Background

1. Health and social services to address the needs of orphans and other vulnerable children in the context of HIV/AIDS Research report and recommendationsPresented at PHRC 29 May 2003 By Sonja Giese Children’s Institute University of Cape Town

2. Background • 6.5 million people in SA infected with HIV (2002) • 3.2 million women between ages of 15-49 (2002) • 70% HIV-infected population in stages 1 and 2 • Estimated 150 000 children lost mother to AIDS in 2002 • South Africa currently has close to 1 million children who have lost a mother • Experts1 predict that this figure will double by 2010 and peak in 2015 1 Centre for Actuarial Research, UCT

3. Aim of the research To develop a set of recommendations to support and inform an appropriate health, social services and education response to the needs of orphans and other vulnerable children in the context of HIV/AIDS, which promote the realisation of their basic rights to survival, protection, development and participation, and do not compound their vulnerability.

4. Objectives • To develop an understanding of the health and social needs and living contexts of orphans, children at risk of becoming orphans, and of their caregivers, with specific emphasis on issues related to accessing health, social development and education services. • To review the extent to which these services were meeting the needs of OVC in contexts of HIV/AIDS • To integrate literature and research into the drafting of the research report and recommendations

5. Methodology • Multi-site (6) qualitative research project • 5 of South Africa’s 9 Provinces • Participants: • Children (who had been orphaned or who were living with a sick/dying caregiver) • Caregivers of these children • Service providers • Other informants • Sought to understand the life experiences of children and their caregivers and the factors that impact positively or negatively on support seeking behaviour, service access and service delivery

6. Tzaneen Ingwavuma Phuthaditjhaba Cato Crest Gugulethu Umzimkulu

7. Relatives live nearby and support the household Ma Ramogae 66 years old      David Sisi Susan Died 25/6/01 Meshack 27 X Mathilda Nthathi Died 1/8/01 Ester 30 Maria 29 X Tiko 18 X Precious 3 X Richard 19 X Vuyo 17 Grade 6 X Tebogo 15 Grade 4 X Kenneth 12 Grade 2 X Tefo 4 X Zama 17 Grade 9  Jo 9 Grade 1  Sara 8 Grade 1 X Age Oldest Youngest Moved into the household after the death of their mother Moved with their mother into the household after she became very ill Lived with their grandmother since their father died and their mother remarried

8. Key health-related issues • Hunger / Malnutrition major concern of children, caregivers and service providers • Children as carers for the sick (paucity of HBC and palliative care services) • Children’s exposure to opportunistic infections through living in HIV-affected household • Health workers unclear on what to do about unaccompanied children attending health facilities

9. Health-related issues cont. • Access to preventative services problematic for young children in the care of elderly eg. EPI • HIV-infected children - not seen as a major problem, or adequately dealt with at 1o level, major concern at 3o • Paucity of VCT services for children • Mental health needs of children experiencing death and dying largely ignored – ongoing support needed as with adult support groups

10. “We are not trained at all to counsel children and would find it very difficult. We are really not sure how to do it. We are also so concerned that if we counsel an 11 year old, for example, there would be no support for that young person when they go home” • VCT counselor

11. Health-related issues cont. • Free health care for children – issues related to health user fees (particularly where hospital is nearest facility) • Relationship between health workers and home-and community-based carers – strengthen health outreach services and ensure continuity of care • Opportunities for the identification and referral of vulnerable children through health care facilities • Commitment of health workers and need for support

12. Key social development issues • Lack of capacity of social workers striking – not reaching most vulnerable • Emphasis of their work on processing foster care placements with very little time / capacity for addressing other areas of need • Insufficient poverty alleviation mechanisms with reliance on foster care grant to address poverty – problematic • Number of grant related issues which need to be addressed

13. Social development cont. • Residential care as a knee-jerk response to “orphans”, extended use of existing facilities • Relationship between social workers and home-and community-based carers / health workers – not able to provide professional support required

14. Key education-related issues • OVC experience similar problems to other children in terms of accessing education eg. school fees and uniforms, hunger • Some additional issues include: • Increased responsibilities for care of younger siblings / sick adults and for income earning • Psychosocial impact on children affected school attendance and performance • Increased mobility • Stigma and discrimination etc..

15. Education cont • Teachers often fail to recognise or respond appropriately to the vulnerabilities of children experiencing orphanhood • Examples of good practice show potential for the positive role of schools in identifying and supporting vulnerable children eg. extended school based feeding schemes, collaborative efforts – schools as nodes of care and support • Universal precautions not widely available in schools eg. gloves, first aid kits

16. Some key recommendations • Putting children first – ensure presence on agendas • Recognising process of orphanhood • Addressing orphanhood within the context of other childhood vulnerabilities (poverty) • Adopting needs-based versus category- based response – non targeted (implications of targeting)

17. Key recommendations cont • Supporting care arrangements – in order to ensure the sustainability of social safety net through course of pandemic (poor caring for poor is unsustainable) • Maximise opportunities within existing service infrastructure eg. HBC and schools • Increased financial and human resources in social sector

18. Key recommendations cont • Facilitate and support collaboration – common denominator in successful initiatives across research sites eg. social workers in school clusters, school nurses, HBC teams. • Reduce burden of orphans on services through provision of treatment, care and support to adult caregivers • The opportunity that HIV/AIDS presents for strengthening service delivery.

19. Full research report and recommendations available Thank you.