Nkululeko Nkomo

Towards a Definition of Orphaned and Vulnerable Children

The HIV epidemic presents challenges including orphans and a large mass of children rendered vulnerable by the epidemic and other societal forces. Focus on orphaned and vulnerable children (OVC) is important, but needs accurate definition. Twelve focus group interviews of service providers, leaders in these communities, OVC and their caretakers were conducted at six project sites across Botswana, South Africa and Zimbabwe to extend this definition. The loss of a parent through death or desertion is an important aspect of vulnerability. Additional factors leading to vulnerability included severe chronic illness of a parent or caregiver, poverty, hunger, lack of access to services, inadequate clothing or shelter, overcrowding, deficient caretakers, and factors specific to the child, including disability, direct experience of physical or sexual violence, or severe chronic illness. Important questions raised in this research include the long-term implications for the child and community, and the contribution of culture systems.

Factors associated with prevalence of mental disorder in people living with HIV/AIDS in South Africa.

Abstract The study examines the association between the presence of mental disorder and a range of independent variables. A sample of 900 HIV-positive individuals was administered the Composite International Diagnostic Interview to determine the presence of selected mental disorders. A structured interview assessed support received and factors that may contribute to mental disorder. Overall prevalence of mental disorder was 43.7%—though higher in Stage 3 (49.7%) and in Stage 4 (68%) of the disease. Eighteen percent of respondents were receiving antiretroviral treatment. Having had pre- and post-test counselling was not related to mental disorder; nor were the number of sessions, the professional status of the counsellor and perceived helpfulness of counselling. Being in an HIV support group was related to presence of a mental disorder, although the frequency of attendance was not. Although most of those who disclosed their HIV status found the experience helpful there was a significant positive association between presence of a mental disorder and having disclosed HIV-positive status. Although being a member of an association for people with HIV/AIDS and being religious was perceived as helpful, neither was statistically associated with the presence of mental disorder. Discrimination by community and family and isolation were related to mental disorder. Death of a significant other due to AIDS was related to mental disorder. The findings suggest a strong need for provision of psychiatric care as part of AIDS care as well as strengthening of support services.

Guardianship of orphans and vulnerable children. A survey of current and prospective South African caregivers

Abstract Increasing numbers of orphaned and vulnerable children resulting from AIDS deaths requires practical placement strategies. While the extended family is regarded as both the most likely and the preferred option by most key planners and organizations, warnings of the limitations of this alternative have been increasing. This study assessed the views of 1400 adults (both current and prospective caregivers) regarding the placement of children. Most current caregivers believed that either their partner (30%), a grandparent (25%) or another family member (33%) would look after the child/children if they were no longer able to. However, 12% of parents could not identify a carer or predicted only a bleak future for their children. There was strong willingness amongst adults of various relational proximity to take in children if required to −71% of both fathers and grandparents, 63% of siblings and 23% of best friends said they would take in children. Nonetheless this research suggests that the willingness may not necessarily be translated into reality. Most prospective caregivers identified significant additional stressors (most importantly financial) and expressed a strong need for assistance if they were to take in additional children. The HIV status of the child is also likely to sway placement decisions for some people. Nonetheless opportunities to keep children in families are clearly high, but people will need considerable help to realize this potential. For some children alternatives other than the extended family will be required

