Coping: a challenge for guardians of children orphaned by HIV/AIDS in a South African township

Abstract

The main objective of this study, part of an investigation into the health of guardians of HIV/AIDS orphans, was to explore the guardians' coping mechanisms. Previous research has shown that there is a relationship between the use of social support networks and the guardians' ability to cope with the challenges of caring for HIV/AIDS orphans. Data were collected by means of a socio-demographic questionnaire and individual semi-structured interviews with guardians who attend a support group organised by a non-governmental organisation in Alexandra, the oldest township in Gauteng and a very poor area of South Africa. The article concludes that harnessing social support networks is an effective strategy that could help guardians cope with the challenges of caring for HIV/AIDS orphans.

Keywords:

• Coping mechanisms
• guardians
• HIV/AIDS orphans
• social support networks

1. INTRODUCTION

The HIV/AIDS epidemic has altered the demographic structure of many societies. Two groups have been identified as the most affected: children orphaned by the epidemic, and other vulnerable children; and the guardians, usually elderly females, who often bear the burden of care (Barnett & Whiteside, 2002).

Orphans are a part of all communities. The AIDS epidemic as reported by Barnett and Whiteside (2002) has resulted in 13.2 million orphans globally. Barnett and Whiteside (2002) define orphans as children who lose their mother or both parents because of AIDS before the age of 15. Many of these orphans are being taken in by grandmothers or other female family members. In southern Africa, AIDS is creating so many orphans that it is very difficult for family structures to cope. Rampant unemployment makes it almost impossible for families and communities to take care of themselves, let alone these orphans. By 2004 the estimated number of orphans in South Africa was 1 126 000 (Dorrington et al., 2004).

This article focuses on the challenges faced by elderly guardians caring for HIV/AIDS orphans in Alexandra Township in Gauteng and the way these guardians cope. A better understanding of the challenges and the way they cope with them is mandatory if solutions are to be found. The article emphasises the importance of ‘bonding social capital’, which, as Campbell (2003) shows, bonds people in relationships characterised by trust, reciprocal help and support, and a positive common identity. It links individuals together, producing close trusting relationships with similar others, in the absence of practical and material resources such as money, food and appropriate services, which are important for coping with a stressor, both practically and psychologically (Meursing, 1997; Campbell, 2003).

2. BACKGROUND

HIV/AIDS heavily taxes the coping resources of individuals and communities. Researchers such as Meursing (1997), Barnett and Whiteside (2002), Campbell (2003) and Kiggundu (2005) have shown that the impact of HIV/AIDS is most visible among the marginalised. Campbell (2003) points out that while it has become common to refer to HIV/AIDS as an epidemic of globalisation, and while much publicity has been given to its impact on people in the wealthy countries of North America and Western Europe, its effect is concentrated in the less affluent areas of the world.

Alexandra, which has been ravaged by HIV/AIDS, is regarded as one of the poorest communities in South Africa (Le Marcis & Ebrahim-Vally, 2005). As elsewhere in the world, HIV/AIDS has caused pain and suffering to people in this community. Campbell (2003) observes that the disease targets people in the prime of their economic and child-rearing lives, leaving the old, sick grandmothers, often with no source of income except their meagre pension money, responsible for caring for the orphans. Demmer (2004:40) notes that AIDS in Africa has been called the ‘grandmother's disease’ because older women are expected to care for the children orphaned by AIDS and to feed, house, clothe and educate them. This situation is further complicated if the children are HIV-infected and they later on have to bury them. The grandmothers are deprived of the support their children would have given them in their old age. Caring for orphans can be a major stressor in the grandmothers' lives, affecting their health and ability to cope and their general well-being (Simpson, 2006). A study by OXFAM (Rajcoomar, 2005) explores the way HIV/AIDS has affected the lives of rural grandmothers, showing that there has been a complete reversal of roles, where the elderly now rear the orphaned and vulnerable grandchildren. It is thus essential to understand the challenges these elderly guardians face in caring for HIV/AIDS orphans in Alexandra and to determine whether sufficient support, psychological and social, is available to them to help them cope.

