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A baseline study on psychosocial support
of orphans and vulnerable children in two
villages in Botswana
GN Tsheko
K Bainame
LW Odirile &
M Segwabe
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Compiled by the Masiela Trust Fund’s OVC Research Unit, Botswana, in collaboration
with the Social Aspects of HIV/AIDS and Health Research Programme, Human Sciences
Research Council, South Africa
Published by HSRC Press
Private Bag X9182, Cape Town, 8000, South Africa
www.hsrcpress.ac.za
First published 2007
ISBN 978-0-7969-2178-9
© 2007 Human Sciences Research Council and Masiela Trust Fund
Copyedited by David Le Page
Typeset by Simon van Gend
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Tables and figures iv
Acronyms and abbreviations v
Acknowledgements vi
Executive summary vii
The situation of orphans in sub-Saharan Africa 1
Overview of the OVC situation in Botswana 1
Government response to the plight of orphans 2
Background to the OVC project 4
Objectives of the study 5
Description of study sites 6
Populations and samples 8
Study instruments 9
Ethical considerations 10
Data collection procedures 10
Data management 11
Orphans and vulnerable children ages 6–14: Survey findings 12
Discussion of findings: OVC ages 6–14 in Palapye 15
OVC ages 15–18 in Palapye: Survey findings 18
Discussion of findings: OVC ages 15–18 in Palapye 24
Parents/guardians of OVC in Palapye: Survey findings 27
Perceptions of HIV/AIDS and other health-related issues 29
Discussion of findings: Parents/guardians of OVC in Palapye 30
Orphans and vulnerable children ages 6–14: Survey findings 32
Discussion of findings: OVC ages 6–14 in Letlhakeng 35
OVC ages 15–18 in Letlhakeng: Survey findings 36
Discussion of findings: OVC ages 15–18 in Letlhakeng 42
Parents/guardians of OVC in Letlhakeng: Survey findings 43
Perceptions of HIV/AIDS and other health-related issues 45
Discussion of findings: Parents/guardians of OVC in Letlhakeng 46
Conclusions 48
Recommendations 49
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iv
Table 3.1: What OVC 15–18 in Palapye miss about their late mothers – percentage
distribution by gender 21
Table 3.2: Quality of relationships between OVC 15–18 and their guardians, in
Palapye 21
Table 3.3: Primary confidants of OVC ages 15–18 in Palapye 23
Table 3.4: Most common health problems mentioned by OVC 15–18 in
Palapye 24
Table 3.5: Employment status categories of parents and guardians of OVC in
Palapye 28
Table 3.6: Key needs of OVC in Palapye, as identified by parents/guardians 28
Table 4.1: OVC 15–18 in Letlhakeng: Household resources 38
Table 4.2: Primary confidants of OVC ages 15–18 in Letlhakeng 39
Table 4.3: Factors leading OVC in Letlhakeng to feel hopeful about life 40
Table 4.4: Employment status of parents and guardians in Letlhakeng 44
Table 4.5: Key OVC needs described by parents and guardians in Letlhakeng 45
Figure 1.1: Trends and patterns of registered orphans from 1999–2004 2
Figure 1.2: Specific needs of orphans and vulnerable children 4
Figure 2.1: Map of Botswana 6
Figure 3.1: OVC 15–18 in Palapye: Reasons for not attending school, by gender 19
Figure 4.1: OVC 15–18 in Letlhakeng: Reasons for not attending school, by gender 37
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v
CBO community-based organisations
FBO faith-based organisation
HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome
HSRC Human Sciences Research Council
IEC information, education and communication
MRC Medical Research Council
NGO non-governmental organisation
OVC orphans and vulnerable children
PMTCT prevention of mother to child transmission (of HIV/AIDS)
PSS psychosocial support
SADC Southern African Development Community
SPSS Statistical Package for Social Sciences
STI sexually transmitted infection
VCT voluntary counselling and testing (for HIV/AIDS)
WKKF WK Kellogg Foundation
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vi
The researchers and authors of the document, Dr GN Tsheko, Mr K Bainame, Ms M
Segwabe and Dr LW Odirile would like to thank all those who made it possible for
this work to be completed. This study was supported by the Kellogg Foundation and
undertaken by Masiela Trust Fund OVC Research-Botswana under the umbrella of the
HSRC in South Africa. The researchers are indebted to the field assistants, all respondents,
and community leaders in Palapye and Letlhakane who participated in this study.
A special thanks goes to Dr K Solo and Ms G Moalosi who were involved with the
original drafting of the report.
We cannot stop thanking the staff at Masiela Trust Fund for the support they provided
during the study period.
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vii
This study describes a baseline psychosocial survey conducted in two communities in
Botswana, in preparation for a five-year intervention project intended to help orphans
and vulnerable children (OVC) in these communities.
The Human Sciences Research Council (HSRC), together with its research partners within
the Southern African Development Community (SADC) region (the University of Botswana
and the Botswana Harvard Partnership in Botswana as well as the National Institute
of Health Research [formerly Blair Research Institute] and the Biomedical Research &
Training Institute‘s Centre for International Health and Policy in Zimbabwe) have been
commissioned by the WK Kellogg Foundation (WKKF) to develop and implement a five-
year intervention project for OVC commencing in 2003. The project is intended to assist
families and households coping with an increased burden of care for affected children
in Botswana, South Africa and Zimbabwe. The HSRC chose the Masiela Trust Fund as a
grant maker to work with researchers from the University of Botswana. The Masiela Trust
Fund in turn selected various community-based organisations (CBOs) and faith-based
organisations (FBOs) to implement the appropriate interventions at all the identified sites.
The general aim of the project is to ease the increased burden of care for OVC. The
purpose of the psychosocial survey (PSS) was to gather baseline OVC data to facilitate the
introduction and evaluation of the effectiveness of orphan care intervention programmes
for strengthening community participation and empowerment of OVC in two research
sites in Botswana. This information will be used in evaluating the effectiveness of the
new OVC interventions that will be implemented in the two sites in Botswana as part of
the overall OVC project.
