This article was downloaded by: [Linnaeus University] On: 09 October 2014, At: 21:45 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

African Journal of AIDS Research Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/raar20

Willingness to care for children orphaned by HIV/ AIDS: a study of foster and adoptive parents Loraine Townsend & Andy Dawes Published online: 11 Nov 2009.

To cite this article: Loraine Townsend & Andy Dawes (2004) Willingness to care for children orphaned by HIV/AIDS: a study of foster and adoptive parents, African Journal of AIDS Research, 3:1, 69-80, DOI: 10.2989/16085900409490320 To link to this article: http://dx.doi.org/10.2989/16085900409490320

PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions

Copyright © NISC Pty Ltd

African Journal of AIDS Research 2004, 3(1): 69–80 Printed in South Africa — All rights reserved

AJAR ISSN 1608–5906

Willingness to care for children orphaned by HIV/AIDS: a study of foster and adoptive parents Loraine Townsend1* and Andy Dawes2 Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, Observatory 7925, South Africa 2 Child Youth and Family Development, Human Sciences Research Council and Department of Psychology, University of Cape Town, Cape Town 7701, South Africa * Corresponding author, e-mail: [email protected]

Downloaded by [Linnaeus University] at 21:45 09 October 2014

1

There is substantial evidence to indicate that South Africa is facing the prospect of a large number of children, now and in the future, who will be orphaned as a result of the HIV/AIDS pandemic. Following the incapacitation and/or death of their parents, many of these children will be cared for by the safety net provided by members of their extended families. However, there is evidence to suggest that this safety net is fast becoming overwhelmed and possibly reaching saturation point. The ideal would be for as many of these children as possible to experience some type of family life in which to grow and mature into responsible adults. The present study explores adoptive and foster parents’ (n = 175) willingness to care for a child orphaned by HIV/AIDS. Although some differences were noted depending on the HIV status of the child and whether the respondent was an adoptive or foster parent, results indicate an overall willingness in these populations to care for children orphaned by HIV/AIDS. The evidence also suggests that HIV-negative female orphans who are younger than 6 years, and who are family members, or from the same cultural background as the potential caregivers and do not have surviving relatives or siblings, have the best chance of being taken into foster or adoptive care. Keywords: alternative parental care, orphan profile, parental death, postal survey

Introduction According to a recent UNICEF, USAID and UNAIDS report, more than 13 million children around the world have lost either their father or mother or both parents to AIDS (UNICEF, 2002). By the year 2010, this number is expected to increase to 25 million, 90% of whom will be from subSaharan Africa. In South Africa, current data suggests that 13% of children aged between 2–14 years have lost a mother, a father or both parents due to HIV/AIDS (NMF/HSRC, 2002). Among children aged 15–18 years, close to 25% have lost at least one caregiver (Brookes, Shisana & Richter, 2004). Moreover, projections estimate that by the year 2015 orphans will comprise between 9–12% of the total population (between 3.6 and 4.8 million children) (South African Law Commission, 1999, in Smart, 2000). Johnson and Dorrington predict that as many as 5.7 million children, 18 years old and younger, are at risk of losing one or both parents in the same period (cited in Wilson, Giese, Meintjies, Croke & Chamberlain, 2002). Other projections and estimates report similarly alarming results, pointing to the ‘unprecedented wave of orphaned children’ in South Africa (Schonteich, 1999, p. 1). Even if these figures prove to be over-estimates, there is enough evidence to indicate that a large number of children in South Africa, now and for many years in the future, will grow up without the beneficial experience of family life. In fact, with AIDS-related death rates

expected to increase for at least the next two decades, the proportion of orphans will remain high until at least 2030 (Foster & Williamson, 2000). However, these predictions have been made on the basis of no anti-retroviral therapy (ARVT) being available to the vast majority of HIV-positive people. Should the South African government provide anti-retroviral treatment in the public sector, it is likely that the projected numbers of orphans will be less. The only modelling of the effect of ARV therapy on orphaning known to the writer has been done by Nicoli Natrass (Natrass & Geffen, 2003). In this instance Natrass provides a rationale for rolling out Highly Active Antiretroviral Therapy (HAART) rather than the less expensive combination of Voluntary Testing and Counselling (VTC), Mother to Child Treatment Prevention (MTCTP) and more effective treatment for sexually transmitted diseases. With HAART, she estimates that the predicted number of maternal orphans under the age of 18 years in the year 2015 will decline from 31 080 000 (with the roll-out of the less expensive treatments) to 2 195 000 (with the roll-out of HAART), a reduction of 913 000 in the predicted number of orphans. There is no doubt that ARVT, and in particular HAART, will substantially reduce the projected number of children orphaned as a result of HIV/AIDS. The South African government has since announced its intention to roll out ARV

70

Downloaded by [Linnaeus University] at 21:45 09 October 2014

treatment across the country. Clearly, this action will reduce the number of children who would be orphaned by HIV/AIDS; subsequent projections should reflect action taken to increase the availability of life-prolonging treatment. The impact of HIV/AIDS on children The consequences of HIV/AIDS for children are complex and multiple. Long before the point of orphaning, these children will certainly have been affected by HIV/AIDS in a number of ways, many of which have serious implications for their psychological well-being. Firstly, it is very likely that they will have experienced extreme poverty. Based on an absolute poverty line of R400 per month per capita, roughly 75% of children in South Africa live in circumstances of poverty (Wilson et al., 2002). Research confirms that children living in poor households and informal settlements are most likely to lose one or both parents to AIDS (Brookes et al., 2004). Furthermore, it is widely documented that households in which one and often both parents are HIV-infected are more prone to increasing poverty conditions than households that have no HIV-infected members (Schonteich, 1999; Steinberg, Kinghorn, Soderlund, Schierhout & Conway, 2000; Whiteside & Sunter, 2000; Giese, 2001; Richter, 2003). These conditions of extreme poverty may result in endemic chronic stress, affectively distant, punitive and inconsistent parenting (Richter, 1994; McLoyd, 1995) and negative emotional states such as helplessness and hopelessness, decreasing self-esteem, depression and anxiety. Once these children are orphaned, their already poor economic circumstances are very likely to worsen. Poor outcomes are consistently documented for children experiencing these circumstances (Wild, 2001). Secondly, it is also very likely that they will have spent many months of uncertainty and anxiety as important people in their lives suffer intermittent and progressive HIV-related illnesses (Halkett, 1999; Harber, 1999a; Foster & Williamson, 2000; Whiteside & Sunter, 2000). Furthermore, given the unnaturally large number of people who are (and will be) dying from AIDS-related illnesses in South Africa, children who endure the death of their parent(s) will more than likely also experience the death of other family members and/or members of their immediate communities. The stress of parental death will be compounded by the real possibility of witnessing multiple deaths. Thirdly, another negative effect of living in an HIV-infected household is the well-documented pervasive stigma attached to HIV-infection and AIDS-related death. This often results in isolation of the members of the household (Halkett, 1999; Harber, 1999a; Draft Discussion Paper, 2000; Smart, 2000; Whiteside & Sunter, 2000; Amman, 2002). Coupled with the stigma of poverty, this can have serious consequences for children who, at this time, are probably most in need of support from others. Besides experiencing the negative psychosocial consequences of HIV/AIDS, and/or being HIV-infected themselves, there are a number of other concerns relating to children once they are orphaned. For instance, orphaned children may end up living on the streets (Foster & Williamson, 2000; Hasewinkel, 2000; Steinberg et al., 2000; Giese,