2.1 Coping theories

Definitions of the term ‘coping’ are various but closely linked, with the variations manifested more in detail than in substance. For instance, Lazarus and Folkman (as quoted by Taylor,  1986) define ‘coping’ as a process by which people manage internal or external demands that tax or exceed the available resources. This, as Schafer (2000:292) explains, requires them to constantly change their functioning so as to manage these demands. Moos and Schaefer's definition, as cited by Folkman (2003), distinguishes two styles of coping: ‘emotion-focused’ and ‘problem-focused’ in the context of a specific stressful encounter or situation.

2.1.1 Problem-focused coping

On being confronted with a new event, a person makes a primary appraisal of it to determine whether it poses a threat or not. If the event is indeed judged to be threatening, then the person assesses which resources and potential coping strategies are available to deal with the stressor (Folkman & Lazarus, 1988, as quoted by Meursing, 1997). If the person judges that sufficient resources are available to deal with the stressor, he or she is likely to engage in problem-focused coping, also called ‘active-behavioural coping’ by Meursing (1997). This means that the person tries to deal with the problematic situation itself; for example, by seeking information, by planning, by taking direct action or by seeking help.

2.1.2 Emotion-focused coping

A person who engages in emotion-focused coping, on the other hand, feels powerless when discovering that there are insufficient resources to deal successfully with the stressor. This type of coping, as noted by Meursing (1997), attempts to deal not with the stressor itself but with the emotional strain it produces. For example, the person may re-interpret the stressor more positively, ventilate negative emotions or resort to denial of the stressor (Folkman & Lazarus, 1988, as quoted by Meursing, 1997).

2.1.3 Factors influencing the coping style

Several researchers, such as Helman (1990), Bandura (1995) and Simpson (2006), have identified factors that influence people's coping styles. Bandura (1995) states that the degree of control people feel they have over a stressor is central to the subsequent orientation towards taking action to master the problem itself, or towards reducing emotional strain. The extent to which people can organise and execute the courses of action required to deal with events depends on what he calls ‘self-efficacy beliefs’. These beliefs are the outcome of the balance between situational demands posed by a stressor on the one hand, and a number of personal and contextual variables on the other. Relevant personal variables influencing perceived self-efficacy are coping skills and biological resilience or vulnerability. Important contextual variables are the availability of social support and material resources for coping (Bandura, 1995).

Access to practical and material resources, such as money and appropriate services, is important for coping with a stressor, as noted above. Billings and Moos (1981) found that American families with a higher level of income and higher education used more active, problem-focused coping strategies in dealing with problems than families from lower socio-economic backgrounds. These findings suggest that access to adequate material resources is associated with more problem-oriented coping, which in turn may be linked to a heightened sense of control or self-efficacy. In contrast, socio-economic conditions where a lack of resources is a permanent fact of life – possibly over generations – may decrease a person's self-efficacy beliefs. In the same way that Helman (1990) links poverty to a low sense of control over health, Lewis (1996) asserts that people who live in poverty have a low sense of control over life stressors, which means they have a short-time perspective and use short-term problem-solving strategies.

The other major contextual influence on self-efficacy, as explained by Meursing (1997), is the availability of social support. Practical, material information and emotional support from friends and family increases the instrumental means to deal with a problem, and can act as a buffer against emotional strain, thereby increasing perceived self-efficacy. Even when a person initially judges a stressor to be beyond his or her control, this judgement may well be revised once adequate social and emotional support becomes available. Thus, social support can stimulate active, problem-focused strategies, while lack of social support may cause a person to use emotion-focused strategies.

Besides the support a social environment may provide or withhold, self-efficacy beliefs may be influenced by social models that provide an opportunity for vicarious learning. Thus, a person's sense of self-efficacy can grow by seeing others in a similar situation succeed through perseverance.

According to Bandura (1977), the example of successful social models may transmit knowledge, skills and strategies to achieve the desired ends. Social persuasion employed by a trusted communicator (such as a counsellor) can also strengthen the belief that one ‘has what it takes’ to succeed, thus increasing motivation for sustained effort. Most importantly, self-efficacy is built upon performance experiences. Success, particularly success achieved in the face of adversity, increases self-efficacy beliefs. For some people, self-efficacy beliefs may become a more or less permanent feature of their personality (Bandura, 1977).

