Role of Professional
Social Workers in Promotion of Quality of Life of Children Orphaned by AIDS: A
Study
Dr.
Abraham Mutluri[1]
Abstract
This
article discusses the role of professional social workers in promotion of
quality of life of children orphaned by AIDS. Children orphaned by AIDS are the
children, who have the age of below 18 years, and lost one or both biological
parents due to AIDS. It is estimated that there are 13.8 million children
worldwide had lost mother or father or both parents to AIDS as of 2020.
Children orphaned by AIDS face economic, social, psychological, and health
problems. It is very difficult for them to access the basic needs such as food,
shelter and clothing as well as education. This study conducted in two states
of India i.e. Andhra Pradesh and Telangana with 316 children orphaned by AIDS.
The study found that women-headed, granny-headed and child-headed families are
more in HIV affected families. Stigma and discrimination were faced by 64.2 per
cent respondents. About 35 per cent of the children are not attending the
schools regularly, 72.2 per cent respondents required psycho-social support.
Social work is a practice-based profession and it believes that every child is
unique. There is a lot of scope for the practice of social work profession with
these children. Social workers work as a social case-worker, social group
worker, community organizer, social activist, social welfare administrator, social
researcher, counsellor, communicator, and educator etc. to promote the quality
of life of children orphaned by AIDS. This study suggested a strategy to work
with children orphaned by AIDS.
Keywords:
Children, HIV/AIDS, Orphans, Social Work,
Stigma, Discrimination
1. Introduction
Human
Immunodeficiency Virus (HIV) is a silent, symptomless infection that could be
entered the human body during the intercourse of unprotected sex, through blood
transmissions, unsterilized needles and from infected mother to child. The HIV
attacks the immune system of human beings, making the human body steadily
incapable of fighting agonist the common infections (Ch. Keerthi, 2010, &
Samiran Panda, 2011). Acquired Immunodeficiency Syndrome (AIDS) is the final,
serious stage of HIV infection (NACO, 2003). In course of time, the person
becomes ‘immune-deficient’ and susceptible to ‘opportunistic infections’, such
as tuberculosis, continuous fever, continuous diarrhoea, bacterial pneumonia,
herpes zoster, mouth ulcers, skin diseases, etc. (World Health Organisation,
2004). HIV/AIDS has had a profound negative impact on social and economic
development, diminishing the economic viability and, potentially, the political
stability of countries with high rates of infection (Silverman, 2004). The
origin of HIV/AIDS came to light in the early 1980s in South Africa (Avert,
2012). Since then it is transmitted to all the countries in the world.It is
reported that there are 75.7 million people have infected with HIV in the
globe. Among them, approximately 32.7 million people have died due to AIDS and
38.0 million people are living with HIV/AIDS in the globe (UNAIDS, 2019). Among
them, 36.3 million were adults and 1.7 million were children below the age of
18 years (Avert 2020).
India
is one of the highly affected countries in the world after South Africa and
Mozambique (Index Mundi, 2020). In India, there are 2.1 million people are
living with HIV/AIDS and about 69,000 people were died due to AIDS. The
prevalence rate is 0.2 per cent in India (UNAIDS, 2020). The major virus
carriers and key population in HIV/AIDS transmission are women in prostitution,
men who have sex with men, truck drivers, street children and migrant workers.
They have a risk with their sexual behaviour, multiple sex partners, failure to
use of condoms, susceptibility to sexually transmitted infections, and delays
in seeking sexual health care due to fears of discrimination (Radhika
Ramasubban and Bhanwar Rishyasringa, 2005). It is reported that, in India, 88.2
per cent of the infections occurred through unprotected heterosexual contact
(Bhupendra Kumar Rohit, 2019).
2. Children Orphaned by AIDS
Children orphaned by AIDS are the children
who have the age of below 18 years and lost one or both biological parents due
to AIDS (UNAIDS,2003). It is estimated that there are 13.8 million children
(0-18 years) worldwide had lost mother or father or both parents to AIDS as of
2020. That number continues to rise (Kathryn Reid, 2020). Children orphaned by
AIDS are two types.
