multiple vulnerabilities: qualitative data for the study of orphans and vulnerable children in south...
TRANSCRIPT
Multiple vulnerabilities
Qualitative data for the study of orphans and vulnerable children
in South Africa
Alicia Davids, Nkululeku Nkomo, Sakhumzi Mfecane, Donald Skinner & Kopano Ratele
Edited by Donald Skinner & Alicia Davids
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Compiled by the Social Aspects of HIV/AIDS and Health Research Programme,Human Sciences Research Council
Published by HSRC PressPrivate Bag X9182, Cape Town, 8000, South Africawww.hsrcpress.ac.za
© 2006 Human Sciences Research Council
First published 2006
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.
ISBN 0-7969-2139-3
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CONTENTS
List of tables and figures vList of authors viAcknowledgements viiAcronyms and abbreviations viiiExecutive summary ix
Chapter 1 Introduction — Donald Skinner and Alicia Davids 1
Defining orphanhood and vulnerability 1 The situation of OVC in South Africa 2
Chapter 2 Background and aims of the project — Donald Skinner and Alicia Davids 5
Aims of the research 5
Chapter 3 Methodology — Donald Skinner and Alicia Davids 7
Semi-structured interviews 7 Research instrument 7 Sampling method 7 Sample Kopanong 8 Sample Kanana 8 Observations 9 Analysis 9
Chapter 4 Qualitative Report Of Ovc Living Conditions And Services In The Kopanong Municipality, Free State Province — Sakhumzi Mfecane, Donald Skinner and Alicia Davids 11
Geographical context 12 Economic situation 14 Poverty and unemployment 14 Situation of youth 15 Situation of HIV/AIDS 17 Context of people living with HIV/AIDS 21 Context of OVC 24 Support systems for OVC 30 Challenges facing government departments 35 NGO, CBO and FBO support structures 37 Challenges facing NGOS/CBOS 39 Discussion 40
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Chapter 5 Qualitative Report Regarding The Situation Of Orphans And Vulnerable Children (Ovc) In Kanana And Umuzimuhle Townships, North West Province — Kopano Ratele, Donald Skinner and Nkululeku Nkomo 43
Distinctive and common elements between the two townships 43 Umuzimuhle 43 Kanana 44 Major problems in the target areas: unemployment, poverty and
shortages of food 45 HIV/AIDS: impact on the community 49 The situation of OVC 54 Situation of households caring for OVC 61 Support structures for ovc in the community 73 Conclusion 78
Chapter 6 Overall Conclusions And Recommendations — Donald Skinner and Alicia Davids 81
Care of OVC 82 Support for families and households that care for OVC 83 Support for communities that care for OVC 84 HIV prevention and intervention 84 Recommendations for state services 85 Recommendations for NGOs that support OVC 86
Appendices 89
References 105
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Tables
Table 1 Ethnic composition in 2001 compared with the average for the district in 1996 11
Table 2 Education levels for persons 20 years and older, 2001 12
Figures
Figure 1 Map of the Kopanong Municipality 13
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LIST OF TABLES AND FIGURES
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Alicia Davids, Health Promotion and Behavioural Intervention Research Unit, Medical Research Council
Nkululeku Nkomo, Social Aspects of HIV/AIDS and Public Health, Human Sciences Research Council
Sakhumzi Mfecane, WISER, University of the Witwatersrand
Donald Skinner, Social Aspects of HIV/AIDS and Public Health, Human Sciences Research Council
Kopano Ratele, Dept of Psychology, University of the Western Cape
AUTHORS
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This report reflects a collaborative endeavour involving many people. Although the list below is not an exhaustive one, we wish to thank the following people and organisations for their participation and unstinting support in this study:• The WW Kellogg Foundation for their financial support and making this study possible• The Nelson Mandela Children’s Fund, our partner for this project in South Africa.• Our colleagues from the HSRC who assisted in providing information, doing
fieldwork, reading and editing and giving comments, including Alicia Davids, Nkululeku Nkomo, Adlai Davids, Leickness Simbayi and Anna Strebel.
• Representatives from Kopanong, who provided assistance when needed. Particular thanks is given to Jackie Lingalo, Mr Lethuteng and Thomas Tladi, District Manager Department of Social Development; Mr Serf Van Schalkwyk, District Manager Department of Agriculture; Mrs Rebecca Sempe, District Co-ordinator of the health department; Mr Lerato Khetshane, District Manager Municipality; Mr Motshepehi; Jacob Mphakwanyana, Teacher and HIV Educator; Vuyokazi Buwa, Social Worker and Community Liason (OVC and HIV focused) Department of Social Development; Ms Magazine Peterson, Councillor Springfontein; Mr Thabo Hlasa, ANC Chaiperson Trompsburg; Mr Mancane Rigala, fieldwork guide Springfontein (now working for municipality); Ms Mariana Sibunyane, Councillor Jagersfontein; Mrs Anna Morapelo, Councillor Bethulie; Mr Michael Moitse Councillor Fouresmith; Mr Sello Ntaysane, Mayor of Kopanong and Ms Nonceba Tafane, Philani Victim Support Centre.
• In Matjhabeng: Mr Mpho Ralipeli from the Matjhabeng AIDS Consortium; Ms Palesa Mphatsoe (Social Development); Mr Clifford Clark from Mathjaben Christian Leaders Forum; Mr Ernest Molefi (Morning Star); Mr M Khantsi from the Department of Health; Ms Lebohang Mokoena Department of Home Affairs; Ms Nuku Radebe from Meloding Day Care Centre advisory board; Ms Monica Mokalake (Day Care Centre advisory board). The three women from Thabong and Bronville who gave us a tour of Thabong and other areas surrounding the township, Elizabeth Noe, Gladys Khasu and Rosina Thajana, and last, but not least, Rev Paul Okpon.
• In Kanana: Ms Nella Modjanaga and Mr Gideon Engelbrecht from the Department of Health. They, particularly Mr Engelbrecht, facilitated interviews with people from NGOs and nursing sisters at Grace Mokgomu Clinic. Matladi Lesupi and Nomonde Lehloo, from KOSH Care and Support Group and Hospice respectively, both of whom facilitated interviews with carers and OVC. Sibongile Dlamini and Ncebo Molefe, who took us for a tour of Kanana and Umuzimuhle. Officials from the Departments of Health, Education and Social Development, as well as from the City Council of Klerksdorp (i.e the office of the speaker) who granted interviews. Representatives from NGOs who granted interviews.
Finally, we would like to thank all the people who participated and provided information, including those OVC and their carers without whose generosity this study would not have been possible. Their participation is testimony that if we all put our energies together we can obtain the information necessary to tackle the epidemic that confronts us all and provide the much-needed care for orphaned and vulnerable children.
ACKNOWLEDGEMENTS
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ACRONYMS AND ABBREVIATIONS
AIDS acquired immunodeficiency syndrome
ARV antiretroviral drugs
CBO Community based organisation
DoA Department of Agriculture
DoE Department of Education
DoH Department of Health
DSD Department of Social Development
FBO Faith based organisation
GDP gross domestic product
GMC Grace Mokgomu Clinic
HIV human immunodeficiency virus
IDP integrated development plan
KOSH District of Klerksdorp, Orkney, Stilfontein and Hartebeesfontein
NGO non-governmental organisation
OVC orphans and vulnerable children
PLWHA people living with HIV/AIDS
PMTCT prevention of mother-to-child transmission
STI sexually transmitted infection
RDP reconstruction and development programme
UNICEF United Nations International Children’s Fund
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EXECUTIVE SUMMARY
In 2002 the Human Sciences Research Council (HSRC) received funds from the Kellogg Foundation to undertake research and interventions for orphaned and vulnerable children (OVC) in three countries in southern Africa, these being South Africa, Botswana and Zimbabwe. The project aims to contribute towards improvement of the conditions of OVC in these countries. In South Africa, the HSRC partnered as the researchers with the Nelson Mandela Children’s Fund (NMCF) as the facilitators of the interventions. The NMCF directs the funding and provides support to local non-governmental organisations (NGOs) and community-based organisations (CBOs) in identified sites to implement interventions. Work is being done in two provinces identified as having a great need for such interventions.
Qualitative studies were conducted in Kopanong, a local municipality in the Xhariep district, Free State, and Kanana, a local municipality in the southern Klerksdorp district, North West Province. This research was conducted to develop an understanding of the core dynamics affecting OVC in these communities. This information would facilitate developing and implementing interventions to provide assistance to OVC, their carers and their communities and act as part of the baseline information for evaluating these interventions. Thirty in-depth interviews were conducted in Kopanong and 36 in Kanana. Information was collected from government departments, NGOs/CBOs, OVC and their carers, community leaders and community members. These explored in detail the situation of OVC, status of people living with HIV/AIDS (PLWHA) and that of carers of OVC. Finally, this phase intended to document services offered to OVC by government and NGOs, identify strengths and weaknesses of these services and to identify possible ways of improving them. A brief summary based on the results of the interviews follows.
Kopanong district, in the southern Free State province, covers a large area geographically, but is very sparsely populated. It comprises some small towns, but consists mostly of farms. The community is extremely poor, with high levels of unemployment. While some of the towns are built close to the major highway leading to Bloemfontein, many of the roads between the towns are untarred. The poor roads and long distances between towns make community development and the provision of services more complicated.
Kanana, in the North West province, is a large, densely populated township close to Orkney that constitutes part of a series of towns servicing the gold mines. The towns comprise many migrant workers from across the country, their families and many others who have come to seek work or income. There are a large number of informal houses in the district, which contain their own health threats. The industry in the area is threatened as the gold price comes under increasing pressure.
HIV/AIDS is a significant concern in the communities. The respondents all felt that the poverty in the area was the most serious contributor, with the high levels of substance abuse and the silence around and fear of HIV/AIDS also being serious. In Kopanong particularly, there were very few HIV/AIDS interventions because even the large national campaigns such as LoveLife did not have a presence there. A particular problem noted was alcohol abuse among both youth and adults, which was regarded as resulting from inactivity and pessimism about the future, as career prospects within the area are limited. Alcohol abuse was felt to have multiple negative consequences, for example, engaging in unsafe sex and wasting already limited financial resources.
A number of factors were felt to be contributing to children feeling vulnerable. Both communities were reported already to have large numbers of children who had been orphaned by HIV/AIDS, as well as by other causes. The number of fathers who were
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absent made this worse. Concern was already being raised that there are insufficient caretakers to look after the children who are in need of assistance. At the time of the research, it appeared that virtually all of the children were living with a caretaker, with few child headed households.
A number of the other contextual variables were given as contributing to the vulnerability of children living in these areas. Prevalence of HIV/AIDS was already seen as high in the communities, with respondents feeling that the figures were rising steeply. A further, and ultimately greater, concern related to the financial capacity of existing households to provide care. Poverty was felt to be the major factor that would lead to children not being cared for in the future. Other factors included the impact of the desperate levels of poverty, which respondents felt was forcing boys into crime and girls into survival sex as a means of coping. Other concerns centred around substance abuse, both by carers and the children themselves, and very high levels of child abuse. The latter included physical and sexual abuse for the purposes of financial gain. This is a particular concern as the damage done to children has long-term implications.
It appeared from the interviews that most caretakers who took in additional children were doing this to provide care and were genuinely concerned about these children. Varying levels of ubuntu (sense of community caring for one another) were found in both communities. However concerns were raised about carers taking in children for the purposes to take advantage of their grants. A number were accused of taking the grants for themselves and providing minimal care and assistance to the children that they had taken on. Substance abuse was felt to result in the adults not being available to provide care and direction, and it absorbed most or all of the financial resources of the household. Concern about carers also centred around the potential for their neglect of the children generally while child abuse too was seen as a serious problem, including sexual, physical and financial abuse. This has serious long-term implications and is difficult to prevent or address.
Unemployment results in inactivity and subsequent involvement in destructive lifestyles, which further contribute to the vulnerability amongst community members. This has major implications for the OVC who live in these communities. Carers who have limited or no financial support and who are unemployed, care for the majority of OVC. Households then lack resources to provide for children and are in turn resistant to taking on more children. Often they lack access to basic necessities for a child, for example, school uniforms, regular and healthy food, and have insufficient time to offer adequate individual care. Concerns were also raised regarding social conditions that lead to some parents neglecting their children and who rather entertain themselves in local shebeens than look after their children, which further exacerbates OVC vulnerability.
The interviews showed municipalities characterised by poverty, high rates of unemployment, limited resources, poor roads and infrastructure, and for many, problems of access to services. Direct access to individual services varied. Most children had access to health services, with virtually all living within accessible distance of a clinic. Difficulties in talking about HIV made services for treatment and prevention in this area difficult to reach. For example services are difficult to deliver as service providers are expected to travel long distances on poor roads. The municipality of Kopanong is dispersed, which exacerbates the slowness of service delivery.
Multiple vulnerabilities
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Government departments and NGOs/CBOs are doing their best to address local problems but are often limited, particularly the NGOs/CBOs, by lack of funds and other infrastructural constraints. Both communities have battled to sustain NGOs, a more serious problem in Kopanong given the small towns and distances between them. However, despite these problems, there is hope and commitment to improving the lives of OVC and services offered to them. The HSRC and NMCF will work closely with the communities and their representatives to try and address limitations expressed in the delivery of services for OVC.
Executive Summary
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CHAPTER 1
Introduction
Donald Skinner and Alicia Davids
South Africa is one of the countries in sub-Saharan Africa with the highest HIV prevalence. A national study on HIV prevalence by Shisana et al. (2002) showed that approximately 11% of South Africans are living with the HI virus. The Department of Health Annual Antenatal surveys (2004) showed national figures among pregnant women to be 27.9% in 2003 and 29.5% in 2004. It is further estimated that every day about 1 700 South Africans become infected with HIV (Department of Health, 2003).
The epidemic has serious implications socially and economically. One particular consequence is an increase in the number of orphans. UNICEF estimates that currently about 11 million children under the age of 15 years in southern Africa have lost one or both parents; this number is expected to reach 20 million by 2015. According to the UNAIDS annual report (2004), by the end of 2003 AIDS-related deaths gave rise to about 1.1 million orphans in South Africa. Johnson and Dorrington (2001) further projected that if current sexual practices do not change, roughly 15% of all children under the age of 15 years are expected to be orphaned in South Africa in 2015. The statistics suggest that South Africa has to prepare for a large number of children in need of care and there is a need to develop interventions to attend to these needs. Other factors such as substance abuse, civil violence, and other diseases, also contribute greatly to the number of orphans. The state of orphanhood can greatly increase vulnerability among the affected children. Prior to the death of the parent, in the case of HIV, a child may be required to provide care for ill parents and may even be forced to leave school to fulfil this responsibility.
It needs to be recognised that children beyond those orphaned may have their lives compromised. Children may be vulnerable due to poverty, abuse, violence and many other causes. In recognition of this need the WK Kellogg Foundation agreed to fund the HSRC to lead a large study looking at the potential needs of children affected by the HIV/AIDS epidemic and to develop adequate responses.
Defining orphanhood and vulnerability
To be able to better understand the situation of children in these communities it is crucial to understand the community’s definition of orphans and vulnerable children (OVC). Current literature showed that definitions of an orphan differ from one country or context to another (Smart, 2003).
Early in the project, six focus groups were conducted across the three countries to establish a community-acceptable definition of OVC. The groups incorporated community representatives, service providers, OVC and their carers. Based on their inputs the following descriptions were accepted. An orphan refers to a child below 18 years who has lost one or both parents. This could be due to AIDS, other illnesses, violence or other causes of death.
Drawing on this research the definition of what makes a child vulnerable is more complex and focuses on contexts that centre around three core areas of concern (Skinner et al., 2004):
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• material problems, including access to money, food, clothing, shelter, health care and education;
• emotional problems, including insufficient caring, love, support, space to grieve and containment of emotions;
• social problems, including lack of a supportive peer group, of role models to follow, or of guidance in difficult situations, and risks in the immediate environment.
The situation of OVC in South Africa
By extension from this definition the situation of children is described, drawing on available information from the literature on the epidemiological distribution of the factors of concern. Evidence is drawn from the literature to describe the prevalence in South Africa of a number of the conditions that are felt to contribute to the vulnerability of children.
Orphan status and care
In line with the report on the definition of OVC (Skinner et al., 2004), drawn from the communities where the project is being done, found that the loss of either parent put strain on the child, as the loss of the mother often means loss of the direct carer, while the loss of the father puts the household in a difficult financial situation. HIV/AIDS stands out as a cause of orphanhood, in that if one parent is infected with HIV, the probability that the spouse too is infected is high (Bray, 2003). Migrant labour also constitutes a particular form of loss of a parent for a period of time while they go in search of income.
Orphans and deserted children are very dependent on the availability and quality of replacement carers for their ongoing support. With children taken in by extended families or members of the community, pressure can be put on these families due to the increase in the size of the households. The number of people per household does not provide an accurate measure of children per carer, but is a guide. According to census 2001, households of seven or more people constitute 13.9% of the population. (Statistics South Africa, 2003). Data from across Africa indicate that where the epidemic is more severe, and/or the extended family is weakened, orphaned children are more frequently cared for by grandparents. The pressure of the increasing number of OVC has seen families splitting and reforming in different ways in response to more stressful circumstances (Bray, 2003). The long-term impact of this and the capacity to sustain care still need careful monitoring and evaluation.
Of great concern is the high number of inadequate carers, including those who do not have the skills, do not wish to assume the role, or are too old or too young to fulfil the task. Many of those without the skill will have had bad role models themselves. Of particular concern is the increasing numbers of grandparents who now have to take over care of the orphaned children. While some are competent, many are too old to cope, especially with large numbers of children (International HIV/AIDS Alliance, 2004).
Illness of a parent reduces their capacity for providing care, with HIV/AIDS generally having a more devastating impact. There is also the psychological impact on the child of having to watch parents’ illness and ultimately preparing for death. HIV usually affects families long before parents die. Household incomes plummet when adults fall ill from HIV so that illness of a parent often reduces their capacity to provide care for their children, increasing the child’s vulnerability (Booysen, 2003).
Multiple vulnerabilities
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HIV/AIDS, other illnesses and disability among children
National seroprevalence figures for children aged 2–14 are 5.6%, while youth aged 15–24 are 9.3% (Shisana and Simbayi, 2002). While these are lower than the adult levels they are still high. The prevention-of-mother-to-child transmission (PMTCT) programme, if fully implemented, will reduce this risk.
Having HIV/AIDS, or being associated with the disease by being in the same household as a person with the disease, or being an orphan of someone who has died of AIDS, can raise stigma. The latter is heightened if there is insufficient care for the child after the death of the parents. The child becomes seen as a threat or an indictment by the surrounding community. Stigma can affect children in multiple ways, but in particular, they are excluded from community support, and can begin to internalise the stigma leading to the entrenchment of a highly damaged self image (Skinner & Mfecani, 2005).
Other health impacts on children include malnutrition and illness. In 1999, 21.6% of children one to nine years of age were stunted, 10.3% were underweight and 3.7% were wasted. Deficiencies in micronutrients, with implications for development, are also a common problem. (Solarsh and Goga, 2004) Diseases of threat include TB, cholera, measles, influenza and malaria. Disability among children is one area that warrants separate attention. Both physical and mental disabilities are important to consider. It is difficult here to give clear figures, as problems of definition are found again. In 1999, a survey by the Community Agency for Social Enquiry (CASE, 1999) found a 5.9% prevalence of disability in children.
Poverty
Wealth, disposable income, and other assets of the household are closely linked to child health and welfare, which would be expected to be compromised in households losing men and women at ages of prime economic activity (Bicego et al., 2003). Poverty impacts on children in that they are deprived of clothing, adequate nutrition, access to services, proper housing, etc. The impact is pervasive over time and throughout the country, although certain provinces are worse than others. Poverty affects entire communities, with children living in generally deprived contexts. The situation is worse on farms and in rural areas, which are often also more invisible. There are varying constructions of poverty, but using a straight World Bank approach of ‘a dollar a day’ (World Bank, 2000), indications are that at least 45% of South Africans live in absolute poverty (Hill and Smith, 2003). In 2002 one estimate found that 11 million children lived on less than R200 per month (Streak, 2002).
Housing does have specific implications of its own, as poor informal housing is highly associated with a range of negative health impacts including HIV infection and such residents are more likely to be disadvantaged regarding access to services (Shisana and Simbayi, 2002). Census 2001 showed that there are 1 376 706 informal houses plus 459 526 informal dwellings or shacks in backyards; this equates to 16.4% of all households. The highest levels of informal housing are found in the Free State (26.1%) and Gauteng (23.9%) (Statistics South Africa, 2003).
Access to services
Despite the national priorities of the Department of Health (DoH), Department of Education (DoE) and Department of Social Development (DSD) to ensure that particularly all children have access to services, significant gaps remain. If children are unable to
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access services there are dangers of them being less healthy, not receiving an adequate education and suffering other compromises to their development, for example, missing a scheduled clinic visit for an immunization could predispose the child to an infectious disease. One of the more consistent pieces of evidence of differential opportunities for AIDS orphans is access to schooling. Both quantitative and qualitative data from a number of African countries confirm significantly lower school enrolment rates in orphans than in non-orphans (Desmond and Gow, 2002).
Abuse of children
The abuse of children is really a specific subset related to poor carers, concerning especially those who deliberately try to extract benefit from the child, at the child’s expense. Abuse takes many forms, including sexual, physical or emotional abuse, plus abuse of grants and use of children for labour, with there being considerable variation within these categories (Richter and Higson-Smith, 2004). Official figures that do exist are certainly a massive undercount of the reality. Abuse remains one of the most devastating events for children and the impact of this can last throughout their lives. While this does not always occur within the family, the family does remain as the most likely site of abuse.
Child prostitution and survival sex constitute an additional form of abuse or area of vulnerability for children. Children may be forced by poverty into exchanging sex for money in order to survive (Perschler-Desai, 2001) or may be forced by gangs into prostitution (Molo Songololo, 2000).
Violence and substance abuse in communities
The principle problems of violence in communities relate to crime, the presence of gangs, community and political violence, sexual violence and also domestic violence (Standing, 2003; Anderson and Mhatre, 2003). Gender and domestic violence constitute a particular problem as the impact of this is felt directly in the homes and is witnessed and experienced directly by children. Problems are accentuated by the acceptance in many communities that this is normal and the inadequate responses by police, although the latter is being addressed within the SAPS (Jackson, 1997).
Substance abuse has been, and is, a consistent problem across South Africa. The problem of excessive alcohol use is well established (Parry, 1997), but there is evidence of large increases in the use of illegal drugs (Leggett, 2001; Ryan, 1997), especially with the opening of the country’s borders following establishment of democracy. If the carers themselves are abusing substances, it heightens the problems for children as resources are wasted and the caretakers are often out of the house and incapable of providing care.
Overall vulnerability of children
Many of the factors contributing to vulnerability in children overlap. So if a child is vulnerable in one context, they are more likely to be vulnerable in other contexts. Thus, children who have lost their parents to HIV are also more likely to become part of a household that is overcrowded and poor. In turn they are more likely to be subjected to stigma and disease themselves. These contributions cannot simply be summed using an arithmetic basis, but compound the problems and obstacles for children to find safe spaces for healing and integration and to allow for the development of coping strategies. The actual impact of orphanhood as a result of HIV/AIDS, plus the other sources of vulnerability, need to be thoroughly examined.
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CHAPTER 2
Background and aims of the projectIn 2002 the HSRC received funding from the Kellogg Foundation to develop and implement a five-year intervention project on the care of OVC, as well as households and communities coping with the care of affected children in Botswana, South Africa and Zimbabwe. The project comprises two components, firstly funding and technical assistance directed at interventions to assist OVC and secondly research to develop a better understanding of the situation of OVC and towards the development of best practice approaches for interventions. The HSRC is collaborating with research institutions in Zimbabwe and Botswana and with non-governmental organisations (NGOs) that would act as implementing partners for the interventions. In South Africa, the Nelson Mandela Children’s Fund (NMCF) was chosen to work with the HSRC as an implementing partner.
As an implementing partner, the NMCF works with, and directs project funding to, various community-based organisations (CBOs) and faith-based organisations (FBOs) in the intervention areas to deliver necessary services to those who need them. The project will also work in partnership with all levels of government in each country, as well as with the local communities at the various sites to ensure that the intervention programmes continue after the project officially ends in December 2006.
The ultimate goals of the project are to develop, implement and evaluate existing and/or new OVC intervention programmes to develop best practice approaches that will: • improve the social conditions, health, development, and quality of life of vulnerable
children and orphans;• support families and households coping with an increased burden of care for
affected and vulnerable children;• strengthen community-based support systems as an indirect means of assisting
vulnerable children;• build capacity in community-based systems for sustaining care and support to
vulnerable children and households, over the long term.
Certain research tasks were also undertaken as part of this project. The first was to conduct a situation analysis that would identify services already available in these study areas, identify their strengths and weaknesses and suggest ways of strengthening them. This was followed by the baseline research, including qualitative interviews, a census survey and a directed survey of OVC at this site. This information informs both intervention plans being developed to assist OVC and indicators for monitoring the interventions. At the end of the project the baseline research processes will be repeated. This, together with process evaluations, will be used to assess the effect of the interventions. This report is concerned with the qualitative research component, which took place between 2003 and 2004.
Aims of the research
Qualitative research was conducted primarily to seek the views of the residents of Kopanong and Kanana about the general living circumstances of OVC, the levels and impact of HIV/AIDS, social problems present in the community, and the services available to address the needs of OVC as well as of the general community. The latter included government and non-government services. Secondly, this process also served as an entry into the field. Through interactions with key stakeholders and certain community
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members, researchers sought to create an atmosphere conducive for the subsequent survey and interventions.
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CHAPTER 3
MethodologyThe focus of the qualitative research was on semi-structured interviews with a diverse range of participants, but additional information was obtained from observations while in the field.
Semi-structured interviews
Semi-structured interviews were guided by an interview schedule that was developed on the basis of the objectives of the study and agreed upon by all researchers from the three countries. The aim of the interview schedule was firstly, to ensure similarity of issues discussed in all interviews and secondly, to ensure a certain amount of control over issues discussed with participants. However, participants were also encouraged to explore other issues that were outside the guide as long as they were still relevant to the overall project. This resulted in the discovery of additional content areas that were later followed up and incorporated into subsequent interviews and discussions. All interviews were tape-recorded and later transcribed. Some were conducted in English while others were conducted in indigenous local languages, particularly isiXhosa, Afrikaans and seSotho.
Research instruments
The complete interview guide used to gather the data can be found in the Appendices. The items of the guide were adapted and varied according to the person being interviewed, and the interviewer could introduce new items if these appeared important in the context of the interview. The discretion about where to place the emphasis during the interview was left to the interviewer, but the key items that needed to be covered were: • The living situation of OVC, including care, access to services, housing and nutrition
etc., ranging from those in the worst conditions to those who were better off.• The extent of HIV/AIDS as a problem in the community.• Personal knowledge, beliefs and behaviour in relation to HIV; behaviour in question
was not only sexual behaviour, but also support and advocacy – the prime target of these questions was the informant themselves, but they were also asked to reflect on the general situation in the community.
• Attitudes of the community and carers towards OVC, especially incidents of stigma and discrimination, as well as violation of human rights of those living with HIV/AIDS.
• Challenges in caring for OVC.• Policy and legislation for the protection of OVC.• Initial evaluation questions about the implementing intervention organisation
in the sites.• Major sources of information on HIV and AIDS.• Challenges in protecting themselves from HIV.
Sampling method
Participants were sampled purposively to select key informant interviewees based on their involvement in OVC and HIV-related work and their experiences of either caring for OVC or being an orphaned / vulnerable child themselves. Other categories of participants (community members and community leaders) were selected on the basis of their knowledge of community issues and involvement in community development initiatives.
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In South Africa interviews were carried out with representatives from local government, NGOs, OVC, OVC carers and general community members and leadership. The emphasis was first on selecting OVC and secondly, their carers, but it was often difficult to contact and establish these interviews. Purposive sampling was used to ensure an adequate distribution of respondents in the study. The number of interviews decided upon also depended on the size and distribution of the target communities, the number of NGOs in the communities and OVC-related state services in the region.
Sample Kopanong
The sample in Kopanong consisted of 30 interviews. The breakdown of participants were as follows:• Seven government officials from the: DoH; DoE; Department of Agriculture;
DSD (three) and the Kopanong municipality.• Five Non-governmental Organisations: Oranje Vrou Vereeneging, Philani Victim
Support Centre, Lekomo HIV/AIDS Consortium; Bokolokong HIV Support group, Bokomoso HIV Consortium.
• Four community members: the participants in this category included youth and adults based in Kopanong referred to the research assistant as possible interviewees by our contact people in their towns.
• Four community leaders: community leaders representing five towns were selected on the basis of their availability and willingness to share their opinions about the research topic. Due to limitations in sample and vastness of the municipality, leaders from all nine towns could not be interviewed.
• Six carers based in Philipolis (four) and Springfontein (two): they were also selected by the research assistant who was familiar to them, based on their willingness to share their opinions on the project. Three of the carers cared for children whose parents died of AIDS–related illnesses.
• Four OVC (three orphans and one vulnerable child) from Fauresmith, Philipolis and Trompsburg. Originally 10 interviewees were selected, but many refused to be interviewed or were too young to go through the research process. Replacement interviews were sought, but problems occurred here too.
