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HIV/AIDS Orphans in Homes/Orphanages and the Community Are we missing something?

A situational / special needs assessment

Researchers Kofi Boakye and Kwesi Nkum Wilson Country: Ghana Project Mentor: Joshua BAKU Research financed by the

Educational Research Network for West and Central Africa (ERNWACA) With project support from UEMOA regional Centre of Excellence

and the Ministry of Foreign Affairs of the Netherlands

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TABLE OF CONTENTS Abstract i CHAPTER ONE 3 Introduction 3 Conceptual Framework 4 Problem Analysis, 4 Policy and related significance of the Research, 5 Objectives 6 Hypothesis 6 Limitations 6 Organisation of Study 6 CHAPTER TWO 7 Literature Review 7 CHAPTER THREE 10 Methodology 13 CHAPTER FOUR 13 Data Analyses 13 CHAPTER FIVE 30 Discussions on Findings 30 CHAPTER SIX 34 Recommendations and Conclusions 34 References 36

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ABSTRACT The study sought to unearth the special needs of HIV/AIDS orphans in orphanages and homes with emphasis on education, food, shelter, clothing and affection and guidance and counselling needs. It also tried to make recommendations on how these needs could be met. It was carried out orphanages mainly in the Manya Krobo, and New Juaben districts in the Eastern Region of Ghana, which are noted for their high death rates resulting from AIDS. The sample consisted of 77 children aged between 6 to 15 years from the two districts (23 from Manya Krobo and 54 from New Juaben) and their caregivers. Altogether it covered about 82 percent of AIDS orphans in the age group in the surveillance of the District Health Management Team (DHMT) in the two districts. Data was collected by trained research assistants. Some of the findings from the study were that the majority of the orphans perceive the provision of food, shelter, education and affection as somewhat adequate however, the guidance and counselling needs were seriously lacking. Clothing provision was however perceived to be very inadequate. Some recommendations were made at the end of the study and some of these included the need for caregivers, especially grandmothers to be given special material assistance to enable them care for AIDS orphans, efforts should be made to convince caregivers of the importance of family home care for orphans instead of institutional care, such as orphanages and finally, guidance and Counselling in the homes should be given priority attention and training should be given to caregivers immediately in this area

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CHAPTER ONE 1.0 Introduction "The silence that surrounds children affected by HIV/AIDS and the inaction that results is morally reprehensible and unacceptable. If this situation is not addressed, and not addressed now with increased urgency, millions of children will continue to die, and tens of millions more will be further marginalised, stigmatised, malnourished, uneducated, and psychologically damaged"1 On the 27th of June 1997, the United Nations warned, “Africa was in danger of becoming a continent of orphans unless swift action was taken to control the spread of the deadly virus that leads to AIDS. This statement by Peter Piot, the Executive Director of UNAIDS highlighted the survival and development of the African child in particular as a child at risk and called for special protection and assistance as enshrined in the Convention on the Rights of the Child. By 2003 15 million children under 18 had been orphaned by HIV/AIDS worldwide. About 12 million of these live in sub-Saharan Africa, and it is expected that this number will have risen to more than 18 million by 2010.2

1.2 Conceptual Framework Young children born into HIV /AIDS affected families and communities are exposed to negative consequences, as the following figure3 shows

1 Speech : 'Urgent Action for Children on the Brink', Carol Belllamy, www.unicef.org/media/media_9403.html 2 UNAIDS/WHO 2004 Report on the global AIDS epidemic 3 World Bank (2003): Operational Guidelines for Supporting Early Child Development (ECD) in Multi-sectoral HIV/AIDS Programs in Africa

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Figure 1: Negative Implications of Young Children Born into AIDS-affected Communities Source: World Bank (2003): Operational Guidelines for Supporting Early Child Development (ECD) in Multi-sectoral HIV/AIDS Programs in Africa

A child born into an HIV/AIDS community is likely to suffer an exacerbated poverty level, and subsequently would be stressed psychosocially. The negative consequences of these two variables are limitless if not checked on time. The study is therefore based on this premise. This stress could be fed from two sources – the family on one hand or the extended or external family, which may not have the resources for another set of mouths. The obvious choice then becomes the home or orphanage. At the orphanage, the child’s psychosocial environment must be tuned or prepared to assist the child to be re-integrated into the society and become socially responsible in the midst of stigma and the probable silent needs which may be lacking. 1.3 Problem Analysis Traumatized by the death of parents, stigmatized through association with the disease and often thrown into desperate poverty by the loss of bread-winners, this growing army of orphans -- defined as children who have lost one or both parents -- is straining the traditional

HIV-positive parents

Transmission of HIV to child

Family overburdened as a result of caring for foster children and/or ill family

members

Orphanhood

Fewer household resources for nutritious foods, education and

other investments in young children

Poor cognitive and social development

Foster care, Institutional care street children, and child-headed households

Nutritional deficiencies

Stunting

Childhood

morbidity and mortality

Poverty level exacerbated

Psychosocial stress

Opportunistic infections, increased susceptibility to

childhood diseases

Increased susceptibility to

childhood diseases

Child born in AIDS-affected community

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extended family and overwhelming national health and education systems in the most severely affected countries” (Fleshman, 2001). The needs of AIDS orphans are as immediate as their next meal and as extended as access to education, guidance and care until the end of their adolescent years. Speaking to leaders of industrialized countries at the July 2001 Group of Eight meeting in Genoa, UN Secretary-General Kofi Annan appealed for the resources "to care for all whose lives have been devastated by AIDS, particularly the orphans." Orphans will often have many physical needs such as nutrition and health care, and these can often appear to be the most urgent. But they will have significant emotional needs as well as the sickness and death of a parent is clearly a major trauma for any child. The emotional needs of the children must not be forgotten. Many homes have sprung up to cater for the orphans whose traditional homes can no longer offer the needed support and care for the orphans. The question is, are these homes really catering for the needs of the orphan or are merely offering shelter and acting as an alternative to care? Not many studies have been conducted on needs assessment of orphans in the home. Indeed the homes are welcome, despite the fact that they are not too popular and criticisms abound. However, with the crippling traditional household and its capacity to care for the orphans, these homes and orphanages should be revisited and made capable of nurturing and culturing the orphan. There is therefore the need to conduct a psycho-social needs assessment of the orphans with a focus on the guidance and counselling needs in some selected orphanages. 1.4 Policy and related significance of the Research Mr Alfred Salia Fawundu, UN Resident Coordinator and UNDP Resident Representative in Ghana, maintained that "while we are all concentrating our energies on achieving the millennium development goals, it was barely possible to achieve those goals such as eradication of poverty, universal primary education or reduction of child mortality by 2015, without tackling the issue of AIDS orphans and the vulnerable". He said the major task assigned the government on the issue of AIDS was to formulate an appropriate policy and guidelines on how to tackle the serious issue and provide care and support for children and their caregivers4. Clearly then, the care of orphans and vulnerable children has indeed become an entry point to meeting and sustaining the Millennium Development goals in Sub-Saharan Africa5. The study will be of significant benefit to a host of stakeholders. In the first place, it will be instrumental to the Government in its drive to develop a workable policy for AIDs orphans, which has not yet been put in place. Again, it will assist the District Assemblies to define and draft interventional strategies for households hit by the epidemic. NGOs and other bodies who would like to intervene in helping orphanages and homes, but do not know exactly where to begin or invest will also find this study helpful in that it would expose the immediate needs of the orphans and this will go a long way to help in sustaining efforts that are put in to alleviate the psychosocial problems associated with HIV/AIDs orphans. Last but not the least, a study of this nature will fill in the void of misinformation

4 Ghana News Agency, 2003 5 MDG Report 2002

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and help in building a database of empirical information on the status of Ghana’s HIV/AIDs orphans. 1.5.0 Objectives 1.5.1 Broad Objective The main objective of this research is to conduct a situational needs assessment into the psychosocial, emotional and guidance and counselling needs of HIV/AIDS orphans in homes and orphanages. 1.5.2 Specific Objectives The specific objectives of this study are the following:

• To unearth the special needs of HIV/AIDS orphans in orphanages and homes with emphasis on education, food, shelter, clothing and affection.

