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Children - Exec Summary 1.3 Findings
Participants felt that:
1.3.1. Many factors make children vulnerable in Cambodia, nearly all of them related to poverty. Girls have more vulnerability factors than boys do, and the most vulnerable age is 7-12 years. The most vulnerable children overall are orphans from poor families.
1.3.2. Children affected by HIV/AIDS are exposed to increased factors of vulnerability through high levels of psychosocial stress and stigma.
1.3.3. The impacts of having a parent with HIV-related illness on children are multiple and serious. Families can slide into poverty quickly. Children become carers and income generators, some have to leave home.
1.3.4. After the death of a parent, children can be cheated of land, housing and other assets. Some may have to work or beg to pay back their parents' debts. Siblings are often split up and are unable to look after one another.
1.3.5. There are limitations to all the options for the care of orphans when both parents have died of AIDS. Grandparents are old and poor and the demographics show proportionately few people of grandparent age; other relatives may treat them as servants; monks have limited resources; children prefer family life to orphanages; life on the street can be dangerous and unhealthy. Adoption and fostering practices are largely unregulated.
1.3.6. Adults often see orphanages as the answer, but children – particularly those in orphanages themselves - disagreed. Overwhelmingly children said they would prefer to live in a family within a community.
1.3.7. The psychosocial impact on children affected by AIDS is very high. Caring for sick parents, coping with grief, being relocated to unfamiliar surroundings, separated from siblings and other support networks can all be traumatic for children. Children may worry that they themselves are infected, that their parents have done something bad, or even feel that they themselves are in some way responsible for what has happened. They may be actively discouraged from talking about a situation where the death of parents is associated with sex. They may be made fun of by other children, or isolated from playing with other children by adults who are misinformed about HIV transmission. Often children in distress behave in ways that may be interpreted as misbehaviour.
1.3.8. Generally, adults don't bother with explanations about why a parent has died if the child is less than 11 years of age. Only a few individuals and organisations in Cambodia have skills to help children grieve, and to help vulnerable children cope with multiple stresses.
1.3.9. Children with HIV are at risk of being denied some basic rights. Poverty and misinformation can result in families thinking it is not worth treating a child with HIV or sending them to school. There is little experience amongst health workers of treating children with HIV/AIDS in Cambodia, and drugs are either expensive or not available.
1.3.10. There are almost no specialist services for children affected by AIDS in Cambodia. Supporting the family through illness and death from HIV/AIDS is very important to help them not waste precious resources on false cures, and to plan for the future of their children.
1.3.11. Bolstering the existing coping mechanisms of carers and of children themselves is an important goal. This could be done through targeting income generating schemes, credit and savings or by giving direct material support to those caring for children orphaned by AIDS. Children are extremely capable, and orphans can be given skills and opportunities to look after themselves.
1.3.12. Community resources could be enhanced to protect the interests of children affected by AIDS. Widespread HIV/AIDS education is necessary first so that people are not afraid of getting HIV. Role modeling the care and support of people with HIV/AIDS is a good way to help people see there is no risk. Neighbours can help care for the sick and help with practical chores. Community leaders can help solve domestic conflict, including land disputes; negotiate reduced school fees for the poor; encourage community protection of vulnerable children and help keep brothers and sisters together.
1.3.13. It is very important that community programmes of both NGOs and local government integrate HIV/AIDS care and support issues into all activities and into staff training at all levels. To help children, organisations should target families who are economically weak and vulnerable, where parents are chronically sick or the father is absent, and families who are homeless or have no land.
1.3.14. Certain government ministries are key in responding to the needs of children affected by AIDS. In addition to the Ministry of Health, the Ministries of Social Affairs, Women’s Affairs and Rural Development have potentially important roles with children affected by AIDS. Government social workers aware of children in families with HIV/AIDS could assist with placement in the community, child protection and continued education. VDCs can facilitate community protection of these children.
1.3.15. Better access to general health care through government health centres would benefit families affected by AIDS, as would expanding home care and national coverage of HIV counselling and testing centres. Planning for children’s future is crucial, and increased access to testing and counselling would facilitate this.