Sample Kanana
Thirty-six respondents were interviewed in Kanana. The specific interviews were conducted with:• Eight staff or officials from various governmental departments or agencies, including
clinics and schools.• Nine participants from NGOs or CBOs working with OVC namely: Child Welfare,
Diocese, Hospice, Imbizo Service and Bread 4 Support, KOSH Care and Support Group, Ondersteunings Raad, Philani Health Care Centre, Sizanani Educare Centre, Suid Afrikaanse Vroue Federasie.
• Seven community leaders, in particular two traditional healers who were involved in either NGO activities or government initiatives.
• Five carers of OVC, who were drawn from extended families, foster homes and shelters.
• Seven OVC.
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One focus group interview was conducted. Stakeholders included OVC, persons giving care to OVC, non-governmental organisations, and government officials. The focus group was conducted by a facilitator who was supported by a co-facilitator, in order to ensure that the group ran as smoothly as possible.
Observations
In addition to formal interviews, data were also collected by means of observation when visiting the communities. We paid particular attention to housing structures, nature of roads and accessibility of each town, levels of poverty, commercial activities and other issues relevant for a better understanding of the context. Some interviews took place inside households, so the living situations inside the house could be observed. Data collected through observation was recorded by means of note taking.
Analysis
A thematic content analysis method was used to identify the major themes and discourses that emerged from the transcriptions. For the analysis of the Kopanong data, Atlas ti was used. Quotes that were considered representative of the analysis were selected. These also allowed the community members more of a voice. Names and identifying details were changed to protect informants where necessary.
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CHAPTER 4
Qualitative Report of OVC living conditions and services in the Kopanong Municipality, Free State province
Sakhumzi Mfecane, Donald Skinner and Alicia Davids
Xhariep district is composed of three local municipalities, i.e. Kopanong, Mokohare and Letsemeng. Kopanong is the biggest of the three municipalities with a total population of 55 942, followed by Letsemeng (42 979) and then Mokohare (36 316). Xhariep district has a total of 17 towns and nine of them fall under the Kopanong local municipality. These are Trompsburg, Edenberg, Reddersburg, Springfontein, Gariep Dam, Jagersfontein, Fauresmith, Bethulie and Philipolis. Bethulie is the biggest of the towns, with a total population of 12 374 and Gariep Dam has the smallest population size (1179). In terms of spatial occupation, Xhariep district is regarded as the biggest in South Africa, yet it has the lowest population density in the Free State province. The district covers an area of 34 131.55 km2, but has a population of a mere 124 000 people.
The majority of the Xhariep population are African, followed by whites, coloureds and Indians. Children (<18 years) constitute 33.96% of the population and 34.35% are youth (18- 39), followed by middle-aged, 27% (40-64) and then elderly 6.71% (>64). Although elderly people form the minority, many children rely on them for support since many of the young people are unemployed or have died.
Table 1: Ethnic composition in 2001 compared with the average for the district in 1996
Area African Coloured Indian White
Kopanong 72.52% 17.83% 0.04% 9.62%
Letsemeng 64.99% 25.26% 0.04% 9.71%
Mohokare 89.33% 2.92% 0.02% 7.73%
Xhariep 2001 74.64% 16.19% 0.03% 9.14%
Xhariep 1996 72.92% 11.17% 0.07% 12.19%
Source: Stats SA (Census 1996 & 2001).
The majority of Xhariep residents have access to basic amenities. For example, clean water is available to 91% of residents (IDP Xhariep, 2003). The source of water depends mainly on the housing arrangements. For example, residents of informal settlements use communal taps, which are available within a distance of 500 metres. Residents of formal houses, on the other hand, make use of onsite taps, which may be either inside or outside the house. Housing arrangements exhibit the national trend, whereby whites
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predominantly occupy towns, while Africans and coloureds mainly dominate townships. Coloured residential areas are also separated from those of the Africans, although the distance between them is not far. The illiteracy rate for the district is 22.74% according to Census 2001 (Stats SA, 2003). This has shown an increase of 1.33% since 1996. Table 2 provides a breakdown of education levels per municipality for 2001.
Table 2: Education levels for persons 20 years and older, 2001
Area No
schooling
Some
primary
Complete
primary
Some
secondary
Grade 12 Higher
qualification
Kopanong 20.94% 25.12% 8.52% 27.74% 13.02% 4.66%
Letsemeng 25.25% 26.16% 7.85% 24.32% 12.40% 4.02%
Mohokare 22.61% 30.40% 8.64% 22.54% 11.13% 4.67%
Xhariep 22.74% 26.86% 8.34% 25.28% 12.32% 4.46%
Source: Stats SA 2003.
As can be seen, the majority of people in the district have some primary school education, but less than 9% have completed it. Less than 5% have an education beyond grade 12, while only 12% have reached grade 12.
Geographical context
The community is difficult to work in due to the large size and the distribution of the population across nine small towns. This is exacerbated by undeveloped road infrastructure. Although the district is easily accessed through the national road and other main roads, travelling within this district from one town to the next requires driving on gravel roads. For residents of the Kopanong municipality, access to different towns is further restricted by a lack of public transportation. They rely on taxis travelling to Bloemfontein, which are unreliable and expensive. Other options are hiring a private car, which is even more expensive.
The difficulty of driving long periods of time on gravel roads has implications for service delivery by both government and NGOs. For example, social workers do not have quality time to monitor the well-being of the children that they have placed. They reported spending more time driving to certain places than attending to the needs of children. Motor vehicles commonly broke down due to the poor quality of the roads. These conditions discouraged service providers, for example doctors, from working in the district.
But the biggest challenge in this district is the big size of the community, the vast area, the vastness of the area. For instance, for me to move from here in Koffiefontein to Smithfield the other sub office it’s a two hours drive, and if you drive for two hours within the same district it’s too much. That is one big challenge (DSD representative).
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Figure 1: Map of the Kopanong Municipality
Source Municipal Demarcation Board (2004) http://www.demarcation.org.za
Farm workers constituted a particularly difficult group to access. The majority are uneducated and uninformed about certain government services available to them, so very few are aware of the government services aimed at assisting OVC and their families. Efforts are required to extend services to these residents. Currently DSD has no staff that focus specifically on farms. All are based in residential areas around towns. Other departments also need to attend to the situation of farm residents. For example the Department of Home Affairs can help with acquiring identity documents, which can help facilitate the grant process.
The second major problem resulting from the vastness of the district is accessing OVC living on the farms. These are spread out over the whole district, there is little prior information available on each farm, each farm has to be visited and the farmer negotiated with separately and it is difficult to contact people in advance of a visit. There are farms that are so difficult to access. So much so that when you go to those areas they don’t know anything about HIV/AIDS and on top of that some of them are infected already. People are not informed because of their areas (DSD representative).
Economic situation
Kopanong Municipality makes the largest contribution to the total Gross Domestic Product (GDP) of the district (42.41%), followed by Letsemeng (29.84%) and Mohokare (27.75%) Municipalities (Xhariep District Municipality, 2005). The economy of the district is dependent primarily on agriculture, which contributes 35.91% to the GDP of the district, followed by government (16.17%). Mining contributes to the GDP by 6.35%. The dependence on agriculture means that the economy of the district is at risk due to the decline of the agricultural sector in the past few years. A long drought and the rise
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in costs of farming as well as competition from international markets contribute to the decline of the agricultural sector.
The economic situation was reported to have been made worse by the fall in profitability and closure of many of the gold mines in the district. The economy of the area has been reducing in size over the last few years. Central to this is the recession in the mining industry. The gold price has dropped considerably from when these mines were originally developed and the gold reserves in the mines are running out. The collapse of the mining industry raises further problems, for example, most of the migrant labourers left the community when they lost their jobs, many leaving families behind without support. The female household heads often have to look for employment in the nearest major cities, such as Johannesburg and Bloemfontein. Once there, it is difficult to find jobs due to lack of skills and low levels of education. The representative of the municipality interviewed noted that the retail sectors in the community offer limited employment and have to operate off a very limited base of income in the community. Unlike other towns in South Africa, informal trade, whether in the form of food, clothes, etc., does not exist within towns except during the periods of grant payments and other similar points of income, when products can be sold to the recipients.
Poverty and unemployment
Poverty and unemployment are evident from the numbers of people who are hanging around in the townships during working hours. Most of them were reported to spend their time in shebeens that sell cheap alcohol. Unemployment has mainly resulted from the deterioration of the mining industry that provided the bulk of employment for the majority of men. Many people lack skills required for employment because of lower levels of education within the district.
The municipality reported that there are currently programmes within communities aimed at alleviating unemployment and providing some form of support for the families affected. Community leaders try to initiate certain job opportunities, though on a short-term basis for a limited number of people. The community leader of one of the towns gives an example:
I gave work to a 175 people, and I’ve got 210 that are still unemployed. And I’ve got another project, a sewer project. And they are going to electrify 185 houses. So I will be sharing these two projects to the other unemployed people. I hope, if those are finished, that there will be something in the pipeline. (Community leader, Springfontein).
In other towns similar programmes are taking place.
We have a lot of projects like the [inaudible] stadiums, presently being built, the community hall … Or also building of those houses (government- funded RPD houses), people get jobs and houses are being built. Up to this far I can say there is plus minus 300 houses locally, just locally. (Community leader, Edenberg).
Unfortunately these interventions are short-term; they are not sustainable and do not reach many people. There is a need to create job opportunities that are more sustainable but this is also difficult in a semi-urban district. The local municipality is also engaged in various
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activities aimed at helping the poor. There are certain projects led by the municipality, including poultry, bakery, etc., but some of them collapse due to lack of business skills and greediness, which results in the improper use of money. There is a need first to train people about financial management and accountability before giving them money.
Government departments felt that the high rates of poverty impact negatively on their ability to effectively provide services for those that need them most. Since many people are impoverished and services are limited, it becomes difficult to provide services to all. This sentiment was clearly expressed by the service provider from the Department of Agriculture (DoA).
Basically, there are a lot of poor people outside here, jobless people you know, and we haven’t got all the funds to assist each and everybody. We would like to give each and everybody in town a backyard garden, but we haven’t got the finance for it. Funding and manpower is a problem. (DoA service provider).
There were also complaints that even those who are better off want to benefit from poverty alleviation programmes. Rumours existed that certain teachers received government grants aimed at the poor. Others accused government representatives of being corrupt by assisting their own people and showing nepotism. In a community where the majority are poor, it would certainly be difficult to determine who is most at need, but systems could be developed to detect those that abuse the systems of support aimed at the poorest.
Situation of youth
The majority of young people were reported to be unemployed and living within their family households where they are dependent on either parents or grandparents for financial support. According to a government representative, a key problem faced by young people in Xhariep is lack of support to study at tertiary level. Some pass grade 12, but due to lack of financial support and limited access to knowledge about studying further, they are unable to proceed. There is a need to increase awareness amongst youth about study opportunities. One government representative, however, felt that there are many opportunities that they as a department offer, but the young people are not making use of them.
Our Department is more on food parcels, when I was having a meeting with the youth, they were not aware that we could give them food parcels. In some areas, it (the department) needs to be marketed so that people can be aware. (DSD representative, Jaggersfontein).
A further key problem experienced by youth and young adults is the lack of job opportunities. The Kopanong municipality is a secluded area and access to information is very scarce. Many people rely on television and radio to be informed about certain opportunities, but it is difficult to follow up the information due to lack of access to resources, for example, transport, fax machines etc. The assessment given by a number of staff from DSD is that unemployment leads to increased substance abuse and to feelings of incompetence. Over time, the youth will loose even the skills that they gained at school as there is no context within which to use and apply their knowledge.
Crime
Lack of recreational facilities and non-involvement in activities further contributes to the problem of youth inactivity. Everyday young people are seen in the nearby shebeens
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consuming alcohol because they have no other forms of entertainment – this practice is in fact predominant in many parts of South Africa where unemployment is rife. The end result of inactivity and drinking is involvement in socially unacceptable behaviour, for example, crime. Although serious crimes are uncommon in Xhariep, minor crime such as petty theft, assault and burglary occur. Use of illegal drugs also happens, although not on a wide scale. There are a number of incidents of sexual crimes, including rape of both adults and children. According to a social worker in the DSD rape of children is the most common.
The motivations for crime are essentially poverty, but also include youth trying to find some entertainment and release from the sheer boredom of their lives.
In some cases it’s peer pressure, hey, and in some cases it’s just naughtiness, or maybe the child wants to experiment … what if I do this, I can do this. In some cases he’s bored because you find this child at home. The circumstances … the parents are unemployed and … you know these children of today, they are … they’re exposed to luxurious things. Like if a friend has a cellphone and he doesn’t have … he’s unable to accept the family’s poor background and he wants that cellphone, so if it means he must go and steal that cellphone to have it, he will do that. (DSD representative, Jaggersfontein).
The DSD runs a programme for children who have been detained. These children are offered diversion programmes and then follow up. The diversion programme is once a week for six weeks. Having completed this, the social worker can go to court to ask that the case be withdrawn. This has been well supported by the community where it is understood. Initially there was a lot of fear, particularly amongst the youth themselves. Some try to run away when they see the social worker coming to visit them. The programme is overloaded and there are problems in reaching all the children due to the distances involved and the poor quality of roads between many of the towns.
Pregnancy
Pregnancy is an additional problem among the youth, indicating that there is low usage of any contraception, including condoms. Participants were concerned that youth engage in sexual intercourse at very young ages and that they do not take good care of themselves in these relationships.
Situation of HIV/AIDS
The general perception of respondents was that the rates of HIV/AIDS in Xhariep are very high. From comments of participants it became clear that HIV/AIDS is no longer seen as a distant reality.
No, I can tell you, in this town it (HIV/AIDS) is a lot. Last time when we got the report from the clinic, they just said that the HIV status in our community is very rife. (Community leader, Edenberg).
Within the district there are specific areas that are singled out as being exposed to higher risks of HIV/AIDS than others. These are areas either closer to the national road, the N1, for example, Springfontein, or those with mines, for example, Jagersfontein. Singling out certain areas as being riskier for HIV/AIDS is dangerous in that this could create a false sense of security amongst those who do not reside in these areas. It could also contribute to stigmatising attitudes for those who live in these high-risk areas.
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It’s a big problem … we have areas like Jagersfontein, there’s an area in Jagersfontein where it’s quite rife, Springfontein ja, I think it’s Springfontein number one. And the reason for that is that in Springfontein you have, it’s on the N1, the Springfontein, you have trucks coming in and out the area. (DSD representative, Koffiefontein).
During interviews, several participants shared personal stories about people intimate to them who they knew to have either died of HIV/AIDS or who are currently infected. Throughout our fieldwork other people also talked about people they knew who were either infected with, or had died of, HIV/AIDS. Some carers disclosed openly that their dependant’s biological parents died of HIV/AIDS. Others talked of people they knew within the community.
There is my daughter that has passed away, there is a old lady up the road whose child died, another lady not far from here whose daughter died, the two people I mentioned before, that makes it five. Plus a granny over there on the small farm, which makes it six and my brother’s child, which makes it seven. Who else … my brother’s wife’s’ sister which makes to eight. And two other uncles whose daughters died … that is ten people that I know of which has died as a result of HIV/AIDS. And if you notice its almost just daughters that are dying. Here is a lot, a whole lot and many of them have died already, here is one at the farm, he got sick had to take medicine and his girlfriend saw how sick he was. (OVC carer, Philipolis).
Knowledge of HIV/AIDS
Among the general population, knowledge about HIV/AIDS was felt to be generally sufficient for people to be able to take precautions, but many would still rather take risks. Participants felt that the knowledge and acceptance of its implications had not become part of the community framework. This general acceptance of unsafe practices puts distinct limits on people using safer sex practices.
It’s a question of, I don’t know I’ll be right to say, culture, our way of doing things. We are used to the old habits and we just do not want to part with them. So this is where moral regeneration comes in. (Community member, Reddersburg).
People are still … they don’t use the condom anymore, they … there are some people who are sceptical that HIV is here. Maybe it’s question that if you meet a new partner you want to go skin to skin on the first, you see … you need to enjoy. But they are not aware of the dangers … they are aware of the dangers but some … they take chances on themselves here. They will get upset or they will get scared when he sees someone who is HIV positive … he’s now going to take into consideration AIDS truly exists. (Community member, Reddersburg).
The nature of the risk behaviour, especially among young people, was shown in this response from an NGO support group:
I think HIV is a great problem in our community because why the youth they’ve got a bad habit of using alcohol. A child from 14 years using alcohol, even lower than 14 years, they’re using alcohol. And whenever they’re drunk they’re really, they’re really, really reckless with their lives. Everybody is coming and especially let me say like places like our community where it’s a small place where we haven’t got like
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you’d say resources like mines and factories and so on. Those people, whenever there’s a new face in our community they are after that somebody. And when that somebody is now committed with, let me say involved with that person, that person is going to sleep with her, after that coming back again, take another one, there’s something like that. (Bokolokong HIV Support Group representative, Fauresmith).
So far even being aware of people dying from AIDS appears to have done little to influence behaviour change among the general population. There were also reports of certain people in the community that want to deny the existence of HIV, and would rather turn it into a joke. This is becoming a serious issue as more and more people, including youth, are dying.
I don’t want to say that really people don’t know about AIDS, it’s just that uh, there are some people that … say mickey mouse things of sort, uh a joke of some sort and they are realising it now because people. (Municipal representative, Trompsburg).
Factors contributing to HIV/AIDS in the Xhariep district
The reported high incidence of HIV/AIDS in Kopanong prompted further questions regarding factors that contribute to the problem in the district. Unemployment and poverty were felt by local health and social service providers to underlie most of the risk issues. Additional factors that raised concern include gender violence and discrimination, substance use/abuse and prostitution. Although these issues will be discussed separately they are often interlinked.
Substance abuseIn the views of participants, alcohol abuse was rife in Kopanong and both elders and younger residents abused it to unacceptable levels. Alcohol abuse is exacerbated by the prevalence of many shebeens that sell affordable alcohol even to young children. Shebeen owners do not observe the age restrictions in selling alcohol. As stated above alcohol and shebeens have become a focal point for entertainment due to lack of alternative forms of enjoyment within the community. Shebeens are also equipped with jukeboxes, which increase their attractiveness to young people. On weekends and after school, young boys and girls are seen in local shebeens playing pool and drinking mainly cheap alcohol with nothing else to do.
Participants felt strongly that there is a close association between substance abuse and HIV/AIDS. Alcohol made young people easy targets for men seeking sex, while some parents neglected their children due to drinking.
You find a lot of girls, specifically young girls that drink … and they actually sleep around to get alcohol and it happens a lot. Parents drink too much and the children walks around hungry and dirty. (OVC carer, Philipolis).
I think so because alcohol is a major thing leading to HIV/AIDS. We know each other here, it is a small town and there are sometimes allegations say for example they say there is this person who has AIDS but then once you are at the taverns you don’t even think this person has HIV, you just regret tomorrow that you slept with someone without using a condom. And even there ladies here in Bethulie when they are drunk they are easy and it is whereby the rate of AIDS is becoming high. (Community member, Bethulie).
Asked about possible interventions to address the problem of alcohol abuse, some participants felt pessimistic and said that as long as the prevailing social circumstances
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exist it will be difficult to deal with the problem of alcohol abuse. Interventions aimed at reducing alcohol abuse and subsequent HIV exposure should be holistic and try to address underlying causes of alcohol abuse, rather than targeting it directly as it is linked to factors beyond the immediate control of an individual.
There is not much they can do here because this is a rural place and there are not places we can entertain ourselves. We are only going to the taverns drinking and you see and by going there rate of crime is going up and the rate of HIV is going to be high. This HIV/AIDS we are getting there, so there are no places to entertain ourselves, just the taverns. The rate of crime is going up because we are drinking too much, there is no way, no place to go. (Community member, Bethulie).
Gender violence and gender discriminationParticipants alluded to gender-based violence as one of the contributors to HIV/AIDS. Domestic violence, in particular, was said to be common and participants felt that it had a negative effect in the community. Conversely, beliefs about a woman being HIV positive may result in gender-based violence.
Ja, that one (gender violence) is a problem. That one is really, really a problem. That domestic violence, I’ve got a lot of cases. The cases are too much at the police station. They always give me statistics at the police station. It’s a lot, and there, you also need a lot of awareness. They are for women and men, because most of the time women are abusing the man, or the man is abusing the woman. It is also too much to talk through now. They fight and my fear is that it affects the children, because if you have a boy and girl in your house, the boy will take it that this is something good because my father is always beating my mother on weekends, you see. And children grows up seeing those things, tomorrow he will think that it is something good. If we don’t try to do the awareness now, you see, it will remain a problem. (Community leader, Springfontein).
People should be made aware of gender based violence even though it is often difficult to address as it is viewed as a private matter that tends to happen indoors. This contributes to silence and non-reporting of incidents of violence. The service provider below recognizes the connection between gender violence and HIV/AIDS:
There’s no way you can separate the gender-based violence and HIV/AIDS, you know. Because we as women, we are the most vulnerable people, right, and the next thing because we can’t speak out and say anything that’s why we are so vulnerable. (NGO representative, Trompsburg).
ProstitutionIn the context of Kopanong, the majority of young people are unemployed and where job opportunities are minimal, the practice of sex for gifts is more likely to occur. Employment is an advantage and therefore men who are employed may use their sought-after status to attract women who badly need financial support. In shebeens, it was common for women to associate with men who were employed who could buy alcohol for them. In return it was common for men to demand sexual favours if they buy alcohol for a woman.
As pointed out earlier, Springfontein and Jaggersfontein were singled out as having more cases of HIV infection compared to other towns. Springfontein was singled out particularly because of its association with the practice of prostitution by young women, who were said to exchange sex for money with truck drivers who stop at a garage to rest. Other
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towns such as Gariep Dam Trompsburg and Edenberg are also situated close to the national road, but it was in Springfontein that most of commercial sex took place.
And the reason for that (high rates of HIV infections in Springfontein) is that in Springfontein you have, it’s on the N1, the Springfontein, you have trucks coming in and out the area. (DSD representative, Koffiefontein).
The trucks can come in, but our ladies must not die, because some of them are saying that they can’t get jobs, they are hungry and they have to go the trucks. What is the use you go there? Have that relationship, it’s not a stable one, but after a few years, or two, three years, she gets sick and then? She is a burden. To whom: to the granny. You see, the granny gets a R700, R740, you see? What is the use, it’s better to keep yourself safe, you see, stay in the house. I always say to them, if you stay in your mother’s house, there wouldn’t be problems. (Community leader, Springfontein).
Prostitution is difficult to address in these communities since it is still practised clandestinely; many people know about it but very few are willing to discuss it. One informant denied its existence and said it was an attempt to tarnish the image of his town.
As the last quote illustrates, poverty is a key factor driving young people to engage in prostitution, often without condoms. Survival sex involves a process of having sex with someone in exchange for gifts such as food or alcohol. This practice is common and it is particularly attributed to poverty and unemployment experienced in the area. Women, in particular, have limited chances for employment, which results in reliance on men for financial support. Participants in all categories acknowledge that survival sex is common in Kopanong and that it increases the risks of acquiring HIV/AIDS and other sexually transmitted infections (STIs).
I mean, it’s a given point that if I’m struggling, if I don’t have something to eat, there are some, for instance, some sort of last resort. They can resort to a method like prostitution, not necessarily prostitution. To people it’s an unofficial prostitution. (Community member, Reddersburg).
This participant provides a better description of survival sex:
Like when you are involved with someone who is working, and that person is taking advantage, he’s not necessarily in love with you. So that if they want to survive, I have to get involved with someone so that person can be able to give me things. Sometimes you’ll find that it’s a lady from Fauresmith go out and work maybe in Bloemfontein. Now when they come in Bloemfontein so now they have a nice boyfriend, she falls pregnant, and from there she comes back home, when she come home here, jobless. When she’s jobless, she’s asking how am I going to obtain money and what am I going to use. Now they go out searching for Mr Big Bucks, they’re searching for Mr Big Bucks and so on. (NGO Support Group).
Context of people living with HIV/AIDS
Incidents of stigma and discrimination were reported against people living with HIV/AIDS (PLWHA). Participants had mixed feelings regarding the community’s attitudes towards PLWHA. At personal levels they expressed great concern and support for those living with
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the virus, but felt that the community at large has not been accepting of them. It was felt that at home and the community, people living with HIV/AIDS were still perceived and treated negatively. Others, however, felt that this was beginning to change.
I think the communities are beginning to change. I think it is beginning to change from that stigmatisation to sensitive and caring, ja. I’m saying this because you’ll find people coming to report that, man this is situation in that house and I think it’s because of HIV and AIDS you know that way people are sensitive. My fear is or concern is that it is those people living with the virus themselves who now begin to stigmatise themselves. They also begin to, for fear that people are going to laugh at me they hide. (Community member, Bethulie).
People were saying, ‘but where is this food going?’ and they were told, those food are for the victims, you know, and the people that are really in dire need. People were starting to discuss. One person, uh, started talking badly about HIV/AIDS you know. He was actually called to order by members of the public. (Community leader, Bethulie).
It appeared that initially people only took HIV/AIDS seriously if it affected a member of their family, but it is becoming far more generalized now. People have begun to realize the seriousness of the epidemic, and by now most families in the district have been affected either directly or indirectly by HIV/AIDS.
A major concern raised by participants regarding the context of PLWHA was their unwillingness to disclose their status. Service providers felt that this was limiting them from providing appropriate support for them. They were almost desperate to get HIV positive people who would openly disclose their status to the other community members, as they felt this would solve a lot of the problems around stigma and disclosure.
One thing that we are trying to do now at this present moment that if we can get a person who discloses then we can come out with a support group where they can come together and discuss their problems. And one thing, if a person doesn’t openly disclose, he or she will isolate herself from the people from the outside world, ‘no I’m HIV positive now, I can’t go to somebody and talk to him, no you’re my friend like before’. Ja, he or she isolates herself. Now the problem is if we can get only one person to disclose. (DSD representative, Koffiefontein).
Community representatives share the same sentiments, but said in their communities none of the HIV positive people have openly disclosed their status. It is kept confidential until one dies. Fear of negative reactions from the community was also expressed in this comment:
From my knowledge I would say no, I don’t know a specific person who just stands in the community and say, ‘I’m positive’. You only see people who are dying then you suspect these are some of the symptoms of the HIV but I never saw someone who said, understand, within our community and saying, ‘I’m HIV positive,’ I’m going to take some measure to educate you people because the fact that if he disclose his status, or our status he’s going to be the target of people. People are going to ignore him; people are going to rebuke him. (Community member, Reddersburg).
Non-disclosure of HIV status is a national problem. It is not exclusive to the Xhariep district. In a small district like Xhariep, non-disclosure of HIV status may result from a fear that many people might be aware of the HIV status of a person since people are known to each other and they may thus treat the person badly.
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Fear of HIV disclosure is moreover reflected in an unwillingness of communities to undertake voluntary counselling and testing (VCT), as expressed by health service providers. One of the counsellors based in clinics that provide VCT attributed this reluctance to fears of the breaking of confidentiality amongst the general population, due mainly to closeness of members of the community. There seems to be a mistrust of service providers regarding their ability to maintain confidentiality about HIV status. All people are familiar to each other, so there was a concern that service providers may leak the information about one’s HIV status to the entire community. A community member whom we interviewed also echoed these sentiments.
Ja, the problem is nê, that they raised is that if they have themselves tested you see, is that the person who is going to test them and give them the results then he or she will talk about it to the community you see … they have that fear of others. Others said that it is better to go outside and be tested and come back knowing their status from outside. (Community member, Bethulie).
A community leader who felt that service providers in general were positive towards PLWHA contradicted the above concerns.
Sisters are treating them well, because some of them would talk to me, because sometimes when I have community meetings, I explain to them, and ask them how is the treatment. Some of them would talk to me, you see, outside, not inside the hall. But so far, I didn’t get any complaints from some of those HIV positive people. (Community leader, Springfontein).
She said PLWHA tend to have internalised stigma, which makes them unwilling to interact with other members of the community, some of whom might in fact provide assistance as shown below. The quote below also shows the level of confusion about HIV:
I was supposed to have a meeting, and I tried to help her (an HIV positive person), and she said to me, ‘no, don’t touch me, because I’m HIV positive, and I see that you don’t have gloves or something’, we were looking for a plastic, ‘so leave me just like that, I’m HIV positive’. And I said to her, ‘Ah, are you really HIV positive?’ she said, ‘Yes, that’s why I said that you must not touch me’, and I said to her, ‘Okay, you must go to the clinic so that they can have your name there, it’s secret, at the clinic the information is closed.’ (Community leader, Springfontein).
A discrepancy between stigma and actual attitudes of community members towards PLWHA might be due to silence around HIV in families and the community. HIV is not talked about, so it is difficult to know what other people think about it and about those living with it. PLWHA thus assume that ‘others’ will treat them negatively if they disclose their status. There is a need to create forums in which people can talk openly about HIV/AIDS. This can encourage those living with it to disclose their status (to family, community and service providers) if they realize that the community’s attitudes are positive. It is also necessary to check what community attitudes are in reality, as they may present a less discriminatory perspective than is true, because they thought this is what the researchers wanted to hear.
