1. Psychosocial Issues facing Children & Adolescents living with HIV/AIDS in South Africa

2. Overview of Field Placement  University of Kwazulu Natal – School of Social Work & Psychology  Sinikithemba HIV/AIDS Care Centre  History  Client Population  Social Work Department

3. Areas of Field Work  Casework with children and their families at the SKT Paeds Clinic  Casework in SKT HIV/AIDS Care Centre (Adult clients)  Discharge Planning at Mc Cord Hospital Wards  Psychosocial Assessment Paediatric Intake Form  ‘Role of the Social Worker in the Paediatric Clinic’

4. Areas of Field Work continued…  Study of disclosure of HIV status to children at the Sinikithemba Paediatric Clinic  Disclosure Policy  Disclosure Protocol  Guidelines for staff: Working with Children & Caregivers on Disclosure  Trainings Completed:  Certificate in HIV/AIDS Counselling  South Africa Department of Health ARV Training Program for Social Workers  Weekly in-service trainings at SKT

5. Sinikithemba Paediatric Clinic  Multidisciplinary Team  Demographics of Client Population  Profile of Caregivers

6. Psychosocial Issues  Disclosure  Care & Treatment Financial Support Emotional Support  ARV Adherence Support  Community support  Grief & Bereavement  School Adjustment & Functioning

7. DISCLOSURE Normalizing HIV Status Disclosure: The window to providing for Psychosocial needs of Children & Adolescents ARV ADHERENCE STIGMA & DISCRIMINATION ACCESSING COMMUNITY RESOURCES GRIEF & BEREAVEMENT ACCESSING SUPPORTIVE COUNSELLING PROVIDING FOR SAFETY OF CHILD IN ALL SETTINGS FORM OF PREVENTION

8. Disclosure …. the process through which a child/adolescent receives, and copes with information about his/her HIV status … a process as opposed to a one-shot dose of information … continues as SKT supports the child and his/her caregivers to increase their understanding of HIV and learn how the virus behaves in the body

9. Categories of disclosure status  Disclosed  Partially disclosed  Not disclosed

10. Considerations in Disclosure  Age of Disclosure  Formulating a Disclosure Plan  Legal & Ethical Issues  The Disclosure Process

11. Decision-Making for Caregivers  may decrease the ability of caregivers to control secondhand disclosure by others  Children/adolescents, even though secrecy is requested, may disclose their status and the status of caregivers to others  Possible increased vulnerabilities for child/adolescents – depression, isolation are some difficulties which he/ she may experience as a result of learning of his/her status  Caregivers who are having difficulties in coping with their own status and illnesses may experience extreme anxiety in the disclosure process

12. Misconceptions  ‘Disclosure will only be necessary if I get really sick, my child does not need to know.’ Disease Progression instead of an ‘anticipated rewards vs. costs’ approach to disclosure  ‘The child just talks too much, she/ he has no control over his/her mouth’  ‘My child will kill him/herself if he knew’  ‘If my child asks if she/he has HIV I will tell him/her no, when he/she gets older they will understand why I did what I did’

13.  ‘Children cannot understand death!’  ‘If my child learns that I gave him/her HIV he/she will hate me’

14. Disclosure & the Social Worker’s Role  Psychosocial Assessments  Home Assessments  Educating Caregivers  Building Patient’s competencies for treating with the progression of the Illness  Building Community resources

15. QUESTIONS ….