Townsend and Dawes

2001; Muminovic, 2002). Many are likely to drop out of school and others may enter the illegal child labour market (Richter, 2003). Others will become members of child-headed households particularly vulnerable to extreme poverty, poor nutrition, poor housing, discrimination, exploitation, educational failure and physical and sexual abuse (Nelson Mandela Children’s Fund, 2001). Others may be accommodated in institutional settings, where ‘research world-wide has shown that institutional care can have deleterious effects on a child’s physical, emotional and psychological well-being’ (Harber, 1999a, p. 21). Furthermore, ‘growing up without parents, and badly supervised by relatives and welfare organisations’, these children will be at greater risk than average for engaging in criminal activities (Schonteich, 1999, p. 1) and vulnerable to sexual exploitation (Muminovic, 2002; Richter, 2003). At the core of each of these concerns appears to be the assumption that many orphaned and AIDS-affected children will lack adult supervision and support, and will thus miss out on exposure to a number of important formative influences, such as: ‘The early bonding experiences critical for good caring human relationships’; ‘The modelling, boundary setting and development of value systems necessary for moral development’; ‘The support, caring and discipline needed for emotional stability’ (Freeman in Richter, 2003, p. 12) While many of these concerns may be well-founded, it is important to consider three issues. Firstly, it appears that many of them are based on limited evidence of their pervasive existence. In a review of research evidence from African and American literature, Wild concludes ‘there is no definitive answer to the question of whether losing a parent to AIDS places children at risk for psychosocial adjustment difficulties’ (Wild, 2001, p. 16). Secondly, Richter draws our attention to children’s resilience in the face of extreme adversity, the essence of which is based on ‘the instrinsic biological processes which drive child development where children actively seek out these formative experiences even in conditions of extreme difficulty’ (Richter, 2003, p. 12). Thirdly, echoing the above, Bray cautions against apocalyptic predictions for orphaned children and their suggested part in the future breakdown of society (Bray, 2003). She goes on to warn against interventions for these children that are essentially ill-informed, largely based on fear, and that may inadvertently undermine children’s and communities’ effective strategies for coping in these conditions. In spite of these cautions, we need to acknowledge that there will be a number of AIDS-affected and orphaned children who will suffer the adverse consequences suggested by many authors. As such, the concerns outlined above cannot be ignored and interventions need to be planned proactively to avert these deleterious outcomes for children, however many there may turn out to be. Caring for children orphaned by HIV/AIDS The large (and increasing) number of orphans in South Africa begs the question: who is caring for children orphaned by HIV/AIDS?

Downloaded by [Linnaeus University] at 21:45 09 October 2014

African Journal of AIDS Research 2004, 3: 69–80

In South Africa, alternative parenting within family contexts for children in need has been provided by kinship care (within the extended family), informal foster care, or formal foster care, and adoption. The latter two options (formal foster care and adoption) are heavily entrenched in First World models of alternative family care and have been under-promoted and consequently under-utilised by the majority of South African families (Brink, 1998; Harber, 1999b). The first two options centre around the fact that childcare, within black African culture, has historically been viewed as a social task, performed by the entire extended family rather than an individual household (Pakati, 1984; Thomas & Mabusela, 1991; McKerrow & Verbeek, 1995; Tolfree, 1995; McKerrow, 1996a; 1996b; Brink, 1998; Halkett, 1999). It would appear that one of the major problems associated with these forms of care, as a means to alleviate the looming crisis in alternative care arrangements for children orphaned by HIV/AIDS, is that ‘[t]he AIDS epidemic has now stretched the resources of extended families to the limit...’ (Harber, 1999a, p. 7). Other authors agree that the extended family is becoming overwhelmed (Halkett, 1999; Harber, 1999a; Smart, 2000) and possibly reaching saturation point (McKerrow & Verbeek, 1995; McKerrow, 1996a; Harber, 1998; Halkett, 1999). Elderly relatives are finding themselves having to provide care for more and more sibling groups. They themselves are in impoverished conditions, are often elderly and lack energy, and frequently report an inability to discipline the children in their care (Barnett & Blaikie, 1994 in Harber, 1999a), besides which the next generation of grandparents will be severely depleted by AIDS and so this source of alternative care will be less available in the long term (Harber, 1999a). Harber reports, too, that in many African countries AIDS has produced the situation where there is no-one remaining within an extended family who is willing or able to care for orphaned children (Berer & Sunandra, 1993; Barnett & Blaikie, 1994 cited in Harber, 1999a): an observation mirrored by Foster, Makufa, Drew, Kambeu and Saurombe (1996). The stigma surrounding HIV/AIDS has also produced the situation where relatives are reluctant to, or will not, care for children orphaned by HIV/AIDS (McKerrow & Verbeek, 1995; Harber, 1998). If we accept that there is a limit to the capacity and acceptability of existing alternative caring arrangements for orphans, and that many children orphaned by HIV/AIDS are likely to be emotionally, behaviourally and physically compromised, the next question that begs answer is: who will care for these children in the future? Clearly, a proportion of these children, particularly those without kin to care for them, will need to be taken into care. As children’s homes are a very undesirable option, another possibility is adoption or fostering by people who are not kin. What are the factors that would influence a decision to foster or adopt a child orphaned by HIV/AIDS? This was the overarching question explored in a larger study by Townsend (2001). For the present report, we focus on a specific section of the larger study that set out to: • explore the characteristics of orphaned children that would either facilitate or hinder prospective, alternative carers’ decisions to care for them, • investigate the relationship between potential, alternative