HIV interventions in Xhariep district
HIV interventions in Xhariep district do not seem to reflect the magnitude of the problem as expressed by participants. For example national campaigns like LoveLife, which focus predominantly on youth, do not exist in the district, not even posters. Even NGOs/CBOs
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that operate in the district have HIV as an attachment to their programme rather than a priority. Although the Xhariep municipality acknowledges the problem of HIV/AIDS, there are no clear plans to address it in their Integrated Development Plan (IDP) for the district, which guides all state service delivery for the period under question.
CBO representatives also expressed concern for lack of community-based educational programmes, which they said are necessary to increase levels of knowledge within these communities. They said education focused mainly on people who were accessible through institutions, for example, clinic attendants and those contacted through the home-based care programmes co-ordinated by the DoH. School-going children, on the other hand, said they learn about HIV/AIDS from school, but this is also offered on a limited scale.
A need to provide more education was supported by community leaders.
They should also be educated. There should be HIV education even in our schools, even in our families, everywhere, everywhere in the community. Because this … truly this thing is taking a toll on our country. (Community leader, Edenberg).
Another participant felt that clinic handouts are not sufficient in educating people about HIV/AIDS. There is a need for human contact where people can be given the chance to engage on this issue.
Ahh, sometimes you see, at the clinic they would talk about the AIDS, and give handouts, you see. So that when they came at home, they must re-touch on it. What it’s done, you had to be honest, and that’s all. The clinic talked about that, to give them handouts and then it’s finished. (Community member, Bethulie).
One suggestion was that door-to-door visits were required to educate the community about HIV/AIDS and its effects. Given the smallness of towns, they felt this is possible to achieve.
Because in door to door, you will be speaking to people directly. Although finally the decision will lie with you as an individual. But at least with door to door we will be speaking person to person. And then people will have enough time to ask questions. And I was saying, my plan, I had a plan already, but unfortunately it could not be funded by the department … In my plan, I was saying, Edenberg, for instance, it has less than 700 households. But within a month, I think we are have a staff of twenty people, within a month we’ll be sure that the whole community will know about HIV/AIDS. And when you are working with doorknockers, it can take us at least an hour to explain to the individuals. (NGO representative, Edenberg).
The need for more education advocated by these participants contradicts the view held by others that knowledge about HIV/AIDS is vast in Xhariep and that HIV/AIDS increases because of other factors beyond individual control. There is a need to strike a balance between these two views. Media contributes greatly to education of the general population (Shisana and Simbayi, 2002). But in Xhariep, due to being poor, not everyone has access to the radio and television. Older people in particular, spend their time socialising in drinking places rather than listening to radio and TV. Furthermore, farm residents are alienated from talk and general information about HIV/AIDS. Repetition of information is also needed to counteract misinformation. While contextual factors may contribute to the increase of a problem, ignorance and failure to acknowledge personal risk can further exacerbate the problem, hence education becomes important.
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Context of orphans and vulnerable children
Children are at risk due to being orphans, but may also be vulnerable for a range of other reasons, including poverty and a lack of access to material resources, lack of adequate care from caretakers and direct threats in the community, such as sexual and physical abuse, violence and substance abuse. All of these are part of the important context for assessing the position of children.
Participants were asked to provide their own perceptions on the situation of orphans and vulnerable children based on their own observations and experiences. There was consensus amongst all participants about the increase in numbers of orphans and vulnerable children.
Yo, it’s a lot you know (number of orphans), it’s a lot because you know that it’s only because I also see that people are too negligent, you know. Even though ... our own community … they don’t care and sometimes we don’t get the information in time or so that we can intervene in time. Sometimes we get into a case whereby we find out it’s more or less five months ... the child doesn’t go to school, she’s loitering and whatever, you know that. But if the incidents are reported in time we can react in time you know so that we can see what we can do for the child you know. (NGO, Trompsburg).
The participant above established a centre to provide help for the abused women and children in Kopanong. She recently received financial support from DSD to upgrade the place in order to improve her services.
Another community member acknowledges the existence of the problem:
Yes, this community has got such children, even at home, the sister of my mother that passed away which is seven years back, that child of hers is not going to school, his mother passed away a long time ago, he does not know his father, I don’t know his father. He is just going around in the location and even at our home we are suffering but at least my mother is getting a pension, and I have a small tuck shop. (Community member, Bethulie).
It is difficult to estimate the extent of orphanhood in Kopanong because of its invisibility. Unlike in other major cities where orphans and other needy children would be seen wandering on streets and asking for food and money, in Kopanong this is not in existence. Instead in Kopanong orphans are taken in either by family members or other concerned community members. Even when there are children in need on the streets someone will take them in for a short period of time to give them food and shelter before sending them away. It seems the culture of Ubuntu (sense of community caring for another) is still present, although it is often undermined by lack of resources in these households. Unfortunately, this does not mean that children are uniformly well treated. The conditions under which OVC live need to be examined regarding their households, nutrition, community perceptions and treatment of OVC, child abuse and neglect and the context of carers.
Conditions in households
Conditions of OVC are partially detectable by observation during interviews and OVC census fieldwork of the households in which they lived. During our visits to these households it appeared that the majority lacked basis resources required for a household. For example, some did not have a have an electric stove, clean water and a flush toilet. Participants described the living conditions of orphans and other vulnerable children
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as being below acceptable standards. They were concerned that these children lacked access to basic requirements for a proper upbringing, for example proper diet, school attendance, shelter and food.
My opinion is that those that I’ve got to know, their living conditions were not okay. And unfortunately it is mostly people who are unemployed who in most cases would be part of a big family and a struggling family. (Municipal representative, Trompsburg).
The participant below provides an example of vulnerable children she observed from her immediate environment. She herself has adopted two orphans to move in with her, her husband and another four children.
The conditions where they live … let me think about these poor children, because I’m also concerned about these poor children. It is a small house. It’s a four roomed home. I say it’s small. The grandmother and grandfather are unemployed, but they not at the age to qualify for an old age grant. (Community leader, Springfontein).
The informal settlements were said to constitute a particular risk for children. The majority of people living in the informal settlements are unemployed and lack access to basic services such as clean water and sanitation. Alcohol consumption was also said to be higher in the informal settlements, as many people have nothing to do during the day. This places children at higher risk. Due to the conditions in these informal settlements, many of the children will be vulnerable.
The situation was felt as sufficiently desperate for some of the service workers in both the NGOs and government departments to start discussing building orphanages as a way of addressing the OVC problem.
I think one of our strategies is to have orphanages … we don’t want to separate them, but maybe depending on the circumstances, I think orphanage uh, will be fine … indeed we need them, because there are families really that cannot cope with these people, you find that it is an old mother, about 65, not 65 even, 68, 75 years old, sitting with these two or three kids, you know. (Community leader, Springfontein).
This idea seems to be acceptable among some community members who have expressed their willingness to care for the children in these orphanages.
When I talked to some of them, they’ve said it will be something good for us to have a shelter for those people, because another lady she said to me she would be prepared to leave her house and stay with those children in that house. (Community leader, Springfontein).
An additional motivation for the establishment of an orphanage is the high level of child abuse that these children may experience within their households. The orphanage was felt to provide an optional place for the child to live so that they could be removed from the abuse situation and receive some protection. Even another household in the same community was still felt to present a threat, as the abuser is likely to know where to find the child.
Other respondents, particularly from the government, were considerably less keen on the idea of orphanages, preferring to seek out family based care, even if the final household is not part of the child’s extended family.
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Knowing that a child will get a plate of food does not give us a parent. A challenge is to go and seek someone that will make him bring a plate of food ... It (the orphanage) could just be a place where children are in trouble, or children who are identified to have been dumped overnight, not a permanent place. (Municipal representative).
This response matches the vision of the government, which is to make sure that children are kept within a family environment where they could be raised by a caring parent. However it is difficult to guarantee safety for children, particularly given the shortage of staff to monitor the household situation of fostered/adopted children. In one of the households where we conducted interviews, for example, an adopted child lived with family members who were drunk during the interview. The social worker had not made a visit since she left the child under the care of a guardian. If DSD is to keep children within households, rather than putting them in orphanages, they must develop a monitoring system whereby children’s conditions can be constantly monitored to ensure their safety and access to government grants that are meant for their own wellbeing.
Nutrition
Participants also raised serious concerns about the nutritional status of orphans. Cases of children who go to school or bed without eating were said to be common occurrences in the Kopanong municipality.
You find the school going children né; he goes to school without eating properly. How do you expect that child to listen in the class, it’s getting difficult for him to listen. He goes to sleep without eating, he’s sleeping with a few blankets, some of them are torn, you see. (Community member, Reddersburg).
The food crisis experienced by some children was also acknowledged by the municipal representative, as he felt that it affected the children’s school attendance.
A crisis that they are facing is a food crisis, some of them haven’t got enough clothes, but I don’t … But those children, the crisis they are facing really, they are facing food crisis. Some are not attending school and so on. (Municipal representative, Kopanong).
The DoE is trying to address the problem of lack of food for school-going children by providing them with biscuits and soup during school hours. According to the DoE representative, this intervention increased the number of school children in Kopanong. However, during our fieldwork, this intervention was halted. Other community members also felt that the food was not enough to satisfy hungry children, as it was only soup and biscuits. Some teachers were also accused of taking the food to their own homes or relatives, even though they were fully employed and were able to provide for their families. A mistrust of service providers exists in Kopanong. This may be due mainly to limited resources that increase the level of competition amongst the community members, since everybody wants to benefit from the interventions. As will be seen below, other government interventions, for example, food parcels, also resulted in conflict in the community, as some service providers were accused of favouring certain people and ignoring others.
Community perceptions and treatment of OVC
It is essential to understand the community’s reactions to OVC since their support is crucial for the success of interventions aimed at addressing their needs. We asked participants how they thought others perceived OVC and the level of support available
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within the community. The dominant response was that the general community cared about the OVC, although many people lacked resources to support them.
They are sympathetic. A lot of people are starting to realise that we understand that there are no jobs in our country, so there’s no need for like, to cast someone out, if that person is struggling … Some people, like, if someone stays alone, he prefers to adopt if there is a kid to help him in the house. (Community member, Reddersburg).
What I can say is, they feel for them to be honest. Because I’m talking via the stakeholders you see, because I’ve got a lot of stakeholders in my ward. And I can see via them when we sit and discuss, they feel for them, because most of them are foster parents just to help, maybe to give some love to these children and so on. (Community leader, Springfontein).
The municipal representative felt that the absence of street kids is an indication of support provided by the community. However, financial constraints limit some members of the community from taking in extra children as this would impact on their already limited resources. It is crucial to address poverty in Kopanong, as it is a major factor that limits the provision of proper care for OVC.
The above comments seem to suggest a positive attitude towards the OVC in general, but all participants did not feel this. Carers of HIV affected children felt that these children are highly stigmatised in the community compared to others. This led to some carers concealing the cause of their parents’ death, if HIV related, in order to protect themselves from negative reactions from the community. These negative attitudes include warning their own children not to play with an HIV positive child.
There are stigmas because some people they don’t want to see their children playing with their children you see. So we have to come in, make, you know how a child is, a child don’t know nothing and he has to integrate with other children so that he can play and so on. (OVC carer, Philipolis).
The stigma may be due to the silence about HIV/AIDS that seemed to prevail in the community. Although many people were known or assumed to have died of AIDS-related illnesses, talk about HIV/AIDS is still a taboo in these communities.
A lot of the people in the community do not know, people sometimes don’t want to speak about it, they keep it as secret, if their child is perhaps sick it is not something they want to talk about. (OVC carer, Philipolis).
The concealment of the orphan status of children will impact negatively on access to government and NGO support systems. It is crucial to address stigma attached to AIDS-affected children in order to allow their carers to access services without fear of discrimination by other community members.
Child abuse and neglect
Child abuse and neglect can either be physical or emotional. Abuse can involve forcing children to work, either doing excessive chores in the family home as payment for food, or an outside job to bring in income. It can be the denial of certain rights entitled to children. The government grants aimed at assisting children can also be abused by of the carer. In Kopanong the latter form of abuse was said to be very common. Many people
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adopt children purportedly to provide care for them, but instead use the money for their own benefit. Poverty contributes to this practice, as many carers and family members are unemployed and see this money as relief from poor circumstances.
Physical or sexual abuse was also common. The DoE are trying to assist, but the large distances make identification, reporting and follow-ups very difficult. It is likely therefore that the reported cases constitute a very small minority of the actual incidents of child abuse. This remains a crucial issue that has to be addressed by any intervention working with children. It is also the most damaging and destructive of all events for children. From the interviews it appears that, excluding a few respondents, child abuse is not seen as important or as too complicated to address, which is going to increase the problems of addressing it. Sexual and physical abuse is regarded as a familial private issue. Some community members felt uncomfortable to intervene if a particular family was known to be abusing a particular child. Community members preferred to keep quiet in case their intervention could jeopardise the situation of a child and maybe lead to further abuse, or they feared the confrontation in a small town.
If you should see your neighbour’s child is not staying right, you want to do something about it, but on the other hand you know the consequences will be bad, maybe even for the child itself. (Community member, Bethulie).
Respondents observed that parents tend to leave their children unattended while they are socialising in local shebeens where alcohol is sold. These children are at higher risk of rape and hunger. A service provider from an NGO describes one case of child neglect, which was a painful experience:
I’ve got a child who can’t hear, who’s deaf and dumb and all those things, that she can’t speak and all those things. When I got this child she was burnt ... the whole arm. She’s got burns all over her body and she ... her behaviour is like a dog, she eats like a dog, she drinks like a dog, whatever she’s doing is doggish, you know. And even the words ... she wants to speak, she’s just barking like a dog. (NGO Representative, Trompsburg).
The child described above was burned while being neglected by the carer who was supposedly drunk. A founder of an NGO caring for abused women and children in Kopanong took her in. Some of the service workers were arguing that the policy should include the arrest of some of the parents for child negligence. The worker from an NGO felt that this only had to happen once, then all the other parents would start caring for their children as they would not want to go to jail.
Community involvement is needed to end child abuse. The community has to make it clear that child abuse is not acceptable. The community also has to get it out into the open so that cases can be reported.
We had a problem ... whereby a father raped his own child. It was really, really a problem. So they had to discuss this with the police, but the child don’t want to admit. The mother, she’s the one who called them, she called the father a rapist, but she refused give evidence this girl so that case go nowhere because people are afraid really. (Bokolokong HIV Support Group representative, Fauresmith).
There have been attempts to set up a trauma centre in Trompsburg so those affected have somewhere to go for support. This is especially important for child abuse, as the child has to be removed from the abusing parent or adult. Details of the centre are provided in the NGO section.
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Context of carers
The major concern facing carers regarding the upbringing of children was financial, especially with regards to children’s school requirements and food. Most of the carers of orphans were dependent on pension grants, which they used to support the children, while some received child support grants.
Yes it’s just that money I’m struggling to get, so that I can buy better things for them. I need money for food because the food is expensive and out of that R500 that I get, I must buy food, electricity, pay policies and pay for water. (OVC carer, Philipolis -1).
I’m just concerned about how am I going to take care of them with the little money I have. (OVC carer, Philipolis-2).
Although support grants are available from the DSD not all carers get them, due to either lack of knowledge about the grants and application requirements, or lack of availability of key documents, such as identity documents and birth certificates. Two of the carers interviewed, for example, said they were still confused about relevant documentation and where to apply for grants.
In addition to financial needs, carers also expressed serious concerns about food shortages in their households.
I have to buy food for them and also see to myself. The food is not cheap … They don’t eat in the morning before they go to school and even in the afternoons. (OVC carer, Philipolis -2).
The absence of parents who have not died contributes to vulnerability of children in Kopanong. Fathers were particularly singled out as being absent. One carer, for example, cared for children whose father was alive but did not provide financial assistance to his children. He lived in Colesburg, about 200km from Kopanong, and only came back occasionally. Both mothers and fathers were accused of spending too much of their time socialising in shebeens and drinking alcohol, with almost complete neglect of children. Almost all participants expressed concerns about high levels of alcohol abuse by carers, which they said affected children badly.
One participant however took a sympathetic view towards some of the apparently neglectful parents, as she felt these parents lacked the training and skills required for the proper upbringing of a child.
Maybe it will help if we can get those workshops first and talk with the mother you see. I think they as the mothers, if we can talk to them, teach them. Some of them need to be taught ... That’s the other part. Most of them come from the farms and we teach them at the workshops. To have workshops maybe twice a month with them to teach them first. (Community leader, Springfontein).
Despite these negative reports about carers, our interviews with carers revealed that not all of them are negligent and uneducated about the proper treatment of children. Some who participated in interviews were knowledgeable on how they should be treating their children, although processes for obtaining access could have lead to the selection of the better carers for the interviews.
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I must not beat them. I must show them love and respect. I must treat them very well … they have a freedom here to do whatever they want – they watch TV at any time. They are very happy to be here. (Carer, Springfontein).
The participant has adopted two children whose mother is alive, but their mother drinks and is unable to care for them. She is the woman’s sister-in-law and was entrusted by the family to take these children in for a better life. She also cares for her two own biological children in a three-bedroom house shared with her husband. Both children receive social grants from DSD and the money is spent exclusively for their school fees, food and other needs.
Another example of good parenting comes from a carer in Bethulie who cares for her two grandchildren, whose parents are both still alive but do not provide financial support. She struggles with the little money she receives from DSD for one child and her own pension grant. But despite these challenges she works hard to ensure that the children in her care eat healthily and are able to attend school like other children.
Yes, I buy them meat, food, everything and next month I will do the same, a social worker who arranged the grant also advised us not to misuse the money. We must keep it and use it wisely. I am struggling on my own and I still owe Zwelinzima store money (for food taken on credit). (OVC carer, Philipolis).
It is therefore unfair to generalise about all OVC carers as being irresponsible. As the community leader stated above, there is still a need to educate carers about proper ways of raising children. It is also important to take into account cultural and contextual variations regarding proper upbringing of a child. Educational workshops should thus be sensitive to the context of Kopanong, that is characterised by high levels of poverty and unemployment and limited knowledge, due mainly to low standards of education and limited access to media.
Support systems for OVC
The support systems for OVC include current government-based and NGO/CBO interventions aimed at addressing needs of OVC and their carers in the Xhariep district.
Government-based support structures
Since 1994 when the first democratic government was elected in South Africa, the key focus for government departments has been to ensure that all South Africans have access to basic requirements for proper living conditions. These included shelter, food, water and sanitation, health care, education and others. All government departments are expected to work together to ensure that these objectives are being achieved and that the lives of the poor are improved. Several policies have been drawn up by government departments to ensure that these objectives are achieved. However their implementation has been insufficient, as many people still do not have access to basic living requirements.
With regard to children, the constitution recognises that children should have basic rights including access to shelter, food, education, clothing, health services and a registered name. Collaborative efforts between government departments are required to ensure that these objectives/goals are achieved, but as seen above, this does not adequately exist on the ground. Below is a description of government services aimed particularly at improving services for children, with limitations within these services and suggestions of ways to improve them to increase their accessibility to target recipients.
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In South Africa, services for poverty alleviation are distributed among various government departments, but the DSD plays a leading role in addressing needs of OVC and families caring for them. Other departments directly involved with OVC are the DoE, DoH, Department of Home Affairs and DoA. DSD focuses on providing grants, emergency food rations and ensuring that children are in places where they can be taken care of.
In 2000, the government initiated the provision of social grants to support children from impoverished households. Since then the uptake of grants has increased from 3.2 million in 2000 to 5.6 million in 2003 (DSD report, 2004). However, the uptake of grants in Free State province, a province where this study is taking place, is still low and is second lowest after the Northern Cape province (DSD report, 2004).
Two forms of grants are provided to children aged between 0-18 years, i.e. the child support grant for children up to 11 years and the foster care grant. While the child support grant is relatively easier to get, the foster grants are difficult to get due to legal processes and other structural factors. Social workers are the first contact person but certain legal procedures have to be completed before a foster care grant can be approved. These include presenting a court case to motivate for the legitimacy of giving a grant to a recipient. The frustrations caused by this process are expressed in the comment below:
It’s not easy because we are not the only role players, the Department of Social Development, there’s Department of Justice as well. And for the parents, once the parents have approached us, we do the screening and the necessary investigations and then write a report, which we must then go present in court. The court determines when to hold the hearings, you know, to the extent that sometimes it would take more than three months before a foster care placement is finalised. You know you must bargain about six month for the finalisation of it. And it means that before it is finalised, before there is a court order, the family or a child cannot access some services. For instance, the child cannot get a foster care grant. Although we would be doing something to assist maybe providing food parcels, but the grant, will he ever get the grant. (DSD representative, Koffiefontein).
Many DSD staff were frustrated about the lack of urgency from the Department of Justice in dealing with matters related to OVC. A key problem however may be the workload and staff shortages experienced by all government departments in the district. The Department of Home Affairs were also heavily criticized for being slow in providing the necessary documentation that is required to access the grants. Some parents and children, particularly those living on farms, are unable to access grants due to lack of identity documents. The Department of Home Affairs has offices in Bloemfontein and their staff visit the district only once a month to take identity document applications. In a dispersed municipality like Xhariep, with bad roads, it is impossible to reach all 17 towns within one day. More effort is required to make the department more accessible to the community. There were plans to move offices of government departments that serve Xhariep away from Bloemfontein and closer to areas where they were offering services. This can be seen as a positive step toward increasing access to government services.
Food parcels
Food parcels are provided in conjunction with financial grants to assist households that provide care and support for OVC and HIV infected people. Those identified as poor and needy furthermore benefit from the food parcels. The DSD representative describes the nature of this assistance as:
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The value of the food packet is about R400. We have a budget in the district, for instance here I have R600 000 that I must use for buying food parcels. We call it social relief of distress. Besides this R600 000, the consortium (Lokomo/Bokomoso), the district consortium also has funds, which it must use to buy food parcels for people who have the virus. But when people come to us as a department they would have to say ‘we are unemployed and we have this number of children or we are this number in the family’. As long as it’s a needy case, we would give parcels. My position is that we must not create hurdles you know, if somebody comes in and wants food, we must give food. (DSD representative, Koffiefontein).
Food parcels are also provided for a period of three months for families still awaiting the approval of grants, but can also be provided on a long-term basis in cases where someone does not qualify for grants, yet is in need of food.
If it’s someone who is waiting for permanent assistance, it will be for those three months. But if it’s someone who did not qualify for any permanent grant we would look at other circumstances and give. In most cases those are the people that you’ll find we’ll give more than three months.(DSD representative, Koffiefontein)
Due to the high levels of poverty in the area, the process of allocating food parcels becomes complicated, as the majority of people meet the criteria but only a few can benefit. Choosing one household out of an equally needy group can result in conflicts within the community, as everybody feels they are also entitled to receive support. Access needs to be increased to make sure that as many deserving people as possible can benefit.
The provision of food parcels was a controversial issue during the fieldwork, with some people claiming corruption and favouritism amongst service providers who were accused of giving the food to their own friends and relatives who were not in desperate need of food. This prompted community leaders to involve themselves in the process of delivering food parcels. They stay within these communities and feel they have a better understanding of the most needy people within their areas. They work together with DSD and the community to determine the criteria for receiving grants and also identify people who are in desperate need of food, giving priority to those most in need.
To identify them, I meet with all the different stakeholders. I call the different stakeholders and tell them that we are going to distribute food parcels. Maybe 67 food parcels. So what we have to do is to select 67 people out of that, out of all these people. But we must look for the needy, needy people. Those who don’t have any income, and those who earn R200 or less. (Community leader, Springfontein).
A community leader from Bethulie uses a similar method to determine who should receive grants.
Sometimes we look, okay, in a house there is a granny, living with four or five children, but at least the grandfather is there. We take it that at least there is an income, although those people need these food parcels. And then we would go to a house where they don’t have any income and then we would give those. But those who are HIV positive, it is a must to give them, because they don’t have an income, at least some of them. Others are receiving a grant now. (Community member, Bethulie).
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It is important that community leaders work together with government officials. This collaborative effort in service delivery contributes to services reaching those who need them most and discourages the practice of corruption both by government officials and the community.
School-based support
The high levels of poverty in Kopanong, and South Africa in general, impact heavily on school-going children. Some are expected to go to school without having eaten anything, while others lack school uniforms. Others also travel long distances to go to school. Due to these difficulties some children have been withdrawn from school by their parents who are unable to meet their school demands. Other children have run away. The DoE recognises these constraints and has since developed certain interventions at schools to assist those children who come from impoverished households.
A key intervention by DoE is the provision of feeding schemes taking place at primary school level. Children receive biscuits and soup to help them concentrate while attending school. According to the representatives of the department, this support system contributed to an increase in numbers of children attending school. Most of these children come from poor families where food is not always available. The department shows serious concern about the problems of poverty amongst children. For example, earlier this year they embarked on a process of encouraging children to carry provisions to school in order to minimize hunger during school hours. But this process was not successful because some children who came from impoverished households were unable to bring food, which then exposed them to other students as being poor. This intervention has since been withdrawn.
Another support system offered by DoE is exemption from paying school fees for learners coming from impoverished households. This is aimed at relieving them of the costs of schooling. This intervention however, is not popular amongst residents, according to the principal in Kopanong. He said many parents are either not knowledgeable about the exemption or too embarrassed to disclose their financial bankruptcy to school authorities. Efforts are required to address both possibilities. School principals were also often resistant as this compromised the school.
A key problem encountered by DoE has been the identification of orphans at schools, which has impacted on their ability to provide support to those who needed it. The problem prompted them to undertake a process of identifying orphans at schools, which took place during our fieldwork period. This process should assist in fast tracking the provision of support for those that need it.
Health support services
The DoH is the custodian of health services in South Africa. Its primary goal is to ensure increased access to health services by all sectors of society, particularly the poor, who often have difficulty in accessing health facilities. The government has made positive progress in ensuring this goal and in the Xhariep district this is demonstrated by the availability of a health facility in each town, all within a five kilometre distance.
Ja, I think it is reachable; they are not five kilometres … from the extension, from where the people stay. Ja. In each town there is one clinic, which caters for the whole community, but it is not more that five kilometres … It’s about two, one kilometre … It’s a few kilometres … It’s less than one kilometres, it’s small communities. (DoH representative).
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Since the clinics are within reach, patients do not require transportation to access these clinics, therefore there are no extra costs incurred in using them. This increases their access. A key concern, however, is unavailability of doctors in the district – participants felt strongly that there needed to be a visiting doctor at least once a week. Currently nurses carry the load. This is done efficiently, but there remains a desire for a doctor’s services.
The problem; we don’t have doctors in each clinic … You will find like one doctor is catering for four towns and the hospital. Like it is now, I will make an example of where there are three towns. And the hospital, the doctor is going, there was one doctor, I don’t know if she has left now, I think she was finishing off there, or she is finishing this month, I don’t know … Doctors don’t want to come to our area. They are not motivated to come here because it is a rural area in the first place. (DoH representative).
And this one doctor does not come from here. We don’t have doctors here only sisters. This doctor does not come everyday, maybe once a week and he will just see a certain number and many people are waiting for the doctor. He comes from outside and he comes once a week, it’s a problem. (Bethulie ward councillor).
Xhariep is not an isolated case but a reflection of a national problem. Lack of doctors in public health facilities, particularly in rural areas, is a national problem. Doctors tend to be attracted more to the private sector (Shisana and Louw, 2005). The DoH is aware of the problem and is currently making efforts to address this. They are giving incentives to doctors who are willing to work in the rural areas. Yet it seems, despite these efforts, many doctors are still not motivated to work in the Xhariep district.
Hey, I think the Department of Health is trying to, to make some, I think, what is it now … incentives? I’m not aware if they are already giving, but there are allowances there for this cause, uh, professions … like the pharmacists and the doctors. You see … It’s far. You find that one doctor goes to the clinic for only three hours and then he has to go to another clinic. From there he is on call at the hospital, he must go back to the hospital, but if there is an emergency at the hospital, then he has to go, which means that he will be there for half a day. (DoEH personnel).
Specific services for OVC
In addition to the DoH’s directed free services to mothers and children it has programmes that focus specifically on OVC. Needy children are identified during the home-based care visits, which focus on sick people who are unable to access health services by themselves.
We don’t do house-to-house visits (to identify OVC). Ja, through our own investigators (home-based carers} they come and report at the clinic when there’s a need and then such cases are being referred to the Social Development … So for them it is just to identify that there is a child … who is in need of particular assistance and then you. Then we refer … But we also assist maybe like for instance, if there’s a need for nutrition. (DoH representative, Bloemfontein).
This comment seems to suggest a smooth referral system whereby government departments work together in delivering services. The DSD, however, was unhappy about processes followed by DoH in its referral procedures. For example they felt that the department was denying a lot of HIV patients access to DSD due to its insistence on confidentiality. This representative felt confidentiality was rather a barrier for those who require help.
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You’ll find that at Social Development we are not the first people who get into contact with these people (PLWHA). Health is the first contact. And then we have a problem where Health would say ‘no, we are not going to tell you who is sick’ and, but in the meantime he’ll know that he is sick is when like he comes to us because he sees that he’s about to die and he starts to think about the child and it’s late. So our wish is that we could make contact at a very early stage and because we’re trying to address it in our own way because Health does not officially want to come to us or to assist. We are moving into communities and establishing PLWHA structures with that we’ll be able to reach a lot of people. (DSD representative, Koffiefontein).
