Multiple vulnerabilities Qualitative data for the study of orphans and vulnerable children in South Africa Free download from www.hsrcpress.ac.za Alicia Davids, Nkululeku Nkomo, Sakhumzi Mfecane, Donald Skinner & Kopano Ratele Edited by Donald Skinner & Alicia Davids Compiled by the Social Aspects of HIV/AIDS and Health Research Programme, Human Sciences Research Council Published by HSRC Press Private Bag X9182, Cape Town, 8000, South Africa www.hsrcpress.ac.za © 2006 Human Sciences Research Council First published 2006 Free download from www.hsrcpress.ac.za All rights reserved No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers ISBN 0-7969-2139-3 Production management by comPress Distributed in Africa by Blue Weaver PO Box 30370, Tokai, Cape Town, 7966, South Africa Tel: +27 (0) 21 701 4477 Fax: +27 (0) 21 701 7302 email: orders@blueweaver.co.za www.oneworldbooks.com Distributed in Europe and the United Kingdom by Eurospan Distribution Services (EDS) Henrietta Street, Covent Garden, London, WC2E 8LU, United Kingdom Tel: +44 (0) 20 7240 0856 Fax: +44 (0) 20 7379 0609 email: orders@edspubs.co.uk www.eurospanonline.com Distributed in North America by Independent Publishers Group (IPG) Order Department, 814 North Franklin Street, Chicago, IL 60610, USA Call toll-free: (800) 888 4741 All other enquiries: +1 (312) 337 0747 Fax: +1 (312) 337 5985 email: frontdesk@ipgbook.com www.ipgbook.com CONTENTS List of tables and figures v List of authors vi Acknowledgements vii Acronyms and abbreviations Executive summary ix Chapter viii Introduction — Donald Skinner and Alicia Davids Defining orphanhood and vulnerability The situation of OVC in South Africa Chapter Background and aims of the project — Donald Skinner and Alicia Davids Free download from www.hsrcpress.ac.za Aims of the research Chapter Methodology — Donald Skinner and Alicia Davids Semi-structured interviews Research instrument Sampling method Sample Kopanong Sample Kanana Observations Analysis Chapter Qualitative Report Of Ovc Living Conditions And Services In The Kopanong Municipality, Free State Province — Sakhumzi Mfecane, Donald Skinner and Alicia Davids 11 Geographical context 12 Economic situation 14 Poverty and unemployment 14 Situation of youth 15 Situation of HIV/AIDS 17 Context of people living with HIV/AIDS 21 Context of OVC 24 Support systems for OVC 30 Challenges facing government departments 35 NGO, CBO and FBO support structures 37 Challenges facing NGOS/CBOS 39 Discussion 40 Chapter Qualitative Report Regarding The Situation Of Orphans And Vulnerable Children (Ovc) In Kanana And Umuzimuhle Townships, North West Province — Kopano Ratele, Donald Skinner and Nkululeku Nkomo 43 Free download from www.hsrcpress.ac.za Distinctive and common elements between the two townships 43 Umuzimuhle 43 Kanana 44 Major problems in the target areas: unemployment, poverty and shortages of food 45 HIV/AIDS: impact on the community 49 The situation of OVC 54 Situation of households caring for OVC 61 Support structures for ovc in the community 73 Conclusion 78 Chapter Overall Conclusions And Recommendations — Donald Skinner Alicia Davids 81 Care of OVC 82 Support for families and households that care for OVC Support for communities that care for OVC 84 HIV prevention and intervention 84 Recommendations for state services 85 Recommendations for NGOs that support OVC 86 Appendices 89 References 105 and 83 LIST OF TABLES AND FIGURES Tables Table Table Ethnic composition in 2001 compared with the average for the district in 1996 11 Education levels for persons 20 years and older, 2001 12 Figures Map of the Kopanong Municipality 13 Free download from www.hsrcpress.ac.za Figure v AUTHORS 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 Free download from www.hsrcpress.ac.za Kopano Ratele, Dept of Psychology, University of the Western Cape vi Free download from www.hsrcpress.ac.za ACKNOWLEDGEMENTS 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 vii ACRONYMS AND ABBREVIATIONS antiretroviral drugs CBO Community based organisation DoA Department of Agriculture DoE Department of Education DoH Department of Health DSD Department of Social Development FBO Faith based organisation GDP gross domestic product GMC Grace Mokgomu Clinic HIV human immunodeficiency virus IDP integrated development plan KOSH District of Klerksdorp, Orkney, Stilfontein and Hartebeesfontein NGO non-governmental organisation OVC orphans and vulnerable children PLWHA people living with HIV/AIDS PMTCT prevention of mother-to-child transmission STI sexually transmitted infection RDP reconstruction and development programme UNICEF viii acquired immunodeficiency syndrome ARV Free download from www.hsrcpress.ac.za AIDS United Nations International Children’s Fund EXECUTIVE SUMMARY Free download from www.hsrcpress.ac.za 