1)
Children Affected and Orphaned by HIV/AIDS means a child between
the ages of 0-18 years who had lost his/her single or both parents due to AIDS
and became orphan.
2) Children Orphaned and Living with HIV/AIDS means a child between the ages of 0-18 years who had been infected with HIV from their biological parents and also lost his/her single or both parents due to AIDS (Mutluri Abraham, 2015).
The impact of HIV/AIDS is very high on both types of orphaned children. Children orphaned by AIDS are more vulnerable to abuse, exploitation, neglect, and lack of adult love, care and support (UNICEF, 2012). The children orphaned and living with HIV/AIDS are more vulnerable than other orphans. The professional social workers have done many interventions to bring out the changes in the HIV affected and infected families. They initiated many interventions through the Non-Governmental Organisations for children orphaned by AIDS. The present article discusses the social work practice and interventions for children orphaned by AIDS.
3.
Research Methodology
3.1Aim of the study
The
study presents information about the circumstances of children orphaned by AIDS
and discusses the scope of the social work profession.
3.2Objectives
The objectives of the study are as
follows:
1.
To understand the psycho-social,
educational and economic problems of children orphaned by AIDS
2.
To examine the scope of the
social work profession to promote the quality of life of children orphaned by
AIDS
3.
To suggest the better
social work interventions to promote the healthy and happy life of children
orphaned by AIDS.
3.3Research Design and
Sampling
The research study was
conducted in three high prevalence districts (Krishna, YSR Kadapa, and
Karimnagar) of two states in India i.e. Andhra Pradesh and Telangana. The descriptive
research design was formulated for the present study. The researcher conducted
a baseline survey with Non-Governmental Organizations (NGOs) and Anti-Retroviral
Therapy (ART)centers and identified 5146 children orphaned by AIDS ranging from
the age of 01-18 years. Then the researcher excluded the children below the age
of 8 years as they are too young and innocent to express different aspects of
their problems and social work practice. Hence the study is confined to the
children between the ages of 8-18 years only. After the elimination process,
the number of children falling within the sampling frame was 3160. The
researcher applied the systematic random sampling method and has taken 10
percent of the universe as the respondents for the study.
3.4 Data Collection and Analysis
The researcher collected the
data from 316 children through structured interview schedule at the houses of
the respondents. The data were analyzed through MS Excel and Statistical
Package for Social Sciences (SPSS) 17th version.
4. Results of the Study
1. The HIV/AIDS pandemic changed the family system and increased the woman headed families in HIV affected households. The study found that 36.0 per cent of the families in this study are women-headed families (mother) and 24.0 per cent of the families are grandparents headed families and 13.0 per cent are child-headed families. The epidemic of HIV is more likely to cause changes in the family structure of the society and it is evident from the data that 83.0 per cent of the families are other than male (parental) headed families.
2.
Children
orphaned by AIDS are more vulnerable than the other orphaned children because
HIV/AIDS is associated with stigma and discrimination and health problems. The
study found that 64.2 per cent of the respondents in the present study faced
stigma and discrimination at least one time in their life.
3.
Due to
the fear of transmission of HIV/AIDS, the family members, relatives of the children
and community members not providing the care and support services to these
children. The study found that 55 per cent of the respondents stated that their
relatives are not visiting their houses due to fear of HIV/AIDS and Poverty.
4. Children orphaned by AIDS are also at risk of missing out on school and the protection of a family that is an essential element of their development. The study found that 35 per cent of the children orphaned by AIDS are not attending the schools due to their personal and family problems. Their names are enrolled in the schools but they may not attend the schools regularly.
5. After the death of their parents with AIDS, psycho-social impact on children orphaned by AIDS is very high than other children. They have post-traumatic stress, grief, depression, fear, anxiety and hopelessness. It is found that 72.2 per cent of the respondents stated that they required psycho-social support from the social workers and counsellors.