People do no want it to be known that they are ill or HIV positive. Already there is the fear that if they go to the clinics their status will be revealed. The DSD request will conflict with basic ethical principles and possibly distance people further from services. This is a critical issue that needs to be discussed between these two government departments. While it is crucial to make early interventions for those infected it is also important for health professionals to maintain confidentiality with their clients, particularly in a district where HIV/AIDS is still not openly discussed. Therefore a compromise needs to be made for PLWHA on behalf of the DSD.
Challenges facing government departments
A number of limitations or challenges existing within government departments that offer support to OVC.
Staff shortage
Staff shortages were seen as a major barrier to effective delivery of services particularly for the DSD. The DSD is largely under-resourced, especially given the highly dispersed nature of the community, meaning that staff travel long distances to make contact with people in need. The number of towns in the district means that the DSD cannot have offices in all of them, thereby necessitating travelling by staff on a regular basis.
All DSD respondents expressed their discontent about the lack of staffing. For example, it was revealed that in some towns there are no permanent social workers – they rely on services of a social worker from another town. This slows down the process of service delivery as they drive long hours before reaching the next town. The poor nature of roads exacerbate these challenges. Service providers don’t only have to travel long distances between towns. They travel on a gravel road that is unsafe, so that car breakdowns were reported as common occurrences. Many social workers are reluctant to even go to Xhariep, preferring to remain in Bloemfontein where there are better resources. Other departments reflected similar problems, for example, there are none or few doctors in DoH services and no local offices for the Department of Home Affairs.
For instance, for me to move from here in Koffiefontein to Smithfield the other sub office it’s a two hours drive and if you drive for two hours within the same district, it’s too much. That is one big challenging. (DSD representative, Koffiefontein).
Lack of collaboration
A key challenge raised by government officials was a lack of collaboration between government departments mandated with the improvement of social conditions in the Xhariep district. Collaboration between the DoH and DSD was particularly seen as posing
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serious problems, as these are the two primary departments which are custodians of poverty alleviation in the district. Both DSD and DoH acknowledged that the interaction between them was very minimal and only occurred when the need arose, for example, a referral. The government officials indicated that there was a need for more regular interaction.
The DSD representative felt that government departments do not work together as a unit to deliver services, but each department is concerned with its own image to the recipients. He felt it was necessary that services be provided collaboratively for the sake of the community rather than political point scoring.
The lack of collaboration, both within and between departments, results in duplication of services. This problem is evident in the identification of OVC and provision of food parcels. All the government departments are involved in this process, although in various ways with inadequate sharing of information at a town level. The latter may also reflect the lack of local offices and staff.
A specific conflict of interest arose around the work of home-based care workers who are paid by DoH to offer services to those who are unable to access DoH services. But the same people are utilised by DSD to also distribute food parcels and identify OVC in the households. The home based care workers felt that the health department was unhappy about their involvement with DSD, and that this was perceived as a distraction from their paid job. A high-profile government representative also acknowledged this role-confusion.
If I can give you an example, there’s a consortium … now unfortunately one thing that we did not realise when we formed this consortium, we invited organisations dealing with HIV and AIDS to a meeting where we discussed the formation of a consortium and people came and people chose and elected people that they put in the consortium. And then later we then realised, we found out that most of the members of the consortium are contracted to the Department of Health as community home based carers. Now there’s a big issue between Social Development and Health where Health is saying to home-based carers ‘you choose, you work with us or you work with Social Development, but you cannot have two masters’. Now my motivation to the home based carers is ‘we don’t want you to choose, we want you to render an effective service to the people that you are servicing you know’. (Government representative, Kopanong).
This participant felt this conflict was unnecessary and that both government departments should focus on the broader picture, which is rendering services to the needy.
The moment we fight over who is servicing who, then we’re killing that person …Yes and of course you do not want to bite the hand that feeds you. So we are also looking at things like that, but I’m saying to them I don’t want you to lose that R500 or is it R700 that you are getting. But I’m saying if patients are continuing to die then you’re contributing because they are not allowed to refer their patients to social worker. (Government representative, Kopanong).
It is becoming clearer that conflict does exist between DSD and DoH about entitlement to provision of services, particularly by CBOs. This needs to be addressed for the benefit of the community rather than that of the respective departments.
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Lack of community involvement
Another key concern expressed by government departments was the limited involvement by the community on matters related to community development initiatives for OVC. They felt that the community has developed reliance on the government support systems and that they are doing little or nothing to uplift them from poverty. Even when poverty alleviation projects are available, for example, vegetable gardening, there is minimal participation from the community members.
In cases where there is involvement by the community, the community is often attracted by financial incentives rather than a serious concern about improving the circumstances of the community as a whole. As a result individuals misuse the money that has been made available, for example, for income generation projects for their own personal enrichment.
NGO, CBO and FBO-based support structures
NGOs are a crucial sector in the delivery of services in South Africa. Some work closely with government departments to deliver services where the government does not have enough capacity to do so. This project aims to work closely with locally based NGOs/CBOs that focus particularly on OVC, to strengthen their existing OVC services and build partnerships with them. Very few NGOs/CBOs exist in Kopanong municipality, particularly focusing on orphaned and vulnerable children. There were only two NGOs that focused specifically on children. Other NGOs, coordinated by the DoH, focused on provision of home-based care.
Home-based care services
The home-based care services are provided by the local CBOs, on behalf of the DoH, to people who are unable to access health facilities, for example, PLWHA and pensioners. Services include personal hygiene of patients, information provision on HIV/AIDS, counselling, and observation of treatment, for example, DOTS for tuberculosis. In return for these services the CBO members are reimbursed R500.00 by the DoE. Each clinic in Kopanong municipality has representatives from CBOs who provide these services.
In 2003 the DSD recognised the need to coordinate the services of these home-based CBOs and formed a consortium that would oversee the delivery of such services, namely the Lekomo HIV Consortium. Its primary objectives were to co-ordinate the activities of the NGOs in the Xhariep district, avoid duplication of services, and ensure quicker delivery of services. Prior to the formation of the consortium problems existed in these areas.
The objective of Lekomo is to support the terminally ill, who are terminally ill with HIV/AIDS, to support HIV and AIDS orphans, to promote this facility and community, to educate the community about HIV and AIDS … And to educate the PLWHA about their rights, their constitutional rights. And to encourage those who are infected to disclose their status and then also to facilitate the identification of orphans and children and child-headed households … to also encourage the infected and affected to remain in their community, so that they don’t move out of their communities. But it’s that, that is basically what we do. (NGO representative).
Initially, one consortium was formed to cover all towns in the Xhariep district, but due to the vastness of the area a sister consortium, Bokomoso, was also formed to cover a certain portion of the district.
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The consortiums have four specific focus areas:• home-based care• information, education and communication (IEC) on HIV/AIDS• distribution of food parcels• identification of OVC.
Currently the two consortiums have affiliates from all towns in the Xhariep municipality. They meet regularly, under the supervision of the DSD community liaison officer, to discuss progress and other issues related to the provision of services.
NGOs focusing on OVC
As indicated above, there were no NGOs in the Kopanong municipality that focused entirely on children. Children in need are often contacted during home-based care visits and then referred to DSD for further assistance. Two NGOs, Orange Vrou Vereeniging and Philani Victim Support Centre, were the only two that had services for children, although the primary focus of Philani Victim Support Centre was abused women. Below is a brief description of their OVC services.
Orange Vrou Vereeniging OVV was established in 1904 after the Anglo Boer war to help the poor white community, but it has since extended its services to black and coloured communities in the past eight to nine years. The focus is primarily on children, although old-aged pensioners also get assisted when necessary.
We specifically tried to work with children because we tend to find that some of the older people, if we help them, if we for instance provide food then they sell it and they buy alcohol with it. So we are mainly focusing on trying to get children out of, to help them to maybe lift them out of those situations. (NGO participant, Trompsburg).
Children are cared for at a nursery school where they receive food, clothing and other forms of care. Most of the children come from highly impoverished households that are unable to pay the minimum of a R20 monthly fee. This increases pressure on the organisation, since they are not properly funded. The nursery school operates from an old building in Trompsburg.
The organisation lacks financial support and relies mainly on donations from local businesses and individuals, for example, some farmers assist with food, but this is not enough to meet the organisation’s financial needs. According to their representative, there was little support from government departments. In fact on certain occasions they have clashed with the government representatives on matters related to provision of support for OVC, particularly the distribution of food parcels. The distribution of food parcels is a key challenge given the high levels of need within the community. Since people are poor, they all feel entitled to the food parcels. There is a need to develop measures that will ensure that only deserving people receive them.
Philani Victim Support CentrePhilani Victim Support Group is another NGO that focuses on OVC with regard to interventions. It was established in 2000, primarily to address problems of domestic violence, sexual violence, and rape. But the organisation has since incorporated children, due to the increase in prevalence of OVC in the area. They assist children who have been neglected, raped or made homeless by providing temporary shelter, food, and counselling.
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And what we normally do … we get victims of rape, violence, neglected children because now all of a sudden … neglected children was not our aim … is not on our objectives or whatever you know, we just have abused women. But now that the need is arising we have neglected children (in our organisation). We also play a role in the community as a place of safety for neglected children. I think now in my position I’ve already fostered two children. Recently I think, let me talk about the recent case. Last week we had about three children who had been neglected. The two hitchhiked to Bloemfontein so at least we had placed them for safety with one of the … two of the women that are here with us in the same town. (NGO representative, Trompsburg).
For the last four years Philani Victim Support Group has operated without financial assistance from the government, until 2004 when they received funding from the DSD. The money was immediately used to purchase furniture required for better provision of services. For example, during our first visit the NGO had no beds or safe places for children. On our second visit after they had received funds they had purchased four beds, blankets and sheets, a TV set and other household furniture required for the comfort of the children. The organisation is staffed mainly by women residing in Trompsburg who have received training in domestic violence issues and counselling.
Challenges facing NGOS/CBOS
Similar to the government departments, the NGOs based in Xhariep faced a number of specific challenges that impacted on their ability to effectively deliver services to their clients.
Lack of money and resources The key challenge faced by NGOs/CBOs was insufficient financial support. DSD offers most of the support for NGOs but this is not enough to meet their needs. Most of the NGOs are left to operate without sufficient equipment to offer full delivery of their services. For example, most do not have access to telephones, faxes and computers, so they have to ask other nearby government offices to use their resources. It also impacts on their capacity to employ of staff, reimburse costs and ultimately on the number of children served.
TransportLack of transportation is a particular challenge, as people are unable to extend their services to other towns where there is a need. The members of the consortiums were particularly concerned about transport costs incurred in travelling for meetings. Since there is no reliable public transport and the towns are dispersed, they have to hire cars to take them to meetings, which is expensive. Costs of working in rural communities are often higher than in urban areas, due to the high needs and a lack of backup services.
Discussion
As illustrated by the responses taken from the interviews conducted with the participants, it appears that the Kopanong municipality is under-resourced, as it lacks basic facilities that are taken for granted in some of the better-developed South African districts, for example, transportation. The results of the interviews, furthermore, revealed weaknesses in interventions aimed at assisting OVC and their carers, for both government and non-governmental organisations. Some of these weaknesses are indirectly related to the structural constraints, for example, bad roads, long distances, lack of resources, while
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others directly result from within these government departments/NGOs. For example, we have seen a lack of cooperation between government departments, which results in unnecessary duplication of services and an unfriendly atmosphere between government service providers. Even within the government departments these problems exist and impact heavily on the delivery of services to the community.
Lack of community participation is another issue that affects effective delivery of services in Kopanong. Those community members who are involved in poverty alleviation projects were accused of doing so for self-benefit rather than for the care for OVC. This attitude has negative effects, as resources are wasted and unaccounted for. The root of this problem is mainly the lack of skills, which was due to the low levels of education in the community and the organising of financial support given to people who don’t have financial management skills and thus misuse the money.
The problems expressed by the participants can be better understood if they are placed within the context of the structure of the district. The district is situated far from bigger cities that have resources, for example, Johannesburg and Bloemfontein. Although access to the district is easier with the use of national roads, travelling between towns is made difficult by poor road infrastructure, predominantly gravel roads. The municipality has a low population density, although it covers the largest area compared to other South African municipalities. This results in sparse populations and long distances of travelling from one place to the other. With poor road infrastructure and unreliable public transportation movement around towns is restricted even for the service providers.
Stigma has been noted as a problem experienced by OVC and carers in the Kopanong community. Thus civil society organizations, health professionals in both the public and private sector, and government agencies need seriously to focus their energies on de-stigmatizing HIV/AIDS as a social and human rights issue. There is also a need to have a broader spectrum of accessible, well-trained community level caregivers targeting pensioners to strengthen their knowledge base on HIV/AIDS and sexuality.
The geographical location of the district further disadvantages the community, as it is difficult to travel from one town to the next due to distance and expensive public transportation and there are no career development opportunities as developed towns are far away. This produces pessimism and subsequently results in alcohol abuse to curb boredom and frustration. The youth in particular have no recreational activities, which drives them to the nearest shebeens in search of entertainment. An additional strain is the high level of poverty experienced by the majority of people in the district. The rates of unemployment are high and there are few employment opportunities.
Most of the problems expressed by the participants are not unique to Kopanong; they are common national problems. Compared to urban dwellers, rural and semi-urban dwellers in South Africa are deprived of access to resources that could improve their circumstances. Many people lack information in the first place, as sources of information are limited (mainly access only to radio broadcasts). This was made evident in this project regarding children’s grants, which some people had heard about but were not fully informed, nor did they know the relevant offices to approach for assistance. Others lacked identification documents that are required to access grants in the first place. The situation is exacerbated for farm workers whose educational levels tend to be low and who are too far from the service points (during our fieldwork there were no plans to extend services to these vulnerable farm workers).
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It can be concluded that Kopanong municipality is ideal for the services envisaged for the OVC project. It is an impoverished municipality with high levels of need and limited activities currently in place to address the problems. DSD remains a key government department that addresses needs of OVC, but is also limited by structural and organisational factors. The OVC interventions can help DSD and other locally based NGOs, but other problems that affect OVC have their roots in the social makeup of the community and other structural factors – these therefore also need to be addressed as they will affect OVC interventions.
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CHAPTER 5
Qualitative report regarding the situation of orphans and vulnerable children (OVC) in Kanana and Umuzimuhle townships, North West province
Kopano Ratele, Donald Skinner and Nkululeku Nkomo
To provide the background of the community being researched it is important to describe the infrastructural and socio-economic context of the two township study sites, Kanana and Umuzimuhle, as well as the nearby formerly whites-only town of Orkney. The contextual background is vital as it has a bearing on the life conditions and chances of OVC. The section includes the nature of housing, economic situation of the community, distances from major centres and transport facilities and availability of basic resources.
Distinctive and common elements between the two townships
Kanana and Umuzimuhle and the mining town of Orkney are part of the City Council of Klerksdorp, located in the North West Province of South Africa. In addition to Orkney, the City Council covers greater Klerksdorp, Stilfontein and Haartebeesfontein. The population of Orkney in 2002/2003 was put at 142 200 Black people and 12 000 Whites (City Council of Klerksdorp, 2002/2003). The major employers in the area are the mining groups. Trade, transportation and government are also mentioned as significant employment sectors.
It is important to note that, while the two townships are distinguishable in significant ways, the qualitative data gathered from the communities and analysed in this report are not adequately and consistently distinctive to warrant a full separate analysis. However the townships do differ with regard to income, housing and resources, which is noted in the descriptions of context below. In most respects the communities’ ways of life are similar, especially as both are dominantly influenced by poverty and experience similar social forces in the region. This has to do with the fact that the unemployment rate in 2002/2003 in the City Council of Klerksdorp stood at 40.1% (City Council of Klerksdorp, 2002/2003).
Umuzimuhle
Umuzimuhle is smaller than Kanana and is actually treated as one of Kanana’s wards. Mining and living sections in the Vaal Reefs are widely dispersed, designated into shafts ranging from one to 11. Umuzimuhle covers shaft three.
Mineworkers living in Umuzimuhle come from all the nine provinces of South Africa, as well as SADC countries, mostly Swaziland, Mozambique, Lesotho and Malawi. No person owns property in Umuzimuhle. The two mining companies in the area, AngloGold Mining
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and Harmony Mining, control all the property amongst them, although the Klerksdorp City Council governs the area.
The housing structures in Umuzimuhle are vastly different from Kanana. There are men’s hostels and residential houses built either for mineworkers only (single quarters) or for mineworkers and their families (family quarters). The houses are well developed and there are no informal settlements in the township. With the exception of single quarters and flats, houses have six rooms and have toilets and bathrooms. Roads and streets are tarred and there are land line public phones on almost every street corner. Umuzimuhle has a shopping centre and a petrol station. There is a community hall for public use. In some areas there are informal soccer fields and there is also the Oppenheimer stadium, mooted as a potential host for the 2010 Soccer World Cup, situated close to Umuzimuhle. The township has one secondary school, two primary schools, a clinic under the management of AngloGold and a taxi rank for transport to other shafts as well as to Orkney’s CBD and Klerksdorp.
Kanana
Whereas Umuzimuhle is situated in Vaal Reefs, Kanana is close to the central business district in Orkney. A significant number of people are at home during the day on weekdays, indicating heightened levels of joblessness and thus the deep levels of need. The media have reported about residents of the township who on a daily basis collect food and other things from a rubbish dump near Kanana. Some of these people include very young children. Community members describe the level of crime as very high, with robbery being the most common type of crime. The level of alcohol use is also very high.
The housing provisioning in Kanana can be divided into five types. This information was reported by the municipal officials during the interviews and substantiated by other interviews. The first type is in what is known by community members as the ‘old township’ and is characterised by basic brick and mortar houses with four rooms. Old township houses do not have bathrooms or indoor toilets. The second type of housing is made up of newer houses with more rooms, which are inhabited by professionals and other relatively successful members of the community. The third housing type is made up of what are generally referred to as Reconstruction and Development Programme (RDP) houses. RDP housing is part of the current government’s national policy and programme that aims to give affordable housing to low-income or destitute people. RDP houses differ in size but most have four or five rooms and, unlike housing in the old township, have indoor toilets and bathrooms. The fourth category of housing is a males-only hostel that was built for municipality workers who came from the former homelands created by the apartheid government. As mining and other industries developed, other people moved into the hostel and it has been transformed into family units. The last form of housing structure is that found in the squatter camps or informal settlements. These settlements make up a substantial portion in Kanana. Most of the homes are made of a mixture of iron and wooden boards. In informal settlements roads are generally lacking and the population density is high. Some of the settlements have access to water and sanitation, which ranges from communal taps and bucket toilets to homes with taps and flush toilets.
Kanana’s road infrastructure is, on the whole, underdeveloped. Within the township there are areas that do not have tarred streets, particularly in the informal settlements. Landline public telephones are found on all the street corners of Kanana and in some
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areas there are cellular phone containers for public use. Kanana has two clinics, a library, nine primary schools, one intermediate school and four secondary schools. Shops, liquor stores and funeral parlours are found throughout the township. The James Mpheqeka sports stadium is the dominant recreational facility in the township, offering soccer and cricket fields. Other than this facility, there are informal soccer fields found in various ‘extensions’ (newer part with better housing) in the township. Similar to most townships in South Africa, there are taxis in Kanana that transport residents within the township, to the central business district or to nearby towns.
Major problems in the target areas: unemployment, poverty and shortages of food
The total population of the municipality of Klerksdorp was made up of about 359 202 individuals in 93 339 households in 2001 (Statistics South Africa, 2001). As previously indicated, poverty is rife. Estimates are that 6.6% live below the poverty datum line and that one in ten households have no income at all, making for over 9 000 destitute families. Over half (55%) of the people of working age are not gainfully employed. The number of employed people has decreased from approximately 113 500 in 1996 to just under 96 000 in 2001 (Statistics South Africa, 2001).
Additional to unemployment, poverty and food shortages are key concerns affecting the target communities. Doubtless these problems have a telling impact on the vulnerability of households in the target areas in general and in respect of the lives of children in particular. Recent debates in South Africa about HIV/AIDS have also highlighted the important contribution of poverty to vulnerability in children, both with regard to infection and to compromises in life circumstances (Skinner et al., 2004).
Against this backdrop it is understandable that almost all of the interviewees spoke of ‘having nothing’. Unemployment, poverty and their consequences were dominant themes in the interviews. More specifically, respondents from government employees to NGO/CBO workers, care-givers and OVC, mentioned difficulties of community members or themselves in meeting day-to-day needs of life. Lack of food, lack of means to buy basic clothing, pay school fees, rent or visit health facilities were some of the difficulties mentioned by the interviewees.
Poverty and lack of gainful employment are also related to and result in the lack of psychosocial care and support. Thus, as will be seen later, while a respondent referred to the notion of ubuntu, the interviews show that the generalised socioeconomic deprivation in the communities render ‘being a person because of others’ only an ideal and one which is more and more difficult for individuals and communities to actualise.
Unemployment and lack of income are also implicated in the inability to use available educational opportunities and public health and social services. What elsewhere might be seen as ‘small change’, or an insignificant amount of money, for instance, for transport, actually hampers OVC accessing the structures and programmes they need and that are available for their support and care.
After OVC themselves, those who take care of the children are perhaps at the worst end of the impact of poverty on communities. The three extracts below taken from interviews with individuals who take care of OVC show this. It is significant to note that two of the three individuals are relatives of the children they look after, kin being an important
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system of support for OVC. However, it is also important to note that the ‘stranger’ among the three interviewees is the one who takes care of the highest number of OVC — 47 in all. The first excerpt is from an interview with a ‘non-related woman’ who takes care of close to 50 children. The second extract is from an interview with a grandmother who takes care of an OVC of age 11 or 12, as well as her own adult son who, being ill, and though he has his own house, lives with his mother and niece because he also needs care. The last is an excerpt from an interview with a woman who came to the community from elsewhere, whose own child died. Because of being sick, the woman came to stay with her mother and sister, both of whom subsequently passed away, leaving the interviewee to take care of three children. This last carer, as she is ill herself, also spoke of the fear of dying and leaving the children she was taking care of as her greatest anxiety.
In 1998 I had feeling about these children. I asked my church if we could form a group so that we can help these children. In June 1999 the group was launched. On that day I invited councilors from Orkney and their mayors. I wanted to ask them to help me accommodate these children. I also asked them to help me get food. I suffered up until 2001, that’s when I found someone to help me with food. By that time the number of these children had increased. They helped me by bringing food, although it was only in December. I approached community shops for help but only one man was able to help me. I have tried to put the children at school because I have seen that their parents don’t care. Some are 16 and others are 18 years old. I have tried to register them and I have also asked the educators to support these children because they don’t have anything. There are many children here and I have nothing. There are 47 of them but I have nothing if I don’t have food. We live like that. I am just happy to see them playing and to see them cared for. (Carer).
The problem is that nobody is working and we don’t pay the rent. We live off my son’s grant, he is the only one that helps us with his grant … He (OVC) has needs. Presently I can’t buy him clothes and sometimes we don’t have food … I haven’t paid for school fees …The problem is that we don’t have money. (Carer).
Before I received any help it was difficult for me but now I feel relieved because I can go to the people or services that support orphans. I see myself as providing security for the children … I do not receive any grants but we can take them for free health service … yes I do not pay ... I cannot afford to buy clothes for the children. There is only one (child) who receives help … I did not receive any help for the other children but last year a social worker brought shoes, stationery books and collected the school reports of the other children … Food was last provided in December 2002, last year. It is just recently that I got food … all along I did not get food … I have approached family members and neighbours for food … my sister is a great help especially at the end of the month when she has the money or means … my sister provides us with money to buy electricity cards every month, and she also brings along maize meal (pap) and buys meat. Neighbours do assist with mealie meal (pap), meat and tea when there is a shortage. They also give us clothes. A day before yesterday a social worker brought groceries. After winter she brought groceries and in December she brought grocery again … No, they do not receive money. I have applied for child support grants last year, October 2002. (Carer).
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Interviewees who work for government also mentioned the widespread joblessness and poverty. The extracts below are taken from the joint interview with three DoE officials, the local government councillor, and the DoH official, respectively.
There are a lot of people who don’t have jobs. There are people who left farms thinking that they will find jobs. We try to help the children get schooling, but there are no jobs and there is a lot of poverty. (Respondent from government, DoE).
Some cases have been brought to my attention by social workers. So that’s when I realized that there are orphans in Vaal Reefs, because normally people in that area come from various places for work purposes. Apparently due to poverty kids will move and join their uncles or fathers and all that. Some will try and get a job to try and sustain themselves. (Respondent from local government)
… and if we are trying to manage the HIV thing let us try and address the conditions you know. This poverty thing is very serious so is unemployment. Hence I said that these kids find themselves in wrong places. They are affected psychologically and the value systems in their homes are also not right. I think this needs all our commitment, from government to all those leaders that are on top who make decisions. (Respondent from local government).
In this last instance the official of the health department was responding to the question of what challenges there might be that prevented community members from taking in children who needed families.
The impact of poverty and unemployment on the situation of children was noted a number of times by the official from the DSD. Firstly, in response to the question about where he thinks most OVC come from and secondly, when asked about the type of services offered by his department and who the department perceives to be its target groups.
Well, honestly, they come specifically from informal settlements, the so-called ‘Mkhukhus’ – shacks. Where you find a shanty one-roomed house built, and obviously the majority of those children come from the surrounding farms and as a result of the new dispensation as it unfolds they saw an opportunity for them to come here and they are unemployed. (Respondent from government, DSD).
In fact we target children affected and infected by the HIV/AIDS scourge, poverty and unemployment. (Respondent from government, DSD).
NGOs/CBOs also commented on the problem of poverty. The NGO/CBO worker quoted below spoke at some length on the issue. As with the caregivers above, her response makes mention of the constant lack of food that OVC experience. She was commenting on assistance from the community and or government.
But she ‘Ms. B’ (Carer) gets tired of knocking at every door begging for help. Sometimes you find her just standing there … as if she was contemplating where to escape. One of her younger children collects discarded food at a refuse dump. One day I organized a surprise party for Ms. B’s daughter who is now in Grade 10 because I saw in the daughter’s documents that her birthday was in August. So I organized supper. I got everyone to contribute towards that. When we reached the house I felt like crying when I asked about ‘T’s
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whereabouts. I was told that ‘T’ was not at home. When I asked where he had gone to I was told that he had gone to a refuse dump to collect food. One of the neighbour’s children ran to search for ‘T’. Later that day when ‘T’ stormed in and with pride he said: ‘I am here’. And then he sat down. Poverty does not mean that your humanity has ended but poverty does take away your esteem. We are trying to restore dignity back to the people. You know and we don’t just focus on one person in the family – we try to assist the whole family … That is why ‘Miss K’ is of use to me because I get a list from school principals and they give us a brief story around the child so that we know exactly what is happening. (Respondent from NGO/CBO, Diocese).
Later on this same respondent comes back to the matter of poverty again. Importantly, she refers not only to the burden of poverty, with children who alternate their eating days because of poverty at their home, but also of a positive story of overcoming adversity from an orphan who managed to go to university and get a degree.
We were just afraid that he (orphan who managed to go to university) would resort to drinking and drinking a lot but at the moment he is okay. But he does not have descent clothes. I had to refer him to the pastor and Ms. S (a community leader) and they did what they could to help him. The day he came to our church it was almost as if a king is coming. The reality is that somehow they (pastor and Ms. S) had to ensure that he’s well dressed. There are children especially in preschools that go without breakfast. In one case when a child was asked by a teacher what they ate for breakfast, the five-year-old child replied that they took breakfast in turns and it was not his turn. The child said that the mother couldn’t afford to provide food for all the siblings at once so that is why they took breakfast in turns. Now this is a true state of affairs. (Respondent from NGO/CBO, Diocese).
She concludes by saying:
Some of the challenges you have to face them head on and see exactly what you can do. You have got to be prepared to do that to eradicate and effectively treat poverty because poverty takes a lot out of people. People do not beg because they want to. If they had the means they wouldn’t beg. (Respondent from NGO/CBO).
The focus group also raised discussion on poverty. Asked by the facilitator ‘how rife poverty is in the area’, a respondent simply said, ‘very rife’. Another respondent elaborates on the matter a little later:
It is a large number, they do not have anything. You must remember that the Potch area is a very poor area and the unemployment rate is high and mines in the area are closing down. The mines are downsizing, so it is snowballing in the Potch area and that worries me a lot. The costs affect each and every suburb in the Potch area. (Focus group).
From this section a number of factors related to and with direct and indirect consequences for meeting the needs of OVC in the study site are shown. Among these factors, lack of gainful unemployment and the results thereof rank first. Lack of employment and the resultant poverty mean that people have nothing to deal with the problem of OVC confronting their communities. Not having anything means not just no money but also no resources and the inability to meet basic needs. To have nothing is shown in the fact that carers needed to get outside help to feed the children in their charge, their inability to pay rent, need for help with paying for electricity, inability to buy clothes and shoes,
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pay school fees and buy books. Government interviewees spoke of the challenge to get schooling for children from poor families who have moved to the townships, the need to address poverty in order to manage HIV/AIDS and therefore the multiple burden on families. The interview extract from the respondent from the NGO/CBO sector also centralised poverty as the key difficulty in confronting the problem of OVC. Lastly, poverty and its costs were also noted in the focus group.