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 ix Multiple vulnerabilities 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 Free download from www.hsrcpress.ac.za 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 x APPENDIX Interview schedule for three nation OVC study: immediate carers of OVCs These are the people who provide everyday care to OVCs, who know their major needs and resources available for OVCs As community members they should also be aware of the community’s responses and their attitudes towards OVCs The key areas to be covered in the interview are in bold Below that are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview For each interview different sections of the interview schedule will have to be prioritized and some of the areas of discussion may fall away Do not use the prompts unless the respondent is finding it difficult to talk about the area Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject Free download from www.hsrcpress.ac.za Background of person being interviewed This should serve as an icebreaking section Before you meet the participant you would have been given some brief information about the participant, who he/she is and how you came to interview him/her, so you might not have to ask him/her Before asking the participant to talk about his/her experiences and needs as a carer first explain the study in details Why the person is being interviewed Position in community How he/she came to be in this position We have asked to interview you as we want to know and understand your experiences as a carer for orphaned and vulnerable children What are your major challenges, needs and concerns? What are the living situation of OVCs, ranging from the best off to those in the worst situations, including the number of them in the community? This set of questions aims to assess the care-giver’s assessment of the problem of OVCs in the community, what she/he thinks are the problems and their needs and whether there are any resources locally to help them Also ask if there are any other carers and their roles and who has the ultimate responsibility to care for an/the OVCs in the household Awareness of orphaned and vulnerable children Estimates of the number of OVCs Housing conditions, examples of good and bad Access to facilities by OVCs, particularly educational, health and social services Financial and social resource available for OVCs Community resources available for the care of OVCs Major threats for OVCs, at the levels of physical, emotional and quality of life Attitudes of the community towards OVCs, especially incidents of stigma Caregivers stay within communities, so they should be aware of the community’s attitudes towards the OVCs If time allows, try to probe for concrete examples of these issues, for example, whether their own OVCs have been discriminated against Perceptions of OVCs by the community Stigma against OVCs 92 appendix Anger at OVCs Positive attitudes to OVCs Care and support structures for OVCs Free download from www.hsrcpress.ac.za This section looks at care and support structures for OVCs Ask the participant to evaluate them and also ask about their accessibility and impact At the family/community level ask participant’s details about carers (primary/immediate, secondary and general carers) of OVCs Indications of who is providing this care and support Include examination of systems at the level of the family, community, organizational, state and others that may exist Impact of services Check sustainability of these systems of care Desirability and effectiveness of the different structures for care and support Requirements of these structures to be able to provide a better service Indicators of success for systems of care Challenges for the community in providing care and support This section seeks to know about challenges faced by communities if providing care and support for OVCs As for other questions, ask how these challenges could be overcome Providing the basics of shelter, food, education and care Dealing with emotional impact of orphanhood or vulnerability, for example, mourning, PTSD Interactions of the OVCs with others in the household/institution Dealing with stigma Policy and legislation for the protection of OVCs These questions are aimed at the OVC carer’s knowledge and understanding of policies and regulations regarding their own protection If they know of any of these policies it is important to know the source of knowledge (TV, NGOs etc.) Also evaluate their perceptions of these policies, whether they find them useful or whether they would like them to be amended Knowledge of law, policy or pre-established practices to protect OVCs Attitudes towards such regulations Implementation and support of these regulations Complications in the caring for