• Identify the guidance and counselling needs of HIV/AIDS orphans in orphanages and homes.

• Make recommendations on how these needs can be met 1.5.3 Hypotheses HIV/AIDS orphans in homes are well catered for and therefore do not have any special needs with regard to their provisions for food, shelter, clothing, affection and more importantly education, guidance and counselling. 1.6 Limitations In view of the fact that it is very difficult to get people discuss issues concerning orphans more so HIV/AIDS orphans, researchers did more visitation and advocacy before they could get some level of co-operation from caregivers and orphans. In some orphanages, the researchers had to leave the questionnaire with the senior caregiver who in turn did some briefing to the other caregivers before responding to the questionnaire. This in the opinion of the researchers could affect the way they answered them. This explains why some of the questions, which needed further answers, were not answered, researchers believe vital information might have been lost. 1.7 Organisation of the Study The remaining chapters of this study are organised as follows: Chapter two discusses the literature related to the study. The review involves theoretical and empirical studies of the problem under study. The third chapter describes the methodology used in the study. Specifically, the research design, the research instrument, the piloting procedure, the procedure for data collection and the data analysis are discussed. In chapter four, the main focus is the presentation, analysis while discussion of data collected will be done in chapter five. Finally, summary, conclusion, and recommendations are presented in chapter six.

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CHAPTER TWO LITERATURE REVIEW 2.1 The HIV/AIDS and Orphans Situation in Ghana Ghana has a relatively low prevalence of HIV/AIDS according to the most recent sentinel surveillance report of 2002, which reported a mean prevalence of 3.4%. The HIV/AIDS pandemic has so far rendered 170,000 children orphans and 173,098 have been identified to be vulnerable to the risk of being infected with the disease. The Ashanti, Eastern, Greater Accra and the Volta Regions have the largest concentration of 77.1 per cent of the documented orphans and vulnerable children with the Northern, Western, Upper East and Upper West Regions accounting for 22.9 per cent6. However, the National AIDs Commission Programme projects that there will be far more than 603,000 HIV/AIDS orphans in 20147. 2.2 Orphans and HIV/AIDS The vulnerability of AIDS orphans starts well before the death of a parent. Children living with caregivers who have HIV/AIDS will often experience many negative changes in their lives and can start to suffer neglect, including emotional neglect, long before the death of the parent or caregiver. The economic impact of HIV/AIDS illness and death has serious consequences for an orphan's access to basic necessities such as shelter, food, clothing, health and education. Orphans run greater risks of being malnourished than children who have parents to look after them. In addition there is the emotional suffering of the children which usually begins with their parents' distress and progressive illness. Eventually, the children suffer the death of their parent(s) and the emotional trauma that results. They then may have to adjust to a new situation, with little or no support, and they may suffer exploitation and abuse.8 9 Children grieving for dying or dead parents are often stigmatised by society through association with HIV/AIDS. "We should remember that the process of losing parents to HIV/AIDS for the children often includes the pain and the shame of the stigma and the fear that the disease carries in most our societies." Statement by UNICEF representative Bjorn Ljunqvis10 The distress and social isolation experienced by these children, both before and after the death of their parent(s), is strongly exacerbated by the shame, fear, and rejection that often surrounds people affected by HIV/AIDS. Because of this stigma and often-irrational fear surrounding AIDS, children may be denied access to schooling and health care. And once a parent dies, children may also be denied their inheritance and property. Often children who have lost their parents to AIDS are assumed to be infected with HIV themselves. This further stigmatises the children, reduces their opportunities in the future, and they may also not receive the health care they need, and sometimes this is because it is assumed they are infected with HIV and their illnesses are untreatable.

6 Ghana News Agency, 2003 7 National Aids Control Programme, 2000 8 Jo Stein Sorrow makes Children of us all: A literature review on the psycho-social impact of HIV/AIDS on Children CSSR Working Paper No. 47 9 Reaching out to Africa's Orphans A Framework for Public Action 2004 10 United Nations Children's Fund (2003) 'Statement by UNICEF representative Bjorn Ljungqvist, HIV/AIDS orphans survey findings conference', April 8

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2.3 Interventions Several interventions have been put in place by both the Government and non-governmental institutions including the community and households themselves. However, there never seems to be a satisfactory pathway that makes for a good remedy since all the interventions have their serious limitations. The first and mostly common point of call for caring for the orphan is usually the household. However, in African countries including Ghana, AIDS is generating orphans so quickly that family structures can no longer cope. As one author puts it "Almost throughout sub-Saharan Africa, there have been traditional systems in place to take care of children who lose their parents for various reasons. But the onslaught of HIV slowly but surely erodes this good traditional practise by simply overloading its caring capacity by the sheer number of orphaned children needing support and care. HIV also undermines the caring capacity of families and communities by deepening poverty due to loss of labour and the high cost of medical treatment and funerals."11 It is now known that the traditional safety nets are unravelling as more young adults die of AIDS related illnesses. Families and communities can barely fend for themselves, let alone take care of the orphans. Typically, half of all people with HIV become infected before they are aged 25, developing AIDS and dying by the time they are aged 35, leaving behind a generation of children to be raised by their grandparents, other adult relatives or left on their own in child-headed households or more recently, in homes and orphanages.