HIV/AIDS: impact on the community
This section is devoted more directly to HIV/AIDS. As already suggested by some of the responses above, the disease is a critical thematic area to focus on in looking at OVC. HIV/AIDS, of course, lies at the root of the increase of orphaned and vulnerable children in South Africa, as well as in other southern African countries, and children without parents are put at higher risk and raised levels of vulnerability, not only of abuse and exploitation from others, but of ending up contracting sexually transmitted infections (STIs), including HIV. The perceptions and experiences highlighted here are of people’s understanding of HIV/AIDS and its actual or potential impact on the community, as well as their beliefs around safe sex practices and acceptances of these practices. The responses also draw attention to the views and experiences in the community on the stigmatisation of people living with HIV/AIDS and of children whose parents died from the disease. Participants were also asked to respond to questions of perceived dangers for infection, plans or ideas to address the problem of HIV, as well as prevention programmes and treatment interventions.
Perceptions and experience of impact of HIV/AIDS
In addition to the specific themes detailed below, respondents in the study mentioned the more general aspects of the impact of HIV/AIDS on the community. These include emotions such as fear, silence or denial about the real causes when community members die, stigma and ignorance, risky behaviours and children used to care for sick adults.
The first two quotations below are from persons who take care of OVC, the first of whom was seemingly living with HIV herself. Next is an excerpt from one of the two educators interviewed for the study and then a response from a government employee. The last pair of examples are taken from interviews with a person in the NGO sector and a traditional healer respectively.
The difficulty I experienced was the fear that I would also die due to the condition of my sickness. (Carer).
I hear about it (HIV) but I didn’t see it, I only hear that someone has died of HIV but when he is alive they say he has TB, but when he dies, that’s when you hear that he was HIV. So they make it difficult for us to know how to treat them … I mentioned yesterday that I wish to take the children to the clinic. I am working with children, sometimes they get sick and I have to care for them. So I want to take them to the clinic. People who die of AIDS Even traditional healers are afraid to touch people dying of AIDS. They (people dying of AIDS) can’t even eat. (Carer).
In my view HIV/AIDS is a problem that is spreading daily really. It’s a problem in our communities because many people even though they are aware of the fact that there is HIV/AIDS they don’t protect themselves. People do not use condoms or try to abstain. (Respondent from government, teacher)
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I will give you an example. For instance, there was a case of a child whose parent had died, right. Now the relatives thought that this child was a burden on them. They gave this child to an elderly woman who had a stroke. A child at ten years old had to take care of a person who had a stroke, who couldn’t bath herself. The child also had to wash her clothes, you see. If this child’s parent had not died of HIV, I don’t think the child would have been subjected to that much as, um, Even though people take care of children, these children are also open to abuse. (Respondent from government, DoE).
… it is such a silent illness and nobody talks about it. I know of mothers that had five daughters but now they have only one child left. And if I look at all the children I work with here I would say that this is quite a big problem. (Respondent from NGO/CBO, SAV).
It is big. Instead of decreasing it is increasing. We do not know why it does not decrease. It is worse than before. (Traditional healer).
The responses indicate that there is awareness of HIV/AIDS and its serious impact on the community. HIV/AIDS is said to be ‘big’ and ‘spreading daily’. Respondents also connect it directly to the vulnerability of children. HIV/AIDS is shown to render children vulnerable where parents die from the epidemic. In such cases children might be seen as a burden by their relatives and given away to work for or take care of others. Children themselves also die from HIV/AIDS.
As indicated in the extracts, HIV/AIDS is surrounded by a number of negative emotions and behaviours. These include denial, fear, anxiety, ostracism and stigma (which we come to later). Witchdoctors are said to be afraid to touch those who are infected. Also, it is only when a person has passed away that others hear that it was from AIDS. This seems to point to the need for interventions to include or repeat inputs around stigma and disclosure.
The general impact of HIV/AIDS and its link with poverty
An important point that needs underlining in considering the impact of HIV/AIDS is its entwinement with issues of poverty and heightened levels of unemployment in the country. The need for developing understanding and putting in place policies and programmes to address poverty in confronting HIV/AIDS and its impact on communities cannot be overemphasised. Many of the responses indicated poverty and the antecedent fact of unemployment as making up one of the largest contributing factors to the high rates of HIV/AIDS. Additionally, unemployment was also viewed as underlying the increased burden brought by OVC upon the community. The spread of the disease has been shown by many studies to be fuelled by lack of material resources as well as psychosocial and cultural capital and that the latter conditions are, in turn, worsened by AIDS mortality and HIV infections. Many of the respondents made the connection between families’ and the community’s poor life conditions and HIV/AIDS.
Government officials, without fail, noted the interdependence of the disease and socio-economic conditions. Furthermore, it was suggested that the inability of the government and communities to effectively manage the disease was connected to their inability to manage poverty and levels of unemployment.
The official of the DSD was another who pointed out the association. This was in respect of who is supposed to benefit from the department’s services. His answer was that the
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department worked with ‘children affected and infected by HIV/AIDS scourge, poverty and unemployment’. More specifically, on being asked about how HIV/AIDS has impacted on the community, this official said:
Unemployment is very high and it is the unemployed who are becoming sick. It is very difficult for other community members to take them to the hospital when they themselves are not employed. We do not have enough facilities and programs in our communities. (Respondent from government, DSD).
On being asked about the magnitude of the problem of OVC in the communities, the DoE respondent’s answer flowed into the problems of HIV itself and in turn the pressure that this puts on educators (OVC prevalence itself is discussed in depth later).
…if you look carefully you are going to put such a big burden on the educators and some of them will also be HIV positive and sick along the way somewhere uh, but you cannot ask them to be social workers, health care workers, do home visits and care for the sick people and yet still be expected to teach at school. You see we must think very carefully what burden are we going to put on the educators and the school although they might have infrastructure in the community uh, the burden will become too large for them to handle and then they would neglect their teaching duties and then the system will collapse. (Respondent from government, DoE).
An interesting perception mentioned by the respondent from the DoH was that the rate of new infections may be decreasing or flattening out. This she attributed to raised levels of awareness in the community because of the ‘message reaching the people’. She also maintained that programmes have to keep on ‘educating or doing awareness’.
The most important thing as a department is to involve the community … we must involve the community. So that is why we target churches and burial societies where woman gather. (Respondent from government, DoH).
To the question of what the impact of the disease on the community is, the Life Orientation teacher simply said:
In the first place I can just say that in future there will be so many orphans. (Respondent from government, teacher).
The connection between the impact of HIV/AIDS on the community and poverty was also mentioned by NGO/CBO workers. A telling point is contained in the extract below and highlights the multiple jeopardy faced by poor children, leading to risky behaviour. ‘Do you know of cases of children taking payment for sexual services?’ the participant is asked.
Yes. I think they do that but if you are very hungry and you haven’t got food won’t you do that? What can we do? They need it, they need it. But I cannot tell you the extent or how often that happens but I am sure it happens. (Respondent from NGO/CBO, SAV).
Stigma
There is now a large body of work that details the process by which disease leads to increases in stigma (Parker, Aggleton, Attawell, Pulerwits and Brown, 2002; Sabatier, 1988; Sontag, 1988; Skinner and Mfecane, 2005). Stigma has been shown to be a significant consideration in looking at HIV/AIDS and other diseases. The responses about stigma with regards to HIV were varied and contradictory. However, on the whole, the interviewees perceived little evidence of stigma in the communities under study.
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The government employees differed among themselves about whether or not there was stigma attendant on being an orphan or child in distress.
I think it differs uh, I have heard of one or two situations where kids complain especially on the HIV issue, again they uh, if you are open with your HIV status in some cases you can benefit from that and in other cases there is still a lot of uh, uh … (unclear) and they are afraid to come out in the open uh, so they think you will get … (Respondent from government, DoE).
People have in fact … attitude because sometimes you find that some, if, they that, that, particular child has no parents, they do some things. (Respondent from government, teacher).
This last response is complicated and needs teasing out a little. The teacher says that the community does talk about the disease, but this is abstract talk, since people who have HIV/AIDS are not likely to disclose because of embarrassment or fear of ostracism. The teacher appears to contradict himself by saying people in the community have a (negative) attitude to people with HIV/AIDS even though they are aware and talk of the scourge of HIV/AIDS in the community. The contradiction continues when, immediately after these lines on people having an ‘attitude’, the teacher refers to ubuntu.
…you know that as black people we have that thing of ubuntu (humanity). At least we try to cater for those kids. (Respondent from government, teacher).
It is important to treat talk of ubuntu with caution. While the notion of ubuntu is one that is often referred to in discussions about African cultures, evidence from these interviews indicates that while there are selfless individuals who do all they can to take care of OVC, there are also selfish people who abuse and exploit them for their labour and grants. To put it in another way, ubuntu is not a natural fact of African life, which every African person is born with, but an ideal to which the culture aspires.
Respondents from the NGO/CBO sector also tended to lean towards the view of less rather than heightened stigma in the community.
The social worker told me about a child who was very naughty and the community was very angry with him because he broke into their houses and stole things from them. No, I would be lying if I said that in the area I work in there are negative attitudes. Actually what I could say if I want to be truthful is that nobody identifies them as AIDS orphans. That fact is ignored. It never gets mentioned that the daughter or mother died of HIV/AIDS. (Respondent from NGO/CBO, SAV).
Programmes, ideas or plans to address HIV/AIDS
A number of ideas, plans or programmes in place to address the problem of HIV/AIDS were raised. Here we shall mention those from two sources in government – the departments of education and health. At the same time, as can be read from the first extract, they refer to other work being done around the disease in the community by NGOs. However, it is important to note that the programmes indicated in the extracts are not exhaustive. The extracts are related to programmes directly targeted at the epidemic. Programmes or activities that include a focus on HIV/AIDS but are leveled at OVC are mentioned in the last section of this report.
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The respondent quoted below occupies a position in the DoH in Klerksdorp dedicated to HIV/AIDS and the unit within which she functions has 11 staff members. The interviewee, a nurse, started as HIV/AIDS coordinator in 2000.
… in this section we do prevention. We have health promoters at all facilities that do health education on a daily basis … we have a community liaising office that issues and distributes condoms to NGOs as well as clinics. We also do training on condom use and everything about condom storage and safety. We identify high-risk areas where we should distribute condoms, like hotels, mines and trucks. We also have a group that we have trained to educate people on prevention and we have a care and support programme under the HIV section. Under care and support we provide care for the sick. We have health promoters who do training in home based care and they also monitor those that are trained because it’s volunteers that go out every morning to look after the sick, to feed them and all those kind of activities. We supply them with the material. We have NGOs that are involved in awareness and they campaign for condom use. Those are the main people who are at the community and they report to this office every month because most of them are funded from this office. We help them write proposals and we recommend them for funding. Every year there are NGOs that are funded. (Respondent from government, DoH).
In addition to the preventive work, the office forms part of the implementation of anti-retroviral treatment although they are ‘not hands-on’ but rather ‘part of the team that is implementing’. Asked as to what the basic philosophy of the unit was, the coordinator informs us that it:
… looks at coverage and mostly we want the service to be accessible to every (one) and that is the most important (thing). We will not be able to cure AIDS or do whatever. We want to reduce the infection level. So that is why we want every one to be covered and that is why we train our NGOs. All our NGOs are trained. (Respondent from government, DoH).
The DoH has a number of other special projects. Three were explicitly mentioned by interviewees: (1) a project dealing with the elderly and disabled, (2) a project that leverages traditional healer’s influence in the community, and (3) a project focused on dealing with young people. The youth project is connected to a youth centre in Jouberton. The project, according to the informant, goes out into the community on a daily basis and gets involved with significant days such as 16th June, a public holiday in SA celebrating youth.
As for the challenges that those who work against the epidemic here face, they are understandably monetary as well as those of resourcing.
Budget and transport. We have a problem with rendering services as we have planned because of limited resources. You can see we don’t have a computer right now. We used to have one but it broke. (Respondent from government, DoH).
Other departments besides health have mounted programmes as mentioned by respondents, for instance, the education department. But the main drawback seems to be little coordination, as noted by one of the interviewees. This shortcoming appears to apply widely. So while the DoE interviewees (interviewed in group) said that there was a ‘special programme running … concerning … HIV that they know about’, the group lamented the fact that efforts in confronting HIV/AIDS in communities were unsystematic.
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I have the feeling, the impression that it is not always co-coordinated, because there are many (unclear) working on HIV and AIDS in our country. We started with a sort of forum where we can contribute to those activities and we don’t know each other. There are a lot of NGOs who come and go, so we don’t know who is working where and who is doing what and I think we are also duplicating certain services and neglect others. Many people are working on prevention of AIDS now. (Respondent from government, DoE).
The situation of OVC
One of the key objectives of the larger study is to establish the prevalence of OVC in the community being researched. However, this task is beyond the nature and methods of the qualitative study component. Nevertheless, analysis of the interview material reveals other important issues related to the scale of the OVC problem in the community. These issues include (1) the lack of clarity about what an OVC is, (2) mine companies’ policy on families of deceased employees and its impact on children, (3) lack of funds and services and its relation on the extent of OVC, and (4) other reasons impeding a full appreciation of the nature of the problem, such as cultural or habitual behaviour of black communities.
Lack of clarity about what constitutes an OVC
The lack of a common understanding in regard to what an orphan or vulnerable child is complicates the assessment of the situation of OVC. The term OVC ‘was introduced due to the limited usefulness of the tight definition of the construct of orphanhood in the scenario of HIV/AIDS … this term in turn has its own difficulties, since it is has no implicit definition or clear statement of inclusion and exclusion. It therefore works as a theoretical construct, but requires explanation and definition on the ground’ (Skinner et al., 2004, p1). At an earlier phase, this project attempted to define OVC and established the criteria for orphanhood, as well as material, social and emotional problems. There is however still little agreement around definition among different community stakeholders about what constitutes OVC. This clearly has implications in respect of reliable prevalence figures of OVC.
OVC Prevalence: lack of reliable statistical data
Obtaining quantitative data on OVC is beyond the scope of this qualitative report, but is being obtained from a census survey of the community (Skinner, Mfecani, Nkomo, Josste and Simbayi, 2005). Quantitative data would make any envisaged interventions informed by these interviews more effective. Notwithstanding, interviewees perceived the problem of OVC to be large, increasing and in some cases to be overwhelming. For instance, as previously indicated, the respondent from DSD claimed that he thought ‘our orphan population has in fact been increased by … HIV/AIDS.’
Asked about numbers of OVC at schools, an official from the DoE responded thus:
I think it will differ from school to school. For instance, we visited a school and they estimated that about 25% of their learners are vulnerable, but when we visited another school it was 50% of their learners, uh so it will depend … it’s not clearly specified what we are talking about, um, different departments have different definitions. So they will never give you a clear indication of what is the specific situation at their schools … it is always estimates. (Respondent from government, DoE).
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In their answers then, respondents from the various government departments were admitting that there existed a significant gap in government’s knowledge about the situation of OVC due to a lack of reliable figures. This same admission can be read in the next extracts, even though the respondent from Grace Mokgomu (GM) Clinic, as the respondent from the DSD, expresses an untested perception that the numbers are growing. The first excerpt is from the interview with the HIV/AIDS coordinator in the DoH, who blames the DSD for not focusing on and assessing the problems of OVC adequately. The respondent from the GM Clinic in Kanana is quoted second. This respondent further states that, although a precise count has not been done, an increase has been noted in AIDS-related deaths. She infers that it is this increased mortality rate that has led to the increase in the number of OVC that the clinic has had to assist.
I can’t tell, maybe social service will know. We don’t measure; social service knows all the children receiving grants … there are a lot of people dying and in most cases you find that when both parents die they leave behind five or seven children. (Respondent from government, DoH, HIV/AIDS coordinator).
The numbers are increasing; I can tell you … parents are dying. The children are still okay though. We take care of the kids. (Respondent from government, DoH, GM Clinic).
Turning to the caregivers of OVC, most of those who were interviewed appear to be related to the OVC for whom they are caring. Note that carers interviewed are taking care of between one and four children. However one of the carers looks after 47 OVC, nine of whom live with her. There are many children here and I have nothing. There are 47 of them but I have nothing if I don’t have food … there are nine children staying here. (Carer).
Members of NGOs and CBOs attest to the large numbers of OVC while reporting on their efforts. Although they also do not have accurate numbers on the extent of the problem, their caseloads may be taken to serve as an indication. They all appear to regard the contributions they are making in addressing the problem of OVC as inadequate to combat its widespread nature, as they are under-resourced and therefore unable to take on more cases. The diocese interviewee appears to be overwhelmed, as demonstrated in the first extract. The next extract from the principal of Sizanani Educare Centre concurs with the diocese respondent on the overwhelming size of the problem and further relates this to poverty as the cause of OVC hunger and low attendance at the Educare Centre.
The problem of orphaned children is so widespread and I do not know what to do and where to take these children. In the township some children have no parents and others are neglected. Some children have no parents – their parents have passed away. (Respondent from NGO/CBO, Diocese).
The problem is too big because during lunchtime there are children that stand by the school fence hoping to get food. Perhaps these children do not have food in their homes and their grandparents have told them that the money they receive is insufficient to bring them to the school. There are problems. You can even visit the children’s homes to witness the situation. Unemployment is very high and the attendance statistics of these OVC and pre-school children is low. We used to have 120, 80 and 70 but now it is only less than 50 children. (Respondent from NGO/CBO, Sizanani).
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The principal appears to be relating the lower attendance rates to these children’s families’ inability to provide the money necessary for them to be able to attend. The respondent from Sizanani links the increase in levels of unemployment to the lowering of attendance figures at the school. The poverty in the community means that children are not eating regularly. Thus problems related to HIV/AIDS are exacerbated by poverty and poverty increases the number of children who qualify as OVC.
The founder of the KOSH Care and Support Group (KOSHCSG), a home-based care, organisation gives an estimate of the prevalence of OVC in the area:
Let me say 80% of the children in Kanana have problems and we don’t know who needs help. As an NGO we need help from the community. (Respondent from NGO/CBO, KOSHCSG).
They thus see four-fifths of the children within the area to be OVC, an alarming number of children in need of assistance, that speaks to the widespread nature of the problem. It also appears that the community is perceived as not being adequately supportive. Yet if the figure is really that high, the lack of community support might show the general poverty within the community. In other words, the reason for the perceived lack of sufficient support might be because many members of the community may actually be unable to do anything to alleviate the burden of OVC, as their own children would probably be classified as OVC.
The following respondents are social workers at various NGOs and they give the numbers of children who are on their caseloads. Respondents from the Ondersteunings Raad, and the Suid Afrikaanse Vroue Federasie provide accounts of their caseloads in the following two extracts:
I have 289 foster care children for the Jouberton area. This applies only in the area where OR does its work. These are children that have gone through the court and are receiving foster care grants and I am not referring to the children whose applications are still being processed. They (the 289 children) have gone through the system and over and above just getting them into the system we also have to monitor it. So our case list is very, very high. (Respondent from NGO/CBO, Onderstennings Raad).
We work in a poverty stricken jurisdiction. We have divided the neighbourhood and the four extensions where we work. We have 172 families and there are about three to four hundred children per household. (Respondent from NGO/CBO, Suid Afrikaanse Vroue Federasie).
Of the 170 cases with which Suid Afrikaanse Vroue Federasie social workers deal, about 20 are child-headed households. Thus it appears that the NGOs are dealing with very heavy caseloads. It appears that they are also under-resourced as they may be unable to adequately render the assistance they seek to provide, as indicated by the social worker from the Ondersteunings Raad above.
Not all the OVC being identified were attended to by social workers and thus a great many children are not entered into any official tally, as the following extract from the focus group interview indicates:
One school I have in my records in Kanana has 92 children in need of care that have never been attended to. Also I just want to comment that we have
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a record of schools of all those referred to us and some of them have been attended and some of the children have qualified … there are really children who have not been visited yet. (Respondent, social worker).
Thus there are many children who have not been recorded or identified as being OVC and the lack of human resources appears to be part of the difficulty in dealing with a problem as widespread as this.
NGOs appear to easily and more readily be able to identify OVC than the government departments. The sheer numbers are seen as overwhelming and are indicative of the large extent of the OVC problem, which appears to be due to poverty and exacerbated by HIV/AIDS.
Mine policy and the numbers of OVC
A teacher who was interviewed at the United Primary School in Umuzimuhle had this to say:
In this school we don’t have cases of needy children because this is a mining area. Mines accommodate them …. the mines employ most parents and as a result we do not see cases of needy children at this school. …When a father dies, a family is given a year before they are expected to move. We actually do not have orphans because once the father passes away, the family loses accommodation and they have to move to another area …We do have OVC but the problem is that the children are not noticeable. We don’t notice cases of needy children. The children are not distinguishable from the other children at the school. (Respondent from government, DoE, educator).
Umuzimuhle, part of a mining town, thus appears to have no problem of OVC. This is deceptive. Over and above the fact that definitional issues referred to at the beginning of the section cloud the picture here, orphans or children whose breadwinning parents died from AIDS are absent from the picture because of the mines’ policy of moving people out after the employed person dies. There are no visible OVC in Umuzimuhle schools because mines do not deal with children of employees who die, shifting the burden away to other communities. Hence, while seemingly indicating that employment by the mines decreases children’s vulnerability, the surrounding communities have an added burden when employment ceases or a parent dies and children are orphaned. The mines policy means an increased burden in under-resourced areas as families would have to move out of the mining area.
A child with a parent who worked at the mine who dies, and where the other parent is not employed by the mine, might thus be shifted from one locale to another resulting in him or her becoming vulnerable generally. The vulnerability starts with the loss of a home and without steady income the future will tend to become less secure. As most mineworkers who die are usually migrants from the former homelands, their families will either move out of the mining township to the informal settlement or to the rural areas from which the families came and where they have relatives. Although this respondent is a teacher in a school within a mining area, the teacher talks about OVC within the community.
I’m not sure about the community but I’m sure about the learners and at the present moment I think I’ve got nine of them who don’t have parents. (Respondent from government, DoE, teacher).
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These children were identified specifically, as a result of the school being notified of a parent’s death and were taken in by relatives who were employed by the mine. However in view of the mines’ policy it may be that, had these children not had relatives who were employed by the mine and were thus able to remain in the school, they may well have been removed. As a City Council of Klerksdorp employee states at length:
Well I must say that in Vaal Reefs you cannot, it is not easy to pick up cases because the people there live in mine houses. The people working at the mines are given accommodation by their employer. We are not able to detect clearly, but I have heard of cases when I was there … there are a number of orphans but I can’t tell you exactly in terms of numbers because I had to depend on individual cases. Cases came to me through social workers and all that so that’s when I realized that there are orphans in Vaal Reefs because the people there originate from other areas and they come there for work. Apparently due to poverty kids will move in and join their uncle or fathers and all that. Others will try to find work just to sustain them, so I can’t give you the numbers but what I can say is that there are orphans. I believe that in some cases in Vaal Reefs people don’t come forward because in general the system is closed. I think the accommodation there is private and it is owned by the employer, so information is not accessible like in other locations, like with Kanana … I must tell you that in Kanana there are lots of kids, especially in the shacks … if you go to an area called the Z section and Vaal Park, those are areas that have a problem because of poverty and HIV/AIDS ... my role as a youth counsellor has not been as effective as it should be because of a lack of resources. I have to depend on general information, it would be better if there was facilitation or a way of visiting them time and again and get the exact number of orphans. I must emphasize the question of resources. Some people don’t come forward. It was a particular case where the mother of the child was at a hospital and the father was nowhere to be found. The condition was not good … he informed that their problem in that area with kids is growing. The children have no proper guidance. People in Kanana move from the mines to the township. The new settlements in the township have a lot of orphans. The problem is better managed in Kanana because a number of these organisations operate in the township. I think another thing has been coordination among community leaders and sometimes we are not holistic in our approach in terms of addressing the matter and also the question of all those who volunteer to do such things are not given necessary support. (Respondent from local government).
It therefore appears that there are OVC within the mining areas who are not easily identified. The councillor too concurs with the perception that mine policy obscures the ability to accurately determine the extent of the problem, as well as the fact that the problem is worse in the informal settlements of Kanana. Additionally, he considers the lack of resources, the lack of support, as well as the inability to coordinate with other community leaders, as being part of the difficulty in determining the extent of the problem.
At the level of government departments it seems that there are problems identifying OVC, making it difficult to ascertain the extent of the problem. However, as we saw, interviewees stated that the problem is an increasing one and in need of urgent attention. It ought to be noted that there is an attempt by government to address this by developing a database of OVC.
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Lack of funds and services
Also noteworthy is the lack of available care, as carers are unable to house, feed and clothe the other children due to lack of funds. Although it is difficult to ascertain the full extent of the problem, indications are that the problem is widespread and overwhelms the resources of the helping agencies within the area. Lack of funding and the widespread poverty within the communities under study is hampering the alleviation of the problem. Lack of funding also appears to be a prime concern for NGOs who need to expand their work because of increased numbers of OVC.
The respondents below provide home-based care for terminally ill patients and through this became aware of OVC and their conditions. Lack of funding is reducing the number of OVC who can be assisted by NGOs despite the dire need. The respondent from Hospice forwards reasons why OVC have no caregivers in the first extract and provides the numbers of OVC to whom they are able to offer assistance. Imbizo and Bread4Support, in the second and third extracts, also provide an account of the numbers of OVC they service.
When the parents are sick, there are no active carers. What we have found was that the family structure may be in disarray. There is a mother who is ill and who has children. It becomes difficult for the grandmother, who is senile and probably not well herself, to look after the children because of the age of the children .… 30, it can take in 40 probably, but our big problem is getting them here (to the day care centre at the Hospice) and to take them back home later (the Hospice runs a day care centre that caters for their patients’ children) costs money. (Respondent from NGO/CBO, Hospice)
The funds are little … we can only help 40 children and that is 40 families …the 40 children have no-one to look after them. (Respondent from NGO/CBO, Imbizo).
Both respondents then indicate that their intervention efforts are limited by lack of funds and they therefore have to limit the number of OVC to whom assistance is provided. The point here is that there appears to be a large number of OVC in need of care. The NGOs also appear to be assisting OVC who have no parents and this can be taken to indicate that they are providing care to the worst-off cases, so that there might be many children who qualify within the definition of OVC but are not necessarily orphaned as they are living with a parent who is ill and bedridden.
Other factors hindering understanding about the situation of OVC
In addition to a lack of accurate figures, respondents advanced a number of reasons for the existence of gaps in what is known about the state of OVC. A consequences of the perceived increase in AIDS mortality is that children might be left in child-headed households, not the optimal conditions in which children might grow, and who may remain hidden.
You will appreciate that Klerksdorp is in fact surrounded by mines – Anglo-American Mines and also some other mines at Buffortfontein and Haartebeesfontein mines. Therefore for me the single sex environment … obviously there will be sexual relationships. And about the HIV/AIDS issue, it has become prevalent and obviously some children infected and some affected by HIV/AIDS become a product … and then you find so many children infected and so many affected. So we do have that serious problem with these
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children. Although I do not think the private sector, especially these mines, give a true reflection of the HIV/AIDS scourge in our area. HIV/AIDS is much worse. (Respondent from government, DSD).
The last respondent also implicates mines in the perceived increase in the numbers of OVC. The interviewee considers the upward curve of deaths from the disease to be the result of the proximity of the community to the mines. Being a poverty-stricken community, or a community where unemployment figures are elevated, coupled with the fact of being geographically near to mines, has been shown to increase the chances of risky sexual relationships and the spread of HIV. This set of variables would have an impact on children as they would then become orphaned or vulnerable as a result of HIV/AIDS, as well as affecting the children directly, especially girl-children, who have a higher risk of contracting STIs and the HI virus either through engagement in sexual activity, or as a result of mother-to-child transmission. It appears that the mine administration may be obscuring the depth of the problem of HIV/AIDS, which would affect the compilation of statistics on the number of OVC in the area.
A further set of reasons for an underassessment of OVC revolves around a certain cultural mode or way of regarding health matters, in particular what is seen by one interviewee as a lack of seriousness in the community about child health matters. Related to this is how adult members of kin relate to one another and especially how they relate to children whose parents have died.
This next respondent, from the DoH, notes these reasons, seeing them as hampering a full appreciation of the extent of the problem of OVC facing the community. He starts by indicating that reliable figures are difficult to ascertain, concurring with others about the difficulty of determining the precise extent of the problem. He then talks of it as a problem that might be seen as related to certain black cultural practices, which impede understanding about the nature and extent of the problem of OVC.
In the black community it is very difficult to … determine the extent of the problem for one simple reason. You may find that a child appears to be healthy and nothing may be seen as wrong or taken seriously because the eldest child in that household takes care of him/her right and might actually not be able to pinpoint that there is a problem or that there is a child in the family because the neighbours take care of the children. The second thing that makes it quite difficult is the fact that the relatives move often and when they take responsibility for the children they don’t notify anyone … you find that it’s very difficult to determine unless there is a disaster that actually happens – that you can see that this is a child-headed family. We have started compiling a database within the social cluster, that is the Department of Education, Department of Health and Department of … uh Social Development … the ministry was supposed to … distribute food parcels and the target for the food parcels was child-headed families and we had 20 children-headed families. We couldn’t get to 20 and I am sure that in that particular area or in that community there are more than 20 child-headed families, so that is where the problem lies um Black people as people have a tendency of being very overprotective of children, they believe that they actually protect them. (Respondent from government, DoH).