OVCs This set of questions aims to explore complications experienced by caregivers in providing care for the OVCs Attitudes of carers to OVCs Impact of caring for OVCs on lifestyle Experiences of stigma as a result of providing care to OVCs Impact on rest of household of the entrance of the OVC Suggestions of how to help OVCs in the community It is important to know what caregivers think are the best ways of helping OVCs in their communities Ask what they see as roles of individuals, NGOs, CBOs, FBOs and government structures and what is needed to facilitate the contribution of each of them and who they see as having the ultimate responsibility for helping the OVCs 93 Multiple vulnerabilities Role of individuals, CBOs, NGOs, FBOs, and state structures What is needed to facilitate these contributions? Assessment of the commitment on the part of their structures to assist Secondary set of questions HIV/AIDS is a major threat to health and well-being in southern Africa This section asks about HIV related risk behaviour and strategies to curb HIV/AIDS in communities What you know and understand about HIV and AIDS? What you believe are the key interventions to prevent or limit the spread of HIV? The above questions aims to assess their level of knowledge about HIV/AIDS and their personalization of risk They aim particularly to assess their behaviour and whether it may place them at risks of HIV/AIDS Again sensitivity is very important as personal information may be elicited Free download from www.hsrcpress.ac.za Personal knowledge, beliefs and behaviour in relation to HIV Knowledge and beliefs about HIV Attitudes towards safer sexual practices and PWHAs Past behaviour and commitments to future behaviour Suggestions of how to limit the spread of HIV/AIDS in the community Here we are looking at the OVC carer’s suggestions for dealing with the HIV/AIDS problem in their communities and what they see as best strategies to deal with it Ask in particular about the strategies that can be used to deal with HIV/AIDS amongst OVCs, but also maintain some focus on the general population Educational and information needs Infrastructural needs, for example, PMTCT, VCT and condom distribution Interventions at the social level, for example, stigma, gender discrimination, promiscuity Checks on the health service Risks of HIV as a result of violence Carers may also be exposed to behavior that may increase their vulnerability to HIV/AIDS; probe for some of these Again if none of them reports any of these, probe for ‘others’, whether other carers are at risk or not Child abuse Rape and sexual assault Caring for victims of violence Taking payment for sexual services Challenges to protecting themselves from HIV These questions ask about problems and complications that may be experienced in trying to practise protective behaviour against HIV/AIDS infection What challenges they face in trying to protect themselves from being infected with HIV/AIDS? Access to resources Confusion in information 94 appendix Social pressures, risks of judgment and stigma Skills and capacity in caring for OVCs Free download from www.hsrcpress.ac.za Extent of HIV/AIDS as a problem in the community Carers, especially those who care for HIV orphans, should be aware of the magnitude of HIV/AIDS in their communities They might not have the exact numbers but should merely say how big/small the problem is The first question asks about the community’s awareness rather than the carer’s It is also important to know the impact of HIV/AIDS on resources and social functioning in general For example, does it result in an increase in orphans, does it result in family conflicts, blame and fighting within communities, accusations of witchcraft etc Awareness and knowledge of HIV/AIDS Estimates of the number of people with HIV/AIDS Impact of HIV/AIDS on state and organisational resources available Impact of HIV/AIDS on community resources available Impact of HIV/AIDS on the social functioning of the community Care and treatment of PWHAs in the community Their knowledge about care of people living with HIV/AIDS If services are available ask for details and whether PWHAs have access them, are they enough, who should provide more services? If the OVC for which they care is HIV positive ask about complications in accessing the services Availability of services for PWHAs Impact of services Views on VCT, PMTCT and ARVs Advantages and disadvantages for the PWHA and community of being open about status 95 APPENDIX Interview schedule for three nation OVC study: members of NGOs, CBOs and FBOs The key areas to be covered in the interview are in bold Below that are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview For each interview different sections of the interview schedule will have to be prioritized