6. Children living with HIV/AIDS are more vulnerable and they frequently fall ill with skin infections, eye problems, deaf and ear infections, Tuberculosis (TB) and cough and these are the common infections. The study found that 63.1 per cent of the respondents fall in sick at least one time in the last three months.
7. Caring for sick parents, coping with grief, separation from siblings can all be traumatic for children orphaned by AIDS.
8. Often the changes in family structures make the children orphans or sometimes they have to take up the responsibilities to take care of infected elders, siblings in the family. Children are unprepared and unable to cope with social stigma and loss of community support (Help Age India & India HIV/AIDS Alliance, 2006).
5. Discussion of social
work practice with children orphaned by AIDS
Social Work is theyoungest profession in
India. The social work
practice was started by Clifford Manschardt in 1925 in Nagapada Slum of Mumbai which led to start
a social work education in India in 1936 at Sir Dorabji Tata Graduate
School of Social Work, Mumbai (T.M.Suresh, 2014). First, this institute trained
20 social work practitioners in Mumbai. Then, the social work education has
started in many universities and colleges of India.
5.1
Definition of Social Work Profession
The following definition is approved by the International
Federation of Social Workers (IFSW) and International Association of School Social
Workers (IASSW) in July 2014:
“Social work is a practice-based profession and an
academic discipline that promotes social change and development, social
cohesion, and the empowerment and liberation of people. Principles of social
justice, human rights, collective responsibility and respect for diversities
are central to social work. Underpinned by theories of social work, social
sciences, humanities and indigenous knowledge, social work engages people and structures
to address life challenges and enhance wellbeing” (IFSW, 2014).
Social
work is a profession and academic discipline that seeks to improve the quality
of life and well-being of individuals, groups, or communities by intervening
through it methods such as social case work, social group work, community
organization, social action, social research and social welfare administration.
5.2 Roles and Responsibilities of the
Social Worker
Social
workers work with children orphaned by AIDS at homes, communities, hospitals,
orphan homes and counseling centers, etc. The social workers play different
roles like case-worker, group worker, community mobilizer, social activist,
social welfare administrator, counselor, referral officer, facilitator, family
therapist, liaison officer and play many other roles while working with
children orphaned by AIDS. Social workers are capacitated and trained in
working with these families where one or more members face a chronic or life-threatening
illness and also other professionals working in the same communities. The below
figure explains the working strategy of the professional social workers to work
with the children orphaned by AIDS.
Figure: 1
The working strategy of social
workers to work with children orphaned by AIDS
Children orphaned by AIDS (1) Other related professionals and key persons
(3) Care givers / family members (2) Social Worker
The
professional social workers works with the children orphaned by AIDS as well as
the family members and other related professionals in society. This strategy
helps to sensitize the family members, other professionals working in the same
community and community key persons on the issues of children orphaned by AIDS.
This strategy promotes and increases community support and participation. The
professional social worker should work with all the family members to provide
the care and support services to the children orphaned and living with
HIV/AIDS. He/she has to educate them on ‘client-friendly self-care practices’
which help caregivers to protect themselves when they provide support to the
children orphaned and living with HIV/AIDS.
The
following points provide the role of social workers in the field of children
orphaned by AIDS.
1. Social case worker: Social
case work is one of the primary methods of social workthat enable the social
functioning of individuals. Social case worker applies the principles,
components, techniques and approaches of social case work and provides the
psycho-social support, counseling and emotional support to children orphaned by
AIDS. Social case worker can provide information about stress management,
positive lifestyle choices, safe sex practices and treatments to the children
orphaned by AIDS. The social case worker also conducts the crisis intervention,
therapeutic intervention to adjust extreme external pressures. In addition,
social case workers can provide case management services to children orphaned
by AIDS which involves assessing a children’s needs, developing plans to meet
these needs, linking the child with the appropriate services, monitoring
service delivery, and advocating for the child when necessary. Social case
workers help the children to develop appropriate social
interaction skills.