The two research sites are Palapye in the Serowe/Palapye sub-district and Letlhakeng in
the Kweneng West district. The sample for the study was randomly selected using the
census data that was collected prior to the PSS survey. Instruments for data collection
were questionnaires for 6–14 years, 15–18 years and one for parents/ guardians. All
instruments were adapted from the generic one compiled by HSRC.
A total of 828 parents/guardians of OVC were interviewed, 505 in Palapye and 323 in
Letlhakeng. The pattern of responses in Palapye and Letlhakeng were very similar. The
majority of parents/guardians for OVC were mostly females. This means that the majority
of caregivers are females and it is possible that the majority of these households are
female headed. Female-headed households are generally characterised by poverty. The
findings of the study also show high levels of illiteracy among the study population with
only a few of the respondents reaching tertiary level. This reflected in the fact that most
of the guardians do not have proper jobs and depend on temporary jobs, farm work and
other jobs that do not bring enough income for the caregivers to cater for all the children
in their care. Having insufficient money, caregivers are not always able to provide for the
basic things that are needed for survival.
A majority of the parents/guardians reported that they had heard about HIV/AIDS.
Both parents and guardians reported an increase in the number of both orphans and
vulnerable children living in their neighbourhood. HIV/AIDS was cited as the main reason
for the increase of OVC. Misconceptions about HIV/AIDS obviously persist, as some
claimed they could tell whether someone is infected just by looking at them.
In Palapye, a total of 258 children aged 6–14 years were interviewed and in Letlhakeng,
84. Most of the children are in school (90% in Palapye and 70% in Letlhakeng). Reasons
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viii
commonly given for not being in school included lack of funds, having completed school
or being under age. The claims of some of those respondents to have completed school
were questionable, as most people do not finish at 14 years. This probably means the
OVC in question did not do well during their Junior Certificate Examinations, and they
needed to be supported to continue beyond Junior Certificate. The underlying causes
of non-school attendance need to be investigated in an effort to promote access to
education for all children of school-going age.
The study revealed both the negative and positive aspects of the respondents’ emotional
wellbeing. Feelings of happiness, of being hopeful about the future and good relations
between respondents and their guardians where guardians encourage OVC positively
have all been noted. All these reported positive feelings play an important role in the
respondents’ over emotional wellbeing.
For the age group 15–18 years, 139 children were interviewed in Palapye while 77 were
interviewed in Letlhakeng. A majority of these children were in school (77% in Palapye
and 55% in Letlhakeng). A large majority of those who were not in school explained this
by saying that they had failed.
Despite the positives noted, the study showed that OVC’s go through a lot of negative
emotional phases in their everyday lives. Feelings of unhappiness, worry, trouble falling
asleep, frustration and anger were all noted at high percentages (exceeding 40 per cent).
The study concludes that conditions under which children live in the households
surveyed are mostly conducive to well-being, save for those children who live in
households that are headed by elderly females – where there are inadequate resources
and children are often short of food and money. The study further concludes that the
cultural and traditional norms of inheritance are entrenched and work to the disadvantage
of children who have lost parents. This is particularly common in those cases where
children are still young and there is no consultation.
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1
Introduction
The situation of orphans in sub-Saharan Africa
The AIDS epidemic has created an estimated 15 million orphans worldwide. Eighty per
cent of these orphans live in Sub-Saharan Africa (Kanabus & Fredriksson 2004). Tragically,
the number of orphans in Sub-Saharan Africa will continue to rise in the years ahead.
This is partly due to the high proportion of adults in the region already living with HIV/
AIDS, and the continuing difficulties in expanding access to life-prolonging antiretroviral
treatment (UNICEF 2003). In Zambia, one of the countries hardest hit by the HIV/AIDS
epidemic, the traditional mechanism for the care of vulnerable children, the extended
family, has started to break down under the twin pressures of poverty and disease
(Fleshman 2001: 3). The estimated number of children orphaned because of AIDS in
Zambia is 630 000. The HIV/AIDS epidemic has deepened poverty and exacerbated a
myriad of existing deprivations. The responsibility of caring for orphaned children is a
major factor in pushing many extended families beyond their ability to cope (UNICEF
2003).
Furthermore, orphans may grow up without basic material resources and may lack the
love and support that more emotionally-invested caregivers usually provide. They may
be discriminated because of the sero-status of their parents, or they may be forced to
discontinue their education because of lack of money or the need to take care of their
siblings (HSRC 2003).
Children orphaned by HIV/AIDS are disadvantaged in numerous and often devastating
ways. For instance, in addition to the trauma of witnessing the sickness and death of
one or both parents, they are likely to be poorer and less healthy than non-orphans.
They are more likely to suffer damage in their cognitive and emotional development, to
have reduced access to education, and to be subjected to the worst forms of child labour
(UNICEF 2003). This is particularly true in Sub-Saharan Africa where few social support
systems exist outside of families and where basic social services are largely inadequate
(Kanabus & Fredriksson 2004).
There is a general consensus in the literature that help for orphans should be targeted
at supporting families and improving their capacity to cope, rather than at setting up
institutions for children, as orphanages are not a sustainable long-term solution (UNAIDS
2002). In addition, institutional care can cause permanent setbacks in the lives of children:
those sent away from their villages may lose their rights to their parents’ land and other
property, as well as their sense of belonging to a family and a community.
Overview of the OVC situation in Botswana
The number of orphans in Botswana has increased tremendously in recent years and
HIV/AIDS is the main contributing factor to this increase. In 1999, the number of
registered orphans was 21 209, and this number has more than doubled in five years to
47 964 by 2004 (Social Welfare Division Database 2004).