71

carers and child characteristics and how these may impact on a willingness/unwillingness to care for an orphaned child, and • provide some recommendations, on the basis of the research findings, for the alternative care of children orphaned as a result of the HIV/AIDS pandemic, • in a population who have already taken a decision to care for a non-biological child. Methodology Sample In the study, an option would have been to survey the general population to examine their propensity to care for children orphaned by AIDS. Considering the logistical obstacles and expense of such an approach, the study focused on a population who had already shown a willingness to care for children in need — existing foster and adoptive parents. Not only would they have already taken the step to care for (mostly) non-biological children, but arguably these experienced and already committed groups would be more likely to have a realistic and hence more reliable approach to the questions posed in the study. They were also most likely to provide a home for the child within a family. It was therefore decided to survey a sample of foster and adoptive parents on the register of a large child welfare NGO. The foster carers and adoptive parents were accessed from two centres, Cape Town and George. The Cape Town branch of the NGO agreed to our contacting the 413 registered foster carers on their database. The Cape Town office also agreed to provide access to 150 adoptive parents who had adopted a child through their agency during the last three years. The George office selected 100 of their registered foster carers for the study (out of a total of approximately 400). The selection was done to screen out potential participants whose educational level was regarded as too low for them to understand the questionnaire. Low education levels were not perceived to be a problem with the Cape Town group. Finally, the editor of a national newsletter — Adoption Network News — agreed to include the questionnaires in a posting of one of their quarterly newsletters. Their active database consisted of 245 adoptive parents from around the country but mostly confined to the Gauteng area. While South African fathers are beginning to play greater roles in child rearing, their role is still quite limited. Therefore foster and adoptive mothers only were surveyed. Within the South African context, too, there is an unusually large proportion — by First World, Western standards — of femaleheaded households. The final convenience sample for the survey (it cannot be said to be representative of South African foster and adoptive parents) included 513 foster carers and 395 adoptive parents, resident in Cape Town, George and Johannesburg. A total of 908 participants were sent the survey questionnaire (see below). Of the 908 questionnaires mailed to potential respondents, 175 were returned (19.27% response rate). The demographic characteristics of the final sample are provided in Table 1. The questionnaires The data for this study was gathered by means of a ques-

72

Townsend and Dawes

Downloaded by [Linnaeus University] at 21:45 09 October 2014

Table 1: Sample characteristics Adoptive parents Foster parents Mean age Respondents Partners Married/living with a partner Home language English Xhosa Afrikaans Household income Mean income bracket Mode income bracket Education Respondents Mean level Matriculation Partners Mean level Matriculation Children (R10 000pm Grade 9 45% Grade 10 58.88%

n = 53 n = 63

n = 71 n = 56 n = 223

whether they had received Form A or B of the questionnaire: ‘I would be willing to care for the child described in the scenario if the child is HIV-negative and does NOT have AIDS’ (Form A) or ‘I would be willing to care for the child described in the scenario if the child is HIV-positive and DOES have AIDS and is likely to become ill and will eventually die’ (Form B). These statements were worded in such a way as to expect participants to respond in terms of their actual, rather than their hypothetical, willingness to care for the orphaned child. Only those respondents who indicated ‘yes’ were requested to continue and complete the balance of the questionnaire, which required respondents to answer ‘yes’ or ‘no’ to a number of additional statements further characterising the child described in the scenario. Figure 1 depicts this part of the questionnaire. The following instructions were added or changed in the questionnaire that asked about an HIV-positive child: • DID YOU KNOW THAT A BABY BORN HIV-POSITIVE CAN CHANGE TO HIV-NEGATIVE ANY TIME BEFORE HE/SHE IS 15 MONTHS OLD? Bear this in mind when you consider the next statements. Procedure

tionnaire that was mailed to respondents. Two questionnaire booklets were developed — Form A and Form B. Booklet A assessed the opinions of respondents in terms of their willingness to care for a child who had been orphaned and who was HIV-negative. The other — Booklet B — assessed the opinions of respondents in terms of their willingness to care for a child who had been orphaned and who was HIV-positive. Both questionnaires were constructed and refined, in consultation with research colleagues as well as staff in the participant NGO and finally a group of foster carers (not included in the final sample). The questionnaires were translated from English into Afrikaans and Xhosa. These were then back-translated and discrepancies were corrected in consultation with both the translators and the back-translators. The section of the questionnaire from the larger study pertinent to the current report began by asking respondents to read the following typical orphaning situation: ‘The child in this part of the questionnaire has been orphaned because his or her mother has died of AIDS. It is unknown whether the child has other family members who would be willing, or even able, to care for him or her. The child appears to have no-one to look after him/her and nowhere to go’. They were also alerted to the following: ‘In the questionnaire, you will see that I ask a number of questions about caring for an orphaned child. Caring for an orphaned child would mean taking the child into your own home and treating him or her as you would your own children: providing him or her with food, shelter, and clothing; schooling and medical care; and love, support and guidance’. The first item to which respondents then had to respond either ‘yes’ or ‘no’ was either of the following, depending on

The child welfare NGO required that the researcher mail the questionnaires from their offices. In this way the names and addresses of the foster and adoptive parents never left the NGO office. This procedure was followed in order to protect the anonymity of these parents. The questionnaires that were sent to the mailing list for Adoption Network News were simply included in the posting of one of their quarterly newsletters. The decision as to which of the two questionnaire forms described earlier would be sent to which respondents was done randomly. Half the sample from each source received Form A and the other half Form B. All booklets included a self-addressed, stamped envelope allowing respondents to return their completed questionnaires at minimal inconvenience and no expense to themselves. An incentive for respondents to complete the questionnaires was also included. To this end the letter of introduction explained that 10 respondents who had completed the entire questionnaire would be eligible for a ‘prize’ of a R100 grocery gift voucher. The need to include an incentive has been documented as having a positive effect on response rates (Bailey, 1987). Once it became clear that no further completed questionnaires would be returned, 10 respondents’ questionnaires were randomly selected and the grocery vouchers were sent to them. Results Willingness to care for HIV-positive and HIV-negative children orphaned by HIV/AIDS It was expected that more respondents would be willing to care for an HIV-negative than an HIV-positive child. Arguably, caring for an HIV-positive child would be financial-

Downloaded by [Linnaeus University] at 21:45 09 October 2014

African Journal of AIDS Research 2004, 3: 69–80

73

I would be willing to care for the child if

the child is female the child is male

I would be willing to care for the child if

the the the the

I would be willing to care for the child if

I would be willing to care for the child if

I would be willing to care for the child if

YES YES

NO NO

YES YES YES YES

NO NO NO NO

the child is of the same culture or race as myself the child is of a different culture or race than myself