Formerly, in the early days of the AIDS orphan crisis, there was a rush by well meaning non-governmental organisations to build orphanages. But this response was unsustainable given the scale of the problem, as the cost of maintaining a child in such an institution is many times that of other forms of care12. With the worsening economic situation in most African countries, the traditional household can no longer cater for the orphan and so homes and orphanages are once more fast becoming the next alternative for care. There is therefore the need to revisit the issue of homes and orphanages, with particular reference to the psychosocial and emotional needs of orphans in these homes to know how these needs are being met. Justification for Guidance and Counselling Young people are more likely to make investment when they are able to;

• Recognise that work has value • See that, through work, they can make contributions • Believe that they have some control in creating their own future • Accept that their past accomplishments have merit • Understand how the little things they can do now and can add up a more • desirable life now and late (Make the future in the present) • See beyond stereotypes i.e. perceived limitations based on gender, culture, socio-

economic or physical conditions • Set personal goals and believe in your ability to achieve them • Identify strategies to overcome personal barriers to work and learning

11 dito 12 Mass Orphanhood in the era of HIV/AIDS BMJ 2002;324:185-186

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• Overcome self-defeating behaviours and personal barriers13. 2.4 GUIDANCE AND COUNSELLING NEEDS OF CHILDREN One of the principles underbidding guidance states that guidance is concerned primarily and systematically with the personal development of the (Child) individual. This principle implies that Guidance concept should seek to develop the totality of the individual. The focus of the school lies in intellectual development of the individual, which is a limitation of the total development of a person. Development in this instance implies total growth of the individual-academic, social, moral etc. this is because when one area of the individuals life is affected, it is likely to have a ripple effect one the other areas of the individuals life. Another principle states that guidance is for all students. Guidance should not be given to the troubled individual alone. It must be planned in such a way that all students pupils in the school benefit from the programme. Since F.C.U.B.E demands that every Ghanaian child should be in the school, such a programme must suite every school child. Yet another principle states that guidance is for all ages guidance is considered as a continuous, sequential educational process that is development in nature. That is to say School Guidance must begin from kindergarten through primary, Junior, Senior Secondary School to the University. Schools should design programmes that will suit every member of the school community. From the above discussions it is very important to acknowledge that since guidance is concerned primarily and systematically with the personal development of the individual and that it is for all and at all ages, children need proper guidance in all facets of their development. It is very important for caregivers and orphanages to ensure that the guidance needs – social, educational and vocational- are addressed appropriately and promptly. 13 Bedu-Addo, P.K.A. (2000). Guidance and Counselling ‘Unmasked’ 3rd Ed Accra, Type Company Limited

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CHAPTER THREE METHODOLOGY 3.1. Study Design A survey design was used for the study. This design was selected because it has the advantage of producing a good amount of responses from a wide range of people. Furthermore, it has a greater confidence with regard to particular questions of special interest or value to the research on HIV/AIDS orphans. 3.2 Study Variables The following were among the variables that guided the research

� Perception of provision of food, shelter, clothing, affection and education � Problems encountered in providing food, shelter, clothing, affection and education � Guidance and counselling in dealing with stigma � Guidance and counselling in career development � Knowledge about HIV infection, prevention, care and support � Perception on the ‘S’ factors (shame, stigma & discrimination and silence) in

HIV/AIDS � Counselling in dealing with HIV/AIDS � Attitudes towards HIV/AIDS epidemic and those infected and affected by it.

3.3 Study Population The target population of the study comprised HIV/AIDS orphans, caregivers in orphanages and homes throughout the country. Opinion leaders and Committee members were also included in the population 3.4 Sampling Identifying orphans and vulnerable children constitutes a rare event (Moser and Kalton, (1971). A two-phase disproportionate stratified sub-sampling approach was used to select the homes and orphanages as well as the orphans used in the study. The sample was more representative than on actual size. Gender was taken into consideration in selecting the study sample at the school level. Two orphanages were purposively selected in two districts, the Manya Krobo and the New Juabeng Districts, based on their size, and then the number of orphaned children to AIDS was identified. These districts were purposefully chosen because of the high prevalence of HIV/AIDs in those communities. Characteristics of the sample Orphans Orphans between the ages of 14 and 18 were chosen to respond to the items on the questionnaire. This is because orphans at that age are matured enough to understand their conditions and respond appropriately to the questionnaire and contribute meaningfully to the Focus Group discussion. In all, a total of about 77 orphans were involved in the study. Caregivers Caregivers to the AIDs orphans were identified in each home sampled and also interviewed and given questionnaire to answer. Their answers were used to corroborate the responses of the orphans or provide further insight into the needs identified. In all, about 40 caregivers were used to respond to the questionnaire.

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Opinion leaders Some opinion leaders in the communities within which the orphanage is were also included in the sample to seek their input to the situational needs assessment of the orphans. The opinion leaders were unit committee members, teachers, linguists and other high ranking members in the community. These were randomly chosen. Their contribution was used to moderate some of the responses given by the orphans and their caregivers. The sample size is: HIV/AIDS orphans 77 Caregivers 40 Opinion leaders 20 Total Respondents 137 3.5 Data Collection Technique Two questionnaires (made up of a combination of close-ended and open-ended items) was developed and used to collect data from the orphans themselves and their caregivers. The original instrument was reviewed by the research team and modified after a pre-test. A Focus Group Discussion (FGD) was also held with the orphans themselves and the caregivers, The FGD was used for the purpose of validating responses from the questionnaire and also served as a forum to provide supplementary and more detailed information. The motive for the choice of FGD as part of the data collection process was to make the study as participatory and interactive as possible. This approach had the advantage of creating opportunities for caregivers especially and added some more knowledge and awareness to what they already know in care giving. Additionally, interviews were conducted with some opinion leaders in the areas where the homes or orphanages are situated. An Interview schedule was accordingly developed The co-researchers organized a training workshop for 2 field staff (each handling 2 districts) involved in data collection. The rationale for asking each question was explained, the reliability of the data was checked, skills for questionnaire administration and in particular the conduct of FGDs sharpened, while logistical and supplies arrangements and other related issues were also discussed at the workshop. It was projected that the fieldwork will take 18 days, however due to the peculiar nature of the work it took over four (3) months to complete the data collection. 3.6 Data Processing and Analysis The data collected was cross-checked in the field by the research team members for completeness, consistency and errors and corrections were made accordingly. Thereafter, the responses were edited, coded and scored. Both quantitative and qualitative components of data collected were analyzed using the Statistical Package for Social Sciences (SPSS Version 11.0). The use of frequencies, percentages, correlations and the Analyses of Variance (ANOVA) was used to find out the differences among the orphanages selected. Analysis was also gender sensitive. The use of charts also aided illustration of some of the pertinent issues in the analyses.

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3.7 Limitations Initially, orphans in homes alone were to be interviewed but due to their small numbers and their young age to properly understand the questionnaire, the research had to go beyond the homes into the community, to orphans who were staying with their caregivers to properly do a situational analyses and understand the needs of the orphans. Again, getting the older orphans in the homes was a problem, since they were inaccessible and were in the boarding house so their answers would be skewed or the possibility of the Hawthorne effect would come into play.

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CHAPTER 4 RESULTS OF THE STUDY 4.1 Introduction This chapter presents the results of the study. It is in three parts. The first gives the characteristics of the respondents to serve as background information. The second part brings out the findings on the different care components as the AIDS orphans perceive them and the extent to which they are related to the characteristics of the caregivers. The final part shows the interventions that the respondents want to see in place to assist the AIDS orphans. 4.2 Characteristics of the Respondents 4.2.1 Characteristics of the Orphans Interviewed The general characteristics of the orphans are as shown in Table 4.1 Table 4.1 General Characteristics of The Orphans Interviewed, By District.