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Figure 1.1: Trends and patterns of registered orphans from 1999–2004
Source: Ministry of Local Government (Department of Social Services, 1999–2004)
Botswana’s registered orphans are cared for under the orphan care programme and they
are supplied with a food basket that contains the main basic food and toiletry items on
a monthly basis. The programme also supplies school uniforms, clothes and blankets as
and when needed. Findings from the Rapid Assessment on the situation of orphans in
Botswana (Muchiru 1998) indicated that many orphans still do not have access to basic
necessities such as food, clothing, shelter and toiletries. The assessment also established
that these children’s basic fundamental human rights were being violated both by society
and by caregivers, including relatives. In some cases for example, orphans’ food rations
are sold or shared among relatives. There are instances of orphans being used as cheap
labour by the business community. The problem is further aggravated by many caregivers
being aged grandparents who live in abject poverty and are themselves in many cases
dependent on the destitute programme or on old-age pensions (Ministry of Local
Government 1999).
The advent of HIV/AIDS has not only increased the problem of orphans but also
compounded the phenomenon of vulnerable children. The long-term sickness and
eventual death of a parent or both to HIV/AIDS exposes their children to all kinds of
abuse. For instance, it is frequently mentioned that many vulnerable children end up
leaving their homes to join the ranks of ‘street children’ while some remain in poverty in
their homes. According to Solani (2002), the main underlying reason why children go to
the streets is poverty.
Government response to the plight of orphans
In view of the rapid increase of the number of orphans, the government of Botswana,
through the Ministry of Local Government which has sectoral responsibility for protecting,
1999 2000 2001 2002 2003 2004
0
5 000
10 000
15 000
20 000
25 000
30 000
35 000
40 000
45 000
50 000
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caring for and mitigating the impact of HIV/AIDS on children, developed a Short-Term
Plan of Action on the care of orphans in 1999. Some of the key activities/projects of the
programme are discussed below.
National orphan care programme
The government of Botswana initiated a national orphan-care programme in 1999
to coordinate, through the Social Welfare Department under the Ministry of Local
Government, all efforts addressing the orphan problem. Since the start of the programme
in 1999, all districts have the responsibility to assess, register and support orphans.
The Botswana orphan care programme is guided by a Plan of Action (Ministry of Local
Government 1999), which has the following stated objectives:
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support services and protection of their basic rights;
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cause of death of parents;
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responding to the orphan crisis;
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problem; and
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orphans.
The orphan care Plan of Action has implemented the following:
Provision of basic needs
Given that many of the orphans are without adequate food, clothing, decent shelter and
toiletries, provision of these basic needs was perceived as the most urgent and immediate
focus of the orphan care programme. In collaboration with the Ministry of Health a ‘food
basket’ was established for orphans and other children in need of nutritional care. The
food basket contains all the necessary food items for example maize-meal, rice, meat,
vegetables, toiletries and others. These are issued on a monthly basis to all registered
orphans nationwide (Ministry of Local Government 1999).
Access to education
Primary education in Botswana used to be absolutely free, but this changed at the
beginning of 2006. To ensure that orphans remain in schools and get appropriate
education, orphans are provided with appropriate school uniform, shoes and other
miscellaneous school costs.
Security
To ensure sustained/continued protection of orphans from abuse, the orphan care
programme is mandated with the responsibility of the well-being and security of orphans.
Alternative care
Given the complexity of the orphan problem, the government has since identified the
need to establish alternative care for orphans guided by the ‘Regulations governing
alternative arrangements for children in need for care’ (Ministry of Local Government
1999).
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The response of the government of Botswana is in line with the Millennium Development
Goals, which were adopted by 189 United Nations member states in the year 2000 to
combat poverty, hunger, disease, discrimination against women, degradation of land and
illiteracy (Government of Botswana/United Nations 2004).
Figure 1.2: Specific needs of orphans and vulnerable children
Adapted from a workshop on Capacity Building for Community-Based Organisations on OVC, Botswana
The Government of Botswana and its partners provide material support for OVC as
shown in Figure 1.2 above. Some of the overlapping needs are provided to a limited
extent. The non-material needs, which are mainly psychosocial, are not adequately
provided for, if at all.
Background to the OVC project
The Human Sciences Research Council (HSRC), together with its research partners within
Southern African Development Community (SADC) region (the University of Botswana
and the Botswana Harvard Partnership in Botswana, the National Institute of Health
Research, and the Biomedical Research & Training Institute’s Centre for International
Health and Policy in Zimbabwe) was commissioned by the WK Kellogg Foundation
(WKKF) to develop and implement a five-year intervention project for orphans and
vulnerable children (OVC), and families and households coping with an increased burden
of care for affected children. This project is to run initially in Botswana, South Africa and
Zimbabwe, commencing in 2003. The Masiela Trust Fund was selected as a grant maker,
to work with researchers from the University of Botswana. The Masiela Trust Fund in turn
selected community-based organisations (CBOs) and faith-based organisations (FBOs) to
implement the appropriate intervention programme at all the sites that are identified.
Spiritual
Guidance
Identity
Sense of Belonging
Life Skills
Acceptance
Freedom of expression
Playing
Love
Support
Counselling
Interaction
Parental love
Survival skills
Right to Religion
Health
Support
Leisure
Education
Protection
Entertainment
Clothing
Support
Books
Legal
Advice
Shelter
Food
MATERIAL
OVERLAPPING NEEDS
NON-MATERIAL
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The project is expected to assist some of those families and households coping with an
increased burden of care for affected children at the sites selected in Botswana, South
Africa and Zimbabwe. The specific objectives of the project are as follows:
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OVC at family, ward, community, national and international level;
UÊ ÌÊÕÃiÊÌiÊvÀ>ÌÊLÌ>i`ÊÌÊLÕ`ÊV>«>VÌÞÊÊVÕÌÞqL>Ãi`ÊÃÞÃÌiÃÊvÀÊ
sustaining care and support to vulnerable children and households over the long
term; and
UÊ ÌÊÕÃiÊvÀ>ÌÊLÌ>i`ÊÌÊ«ÀÛiÊ6É-Ê>Ü>ÀiiÃÃ]Ê>`ÛV>VÞÊ>`Ê«VÞ
support programmes for the benefit of vulnerable children families and communities.