YES YES

NO NO

the child has no known relatives or brothers and sisters the child has relatives and/or brothers and sisters with whom I would permit the child to stay in contact the child has relatives and/or brothers and sisters with whom I would not permit the child to stay in contact at the same time I was asked to care for one or more of the child’s brothers and/or sisters

YES

NO

YES

NO

YES

NO

YES

NO

the child is a member of my own family or extended family e.g. my aunt’s child the child is a neighbour or friend’s child the child is not a member of my family nor a friend’s or neighbour’s child

YES YES YES

NO NO NO

child child child child

is is is is

between between between between

0 and 1 year old** 1 and 6 years old 6 and 10 years old 10 and 16 years old

** the child is between 0 and 15 months old Figure 1: The section of the questionnaire examining characteristics of the orphaned child

ly, physically and emotionally taxing with the child most likely becoming progressively ill and eventually succumbing to the virus. Although more respondents were willing to care for an HIV-negative child (76.25%) than an HIV-positive child (62.20%), a chi-square analysis showed this difference was not statistically significant. While there is a trend for potential carers to prefer an HIV-negative child, it is by no means the case that infected children are significantly less likely to be taken into family-based care, at least by this study’s respondents. A comparison of adoptive and foster parents was undertaken. In contrast to fostering, adoption involves a lifetime commitment with no way out (returning the child to the agency) should matters not work out between the child and her new carers. In addition, the emotional costs of taking on an infected child who might then die might operate against a decision to adopt such a child. Therefore it was expected that adoptive parents would be less inclined than foster parents to care for an HIV-positive child. This prediction was confirmed. Chi-square analysis demonstrated that the adoptive parents among the sample’s respondents reported a significantly greater willingness to care for an HIV-negative rather than an HIV-positive child (88.57% and 47.06% respectively) (χ2 = 13.68, P < 0.01). There was no significant difference in the sample’s foster carers’ willingness to care for either an HIV-negative or HIV-positive child (71.27% and 77.27% respectively) — again confirming expectations. The foster carers were more likely than the adoptive parents to willingly care for an HIV-positive rather than an HIV-negative child (77.27% and 47.06% respectively) (χ2 = 7.61, P < 0.01). These findings are presented in Figure 2. The child’s gender On the basis of a reported preference for female children,

this aspect of orphaned children was explored (Pakati, 1984; McKerrow & Verbeek, 1995; McKerrow, 1996a; Sishuta, 1996). However, as the gender categories were not mutually exclusive (i.e. some respondents marked both the ‘female’ and the ‘male’ categories), statistical analyses of the difference in preference for either a female or male child were not possible. Figure 3 demonstrates the frequency that either of the gender categories was chosen, irrespective of whether some respondents had checked both categories and, as such, represents respondents’ inclination towards a choice for a female child rather than a male child irrespective of the child’s HIV status. The child’s age Based on evidence that young children (not infants) are easier to place than older children and adolescents, it was expected that the current study’s respondents would show similar preferences (Pakati, 1984; McKerrow & Verbeek, 1995; McKerrow, 1996a; Sishuta, 1996). However, due consideration was given to the possibility that these expectations would be confounded by differences in practices associated with adoption and foster placement. Traditionally, adoption is a practice that places infants with new families, and it was expected that the current sample of adoptive parents would show a greater willingness to care for infants up to the age of one year, rather than older groups of children. On the other hand, foster care places children once they have been found to be in need of care, and in most instances they are likely to be past infancy. It was expected that this study’s foster carers would show a greater willingness than adopters to care for children over the age of one year. Finally, age preference was examined with regard to the child’s HIV status. Figure 4 demonstrates the preferred age of an orphaned

Townsend and Dawes

Adoptive parents Foster parents

90 80 70 60 50 40 30 20 10 HIV-negative child

HIV-positive child

PERCENTAGE INDICATED "YES"

PERCENTAGE INDICATED "YES"

74

HIV-negative HIV-positive

100 90 80 70 60 50 40 30 20 10 Female

Male

Figure 2: Willingness to care for a child orphaned by HIV/AIDS

PERCENTAGE INDICATED "YES"

Downloaded by [Linnaeus University] at 21:45 09 October 2014

Figure 3: The child’s gender

adoptive parents still showed a marked preference for a young child (0–15 months old), their willingness to care for the older age groups of HIV-positive children (6–16 years) was considerably higher than for the same age groups of HIV-negative children. The foster carers, on the other hand, showed no remarkable differences in willingness between HIV-negative and HIV-positive children.

Foster parents Adoptive parents

90 80 70 60 50 40 30 20 10 0-1y

0-1y

1-6y

1-6y

6-10y

6-10y

HIV-neg. HIV-pos. HIV-neg. HIV-pos. HIV-neg. HIV-pos.

Figure 4: The child’s age

HIV-negative child as indicated by the study’s adoptive and foster parents. Chi-square analysis revealed that significantly more of the adoptive parents (90%, n = 27) than the foster carers (65.38%, n = 17) were willing to care for a child between 0 and one year old (χ2 = 5.01, P < 0.05), as was expected. This trend in age preference begins to reverse when the child is between one and six years old. The foster carers expressed a greater willingness to care for children in this age group (61.54%, n = 16) than did the adoptive parents (53.33%, n = 16) — although this difference was not statistically significant. Again confirming expectations, the foster carers were more willing than the adoptive parents to care for an older, HIV-negative child between the ages of six and 16 (χ2 = 8.79, P < 0.01). The preferred age of an HIV-positive orphaned child as indicated by the study’s adoptive and foster parents is also indicated in Figure 4. Chi-square analyses of the differences between the adoptive and foster parents in terms of age preference revealed no significant differences. Although the