DISTRICT TOTAL

Manya Krobo New Juaben

VARIABLE

n % n % N %

Sex Boys Girls Total

27 27 54

50 50 100

14 9 23

61 39 100

41 36 77

53 47 100

Age Group Young (6-12 yrs.) Old (13-15 yrs.) Total

32 22 54

59 41 100

14 9 23

61 39 100

46 31 77

60 40 100

Schooling In School Not in School Total

45 9 54

83 17 100

15 8 23

65 35 100

60 17 77

78 22 100

In all, a total of 77 AIDS orphans comprising 41 boys and 36 girls were interviewed in the two districts. As the Table shows, a higher proportion was from the Manya Krobo District than their counterparts from the New Juaben District. In terms of age structure, there was a greater number in the primary school age-group than those in the JSS age group (13-15 years). Almost four out of every five children were in school. 4.2.3 Characteristics of the Caregiver Respondents In Table 4.2, the characteristics of the caregivers of the AIDS orphans have been summarised.

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Table 4.2 Characteristics of the Caregiver Respondents, Distribution By District

DISTRICT TOTAL Manya Krobo New Juaben

VARIABLE

n % n % N

%

Sex Males Females Total

15 37 52

29 71 100

2 21 23

9 91 100

17 57 73

23 77 100

Age Group Below 40 Years 40 Years and above Total

13 38 51

25 75 100

5 17 22

23 77 100

18 55 73

25 75 100

Educ. Background Never Basic Higher Total

28 12 10 47

56 24 20 100

10 9 3 22

45 41 14 100

38 21 13 72

53 29 18 100

Broad Salaried Occupational Non- Sal Group Total

4 43 47

9 91 100

2 17 19

11 89 100

6 60 66

9 91 100

The characteristics of the caregivers in the two districts generally reflect their counterparts in the literature: higher proportion of females than males, mostly above 40 years, generally with little or no formal educational background, and in non-salaried occupations. Analysis Approach The approach followed here is first a presentation of the extent to which the AIDS orphans perceived their provision of care. Each component of care (food, shelter, clothing, schooling and affection would be discussed in turn and compared among the two districts, and the characteristics of the caregivers, to ascertain the influencing variables in the care provided. 4.3.2 The Provision of Food for AIDS Orphans The general perception of the orphans in terms of the provision of food was as found in Figure 4.1 below.

Fig 4.1 Aids Orphan 's Perception of Food Provision

Adequate81%

Not Adequate19%

Adequate

Not Adequate

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The figure shows that four out of every five orphans in the study perceived that their food provision was adequate; only one out of five thought it was inadequate. An analysis of variance to determine the relationship of care factors to the perception of care was made. Table 4.3 Analysis of Variance Between Orphans’ Perception Of Food Provision And determinants of care.

Determinants of Care

Sum of Squares

df Mean Square

F Sig. Decision

Between Groups 1.691 1 1.691 8.785 .004 p.<.05

Reject Ho:

Within Groups 14.439 75 .193

District

Total 16.130 76 Between Groups .500 1 .500 2.860 .095 Accept Ho: Within Groups 12.594 72 .175

Sex of Caregiver Total 13.095 73

Between Groups .212 1 .212 1.126 .292 Accept Ho: Age of Caregiver Within Groups 13.350 71 .188 Total 13.562 72

Between Groups 2.825 1 2.825 5.006 .028 p.<.05

Reject Ho:

Within Groups 39.495 70 .564

Educational background of caregiver

Total 42.319 71 Between Groups .134 1 .134 1.609 .209 Accept Ho: Within Groups 5.321 64 8.314E-02

Caregiver's broad occupation Total 5.455 65

Between Groups .545 1 .545 3.129 .081 Accept Ho: Within Groups 12.549 72 .174

Caregiver's attitude toward AIDS orphan

Total 13.095 73

Between Groups .206 1 .206 .572 .452 Accept Ho: Within Groups 23.067 64 .360

Relationship of Caregiver to Orphan

Total 23.273 65

Table 4.3 shows that of all the seven variables of factors of care of the caregivers, only two were significantly related (p.= <.05) to the provision of food as the AIDS orphans perceived it. These factors were the districts in which they lived and the educational backgrounds of the caregivers. It was found from the Table?? that while 89 per cent of the orphans in Manya Krobo perceived their food provision as adequate, only 61 per cent of their counterparts in the New Juaben District had that perception.

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Table 4.4 Crosstabulation of AIDS Orphans’ Perception of Food Consumption and District

District Manya Krobo New Juaben

Total

Orphans’ Perception of Food Consumption n % n % n % Adequate 48 88.9 14 60.9 62 80.5 Not Adequaate 6 11.1 9 39.1 15 19.5 Total 54 100 23 100 77 100.0

Pearson Chi-Square. Value of 8.073 with 1 degree of freedom. = .004 (Significant at P=<. 05 level) Regarding the educational background of caregivers, the Table 4.5 shows that the higher the educational level of caregivers the higher the corresponding percentage of their orphans expressing adequacy of food provision. Table 4.5: Crosstabulation of AIDS Orphans’ Perception of Food Consumption and Educational Background of Caregivers

Educational Background of Caregivers Nil Basic Post-Basic

Total

Orphans’ Perception of Food Consumption n % n % n % n % Adequate 27 71.1 17 81.0 13 100.0 57 79.2

Not Adequate 11 28.9 4 19.0 - - 15 20.8 Total 38 100.0 21 100.0 13 100.0 74 100.0

Pearson Chi-Square Value 4.979 with 2 degrees of freedom = .083 (Not significant) 4.3.3 The Provision of Shelter for AIDS Orphans Figure 4. 2 below shows that a large majority of the AIDS orphans (71 per cent) perceived that their provision of shelter was adequate. However, a sizable proportion of one quarter of their number thought their shelter was not adequate. Again, an analysis of variance to test whether there was any relationship between the shelter provision and the care components was made.

Fig 4.2 Aids Orphan 's Perception of Shelter Provision

Adequate74%

Not Adequate26%

Adequate

Not Adequate

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Table 4.6 Analysis of Variance Between Orphans’ Perception of General Provision of Shelter and determinants of care


Sum Of Squares

Df

Mean Square

F

Sig.

Decision

District

Between Groups .598 1 .598 2.822 .097 Accept Ho:

Within Groups 15.254 72 .212 Total 15.851 73

Sex of Caregiver

Between Groups .695 1 .695 4.100 .047 p.<.05

Reject Ho:


Age of Caregiver




Between Groups 1.094 1 1.094 1.821 .182 Accept Ho:


Caregiver's broad occupation


Within Groups 5.308 63 8.425E-02

Total 5.446 64 Caregiver's attitude toward AIDS orphan




Between Groups .333 1 .333 .912 .343 Accept Ho:


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It was found that the determinants of care variables of district, caregivers age, educational level, occupation, attitude or relationship had no significant relationship to the provision of shelter as the AIDS orphans perceived it. The only factor that made a significant difference was whether their caregivers were male or female. This is evidenced in the crosstabulation below where 94.1 per cent of the male orphans as against only 75.4 per cent of the females found their shelter provision as adequate. The significance was at the p. = <. 05 level. Table 4.7 Crosstabulation of AIDS Orphans’ Perception of Shelter Provision and Sex of Caregivers

Sex Of Caregivers Male Female

Total

Orphans’ Perception of Food Consumption n % n % n % Adequate 16 94.1 43 75.4 59 79.7 Not Adequate 1 5.9 14 24.6 15 20.3 Total 54 100 23 100 74 100.0

Pearson Chi-Square Test value of 3.982 with 1 degree of freedom . P.= .046 (Significant at P. =<.05 level)

Another observation that came to light was that the orphans preferred to stay in the big towns rather than where they were staying presently. 4.3.3 The Provision of Clothing For AIDS Orphans The general perception of the orphans in terms of the provision of clothing was as found in Figure 4.4 below.