The overall philosophy behind the project will be to empower communities to help
themselves, with a very strong emphasis on sustainability of the project after funding from
donors ceases.
Purpose of the OVC Psychosocial Survey (PSS)
The purpose of the study described in this monograph was to gather baseline data to
facilitate the introduction and evaluation of the effectiveness of orphan care intervention
programmes for strengthening community participation and empowerment of OVC at
the two project sites in Botswana. This information will be used to evaluate the OVC
interventions that will be implemented in the two sites as part of the overall (three-
country) OVC project.
Objectives of the study
The specific objectives of the study were to gather information that:
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the care and support to OVC specifically in relation to their psychosocial needs; and
UÊ Ì>ÌÊÜÕ`Ê`iÃVÀLiÊÌiÊ«>VÌÊvÊ6É-ÊÊV`ÀiÊ>ÃÊÜiÊ>ÃÊi>ÃÕÀiÊÌiÊ
impact that programmes are having on the quality of life of OVC.
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Methodology
Description of study sites
A cross-sectional survey design was adopted. The two study sites in Botswana are
Palapye in the Serowe/Palapye sub-district and Letlhakeng in the Kweneng West district
(see Figure 2.1).
Figure 2.1: Map of Botswana
Palapye site
Palapye village is located 315 kilometers from the capital city of Botswana, Gaborone.
Its population is estimated at 26 086, of which 57.3 per cent is female (Central Statistics
Office 2001). There are 6 200 households in Palapye, 3 229 are female-headed and 2 971
male-headed. The average household size in Palapye is 4.2.
Consistent with the typical system of government in rural Botswana, there are four local
authorities in Palapye. The Department of District Administration is responsible for local
economic planning and development in collaboration with a number of committees
and civil society. These range from District Land Use Planning Committees to Village
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Development Committees. Land Boards are another authority found in Palapye. The
mandate of the Land Board is to administer land applications and allocations. The District
Council, which is composed of the local political leadership and local civil servants, is
responsible for the provision of basic physical infrastructure, and management of local
essential services such as health clinics, school classrooms, collection of refuse and
bylaw promulgation and enforcement. The Department of Tribal Administration is the
fourth local authority. It is responsible for customary matters, the administration of the
ethnic group and delivery of customary justice through the customary court commonly
known as the Kgotla. A Senior Chief Representative helped by a Deputy Senior Chief
Representative traditionally heads the village. In the national context, Palapye is a
parliamentary constituency and it has an elected member of Parliament and a number of
elected councillors representing the wards in the village. Members of the Land Board are
also elected for a term of duty at the Kgotla.
There are two hospitals and six clinics in the sub-district. Palapye, which is the capital
of the sub-district, is the main hub of economic activities. The major economic activities
in Palapye are mining and quarrying, manufacturing (including repair of machinery and
equipment), construction, wholesale and retail trade (including repair of motor vehicles
and personal household items), hotels and restaurants, and real estate business. In the
Serowe/Palapye sub-district, the unemployment rate is 23.5%–27.5% for adult women and
20.5% for adult males (Central Statistics Office 2001).
The types of housing found in Palapye are traditional and mixed houses (n = 1 962),
detached and semi-detached (n = 2 689) and town house/terraced housing (n = 187).
Some households have piped water indoors (n = 2 033), some get piped water outdoors
(n = 2 900) and some access communal taps (n = 1 138) (Central Statistics Office 2001).
Palapye is situated mid-way on the main highway from Gaborone to Francistown. It is
a major stopover for truckers, people travelling and government officials on duty. It is a
major conference centre. Palapye is said to have the largest number of guesthouses (n =
17) outside of Gaborone and Francistown (Muchiru 1998).
Over 500 truckers stop over in Palapye each month. Between 19–23 buses en route to
other parts of Botswana and to Zimbabwe pass through Palapye each day. It is estimated
that there are approximately 200 commercial sex workers, 140 migrant workers, and
over 1 000 informal traders (Muchiru, 1998). Some 120 commercial sex workers are
semi-resident in Palapye; others come from as far as Francistown, Selibe-Phikwe, Maun,
Gaborone, Kasane and Serowe (Muchiru 1998).
There is an abundance of transport; a number of taxis and combis provide transport
within the village. The numbers of households owning some kind of transport are as
follows: van bakkies (n = 741), cars (n = 777), tractor trailers (n = 152) and donkey carts
(n = 662) (Central Statistics Office 2001).
According to the Botswana 2003 Second Generation HIV Surveillance Report (December
2003), Serowe/Palapye has an HIV prevalence rate of 43.3 per cent among pregnant
women. This is one of the highest prevalences in the country, according to currently
available statistics.
In Serowe/Palapye sub-district there were 5 697 registered orphans as at December 2004
and of these, 1 743 were registered in Palapye (Social Welfare Division Database 2004).
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Letlhakeng site
Letlhakeng village is situated 120 kilometers west of the capital city of Botswana,
Gaborone, in the Kweneng West District. The population of Letlhakeng is estimated at
6 032 and females make 55% of the population. (Central Statistics Office 2001) There
are about 1 297 households of size 4.6. Of these households 481 (37.1%) are headed by
males while 816 (62.9%) are headed by females. Letlhakeng is a rural area, with very
little economic activity. In the village, 62 people are engaged in agriculture, hunting
and forestry and 57 in manufacturing, including the repair of machinery and equipment.
A total of 80 are in construction activity, 84 are in wholesale and retail trade including
repair of motor vehicles. Public administration employs 351 people and 92 work in
education.
In the Kweneng West sub-district, the unemployment rate is 17.4%, with 27% of women
being unemployed and 13.4% men being unemployed (Central Statistics Office 2001).