Mental Disorder in People Living with HIV/Aids in South Africa

We investigate the prevalence of mental disorder in people living with HIV/AIDS in a developing country context and examine the relationship between the presence of mental disorder and various independent variables. Nine-hundred HIV positive people were interviewed in 18 recruitment sites across five provinces in South Africa, using a cross-culturally validated diagnostic instrument and a structured socio-demographic and health information questionnaire. Prevalence of mental disorder was established using the Composite International Diagnostic Interview (CIDI). Chi-square, Fischer exact test, and binary logistic regression examined the relationship between mental health disorders and demographic characteristics, disease stage, CD4 count, and whether the person was on anti-retroviral treatment. A number of respondents (43.7%) were found to have a diagnosable mental disorder. Depression was the most common disorder (11.1% major and 29.9% mild depression), followed by alcohol abuse disorder (12.4%). The presence of mental disorder was significantly associated with gender, employment status, having children, and the clinical stage of the disease. Gender and the stage of disease were the best predictors of mental disorder. Rates of mental disorder were substantially higher in people living with HIV/AIDS than generally found in populations in developing countries and similar to HIV positive groupings in developed countries. Viral impacts on the brain, psychological reactions, and social conditions all contributed to the higher prevalence rates. Mental health interventions need to become a central part of comprehensive HIV/AIDS support, care, and treatment programmes.

Assistance needed for the integration of orphaned and vulnerable children – views of South African family and community members

Guardianship within families is often regarded as the most viable and preferred option for orphaned and vulnerable children (OVC). However, this will place a considerably increased burden on the new caregivers of these children. This study examines whether assistance to prospective families would incline them towards incorporating children and, if so, what would act as ‘threshold’ incentives for them. Adults (N = 1 400) in diverse locations and of various ‘relational proximity’ to children were interviewed in three high HIV/AIDS prevalence provinces in South Africa. Close relatives were more inclined to take in children and would generally require lower levels of assistance than more distanced adults. Nonetheless, for most poor families, no matter their relation to the child, help is critical. More distanced families, friends and strangers also showed a strong willingness to incorporate children - provided they receive sufficient help. For all categories, the greater the assistance the more likely they would be to take in children.While direct financial assistance was important, assistance with education-related costs and having a trained and caring person come in ‘now and then’ to help were also significant factors. The age and HIV status of the child were viewed as important intervening factors in deciding whether or not to take in an additional child/ren by some people.

Primary health care service delivery in South Africa

PURPOSE The papers aim is to determine the role of non-profit organizations (NPOs) in filling possible gaps in primary health care (PHC) service provision. DESIGN/METHODOLOGY/APPROACH District (n = 10) and sub-district needs (n = 14) analyses were conducted in five South African provinces. In each case, the district/sub-district manager was interviewed using a semi-structured interview guide. FINDINGS The service gaps identified were understaffing/lack of capacity, difficulty in retaining and recruiting staff, service disparities, inaccessibility of services/low-service utilisation and limited funding. It was believed that NPOs could fill these gaps. About 83 per cent perceived the relationship between government and NPOs as good. Contract monitoring, quality of service, communication and quality control were said to be unsatisfactory. The majority of sub-districts (11) indicated that they provided supplies to NPOs; 50 per cent perceived the relationship between the sub-districts and NPOs as good or very good. NPOs have critical role to play in PHC service delivery. ORIGINALITY/VALUE The study provides critical information required to make informed effective strategic decisions that support district/sub-district performance and sustainability in a decentralized health system.

Experiences of children heading households in the wake of the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) epidemic in South Africa.

The phenomenon of child-headed households has emerged from an escalating rate of orphanhood resulting from human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). While the issue has received much media attention in South Africa, very little scientific information focusing particularly on the psychosocial experiences of the children has been published. In the present paper 14 children in Gauteng and KwaZulu Natal provinces of South Africa, heading households as a result of HIV/AIDS-related parental death, were interviewed in depth to explore their psychosocial experiences and perceptions. Interpretative phenomenological analysis was utilized to analyse the data. The findings indicate that pre-parental death experiences were characterized by complex experiences of illness in the household. The death of a parent(s) was itself experienced with great difficulty and sense of loss, with a theme of apportioning blame for parental death on other people emerging from the interviews. Post-bereavement, the defining psychosocial challenges included perceived lost childhood and self, sense of abandonment, concerns over day-to-day survival and grappling with conflicting demands on both physical and emotional energy. It also emerged that for some respondents these experiences were aggravated by negative attitudes and treatment from other people in their communities. In the light of these results increased support, including professional attention where indicated, is encouraged.