The child’s cultural background This section of the study assessed willingness to care for a child of a different cultural background to that of the potential caregiver. This was done in order to investigate the possibility of a wider range of persons being willing to care for the predominantly Black orphan population. In the case of an HIV-negative child, 91.53% (n = 54) of those questioned indicated that they would care for an HIVnegative child if he/she was of the same culture or race as themselves. Sixty-one percent of the same group (n = 36) indicated a willingness to care for a child of a different culture or race to themselves. It is encouraging that a significant proportion of the sample was prepared to care for an HIV-negative child from a different background than their own. Nonetheless, the results suggest a trend towards a greater willingness to care for an HIV-negative child of the same culture or race. In the case of caring for an HIV-positive child, 78% (n = 39) indicated that they would care for the child if he/she came from the same background as themselves. Exactly the same proportion (78%, n = 39) was willing to care for a child of a different culture or race (refer to Figure 5). These results suggest the possibility that the vulnerability of HIV-positive orphans gives them some advantage over their HIV-negative counterparts when it comes to the probability of being taken into foster or adoptive care. The presence of the child’s relatives or siblings Children from large sibling groups are particularly hard to place in alternative caring situations (Churchill, Carlson & Nybell, 1979). This dimension of the child’s background was explored to assess decisions to care for orphans from such backgrounds. Furthermore, the need to keep sibling groups

PERCENTAGE INDICATED "YES"

African Journal of AIDS Research 2004, 3: 69–80

Same culture Different culture

90 80 70 60 50 40 30 20 10 HIV-negative child

HIV-positive child

Downloaded by [Linnaeus University] at 21:45 09 October 2014

Figure 5: The child’s cultural background

together is an overriding concern of community members, alternative care practitioners and policy makers. It was hoped that the study would provide pointers as to whether keeping siblings together in this type of family care situation was a realistic option. It was also expected that there would be differences between adoptive and foster parents in their willingness to care for an orphan (regardless of the child’s status) based on the presence and/or contact with the child’s siblings and relatives. The traditional nature of adoption, where a child is incorporated into a new family as if he/she was born into the family, would possibly reduce adoptive parents’ willingness to maintain contact with the child’s other family members. Foster carers, on the other hand, who are accustomed to the presence and contact between foster children and their families of origin were expected to show no such bias. As was the case with the child’s gender (above), the three categories (no relatives, in contact with relatives, and not in contact with relatives) were not mutually exclusive, and statistical analyses of these differences were not possible. However, as is demonstrated below, the present study’s respondents showed a clear inclination to the choice for the child to have no relatives/siblings, irrespective of his/her HIV status. Across the three categories, adoptive parents and foster carers among the study’s sample were compared in terms of their preference with respect to an HIV-negative child (refer to Figure 6). Although a full 100% (n = 31) of the adoptive parents indicated that they would care for the child if he/she had no relatives, only 88.46% (n = 23) of the foster carers checked this option. Very similar percentages of the adoptive and foster parents (64.52% and 68% respectively) were not opposed to the child remaining in contact with relatives and/or siblings. Similarly, comparable percentages of the adoptive and foster parents (64.52% and 60% respectively) indicated that they would not want the child to remain in contact with his/her relatives and/or siblings. These findings are contrary to the expectations outlined above. Among this study’s adoptive and foster parents, both were equally willing to care for a child if he/she had no relatives. Surprisingly,

75

the adoptive parents were as willing as the foster parents to care for a child if he/she had relatives/siblings. Adoptive parents and foster carers among the study’s sample were also compared across the three categories with respect to an HIV-positive child. Figure 6 shows that similarly high proportions of both the adoptive and foster parents indicated that they would care for the child if he/she had no relatives (93.33% and 94.12% respectively). More of the adoptive than foster parents were not opposed to the child remaining in contact with relatives and/or siblings (86.67% and 61.76% respectively). Also, more of the adoptive than foster parents indicated that they would not be amenable to the child remaining in contact with his/her relatives and/or siblings (73.33% and 58.82% respectively). These findings, although similar to those found for an HIVnegative child, indicate that respondents, irrespective of whether they were adoptive or foster parents, showed no overriding preference for the child to have no relatives/siblings or to have relatives/siblings or to remain in contact with these family members. An additional question in this section asked respondents whether they would also care for some of the child’s siblings. Only 37.29% (n = 22) of respondents were willing to do so if the child was HIV-negative and 48% (n = 24) if the child was HIV-positive. These findings point to the fact that, irrespective of the child’s HIV status, this study’s respondents were most willing to care for an orphan who had no relatives/siblings. But, should the child have siblings, they were more willing for the child to maintain contact with them rather than care for their siblings too. The possibility of caring simultaneously for some of the child’s siblings was explored between the study’s adoptive and foster parents. With respect to an HIV-negative child, only 29.03% of the adoptive parents indicated that they would care for some of the child’s siblings whereas 52% of the foster parents indicated similarly. Although this difference appeared to be large, a chi-square analysis proved it to be insignificant. In the case of an HIV-positive child, only 33.33% of the adoptive parents indicated that they would care for some of the child’s siblings whereas 70.59% of the foster parents indicated similarly. This difference was significant (χ2 = 5.98, P < 0.05). These findings suggest that an HIV-positive child placed with foster carers may have some advantage over his/her HIV-negative counterparts: he/she is more likely to be able to remain with his/her siblings. Relationship to the child The nature of both adoption and foster care is such that nonbiological children are cared for in both these situations. It was therefore expected that respondents, whether adoptive or foster parents, would be equally willing to care for a child no matter how close (for example, from their own biological family) or distant (for example, a non-biologically and unrelated, or unfamiliar child) their relationship to him/her was. Across the three relationship categories (family, neighbour/friend and stranger), the study’s adoptive parents and foster carers were compared in terms of their preference with respect to an HIV-negative child. Clearly, both the adoptive and the foster parents showed the greatest willingness to care for an orphan from their own families, although the

PERCENTAGE INDICATED "YES"

76

Townsend and Dawes

Foster parents Adoptive parents

100 80 60 40 20 0

Downloaded by [Linnaeus University] at 21:45 09 October 2014

None

In No contact contact

HIV-negative child

None

In No contact contact

HIV-positive child

Figure 6: Presence and/or contact with the child’s relatives and/or siblings

adoptive parents (90%, n = 27) were more willing to care for a child from their own family than were the foster parents (72%, n = 18). However, the foster carers (48%, n = 12) were more willing than the adoptive parents (20%, n = 6) to care for a friend’s or neighbour’s child, and more of the foster carers (23.08%, n = 6) than the adoptive parents (13.33%, n = 4) seemed willing to care for a stranger. Again, although statistical analyses of these differences were not possible due to the relationship categories not being mutually exclusive, these findings indicate that the foster parents showed a clearer inclination to choose to care for a child who did not come from their own families than did the adoptive parents. Figure 7 also shows these findings. Similarly, across the three relationship categories the study’s adoptive parents and foster carers were compared in terms of their preference in relation to an HIV-positive child. Although it appeared that a greater proportion of the adoptive parents were more willing than the foster carers to care for any of the three categories of children, it was not possible to subject these differences to statistical analyses for the same reason stated above. However, it seems apparent that both the adoptive and foster parents were similarly willing to care for an HIV-positive child, irrespective of their relationship to the child. Figure 7 also depicts these findings. Discussion Willingness to care South Africa is facing the prospect of a large number of orphaned children now and in the future. Evidence suggests that traditional forms of alternative parenting appear inadequate to satisfy the great need for family care. Additional hindrances to persons likely to take on the care of these children revolve around the probability that the great majority of them will fall into the group of children classified as ‘hard to