This sub-district remains one of the poorest in the country, with a greater section of the
population living in poverty. The types of housing found in Letlhakeng are traditional
houses, mixed detached and semi-detached houses. There are 883 households with
traditional and mixed houses; 138 have piped water indoors, and 246 have piped water
outdoors, while 894 have access to communal taps (Central Statistics Office 2001).
Modes of transport in Letlhakeng are van bakkies (n = 152 households), cars (n = 67
households), tractor trailers (n = 41 households) and donkeys (n = 181 households).
According to the Botswana 2003 Second-Generation HIV Surveillance Report (December
2003), Kweneng West had an HIV prevalence of 27.0 per cent – one of the lowest in
the country. In Kweneng West sub-district, there were 1 160 registered orphans as at
December 2004 and in Letlhakeng alone there were 542 registered orphans in the same
period (Ministry of Local Government: Department of Social Service 2004).
Populations and samples
For this study, the target population was OVC aged 6–14 and 15–18 years, and their
parents/guardians in Palapye and Letlhakeng. Skinner et. al. (2004), define a vulnerable
child as someone who has no or restricted access to basic needs and their rights are
denied even if they have both parents. A vulnerable child is a child who is either
orphaned or is living in crisis situations due to multiple causes. Such situations may result
in prostitution or street life. These are children who belong to high risk groups and lack
access to basic social facilities. Risk can be identified in terms of malnutrition, morbidity,
death and loss of education (World Bank and UNICEF 2002).
Sampling procedures and sample
Prior to this survey, an OVC census survey was conducted to estimate the size of the
OVC population in the research sites; Palapye and Letlhakeng. The sampling for this
psychosocial survey was to be drawn from this estimate of the OVC population. An
inclusion criterion was developed to serve the purpose of reaching households in the
sample which had at least one orphan and/or a sick member, as identified through the
OVC census held in each site prior to this survey. In a household, three types of people
were targeted; OVC aged 6–14 years, 15–18 years and OVC parents/guardians. In Palapye,
471 OVC were interviewed, of which 258 were aged 6–14 years and 139 were aged 15–18
years. In addition, a separate sample of 505 parents and guardians in households with
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OVC were selected to participate in the study. In Letlhakeng, 164 OVC were interviewed,
of which 84 were aged 6–14 years and 77 were aged 15–18 years. Furthermore, a
separate sample of 323 parents and guardians in households with OVC were selected to
participate in the study. An alternating selection schedule was used so that both sexes
would be equally represented in the sub-sample.
Study instruments
The questionnaires for all three categories of respondents (OVC aged 6–14 years; OVC
aged 15–18 years; parents/guardians) were adapted from the OVC generic protocol
compiled by the HSRC. These comprised three sets of OVC PSS baseline questionnaires,
which were originally developed by two organisations, Strengthening Community
Participation for the Empowerment of Orphans and Vulnerable Children (SCOPE) and
Family Health International (FHI) for a similar project in Zambia,
1
and were adapted for
use in this study. The questionnaires concerned measured various issues such as food
intake, psychosocial issues, risk taking, decision-making processes and emotional well-
being. All questionnaires were translated into Setswana, the local national language.
PSS questionnaire for 6–14 year olds
This questionnaire was used to measure various issues such as background, information
on father, mother and OVC, food intake, psychosocial issues such as coping with the
loss of a mother and /or father, child/guardian relationships, relationship in household,
child’s feelings on the late mother/father/guardian, displaced and non-displaced OVC,
eligible orphans, eligible vulnerable children and sexual involvement and abuse. The
questionnaire also measured the response, decision-making processes, cultural modes
of caring and inheritance, risk taking, emotional well-being, experiences of stigma and
health and HIV/AIDS-related issues.
PSS questionnaire for 15–18 year olds
This questionnaire was used to measure various issues such as background information
on father, mother and OVC; food intake; psychosocial issues such as coping with
the loss of a mother and/or father; child/guardian/teacher relationships; relationships
in household; the child’s feelings towards a late mother/father/guardian; and sexual
involvement and abuse. The questionnaire also measured the responses and support
offered by NGOs, CBOs, FBOs and the state, decision-making processes and inheritance,
cultural modes of caring, risk taking, emotional well-being and health, and HIV/AIDS
related issues.
Parents/guardians PSS issues questionnaire
The questionnaire for guardians measured demographic details of the child and that of
the guardian. The questionnaire also measured their perceptions and experiences of HIV/
AIDS and related issues, as well as general livelihood issues.
Validation of instruments
The research teams in Botswana, South Africa and Zimbabwe scrutinised the instruments
and checked the content validity during a consensus workshop. There was general
agreement that the questionnaires measured constructs that were important for the
1 See the for details of the SCOPE survey in
Zambia.
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project, and some core questions that needed to be included in the surveys done in all
three countries were identified. Each country added questions that were specific to their
environments, taking into account the unique social contexts found in each country.
Ethical considerations
Ethical approval of the OVC project was granted by the HSRC Research Ethics Committee.
Further, the project proposal was submitted to the Health Research and Development
Committee (HRDC) in the Ministry of Health, Botswana for ethical and scientific review
approval. Obtaining informed consent from possible research participants is an essential
aspect of the overall research process. Informed consent entails informing the research
subjects about the overall purpose of the study, possible benefits of the study, and
explaining voluntary participation and the right to withdraw from the study at any time
(Kvale 1996).This was done prior to administering the questionnaires in the field. The
consent forms were translated into Setswana.
Data collection procedures
Access to the community
Sensitisation workshops were held in each research site prior to the survey, with leaders
of the community. The workshops aimed to communicate the goals and objectives of the
survey to the community, and appear to have succeeded, as the study was well received.
Recruitment and training of field workers
A team of interviewers and supervisors was recruited from the two research sites. These
included retired nurses, teachers and high school leavers. The reason for recruiting from
the sites were to ensure community ownership and empowerment.
