A shortage of pediatric testing kits and specialised medical staff in Zambia is causing delays in rolling out antiretroviral (ARV) drugs for children infected with HIV/AIDS.

Despite the National AIDS Council (NAC) having enough ARV medication to treat about 19,000 children, only about 5,000 are able to access the drugs.

An estimated 1.6 million Zambians are living with HIV - about 17 percent of the adult population - but only about 75,000 have access to ARVs, and even with the low penetration of the rollout so far, analysts say the programme provides adults living with AIDS a better deal than children infected with the virus.

According to Mary Katepa, a specialist in pediatric HIV at the University Teaching Hospital, the shortage of HIV testing kits for children is slowing down the paediatric ARV rollout.

"At the moment, we do not have enough equipment to test children for HIV, especially if they are below two years, so we offer them antibody tests ... but a child can get HIV antibodies from an infected mother because of blood exchange or breast-feeding," she said.

"We can only be sure of the child's status after 18 months, by which time the mother's antibodies are expected to have cleared, and only then can we consider putting such a child on treatment if need be."

The NAC and UNAIDS are trying to compile statistics for the number of children living with HIV, but the health ministry estimates that of the 500,000 births registered every year, nearly 40,000 infants are infected, and 30 percent to 50 percent of those die within 24 months of birth, according to NAC spokesperson Justine Mwinga.

"The largest source of HIV infection in children is mother-to-child transmission during pregnancy, and the majority of HIV-infected children actually die without ever being subjected to HIV testing. This is why we are scaling up the prevention of mother-to-child transmission by routinely testing all pregnant mothers who visit the hospitals and clinics," Mwinga said.

(This is the first time I have heard that the largest source of HIV infection is maternal-child transmission - wow. That is absolutely tragic. With the appropriate treatment during pregnancy and birth, that rate can be reduced to almost nothing.)

The health ministry has set a target this year to reduce the number of HIV-positive births by more than a quarter.

Like other countries in the region, Zambia is suffering from an acute shortage of medical staff, who are migrating in search better working conditions and salaries. Access to pediatric ARVs is being hampered by the lack of infant diagnostic techniques and the inadequate training of health workers and caregivers in the management of HIV/AIDS in children, said Mwinga.

A 2004 study by the health ministry determined that Zambia had about 10,000 registered nurses for a population of about 10 million, but a recent study by the UN Population Fund found that only one nurse was assigned to each ward at Zambia's largest referral hospital, the University Teaching Hospital in the capital, Lusaka.

"Because children are not able to speak for themselves, treatment for them tends to be very complicated," said HIV/AIDS child counsellor Katuta Mulenga. "We have to mostly rely on the parents or guardians [for information] to treat a child, and some of these parents don't want to have their children tested, even if they are suspecting that they could be HIV-positive. It becomes easier in cases where a child is at least 10 years old."

The Zambian Red Cross Society, which also provides HIV/AIDS education and community mobilisation, has encountered problems in providing children with ARVs, but has managed to put about 30 orphans and vulnerable children on ARVs in its home-based care projects.

"We find it very difficult to support many children to access ARVs because of the dosage, which requires highly specialised medical personnel to dispense the drugs, as most of them are meant for adults. It would have been easier if we had children's ARVs in the clinics and hospitals that we are working with," said James Zulu, the society's country spokesperson.

"Due to the toxic nature of most ARVs, we are forced to delay treatment until the child is above 10 years but many children end up dying before they reach that age," he said. We are therefore appealing for ... children's ARVs to help us save lives by scaling up the program."