Fig 4.4 Aids Orphan 's Perception of Clothing Provision

Adequate26%

Not Adequate74%

Adequate

Not Adequate

Fig 4.3 Where the orphan would have liked to stay

0

10

20

30

40

50

60

In Big Town At home Other

Place

Per

cent

age

Place of Stay

19

Generally, majority of the AIDS orphans (almost three-fourths of their number) perceived that their provision of clothing was not adequate. Only about a quarter found the provision to be adequate. The relationship between the clothing provision and their determinants of care are analysed as in Table 4.8 Two determinants of care were found to be significantly influential in bringing about the difference between the proportion of AIDS orphans who perceive their provision of clothing to be adequate and those who do not. These were the districts in which they and their caregivers live and the gender of their caregivers. Regarding the district as a factor, the differences are shown in the following clustered bar chart in Figure 4.5 While 37 per cent representing 20 of the 54 respondents who gave an opinion from the Manya Krobo District said it was adequate, none of their 22 counterparts in the New Juaben District gave such an opinion. All the orphans from New Juaben and the rest of their counterparts from Manya Krobo found their provision of clothing to be inadequate. Table 4.8: Crosstabulation of AIDS Orphans’ Perception of Clothing Provision and District

District Manya Krobo New Juaben

Total

Orphans’ Perception of Clothing Provision n % n % n % Adequate 20 37.0 - - 20 26.3 Not Adequate 34 63.0 22 100.0 56 73.7 Total 54 100.0 22 100.0 76 100.0

Pearson Chi-Square Value 11.050 with 1 degree of freedom. P=<.001

Fig 4.5 Aids Orphan 's Perception of Clothing ProvisionClustered by District

0%10%20%30%40%50%60%70%80%90%

100%


Not Adequate

Adequate

20

Table 4.9 Analysis of Variance Between Orphans’ Perception of Provision for Clothing And Determinants of Care


Sum of Squares

df

Mean Square

F

Sig.

District

Between Groups 2.274 1 2.274 12.601 .001 p.<.01

Reject Ho:

Within Groups 13.357 74 .181 Total 15.632 75 Sex of Caregiver

Between Groups

1.705 1 1.705 10.677 .002 p.<.01

Reject Ho:


Age of Caregiver


Within Groups 13.037 70 .186 Total 13.500 71 Educational background of caregiver

Between Groups

.323 1 .323 .537 .466 Accept Ho:



Between Groups 4.506E-03 1 4.506E-03 .052 .820 Accept Ho:



Between Groups

9.646E-02 1 9.646E-02

.552 .460 Accept Ho:



Between Groups 7.064E-04 1 7.064E-04 .002 .965 Accept Ho:


21

The gender of caregivers in the two districts was a factor that brought significant differences as the following Table shows.

Table 4.10 Crosstabulation of AIDS Orphans’ Perception of Clothing Provision and Sex of Caregivers

Sex Of Caregivers Male Female

Total

AIDS Orphans’ Perception of Clothing Provision

n % n % n %

Adequate 9 52.9 9 16.1 18 24.7 Not Adequate 8 47.1 47 83.9 55 75.3 Total 17 100.0 56 100.0 73 100.0

Pearson Chi-Square value 9.543 with 1 degree of freedom. P= <.002. Significant at P.= <.05 level. The Table shows that a significantly higher proportion of orphans with male caregivers than their counterparts with female caregivers perceived their clothing provision as adequate. The Provision of Formal Education for AIDS Orphans The AIDS orphans were asked whether they were in school as enrolled pupils at the time of the interview. Figure 4.6 shows the responses. Majority of the orphans, almost four out of every five, were in school receiving basic education. The extent to which there were significant differences in determinants of care in the provision of education was explored in the table below.

Fig 4.6 Aids Orphan 's Response to "Areyou in School?"

Yes78%

No22%

Yes

No

22

Table 4.11 Analysis of Variance Between Orphans in School And determinants of care Determinants of Care

Sum of Squares

df

Mean Square

F

Sig.

Decision

District

Between Groups .645 1 .645 3.122 .081 Accept Ho


Sex of Caregiver

Between Groups

6.260E-02

1 6.260E-02

.346 .558 Accept Ho


Age of Caregiver

Between Groups 8.906E-02 1 8.906E-02 .469 .496 Accept Ho



Between Groups

2.001 1 2.001 3.474 .067 Accept Ho






Between Groups

9.150E-02

1 9.150E-02

.507 .479 Accept Ho





23

It was evident from the Table 4.11 that though there were differences, they were generally not significant. Another issue of significance came up with the payment of school fees with the majority of New Juaben orphans saying they were almost always in arrears of school fees. 4.3.4 The Provision of Affection For AIDS Orphans The orphans were asked to state, using a Likert Scale, how they perceived the general affection their caregivers had for them: whether very adequate, adequate, somehow, not adequate, and not very adequate. Very adequate and adequate were summed as adequate; the rest were regarded as inadequate. Figure 4.8 below illustrates their responses. Nine AIDS orphans out of every ten perceived the provision of affection from their caregivers was adequate.

Fig 4.8 Aids Orphan 's Perception of Caregivers' Affection

Adequate91%

Not Adequate9%

Adequate

Not Adequate

Fig 4.7 Payment of School Fees

0

10

20

30

40

50

60

70

80

90

100


District

Per

cent

age

Yes

No

24

Table 4.12 Analysis of Variance Between Orphans’ Perception Of Their Caregivers’ Affection And Determinants of Care Determinants of Care

Sum of Squares

df

Mean Square

F

Sig.

Decision

District

Between Groups .207 1 .207 .961 .330 Accept Ho

Within Groups

15.739 73 .216

Total 15.947 74 Sex of Caregiver

Between Groups

.420 1 .420 2.362 .129 Accept Ho


Age of Caregiver


Within Groups

12.699 70 .181

Total 12.986 71 Educational background of caregiver

Between Groups

1.579 1 1.579 2.671 .107 Accept Ho




Within Groups

5.379 62 8.676E-02


Between Groups

6.743E-02

1 6.743E-02

.365 .547 Accept Ho



Between Groups 1.868 1 1.868 5.531 .022 p.<.05

Reject Ho:

Within Groups

21.271 63 .338

Total 23.138 64

25

It was found that the relationship of caregiver to AIDS orphan was the only variable that significantly brought the difference between the care determinants and the proportion of orphans who perceived their caregivers’ affection to be high and those who did not. Table 4.13 shows the crosstabulation of the orphans’ perception of care and the relationship of caregivers to the orphans. Table 4.13 Crosstabulation of AIDS Orphans’ Perception of Caregiver’s Affection and Relationship of Caregiver to AIDS Orphan

Relationship of Caregiver to AIDS Orphan Grand Parent Other Family

Member Non-relative

Total

AIDS Orphan’s Perception of Caregiver’s Affection

n % n % n % n %

Adequate 42 93.3 14 87.5 2 50.0 58 89.2

Not adequate 3 6.7 2 12.5 2 50.0 7 10.8 Total 45 100.0 16 100.0 4 100.0 65 100.0

Pearson Chi-Square Test Value of 7.244 2 degrees of freedom. . 027 (Significant at P. =<.05 level). It may be observed from the Table that, as expected, those who were significantly perceived by the orphans as providing affection were grandparents followed by other members of the family and non-family members in that order. 4.3.5 The Provision of Guidance and Counselling for AIDS Orphans The provision of Guidance and Counselling services in the orphanages and indeed within the community was very limited. Only 12 of the orphans interviewed indicated that they had ever received some form of guidance and counselling. The number who said yes, said the Guidance they had received was on career and vocational Counselling.