Three-day training workshops for interviewers and supervisors were conducted. Manuals
were developed specifically for supervisors and interviewers. The manuals focused
on conducting interviews during data collection, as well as understanding the survey
instrument. The training was designed to impart a clear understanding of the ethical
issues involved, and of the survey questions, and to ensure appropriate words would
be used in interviews. Time was also set aside for practice, to ensure understanding of
the content of the instrument and to provide a chance to conduct interviews using the
instrument. Feedback from interviewers undergoing training was obtained, and integrated
where appropriate. A consensus on ethical considerations, style of questioning and
appropriate words to use was also reached.
Data collection started shortly after the training. Once in the field, the enumerators
worked closely with their supervisors, area community liaison officers and the research
team. Fieldwork lasted for two weeks.
Quality assurance
Training manuals for supervisors and interviewers were used as the key training
instruments. Training sessions for supervisors and interviewers were conducted
concurrently for three days. The areas of focus during the training were: interviewing
skills, research ethics and quality control checks during and after interviews. During
training, participants engaged in role-plays in groups and then made presentations in
plenary sessions.
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Ten supervisors and 20 interviewers worked to cover each site. Supervisors were in
contact with interviewers at all times. They collected interviewers’ work and helped
them solve problems encountered doing the fieldwork. The research team conducted
training to enable the researchers and fieldworkers to understand the contents of the
questionnaire and how it should be filled out, the various activities and stages involved
in the study, as well as the fieldworkers’ own role in data collection. Members of the
research team oversaw all fieldwork.
Data management
After data were collected from the field, it was brought to the research office at the
Masiela Trust Fund Offices in Gaborone for data editing, coding, entry, cleaning and
analysis. Data entry was done using the Statistical Package for Social Sciences (SPSS)
by well-trained data entry clerks who were oriented to the tool that was used for data
collection prior to starting data entry. There were some data entry quality checks done
during data entry, such as re-entering of cases. Once data entry was completed, the
project researchers cleaned the data. For data analysis SPSS was used to perform simple
cross-tabulations and descriptive statistics.
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Findings: Palapye
This section presents, separately, findings for each group of respondents, that is, the 6–14
and 15–18 year-olds, and the guardians/parents/heads of households.
Orphans and vulnerable children ages 6–14: Survey findings
Background information
The sample from Palapye site consisted of 258 (121 males and 137 females) respondents.
A large majority of the respondents in this age bracket were Batswana comprising of
98.8% of the sample. Out of the 258 respondents, 253 (97.3%) indicated Setswana as
their home language. The remaining indicated ChiZezuru (a Shona dialect), English and
Kalanga.
Education
Ninety-four per cent of the respondents attended school; 93.8% of all females and 92.6%
of all males. For those not in school, reasons cited for not attending school were financial
constraints (14.3%), not liking school (21.4%), being too young to start school (21.4%),
and having completed school (42.9 %).
Religion
Sixty-four per cent of the respondents indicated that they belonged to a religious
organisation; of these respondents, 45% were males and 53% females. Of the 36% that did
not belong to any religion, 51% were males and 49% were females.
Food intake issues
Most of the respondents (97.6%) reported having their meals at home, while only 2% had
their meals at school. Forty-one per cent of the respondents reported that they usually
have three meals a day. Another 40% reported that they usually have two meals a day
while 16.8% indicated having one meal a day, and 2.5% reported having four meals a
day.
Psychosocial issues
Background information on father
Among the 258 respondents, 45.2% indicated that their fathers were dead while 26.3% of
the respondents did not know whether their fathers were dead or alive. Twenty per cent
indicated that their fathers had been very sick over the past three months. About 7% of
the respondents whose fathers were alive reported that their fathers lived in the same
household with them.
Background information on mother
Of the 258 respondents, 38.8% reported that their mother was dead; 0.4% did not know
the whereabouts of their mothers. Among those whose mothers were alive, 20.5% of the
respondents indicated that their mothers had been very sick in the past three months.
Many children whose mothers were alive (about 69% of the respondents) reported that
their mothers lived in the same household with them.
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Household relationships
Displaced orphaned and vulnerable children
Forty-seven per cent (n = 128) of the respondents reported that they had had to move
into another household after their mother/father died. Sixty-one per cent of these
displaced children (of whom 54.5% were male and 66.7% were female) moved with the
other children that they had lived with before their mother/father died. Eighty-three per
cent of the children that they moved with were their siblings.
Non-displaced orphaned and vulnerable children
Among the (n = 179) non-displaced children, 10% of the respondents indicated that a
guardian moved into their household after their mother/father died. Asked how they
were related to their guardian, 28% said the guardian was their grandmother, while 12.8%
indicated that it was their aunt. Ninety-three per cent of these non-displaced children
indicated that there were other children living with them in their parent’s home, and the
great majority of these other children (87%) were their siblings.
Child/guardian relationship
A large percentage (80.8%) of the respondents knew their present guardian very well
before s/he began to take care of them. Only 11.5% of them had known their present
guardians only a little, while 2.4% had not known them at all.
Emotional well-being issues
Most of the respondents (90.3%) indicated that they sometimes feel happy. Some of the
reasons advanced for their happiness included: playing with friends (21.2%), new clothing
bought by parents/guardian (10.6%), and the presence of siblings at home (6.2%). More
than half of the respondents (63.4%) indicated feeling unhappy at different times. When
asked about what mostly caused their unhappiness, responses included having their
parents/guardians or caregiver’s anger directed at them (9.5%), being hurt or beaten by
other children (8.9%), being pressed to do home chores (5.1%), having parent/guardians/
caregivers who were sick (4.5%) and being ill-treated (4.5%). When they felt unhappy,
58.6% talked to other people other than those that are closely related to them, 21.6%
talked to their siblings and 13.6% talked to their friends.
More than forty per cent (42%) of the respondents indicated that they sometimes felt
worried, with 34.8% indicating that it happened quite often and 58.8% reporting that they
sometimes get worried. When the respondents were asked about what worries them,
12.5% indicated sickness of a family member, 10.7% indicated lack of adequate clothing
and school shoes while 9.8% said they worried about the prospect of being beaten. When
respondents got worried, they were likely to talk to other persons other than those that
are closely related to the respondent (65.2%), their siblings (23%) or their friends (5.3%).