2. Social group worker: Social
group work is one of the core methods of social work. This method helps to the improvement
of the social functioning of individuals. It also helps to participate in the
activities of a group for their intellectual, emotional and physical growth and
the attainment of desired goals of the groups (Alpa Parmar, 2014). Application
of social group work in the HIV/AIDS sector is a challenge to social workers
due to stigma and discrimination. Social group worker forms a different type of
support groups with children orphaned by AIDS, children living with HIV/AIDS,
school support groups, community children support groups to bring we feeling
among children and also sensitizes the general public towards their problems.
These groups help their group members when they required support. The social
group worker forms these groups with children orphaned by AIDS and strengthens
them with more competencies.
3. Community Organizer:
community organization is another core method of social work. The community
organizers mobilize the support from community key persons such asAuxiliary Nursing Midwifery (ANMs), teachers, Accredited Social Health Activist (ASHA)workers,
medical officers, Self Help Groups (SHG), religious priests, NGOs, panchayat
members, sarpanch, ward volunteers, etc. to promote continuous support and
protection to the children orphaned by AIDS. The social worker works in the
community to develop the volunteers’ system to deliberate the information to
the children. Social workers should involve the existing community structures
such as SHGs, formers’ groups, fans associations, mother committees etc. for
the help of children orphaned by AIDS. Social workers strive to eradicate
social exclusion and poverty across all fields of practice with community
mobilization. Social workers build the safety-nets for children orphaned by
AIDS in the communities to promote more protection.
4. Social Activist:
Social Action is one of the methods of social work. Mary Richmond, (1922)
coined social action is for mass betterment through propaganda and social
legislation (Vijay Kumar Sharma, 2020). Social workers advocate on the issues
of children orphaned by AIDS through community organization and policy
development. Social workers fight agonist stigma and discrimination shown
toward children orphaned by AIDS in schools and public places. Social workers
do advocacy with government to bring new policies and welfare services to help
children orphaned by AIDS. It is observed that the government of Andhra Pradesh
is providing three per cent reservation to orphans and vulnerable children in
educational institutions with advocacy of social workers. Social workers
advocate for their clients to make sure that their needs are fulfilled and that
their rights are protected.
5. Social Welfare Administrators:
Social welfare administration is a method of social work. According to Richard
M. Titmus, 1948, “Social administration may broadly be defined as the study of
social services whose object is the improvement of conditions of life of the
individual in the setting of family and group relations” (Ramesh Bharadwaj,
2015). It is also called a process of transforming social policy into social
action.The social workers in the HIV/AIDS sector liaison between children
orphaned by AIDS and the government. It is to increase the access togovernment
and NGO schemes to promote the quality of life of children. Social worker
administrates, develop and implement the educational programs for children
orphaned by AIDS. Developing alternative government and NGO programs for
drop-outs, delinquents, and child-headed families etc. The state and
central government have provision for financial assistance to poor people like
civil supply ration, Arogya-sree, or medical facility. Social workers help
children living with HIV/AIDS to get white ration card or low-income
certificate is entitled to apply for government grants.
6. Social researcher:
Social research is a method of social work. The social workers conduct research
on various issues to update the knowledge and provide the answers to the social
problems in contemporary society. Most of the time social workers conduct the
research on interventions, social problems and welfare programmes. Social
workers have a lot of scope to conduct the research with children orphaned by
AIDS. Positive prevention, problems of children living with HIV/AIDS, problems
associated with sibling separation, ART medicine, orphans’ property grabbing
etc. are some of the issues to conduct social research in the field of HIV/AIDS.
Social workers find new interventions through their research to help children
orphaned by AIDS. The social worker may actively involve in the fact-finding
research to investigate human rights violation of the children orphaned by
AIDS.
