIV testing and ARVs.
"I am always told there is no medication. I wish God will just take me rather than suffer like this," said a tearful Irene.
*Names changed to protect the identity of the minor.