Fig 4.9 Have you ever received any Guidance Services?

84%

16%

No

Yes

26

Summary on Findings on Perceptions of Care and Their Relationship to the Determinants of Care From the foregoing findings, it may be summarised that to some extent, the needs of the AIDS orphans were being met. Food, shelter, education and affection were generally perceived to be provided adequately. The only need that was perceived by the orphans as not being adequately provided was clothing, and this was noted in both districts. The study thus confirmed that: • There were significant differences in the provision of food in terms of district; • There were significant differences in the provision of shelter in terms of caregivers’ gender; • There were significant differences in the provision of shelter in terms of the caregivers’ relationship to the orphans; • There were significant differences in the provision of clothing in terms of district; • That there were significant differences in the provision clothing in terms of the gender of caregivers; and, • There were significant differences in the provision of affection in terms the caregivers’ relationship to the orphans. • The orphans hardly receive any form of Guidance and Counselling These findings will be discussed further in the next chapter. Intervention for AIDS Orphans In addition to the types of care for AID orphans and the extent to which they were related to the care determinants, the study explored the interventions that the caregivers would like have for the orphans. They were asked if they received any assistance and if so from what source; their opinion on orphanages, and what they thought living parents, communities, religious organisations, District Assemblies and the Government could do for AIDS orphans. The findings on these are given in turns. Assistance to AIDS Orphans When the caregivers were asked whether they received any assistance in caring for their orphan wards, their responses were as summarised in Figure 4.8 below.

Fig 4.8 Do you as a Caregiver Receive Assistance for Aids Orphans

Yes37%

No63%

Yes

No

27

Only a little more than a third (37.1 per cent) of the caregivers who responded to the question said they receive some help for the upkeep of the orphans in their charge. The assistance was mainly in the form of cash and kind from mainly close relatives, churches, and other non-governmental organisations. In the Manya Krobo District, for example, the Roman Catholic Church was very active in assisting orphans in schooling, and helping in giving vocational training to grown-up orphans. Opinion of Caregivers on Orphanages All the caregivers in both districts had positive opinions on orphanages, and stated that they should continue operating and be encouraged to improve their services. Interventions By Parents and Various Bodies The caregiver respondents were asked how they thought Parents (i.e. surviving parent), extended families, the community, District Assembly, Churches, NGOs and the Government could contribute to the welfare of the AIDS Orphans. These are summarized in Table 4.14. Table 4.14 Caregivers’ Suggestions on Ways in Which Parents and Various Bodies Can Assist AIDS Orphans

For parents and other members of the family, the caregivers suggested acceptance of the orphaning situation, moral, financial and material support. Free educational opportunities, material and financial support as well as creation of income generating activities were those suggested for the community, District Assembly, religious organizations and the central government.

Source of Assistance

Suggested Assistance

%

N

Surviving Parent Acceptance, support and emotional care Material and financial support

54.7 34.7

41 26

Other Family Members

Acceptance and Support Material and Financial Support Free educational opportunities

45.3 36.0 22.0

34 27 9

Community Material and Financial Support Acceptance, support and emotional care Accepting them and integrating them Create income-generating Activity for them

26.7 23.4 20.8 13.0

20 18 16 10

District Assembly Free educational Opportunities Create income generating activities Give material and financial support

45.3 36.0 14.3

34 27 11

Religious Organisations

Give free educational opportunities Create income generating Activities Give material and Financial Support

32.0 32.0 25.3

24 24 19

Central Government

Give free educational opportunities Give material and financial support Create income generating activities for them

89.3 5.3 4.0

67 4 3

28

Fig 4.15 Fig 4.16 The district was also of significance in determining the perception of clothing provision. As the graph shows, there was a realisation that material items with reference to clothing were in high demand by orphans in the New Juaben district than Manya Krobo. However, as the literature suggests, clothing was a concluded priority need by all orphans in the research. Views from Opinion Leaders The views of opinion leaders were sought on the issue of AIDS Orphans. In all, 15 opinions were sampled from a cross-section of the adult society. These opinion leaders were teachers, catechists and District Assemblymen and Assemblywomen. The justification was that these leaders were an important component of the society at large and the AIDS orphan in particular. Views were sought on the presence of orphans in the community, the threat of the AIDS orphan pandemic, background of the AIDS orphan, the societal attitude towards these children and their special needs. The contribution of various institutions, support systems and the components of a policy/declaration for AIDS orphans and finally the issue of orphanages were highlighted in the interview schedule. These are discussed in turn. The Special Needs of AIDS Orphans The special needs of orphans were varied. They included affection from friends, extended families and friends, educational and financial support and the need for basic health. Another overlooked need was that of Guidance and Counselling. There was the need for emotional and psychosocial independence on the part of the orphans. Summary Data on the three main objectives have been presented and analysed in this chapter. The characteristics of the caregivers and orphans, the types and levels of care that the AIDS

Needs of the Orphan in the Community - Caregiver's percpt'n by District

District

New JuabenManya Krobo

Per

cent

120

100

80

60

40

20

0

what do you think ar

school related

material things eg.

clothing

food

money

emotional/ love./ ca

re./ support

drugs

Desired needs of orphans - Caregivers Perception by Gender

Sex of Caregiver

femalemale

Per

cent

120

100

80

60

40

20

0

Needs

school related

material things eg.

clothing

food

money

emotional/ love./ ca

re./ support

drugs

29

orphans perceive to be receiving and how they are related to the determinants of care as well as suggested interventions have been given. The major findings from this will be discussed in the next chapter.

