Though the levels of HIV/AIDS are lower in children than adults, children remain the most highly vulnerable segment of our modern society. The number of orphans is increasing daily while there are few support systems or networks for them outside the family. The basic human rights of these children are violated or severely threatened. Some are withdrawn from school and others assume adult related responsibilities prematurely. Girls indulge into early premarital sex only for economic gains and survival. In all these situations, children are subjected to such exploitative circumstances that they only end up being submissive.
The future might look bleak for these children as long as they do not receive social support. The community need to nurture its own children since ‘nurturing is an important component of any child’s growth and thus it is important to meet the psycho-social needs of children’.
The article also addresses issues around HIV/AIDS mainly looking at the social support that people living with HIV/AIDS might need. Issues to deal with stigma and discrimination are also core elements.
Secondly, community participation and responsiveness need to be over–emphasized if ever the goal of providing help and care to AIDS patients is to be achieved.
As it is universally acknowledged that no nay human being can add days into the life of an AIDS patient, we can also add quality into his or her life. The social aspect is an integral element in the life of any individual person. Ultimately, psychosocial support for HIV/AIDS patients need to be scaled up and encouraged in any community.
The psychological caring of orphans, vulnerable children and People living with HIV /AIDS becomes an indispensable component of anyone involved in the field of human service delivery. There is need for the continuous research and discussions on the emotional or psychological benefits of social support.
Psycho–social support to Orphans and Vulnerable children
What is psycho-social support?
According to Southern Africa HIV/AIDS. Psycho-social support can be defined as ‘an ongoing process of meeting the social, mental and spiritual needs, which are considered essential elements for positive human development.’ Culture also needs to be seen as a pivotal point for the enrichment of children’s identity.
Core elements in psycho-social support.
Four important components of psycho-social support were identified by Safaids. These are briefly discussed below:
(a) Emotional needs
These include the need for love, security, encouragement, confidence, motivation, and self-esteem. It also includes a sense of affiliation or belongingness, trust and security. The physical needs for children are also necessary and these include food, shelter, school uniforms, fees and basic health care.
(b) Mental needs.
Mainly refers to children’s areas of mental growth. Formal and informal education are essential elements within the mental framework. Opportunities for ‘observational knowledge, adaptational skills and general life skills’ are fundamental in the development of the child. Children’s social requirements are essential and they involve ‘children in a community without them feeling stigmatized or different, to develop a sense of belonging, form friendships and community ties, acceptance, identity, and acknowledgment from peers’.
(c) Spiritual needs
Spiritual needs enable children to develop a hope for their future. “They also need to develop trust and security in their survival. They can even call for spiritual guidance and support from a Higher Being”.
Who is an Orphan?
“An orphan is a child under the age of 18 who has either lost one or both parents” (Safaids, issue 60: June 2004).
Both UNICEF and UNAIDS define an orphan “as a child under 15 who has lost his or her mother (maternal orphan) or both parents (double parents)”. However, the definition excludes the following categories of orphans:
(a) Paternal orphans: children whose father has died
(b) Orphans between 15-17
Children and Vulnerability
Children, particularly orphans are among the most vulnerable groups in each society. The reason being that “there are few support systems outside the family for them.” (Safaids: issue 60: June 2004:1)
Malnutrition is among the greatest and immediate risk orphans face. Secondly, they are often denied access to education because members of their extended family can no longer afford it. Orphans are usually emotionally deprived, financially challenged and desperate. It is because of this desperation that these children are sexually abused and in some cases they end up being commercial sex workers.
In short, orphans are subjected to many exploitative situations and as a result they end up getting HIV/AIDS.
Existing strategies for dealing with children in Zimbabwe
It is imperative at this point to identify existing strategies or approaches that are commonly used to support children mainly orphaned by HIV and AIDS.
According to Safaids, there are three commonly used strategies to support children orphaned by AIDS. These are discussed below:
(a) Institutional arrangement
This includes various types of orphanages known as Children’s Homes. Examples of such Homes in Zimbabwe are Harare Children’s Home, Chinyaradzo and SOS Children’s Home. These orphanages “often provide high quality care in terms of material needs such as food or clothing, but they have limited capacity” mainly because of the unavailability of funds.
The institutional approach is considered to be very expensive to run and monitor. Thus, this is not highly recommended in these trying times of global recession. Most of these orphanages or institutions depend heavily on donations and this renders them unsustainable and temporary.
It solely relies on the community responses. It makes use of community volunteers who identify the orphans or vulnerable children in their respective areas. Any form of assistance is channelled through these community-based volunteers. The essence of the community-based approach is to ‘encourage self reliance rather than dependence on on-going external inputs’.