and some of the areas of discussion may fall away Do not use the prompts unless the respondent is finding it difficult to talk about the area Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject Background of person being interviewed Free download from www.hsrcpress.ac.za Background here should be about the organization, resources they provide to the communities, their roles in the care of OVCs and around HIV/AIDS generally As in other groups, it is important that background to the study and the research institution be provided Why the person is being interviewed Position in community How he/she came to be in this position What is your or your organization’s role in relation to OVCs? What is your or your organization’s source of knowledge about OVCs? What work does your organization and how you assist OVCs? What you think is the size of the problem and what impact is it having on this community? What are your major challenges, needs and concerns, and how these relate to your own resources? The living situation of OVCs, ranging from the best off to those in the worst situations, including the number of them in the community This set of questions aims to assess the NGO, CBO, FBO’s assessment of the problem of OVCs in the community, what they thinks are their problems and needs and whether there are any resources locally to help them Awareness of orphaned and vulnerable children Estimates of the number of OVCs Housing conditions, examples of good and bad Access to facilities by OVCs, particularly educational, health and social services Financial and social resource available for OVCs Community resources available for the care of OVCs Major threats for OVCs, at the levels of physical, emotional and quality of life Extent of HIV/AIDS as a problem in the community NGOs, especially those working with HIV orphans, should be aware of the magnitude of HIV/AIDS in the communities they serve If they not have exact statistics they should merely say how big/small the problem is It is also important to know the impact of HIV/AIDS on resources and social functioning in general For example, does it result in an increase in orphans, does it result to family conflicts, blame and fighting within communities, accusations of witchcraft etc- how are the organizations dealing with these? 96 appendix Awareness and knowledge of HIV/AIDS Estimates of the number of people with HIV/AIDS Impact of HIV/AIDS on state and organisational resources available Impact of HIV/AIDS on community resources available Impact of HIV/AIDS on the social functioning of the community Attitudes of the community towards OVCs, especially incidents of stigma Free download from www.hsrcpress.ac.za As people who work and stay within these communities what is their assessment of the community’s attitudes towards OVCs? If time allows try to probe for concrete examples of these issues, for example, whether the OVCs they care for have been discriminated against Perceptions of OVCs by the community Stigma against OVCs Anger at OVCs Positive attitudes to OVCs Care and support structures for OVCs Ask about the care and support services available to the OVCs, their evaluation and whether more is needed to help them If some are providing this care, ask about challenges faced in providing the care and suggestions for improvement Indications of who is providing this care and support Include examination of systems at the level of the family; community, organizational, state and others that may exist Impact of services Check sustainability of these systems of care Desirability and effectiveness of the different structures for care and support Requirements of these structures to be able to provide a better service Indicators of success for systems of care Profile and evaluation questions of implementing intervention organization Knowledge of the intervention organization, structure and past activities Perceptions of the organization and their capacity to the work Ideas of how to facilitate the organization’s work Indicators of success for the implementing organization Challenges for the community in providing care and support What NGOs, CBOs, etc think are challenges faced by communities in providing care and support for the OVCs and how these could be overcome Providing the basics of shelter, food, education and care Dealing with emotional impact of orphanhood or vulnerability, for example, mourning, PTSD Interactions of the OVCs with others in the household/institution Access to resources to facilitate care Attitudes of carers to OVCs Assisting the OVC to deal with stigma Experiences of stigma as a result of providing care to OVCs 97 Multiple vulnerabilities Policy and legislation for the protection of OVCs Ask about policies and legislations aimed at protecting OVCs, their views about