Barriers to, and recommendations for, the provision of care and support to children living as AIDS orphans in township communities in South Africa: a cluster analysis

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Background: Orphanhood is a major consequence of the AIDS pandemic; the total number of people living with HIV in South Africa increased from an estimated 4·72 million in 2002 to 7·03 million by 2017. In South Africa, most children who are orphaned because one or both parents died from AIDS live in township communities. The aim of this study was to identify barriers to, and recommendations for, providing care and support to these vulnerable children.

Methods: I undertook in-depth interviews with professionals caring for and supporting children who are AIDS orphans at four primary health care clinics and 12 satellite health care clinics in township communities in Nelson Mandela Bay, South Africa. Interviews were recorded and transcribed verbatim. Primary health care nurses and social workers were selected using criterion-based purposive sampling; snowball sampling was used to select psychologists.
I asked participants to make recommendations for how care and support is provided for children who are AIDS orphans living in township communities in South Africa. Data were coded 0 for absent and 1 for present and used the heatmap.2 command in the R package gplots, which uses Euclidean distance to cluster the pattern of participant responses.

Findings: Between April and October, 2013, ten primary health care nurses, eight social workers, and six psychologists were interviewed. Analysis undertaken in September, 2018, identified six clusters illustrating barriers to providing care and support: fundamental barriers such as low morale in professionals; barriers primarily related to legislative and policy frameworks; lack of human and financial resources; grief, high-risk behaviours, and cumbersome bureaucratic processes; poverty; and barriers related to poverty including non-disclosure of HIV status. Recommendations identified
fell into the following broad themes: development of resilience of health and social care professionals; development of responses to meet the unique needs of these AIDS orphans; developing, empowering, and capacitating professionals; and facilitating an empowering working environment.

Interpretation: Significant clusters emerged from analysis and these identified barriers to, and recommendations for, delivering care could be used to form the cornerstone of an intervention to provide best practice care and support for these vulnerable children.

Funding: None

Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Declaration of interests: I declare no competing interests.
Original languageEnglish
Pages (from-to)S3
JournalThe Lancet Global Health
Issue numberSpecial Issue 1
Early online date17 Apr 2020
Publication statusPublished - Apr 2020


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