place’. That is, many orphaned children are likely to exhibit emotional and behavioural problems as a result of the difficulties they have endured. These problems are likely to accompany them into their new care situation. Furthermore, many will have siblings. Likewise, the fact that some will also be HIV-positive and are known to originate from HIV-infected households, coupled with the pervasive stigma attached to HIV/AIDS in this country, will add to their adjustment difficulties. An encouraging outcome of the study is that 69% of the respondents indicated that they would be willing to care for a child orphaned by HIV/AIDS. Only one other study, investigating children orphaned by HIV/AIDS or displaced for other reasons, confirms this relatively high proportion of willingness to care for children in these circumstances (McKerrow & Verbeek, 1995). This study contained the only direct measure of willingess known to the researcher at the time of writing. McKerrow and Verbeek (1995) found that 62% of their sample of 1 100 households in eight Kwa-Zulu Natal communities was willing to care for ‘children in distress’. The fact that the current study’s sample is made up of people who have experience as adoptive and foster parents is also cause for optimism as it suggests that these groups could form a pool of willing carers for orphaned children. A profile of an orphan most likely to be cared for On the basis of the results reported above, a profile of children orphaned by HIV/AIDS more likely to be accepted into family care is presented in Table 2. According to Richter (2001), ‘[c]hildren who slip through these safety nets become highly vulnerable and exposed, and include street and working children, as well as childheaded households’ (p. 3). This study suggests that we can add the following characteristics to Richter’s list on the basis that they are characteristics that are less likely to facilitate the child’s placement: • male children • those older than 6 years • those with surviving relatives and/or siblings • HIV-negative children not related to prospective carers There are striking similarities in some of the above findings and those from Pakati’s (1984) study of attitudes to adoption in a South African black community. Her sample of adoptive parents had distinct preferences for a child up to the age of five years old. Sixty-one percent also stated a preference for a female child. There was no reference to HIV/AIDS in her study — understandably since it was undertaken at a time when HIV/AIDS had not even begun to impact on this country. However, age and gender preferences in a study conducted nearly twenty years back are mirrored in the current study (in which the majority of participants were not black). Both studies point to male children being harder to place (regardless of HIV status) if they are over the age of 6 years. Interestingly, with regard to the orphaned child’s culture/ethnicity and his/her relationship to a prospective carer, HIV-positive children have some advantage over their HIVnegative peers. The present data indicates that respondents were willing to care for an HIV-positive child irrespective of his/her cultural/ethnic background. They were also similarly

African Journal of AIDS Research 2004, 3: 69–80

77

Table 2: Preferences of potential carers for children orphaned by AIDS HIV-positive child Female child Up to the age of 6 years Culture/ethnicity not relevant Child has no relatives or siblings No particular preference for a child of relative or other close associate

Much of the literature on orphaning as a result of the HIV/AIDS epidemic has reported a predominant desire amongst all role players to keep orphaned siblings together (McKerrow & Verbeek, 1995; McKerrow, 1996a; 1996b; Halkett, 1999; Smart, 2000). The data from the present study seems to suggest that this may not be as difficult as one may assume. Close to half the respondents in this study indicated a willingness to simultaneously care for an orphan’s siblings. In spite of this, though, respondents also reported a greater willingness to care for an orphan, irrespective of his/her HIV status, if he/she had no relatives or siblings.

Foster parents Adoptive parents

90 80 70 60 50 40 30 20

HIV-negative Child

Stranger

Neighbour/Friend

Family

Stranger

0

Neighbour/Friend

10 Family

PERCENTAGE INDICATED "YES"

Downloaded by [Linnaeus University] at 21:45 09 October 2014

HIV-negative child Female or male with preference for female child Up to the age of 6 years Of the same culture/ethnicity as prospective parent Child has no relatives or siblings Be a member of prospective parent’s family

HIV-positive Child

Figure 7: Relationship to the child

willing to care for this child should he/she be from their own family, a friend’s or neighbour’s child and/or a stranger. These stated preferences suggest a wider range of potential carers for HIV-positive children as opposed to HIV-negative children. McKerrow and Verbeek’s (1995) study, referred to above, offers a different picture. Although these authors made reference only to the fact that children came from an HIV-infected household and not whether the orphans themselves were either HIV-negative or -positive, their findings suggest a far greater willingness to care for children orphaned by AIDS if they are from the prospective carers’ own family. These findings are consistent with the findings of the current study, but only with respect to an HIV-negative child and not an HIV-positive child. One possible explanation may be that, given an HIV-positive child’s expected short life-span, the importance of cultural/ethnic similarity is of less concern to prospective carers and probably overshadowed by a desire to give a dying child a secure and loving environment in which to spend his/her last days. On the other hand, cultural/ethnic similarity is important when a child is expected to remain with the prospective parents for a large part of or all of the remainder of his/her life.

Foster and adoptive parents’ willingness to care for a child orphaned by HIV/AIDS A deeper analysis of the data reveals that there were significant differences between the study’s adoptive and foster parents in terms of their willingness to care for a child orphaned by HIV/AIDS, as well as differences depending on the HIV status of the orphaned child. As was pointed out earlier, one would anticipate that many of the differences between the adoptive and foster parents could revolve around the nature of and these groups’ differing expectations inherent in each of the types of alternative parenting. For example, adoption traditionally has centred on the incorporation of an infant into an existing, childless family. Caring for an adopted child would involve a life-time commitment similar to the case of biological parenting. Once the adoption has been legally finalised, in the vast majority of cases there is no further intervention of either the placement agency nor the child’s biological family. On the other hand, foster care typically centres around the care of older children (probably beyond infancy) who are in need of care due to biological parenting break-down. The fostering arrangement is expected to be for an indefinite period and should terminate once the child’s biological parent/s are able to resume parenting of their child. However, recognition is given to the fact that many foster care arrangements tend to be long-term, if not also life-time commitments. At all times, the placement agency is expected to be involved in continuing assessment and various interventions both with the foster family and the child’s biological family. Further, the child’s biological family is at all times a ‘presence’ in the caring arrangement. Given the expectation of life-time commitment, adoptive parents in the current study were more willing to care for an HIV-negative child than they were to care for an HIV-positive child. This preference is likely to be informed by the probable short life-span of an HIV-positive child. The foster carers, more familiar with short-term caring, did not show such dis-

