Tài liệu Multiple Vulnerabilities qualitave data for the stydy of orpharns and vulnerable children in South Africa ppt

List of tables and figures vList of authors viAcknowledgements viiAcronyms and abbreviations viiiExecutive summary ix Alicia Davids 1 Defining orphanhood and vulnerability 1The situation

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

Published by HSRC PressPrivate Bag X9182, Cape Town, 8000, South Africawww.hsrcpress.ac.za

© 2006 Human Sciences Research Council

First published 2006

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List of tables and figures vList of authors vi

Acknowledgements viiAcronyms and abbreviations viiiExecutive summary ix

Alicia Davids 1

Defining orphanhood and vulnerability 1The situation of OVC in South Africa 2

Alicia Davids 5

Aims of the research 5

Alicia Davids 7

Semi-structured interviews 7Research instrument 7Sampling method 7Sample Kopanong 8Sample Kanana 8

Conditions And Services In The Kopanong Municipality, Free State

and Alicia Davids 11

Geographical context 12Economic situation 14Poverty and unemployment 14Situation of youth 15

Situation of HIV/AIDS 17Context of people living with HIV/AIDS 21Context of OVC 24

Support systems for OVC 30Challenges facing government departments 35NGO, CBO and FBO support structures 37Challenges facing NGOS/CBOS 39

Vulnerable Children (Ovc) In Kanana And Umuzimuhle Townships, North

Skinner and Nkululeku Nkomo 43

Distinctive and common elements between the two townships 43

Alicia Davids 81

Care of OVC 82Support for families and households that care for OVC 83Support for communities that care for OVC 84

HIV prevention and intervention 84Recommendations for state services 85Recommendations for NGOs that support OVC 86

Appendices 89 References 105

Table 1 Ethnic composition in 2001 compared with the average for the district

in 1996 11Table 2 Education levels for persons 20 years and older, 2001 12

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

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

AIDS acquired immunodeficiency syndromeARV antiretroviral drugs

CBO Community based organisationDoA Department of AgricultureDoE Department of EducationDoH Department of HealthDSD Department of Social DevelopmentFBO Faith based organisation

GDP gross domestic productGMC Grace Mokgomu ClinicHIV human immunodeficiency virusIDP integrated development plan

KOSH District of Klerksdorp, Orkney, Stilfontein and HartebeesfonteinNGO non-governmental organisation

OVC orphans and vulnerable childrenPLWHA people living with HIV/AIDSPMTCT prevention of mother-to-child transmissionSTI sexually transmitted infection

RDP reconstruction and development programmeUNICEF United Nations International Children’s Fund

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

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

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

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):

• 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)

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

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

Background and aims of the project

In 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

members, researchers sought to create an atmosphere conducive for the subsequent survey and interventions.

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

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

• 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

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

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

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

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

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)

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

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

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

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

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

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)

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

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 abuse

In 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

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 discrimination

Participants 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)

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

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

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

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

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

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

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

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

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