3. THE RESEARCH DESIGN

This study was part of a larger investigation into the health status of guardians of HIV/AIDS orphans who attend a non-governmental, non-discriminatory, non-profit voluntary organisation, based in Alexandra, in Region 7 of the of the Johannesburg Municipality, which provides care, support and empowerment to a broad spectrum of people living with and affected by HIV/AIDS. Alexandra is the oldest township in Gauteng and one of the poorest areas in South Africa. Its poor infrastructure, congestion and widespread crime make living conditions difficult. This article explores the challenges these guardians face and the way they cope with them.

Before conducting the cross-sectional baseline survey, the researchers visited this HIV/AIDS centre to introduce themselves, make observations, and explain the objectives of the project to the elderly people attending the centre and obtain their consent to take part. Approval from the Ethics Committee of the University of the Witwatersrand was granted unconditionally.1 The study met the Medical Research Council guidelines for research in human beings. Participation was voluntary, and respondents could withdraw at any time. Their written consent, or fingerprint for illiterate respondents, was obtained, and anonymity and confidentiality were ensured as they were allocated numbers and no names were used.

3.1 Sample strategy

A random sample of 62 guardians, 50 per cent of the total number attending the support group, was selected for the cross-sectional baseline survey. Eight fieldworkers, Zulu and Sotho speakers, were recruited and trained using a training manual and participatory facilitating methods. The data from 62 socio-demographic and health questionnaires were compiled and analysed for the purpose of this article.

A subsample of 30 guardians was interviewed, using semi-structured interviews, to explore the challenges they face and to discover how they cope. An in-depth, qualitative approach was used. Individual interviews were conducted mainly in English, with some interpretation in Zulu and in Sotho by the principal investigator. To maintain privacy throughout the interviews, no fieldworkers were used for this part of the study. However, despite the sensitivity of the subject matter, the respondents were willing to discuss the challenges openly.

3.2 Data collection

3.2.1. Characteristics of participants

A social-demographic and health questionnaire was compiled in English. The reproducibility of the questionnaires was tested by having the same 10 guardians complete one questionnaire each week for a period of 4 weeks, after which the answers were compared. On the basis of the results, the questionnaire was accepted to be reproducible as a high correlation was found (r = 0.623, p ≤ 0.05). All of the respondents were interviewed by fieldworkers to obtain demographic data such as age, gender, role in the family, home language, level of education, health profile, number of household members; socio-economic data such as employment status; and physical and infrastructural data such as location (informal settlement, township, etc.), size of house (number of rooms), type of house (brick, grass, mud, zinc, shack, etc.), and services available (electricity, water, toilet, waste removal, etc.).

3.3 Statistical analysis

The demographic and socio-economic data were captured and analysed using the Statistical Package for Social Sciences for the Windows version 14.0 program for all variables except dietary intake data. Data from the interviews were analysed manually, drawing on memos and summary sheets, which captured the main concepts, themes, issues and questions.

4. RESULTS

The research results were categorised into themes. The authors linked local and international authors' insights on these themes to information gleaned from questionnaires and interviews. Significant statements made by respondents during the interviews are quoted below to illustrate certain themes.

4.1 Characteristics of the respondents

4.1.1 Socio-demographic profile

All of the respondents were black (n = 62, 100 per cent). Their ages ranged from 36 to 83 years, with a mean of 60.9 years. The majority were women (n = 60, 96.8 per cent),2 and there was a high percentage of widows (n = 24, 38.7 per cent) and single respondents (n = 19, 30.6 per cent). A low literacy level was prevalent in this community, as only 32.2 per cent (n = 20) of the respondents had attended secondary school or tertiary institutions. Table 1 presents further statistics for the sample.