these, including strengths and limitations and whether they would like to see this policy and legislation amended Knowledge of law, policy or pre-established practices to protect OVCs Attitudes towards such regulations Implementation and support of these regulations Suggestions of how to help OVCs in the community Ask about what they think could/needs to be done to help the OVCs and who has the ultimate responsibility to help them; what is needed – human resources, financial assistance etc Role of individuals, CBOs, NGOs, FBOs, and state structures What is needed to facilitate these contributions Assessment of the commitment on the part of their structures to assist Free download from www.hsrcpress.ac.za Suggestions of how to limit the spread of HIV/AIDS in the community Ask what interventions they think are required to limit the spread of HIV/AIDS in the community Is it education, infrastructure, reduction of stigma, improvement of health services, gender equity etc Also who should take responsibility to provide these? Educational and information needs Infrastructural needs, for example, PMTCT, VCT and condom distribution Interventions at the social level, for example, stigma, gender discrimination, promiscuity Checks on the health service Care and treatment of PWHAs in the community Their knowledge about care of people living with HIV/AIDS If services are available ask for details and whether PWHAs access them, are they enough; who should provide more services Ask complications in caring for PWHAs: Availability of services for PWHAs Impact of services Views on VCT, PMTCT and ARVs Advantages and disadvantages for the PWHA and community of being open about status Risks of HIV as a result of violence Ask about the incidence of the behaviours that may place people at risks of HIV/AIDS Child abuse Rape and sexual assault Caring for victims of violence Taking payment for sexual services 98 APPENDIX Interview schedule for three nation OVC study: members of state services or government The key areas to be covered in the interview are in bold Below that are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview For each interview different sections of the interview schedule will have to be prioritized and some of the areas of discussion may fall away Do not use the prompts unless the respondent is finding it difficult to talk about the area Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject Free download from www.hsrcpress.ac.za Background of person being interviewed Background here should be about the government services provided to OVCs and those aimed at reducing the incidence of HIV/AIDS in the areas: What is the government doing and who in the government is providing these services? If more than one government department is entrusted with providing these services, who is coordinating them? Why the person is being interviewed Position in community How he/she came to be in this position What is your or your organization’s role in relation to OVCs? What is your or your organization’s source of knowledge about OVCs? What work does your organization and how you assist OVCs? What you think is the size of the problem and what impact is it having on this community? What are your major challenges, needs and concerns, and how these relate to your own resources? The living situation of OVCs, ranging from the best off to those in the worst situations, including the number of them in the community Awareness of orphaned and vulnerable children Estimates of the number of OVCs Housing conditions, examples of good and bad Access to facilities by OVCs, particularly educational, health and social services Financial and social resource available for OVCs Community resources available for the care of OVCs Major threats for OVCs, at the levels of physical, emotional and quality of life Extent of HIV/AIDS as a problem in the community State officials, especially those who provide social services and those who work in vulnerable communities, should be aware of the magnitude of HIV/AIDS in their communities Ask if there are statistics of the situation available and if not, ask them to estimate the magnitude of the problem It is also important to know the impact of HIV/AIDS on resources and social functioning in general For example, does it result in an increase in orphans, does it result in family conflicts, blame and fighting within communities, accusations of witchcraft etc.? In this case, awareness relates to awareness among officials 99 Multiple vulnerabilities Awareness and knowledge of HIV/AIDS Estimates of the number of people with HIV/AIDS Impact of HIV/AIDS on state and organisational resources available Impact of HIV/AIDS on community resources available Impact of HIV/AIDS on the social functioning of the community Attitudes of the community towards