7. Counselor:Counselling is a confidential communication between
the counselee and counselor. Social workers provide the counselling services to
deal
with the psychological, mental, social, and financial difficulties of children
orphaned by AIDS. Social workers may use a number of different
psychotherapeutic strategies during their meetings with children orphaned by
AIDS to help their clients control negative feelings, resolve behavioral issues
to achieve those goals. Disclosing the HIV status of parents, death status of
parents to the children is a challenging task. It may deal with grief counselling.
A social worker is supposed to display impeccable professionalism and
unshakable empathy during this vital process. Social workers provide counselling
to promote the educational standers of the children. Social workers educate the
children on peer pressure and its problems.
8. Educator: Due
to the economic strain placed on these HIV affected families and household
members are under pressure to engage in income-earning activities and that
children often drop out of school to find work. Few children also migrate from
their own villages for their livelihoods. The social worker should educate the
family members and readmit the children in the school. He should have to
mobilize the local resources to provide quality and continuous education
services to the orphan children.
9. Communicator: Social
worker uses appropriate communication strategies to interact with children
orphaned by AIDS. The interactive communication strategies are storytelling,
drawing, puppetry, play way methods, singing etc., which may help ventilate
their issues with the social worker.
10. School social worker:
Children orphaned by AIDS have education in the local government schools. The
social workers have to sensitize the teachers towards the problems of children
orphaned by AIDS. Social workers have to form the school support groups in the
schools to promote the cooperation from the other children and teachers of the
school. Social workers create awareness on health problems, opportunistic
infections, locally available nutritious food material, TB medicine and ART
medicine to the children orphaned by AIDS. Social workers also create awareness
on modes of transmission of HIV/AIDS through Information Education and
Communication (IEC) material and posters to children orphaned by AIDS.
11. Home visit: Home
visits are one of the important activities for social workers. Social workers
understand the psycho-social, economic, behavioral and health conditions of the
children during the home visits. Often, social workers have to visit the houses
of children orphaned by AIDS and provide the counselling and moral support to
them. He/she interact with the extended family members and promote the
cooperation to children orphaned by AIDS.
12. Resource mobilization:
social workers mobilize the local resources from philanthropists, volunteers,
key persons, existing groups, political parties and other donor organizations
to help the children orphaned by AIDS in the form of cash, kind and material.
13. Exit Strategy of NGOs:
Most of the time the social workers work in NGOs and the NGOs depends upon
donor organizations. After completion of the project (I year or 2 years) the
NGO stop their activities. The social workers should have to suggest to NGOs to
apply the exit strategy. The NGOs should inform the project implementation
status to the children orphaned by AIDS before 3-6 months. So, the children
choose another source for the support services.
6.
Conclusion
Social Work is one of the important
professions in the world. It contributed a lot in providingof care, support and
treatment services to the people living with HIV/AIDS. There is a lot of scope
for social workers to work with children orphaned bythe AIDS. Social workers
moulded many lives of children affected by AIDS. Social Workers provided the
support services, counselling, conducted research and involved in other related
activities. The social workers have love, care, affection and compassion
towards children. Social workers have started many NGOs and provided the
services to AIDS Orphans. HIV infection is not
the end of life. People can lead a healthy and happy life for a long
time with appropriate medical care. Anti-retroviral therapy (ART) is boon
to children living with HIV/AIDS. Medication thus enhances both quality of life
and longevity (NACO, 2020). Overall, this article presented its objectives and
discussed social work practice with children orphaned by AIDS.
REFERENCES
Abraham Mutluri and Rangarao, ABSV.
(2015).Situational Analysis of Children
Orphaned by AIDS, Prudvi Publications, Visakhapatnam. pp.47-48
Alpa Parmar. (2014). Methods of Social
Work and Its Role in Understanding Team Climate and Team Effectiveness for
Organizational Development, Journal of
Sociology and Social Work, 2(1), 303-318
Avert (2020) HIV/and AIDS in India,
retrieved on 18-12-2020 from https://www.avert.org/professionals/hiv-around-world/asia-pacific/india
Avert. (2012). Scenario of HIV/AIDS in
India and Globe, retrievedfrom http://www.avert.org/origin-aids-hiv.htm.