Table 1: Socio-demographic characteristics of the sample

Characteristic	Total sample (n  =  62)
Gender
Men	2 (3.2)
Women	60 (96.8)
Marital status
Widowed	24 (38.7)
Married/living with partner	11 (17.7)
Never married/single	19 (30.6)
Divorced/separated	7 (11.3)
Education level
No formal education	14 (22.6)
Primary school	28 (45.2)
Secondary school	17 (27.4)
Post-school	3 (4.8)
Note: Data presented as n (%).

None of the respondents lived alone and the average household size was six persons, which indicates widespread overcrowding. Table 2 shows that most of the respondents were living in brick houses (n = 52, 83.9 per cent). The houses ranged in size from relatively small with only one or two rooms (n = 38, 61.3 per cent), to three to four rooms (n = 11, 17.7 per cent) and to larger houses with more than four rooms (n = 13, 21.0 per cent). Clean water was available to the majority of the respondents (n = 51, 82.3 per cent.)

Table 2: Living conditions

Characteristic	Total sample (n  =  62)
Number of people in household
1–5	34 (54.9)
6–9	21 (33.9)
≥10	7 (11.3)
Head of household
Mother	20 (32.3)
Grandmother	35 (56.5)
Other	7 (11.2)
Type of house
Brick	52 (83.9)
Zinc shack	8 (12.9)
Other	2 (3.2)
Number of rooms
≤ 2 rooms	38 (61.3)
3–4 rooms	11 (17.7)
>4 rooms	13 (21.0)
Availability of clean, safe water
Tap inside the house	21 (33.9)
Tap outside the house	30 (48.4)
Fetch water from elsewhere	4 (6.5)
Note: Data presented as n (%).

Table 3 shows that 50.9 per cent (n = 28) of the respondents in the sample were retired. Only 21.8 per cent (n = 12) said they were unemployed; however, about one-third of the sample relied on only one person contributing to household income (n = 20, 32.8 per cent). The monthly income of nearly one-half of the households (n = 27, 45.0 per cent) was R501−1000 (US$77−154).3 Less than one-third of them (n = 18, 29.9 per cent) had a monthly income of more than R1000. Nearly one-half of the respondents (n = 29, 46.7 per cent) reported monthly household food spending of less than R200 (US$31). The grandmother was responsible for preparing food and deciding what food to buy (n = 35, 56.5 per cent), as well as feeding the children (n = 36, 58.1 per cent), in well over one-half of the households. The results further show food insecurity as 37.1 per cent (n = 23), indicating a chronic shortage of money to acquire their primary requirements.

Table 3: Income levels and buying patterns

Characteristic	Total sample (n  =  62)
Grants received
State old-age pension	28 (50.9)
Number of people contributing to household income
1	20 (32.8)
2	19 (31.1)
>2	22 (36.1)
Total household income per month
<R500 (US$75)	16 (25.0)
R500–R1000 (US$100–149)	27 (45.0)
R1001–R2000 (US$149–299)	17 (26.6)
>R2000 (>US$299)	2 (3.3)
Monthly food expenditure
R0–R100 (US$0–15)	19 (30.7)
R101–R200 (US$16–30)	10 (16.1)
R201–R300 (US$31–46)	13 (21.0)
>R300 (>US$45)	9 (14.5)
Do not know	11 (17.7)
Household member responsible for food preparation
Mother	15 (24.2)
Grandmother	35 (56.5)
Household member responsible for food buying decisions
Mother	20 (32.3)
Grandmother	35 (56.5)
Household member responsible for feeding the children
Mother	20 (32.3)
Grandmother	36 (58.1)
Reported head of the household
Mother	21 (33.9)
Grandmother	35 (56.5)
Number of meals served per household per day
2	12 (19.4)
3	44 (71.0)
>3	6 (9.7)
Note: Data presented as n (%).

4.2 Challenges

4.2.1 Old age and sickness

Asked about the challenges they faced, the respondents said that they were overburdened by the responsibility of taking care of orphans. They were all caring for at least two orphans, and the majority (n = 60) had four or more children to care for. The orphans were aged between 6 months and 18 years.