Downloaded by [Linnaeus University] at 21:45 09 October 2014

78

tinct preferences and were equally willing to care for either an HIV-negative or an HIV-positive child. Congruent with the traditional placing of infant children with adoptive parents, the current sample’s adoptive parents were more likely to express a willingness to care for an orphaned HIV-negative child between the ages of 0 and one year old than any of the other age groups of children. The foster carers had similar preferences but were significantly more willing than the adoptive parents to care for children older than one year old. As mentioned earlier, this may be as a result of these parents’ familiarity with and expectations to caring for children beyond infancy. Different results emerge when the hypothetical child is HIV-positive. In this instance, although the adoptive parents still showed a slight preference for an infant, they were as willing as the foster parents to care for the older groups of children. Given the short life-span of these children, perhaps what is being witnessed here is a change in adoptive parents’ motivations towards being closer to those of foster carers’, that is, being more centred around altruism and a desire to help needy children in the shorter term. Not surprisingly, the study’s adoptive parents strongly indicated their preference for the child to have no siblings or relatives, irrespective of the child’s HIV status. Again this is an indication of the expectations of adopted parents informed by the traditional non-disclosed nature of adoption. In these instances, virtually no information and/or contact with the child’s biological family is the norm. Surprisingly, however, one would expect foster carers to be more accommodating of relatives and siblings, but in this study a great majority also indicated a preference for the orphaned child, irrespective of its HIV status, to have no siblings or relatives. Having noted this preference, should the orphan have siblings and relatives, both the adoptive and foster parents were equally willing for the child to remain in contact with them. This is surprising in that, given the same reasons as above, one would expect foster parents to be more willing for the child to remain in contact with relatives and siblings. Furthermore, one would expect adoptive parents to state a preference for the child not to have contact with relatives or siblings. In fact, the adoptive parents were far more willing than the foster parents for an HIV-positive child to remain in contact with his/her siblings and relatives. Given that adoptive and foster parents care mostly for non-biological children, it was surprising to note that the current study’s data pointed to a strong preference amongst both adoptive and foster parents for the orphaned child, irrespective of his/her HIV status, to be a member of their own families. Only if the child was HIV-positive did this situation appear to change, with both the adoptive and foster parents indicating a willingness to care for non-biological children. Limitations One of the foremost limitations of the study was its small sample size as a result of the poor response rate (just under 20%). It is known that postal survey response rates are low (Bailey, 1987). Furthermore, due to issues of anonymity and confidentiality, foster parents and particularly adoptive parents are a population that is difficult to access. It is likely that the high refusal rate introduced a systematic bias in the final

Townsend and Dawes

sample. For example, the demographic profile of respondents points to the fact that they were a relatively well-educated group of persons. It is likely that the responses of less educated persons were not forthcoming. Furthermore, it is possible that those who were more willing to care for a child with HIV/AIDS were also more likely to respond to the questionnaire. These potential biases makes it necessary to accept that those who did respond to the survey cannot be considered representative of the adoptive and foster parent population. Clearly, a better response rate and a larger number of respondents would have added substantial weight to the conclusions drawn and recommendations made from the results. Recommendations • In the current study, those adoptive and foster parents who did respond indicated that they would be willing to care for a child orphaned by HIV/AIDS. Two spin-offs are relevant here. Firstly, adoption and foster care as models of alternative parental care for orphans may be more viable than some may have presumed. To this end, adoption and foster care can be promoted as realistic and workable options for these children. Secondly, adoptive and foster parents may be a pool from which practitioners could begin their efforts at recruitment, particularly, as Brookes et al. (2004) note, ‘there is still time to anticipate and prepare for an increase in orphanhood’ (p. xv). • However, the present study did uncover significant differences between adoptive and foster parents. These differences appear to be situated in the different policy practices, motivations and reasons inherent in each form of alternative parenting. For this reason, it seems appropriate to recommend that alternative family care for orphans should be re-conceptualised and re-organised around more appropriate assumptions and guidelines, perhaps incorporating elements from both adoption and foster care. As only two examples, there would be a need to move away from the assumption that adoption involves infants only, and to move away from the assumption that foster care is necessarily a relatively short-term alternative care arrangement. • The finding that there was a strong preference for children to come from respondents’ biological families points to the need to promote adoption and foster care amongst those groups of persons for whom these services have historically been unavailable. • The finding that there was no distinct preference for HIVpositive children to come from respondents’ biological families suggests that recruitment outside of the biological family, and thus possibly across cultural/ethnic boundaries, should be considered a viable option for these children. • Protection for those children for whom these forms of alternative care appears to be less likely will be necessary. In addition, further research needs to be done to explore why male children, particularly those over the ages of six years, are not favoured for foster care. • Interview studies with random groups of foster and/or adoptive parents should be undertaken in order to reduce the possible bias introduced by low survey response rates.

African Journal of AIDS Research 2004, 3: 69–80

Conclusion

Downloaded by [Linnaeus University] at 21:45 09 October 2014

This study has shown that the adoptive and foster parent communities may well be viable groups from which to recruit carers for children orphaned by the HIV/AIDS pandemic in this country. Valuable information has also been gained with regard to the characteristics of children who are more or less easy to place, suggesting that those who are difficult to place, particularly males and children over six, will require particular attention, lest they fall through the cracks of the adoption and foster care systems. Unless attitudes to fostering for older children and boys can be changed, these categories of hard-to-place orphaned children are potentially most vulnerable to neglect through a lack of alternative family care options. The authors — Loraine Townsend is a research officer and PhD student in the Department of Psychiatry and Mental Health at the University of Cape Town where she is currently involved in a prospective cohort study exploring adolescent risk behaviours. Her research interests include adolescent risk behaviour, particularly among high school drop-outs. Andrew Dawes is a Director in the Child Youth and Family Development, Human Sciences Research Council, and an associate professor in Psychology at the University of Cape Town. He has extensive research experience in applied developmental psychology. His main research interests include the impact of violence and abuse on children (including children in armed conflict), and violence prevention.