Beyond the fact that surveys on the extent of the problem had not been conducted at the time of writing the report, a further complication of the picture is then said to be the community’s lack of seriousness or lack of education regarding child health and
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development. The fact that OVC may be part of child-headed households or be cared for by kin or neighbours or the community contributes to the complication. Kin, or child-heads or neighbours looking after OVC may keep children who may be in need of help away from the required services or agencies. This may be due to the erroneous belief that they are protecting the children, being misinformed or uniformed. Another reason may be that those looking after OVC may themselves be under stress, feeling harried and so unable to give optimal care to the children. All of these are seen as contributing to heightened negligence and deepening of vulnerability of children.
A further problem noted by the DoH official is also related to a certain cultural mode of taking care of each other or a sense of family responsibility. In this case, however, this can be part of the problem since it hinders government efforts to develop an accurate understanding of the extent of OVC and their needs. The problem noted by the official is that relatives of OVC may take them in and consequently relocate them without informing those agencies that might have been able to help, or without interacting with the relevant state structures. Relatives who take responsibility for the children at times do not inform the DoH as to the cause of death. This further exacerbates the inability to compile data on OVC in relation to HIV/AIDS, as well as other chronic illnesses. In general, therefore, such practices of kin taking in OVC make it difficult to have accurate data to track OVC and to get to a true picture of the problem.
It would appear too that at present the health department is dependent on data from DSD, which would be based upon the figures of OVC receiving grants. However as many OVC are not able to access grants, due to not having identity documentation, these figures are also not reliable.
The DoE, including at the level of schools, are also unable to offer precise numbers on OVC. It appears that the numbers available to the department are dependent on the data that they receive from the schools, but schools do not keep such figures.
To conclude the section, there is no clear picture of the number of OVC in the target communities. At the base of this problem is the lack of statistics on OVC, a matter that the larger study, of which this report is part, will redress. But identifying a true picture of the problem is beset by other problems which have been noted above: defining what constitutes an OVC; a shifting population of OVC caused by the mines’ policy and the mines’ obscuring the extent of HIV/AIDS within their communities; lack of being notified as to cause of death and relocation of OVC, the community’s unwillingness to disclose the existence of OVC; child-headed households; the reliance of data based on social service grants accessed; lack of funds and other resources and support and coordination amongst community leaders.
Situation of households caring for OVC
This section looks at the prevalence of households providing care and their financial, spatial and emotional capacity to provide care. It furthermore considers the existence and levels of use or abuse of OVC for labour needs of the household of carers, for obtaining resources such as grants, or for any other purposes. The section concludes by turning to the perceptions of the nature and role of carers and what assistance carers need to continue to provide care.
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Number of households providing care
Most OVC appear to remain with members of their families and are passed around within the extended family with grandparents and aunts as caregivers. What is unspoken is that poverty affects the ability of most relatives of OVC to render any kind of optimal care. Therefore where family members are not available or unwilling to care for OVC, and they are not taken into foster care or adopted, OVC have to fend for themselves and become either child-headed households or street children. Due to poverty and the financial strain that most of the households in the area experience, they are unwilling or unable to provide assistance and care to OVC through fostering or adoption.
All the respondents in the NGO and CBO sectors agreed that most OVC live with and are taken care of by their female relatives. However, family members are not always willing or able to provide care and assistance to OVC due to their penurious circumstances. The lack or slow rate of delivery of financial assistance from the state also has an effect on the willingness of some family members to render assistance to OVC. In the first extract, the Ondersteunings Raad respondent says that she always had family members who were willing to care for HIV-positive OVC. The second extract taken from the social worker at the Suid Afrikaanse Vroue Federasie highlights the operation of kin-based systems of care, while the third extract from the member of KOSH Care and Support Group details the effect financial considerations have on some family members leading to the rupture of a kin-based system of care, and the last extract details what the consequences of the complete rupture of this kin-based system of care is for OVC.
I was very lucky, I never ever sat with an HIV positive child that I could not place because there was always family members. (Respondent from NGO/CBO, Ondersteunings Raad).
… it is mostly grandmothers and aunts who provide care … the children usually stay within the family. I have one child who lived with his grandmother who died, lived with an aunt who died and is now living with the second aunt. So they are passing them on within the family. When there is nobody to look after them is usually the brother or the sister that is already 18 or 19 years old and they are the head of the family. (Respondent from NGO/CBO, Suid Afrikaanse Vroue Federasie).
Grandmothers are trying but there are a few aunts who are trying to support the children because they talk about their own problems. They also complain that the grants are too slow – they want things speeded up. So we try to solve that – so that people can have grants. (Respondent from NGO/CBO, KOSHCSG).
… there is a child left by the father and mother and is staying alone … and there is a boy whose sister is going to get married … he stays alone as well as a family of three children, the eldest one is a girl of 19 years and the younger one unfortunately died because the mother and father died and they are alone in the house … and we got another family of a 15 year old and a five-year-old who is HIV positive and the mother and father have died already. (Respondent from NGO/CBO, diocese).
OVC are therefore taken care of by members of extended families. However financial reasons result in family members, and even parents, abandoning children. In the last case mentioned by the respondent from the diocese, the OVC are provided occasional assistance by their neighbours.
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Looking to strangers, as opposed to kin, to care for OVC is unpromising as most of the respondents indicated that community members were not coming forward as possible caregivers. This relates to the notion of ubuntu addressed earlier in the report, where it was suggested that ubuntu can only be seen as an ideal, which is increasingly hard to put into practice because of the widespread and deep poverty in African communities in South Africa. Indeed, the main reason cited for more community members not fostering or adopting OVC is poverty. The respondents from the Suid Afrikaanse Vroue Federasie and KOSHCSG in the first two extracts relate their perceptions of the negative attitudes of community members toward fostering OVC. The third extract by the respondent from Child Welfare gives poverty as the reason, which is reflective of most respondents’ thinking in regard to this issue.
… if you and I are speaking of strangers that can take care of the children they do not actually address the problem. (Respondent from NGO/CBO, Suid Afrikaanse Vroue Federasie).
They look at it as if is not their problem. When we conducted a workshop to teach them how to foster and how to adopt, no one was interested in attending or just doing anything … they have no interest. (Respondent from NGO/CBO, KOSHCSG).
… if a person is unemployed and is thinking of taking another child it’s a battle to that family. What is happening now is that we look at our family, I rather take my brother’s child than taking a child from outside. (Respondent from NGO/CBO, Child Welfare).
In concurrence with the NGO/CBO respondents, the two traditional healers interviewed noted the lack of households willing to take in orphans. As one of the healers remarked, there ‘are not many, just a few’ households providing care to OVC. But the traditional healer also provides other explanations for the low numbers of households providing care for OVC. From his response, at times contradictory, it seems that the community’s poverty has a two-fold effect on the willingness of community members to provide care for OVC: (1) community members cannot afford to provide care, and (2) if they are willing to foster OVC they may be labelled as doing so out of ‘selfish motives’ and thus considered to be avaricious. In addition, the children are stigmatised and seen as likely to present problems in the future.
People are scared that the child in future is going to be a burden. Some think they will invite bad luck for themselves and some are afraid of the challenge or funny things that could be presented by the child as he/she grows up … society will say you adopted the children because of selfish motives and for your own benefit. Because mostly if you walk around the street you will see and hear that the children stay with somebody but do not look clean, which means that the person who takes care of the children only uses the children for selfish ends or benefit. (Respondent, traditional healer).
When questioned about the numbers of households caring for OVC, government officials also cited poverty-related factors as a reason why the wider community was not willing to house and care for OVC, although there are some community members who do take in OVC. The educators who were interviewed concurred that poverty and related factors resulted in people not rendering assistance to OVC and in the first extract the teacher at Vaal Reefs gives the lack of space in their household as being a reason. In the second extract the supervisor at the clinic reiterates the reasons for the scarcity of caregivers and
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households willing to provide care for OVC to whom they aren’t related, despite her having stated that ‘there are people who adopt these children’. In the third extract the Council member also makes mention of specific community members assisting OVC.
… because of the accommodation you find that they are living in a small house and there are so many people inside the house, extended families, so its hard for them to take other children that they are not related to. (Respondent from government, DoE, teacher).
Most people are poor and they are unemployed and most of our people are not working. The mines are closed so there is no work, so to them if they take these children it would be expensive. It will be their children and these children, so they see it better to suffer with their own children only. (Respondent from government, DoH, nurse).
At Vaal Reefs there is a lady that I know of that takes of children that cannot live in their own homes because the conditions are not conducive. There is also another one in Kanana that I know whose focus is on orphans. In Tigane there is another lady there as well but the problem is that they all operate as small units. (Respondent from local government).
Most OVC appear therefore to be resident with their relatives, who for the most part are grandparents. Although there are a few community members providing homes for OVC to whom they are not related, there are many more who are not provided with care. The poverty of the targeted area is the principal reason for the lack of willingness to render care and assistance to OVC and where assistance is forthcoming it is curtailed by lack of financial resources.
Capacity at a financial, spatial and emotional level to provide care
The households caring for OVC experience dire poverty due to the high rate of unemployment. OVC do not have food security and heads of child-headed households and other OVC sometimes resort to illegal activity to secure money or resources. Grandparents, who are most often the carers of OVC, might not have the requisite documentation to qualify for state pensions and where children receive grants this grant may be the only source of income in some households. Most of the households providing care for OVC lack financial resources, which has an effect on housing as well as on the emotional well-being of the children. The extent of poverty results in OVC not receiving the necessary levels of nutrition, education and secure housing.
All the CBO/NGO respondents noted the lack of employment and poverty that characterise the target area and the concomitant results thereof: lack of food security, inadequate housing, an inability to provide for educational requirements and OVC involvement in illegal activity to acquire financial resources. One of the rrespondents told of a case where a child was held back two grades because they were unable to pay school fees. The stresses of poverty may also have a negative effect on some of the caregivers. The first extract is taken from a respondent in the focus group who described a situation where an OVC lived with a parent in a home without a door. The respondent from the Suid Afrikaanse Vroue Federasie), in the second extract, speaks about poverty in households that take in OVC and the concerns related to their basic needs being unmet. The social worker at Child Welfare, in the third extract, speaks about the unemployment that characterises the families that care for OVC.
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It would create terror having to come from that kind of family where there is no food. Obviously they would be vulnerable in the sense that they would agree to anything if somebody gives them money ... these children who do not have shelter and do not have basic food and means of education are vulnerable not out of choice but lack the basic rights of the child. Children need shelter, food and health. (Respondent from NGO/CBO, focus group).
The family that usually takes in the OVC haven’t got the means, they do not have the money to look after this child … So housing, a place for the children to stay where they would get food, clothes … it is food and housing our main problem. (Respondent from NGO/CBO, Suid Afrikaanse Vroue Federasie).
Most of the families caring for affected children have members that are unemployed. I think the reason being these are grandparents looking after these kids, so some of them are pensioners. (Respondent from NGO/CBO, Child Welfare).
The lack of employment and poverty noted by respondents has resulted in some OVC becoming prostitutes or turning to crime. The respondent from Child Welfare in the first extract below gives the explanations that OVC have provided to her as to why they have become prostitutes. The respondent from the diocese in the second extract gives an example of a male child-head of a household who engaged in criminal activity to obtain resources.
Ok, I had few cases where children will tell you that the reason why maybe they are selling their bodies is because they were living with their grandmother, the grandmother couldn’t afford this and this, so they decided to go and get money from the street. (Respondent from NGO/CBO, Child Welfare).
One of the 18-year olds was caught for stealing and he went to jail and afterwards he came to see me and I asked him why and he told me that he must have money to look after the other siblings. (Respondent from NGO/CBO, Sizanani).
Food and general lack of capacity to meet basic needs were of primary concern to caregivers of OVC. Of all the interviewed caregivers only one was receiving a child support grant. Most of the OVC appear to be concerned with the inability of their caregivers to pay their school fees.
They just ask for food, which we often do not have but if we have food we give to them. (Respondent, OVC).
Every year if it is December we do not receive reports because it is said we did not pay school fees. (Respondent, OVC).
The problem is that nobody is working and we don’t pay the rent. We live off my son’s grant; he is the only one that helps us with his grant. (carer).
I do not get grants. (carer).
I don’t have money…I spoke to her about going back to school and she is okay with the idea. She said that if I had enough money she would go back but presently I don’t have money. (carer).
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The study found that predominantly the children come from informal settlements and live in shacks, although there are some who live in houses. That is to say, the housing situation of OVC is inadequate. A respondent referred to homes where because a mother is suffering the house has become almost inhabitable such that you could not ‘tell from their house whether it is outside or inside the house. The doors are dilapidated and in some houses shovels and spades are used as doors’. The lack of physical security afforded by these houses is therefore another factor that exacerbates the levels of insecurity that OVC experience. A carer states that she would like to care for many OVC but her ‘problem is that there are many and my house is too little’. The traditional healers too mentioned the inadequate shelter, the survivalist existence, hunger, and unmet psychosocial needs.
In most cases we found them at the shacks where you find some times there is no electricity and the shelter is not in good condition … The environment is not good … when we go there we found the children dirty and the house is not clean, which causes diseases for the child. (Respondent, traditional healer).
And sometimes in the informal settlements, there are children who stay with grandmothers. They eat only on the day they get child grants from the government and when the grant is finished there is no longer food. They will start roaming the street and people will give them 50 cents in return for favours. (Respondent, traditional healer).
Government is aware of the financial, material, social and psychological circumstances within which the community, and therefore, OVC exist. In the same vein as traditional healers, carers and OVC, and NGO/CBO workers, respondents from government attested to both the constant lack of financial resources and the influence of such lack on accessing psychosocial services in addition to shelter, food and education. The first excerpt is from a teacher involved in the feeding scheme at United Primary School who goes on to interpret the position in which OVC exist as due to the fact that children are taking care of other children. The second extract is from a DoH official, the third from a HIV/AIDS coordinator with the DoH, the fourth by a supervisor at clinic, and last is the interviewee from DSD.
Sometimes you find cases of older siblings that look after siblings who are not able to provide financial support to their siblings or they are unable to attend to their sibling’s school related matters because of their engagement in other activities … being thrust into positions that they are not prepared for. I think the role of parenthood is something that they are not ready for. (Respondent from government, DoE, teacher).
We have found that one household they just have pap and potatoes, bread, in another household they only had an onion to share. (Respondent from government, DoH).
Some are in four-roomed houses and some are in big houses – it depends. To me, though, welfare just does not hand them over without checking for things like whether those people work. (Respondent from government, DoH, GM Clinic).
If children are left with granny its very difficult to find out that the child is an orphan because the care will be good … I had an incident that a child had to steal because the granny was sick. She could not even wake up to collect his
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pension so the child of seven years had go and steal in the neighbourhood just to help the granny. It was not because he wanted to steal but he thought that he was making some means for the household to survive. (Respondent from government, DoH, HIV/AIDS coordinator).
Some of our concerns could be the welfare of those who are supposed to take care of vulnerable children. For example, we have a typical case where you find the mother died and then you have two young girls who have to take care of the younger brother and they are all in school. Now what we do is we approach the next of kin to take care of the child and relieve these other children. That is why what we do is to ensure that the situation does not interfere with the schooling of the children left behind by the mother. For example, in the case that we had, we have those two girls who had to take care of the younger brother ... And that created some kind of neglected HIV/AIDS infected and affected children. The other thing the children are not able to attend school because they cannot afford to pay. (Respondent from government, DSD).
It is clear that the lack of money and material poverty shown in the extracts above does not only speak to the financial security of the lives of OVC. They also indicate that poverty and lack of material resources have unfavourable consequences for the emotional, social and mental development of OVC, leading to children experiencing a variety of stressors, as well as having trouble attending to these stressors. To give a final indication, when an OVC was raped by a neighbour and seemed to be suffering from post-traumatic stress, the child attended counselling initially but was unable to continue because of lack of finances for transport, as the counsellor was in town. This point leads us to the next sub-section, which deals more directly with abuse.
Levels of abuse
OVC experience varying forms and severity of abuse, covering physical, economic, sexual and psychological abuse. The perpetrators of the abuse are seen to be not only caregivers but members of the wider community, other OVC and neighbours. NGO/CBO respondents attested to the fact that OVC experience many forms of abuse. Interviewees pointed out that OVC experience sexual abuse from other OVC, are put at risk of rape in child-headed families, resort to prostitution and witness sexual violence being perpetrated on their caregivers. The poverty of the area combined with the substance abuse so endemic to low-income areas lead to situations where an OVC might get sold by their parents for money. Being neglected, OVC may suffer health problems as a result.
The rape happened to the mother and the child witnessed it … the children once you are raped are left by themselves. (Respondent from NGO/CBO, Hospice).
And also you know, we have a little boy staying with a little girl … they live in a one room shack and it is a problem, and even though it is not abuse but it does not mean that what we see is not wrong. When he wants to play with the little girl’s sexual organs he does not see anything wrong there. For us it is a problem and it is unacceptable behavior for us in this crèche. (Respondent from NGO/CBO, Hospice).
Rape takes place in such family because of the children being left alone by the 18-year old sister who went to look for food at the time of the rape. (Respondent from NGO/CBO, Sizanani).
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I know of one case that the social worker handled about a week or two ago where a 12-year old girl whose father and mother are alcoholics and they sort of sold her for liquor and she was raped. She has been really hurt very badly. What I see happening most of the time is that within these very poor family with no food and income, young teenage girls around 13 or 14 years old they already have babies of their own. (Respondent from NGO/CBO, SAVF).
We have a lot of problems with orphans as a result of HIV. Some of the problems result from negligence by parents. You find that a child has been raped but even after two years no action has been taken … because some of these children are not receiving any help, they turn to crime and prostitution. Others become street children. A lot of these children under the age of 18 years are HIV positive not because of rape but because of the situation they found themselves in. (Respondent from NGO/CBO, KOSHCSG).
Similar to sentiments expressed by respondents from NGOs/CBOs, the officials representing government departments and agencies also indicated factors that render OVC vulnerable and the kinds of abuse that they experience. What is noteworthy in the extract by the health department interviewee is the fact that, although girl-children might be considered to be more vulnerable to prostitution, lack of care and support renders children of both sexes equally at risk. Neglect was mentioned by several respondents.
You know in the past it used be a girl child who was vulnerable to sexual offence, presently boys because the rate of homosexuality has also risen, boys are also vulnerable. So you find that whether it is a boy or a girl, the eldest child if they do not have the support system they end up being child prostitutes. (Respondent from government, DoH).
Children are left alone and no one is taking care of them – that’s where the abuse comes. No one looks after that child, so people are take chances … (Respondent from government, DoH, GM Clinic).
We find them very late, because no one takes them to the clinics and sometimes we feel or maybe if they could have brought him earlier we could have prevented things like diarrhoea. (Respondent from government, DoH, GM Clinic).
The parents don’t go to school meetings and school fees tuition is also not paid … school fees. (Respondent from government, DoE).
Some family environments are so bad that the children end up resorting to destructive activities such as alcohol misuse. (Respondent from government, LG).
Traditional healers echo the perceptions stated by the previous respondents. In addition to the forms of abuse already noted the extracts below add verbal abuse, as well as connecting abuse to HIV/AIDS:
There are other community members that give us problems like raping the children, abuse … Sometimes they give the children money and rape them. (Respondent, traditional healer)
There are many cases and reports of child abuse by stepfathers. There is also child abuse without rape but reckless abuse such as talking to the child using abusive language. (Respondent, traditional healer).
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It is important to note once again that not all members of the extended family treat OVC in an abusive manner. Generally OVC under the care of grandmothers feel loved and cared for. It seems that OVC may be resented as a burden by some members of the extended family and, as indicated by the traditional healer above, they may therefore be subjected to verbal abuse.
She spoke to her one day on a Saturday. She said I must take food and when I did she shouted at me that I take a lot of food. My grandmother asked her why she shouts at me only just for food. (Respondent, OVC).
… about the child, a neighbour raped her in 2001. She was raped by a boy of 15 and at that time she was eight years. The case was postponed for some time. (Respondent, carer).
Since my grandmother died we started suffering and my uncle chased me away from home. He says that this is not my home. He burned my clothes and he took the food that we were given by the people from health care. (Respondent, OVC).
It is evident that being an orphan puts a child at elevated risk. Furthermore the risk of abuse emanates from a variety of sources including other OVC, neighbours, relatives and the environment. This risk includes vulnerability to neglect, verbal abuse, prostitution, sexual abuse and rape, psychosocial abuse, lack of schooling, homelessness and being sold into near slavery. Further, the degraded economic situation results in OVC experiencing forms of self-inflicted abuse, such as substance abuse. The confluence of desperate poverty and the proximity of the mine present some OVC with prostitution as the only option of survival. Interestingly, the interviews yielded no accounts of OVC being beaten. This means that for OVC interviewed for this study physical violence was not cited as a problem.
Furthermore it needs to be noted that, although there was no mention of abuse by state agencies and government intermediaries, the report has alluded to what amounts to abuse as evinced by non-responsiveness of policies and programmes. It ought to be added that failure to deliver assistance in an efficient and effective manner renders government complicit in the forms of abuse that are consequent on lack of financial resources.
Use or abuse of OVC to obtain resources, and perceptions about carers
The misuse of OVC for monetary gain is perceived to be widespread. Many of the respondents in the study claimed that there are people who foster children for the money and that they misuse the funds, as well as the fact that OVC may be treasured only for their labour. Not only do the extracts show the possible exploitation of OVC, they also point out some of the perceptions held about carers by the interview subjects. In one instance, an interviewee related that a child had to be removed from a foster family because those in charge of the child misused the money meant for the child.
There were very few foster parents who were working, so this is actually an easy source of income for … for, for most people. And find that uh I have because uh it depends also on the social worker who supervises the kids, whether they have money for the children or not … you … find … this person actually using these children as the source of income … there was a case of a child whose parent had died right, now the relatives thought that this child was a burden on them and what they did, they gave this child to an elderly woman (who) had a stroke, a child at ten years old had to take care of a person who
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had a stroke, who couldn’t bath herself, had to wash the clothes, you see if it was a child who had a parent or his parent had not died of HIV, I don’t think (a) child would have been subjected to that much as um, people take care of children but they are also open to abuse. (Respondent from government, DoH)
They were not buying clothes for the child, people told us that they were paying their own accounts and the burial society so that when the child dies they must benefit because the child was HIV positive. So this person was paying for a policy instead so that they can benefit if the child dies … people say that they want to help but they end up doing their own things with the money. (Respondent from NGO/CBO, Philani).
Strangers come and claim that they are the children’s family only to find that they are after children’s grant, which they would use for personal needs such as buying clothes. There is a lot of abuse … the child become neglected. (Respondent from NGO/CBO, Sizanani).
Not all the people who apply for the foster care grant are always vulnerable – there are reasons other than being vulnerable. And we have removed children from parents who had applied for foster care because they have applied purely for the money and that most of the children who are receiving grants come to school very, very dirty. They are not clean and they have a problem with books. You know there is something wrong somewhere. (Respondent, focus group).
Traditional healers also expressed negative views of carers as being avaricious. One of the traditional healers says ‘people take the money for their own benefit’. OVC living within private homes are thus seen by some community members as not being a solution to the problem of caring for them. One new myth is that it is not ‘necessary for the community members to take in’ children seeing ‘organisations that are working hand in hand with the Nelson Mandela Children’s Fund and NGO’ can take care of the problem. A centre to care for OVC is proposed on the basis of this concern. The other traditional healer sees the solution as ‘a one-stop children’s home’.
People just want the grant and they use the money for themselves – they don’t care for the children. People are trying to report them to the police … What I can say is that … I really think there are people committing crime, who want to use the children’s funds for themselves. I lost my wife in 2002 and my mother in law decided that she would register my children for the grant and she spent the money on another last born. So it’s a crime for these people to adopt because they want the money. (Respondent, traditional healer).
The people should not adopt the children. There should be a place for children where any community member who wants to help should go to that children’s home or place and contribute his/her assistance. (Respondent, traditional healer).
What I can say is that they take advantage if the children have no parents. They put up a front when the social worker comes around, like buying cheap clothing for the children … the environment is not good. When we went there we found the children dirty and the house was not clean – that causes diseases for the child. (Respondent, traditional healer).
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As has been noted above most caregivers are seen to be utilising OVC grants for their own purposes. On the other hand, many of the respondents noted that caregivers are unable to render effective assistance due to poverty. The views about caregivers exploiting OVC for their grants however need to be balanced by others which express the sentiment that there are community members who are selfless and whose motives are purely to take care of the children.
There are people that we place the children with without even giving them anything. I have a case where we placed a child with a woman. That child did not have clothes, she went out and bought clothes for that child and she doesn’t expect anything from us. (Respondent from NGO/CBO, Child Welfare).
So there are some good people out there who are doing a very good job, who have taken children into their own homes and you find that in those cases those people are actually digging into their own pockets to help these children. (Respondent from government, DoH).
Forms of assistance needed by households with OVC
As poverty is so endemic to the target areas, most of the respondents from NGOs and CBOs felt that financial assistance was needed so that OVC could, for example, pay school registration fees and meet physical needs such as hunger and shelter. Respondents cited numerous instances where caregivers were unable to access help, grants or services due to their not having the requisite official documentation such as death certificates, birth certificates and identity documents, so assistance with the processing of documents is vital. A few of the respondents considered income-generating projects to be what was required and such projects ought to be focused at grandparents, for they have not been taken into consideration, despite this group making up a sizeable number of caregivers. Many respondents noted how frustrating the process of applying for the grants was, as caregivers had to wait for a long time. Interviewees also signaled the need for educating the community.
I have a problem because people came to me and I tried to get IDs and birth certificates and referred the whole family to a social worker in June. The first appointment for that family to appear before the magistrate was in November. What does that mean for the children who come to me hungry … for me it is too long. (Respondent, focus group with community members).
I don’t think the foster care grant is the solution. We must focus more on income generating projects where we empower families that care for the children with skills so that they can survive on their own. (Respondent from NGO/CBO, Suid Afrikaanse Vroue Federasie).
One child for example was 20-years old and the only problem that he had was that he did not have an ID book. The old people looking after children whose parents have died are always informed that they should bring the death certificates of the children’s parents and their (grandparents) ID books so that we can use them to apply for grants. At least it will be better that way because they will be able to support them with that money. (Respondent from NGO/CBO, Philani).
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I think we need to educate the community and we must teach them that to be a community member it means to help other families because you may never know what tomorrow will bring. They need to be educated that HIV and orphans affect the whole community, not just individuals, that we have to share whatever it is that we can share to help a child. They need to be educated. (Respondent from NGO/CBO, Imbizo).
Government agents also expressed views about what they thought households caring for OVC and OVC themselves require. Below are sentiments by the teacher at United Primary, the DoH official, and the supervisor at the clinic:
I think they must be counselled and secondly, they must be encouraged really to go school and be educated. Lastly, we could donate money and give handouts, money, food clothes but that won’t be good and can’t do them any good. But once they get educated they can be independent and they won’t depend on other people. (Respondent from government, DoE, teacher).
… make sure that these children eat correctly and we need to put a monitoring system in place to make sure that, you know, all the children go through the system. They should be better taken care of as compared to children who have their actual parents living with them. That will take a lot of money – we need to acknowledge that. It would take a lot of money but if you are interested in building resources for this country that is what we have to do and put our money where our children are. (Respondent from government, DoH).
Really maybe if people can work there will be something. Most of these patients here at the clinic are not sick but they have problems. When a patient enters the consulting room she starts crying and then you have to listen and find out how you can help. She would tell that ‘we did not eat yesterday’, ‘we are so hungry’. This is a clinic. What can I do other than to refer her to welfare. That is the procedure we must follow but I can help her now, what about tomorrow? At least if she is working she will earn something and buy food for her children. (Respondent from government, DoH, GM Clinic).
Accessibility of grants or work, housing for their charges and food seem to top the priorities of what carers need. It is clear that all of these concerns are related to and will be alleviated by mechanisms that address poverty and unemployment.
I have applied (for the grant). The social workers have come to me and they have asked me some questions. They said they will tell me when to go to court but I’m still waiting for them … I applied in February 2003. I went again and they told me they will come but they haven’t ... as I told you that at my house there is no one working. We want to live like other people and we want to have food … I wish she could receive it (grant) so that I can pay for her school fees and buy her clothing and school uniform. (Respondent, carer).
If I can get a grant for all the children because all the other children receive grants but this child does not receive one. Maybe if I could receive one she would be like other children … I think people must love her. (Respondent, carer).
What I wanted is a house for these children. That is my first point if they can have their home, where they can be placed so that they could receive good
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care. If I had the power I would do a lot for them, I would get a stand … if the government can help us mostly with school fees. We are trying but it is not very easy because at school they go for trips and we have to pay for that. We need a place where we can stay with them. (Respondent, carer).
OVC themselves have a number of needs, which tend to coalesce around basic needs (though education was noted too): food, clothing, educational material, and shelter. But they also suggest needs relating to warmth, security, nurturance and affection and a sense of belonging.
We don’t have clothes and schoolbooks, as well as shoes. (Respondent, OVC).
…to help me with food and clothes. (Respondent, OVC).
They must take care of us. (Respondent, OVC).