All of the guardians said they were in no position to care for the orphans. Most of them are old. They cannot wash, clean and cook for the children. They do not have any support. One respondent shed tears and said ‘Cha angeke ngisabekezela manje lokhu kungaphezu kwamandla ami angeke ngi qhubeke nokuphila kanje’, meaning she could not take it any longer, that it was too much for her, and that she could not continue living that way. The majority of the guardians were not well. They had developed stress-related illnesses because of the added responsibility. Among their ailments were high blood pressure, diabetes, arthritis and depression, and some were HIV-positive. This illustrates Simpson's (2006:7) argument that the emotional strain of caring can lead to physical and emotional complications such as insomnia, chronic fatigue, tiredness, feeling run down, increased susceptibility to illness, depression, anxiety, poor appetite, lost hope, decreased motivation and chronic pain, such as backache.

Caring for the sick children sometimes means the caregivers get infected. In the study on which this article is based, two respondents said they had been infected with HIV from their daughters during the time they were nursing them. They said their daughters had not told them what they were suffering from, and they had sores all over their bodies yet they would wash them without gloves. One respondent lamented: ‘It was during the very last stages that my daughter admitted to having the virus and by then it was too late for me’. These data accord with Rajcoomar's (2005) statement that the main stressors of rural grandmothers are the financial costs of funerals, caring for sick children and adults, a lack of family support or grief counselling, insufficient knowledge about HIV/AIDS and how to protect oneself from infection, and the financial burdens of orphaned children.

It also bears out Williams's (1998) findings that old people were affected by the epidemic more through fulfilling their parental obligation than through the loss of their children's support. First they care for their children who are sick, then they bury them; finally, they care for their grandchildren. Grandmothers in this study assumed the responsibility for rearing orphans at an age when they no longer worked as they relied on the old-age pension and did not have the energy to work to make up for the extra expense of caring for the grandchildren and orphans. This meant a loss of income, and thus a reduction in food and a deterioration in nutrition status for them and the children.

Some grandmothers were raising grandchildren whose parents had died when the grandchildren were still infants. To compound the problem, some of the children are HIV-positive. Four of the respondents said they were HIV-positive but had not told their grandchildren because they did not want to worry them. They said they always tried to live positively for the sake of their grandchildren. However, all guardians, especially the HIV-positive guardians, worry about what will happen to the children: ‘If I die, who will take care of these children?’ One respondent referred to this as the million-dollar question that they always ask themselves when they meet in the support group.

Respondents were knowledgeable about HIV/AIDS. One respondent said proudly, ‘I now know everything that there is to know about HIV/AIDS, thanks to the nurses at the local clinic’. She had confidence in the anti-retrovirals she was taking and was grateful that the government was supplying these free of charge. She said she had been living with the virus for the past 10 years and was confident she would be able to raise her four grandchildren because of these drugs.

4.2.2 Lack of financial support

Financially, the guardians were not in a position to support the orphans. All respondents said they were struggling to take care of the children. Some said they had given up employment in order to care for them. Some of the orphans were on a foster care grant of R590 per month and some on a child support grant of R180 per month. The guardians said they always apply for foster care grants but the process takes a long time, and they fear that by the time it goes through the children will be over 18 and no longer qualify for the grant. One guardian said:

I applied for foster care grant but I did not get it and now the child is 20 years without a job because he does not have any qualification since I could not afford to take him to school. Another child is 16 years old. He is on foster care grant but it will lapse in two years time when he turns 18 and he would not have finished school.

Several guardians said they had applied for a foster care grant but could not get it because they did not have birth certificates for the children. One respondent taking care of three orphans, aged 6, 5 and 3, said that of the three children only one gets R180 per month from a child support grant.

I do not have the birth certificates of the other two. The mother (my daughter) did not give them to me before she died and I cannot trace them; maybe they did not process them because they did not have an ID … It is very difficult to get a grant without a birth certificate … They also require a Road to Health Card from the clinic, which I cannot trace.

The guardians also mentioned that there is no money for matriculants to further their studies after passing their examinations. Some children study up to Grade 12 but the guardians cannot afford to provide them with higher learning. Guardians are not aware of or advised about the availability of scholarships and bursaries. Some said their children had applied for scholarships for tertiary education but they were told it was too late to apply. One said her oldest grandson had a bursary to go to school but she did not have money for transport. Guardians reported not having enough money to feed all the children. Sometimes children go to bed at night without food.

