Social policy implications for the care and welfare of children affected by HIV/AIDS in Kwazulu-Natal.
In the next few years South Africa with be faced with immense socio-economic problems created by the HIV/AIDS epidemic, not least of which will be the impact on children and their families. Evidence from other African countries shows that the presence oflarge numbers of AIDS orphans has major implications for the societies in which they live. Reports from these countries suggest that, even in the midst of high rates of HIV/AIDS, the African extended family system is remarkably persistent. However there is also evidence"that HIV/AIDS affected children face an increased risk of poor health care, of dropping out of school, of abuse and exploitation. The majority of communities affected by HIV/AIDS in South Africa are already poor, yet HIV/AIDS will place a huge strain on available resources. As the epidemic develops, an increasing number of children are likely to fall through the extended family safetynet and pressure will rise on welfare organisations to provide alternative forms of care. The welfare sector must therefore urgently find innovative ways both to support traditional forms of child care, and to develop new models of care. Welfare organisations are being faced with the challenges presented by HIV/AIDS at a time when national welfare policy is in a process of change. The White Paper for Social Welfare (Department ofWelfare, 1997), promotes a major shift of approach to welfare provision. The new approach is based on the principle wof'developmental social elfare'. This is a broad concept incorporating ideas such as 'building human capacity', 'promoting self-reliance', creating 'appropriate' services through 'community development' and the promotion ofincome generating activities. Organisations are encouraged to move away from a concentration on rehabilitative services and institutional care and to develop a preventative approach which relies more on community-based services and 'community' care. This important shift in welfare policy is being introduced within the constraints of the government's macro-economic strategy GEAR (Growth Employment and Redistribution). GEAR aims to create jobs and to link growth to redistribution. This is to be achieved through a tight monetary policy in which reduction of the budget deficit and 'fiscal restraint' are major emphases. Spending on welfare, along with the rest ofthe public sector is thus constrained within tight budgets. This thesis looks at a changing welfare policy in relation to the development of strategies to support children affected by HIV/AIDs. It explores themes contained in the 'developmental social welfare' paradigm and considers the impact ofthe HIV/AIDS epidemic through an examination of the literature and through empirical research. It focuses on the implementation of macro policy change at an organisational level. The following broad questions formed the basis for this research. 1. Given the growing HIV/AIDS epidemic in KwaZulu-Natal, what is being done by welfare organisations, and by whom, to provide care and support for children affected by HIV/AIDS? 2. Are welfare organisations in KwaZulu-Natal devising 'developmental social welfare' approaches to respond to the challenge of HIV/AIDS? If so, how is this approach being developed to assist children affected by the epidemic? What issues are being encountered? 3. In view of the fact that the AIDS epidemic in South Africa is several years behind other sub-Saharan African countries, are there any lessons that can be learned from other African countries about alternative models of care for affected children which have been developed? The research uses a case study approach within a qualitative research methodology. Research methods used were participant observation, interviews, questionnaires and collection of documentary sources. Three case studies are presented which look at different models of care and support for children affected by HIV/AIDS in the Pietermaritzburg district ofKwaZulu-Natal. Each ofthe case studies focuses on themes contained in the 'developmental social welfare' approach. The first case study looks at a community-based project for the support of HIV/AIDS affected children. It focuses on concepts such as community development and community action and at ideas of 'building human capacity' and 'self reliance'. The second case study considers the theme of,appropriateness' through the development an 'appropriate' adoption service for African children. The third case study, considers the issue of maximising resources through a study of a 'cluster' foster care scheme for HIV positive children. This study paints a picture both of potential disaster and of some possible ways forward. It highlights the achievements of the case study organisations. These include the promotion of awareness about the needs of vulnerable children through a community-based approach, as well as the development of new models of adoption for abandoned children and fostering for mv positive children. However, it also highlights the difficulties which faced these organisations, in particular budgetary constraints and the context of poverty within which they were operating. Tensions were found between the slow progress of community development' and the immediate needs of poor children and their carers in a rapidly progressing HIV/AIDS epidemic. The study points to the important role played by state social grants and the need to protect these . benefits. The study provides examples of the gendered nature of 'developmental social welfare' policies, specifically with regard to notions of 'self reliance' and community care. It proposes the need for a better analysis of the concepts contained within the 'developmental social welfare approach'. The need for a closer collaboration between the state and the non governmental sector is seen as critical to the development of a 'holistic' approach to the support of HIV/AIDS affected children.