They should buy books for them … Mothers must take good care of us. If you want to say something to your mother, she must not ignore you but she must listen to what you want to say …We went to see social workers on Friday. They have promised to phone my grandmother so that we can go to court to apply for a grant. (Respondent, OVC).
… would ask them to take my brothers away from the streets and separate them because when they are together they are a bad influence on each other. I want the government to take them to where they can stay and go to school, where they can change their life for the better. (Respondent, OVC).
Support structures for OVC in the community
Care structures and systems for OVC are found in both the state and NGO/CBO sector, with individual households and community members providing the backbone of the care. This section covers the culture of help in these structures and in the community generally, identifying the assistance needed to provide support to OVC by such individuals, organisations, and governmental structures that do offer care.
Government Departments
There are government programmes aimed at OVC but they appear to be insufficient to address the problem or are seen as inaccessible. These programmes are hampered by lack of resources, lack of coordination and an ambiguous definition of what constitutes an OVC.
Programmes or projects aimed at addressing the problem of OVC gathered through the interviews: • The Department of Education operates the Primary School Nutrition Programme
from schools.• The Department of Education also offers free education and assists in the
identification of OVC.• The Department of Health provides free health care to OVC between 0 and six
years of age, an immunisation programme, a school health programme, a mobile clinic, a nutritional supplementation programme, the prevention of mother-to-child-transmission (PMTCT) Programme, an antiretroviral (ARTV) Programme and a
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voluntary counselling and testing (VCT) programme. As part of the equal circle they operate a cost-effective food gardening project with one of the target groups being children without families.
• The HIV/AIDS unit in the DoH does work around health promotion, HIV prevention and awareness. They also provide funding to NGOs some of which work with OVC. There are youth projects run within the section.
• The DSD implements the delivery of Child Support Grants and the Foster Care Programme. They run nutrition programmes from a variety of government sites. The City Council of Klerksdorp has a Youth Councillor who focuses on the problems of the youth in the area.
• In addition to the various government departments’ programmes aimed at OVC, most departments tend to have policies that are aimed at identifying and referring OVC to the DSD.
These interventions, while significant, are not comprehensive enough for support and care in the area for OVC. The lack of resources, both human and in relation to resources such as equipment and transportation, were mentioned by most of the government officials interviewed and were seen as hampering service delivery and impacting on the efficiency and effectiveness of implementing programmes. Interviewees also indicated that a sizeable proportion of those directly responsible for home-based care work on a voluntary basis.
We do have policies around family with specific programmes targeting the child. But what I am saying is that you can have all kinds of programme names but if you cannot implement them … this is where the problem lies, and unless you have people to deal with these things you are practically going nowhere. (Respondent from government, DSS).
At the moment, we are short staffed. We can no longer do home visits. We used go deep into the townships and we would do awareness there. We cannot do it now … we have three mobile clinics … two mobiles are not working and the other one will start working on Monday. (Respondent from government, DoH, GM Clinic).
… these are people (volunteers) who have actually made it possible for us to do some of our work … Actually the department of health … rely a lot on these volunteers. (Respondent from government, DoH).
The DSD interviewee further felt that implementation was hampered by lack of transformation in the systems and policies at a judicial level, as this impeded the fostering of children.
The area of child foster care programmes is where we have serious problems. We have a system, which has not transformed itself especially around issues such as what is viable from the magistrate. They would have to agree to remove the clause that requires that a person who seeks to foster a child should stay in a stable environment and must have an income from a stable environment … I think the other issue also is the fact that for the first time in the justice system foster care is being challenged by the fact that the age of those prospective foster parents are people who are very young, in other words, we talking 16- to 18-year olds. That is a serious problem because it appears as though the justice system only works in theory and not in practice (Legally young people under the age of 18 carrying responsibility for households cannot be granted foster parenting rights even though in reality there a number of children looking after their younger siblings). (Respondent from government, DSD).
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It therefore appears that there are systems and policies including governmental that hinder effectively addressing the issue of OVC. An interviewee at the DoE also felt that strain was being placed upon their resources as schools and educators were expected to play too many roles.
On the one side teachers have to educate, inform and protect. On the other side, a child may also have physical needs that are not being addressed. Surely teachers cannot be expected to perform all these roles – somewhere a line has to be drawn. (Respondent, DoE eduator)
The lack of coordination between departments is a concern that was addressed by several respondents, who stated that there would be more effective support for OVC if departments knew ‘who is working where and who is doing what’ and not ‘duplicating certain services and neglecting others.’ (Interviewee at Department of Education).
In view of the above the informant therefore felt that the DSD and DoH should play a greater role than the education department and that there should be a way:
… to structure something in the school and in the community to help them take care of these vulnerable children, but I think the lead should come from DSD and DoH and not I think the other way round, uh there should be more um better co-ordination between the two different departments um, each and everyone should know exactly uh, what to do and how to do it. (Interviewee at Department of Education).
However schools may be a source of support for OVC, as educators in their capacity as individuals may be providing OVC with assistance. Thus the teacher at Vaal Reefs Primary said that educators at that school identified OVC and would then:
… ask for donations from learners and educators meaning that we don’t take it from the school coffers – we contribute.
Caregivers, NGOs and CBOs were worried about OVC, not attending school due to an inability to pay school fees, and not having uniforms and books. So it appears that a culture of help within schools may be lacking and they therefore do not appear to be assisting OVC. The lack of service delivery of grants reported by caregivers of OVC, NGOs and CBOs also are testament to the inability of government departments to properly provide an ameliorative environment for OVC.
One NGO worker commented on the problems with schools that result from parents’ inability to secure the necessary resources, financial or otherwise.
And what we have seen lately is half the parents coming and telling us that the school is not friendly. They do not want their children in the school because the children do not have shoes, do not have the right clothes to wear and they do not pay school fees. I have two school cases in Mafikeng I nearly cried where the children are not allowed to attend school because of the mentioned problems.
This statement and similar ones by other respondents from NGOs make it evident that schools are not providing an ameliorative function and rather are adding to challenges that OVC face.
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NGOs/CBOs
There were a number of discrete and converging difficulties signalled by respondents. Once more, the poverty in the area and the number of OVC in need of care, in combination with the lack of financial resources, appear to be frustrating the efforts of most of the respondents. Even where an NGO or CBO’s primary focus is not OVC, they have included them due to the need for assistance, although they are only able to do so in a limited manner. The NGO/CBO services to OVC include the following: • SAVF provides food parcels, assists in placing OVC who have behavioural problems
in intervention schools and assists a nursery school. • KOSH Care and Support Group does home-based care, assists people in accessing
grants and solicits donations of food and clothes for OVC. • Child Welfare in Orkney places children in foster care and involves unemployed
caregivers in income-generating projects. • Sizanani Educare centre provides pre-primary schooling for children between
two and six years of age and accommodates and, for a monthly stipend, feeds the children.
• Philani Health Care Centre provides home-based care and refers OVC to social workers to access grants and also take care of OVC.
• Ondersteunings Raad places OVC in foster care and provides parenting training for caregivers and life skills training for OVC.
• Hospice provides home-based care and runs a crèche for their terminally ill patients’ children.
• Imbizo and Bread4Support operate a day-care centre for OVC and provides them with food and uniforms. They also appear to negotiate with schools on behalf of OVC.
• Diocese appears to be intervening with schools and government departments on behalf of OVC and caregivers as well as providing people with food parcels and running crèches from churches.
Many NGOs/CBOs focus on accessing state services for OVC. NGO/CBO respondents pointed out that the rate at which grants are processed was a major concern, with there being breakdowns in both the courts’ processing of requests and the DSD bureaucracy. The respondent at the diocese made this explicit with the following remark:
The application for grants takes forever and that has frustrated us … so that is the work we do in this office. We investigate why a person that came to us in June but who by December has still not received any reply. At the magistrate’s office where applications are processed, social workers are given one day a week to present their applications, so it is frustrating. But the important thing is now who are we talking about? We are talking about a child who is hungry.
The legal process involved in fostering and processing grant applications is a factor that needs to be considered to expedite delivery. As one of the respondents in the focus group said, the social workers who have to process these applications are faced with an overwhelming caseload, as described below:
One social worker came to a meeting with a notebook. She sees 40 clients a day. She goes to Kanana for instance twice a week, one day is 40 and the other day it is 44, so its 84 a week. So you have to wonder when does she do follow-ups. So children are on that waiting list for up to year and those 100 children are vulnerable children.
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This is then further compounded by the limited time allotted by the courts to the presentation of these cases and results in a backlog which means that, even when OVC are identified and engaged in the process of grant application, they may still have to endure a lengthy wait to receive assistance.
NGOs state that they need financial assistance as they are unable to employ more staff and they appear to have a high staff turnover. The respondent from Child Welfare in Orkney, in response to being asked what their organisational challenges were, replied that they lost most of their social workers to government or the private sector and prefaced it with this statement:
Funding is a challenge because now we need extra social workers but we can’t employ one because we don’t have money. The other problem is that social workers are leaving NGOs – the salaries are very low. So most of us just come and go, especially when it comes to black social workers – they don’t last.
One respondent at KOSHCSG mentioned a variety of challenges related to insufficient funding and it seems that local government intervention limits the kind of initiatives that NGOs can implement:
We cannot do good things like we want because money is our problem. We don’t have transport to take us to them in time. Like in Kanana we go there twice a month but because of money and transport we don’t go in time. We also don’t have the support of our local government. Sometimes they don’t want us to do as we plan – they want us to do things according to their plan. We’ve been waiting for them for almost two years to answer our request that we gave them and food is the problem too.
Many of the NGOs/CBOs felt that the implementation of income-generating projects would help alleviate the plight of OVC, as the poverty in the area caused most of the social problems with which they had to assist, as the respondent from the Suid Afrikaanse Vroue Federasie said:
I think what we really need in the community is job creation where the family can at least have a person employed and the children can be a part of a normal family that is not struggling all the time.
The respondent from KOSHCSG noted that funding is conditional but that funders are unable to ascertain the nature of the OVC problems that NGOs are attempting to alleviate.
We asked funding from the National Lottery Distribution Trust Fund for food parcels and money for an HIV/AIDS project. We got R250 000 for the HIV/AIDS project and they refused to fund us for food parcels stating that we must not give somebody fish but must teach that person to fish, so that the person can learn to catch the fish by him/herself. That is all wonderful but the HIV infected person is going to die anyway so why are they holding good money after bad thinking. We need this food for the children that are still growing and that have a future.
Carers and OVC
The community of the study sites is poor. This affects the way they respond to OVC, as they are unable or unwilling to assist OVC, as attested by a respondent:
If you do not have the food on the table, you need to feed your children before you can feed the children in the neighbourhood. (Respondent from NGO/CBO, Hospice).
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Moreover, some of the neighbours appear to be unwilling to render assistance to families with OVC. Yet as one of the OVC stated, OVC might not want to ask neighbours for food as they are afraid. This not only suggests the fear of stigma, but also that OVC and others are aware that neighbours live in the same kind of penurious circumstances as the children in need. However a few of the OVC and their caregivers did mention that not all members are unwilling to help or are feared, as neighbours and others in the community do assist OVC when they are able to.
… we will finish or exhaust the neighbours’ food. (Respondent, OVC)
Neighbours assist with mealie meal pap, meat and tea when there is a shortage. Also they give out clothes. (Respondent, carer).
The straitened conditions under which the community lives therefore appears to be a factor in their resistance to rendering assistance to OVC and their families. Most of the caregivers were not receiving any assistance from any organisations and had not been able to access grants, which would indicate that a large proportion of affected families are not being reached. Lack of financial resources appears to be the major problem that affects these institutions. The government departments are unable to act effectively as they are hampered by lack of resources, as are the NGOs/CBOs and the community. The judicial system also appears to have an impact on the service delivery of grants and therefore this needs to be taken into consideration.
Conclusion
Most interviewees felt that OVC are already a substantial problem in Kanana and Umuzimuhle. Numbers of orphans are increasing and it is felt that there is a high prevalence of HIV/AIDS. Beyond that there are problems of parental abuse, substance abuse by parents with resultant neglect, general poverty and lack of access to services. These further increase vulnerability. The study has found that most orphans remain with members of their extended families and are passed around within the family, with mainly grandparents and aunts appearing to be caregivers, although poverty too affects their ability to render effective care. Where family members are not available or unwilling to care for OVC, the latter end up fending for themselves, becoming child-headed households if they are not fostered or adopted. It appears that due to the financial strain that most of the households in the area experience they are unwilling or unable to provide assistance and care to OVC through fostering or adoption. The community’s poverty has a two-fold effect on the willingness of community members to provide care for OVC: community members cannot afford to provide care and, if they are willing to foster OVC, they may be labelled as doing so out of ‘selfish motives’ and thus considered to be avaricious. The children might be stigmatised and seen as likely to present problems in the future, but this problem was not seen as salient. OVC do not have food security and child heads of households and other OVC sometimes resort to illegal activity to secure money or resources. Most often the carers of OVC, usually grandparents, do not have the requisite documentation to qualify for pensions and where children received grants it is often the only source of income.
Most of the households providing care for OVC lack financial resources, which has an effect on housing as well as on the emotional well-being of the children. The levels of poverty result in OVC not receiving the necessary levels of nutrition, education and secure housing. All the respondents noted the lack of employment and poverty that characterise the target area and the concomitant results thereof: lack of food security,
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inadequate housing, inability to provide for educational requirements and OVC’s illegal activity to acquire financial resources. Further the stresses of poverty may have a negative effect on some of the caregivers. OVC experience various forms of abuse, such as physical, economic, sexual and psychological abuse. The perpetrators of the abuse are seen to be not only caregivers but also members of the community, other OVC and neighbours. The misuse of OVC for monetary gain is perceived to be widespread. Respondents claimed that there are people who foster children for the money and that foster parents may be misusing the funds.
Perceptions of the role of carers by others are negative. Some interviewees perceive caregivers of OVC to be avaricious, claiming that people take the grant funds for their own benefit. Thus, some community members see having OVC living within private homes as not a solution to the problem of supporting and caring for them. Rather respondents feel that taking care of OVC should be left to NGOs/CBOs or that a centre be established to care for OVC.
The report has shown that, although support structures and systems for OVC are available in the community under study, these systems and structures are overburdened inaccessible, or not well known. Poverty seems to be among the primary set of reasons for this state of affairs. This is naturally related to what is seen to be high numbers of OVC, the lack of resources at community, household and organisational levels, as well as the lack of coordination between organisations, NGOs/CBOS and the different state departments.
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CHAPTER 6
Overall conclusions and recommendations
Donald Skinner and Alicia Davids
The communities described in this report represent very different contexts: Kopanong is a largely rural community comprising nine small towns and a large number of farms on the fringe of the gold reserves, while Kanana is a large urban township comprising mainly migrant workers and other service workers and their attachments, who service the mines in the region. It is part of a dense municipality that forms a center of the gold mining industry. However, many of the problems faced are similar.
The situation for children in both of these communities is serious and there is a high risk that the situation will get worse over time. In both communities the levels of HIV/AIDS are high and community members feel that they are still rising. The implications are already being felt in the rising levels of illness and the increasing prevalence of orphans. In combination with this impact, both communities are experiencing high levels of poverty. Both communities are feeling the effects of the downturn in the gold mining industry, the drought that has affected large areas of the country and the increasing levels of urbanization that have weakened the rural economies. This leaves the remaining residents of these communities, especially the children, in an extremely vulnerable position. As was highlighted in the introduction these children face threats of vulnerability from a range of sources in addition to the poverty and illnesses, particularly HIV, raised above. Substance abuse and community violence is very high, both of which constitute physical, emotional and material threats to the children. Child abuse was also commented on as being a serious problem in both sites. This provides probably the most insidious and long-term damage to children.
There are a number of challenges confronting communities in the Free State and North West provinces. These include high levels of unemployment and poverty, very high HIV rates, an underdeveloped system of care, mixed levels of care in the communities and difficulties in finding foster parents, as well as lack of resources. Access to services presented a particular problem for the Kopanong site, due to the number of small towns and large distances between them. Although high levels of need exist in all the towns, there are not sufficient resources to provide services at this level. Long distances made service providers unwilling to travel constantly, but also put real restrictions on the amount of time that was available and considerably increased the cost of providing, for example, social work services. There is consensus among the NGOs in the area that more can be done to assist OVC. Everyone involved recognizes the need for co-ordination between stakeholders. The general consensus among all the stakeholders is that everyone, from community members to local government, has a role to play.
There are a number of distinct implications of these vulnerabilities for public policy, especially in the areas of public health and social development. Children are not only affected by HIV/AIDS, but by this epidemic in conjunction with a myriad of other factors as outlined above. All of these have the potential of making children vulnerable. The
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situation has to be examined holistically. A particular implication is that the number of OVC is far higher than the number of orphans likely to result from HIV/AIDS. Increasing disparities of income and difficulties in accessing services are likely to occur, especially amongst those most directly affected by HIV/AIDS.
In a context of limited resources, the key findings above have implications for the targeting of responses: • It is important to recognize the interrelated aspects of the HIV/AIDS epidemic and
poverty. The need to focus energies on fighting poverty and curbing the HIV and AIDS epidemic in rural villages and informal settlements is critical.
• It is equally important to mitigate the impact of AIDS in these areas as a priority. As parents die and leave their children alone or with grandparents, it becomes critical to ensure the care and development of these children.
• This care needs to happen on three levels, namely the OVC themselves, their families and their communities.
To be able adequately to understand the interaction of the multiple vulnerabilities that exist, a new and fuller set of indicators will be required for social measurement. All the factors above need to be addressed and the interactions between them need to be acknowledged. The possibility of hidden populations of sufferers increases. Child-headed households are already difficult to trace and bring into the community. As the number of these households rises, there is a risk that they will fall out of the catchment for services and measurement. Those vulnerable here include child headed households, victims of sexual, physical and sexual abuse and children living on farms and areas that are not easily accessible by service providers. It is important to note that adults are often needed to provide protection and to facilitate access to services.
Solutions will have to be broad and have an impact on a systemic basis. This may require considerable rethinking of the delivery of services and methods of accessing assistance. Considerable additional resources will be required, particularly as some of these children will have already lost trust in the existing systems and tend to shy away from contact. Poverty presents the biggest challenge, one that is determined by factors far beyond the reach of these NGOs or even the communities as whole. The lack of profitability in the mines has led to high unemployment and increasing poverty. This is the backdrop to almost all of the other needs that are presented to the NGOs.
From the information above, a number of clear priorities for interventions emerge. These can change or become better understood as more research is done and we obtain wider experience in the district. Therefore it is suggested that the following areas be prioritized for action at the NGO level.
Care of OVC
Direct care of OVC is an obvious first priority for the project. A number of direct recommendations for mitigating the impact of HIV and AIDS for OVC emerged from this work:• Early identification of potential orphans is essential. Stigmatisation around HIV/AIDS
in the communities creates enormous problems, since it leads to people hiding their illness. For orphans it means that there is often inadequate planning for the future, both at an emotional and material level. There is a need to create forums in which
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people can talk openly about HIV/AIDS. This can encourage those living with it to disclose their status, at least to family members and service providers, so that planning for their children can be set out.
• An agreed definition of OVC needs to be accepted and used as a basis for planning, so as to prepare for an extension of services to all children in need.
• The basic needs of these children need to be met. This includes food, shelter, clothing, access to education and health care. As part of this, it is critical to assist OVC in obtaining the necessary legal documentation such as ID documents.
• They require access to essential state services such as health, education and nutrition, both from state services and NGOs.
• They need to get HIV/AIDS and life skills education, as well as other vocational life skills, to reduce their vulnerability to HIV and ensure that they are economically self-sufficient.
• OVC need psychosocial support to cope with grief as a result of the loss of parents, and the stigma related to AIDS.
• Children need to be cared for within a community context and within established sibling systems. This will facilitate maintenance of identity and facilitate their move into community life as an adult.
• Adequate carers, both in terms of numbers and capacity to provide care, need to be obtained.
• Love and caring must not be considered optional extras, but core to the care provided.• Strict measures need to be put in place to prevent abuse; sexual, physical or
financial. This should be backed by a strong advocacy campaign. Sexual and physical abuse holds lifetime consequences and its seriousness needs to be recognised. The acceptance of this abuse within communities needs to be challenged and broken down.
• Protection from early access to, and the temptations of, substance abuse. It is recognised that such an intervention is complicated and will involve addressing the underlying problems.
• Systems are needed to draw those OVC involved in crime and survival sex back into their communities. Both livelihood and social support measures will be needed as the levels of alienation are likely to be high.
Support for families and households that care for OVC
As the prime carers of OVC, families and households who care for OVC need support themselves in the following ways:• Firstly, and most importantly, is the urgent need for the introduction and extension
of ARV medication provision and support. This will ultimately reduce the number of orphans, as parents will live longer and have healthier lives.
• Reduction in poverty levels and unemployment of households is also absolutely essential. Direct income support is important, but there is also a need to empower parents and carers so that they feel able to care and provide for their children themselves.
• Sexual and physical abuse by carers requires strong action. This needs to take the forms of direct legal controls with swift and strict enforcement, support for those damaged and left behind when the perpetrator is removed and advocacy against abuse.
• The challenge of the misuse and abuse of children’s grants by some of the foster parents and caregivers is serious and needs to be acted against. There does however need to be recognition that this may be the only income coming into a household.
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• Assistance needs to be provided to parents who abuse substances, as this interferes considerably with parenting and care, as well as being highly destructive for the parents.
• Training skills in parenting would help a lot of parents and carers in coping with their role.
• Carers need to be monitored to ensure that some do not take on too many children. If these go beyond their capacity to care it is likely that all the children in that household will suffer.
• A reluctance of families, for both financial and personal reasons, to adopt and care for children needs to be taken into account. As the need for carer families rises, so too will forms of encouragement and support need to be put in place for all families that take on children.
• A stigmatising attitude was reported against those taking on children, stating that they did this to exploit the children. This is going to undermine the caring work in the long term, so requires action to support carers and to reduce the space for this abuse to take place.
Support for communities that care for OVC
Communities provide the broader context in which children live, so are the next level of intervention. There are large differences between the two communities, Kanana and Kopanong, covered in this report. This has to be taken into account when looking at recommendations, as the context in Kopanong is probably considerably more complex. Community support includes:• Poverty alleviation projects are key. Within this framework, job creation schemes are
most important as they allow for the development of a positive sense of identity.• The grant system also needs to be improved to increase the number of beneficiaries.
Present obstacles such as provision of identity documents, staff shortages, and poor interdepartmental collaboration need to be addressed.
• A culture of care within the community needs to be revived/encouraged. Community members need to be sensitised about the importance of caring for other needy children even if not related to them by blood.
• Stigma is highly destructive in communities and advocacy work against these attitudes needs to be a focus.
• There is a tendency for the community to leave all responsibilities to government officials. This dependency needs to be counteracted.
• Community-based interventions also need to intensify education about HIV and other related services, for example, VCT, antiretrovirals, PMTCT.
• Improvement to the infrastructure in the communities, for example, roads, community facilities, day care centres and recreational facilities is also needed, since these will allow for the ongoing development of the community.
• Development and support of CBOs is required as these often represent community interests. This will be particularly difficult in Kopanong, given the small size and geographical distribution of the towns.
HIV prevention and intervention
Considerable obstacles remain to integrating information about HIV/AIDS into behaviour and to improving treatment of those living with HIV/AIDS: • AIDS continues to be stigmatized and there is well-founded fear of rejection from
family and friends when a person is diagnosed with HIV. As a result many people
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remain in denial about AIDS, especially when a close friend or relative is dying from HIV/AIDS-related illness. Civil society organizations, health professionals in both the public and private sector, and government agencies need to focus their energies on de-stigmatizing HIV/AIDS as a social and human right issue.
• Once again the essential recommendation of introducing ARV treatment needs to be made.
• OVC implementing agencies need to help communities to open up, discuss and communicate on the issues related to HIV/AIDS. This will reduce the trauma and stress levels of the family and stigmatization of the HIV/AIDS illness and death.
• Safe behaviours for HIV/AIDS are still not acceptable. Efforts need to be made to reinforce single partner relationships, condom usage and testing for STIs as a first priority.
• The district of Kopanong needs to have campaigns introduced, as it is still severely short on educational material.
• Door-to-door visits for HIV information dissemination would be helpful. Each and every house in the district should be visited to teach people about HIV/AIDS and also leave educational and prevention material. This intervention is particularly recommended for Kopanong as the number of households is small for each town.
• All government departments in the social cluster need to adopt a more active role in addressing the issues of HIV/AIDS. A holistic approach needs to be taken that meets the health, nutritional, psychosocial, educational and economic needs of children and the families who care for them.
• As recommended above, action needs to be taken against substance abuse and survival sex as both considerably increase the risk of infection.
Recommendations for state services
Some specific recommendations are made for the state services that provide support to OVC, their families and communities:• Lack of commitment/participation from the community is undermining the efforts
of the service structures. Government representatives were particularly concerned about lack of community involvement in poverty alleviation initiatives. There was a general feeling that community members are relying too much on the support of the government and are doing little to influence change within their environment. However, others felt that the entire community is poor, hence their inability to help themselves. Community involvement needs to be developed, with people becoming involved in the programmes. Communities need to be educated about the proper documents required to access certain services and need to be involved in helping OVC by acting as agents for state services. Importantly, volunteers and community members can assist in the monitoring and follow-up of cases since social workers are not always able to do this.
• Staff shortages, especially in relation to growing problems, increase the difficulty of providing an efficient and effective response. Lack of staffing affects the quality of services provided, for example, social workers are unable to give attention to emotional aspects of their clients and could only provide material support.
• A lack of public transportation was also cited as a limitation in reaching all people in need. Service providers in Kopanong complained about the vastness of the district, which was said to result in slowness in the delivery of services, since they have to drive long distances. This was exacerbated by having to travel on gravel roads.
• Lack of facilities and resources in areas to attend to problems. Lack of infrastructure such as computers further increases workload. Insufficient capacity and inadequate
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resources are two of the most crucial of the challenges faced by government departments interviewed in the RLM. All government departments reported incapacity to respond to all OVC cases with the urgency deserved.
• Demands on the service are increasing constantly, with HIV/AIDS making a huge contribution to this. This puts pressure on an already overburdened system, which has to tackle other major issues such as poverty, unemployment and the general economic downturn. Additional resources are required to facilitate this work.
• Placement of orphans is becoming increasingly difficult, so the DSD is going to need specific community support in this area.
• The grant system also needs to be improved to increase the number of beneficiaries. There is a backlog in the processing of applications and attending to cases from communities. Present obstacles, such as the provision of identity documents, staff shortages, etc., need to be addressed. Intergovernmental collaboration is required to attend to this problem since it emanates from limitations in various government departments.
• Carers need monitoring to ensure that they use children’s grants for the benefit of the children rather than themselves.
• Lack of co-operation between government departments is a huge problem and impedes overall provision of services. Some described their relationship as competitive, since each department wants to come out at the end of the year and describe its successes. This was also said to result in duplication of services. Government departments need to work closely together to make sure that resources are not wasted and that services are not duplicated, and to achieve levels of synergy. The personnel from DSD said that even within the DSD duplication of services happens – that it is not uncommon for one family to receive three food parcels a month from different sectors within the department. All government departments in the social cluster need to take a more active role on addressing the issues of OVC. A holistic approach needs to be taken that meets the health, nutritional, psychosocial, educational and economic needs of children and the families who care for them.
• Cooperation is also required between state services and NGOs/CBOs.
Recommendations for NGOS that provide support for OVC
In poor communities with high levels of social problems, NGOs and CBOs play a potentially important role in facilitating community members accessing assistance. This is particularly important in Kopanong due the lack of resources available there. Recommendations include:• It is a challenge for NGOs to access funding. All NGOs interviewed complained that
they need financial support to extend their services, and many were uncertain of receiving sufficient funding to continue to maintain their current services. Even when there is funding, it not always sustainable or guaranteed every financial year. Some access to resources has to be established to allow NGOs and CBOs to function.
• Insufficient funding makes it difficult for NGOs to retain volunteers or employees. As a result staff turnover is high in most organisations. It becomes difficult for NGOs to keep volunteers motivated when they cannot even offer stipends. There is an exodus of social workers to join the DSD because it offers better pay and more opportunities.
• The majority of NGOs lack the basic requirements to enable them to provide support for OVC, such as computers, space and human resources.
• Lack of skills is a key problem. Many NGOs and CBOs do not have financial, administrative and other skills needed to successfully run an organisation. There
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were complaints that the DSD does not monitor funds given to NGOs / CBOs, so there is no accountability and there is the risk that NGOs will mis-spend the money. Staff of these community-based structures also need additional training, in order to provide the services they are offering better and more efficiently, and to be able to tackle the administrative tasks of running an organisation, such as bookkeeping, record-keeping and management of people.
• Lack of coordination of services means that there are a lot of organisations doing the same work due to limited funding. A lot of the work that NGOs do depends on the direction in which the funding ship is sailing.
• Lack of public transport means that many CBOs have to hire a car in order to travel to another town.
• Concern was expressed that too many NGOs/CBOs are focusing on home-based care, particularly HIV counselling, while other areas of need are not being tackled. This addresses a familiar problem of needing coordianation between NGOs/CBOs.
• A lot of people only join NGOs to gain experience. Once they have this on-the-job training they leave for other posts, including in government and business, which affects services and delivery. There are also high levels of burn-out among staff, which pushes people out of the structures after a few years.