OVCs, especially incidents of stigma Free download from www.hsrcpress.ac.za State officials’ views about the community’s attitudes towards OVCs and if these attitudes are negative, ask about programmes aimed at changing them Perceptions of OVCs by the community Stigma against OVCs Anger at OVCs Positive attitudes to OVCs Care and support structures for OVCs Indications of who is providing this care and support Include examination of systems at the level of the family, community, organizational, state and others that may exist Impact of services Check sustainability of these systems of care Desirability and effectiveness of the different structures for care and support Requirements of these structures to be able to provide a better service Indicators of success for systems of care Profile and evaluation questions of implementing intervention organization Knowledge of the intervention organization, structure and past activities Perceptions of the organization and their capacity to the work Ideas of how to facilitate the organizations work Indicators of success for the implementing organization Challenges for the community in providing care and support What state officials think are the challenges faced by communities in providing care and support for the OVCs and how these could be overcome Providing the basics of shelter, food, education and care Dealing with emotional impact of orphanhood or vulnerability, for example, mourning, PTSD Interactions of the OVCs with others in the household/institution Access to resources to facilitate care Attitudes of carers to OVCs Assisting the OVC to deal with stigma Experiences of stigma as a result of providing care to OVCs 100 appendix Policy and legislation for the protection of OVCs Ask about policies and legislation aimed at protecting OVCs, their views about these, including strengths and limitations and whether they would like to see them amended If no policies and legislation currently exist, probe for reasons for this For example, is it because OVCs are not a priority in the government or that these are still in progress? Knowledge of law, policy or pre-established practices to protect OVCs Attitudes towards such regulations Implementation and support of these regulations Suggestions of how to help OVCs in the community Free download from www.hsrcpress.ac.za Role of individuals, CBOs, NGOs, FBOs, and state structures What is needed to facilitate these contributions? Assessment of the commitment on the part of their structures to assist Suggestions of how to limit the spread of HIV/AIDS in the community Ask what interventions they think are required to limit the spread of HIV/AIDS in the community Is it education, infrastructure, reduction of stigma, improvement of health services, gender equity etc.? Also, within the government who should take responsibility to provide these? Educational and information needs Infrastructural needs, for example, PMTCT, VCT and condom distribution Interventions at the social level, for example, stigma, gender discrimination, promiscuity Checks on the health service Care and treatment of PWHAs in the community Services provided by the government and this department (and others) for care of PWHAs Difficulties implementing them (for example, PMTCT services may not be utilized due to stigma attached to being HIV positive) If services are available ask for details and whether PWHAs access them, are they enough; who should provide more services Availability of services for PWHAs Impact of services Views on VCT, PMTCT and ARVs Advantages and disadvantages for the PWHA and community of being open about status Risks of HIV as a result of violence Ask about the incidence of these behaviours that may place people at risk of HIV/AIDS Child abuse Rape and sexual assault Caring for victims of violence Taking payment for sexual services 101 APPENDIX Interview schedule for three nation OVC study: interviews as background for BSS component The key areas to be covered in the interview are in bold Below that are prompts that may be used to elicit discussion, plus the particular areas that need to be covered in the interview For each interview different sections of the interview schedule will have to be prioritized and some of the areas of discussion may fall away Do not use the prompts unless the respondent is finding it difficult to talk about the area Responses are sought beyond the immediate prompts as long as the discussion stays within the broad subject Background of person being interviewed Free download from www.hsrcpress.ac.za This should serve as an icebreaking section Before you meet the participant you would have been given some brief information about the participant, who he/she is and how you came to interview him/her, so you might not have to ask him/her