Psychosocial Issues facing Children & Adolescents living with HIV/AIDS in South Africa

1. Psychosocial Issues facing Children & Adolescents living with HIV/AIDS in South Africa

2. Overview of Field Placement • University of Kwazulu Natal – School of Social Work & Psychology • Sinikithemba HIV/AIDS Care Centre • History • Client Population • Social Work Department

3. Areas of Field Work • Casework with children and their families at the SKT Paeds Clinic • Casework in SKT HIV/AIDS Care Centre (Adult clients) • Discharge Planning at Mc Cord Hospital Wards • Psychosocial Assessment Paediatric Intake Form • ‘Role of the Social Worker in the Paediatric Clinic’

4. Areas of Field Work continued… • Study of disclosure of HIV status to children at the Sinikithemba Paediatric Clinic • Disclosure Policy • Disclosure Protocol • Guidelines for staff: Working with Children & Caregivers on Disclosure • Trainings Completed: • Certificate in HIV/AIDS Counselling • South Africa Department of Health ARV Training Program for Social Workers • Weekly in-service trainings at SKT

5. Sinikithemba Paediatric Clinic • Multidisciplinary Team • Demographics of Client Population • Profile of Caregivers

6. Psychosocial Issues • Disclosure • Care & Treatment • Financial Support • Emotional Support • ARV Adherence Support • Community support • Grief & Bereavement • School Adjustment & Functioning

7. Disclosure: The window to providing for Psychosocial needs of Children & Adolescents ACCESSING SUPPORTIVE COUNSELLING ARV ADHERENCE ACCESSING COMMUNITY RESOURCES DISCLOSURE Normalizing HIV Status PROVIDING FOR SAFETY OF CHILD IN ALL SETTINGS FORM OF PREVENTION GRIEF & BEREAVEMENT STIGMA & DISCRIMINATION

8. Disclosure • …. the process through which a child/adolescent receives, and copes with information about his/her HIV status • … a process as opposed to a one-shot dose of information • … continues as SKT supports the child and his/her caregivers to increase their understanding of HIV and learn how the virus behaves in the body

9. Categories of disclosure status • Disclosed • Partially disclosed • Not disclosed

10. Considerations in Disclosure • Age of Disclosure • Formulating a Disclosure Plan • Legal & Ethical Issues • The Disclosure Process

11. Decision-Making for Caregivers • may decrease the ability of caregivers to control secondhand disclosure by others • Children/adolescents, even though secrecy is requested, may disclose their status and the status of caregivers to others • Possible increased vulnerabilities for child/adolescents – depression, isolation are some difficulties which he/ she may experience as a result of learning of his/her status • Caregivers who are having difficulties in coping with their own status and illnesses may experience extreme anxiety in the disclosure process

12. Misconceptions • ‘Disclosure will only be necessary if I get really sick, my child does not need to know.’ Disease Progression instead of an ‘anticipated rewards vs. costs’ approach to disclosure • ‘The child just talks too much, she/ he has no control over his/her mouth’ • ‘My child will kill him/herself if he knew’ • ‘If my child asks if she/he has HIV I will tell him/her no, when he/she gets older they will understand why I did what I did’

13. ‘If my child asks if she/he has HIV I will tell him/her no, when he/she gets older they will understand why I did what I did’ • ‘Children cannot understand death!’ • ‘If my child learns that I gave him/her HIV he/she will hate me’

14. Disclosure & the Social Worker’s Role • Psychosocial Assessments • Home Assessments • Educating Caregivers • Building Patient’s competencies for treating with the progression of the Illness • Building Community resources

15. QUESTIONS ….