• There is insufficient involvement of members of the communities in the running and services of the NGOs. Many see very little personal return and there is a general level of despondency about the future in the communities.
• Greater coordination is also required between the NGO/CBO services and those of government. Otherwise there is the danger of wasting resources.
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APPENDIX 1
Interview schedule for three nation OVC study: orphaned and vulnerable childrenThe key areas to be covered in the interview are in bold. Below that are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview. For each interview, different sections of the interview schedule will have to be prioritized and some of the areas of discussion may fall away. Do not use the prompts unless the respondent is finding it difficult to talk about the area. Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject.
Background of person being interviewed
This should serve as an icebreaking section. Before you meet the participant you would have been given some brief information about the participant, who he/she is and how you came to interview him/her, so you might not have to ask him/her. Before asking the participant to talk about his/her experiences and needs as a carer, first explain the study in detail. Why the person is being interviewed.Position in community?How person came to be in this position?We have asked to interview you as we want to know and understand your experiences since (insert appropriate context here, for example, one or more parent died, became ill, or if your situation has changed).What are your major needs and concerns?
Care of OVCs
This set of questions aims to gather information regarding the care received by OVCs. It seeks to explore the OVC’s evaluation of their present situation, whether they are happy with it and whether they would like to see any changes in it. We want to find out if they receive necessary care, whether it is emotional, physical, etc., and who provides it. This section contains very sensitive and personal questions and interviewers need to be patient with them as they might be reluctant to reveal some of their problems to a stranger. Personal history of the OVC.OVC’s own reflection on situation.Housing, access to facilities and resources. Loss of personal possessions.Level of emotional and physical care.Coping methods.Support structures.Attitudes to carers, key influencing figures in their communities.
Attitudes of the community towards OVCs, especially incidents of stigma
What OVCs think of the community’s attitudes towards them is very important to know. Do they discriminate against them, do they feel cared for by the community, do they feel
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rejected, etc.. If stigmatized, who is likely to stigmatise against them – family members, adults, other children, etc.. Probe for any concrete examples of negative/positive attitude of the community. Perceptions of OVCs by the community?Stigma against OVCs?Anger at OVCs?Positive attitudes to OVCs?
Policy and legislation for the protection of OVCs
These questions are aimed at the OVC’s knowledge and understanding of policies and regulations regarding their own protection. If they know of any of these policies it is important to obtain the source of knowledge (TV, NGOs etc.). Also evaluate their perceptions of these policies, whether they find them useful or whether they would like them to be amended. Knowledge of law, policy or pre-established practices to protect OVCs?Attitudes towards such regulations?Implementation and support of these regulations?
Suggestions of how to help OVCs in the community
Here we are looking at the views of OVCs pertaining to how they would like to be helped/supported – who they see as most important/responsible for them (government, NGOs, community etc.). The role of government is particularly important. Role of individuals, CBOs, NGOs, FBOs and state structures?What is needed to facilitate these contributions?Assessment of the commitment on the part of their structures to assist?Actions the government should take to assist OVCs?
Secondary set of questions
HIV/AIDS is a major threat to health and well-being in southern Africa. This section asks about HIV-related risk behaviour and strategies to curb HIV/AIDS in communities. What do you know and understand about HIV and AIDS?Is there anything that puts you particularly at risk for contracting HIV?The above questions aim to assess respondent’s level of knowledge about HIV/AIDS and their personalization of risk. The questions aim particularly to assess their behaviour and whether it may place them at risk of HIV/AIDS. Again sensitivity is very important as personal information may be elicited. Answers here may not necessarily be personal, but may be general and refer to other OVCs who might be practising any of these risky behaviours.
Risks of HIV as a result of violence
Child abuse.Rape and sexual assault.Caring for victims of violence.Taking payment for sexual services.
Multiple vulnerabilities
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Suggestions of how to limit the spread of HIV/AIDS in the community
Here we are looking at the OVC’s suggestions for dealing with the HIV/AIDS problem in their communities and what they see as best strategies to deal with it. Ask in particular about the strategies that can be used to deal with HIV/AIDS amongst OVCs and children in general. Educational and information needs.Infrastructural needs, for example, PMTCT, VCT and condom distribution.Interventions at the social level, for example, stigma, gender discrimination, promiscuity.Checks on the health service.
Personal knowledge, beliefs and behaviour in relation to HIV
This set of questions aims to learn about the OVC’s knowledge, beliefs and practices related to prevention of HIV/AIDS. Also ask if they practise any of their own beliefs, for example, safer sex. Also ask about their attitudes towards people who are living with HIV/AIDS (PLWHA)Knowledge and beliefs about HIV?Attitudes towards safer sexual practices and PLWAs?Past behaviour and commitments to future behaviour?
Complications in protecting themselves from HIV
Knowledge about HIV/AIDS and preventative methods may not necessarily lead to behaviour change. A lot of factors may impede behaviour change. These questions aim at understanding problems and complications that may be experienced in trying to engage in protective behaviour against HIV/AIDS infection. Access to resources?Confusion in information?Social pressures, risks of judgment and stigma?Skills and capacity in caring for OVCs?
Care and treatment of PWHAs in the community
Their knowledge about care of people living with HIV/AIDS. If services are available ask for details and whether PLWHAs access them. If the OVC is HIV positive ask about complications in accessing the services. Availability of services for PWHAs?Impact of services?Views on VCT, PMTCT and ARVs?Advantages and disadvantages for the PWHA and community of being open about status?
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Interview schedule for three nation OVC study: immediate carers of OVCsThese are the people who provide everyday care to OVCs, who know their major needs and resources available for OVCs. As community members they should also be aware of the community’s responses and their attitudes towards OVCs.
The key areas to be covered in the interview are in bold. Below that are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview. For each interview different sections of the interview schedule will have to be prioritized and some of the areas of discussion may fall away. Do not use the prompts unless the respondent is finding it difficult to talk about the area. Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject.
Background of person being interviewed
This should serve as an icebreaking section. Before you meet the participant you would have been given some brief information about the participant, who he/she is and how you came to interview him/her, so you might not have to ask him/her. Before asking the participant to talk about his/her experiences and needs as a carer first explain the study in details. Why the person is being interviewed.Position in community.How he/she came to be in this position.We have asked to interview you as we want to know and understand your experiences as a carer for orphaned and vulnerable children.What are your major challenges, needs and concerns?What are the living situation of OVCs, ranging from the best off to those in the worst situations, including the number of them in the community?
This set of questions aims to assess the care-giver’s assessment of the problem of OVCs in the community, what she/he thinks are the problems and their needs and whether there are any resources locally to help them. Also ask if there are any other carers and their roles and who has the ultimate responsibility to care for an/the OVCs in the household. Awareness of orphaned and vulnerable children.Estimates of the number of OVCs.Housing conditions, examples of good and bad.Access to facilities by OVCs, particularly educational, health and social services.Financial and social resource available for OVCs.Community resources available for the care of OVCs.Major threats for OVCs, at the levels of physical, emotional and quality of life.
Attitudes of the community towards OVCs, especially incidents of stigma
Caregivers stay within communities, so they should be aware of the community’s attitudes towards the OVCs. If time allows, try to probe for concrete examples of these issues, for example, whether their own OVCs have been discriminated against. Perceptions of OVCs by the community.Stigma against OVCs.
APPENDIX 2
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Anger at OVCs.Positive attitudes to OVCs.
Care and support structures for OVCs
This section looks at care and support structures for OVCs. Ask the participant to evaluate them and also ask about their accessibility and impact. At the family/community level ask participant’s details about carers (primary/immediate, secondary and general carers) of OVCs. Indications of who is providing this care and support.Include examination of systems at the level of the family, community, organizational, state and others that may exist.Impact of services.Check sustainability of these systems of care.Desirability and effectiveness of the different structures for care and support.Requirements of these structures to be able to provide a better service.Indicators of success for systems of care.
Challenges for the community in providing care and support
This section seeks to know about challenges faced by communities if providing care and support for OVCs. As for other questions, ask how these challenges could be overcome.Providing the basics of shelter, food, education and care.Dealing with emotional impact of orphanhood or vulnerability, for example, mourning, PTSD.Interactions of the OVCs with others in the household/institution.Dealing with stigma.
Policy and legislation for the protection of OVCs
These questions are aimed at the OVC carer’s knowledge and understanding of policies and regulations regarding their own protection. If they know of any of these policies it is important to know the source of knowledge (TV, NGOs etc.). Also evaluate their perceptions of these policies, whether they find them useful or whether they would like them to be amended. Knowledge of law, policy or pre-established practices to protect OVCs.Attitudes towards such regulations.Implementation and support of these regulations.
Complications in the caring for OVCsThis set of questions aims to explore complications experienced by caregivers in providing care for the OVCs. Attitudes of carers to OVCs.Impact of caring for OVCs on lifestyle.Experiences of stigma as a result of providing care to OVCs.Impact on rest of household of the entrance of the OVC.
Suggestions of how to help OVCs in the community
It is important to know what caregivers think are the best ways of helping OVCs in their communities. Ask what they see as roles of individuals, NGOs, CBOs, FBOs and government structures and what is needed to facilitate the contribution of each of them and who they see as having the ultimate responsibility for helping the OVCs.
appendix 2
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Role of individuals, CBOs, NGOs, FBOs, and state structures.What is needed to facilitate these contributions?Assessment of the commitment on the part of their structures to assist.
Secondary set of questions
HIV/AIDS is a major threat to health and well-being in southern Africa. This section asks about HIV related risk behaviour and strategies to curb HIV/AIDS in communities. What do you know and understand about HIV and AIDS?What do you believe are the key interventions to prevent or limit the spread of HIV?The above questions aims to assess their level of knowledge about HIV/AIDS and their personalization of risk. They aim particularly to assess their behaviour and whether it may place them at risks of HIV/AIDS. Again sensitivity is very important as personal information may be elicited.
Personal knowledge, beliefs and behaviour in relation to HIV
Knowledge and beliefs about HIV.Attitudes towards safer sexual practices and PWHAs.Past behaviour and commitments to future behaviour.
Suggestions of how to limit the spread of HIV/AIDS in the community
Here we are looking at the OVC carer’s suggestions for dealing with the HIV/AIDS problem in their communities and what they see as best strategies to deal with it. Ask in particular about the strategies that can be used to deal with HIV/AIDS amongst OVCs, but also maintain some focus on the general population. Educational and information needs.Infrastructural needs, for example, PMTCT, VCT and condom distribution.Interventions at the social level, for example, stigma, gender discrimination, promiscuity.Checks on the health service.
Risks of HIV as a result of violence
Carers may also be exposed to behavior that may increase their vulnerability to HIV/AIDS; probe for some of these. Again if none of them reports any of these, probe for ‘others’, whether other carers are at risk or not. Child abuse.Rape and sexual assault.Caring for victims of violence.Taking payment for sexual services.
Challenges to protecting themselves from HIV
These questions ask about problems and complications that may be experienced in trying to practise protective behaviour against HIV/AIDS infection. What challenges do they face in trying to protect themselves from being infected with HIV/AIDS? Access to resources.Confusion in information.
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Social pressures, risks of judgment and stigma.Skills and capacity in caring for OVCs.
Extent of HIV/AIDS as a problem in the community
Carers, especially those who care for HIV orphans, should be aware of the magnitude of HIV/AIDS in their communities. They might not have the exact numbers but should merely say how big/small the problem is. The first question asks about the community’s awareness rather than the carer’s. It is also important to know the impact of HIV/AIDS on resources and social functioning in general. For example, does it result in an increase in orphans, does it result in family conflicts, blame and fighting within communities, accusations of witchcraft etc.. Awareness and knowledge of HIV/AIDS.Estimates of the number of people with HIV/AIDS.Impact of HIV/AIDS on state and organisational resources available.Impact of HIV/AIDS on community resources available.Impact of HIV/AIDS on the social functioning of the community.
Care and treatment of PWHAs in the community
Their knowledge about care of people living with HIV/AIDS. If services are available ask for details and whether PWHAs have access them, are they enough, who should provide more services? If the OVC for which they care is HIV positive ask about complications in accessing the services. Availability of services for PWHAs.Impact of services.Views on VCT, PMTCT and ARVs.Advantages and disadvantages for the PWHA and community of being open about status.
appendix 2
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Interview schedule for three nation OVC study: members of NGOs, CBOs and FBOsThe key areas to be covered in the interview are in bold. Below that are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview. For each interview different sections of the interview schedule will have to be prioritized and some of the areas of discussion may fall away. Do not use the prompts unless the respondent is finding it difficult to talk about the area. Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject.
Background of person being interviewed
Background here should be about the organization, resources they provide to the communities, their roles in the care of OVCs and around HIV/AIDS generally. As in other groups, it is important that background to the study and the research institution be provided.Why the person is being interviewed.Position in community.How he/she came to be in this position.What is your or your organization’s role in relation to OVCs?What is your or your organization’s source of knowledge about OVCs?What work does your organization do and how do you assist OVCs?What do you think is the size of the problem and what impact is it having on this community?What are your major challenges, needs and concerns, and how do these relate to your own resources?
The living situation of OVCs, ranging from the best off to those in the worst situations, including the number of them in the community
This set of questions aims to assess the NGO, CBO, FBO’s assessment of the problem of OVCs in the community, what they thinks are their problems and needs and whether there are any resources locally to help them.Awareness of orphaned and vulnerable children.Estimates of the number of OVCs.Housing conditions, examples of good and bad.Access to facilities by OVCs, particularly educational, health and social services.Financial and social resource available for OVCs.Community resources available for the care of OVCs.Major threats for OVCs, at the levels of physical, emotional and quality of life.
Extent of HIV/AIDS as a problem in the community
NGOs, especially those working with HIV orphans, should be aware of the magnitude of HIV/AIDS in the communities they serve. If they do not have exact statistics they should merely say how big/small the problem is. It is also important to know the impact of HIV/AIDS on resources and social functioning in general. For example, does it result in an increase in orphans, does it result to family conflicts, blame and fighting within communities, accusations of witchcraft etc- how are the organizations dealing with these?
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Awareness and knowledge of HIV/AIDS.Estimates of the number of people with HIV/AIDS.Impact of HIV/AIDS on state and organisational resources available.Impact of HIV/AIDS on community resources available.Impact of HIV/AIDS on the social functioning of the community.
Attitudes of the community towards OVCs, especially incidents of stigma
As people who work and stay within these communities what is their assessment of the community’s attitudes towards OVCs? If time allows try to probe for concrete examples of these issues, for example, whether the OVCs they care for have been discriminated against.Perceptions of OVCs by the community.Stigma against OVCs.Anger at OVCs.Positive attitudes to OVCs.
Care and support structures for OVCs
Ask about the care and support services available to the OVCs, their evaluation and whether more is needed to help them. If some are providing this care, ask about challenges faced in providing the care and suggestions for improvement.Indications of who is providing this care and support.Include examination of systems at the level of the family; community, organizational, state and others that may exist.Impact of services.Check sustainability of these systems of care.Desirability and effectiveness of the different structures for care and support.Requirements of these structures to be able to provide a better service.Indicators of success for systems of care.
Profile and evaluation questions of implementing intervention organization
Knowledge of the intervention organization, structure and past activities.Perceptions of the organization and their capacity to do the work.Ideas of how to facilitate the organization’s work.Indicators of success for the implementing organization.
Challenges for the community in providing care and support
What NGOs, CBOs, etc. think are challenges faced by communities in providing care and support for the OVCs and how these could be overcome.Providing the basics of shelter, food, education and care.Dealing with emotional impact of orphanhood or vulnerability, for example, mourning, PTSD.Interactions of the OVCs with others in the household/institution.Access to resources to facilitate care.Attitudes of carers to OVCs.Assisting the OVC to deal with stigma.Experiences of stigma as a result of providing care to OVCs.
appendix 3
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Policy and legislation for the protection of OVCs
Ask about policies and legislations aimed at protecting OVCs, their views about these, including strengths and limitations and whether they would like to see this policy and legislation amended. Knowledge of law, policy or pre-established practices to protect OVCs.Attitudes towards such regulations.Implementation and support of these regulations.
Suggestions of how to help OVCs in the community
Ask about what they think could/needs to be done to help the OVCs and who has the ultimate responsibility to help them; what is needed – human resources, financial assistance etc. Role of individuals, CBOs, NGOs, FBOs, and state structures.What is needed to facilitate these contributions.Assessment of the commitment on the part of their structures to assist.
Suggestions of how to limit the spread of HIV/AIDS in the community
Ask what interventions they think are required to limit the spread of HIV/AIDS in the community. Is it education, infrastructure, reduction of stigma, improvement of health services, gender equity etc. Also who should take responsibility to provide these? Educational and information needs.Infrastructural needs, for example, PMTCT, VCT and condom distribution.Interventions at the social level, for example, stigma, gender discrimination, promiscuity.Checks on the health service.
Care and treatment of PWHAs in the community
Their knowledge about care of people living with HIV/AIDS. If services are available ask for details and whether PWHAs access them, are they enough; who should provide more services. Ask complications in caring for PWHAs:Availability of services for PWHAs.Impact of services.Views on VCT, PMTCT and ARVs.Advantages and disadvantages for the PWHA and community of being open about status.
Risks of HIV as a result of violence
Ask about the incidence of the behaviours that may place people at risks of HIV/AIDS.Child abuse.Rape and sexual assault.Caring for victims of violence.Taking payment for sexual services.
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Interview schedule for three nation OVC study: members of state services or governmentThe key areas to be covered in the interview are in bold. Below that are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview. For each interview different sections of the interview schedule will have to be prioritized and some of the areas of discussion may fall away. Do not use the prompts unless the respondent is finding it difficult to talk about the area. Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject.
Background of person being interviewed
Background here should be about the government services provided to OVCs and those aimed at reducing the incidence of HIV/AIDS in the areas: What is the government doing and who in the government is providing these services? If more than one government department is entrusted with providing these services, who is coordinating them?Why the person is being interviewed.Position in community.How he/she came to be in this position.What is your or your organization’s role in relation to OVCs?What is your or your organization’s source of knowledge about OVCs?What work does your organization do and how do you assist OVCs?What do you think is the size of the problem and what impact is it having on this community?What are your major challenges, needs and concerns, and how do these relate to your own resources?
The living situation of OVCs, ranging from the best off to those in the worst situations, including the number of them in the community
Awareness of orphaned and vulnerable children.Estimates of the number of OVCs.Housing conditions, examples of good and bad.Access to facilities by OVCs, particularly educational, health and social services.Financial and social resource available for OVCs.Community resources available for the care of OVCs.Major threats for OVCs, at the levels of physical, emotional and quality of life.
Extent of HIV/AIDS as a problem in the community
State officials, especially those who provide social services and those who work in vulnerable communities, should be aware of the magnitude of HIV/AIDS in their communities. Ask if there are statistics of the situation available and if not, ask them to estimate the magnitude of the problem. It is also important to know the impact of HIV/AIDS on resources and social functioning in general. For example, does it result in an increase in orphans, does it result in family conflicts, blame and fighting within communities, accusations of witchcraft etc.? In this case, awareness relates to awareness among officials.
APPENDIX 4
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Awareness and knowledge of HIV/AIDS.Estimates of the number of people with HIV/AIDS.Impact of HIV/AIDS on state and organisational resources available.Impact of HIV/AIDS on community resources available.Impact of HIV/AIDS on the social functioning of the community.
Attitudes of the community towards OVCs, especially incidents of stigma
State officials’ views about the community’s attitudes towards OVCs and if these attitudes are negative, ask about programmes aimed at changing them.Perceptions of OVCs by the community.Stigma against OVCs.Anger at OVCs.Positive attitudes to OVCs.
Care and support structures for OVCs
Indications of who is providing this care and support.Include examination of systems at the level of the family, community, organizational, state and others that may exist.Impact of services.Check sustainability of these systems of care.Desirability and effectiveness of the different structures for care and support.Requirements of these structures to be able to provide a better service.Indicators of success for systems of care.
Profile and evaluation questions of implementing intervention organization
Knowledge of the intervention organization, structure and past activities.Perceptions of the organization and their capacity to do the work.Ideas of how to facilitate the organizations work.Indicators of success for the implementing organization.
Challenges for the community in providing care and support
What state officials think are the challenges faced by communities in providing care and support for the OVCs and how these could be overcome. Providing the basics of shelter, food, education and care.Dealing with emotional impact of orphanhood or vulnerability, for example, mourning, PTSD.Interactions of the OVCs with others in the household/institution.Access to resources to facilitate care.Attitudes of carers to OVCs.Assisting the OVC to deal with stigma.Experiences of stigma as a result of providing care to OVCs.
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Policy and legislation for the protection of OVCs
Ask about policies and legislation aimed at protecting OVCs, their views about these, including strengths and limitations and whether they would like to see them amended. If no policies and legislation currently exist, probe for reasons for this. For example, is it because OVCs are not a priority in the government or that these are still in progress? Knowledge of law, policy or pre-established practices to protect OVCs.Attitudes towards such regulations.Implementation and support of these regulations.
Suggestions of how to help OVCs in the community
Role of individuals, CBOs, NGOs, FBOs, and state structures.What is needed to facilitate these contributions?Assessment of the commitment on the part of their structures to assist.
Suggestions of how to limit the spread of HIV/AIDS in the community
Ask what interventions they think are required to limit the spread of HIV/AIDS in the community. Is it education, infrastructure, reduction of stigma, improvement of health services, gender equity etc.? Also, within the government who should take responsibility to provide these?Educational and information needs.Infrastructural needs, for example, PMTCT, VCT and condom distribution.Interventions at the social level, for example, stigma, gender discrimination, promiscuity.Checks on the health service.
Care and treatment of PWHAs in the community
Services provided by the government and this department (and others) for care of PWHAs. Difficulties implementing them (for example, PMTCT services may not be utilized due to stigma attached to being HIV positive). If services are available ask for details and whether PWHAs access them, are they enough; who should provide more services. Availability of services for PWHAs.Impact of services.Views on VCT, PMTCT and ARVs.Advantages and disadvantages for the PWHA and community of being open about status.
Risks of HIV as a result of violence
Ask about the incidence of these behaviours that may place people at risk of HIV/AIDS.Child abuse.Rape and sexual assault.Caring for victims of violence.Taking payment for sexual services.
appendix 4
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Interview schedule for three nation OVC study: interviews as background for BSS componentThe key areas to be covered in the interview are in bold. Below that are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview. For each interview different sections of the interview schedule will have to be prioritized and some of the areas of discussion may fall away. Do not use the prompts unless the respondent is finding it difficult to talk about the area. Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject.
Background of person being interviewed
This should serve as an icebreaking section. Before you meet the participant you would have been given some brief information about the participant, who he/she is and how you came to interview him/her, so you might not have to ask him/her. Before asking the participant to talk about his/her experiences and needs as an OVC, first explain the study in details.Why this person is being interviewed.Position in community.What do you know and understand about HIV and AIDS?Is there anything that puts you particularly at risk for contracting HIV?
Personal knowledge, beliefs and behaviour in relation to HIV
This set of questions aims to ascertain the OVC’s knowledge, beliefs and practices related to prevention of HIV/AIDS. Also ask if they practise any of their own beliefs, for example, safer sex. Also ask about their attitudes towards people who are living with HIV/AIDS (PLWHA)Knowledge and beliefs about HIV.Attitudes towards safer sexual practices and PWHAs.Past behaviour and commitments to future behaviour.
Extent of HIV/AIDS as a problem in the community
Ask participants to estimate the extent of the HIV/AIDS problem in the community. Participants might not have the exact numbers but should merely say how big/small the problem is. It is also important to know the impact of HIV/AIDS on resources and social functioning in general. For example, has it resulted in an increase in orphans, does it lead to family conflicts, blame and fighting within communities, accusations of witchcraft etc.?Awareness and knowledge of HIV/AIDS.Estimates of the number of people with HIV/AIDS.Impact of HIV/AIDS on state and organisational resources available.Impact of HIV/AIDS on community resources available.Impact of HIV/AIDS on the social functioning of the community.
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Suggestions of how to limit the spread of HIV/AIDS in the community
Ask what interventions they think are required to limit the spread of HIV/AIDS in the community. Is it education, infrastructure, reduction of stigma, improvement of health services, gender equity programmes etc.? Also, who should implement these – government, NGOs, other bodies?Educational and information needs.Infrastructural needs, for example, PMTCT, VCT and condom distribution.Interventions at the social level, for example, stigma, gender discrimination, promiscuity.Checks on the health service.
Complications in protecting themselves from HIV
Knowledge about HIV/AIDS and preventative methods may not necessarily lead to behaviour change. A lot of factors may impede behaviour change. These questions ask for barriers to behaviour change for example, what makes people unable to protect themselves against HIV/AIDS? Is it for example, lack of information, lack of access to resources like condoms and health services or pressure not to use condoms?Access to resources.Confusion in information.Social pressures, risks of judgment and stigma.
Care and treatment of PWHAs in the community
Their knowledge about care of people living with HIV/AIDS. If services are available ask for details and whether PWHAs access them. What are their views about these services and if anyone of them tests positive would they utilize them? If not what are reasons?Availability of services for PWHAs.Impact of services.Views on VCT, PMTCT and ARVs.Advantages and disadvantages for the PWHA and community of being open about status.
Attitudes of the community towards OVCs, especially incidents of stigma
Ask community members themselves, participants here should be aware of attitudes towards OVCs, whether they are accepted/rejected in communities. Rejection could be either overt or covert; probe for these. If time allows try to probe for concrete examples of these issues, for example whether they know any OVCs who are being treated badly either within the family or in the community.Perceptions of OVCs by the community.Stigma against OVCs.Anger at OVCs.Positive attitudes to OVCs.
Risks of HIV as a result of violence
Because this will be a focus group, it may not be necessary to ask individual participants if they have experience of this. Rather ask in general whether these practices exist in the community, who is likely to engage in them and why.
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Child abuse.Rape and sexual assault.Caring for victims of violence.Taking payment for sexual services.
Major sources of information on HIV and AIDS
This last section asks about sources of information about HIV/AIDS, asks them also to rank these sources, which one provides the most useful information, which one they utilize often and how could the provision of information about HIV/AIDS be improved. Media sources.Organisational and state services information.Peers and colleagues.
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Anderson, N. and Mhatre, S. (2003). Do unto others – and pay the price: Combating sexual violence in the south of Johannesburg. SA Crime Quarterly, 3 (March). Obtained from http://www.iss.co.za/Publications/CrimeQuarterlyIndex.html.
Bicego, G., Rutstein, S. and Johnson, K. (2002). Dimensions of the emerging orphan crisis in sub-Saharan Africa. Social Science and Medicine, 56: 1235–1247.
Booysen, F. (2003). Out-migration in the context of the HIV/AIDS epidemic: Evidence from the Free State Province. CSSR working paper no. 57. Obtained from www.cssr.uct.ac.za.
Bray, R. (2003). Predicting the social consequences of orphanhood in South Africa. CSSR working paper no. 29. Centre for Social Science Research, Cape Town.
CASE. (1999). “We also count!” The extent of moderate and severe reported disability and the nature of the disability experience in South Africa. South Africa: Department of Health. Obtained from http://www.doh.gov.za.
Department of Health. (2003) National HIV and syphilis antenatal sero-prevalence study in South Africa 2002. Pretoria: Department of Health.
Department of Health. (2004). National HIV and Syphilis antenatal sero-prevalence survey in South Africa 2003. Pretoria: Department of Health.
Desmond, C. and Gow, J. (2001). The Cost-Effectiveness of Six Models of Care for Orphan and Vulnerable Children in South Africa. South Africa: Health Economics and HIV/AIDS Research Division, University of Natal.
Hill, S. and Smith, C. (2003). Child well-being and poverty indicators in South Africa: Creating the real picture. Cape Town: IDASA.
International HIV/AIDS Alliance. (2004). Supporting older carers. USA: International HIV/AIDS Alliance.
Jackson, L. (1997). Recent initiatives in addressing gender violence in South Africa. Occasional paper No. 14. Pretoria: Institute for Security Studies.
Johnson, L. and Dorrington, R. (2001). The Impact of AIDS on Orphanhood in South Africa: A Quantitative Analysis. Cape Town: Centre for Actuarial Research (CARE).
Leggett, T. (2001). Rainbow vice: The drugs and sex industries in the new South Africa. Cape Town: David Phillip.
Molo Songololo. (2000). The trafficking of children for purposes of sexual exploitation - South Africa. Cape Town: Molo Songololo.
Nkomo, N. and Skinner, D. (2004). Situation analysis of services targeting orphans and vulnerable children in Kanana and Umuzimuhle townships in Orkney, North West Province. Cape Town: HSRC press.
Parker, R., Aggleton, P., Attawell, K., Pulerwits, J. and Brown,L. (2002). HIV/AIDS-related Stigma and Discrimination: A Conceptual Framework and an Agenda for Action. Horizons Report. Washington: Horizons Project.
Parry, C. (1997). Alcohol misuse and public health: A 10-point action plan. Obtained from www.mrc.ac.za/policybriefs/6polbrief1997.htm
Perschler-Desai, V. (2001). Childhood on the market: Teenage prostitution in Southern Africa. African Security Review, 10(4). Obtained from http://www.iss.co.za/PUBS/ASR/10No4/Content.html
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