Asked whether they had trouble falling asleep, 39% said they did, and of these 57.9%
indicated that it happened sometimes, with 25.2% reporting it happened often. Those
who had trouble falling asleep cited nightmares/bad dreams (20.4%) and thoughts
about parent/guardian death (7.1%) as reasons for their trouble falling asleep. When
respondents struggled to fall asleep, they discussed it with other persons not of any
relationship to them (63.1%) and siblings (30.1%).
Seventy-three per cent of the respondents did feel frustrated while 48.9% reported
feelings of anger; however, a high percentage of the respondents (81.5%) mentioned that
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they often felt hopeful about the future. The respondents indicated that the opportunity
to attend school makes them hopeful. Ninety-three per cent (95.5% of males and 89.8%
of females) of the respondents indicated that their guardians encouraged them to talk
freely when they are sick, feel bad, or down. Fifty per cent (44.9% of males and 55.1%
of females) of the respondents indicated that their guardians put them on their laps
and put their hands around them as a way of comforting them when they were sick or
down. Eighty-seven per cent (89.7% of males and 85% of females) indicated that their
guardians did not look away when they are talking, but showed interest in what they
said. Furthermore, 89% of the respondents indicated that their guardians spoke kindly to
them, as well as explaining things to them.
Eighty-seven per cent of the respondents (89.9% of males and 84.7% of females) indicated
that their guardians often encouraged them to live without fear, and to function as normal
members of the society. They reported that their guardians often told them to work hard
at school (18%), take good care of themselves (9.7%) and develop a sense of trust (9.7%).
Special items
Forty per cent of the respondents who were orphans indicated that they had photos of
their deceased parents. When they were asked how they felt when they looked at the
relics from their deceased parents, a little more than half (50.5%) reported that they were
saddened, while on the other hand, 15.3% said doing so made them happy. More than a
fifth (22%) of the respondents reported looking at the relics when they felt lonely (12.7%)
and when they felt like being close to their late parents (18.6%).
Sexual involvement and abuse
Three per cent (1.8% of males and 4% of females) of the respondents indicated that they
have had sexual intercourse. One per cent of the males indicated that they had sexual
intercourse against their will. A large percentage (96.9 %, or 95.4% of males and 98.3%
of females) of the respondents indicated that their guardians had never touched them
in a way that made them feel uncomfortable. Similarly, 94.3% indicated that they had
never had other children in the household touch them in a way that made them feel
uncomfortable. But 3.1% reported that they had been touched uncomfortably by other
children. Ninety-five per cent of the respondents indicated that no community member
has ever touched them in a way that made them feel uncomfortable. Only 2.7% indicated
that they had been touched uncomfortably by community members.
Issues of inheritance
Fifty-nine per cent of the respondents reported that they still lived in the same house/
home as they did with their parents. Fifty-three per cent reported that they still had
ownership of the house. In responding to the distribution of family goods and possession
after death of their parent(s), 78.1% said their parents’ goods have been distributed and
56.6% of the respondents said they were consulted while 28.3% were not. The goods
that had been distributed included livestock, furniture, money and other valuables.
Respondents reported that they inherited the following from their dead parents; livestock
(85.5%), furniture (80.4%), money (92%) and various other items (72.4%).
Experiences of stigma and discrimination
A high percentage (97.5%) of respondents indicated that other children in the community
do not have any problems playing with them. Almost all (97.9%) of them agreed that
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adults in the community communicated well with them. Two children (1.7%, n = 237)
that reported that adults in the community did not talk to them cited reasons: ‘because
my parents died of AIDS’ and ‘they do not like me’. A majority of the respondents (91%)
reported that they have not been denied access to school because of their parent’s
sickness/illness/death, while only 3.8% indicated they had been denied access on such
grounds.
HIV/AIDS and health-related issues
Ninety-one per cent (91.8% males and 98.4% females) of the respondents reported
that they did sometimes get sick. The most common illnesses were: colds/flu (35.7%);
headache (28.2%) and coughs (6.2%). When sick, they were generally taken care of by
their guardian (54.3%), siblings (23.8%) and aunt (14.8%). Seventy-one per cent of the
respondents reported that when they were sick, they were always taken to the clinic/
hospital, mostly by their guardian (35.8%), an uncle (23.7%) or a sibling (15.8%). Twenty-
six per cent of the respondents (30.5% of males and 22.7% of females) were sometimes
taken to consult with traditional or faith healers. Guardians were reported by 38.1% of the
respondents to be helpful in assisting them to take their medication.
Fifty-six per cent (49.5% of males and 62.3% of females) of the respondents reported that
someone had talked to them about disease prevention. Those who normally talked to
them about disease prevention included: guardians (27.7%), siblings (27.7%), neighbours
(15.4%) and aunts (13.8%).
Community involvement of guardians/parents
When asked about community meetings called by religious or traditional leaders, where
health promoters come to address people, 39.4% indicated that indeed such meetings
do take place. Seventy-two per cent of the respondents indicated that their guardians
attended such meetings. Sixty-three per cent of the respondents, who indicated that
parents/guardians attended such meetings, said that whenever their guardians/parents
came from such meetings they normally shared or discussed what was said in the
meetings with them. Fifty-three per cent of the respondents felt that leaders were
sufficiently urging solidarity for HIV-affected people and protection for survivors from
discrimination and stigma, whereas 30.1% did not know if that was happening.