Mainly addresses the physical needs of the child. Many organizations have reacted to these physical needs of children. It has been criticised though for encouraging dependency on children.
Challenges or problem areas for children who have lost parents to HIV/AIDS
Poverty still remains a daunting challenge to children who have lost parents to HIV/AIDS. The death of a parent signifies the disruption of the basic pattern of a child’s life. Death means that the child can no longer afford to buy basic food requirements. In most cases children end up having nutrition related problems. Orphaned children also find it very difficult to access health care and this puts them at risk. The death of the parent means that poverty level will increase.
“Increasing poverty causes a degradation of the immediate family environment, multiplies health risks and reduces its ability to obtain health services.” (Safaids: 2004).
The death of a parent can also leave the children being unable to maintain the home. In most reported cases, children have lost their shelter. Secondly, shelter can become inadequate or can be dilapidated. Children will eventually go streetwise because they would have lost shelter. All such problems or challenges are interlinked with poverty.
(b) Education / withdrawal from school
The withdrawal of orphanaged children from formal school remains a major area of concern. Resources may end up being inadequate for children to continue going to school.
(c) Loss of self–esteem, stigma and discrimination
Stigma and discrimination have been the most unfortunate response that orphans and vulnerable children have received from the community. Children who have lost parents are often ostracized from the society. These children are often barred from school, rituals or other social events. The isolation of these children often leads to extreme distress and emotional instability in children. Being ostracized and discriminated against means loss of self –esteem. Children tend to doubt their identity and capabilities.
(d) Rejection and inheritance related issues.
It is because of social stigma that their own relatives reject children who have lost parents to HIV/AIDS. In most cases these children are left without any land, home or any other possession. Some of these children are taken by some relative, others move out of their homes and become destitute at the end.
The emergence of Child Headed Households
Child headed households are households headed by the children after the death of a parent. In Zimbabwe, these child headed families are linked to HIV/AIDS.
Child headed households face so many challenges or problems. In these households, nutrition is poor, sexual abuse is rife, lack of parental guidance or care is evident and the developmental pattern of children and adolescents is disrupted. The emergence of child headed households is mainly a result of the failure of relatives to assume parental duties. The relatives mainly do not have sufficient resources to look after the bereaved children. The death of a child’s parent to AIDS means that the child is bound to face social stigma and society is not prepared to provide care and support. It has been noted that the emergence of child headed households can also be a result of increasing death among adult relatives.
Psycho-social support to orphans and vulnerable children - Analysis
In spite of all the emotional problems, hardships and stigma, children affected by HIV/AIDS have the same usual needs as the other children. These needs range from economic, social, and educational, to psycho-social needs. The psycho-social needs of children have received little attention in Sub–Saharan Africa.
To examine these needs, it is imperative to discuss the extent of HIV/AIDS in Zimbabwe.
HIV/AIDS and children in Zimbabwe
According to UNAIDS, ‘a number of factors have contributed to the difficulties facing Zimbabwe today. These include the effects of the present political impasse, the declining value of the Zimbabwean dollar, rapid inflation, lack of investment, rising unemployment, escalating costs of living, the effects of frequent droughts and the emergence of HIV/AIDS.’
Children are often forced to move out of school because the AIDS affected family can no longer afford it because the breadwinner is ill. The family cannot meet the medical requirements of the patient. Nutrition also becomes a problem and the patient is thus very susceptible to opportunistic infections.
While the government is trying to improve the health delivery system, the absence of foreign currency has impacted greatly on the exercise to make the medical infrastructure of the country even better.
The capacity of many AIDS organizations has been impaired severely by the current fuel crisis. Organizations like World Vision, Island Hospice and John Snow International have been providing food to HIV/AIDS families. However, these organizations have seen their operations hitting the brick wall because their movements are inhibited by fuel shortages.
The role of the extended family has become more pronounced than it was during the medieval times. However, orphans have poised the extended family with an extra burden of care. Thus, such families can no longer cope with this additional burden or responsibility.
“Relatives are starting to look at their familial responsibility towards related children as more of a financial burden.”
The inability of the extended family to cope with this extra load has left orphans with so many hurdles in their lives. Ultimately, child headed families do emerge. Characteristic of such families is sexual exploitation, early or delayed marriages and even child abuse. Prostitution is the only means by which children can fend for themselves. Alas, most of the children will end up having HIV/AIDS by virtue of being absorbed into the commercial sex industry.
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