Bhupendra Kumar Rohit. (2019). HIV/AIDS in
India, Department of Community Medicine, retrieved on 17-12-2020 from
http://www.bmcsagar.edu.in/new_upload/hiv-aidsinindia%20FINAL%20.pdf
National AIDS Control Organization.
(2010). NACO News [Brochure]. Ministry of Health and Family Welfare, Government
of India, New Delhi.
Help Age India and India HIV/AIDS
Alliance. (2006). Forgotten families:
Older people as careers of orphans and
vulnerable children. New Delhi, India.
IFSW. (2014).Global Definition of Social Work, retrieved on 28.05.2020 from https://www.ifsw.org/what-is-social-work/global-definition-of-social-work/
Index Mundi. (2020). Country Comparison,
HIV/AIDS - people living with HIV/AIDS > TOP 100 countries, retrieved on
17-12-2020 from https://www.indexmundi.com/g/r.aspx?v=35&t=100
Kathryn Reid. (2020). what is HIV and
AIDS? Facts, symptoms, and how to help, World Vision, retrieved on 17-12-2020
from https://www.worldvision.org/health-news-stories/hiv-and-aids-facts
Keerthi,Ch. (2010). Community Driven Approaches for Children Living with HIV/AIDS,
Dept. of Social Work, Andhra University, Visakhapatnam
National AIDS Control Organization.
(2020). ART treatment, retrieved on 17-12-2020 from
http://naco.gov.in/treatment
Radhika Ramasubban, and Bhanwar
Rishyasringa. (2005). AIDS and Civil
Society – India’s learning Curve. New Delhi, India: sage.
Ramesh Bharadwaj. (2015). Social Welfare
Administration: Concept, Nature and Scope, Kurukshetra University, Kurukshetra,
Haryana retrieved on 17-12-2020 from
http://www.ignou.ac.in/upload/Bswe-003%20Block-2-UNIT-6-small%20size.pdf
Samiran Panda. (2011).The HIV/AIDS epidemic in India an Overview, People Living with the AIDS
virus the Epidemic and responses in India. New Delhi, India: Sage.
Silverman.(2004). Disclosure of HIV Status
to her Children. Los Angel California: National
Conference Women and HIV, pp. 177.
Suresh, TM. (2014). Introduction to social
work and psychology for social workers, Suresh Murugan Publications, Chennai.
Retrieved on 17-12-2020 from https://books.google.co.in/books?id=Z_tCAgAAQBAJ&pg=PA28&lpg=PA28&dq=The+social+work+practice+was+started+by+Dr.+Clifford+Manschardt+in+1925+in+Slum+of+Mumbai&source=bl&ots=GTJGp_LvRa&sig=ACfU3U2Qp8zHMsLBkgx6S4ei3niM58AXTg&hl=en&sa=X&ved=2ahUKEwjitdup09PtAhVuyDgGHUR0An8Q6AEwB3oECAcQAg#v=onepage&q=naga&f=false
UNAIDS. (2020).Global and Religious
Trends, https://data.unicef.org/topic/hivaids/global-regional-trends/
UNAIDS. (2003). The Role of Education in Supporting and Caring for Orphans and Other
Children Made Vulnerable by HIV/AIDS. Geneva: Joint United Nations
Programme on HIV/AIDS, Global Partners Forum.
UNICEF. (2002). Supporting Community
Efforts to Assist Orphans in Africa. New England Journal of Medicine. vol.6, issue.3 pp.125-129.
Vijay Kumar Sharma. (2020). Emergence of
Social Work Profession in Contemporary Millennium, Social Work Practice in India, Desh Vikas Publications,
Visakhapatnam
World Health Organization. (2004). World
Health Report 2004 changing history.
Retrieved January 10, 2012 from website: http://www.who.int/whr/2004/en/report04_en.pdf pp.5-9.
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