Before asking the participant to talk about his/her experiences and needs as an OVC, first explain the study in details Why this person is being interviewed Position in community What you know and understand about HIV and AIDS? Is there anything that puts you particularly at risk for contracting HIV? Personal knowledge, beliefs and behaviour in relation to HIV This set of questions aims to ascertain the OVC’s knowledge, beliefs and practices related to prevention of HIV/AIDS Also ask if they practise any of their own beliefs, for example, safer sex Also ask about their attitudes towards people who are living with HIV/AIDS (PLWHA) Knowledge and beliefs about HIV Attitudes towards safer sexual practices and PWHAs Past behaviour and commitments to future behaviour Extent of HIV/AIDS as a problem in the community Ask participants to estimate the extent of the HIV/AIDS problem in the community Participants might not have the exact numbers but should merely say how big/small the problem is It is also important to know the impact of HIV/AIDS on resources and social functioning in general For example, has it resulted in an increase in orphans, does it lead to family conflicts, blame and fighting within communities, accusations of witchcraft etc.? Awareness and knowledge of HIV/AIDS Estimates of the number of people with HIV/AIDS Impact of HIV/AIDS on state and organisational resources available Impact of HIV/AIDS on community resources available Impact of HIV/AIDS on the social functioning of the community 102 appendix Suggestions of how to limit the spread of HIV/AIDS in the community Ask what interventions they think are required to limit the spread of HIV/AIDS in the community Is it education, infrastructure, reduction of stigma, improvement of health services, gender equity programmes etc.? Also, who should implement these – government, NGOs, other bodies? Educational and information needs Infrastructural needs, for example, PMTCT, VCT and condom distribution Interventions at the social level, for example, stigma, gender discrimination, promiscuity Checks on the health service Free download from www.hsrcpress.ac.za Complications in protecting themselves from HIV Knowledge about HIV/AIDS and preventative methods may not necessarily lead to behaviour change A lot of factors may impede behaviour change These questions ask for barriers to behaviour change for example, what makes people unable to protect themselves against HIV/AIDS? Is it for example, lack of information, lack of access to resources like condoms and health services or pressure not to use condoms? Access to resources Confusion in information Social pressures, risks of judgment and stigma Care and treatment of PWHAs in the community Their knowledge about care of people living with HIV/AIDS If services are available ask for details and whether PWHAs access them What are their views about these services and if anyone of them tests positive would they utilize them? If not what are reasons? Availability of services for PWHAs Impact of services Views on VCT, PMTCT and ARVs Advantages and disadvantages for the PWHA and community of being open about status Attitudes of the community towards OVCs, especially incidents of stigma Ask community members themselves, participants here should be aware of attitudes towards OVCs, whether they are accepted/rejected in communities Rejection could be either overt or covert; probe for these If time allows try to probe for concrete examples of these issues, for example whether they know any OVCs who are being treated badly either within the family or in the community Perceptions of OVCs by the community Stigma against OVCs Anger at OVCs Positive attitudes to OVCs Risks of HIV as a result of violence Because this will be a focus group, it may not be necessary to ask individual participants if they have experience of this Rather ask in general whether these practices exist in the community, who is likely to engage in them and why 103 Multiple vulnerabilities Child abuse Rape and sexual assault Caring for victims of violence Taking payment for sexual services Major sources of information on HIV and AIDS Free download from www.hsrcpress.ac.za This last section asks about sources of information about HIV/AIDS, asks them also to rank these sources, which one provides the most useful information, which one they utilize often and how could the provision of information about HIV/AIDS be improved Media sources Organisational and state services information Peers and colleagues 104 REFERENCES Anderson, N and Mhatre, S (2003) Do unto others – and pay the price: Combating sexual violence in the south of Johannesburg SA Crime Quarterly, (March) Obtained from http://www.iss.co.za/Publications/CrimeQuarterlyIndex.html Bicego, G., Rutstein, S and Johnson, K (2002) Dimensions