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This section provides the findings of the study, according to the themes that emerged. Firstly, the biographical information of the participants is laid out. Thereafter, the challenges faced by orphans, caregivers and social workers are presented. In terms of gender, these children were proportionately selected, that is, they consisted of six males and six females.

A total number of eight children interviewed were both affected and infected with HIV and AIDS and four indicated that they were affected only. Seven of the orphans were maternal orphans with unknown fathers, two were paternal orphans with unknown mothers and three of them were double orphans. The population of orphaned children in Tembisa is very high with Tembisa Child and Family Welfare Society recording a number of more than families every year.

The average dependency ratio in most of these families is All of the participants were female black Africans. Two social workers were also interviewed as key informants. The study aimed at investigating the challenges that were being faced in the provision of psychosocial support to HIV and AIDS orphans and the results of these are highlighted in this section.

HIV and AIDS has in the past presented a continuum of complex health issues that ranged from protecting personal health to ensuring that societies have adequate supplies of health care. It has been a routine for me and they are now like a part of me. Caregivers reported to understand the need to keep the children under constant monitoring to ensure that they did not default on their medication. It was, however, an agreement with most of the participants in the focus group that keeping track of what the children ate and did during school hours was difficult.

They reported that because these are children and they like to experiment, they eat most of the things that they are told not to eat at the hospital. Furthermore, the caregivers mentioned that they could not afford nutritious food to give the children. The two social workers who were interviewed also highlighted that the health of orphans deteriorated at times because of lack of nutritious food to eat which is required by those who were living with the virus. One of the social workers said: When we send the children for assessments to our doctor or the nurses here, we usually find out that the child's health would have deteriorated in terms of their CD4 count.

This is usually caused by the children not eating the right food they are supposed to eat for example vegetables and fruits. Social Worker 1. Four children reported to be staying in their parental homes and three reported that they lived in the homes of extended family members and that their parents never owned houses of their own. One child stated that: I live with my three siblings in my grandmother's house.

My mother used to live with us before she fell sick and passed away.

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Lucky for us, we are the only family my grandmother has now. Child D. For most of these children, though the case is quite different and another child highlighted that: My aunt has four children of her own and they are girls. She and my mother stayed together in our shack from the time I was born. The shack is two roomed and had one bedroom which my aunt and cousins sleep in. Two of my cousins now have children… there is hardly any space… Child H.

The loss of a parent due to any disease is not easy for a child.

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Losing a parent to HIV and AIDS is not easy for most children as they suffer from psychosocial effects and often lose concentration at school. Seven of the children interviewed were aware that their parents died of HIV and AIDS and two of these witnessed the illness and death of their parents.

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Child B reported: I was twelve and the eldest. I would help to wash and dress my mother. She was very sick but did not want to go to the hospital until it was too late… She passed away at home in my presence sobs …. The child reported that during the time her mother was sick, she went to school occasionally so as to help look after her. Her performance at school dropped a lot that she had to repeat some grades.

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Four years later, she still remembered the death of her mother like it was yesterday. Four of the participants suffered through absenteeism from school and hence missed out on some lessons and important tests. Some two because of family circumstances were forced to enter into the system and be institutionalized, hence resulting in stigmatization by other learners in those schools. These and other factors have resulted in lower performance by most HIV and AIDS orphans as well as the overburden placed on caregivers to address their needs.

The caregivers also highlighted that the children's performance at school were poor. One caregiver mentioned that: At one point I was called by the principal of the school because of the poor performance of my sister's child I am staying with. The principal mentioned that the child was so brilliant but after the death of her mother her grades were getting lower and lower Caregiver AA. Health and nutrition statuses tend to decline as less money is often available to properly feed the household. One caregiver reported that the greatest challenge they had with caring for the orphans was that it was not easy having an extra mouth to feed with the present day economy.

She stated that: I have five children of my own and when my brother died, his three children came to stay with me as his wife died too and I am the only family left. Through the organization's Family Preservation programme, many community children find a source of food security from the food parcels handed out every month. Normally, family preservation is meant to work with a family for at least 6 months and discharge afterwards.

PDF Protecting Childhood in the AIDS Pandemic: Finding Solutions that Work

One social worker stated this: Some of our clients are placed on family preservation as a temporary measure whilst we work on processing their foster care applications which normally take longer than a year Social Worker 2. Tembisa is not an agrarian region; hence farming for food is not an option for many caregivers. None of the community members in the focus groups reported to have a backyard garden in their homes as they claimed that space was taken up by outside rooms which they used as a source of income. Child B reported that she and her siblings stayed with their parents in the rural areas of Limpopo where life was simple and much cheaper.

After the death of their mother, they had to move to Tembisa to stay with their maternal aunt as she was the only surviving family they knew. She described life in Gauteng Tembisa to be precise as very expensive as their aunt had to put food on the table every day, clothe them, pay bills and school fees. For most orphans, the loss of parents meant no more income in the house. According to [ 27 ], the death of a parent signifies the disruption of the basic pattern of a child's life. With death comes the challenge of meeting the child's basic needs.

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This relates to what was outlined that many orphans are being cared for by the already structurally marginalized women, particularly elderly grandmothers often living in destitution [ 1 ]. The Department of Social Development in outlined that the HIV and AIDS pandemic has disrupted family, community and social structures, and has led to a marked increase in the number of orphans and other vulnerable children. The findings of the study strongly support the available literature that argues that children orphaned by HIV and AIDS depend mainly on their extended families to meet their basic needs.

In the case of infected children, their health is determined by the nutrition they get and getting access to their treatments at the right times. Lack of proper finances was found to be a big challenge as most caregivers were either unemployed or at the age of pension. The findings further suggest that although the government has placed certain supports such as social assistance grants, their inaccessibility makes it hard for caregivers to support HIV and AIDS orphans.

Increasing poverty can cause a degradation of the immediate family environment and increases health risks whilst reducing its ability to obtain health services [ 29 ]. The results of the study also showed that the education of the orphans is disrupted.

As [ 30 ] put it across, the loss of a productive family member is likely to be a financial burden and might push a family into poverty, increasing the likelihood that a child orphaned by AIDS will miss out on school. UNICEF [ 33 ] showed that children orphaned by AIDS may miss out on school enrolment, have their schooling interrupted or perform poorly in school as a result of their situation. The study indicates that the physiological needs of the orphans are not being met.

As Maslow's hierarchy of needs outline, if the physiological needs are not met, the human body cannot function properly and will ultimately fail. These needs are thought to be the most important; they should be met first. Communication for development C4D promotes behavioural and social change through communication strategies. Supporting governments to monitor child poverty and scale-up cost-effective investment to accelerate progress.

Three Decades of HIV/AIDS Pandemic: Challenges Faced by Orphans in Tembisa, South Africa

UNICEF works to empower girls and women, and to ensure their full participation in political, social, and economic systems. Supporting governments to increase the transparency, value for money, equity and adequacy of investment in social sectors. UNICEF advocates for quality learning for every girl and boy, especially those in greatest danger of being left behind. Chronic malnutrition will result in stunting — an irreversible condition that literally stunts the physical and cognitive growth of children. UNICEF works with governments to achieve access to adequate and equitable sanitation and hygiene for all.

Investing in children is essential both for the socio-economic development of the region and for its political stability. UNICEF helps to reduce child mortality in the region by working to reach the most vulnerable children.