4.2.3 Insufficient accommodation

Well over one-half of the respondents said they were staying in a one-roomed or two-roomed house. They do not have space for the children. The houses are made of corrugated iron and they are not well ventilated and have no compound or any space to grow vegetables. Some respondents said they did not have toilets. Some said they did not own a house; they were just renting one room. One respondent lamented:

I applied for a house and I am still waiting for a response from government but they are taking too long. I am HIV-positive. If I die where will my grandchildren stay? I do not have any family.

Similar fears were echoed by other HIV-positive respondents. Such harsh circumstances substantially add to the burden of caring for the orphans.

4.2.4 Discipline of orphans

Most respondents said the children were ill-disciplined and stubborn. ‘They do not listen to us, they do not help around the house, and they are moody and unruly’, the grandmothers complained. The respondents attributed the orphans' misbehaviour to missing their parents. ‘My grandchildren have got a temper. I am sure they have not come to terms with the death of their mother and they are looking for someone to blame’, said one.

All of the respondents agreed that children were always nice and sweet when they were young but once they became teenagers they suddenly changed. They did not perform well at school. Some did not attend classes. Grandmothers often do not know how to deal with such situations, or they lack the energy to do so. One grandmother said her grandchild had missed school for 3 months without her knowledge. Many of the respondents said their grandchildren had had to drop out of school because they could not afford the fees.

The grandmothers said that the children were extremely demanding. ‘They are very choosy; they refuse the dry food provided by the NGO [non-governmental organisation] in Alexandra. They are very wasteful.’ One grandmother said she has to pay an electricity bill of R150 per month. They want expensive things the guardians cannot afford. Even before they turn 15 years of age, the girls acquire boyfriends or ‘sugar daddies’, in most cases taxi drivers, so they can get money to buy clothes, cell phones and airtime.

When asked whether the children know about the consequences of their behaviour, the guardians responded that the children know a good deal about AIDS but they do not listen. ‘When we say anything or try to discipline them, they run away from home and come back when they are pregnant. They would not even say who is responsible for the pregnancy.’ While the girls run off with older men in order to get money, the boys resort to stealing. Some become car hijackers. One respondent said her grandson was in jail for car hijacking and armed robbery. One guardian mourned thus: ‘The children are angry when we ask them why, they do not say anything. We do not know how to please them. We try to offer our best but they are still the same.’

While some guardians attributed the children's misconduct to poverty, others vehemently denied this, saying ‘Orphans get help from the NGO in Alexandra. They are just spoiled’−and one of them continued, ‘and we are partly to blame’, Asked why she had said that, she answered that when their daughters or sons die, they transfer all of their love to the orphans and do everything in their power to please them, and in the process the children get spoilt. ‘We give them too much love and they use it against us’, she said.

One respondent who is HIV-positive was forced to reveal her status to her 16-year-old granddaughter in a desperate attempt to change the girl's behaviour and bring her to her senses. She told her that if she continued to run around with men, she would die. However, the girl just laughed and assured her that she always remembers to carry an ‘umbrella’ whenever she anticipates rain. At this, the stunned grandmother dropped the whole matter.

The majority of the respondents mentioned that they have developed high blood pressure because of the stress caused by the children. ‘I worry a lot about this girl and my blood pressure goes up’, said one of the grandmothers of a 16-year-old.

4.3 Coping with the challenges of taking care of orphans

When asked how they cope with the challenges of taking care of orphans, the respondents answered that they have formed a support group with the assistance of an NGO where all interested grandmothers who have lost their children meet to comfort each other. ‘We openly tell each other about the pain we are going through and how we are coping. We give each other moral support.’ They said that, because people are dying every day, new grandmothers are joining every day.

People speak openly about their problems. At first it is very painful. People cry a lot but with time it gets better. We support and advise each other. We sometimes come with pictures of our children and we show each other.