30

CHAPTER FIVE Discussion on the Findings Introduction The findings of the study are discussed in this chapter. Specifically, three main objectives are discussed with reference to the literature where applicable. The characteristics of the caregivers and orphans, the types and levels of care the AIDS orphans perceive to be receiving and how they are related to the determinants of care as well as interventions gathered are discussed. Characteristics of Caregivers The caregivers were mostly females (77%) with three out of every four of them being above 40 years. Only 18% of these caregivers had education above the Middle School Leaving Certificate, and almost nine out of every ten of the caregivers were non-salaried. Again in this study, 61% of the caregivers were grandparents and another 20% stated the orphan was either a nephew or niece. These characteristics mentioned above transcend international barriers in the Third World and is in conformity with findings in the literature which suggested similar research had revealed that “caregivers were much more likely to be women and over half of them were grandparents(St Francis AIDS Department, 1994). Occupation It was expected that with more than half the caregivers above 40 years, these caregivers would not be in any active employment because of the age barrier. With age ranges averaging 60 and more, the caregivers were not expected to be in employment and consequently being salaried. Their income earning potential was therefore limited and to look after orphans on very limited resources was a task many of them found difficult to do qualitatively (Webb, 1995) Characteristics of the AIDS Orphan Fifty nine percent of the orphans in this study were between the ages of 6 – 12 years with the remaining 41% falling between the ages of 13 and 15. Only about one in every five of these orphans was not in school. General Characteristics Several general questions were put to the orphans concerning their daily activities, interests and other general variables. These were intended to draw a vivid description of the typical Ghanaian AIDS orphan. Some of the questions and their percentage responses are as tabulated below:

31

General Data on Orphans Variable Percentage Response Religion 62 - Christian Presence of Siblings 46 School needs met by grandparents 42 Hoping to have Educational attainment up to University/Technical

35 / 34

Farming/Trading most of the time 10 Hope to have a salaried job in future 87 Always in need of money 75 Like household chores 60 Don’t like farming / selling 30 Have free time 85 Money as first priority/Material /emotional 50 / 43 / 8 Love to have parents/close relations around 71 Allowed to play on weekends 69 Like school 77 Late school fees 66 Wash own clothes 58 Eat before going to school 70 Sleeping after 8 pm 66 Waking up between 5 and 6 90 Friends knowing about orphan status 42 Being allowed to study on weekends 20 Taking pocket money 25 Loved by caregiver 88

From the general results attained from the above, a typical Ghanaian AIDS orphan description would be as follows:

“The Ghanaian Orphan” and His Characteristics The orphan may be likely to attend church or have some religious

denomination, would have two or three siblings and generally would like doing household chores. He or she would love to have the company of close relations or family members around him or her. A typical day for the orphan begins between the hours of five and six in the morning. He does his household chores without mumbling, has his breakfast and leaves for school, more often than not with no pocket money and the fear of being driven away from school for the lack of school fees haunting his mind. He however likes school a lot and hopes to get to the university someday and is hopeful of landing a salaried job in the future. In his mind, he is doing well in school. Some of his school needs might be met by his grandparents, who in one out of three cases may send him farming or selling after school. In school, he is comfortable because not too many of his friends know about his orphan status, and he likes his teachers a lot. After school, there is a fifty per cent chance that there would be no food at home. He is normally found doing household chores after school or helping with the preparation of the evening meal. In the evening, there is a slight probability that the homework given in school would be supervised. The evening is usually free or open for the orphan and so it is most likely that he goes to bed well after 8 pm. On weekends, the orphan usually washes his own clothing and thereafter may go out to play or help at the farm. His priority is money, and material things as clothing and at that tender age, may not have any emotions about his condition, after all, he is of the solid opinion that he is loved by his caregiver who usually, is his grandmother.

32

The Determinants of Care Discussed The Provision of Food As was observed, provision of food was adequate, although 20% of the orphans expressed inadequacy. The two variables that influenced the perception of food to be adequate were the district and educational level of the caregiver. Manya Krobo had 89% of orphans expressing adequacy. This finding could be valid based on the fact that Manya Krobo has farming and food processing as a major preoccupation. It would be a wonder then, that in the midst of all the food available, the orphan would be hungry. However, the revelation that more than a third of the respondents in New Juaben did not find their food provision adequate was in line with the revelation by Kongwa P.N (1991), St. Francis AIDS Department (1994) and Rossi M.M. that the provision of food for the orphan was a problem for the caregiver. Provision of Shelter It was found that the provision of shelter had quite a significant relationship with the care determinants of district, caregivers age, educational level, occupation and attitude. Indeed the literature was somewhat silent on this variable and sleeping place for the orphan. The sex of the caregiver however was of significance to the provision of shelter. It was found that 94% of the orphans preferred to stay with male caregivers to female ones. From the orphans point of view though, almost 50% of them expressed the view that they would have preferred to stay in a big town or city, confirming Moise Mensah’s (1996) research that orphans normally left their households to migrate to the city. The bar chart generated from the results of this study Fig4.2 also affirms this opinion. Again, New Juaben, as stated earlier, is more of a commercial town than in Manya Krobo. This finding that the orphans perceived staying in New Juaben as adequate shelter was to some extent in consonance with the literature revelation that the orphans tended to migrate to the commercial towns in their bid to find better accommodation, business and improved ways of life. The Provision of Affection On the all-important question of affection, nine out of ten orphans perceived that the current levels of affection shown them was adequate. Analysis from the Anova table, shows that all the variables but relationship of the caregiver to the orphan accepted the null hypothesis. The perceived affection shown by grandparents was significantly greater than any other grouping of caregivers. This was also confirmed in the literature that the grandparents often had to do some odd jobs like selling and baking to take care of the orphans who were more often than not, directly related (Webb, 1995). If the grandparents were not available, the orphan perceived affection to come more from another family member (87%) than a none relative (50%). Rossi et al, in their study, found that although 65% of the orphan caregivers had added responsibilities, they were prepared to look after the orphan because of the relationship with the orphan, who was usually a granddaughter or son. The same level of affection and concern was expressed in this study, where the caregivers who were also grandparents, were willing to assist the orphan in their own small ways. For instance, to the question whether orphans should be placed at orphanages, 80% of the caregivers insisted the orphans should be taken care of at home and looked after by their own kith and kin. There was a reciprocal return of

33

affection from the orphan, as quite a majority of 88% expressed the fact that they were loved by their caregivers. The Provision of School It was found that a greater proportion of orphans in the Manya Krobo district were in school than those in the New Juaben district. This could also be attributed to the earlier fact that New Juaben was more of a commercial joint than Manya Krobo. The school dropout rate in this area therefore could be expected to be higher. Again, and a more prominent reason for the orphans in the New Juaben area to experience a low school attendance could be obtained from the literature. Webb, Rossi and Kongwa expressed that the caregivers normally found a problem with the payment of school fees. In a commercial town like New Juaben, school fees would be likely to be higher than at Manya Krobo, so this occurrence was to be expected as illustrated in Figure. 4.7 which somewhat justified this assertion. For the educational background of the caregivers it was also observed that the higher the level of education of the caregiver, the higher the willingness to provide education to the AIDS orphan.This could possibly be attributed to their appreciation and value of education since they had ‘walked the same path’. In relation to this, it was found that all the salaried caregivers expressed their desire to provide schooling to the orphan while only three out four caregivers who were non-salaried expressed same. This was because they had a ready source of income and could afford the payment of school fees.. The stigma or relationship of the caregiver towards and with the orphan respectively had nothing to do with the provision of schooling for the orphan. The Provision of Clothing Two variables were found to influence the orphans perception on the provision of clothing. These were the district in which the orphan lived and the sex of the caregiver. From Table 4.10, close to 84% of the orphans with female caregivers expressed inadequacy at the provision of clothing. This was quite surprising since females are generally perceived to be concerned more about the clothing of their wards than males are. Reliably, as the majority of caregivers were female, and not salaried, the provision of clothing was a priority but not more important than food. Indeed the percentage desire for clothing and food were at par, for the females while the male caregivers did not consider it a priority much more a need at all. The Provision of Guidance and Counselling The Guidance and Counselling needs of the orphans were found to be very high while the provision was very low even where it was provided, it was limited to vocational and career counselling. This situation could be attributed to two main reasons; The location was peri-urban and such services are hardly available except in the urban areas The caregivers seemed to be ignorant about the benefits of guidance and counselling.