References Amman, A. (2002) The ongoing HIV epidemic. Student British Medical Journal, 10. Available at www.studentbmj.com/back_issues/1202 editorials [Accessed 20 March, 2003] Bailey, K.D. (1987) Methods of Social Research, 2nd edn. New York, The Free Press. Bray, R. (2003) Predicting the social consequences of orphanhood in South Africa. University of Cape Town, Centre for Social Science Research, working paper no. 29. Brink, P. (1998) Adoption practice in the AIDS era: a South African perspective. Available at www.togan.co.za/cindi/papers/paper1.htm [Accessed 16 June, 2000] Brookes, H., Shisana, O. & Richter, L. (2004) The National Household HIV Prevalence and Risk Survey of South African Children. Cape Town, HSRC Publishers. Churchill, S.R., Carlson, B. & Nybell, L. eds. (1979) No Child is Unadoptable. Beverly Hills, Sage. Draft Discussion Paper (2000) Global framework for addressing the plight of children and adolescents affected by AIDS. UNICEF. Available from [email protected] Foster, G., Makufa, R., Drew, R., Kambeu, S. & Saurombe, K. (1996) Supporting children in need through a community-based orphan visiting progamme. AIDS Care 8(4), pp. 389–403. Foster, G. & Williamson, J. (2000) A review of current literature on the impact of HIV/AIDS on children in sub-Saharan Africa. AIDS 14, Suppl. 3, pp. S275–S284. Giese, S. (2001) The impact of HIV/AIDS on the health and welfare of children in South Africa and on health and welfare services for children. Paper prepared for the Child Health Policy Institute, Cape Town, South Africa. Halkett, R. (1999) HIV/AIDS and the Care of Children. Braamfontein, South African National Council for Child and Family Welfare.

79

Harber, M. (1998) Developing a community-based AIDS orphan project: a South African case study. Paper presented at CINDI conference, Pietermaritzburg 9–12 June 1998. Harber, M. (1999a) Models of Care for AIDS Orphans: Lessons From Sub-Saharan Africa. University of Natal, Durban, Centre for Social & Development Studies. Harber, M. (1999b) Transforming adoption in the ‘new’ South Africa in response to the HIV/AIDS epidemic. Adoption & Fostering 23(1), pp. 6–15. Hasewinkel, S. (2000) The divine child. Report on a workshop held in Cape Town on 28 September 2000: South Africa’s children made vulnerable or orphaned by HIV/AIDS. Available at www.goedgedacht.org.za.divine2.html [Accessed 16 June, 2001]. McKerrow, N.H. (1996a) Responses to Orphaned Children. A Review of the Current Situation in the Copperbelt and Southern Provinces of Zambia. Zambia, UNICEF. McKerrow, N.H. (1996b) Implementation Strategies for the Development of Models of Care for Orphaned Children. Zambia, UNICEF. McKerrow, N.H. & Verbeek, A.E. (1995) Models of Care for Children in Distress. KwaZulu-Natal, Edenvale Hospital. McLoyd, V.C. (1995) Poverty, parenting and policy: meeting the support needs of poor parents. In: Fitzgerald, H., Lester, B. & Zuckerman, B. eds. Children of Poverty: Research, Health and Policy Issues, (pp. 115–132). New York, Garland Press. Muminovic, M. (2002) Children orphaned by HIV and AIDS (2002). Student British Medical Journal 10. Available at www.studentbmj.com/back_issues/1202 editorials [Accessed 20 March, 2003]. Natrass, N. & Geffen, N. (2003) Providing anti-retroviral treatment for all who need it in South Africa. University of Cape Town, Centre for Social Science Research, working paper no. 42. Nelson Mandela Children’s Fund (2001) Report on A Study into the Situation and Special Needs of Children in Child-headed Households. Johannesburg, South Africa. NMF/HSRC (2002) Nelson Mandela/HSRC Study of HIV/AIDS: South African National Prevalence, Behavioural Risks and Mass Media Household Survey. Cape Town, Human Sciences Research Council. Pakati, E.R.V. (1984) Legal Adoption in an African Community. Unpublished Master of Social Science Thesis, University of Natal, South Africa. Richter, L. (1994) Economic stress and the family. In: Dawes, A. & Donald, D. eds. Childhood & Adversity. Psychological Perspectives from South African Research (pp. 28–50). Cape Town, David Phillips. Richter, L. (2001) Slipping through the safety net. ChildrenFIRST 5 (38), pp. 30–33. Richter, L. (2003) The impact of HIV/AIDS on the development of children. Paper presented at the Institute for Security Studies Seminar, Pretoria, South Africa, 4 April 2003. Schonteich, M. (1999) AIDS and age: SA’s crime time bomb? Aids Analysis Africa 10(2) Aug/Sep, pp. 1–4. Sishuta, H.B. (1996) Foster Care as a Form of Substitute Care in the Black Community: an Exploratory-descriptive Study. MSoc.Work Thesis, Rhodes University, Grahamstown, South Africa. Smart, R. (2000) Children living with HIV/AIDS in South Africa — a rapid appraisal. An Interim National HIV/AIDS Care and Support Task Team report funded by Save the Children, UK. Steinberg, M., Kinghorn, A., Soderlund, N., Schierhout, G. & Conway, S. (2000) HIV/AIDS — facts, figures and the future. In: South African Health Review 2000, chapter 15. Available at www.hst.org.za/sahr/2000 [Accessed 12 April, 2001] Thomas, A. & Mabusela, S. (1991) Foster care in Soweto, South Africa, under assault from a politically hostile environment. Child Welfare 70(2), pp. 121–130.

80

Downloaded by [Linnaeus University] at 21:45 09 October 2014

Tolfree, D. (1995) Roofs and Roots. The Care of Separated Children in the Developing World. Hants, UK, Arena. Townsend, L. (2001) Decisions to Care for HIV/AIDS Orphans. Master’s Thesis, Department of Psychology, University of Cape Town, South Africa. UNICEF (2002) Children on the brink, 2002: a joint report on orphan estimates and programme strategies. Available at www.uniceg.org/pubsgen/children-on-the-brink [Accessed 30 March, 2003].

Townsend and Dawes

Whiteside, A. and Sunter, C. (2000) AIDS. The Challenge for South Africa. Cape Town, Human & Rousseau Tafelberg. Wild, L. (2001) The psychosocial adjustment of children orphaned by AIDS. Southern African Journal of Child and Adolescent Mental Health 13(1), pp. 3–22. Wilson, T., Giese, S., Meintjies, H., Croke, R. & Chamberlain, R. (2002) A Conceptual Framework for the Identification, Support and Monitoring of Children Experiencing Orphanhood. Cape Town, The Children’s Institute, South Africa.