The respondents said they found such practices therapeutic and restorative. They also mentioned two ladies from a private organisation who used to come and sit with them every Tuesday and listen to them and comfort them. The grandmothers all agreed that it was healing to meet these ladies and to talk about their problems. The respondents singled out one member working with a local NGO and they described her as having ‘a heart of gold’. They said this particular young woman goes to their homes and helps them care for the sick; for example, bathing the patients, cleaning the environment for the patients, and giving medication as prescribed by the doctor. The guardians said they wished there were more people like that young lady.

Through the NGO, the guardians accessed the Mandela Children's Fund and obtained money to perform a cleansing ceremony for their children and for circumcision. Each one was given R1500 for one child or R2000 for two children for the cleansing ceremony. This enabled them to buy a goat, and food and drinks, but they had to account for every cent. They said that this was a healing and salutary experience for both them and the orphans.

With the help of the NGO, members of this support group also participate in income-generating activities, mutual counselling and providing material support to destitute individuals and families. Grandmothers participate in projects such as candle-making, beadwork, sewing and a food garden project. These were designed to help keep the guardians' minds off their problems as well as to provide fresh vegetables. However, the respondents said that the sewing and beadwork project was not operational because most of them have failing eyesight and cannot afford glasses. Some said they could not come for such activities because they had to stay at home to take care of the children.

The members of the support group also formed a funeral society, which requires each member to contribute R20 a month, and this had helped their families have dignified funerals.

5. DISCUSSION

The study was conducted to explore the challenges faced by guardians of HIV/AIDS orphans in Alexandra and discover how they cope. The findings showed that their main problems were poverty and grief. Many reported having lost more than one adult child in succession. Most have pitiful and insecure houses, which means they lose food and other important items to insects, rodents and thieves. They do not have adequate bedding to keep them warm at night. They said they had reached the end of their tether. The common response, ‘No, this is too much for me’, indicates that they did not have adequate coping abilities.

Most respondents complained of problems disciplining the children in their care. This problem is not unique to guardians of orphans in Alexandra: Barnett and Whiteside (2002) identified similar problems in their study in Uganda. Jackson (2002) attributes the ill-discipline to the enormous mental stress of witnessing the illness and death of their loved ones and a profound sense of insecurity. Impoverished conditions cause children to grow up with low self-esteem and little sense of security. They are poorly educated and have poor social skills and minimal life chances to pull themselves out of poverty, so they have little chance of becoming productive and self-sufficient citizens and parents (Jackson, 2002).

Lack of resources largely affects or limits the self-efficacy of residents of Alexandra Township. However, they do have social and emotional support from friends in the support groups (‘bonding social capital’), which helps them to deal with the stress caused by HIV/AIDS-related problems. It is therefore important that more support groups be established in Alexandra to provide care as well as emotional, practical and moral support and empowerment to the guardians of orphans.

Most respondents said they joined the support group out of desperation and found it beneficial because members share their experiences and ideas, and help each other when they are sick. They said the group has helped them develop a level of trust among themselves and that they were willing to help and support each other. It helps them develop a positive attitude towards life. With its help these guardians, who would otherwise be socially excluded, have – to a certain extent – gained the power to lobby government and other funding agencies and business organisations to recognise and meet their needs.

5.1 Coping strategies

The study findings showed that this community is disadvantaged in terms of access to resources, which implies that poor unemployed people in Alexandra who are vulnerable to HIV/AIDS may not succeed in developing problem-focused coping strategies. Because of their sense of powerlessness and their lack of resources, they are more likely to turn to emotion-focused coping.

The results of this study confirmed Meursing's (1997) finding that the availability of social support, and the practical, material information and emotional support from friends and family, increase the instrumental means to deal with a problem. This can then act as a buffer against emotional strain, thereby increasing perceived self-efficacy. Even when a person initially judges a stressor to be beyond his or her control, this judgement may well be revised once adequate social, material and emotional support become available. Meursing (1997) argues that social support can stimulate active, problem-focused strategies, while lack of social support may result in the use of emotion-focused strategies. By mobilising community members and coordinating support groups, the NGO described in this study provides social support to people who have lost their loved ones to HIV/AIDS and who are taking care of orphans. Such support groups offer them friendship and emotional, practical and moral support, at a time when others are fearful, condemnatory or insensitive to their plight.