34

CHAPTER SIX Summary, Conclusions and Recommendations This chapter presents the summary of the study, the conclusions drawn and recommendations for action. Summary The study sought to unearth the special needs of HIV/AIDS orphans in orphanages and homes with emphasis on education, food, shelter, clothing and affection and guidance and counselling needs. It also tried to make recommendations on how these needs could be met. It was carried out orphanages mainly in the Manya Krobo, and New Juaben districts in the Eastern Region of Ghana, which are noted for their high death rates resulting from AIDS. The sample consisted of 77 children aged between 6 to 15 years from the two districts (23 from Manya Krobo and 54 from New Juaben) and their caregivers. Altogether it covered about 82 percent of AIDS orphans in the age group in the surveillance of the District Health Management Team (DHMT) in the two districts. Data was collected by trained research assistants. The major findings from the study are the following:

� Majority of the orphans perceive the provision of food, shelter, education and affection as somewhat adequate however, the guidance and counselling needs were lacking seriously.

� Clothing provision was generally perceived to be inadequate The following care determinants were found to be strongly linked:

• Food provision and district • Shelter provision and sex of caregiver • Shelter provision and relationship of caregiver to orphan • Clothing provision and district • Clothing provision and sex of caregiver • Affection provision and relationship of caregiver to orphan • Caregivers and provision of guidance and counselling needs

Conclusion Though the study covered only two districts in only one region in the country, some tentative conclusions may be drawn from its empirical evidence. First, like all other children, orphans are in need of the basic necessities of life – food, shelter, clothing as well as education and affection. Although these were provided, they were labelled as somewhat adequate instead of very adequate. Second, the district, sex of caregivers as well as the relationship of caregivers to orphans are important determinants in the provision of the needs of orphans. Recommendations In the light of the findings and the conclusions of the study, the following recommendations are suggested: • The efforts being made by surviving parents, grandparents and others in providing for the needs of AIDS orphans should be encouraged and supported by communities, District Assemblies, other bodies and the Central government.

35

• Provision of clothing for orphans must be improved. • Caregivers, especially grandmothers should be given special material assistance to enable them care for AIDS orphans. • Efforts should be made to convince caregivers of the importance of family home care for orphans instead of institutional care, such as orphanages. • Guidance and Counselling in the homes should be given priority attention and training should be given to caregivers immediately in this area • Further studies should be conducted to strengthen the findings and recommendations of this study for the benefit of orphans, for, like other children in the country, the AIDS orphan cannot wait.

36

REFERENCES Ann Leonard, & Armandbanu Khan (Ed.) Community-Based AIDS Prevention and

Care In Africa: Building On Local Initiatives, Case Studies from Five African Countries. Population Council New York NY

Carol Bellamy (15 Sept 1999) “The AIDS crisis in Africa” Address of the Executive

Director of the United Nations Children's Fund to the International Conference AIDS and STDs in Africa ,Lusaka

Callisto Madavo (1998) “AIDS, Development, and the Vital Role of Government”

Speech delivered at the 12th World AIDS Conference, Geneva, Switzerland in June 30, 1998

Carten & Fennoy, 76(1), The Issue of Orphaning Jan-Feb, 1997 Dansky, 1997; ("Nobody’s Children," "Families in Crisis", task force report by the

Federation of Protestant Welfare Agencies, New York David Brough: Reuters, (February 17 2000) “Plight of Africa's AIDS orphans worsening” David McAlary (1997) AIDS ORPHANS No.:5-38257 Washington) G. Foster,M.D., (May 20 1997), "AIDS and Child Health." AFRO-NETS Mutare, Zimbabwe Gabriel Rugalema (Apr 18 2000) Solutions in addressing AIDS orphans. An email

message to list members on [email protected] ) iafrica.com Sep 99: HIV & AIDS IN SUB-SAHARAN AFRICA (INCLUDING

SOUTH AFRICA The Internet Jerry Large (Jan 2000) “Adopting Africa's AIDS orphans” “Times”, New York Kamanga, P. (1993) "Case Study of CINDI Project Matero-Lusaka: Kwasha-

Mukwenu Matero Project" An unpublished Project in The Impact of HIV/AIDS in Zambia: Orphans (AIDS in Zambia Bibliography #194) The University of Zambia Medical Library and Lenny Rhine Guide to Medical Resources WWW site: http://www.medguide.org.zm)

Kongwa, P.N., Raavand, L.R., Solami, G., Haworth, A., (1991) (#193) "Enumeration

and Needs Assessment Survey for Orphans: Matero East, Lusaka,Zambia" An unpublished Project in The Impact of HIV/AIDS in Zambia: Orphans (AIDS in Zambia Bibliography #193) The University of Zambia Medical Library and Lenny Rhine Guide to Medical Resources WWW site: http://www.medguide.org.zm)

Mawutodzi Abissath – Aids in Africa, Daily Graphic Oct. 7, 2000

37

Moise Mensah(1996) Contribution of the UN Volunteers programme to poverty eradication in sub-Saharan Africa http://www.unv.org)

NACP, 1999 Rachel C. Baggaley and Dale Needham 1997; Africa's emerging AIDS-orphans crisis,

in Canadian Medical Association Journal No. CMAJ 1997;156:873-5) Rossi, M.M. and Reijer, P. (1995), "Prevalence of orphans and their education status

in Nkwazi Compound - Ndola" Paper presented to the 5th National AIDS Conference, Lusaka, 1995 in The Impact of HIV/AIDS in Zambia: Orphans (AIDS in Zambia Bibliography #197) The University of Zambia Medical Library and Lenny Rhine Guide to Medical Resources WWW site: http://www.medguide.org.zm/)

Roxane Tracey, (Jul.2000): AIDS orphans - A global plight in “Science Today” Watch

@discovery.ca) Slack Incorporated”[Newspaper](1998):The hidden plague: Number of AIDS orphans rising) The Courier N° 126 March-April 1991 - Dossier: AIDS - The big threat / Country

report: Burkina Faso Theresa Cameron(1999)The Children Left Behind President and Fellows of Harvard

College. Harvard College UNAIDS website(1997): “Children living in a World with AIDS UNAIDS(1998):World AIDS Campaign with Young People) UNAIDS, 1998 – AIDS in Africa USAID(Jul,2000)-AIDS crisis in Africa. Report presented at the 13th International AIDS Conference in Durban, South Africa) Webb, D. (1995) "Orphans in Zambia: Nature and extent of demographic change" in

AIDS Analysis in Africa (Southern Africa Edition), Vol 6, No. 2, pp 5-6. The Impact of HIV/AIDS in Zambia: Orphans (AIDS in Zambia Bibliography #198) The University of Zambia Medical Library and Lenny Rhine Guide to Medical Resources WWW site: http://www.medguide.org.zm

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