Discussion of findings: OVC ages 6–14 in Palapye
Over 90% of the children were in school. These figures compare favorably with the
National Net Enrolment Ratio of 95.3% of a similar age group category, 7–13-year-old
children (Education Statistics 2001). The figures show that OVC are not disadvantaged
as far as education is concerned. However, the small percentage not in school cited
not liking school, lack of financial support, being underage and completion of school
as reasons for not being in school. Children being under-age is to be expected, given
this age-group, as the minimum age at which children start school in Botswana public
schools is six years (and maximum is ten years). The number claiming to have completed
schooling is questionable, as most people do not finish at 14 years. This probably means
the OVC in question did not do well during their Junior Certificate Examinations and
that they needed support in continuing beyond Junior Certificate. The underlying causes
of non-school attendance need to be investigated further in an effort to promote access
to education for all children of school-going age. Strategies that encourage and support
continuation of school need to be developed, to strengthen the educational support given
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to OVC. These strategies need to include skills training to assist OVC to either find jobs or
start their own businesses after they complete school.
The study revealed both the negative and positive aspects of the respondent’s emotional
well-being. Feelings of happiness (90%), being hopeful about the future (81.5%),
and good relations between respondents and their guardians (87%) where guardians
encourage OVC positively have all been noted. All these reported positive feelings play
an important role in the respondent’s emotional well-being.
Despite the positives noted, the study also showed that OVC experience a lot of negative
emotional phases in their everyday lives. Feelings of unhappiness, worry, trouble falling
asleep, frustration and anger were all noted at high percentages exceeding 40%. What
also came out is that the feelings were experienced more often and sometimes than
rarely. This goes to show that OVC generally do not have a good life and their happiness
is constantly challenged by the factors that surround their everyday lives. Such emotional
conditions tend to traumatise children, leading them to experience emotional discomfort.
Emotional distress among OVC is a clear indication of psychosocial problems that need
targeted responses.
The study revealed that respondents were likely to talk to an unspecified other, sibling
or friends when experiencing some negative emotion. This shows that OVC are able
to open up about what makes them uncomfortable however, it is worrying to note
that they infrequently chose to talk to their guardian. This could be a sign that the
positive relationship between the guardian and OVC being painted by the findings is
not necessarily positive or OVC may not feel free to discuss some issues with someone
older despite the solid relationship that exists. Such issues suggest there is a need for the
provision of psychosocial counselling.
Nearly 40% of the respondents reported that their fathers were not alive, while 39%
reported that their mother was not alive. Grandmothers and aunts were the most common
guardians of OVC. The growing number of OVC under the care of grandmothers could
be a reflection of absenteeism of biological parents, partly as a result of HIV/AIDS.
Orphans have generally watched their parents get ill and eventually die. As a result, they
suffer extreme emotional pain, forcing them to deal with issues of loss and bereavement
at a very early age. Additionally, being raised by grandmothers places orphans at an
added disadvantage, as the quality of care they get is compromised. Grandmothers are in
most cases elderly, ailing and live in poor socio-economic conditions.
A growing child requires well-balanced, nutritious meals to be healthy. Getting such
meals depends on household food security. On average, 40% of the children reported
eating two meals a day but there were those who ate one meal a day. Many studies have
shown that adequate access to food is critical for growing children. If the frequency of
eating is only once or twice a day, this is usually not sufficient to enable a young child’s
food intake to meet minimum daily requirements for energy and vital nutrients (Kinabo
1998).
Most respondents ate carbohydrate-concentrated food with very little protein, minerals
and vitamins. Such inadequacy places great challenges to OVC’s nutritional security. A
number of factors may be contributing to these situations, which may include shortages of
food due to unemployment and poverty in the household. The other contributing factor
for orphans registered under the national orphan care programme could be that the food
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package provided by the programme contains mainly food that is rich in carbohydrates,
and little of other nutrients.
Grandmothers were cited as guardians by 28% of these OVC. This finding shows the
burden of care that women carry. However what is more important to note is that in
most cases these grandmothers are elderly and ailing, making it difficult for them to cook
for these children. In addition, their socioeconomic conditions are not always favourable,
making it difficult for them even to acquire enough food to feed all the children in their
care (Muchiru 1998).
In this study, almost 12% of the respondents hardly knew their guardians while just over
2% did not know them at all before the death of their parents. It can be difficult for the
child to get to know the guardian, especially if the guardian does not understand that the
child is mourning the death of the parent.
It is clear from this study that the core OVC caregivers are the extended family. These
caregivers need support, and skills and knowledge to provide psychosocial support to
improve the quality of life of OVC and help OVC settle into the new family structure with
as little disruption as possible.
Forty per cent of the respondents indicated that their deceased parents left some items for
them in the form of photos, letters, clothes, and jewelry and personal identification cards.
Such items tend to have some sentimental value to the orphans. The fact that a little more
than half of the respondents (50.5%) who had lost a parent indicated that they were sad
when looking at these items was an indication that they generally missed their parents.
Nearly 20% of the respondents felt closer to their deceased parents when they looked
at these items. The reactions of orphans towards these items was an indication that they
are grieving the loss of their parents, and this grief should not be ignored. It is clear
that orphans need psychosocial support and meeting the need for this support demands
intervention from both the government and NGOs.
The findings of the study showed that even though a good number of respondents
(78.1%) were consulted when their deceased parents’ belongings were distributed, not
all such property was inherited by the deceased children. This is disturbing, as it is
evidence that property grabbing does take place, and the very young are especially
vulnerable to this because most of the time they would not know what their parents had
left behind, and neither know nor can fight for their rights. They are not in a position to
seek legal assistance. Laws protecting children need to be enforced to protect children’s
property, and parents need to be encouraged to write down wills. Community members
including OVC need to be encouraged to visit existing structures such as the District
Commissioner’s office, Customary Court and others that can assist them in claiming their
birthrights.
The findings of the study show that a small number (3%) of the respondents had had
sexual intercourse. Even though the number is small, it cannot be ignored as it shows
that sexual activity starts at a very young age. It is likely that sexual activity at this
age occurs without protection and sufficient knowledge or skills, thus exposing the
children to sexually transmitted infections (STI) including HIV/AIDS. The findings also
show that there have been cases – such as the 3.1% and 2.7% reporting being touched
uncomfortably by other children and community members respectively – suggesting
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