As explained in Section 2.1.3 above, the social environment and the example of others can increase a person's sense of self-efficacy and improve their motivation to cope with their problems. In the study on which this article is based, the guardians mentioned that whenever they meet as guardians of orphans, they listen to each other, share their experiences, cry, and comfort, strengthen and give each other hope.

It can therefore be argued that, while the lack of resources to a large extent affects the self-efficacy of the guardians in Alexandra Township, these guardians do, however, have social and emotional support from friends in the support groups (‘bonding social capital’), which helps them deal with the challenges of caring for HIV/AIDS orphans. Schafer (2000:439) argues that a person needs a network of social support during a crisis. Commenting on the importance of social support, Olivier (2005:356) points out that being integrated into a supportive and protective social structure makes a person less vulnerable during difficult times because it promotes a sense of coherence and connectedness that a person can draw on, and brings positive benefits, strength and security, by providing someone who will listen, love and understand, someone who has empathy and who helps.

It should be noted that, whereas other studies such as Rajcoomar (2005) and Simpson (2006) have emphasised the church as a support network, the respondents in this study did not mention this, although most of them said they were churchgoers. They explained that they felt that the church members did not actually understand the guardians' plight and they could not open up to them.

Grandmothers in this study said they were faced with many stressors. Such grandmothers are likely to die sooner than would normally be the case. If they can be assisted to reduce the stress factors, they would gain directly from additional healthy years.

On the basis of the findings of this study, the authors make several recommendations, as follows.

• Social support for grandmothers should be increased by providing them opportunities to meet in groups, and by reinforcing local women's organisations.

• To reduce the burden on the old, sick, unemployed grandmothers, the children could be placed in foster care or in foster homes. The government should support initiatives to educate communities about foster care and to raise awareness of the plight of orphans, so that community members can volunteer to provide homes for the orphans.

• Support and incentives should be given to community members who offer to care for the orphans. According to Simpson (2006:42), guardians would also benefit from spiritual support and prayers.

• More income-generating activities should be introduced, as well as training programmes to teach the guardians skills and help them become self-reliant rather than relying on handouts from well-wishers.

• There should be programmes to educate the orphans about their roles and responsibilities, using motivational speakers and role-models to address and encourage them.

• There should be workshops and training for the guardians on how to deal with orphans and reduce stress, and to alert them to the social support services available in the communities.

• Social grants, as observed by Booysen (2004:1), play an important role in mitigating the impact of HIV/AIDS. The grant application process should be speeded up. Government departments such as Home Affairs and the Department of Health should find a way to help applicants obtain the relevant documents so orphans can get their grants.

• The guardians' access to resources, including housing, social grants, state old-age pensions, disability grants and health facilities, must be ensured.

6. Conclusion

This study showed that guardians of orphans in Alexandra face enormous challenges when it comes to caring for and supporting HIV/AIDS orphans. Because this community is so disadvantaged in terms of access to resources, these poor, old, unemployed guardians develop a sense of hopelessness. The study showed that they were exhausted and depressed. This prompts a question: How do these seemingly helpless guardians cope and where do they derive their resilience from?

The authors argue that, despite the lack of resources, these guardians were receiving social and emotional support from friends in the support group, which helped them to a large extent to cope with their difficulties. They argue that harnessing social support networks could be an effective strategy for helping guardians to cope with the challenges of caring for these orphans in a resource-constrained setting like Alexandra Township.

Some insight into the guardians' coping ability was gained through this study. It is hoped that the Department of Health and Welfare, NGOs, community-based organisations, churches and other psychosocial support services will be challenged to provide better access to services, which will ensure that guardians of HIV/AIDS orphans are provided with the necessary support to enhance their coping mechanisms.

Notes

¹Protocol number MO80365, 25 March 2008.

²Although two men formed part of the baseline survey, the project focused on ‘female guardians’. Two men was too small a sample size to provide statistically representative data, so their comments were not included.

³At the time of the study, US$1 was equivalent to R.6.50 (February–March 2007).