of the emerging orphan crisis in sub-Saharan Africa Social Science and Medicine, 56: 1235–1247 Booysen, F (2003) Out-migration in the context of the HIV/AIDS epidemic: Evidence from the Free State Province CSSR working paper no 57 Obtained from www.cssr.uct.ac.za Bray, R (2003) Predicting the social consequences of orphanhood in South Africa CSSR working paper no 29 Centre for Social Science Research, Cape Town CASE (1999) “We also count!” The extent of moderate and severe reported disability and the nature of the disability experience in South Africa South Africa: Department of Health Obtained from http://www.doh.gov.za Free download from www.hsrcpress.ac.za Department of Health (2003) National HIV and syphilis antenatal sero-prevalence study in South Africa 2002 Pretoria: Department of Health Department of Health (2004) National HIV and Syphilis antenatal sero-prevalence survey in South Africa 2003 Pretoria: Department of Health Desmond, C and Gow, J (2001) The Cost-Effectiveness of Six Models of Care for Orphan and Vulnerable Children in South Africa South Africa: Health Economics and HIV/ AIDS Research Division, University of Natal Hill, S and Smith, C (2003) Child well-being and poverty indicators in South Africa: Creating the real picture Cape Town: IDASA International HIV/AIDS Alliance (2004) Supporting older carers USA: International HIV/ AIDS Alliance Jackson, L (1997) Recent initiatives in addressing gender violence in South Africa Occasional paper No 14 Pretoria: Institute for Security Studies Johnson, L and Dorrington, R (2001) The Impact of AIDS on Orphanhood in South Africa: A Quantitative Analysis Cape Town: Centre for Actuarial Research (CARE) Leggett, T (2001) Rainbow vice: The drugs and sex industries in the new South Africa Cape Town: David Phillip Molo Songololo (2000) The trafficking of children for purposes of sexual exploitation South Africa Cape Town: Molo Songololo Nkomo, N and Skinner, D (2004) Situation analysis of services targeting orphans and vulnerable children in Kanana and Umuzimuhle townships in Orkney, North West Province Cape Town: HSRC press Parker, R., Aggleton, P., Attawell, K., Pulerwits, J and Brown,L (2002) HIV/AIDS-related Stigma and Discrimination: A Conceptual Framework and an Agenda for Action Horizons Report Washington: Horizons Project Parry, C (1997) Alcohol misuse and public health: A 10-point action plan Obtained from www.mrc.ac.za/policybriefs/6polbrief1997.htm Perschler-Desai, V (2001) Childhood on the market: Teenage prostitution in Southern Africa African Security Review, 10(4) Obtained from http://www.iss.co.za/PUBS/ASR/ 10No4/Content.html 105 Multiple vulnerabilities Richter, L and Higson-Smith, C (2004) The many kinds of sexual abuse of young children In Richter, Dawes and Higson-Smith (Eds) Sexual Abuse of Young Children in southern Africa Pretoria: HSRC press Ryan, T (1997) Drugs, violence and governability in the further South Africa Occasional paper No 22 Pretoria: Institute for Security Studies Sabatier, R (1988) Blaming Others: Prejudice, Race and World-wide AIDS London: Panos Skinner, D and Mfecane, S (2005) Stigma, Discrimination and it Implications for our Society Journal of Social Aspects of HIV AIDS Research Alliance, (3): 157–164 Skinner, D., Tsheko, N., Mtero-Munyati, S., Segwabe M., Chibatamoto P., Mfecane S., Chandiwana, B., Nkomo, N., Tlou, S and Chitiyo, G (2004) Definition of Orphaned and Vulnerable Children Cape Town: HSRC press Free download from www.hsrcpress.ac.za Shisana, O and Simbayi, L (2002) Nelson Mandela/HSRC Study of HIV/AIDS South Africa National HIV Prevalence Behaviour Risks and Mass Media Household Survey, 2002 Pretoria: HSRC press Smart, R.A 2003 Policies for orphans and vulnerable children: A framework for moving ahead Washington: Policy project, USAID Solarsh, G and Goga, A (2004) Child health In South African Health Review, pp101–126 Health Systems Trust: Durban Sontag, S (1988) AIDS and Its Metaphors London: Penguin Press Standing, A (2003) The social contradictions of organized crime on the Cape Flats Occasional paper 74 Pretoria: Institute for Security Studies Statistics South Africa (2003) Census 2001: Census in brief Pretoria: Statistics South Africa Streak, J (2002) Child poverty monitor, No Cape Town: IDASA Unicef 2004 Factsheet: Children without primary caregivers and in institutions Geneva: Unicef (this should replace the UNAIDS ref on page 10) World Bank (2000) World Development Report 2000/2001: Attacking Poverty Washington DC: World Bank Xhariep District Municipality (2005) Kopanong local Municipality Obtained from www xhariep.gov.za/kopanong.htm 106 ... 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... 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... 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