An investigation into the effectiveness of group therapy in reducing the fear of public

stigma among guardians of children living with HIV/ AIDS in Outapi district.

By

Elizabeth Hishishii Shilyomunhu

Submitted to the Faculty of Humanities and Social Sciences in the partial fulfilment of a

Bachelor of Arts degree in the Department of Human Sciences.

At the

University Of Namibia

Mentor: Ms. Emma Leonard

External Moderator: Prof. L.S. Terblanche

6 November 2012

1

ABSTRACT

HIV/AIDS is a global challenge and its impact is evident. The devaluation of identity and

discrimination associated with HIV-related stigma do not occur naturally. Rather, they are

created by individuals and communities who for the most part, generate the stigma as a

response to their own fears. HIV-infected individuals, their loved ones for example family

members, friends and caregivers are often subjected to rejection by their social circles and

communities when they need support the most. Stigma associated with HIV/AIDS adversely

affects children and their caretakers/guardians in ways that have long-term negative

psychological and social effects. Because of the stigma, individuals, families and even whole

communities often discriminate against others in ways that cause great suffering.

A single-system study was undertaken to investigate the effectiveness of group therapy in

reducing fear of public stigma among guardian of children that are living with HIV/ AIDS in

Outapi District, Omusati region. Seven research respondents were selected by means of

purposeful non- probability sampling from the client files of the Outapi Communicable

Disease Clinic (CDC). Data was gathered through pre- and post-interviews categorised into

themes and analysed.

The study findings revealed that stigma is a major social challenge faced by guardians of

children living with HIV/AIDS. The guardians reported that disclosing the child’s status was

very difficult because they fear judgment and rejection from their community, friends, family

or even the children themselves. The findings showed a correlation between the literature and

the findings of the study. Social support programme example therapy group revealed by other

researchers emphasised the importance of these groups in addressing fear of stigma among

guardians/caretakers of children living with HIV/AIDS. Therapy groups help members to

become more assertive and develop new coping skills to cope with stigma in order to care for

the children under their care and for themselves, this was proven also by this study. There is

a general need for more research in specific communities such as Outapi District, which has

not received much attention, especially in the context of HIV/AIDS and guardians’ coping

mechanisms to HIV/AIDS stigma. The research findings can be helpful to Social Workers in

establish group therapy sessions for these guardians.

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Table of content

Pages

Abstract....................................................................................................................1

Table of content....................................................................................................... 2

Acknowledgments....................................................................................................4

Dedication................................................................................................................ 5

Chapter 1: Orientation to the study

1.1 Introduction........................................................................................................6

1.2 Definition of concepts........................................................................................7

1.3 Formulation of the problem................................................................................8

1.4 Aims and objectives............................................................................................9

1.4.1 Overall aim of the study................................................................................9

1.4.2 Objectives of the study..................................................................................9

Chapter 2: A guide through the literature reviewed

2.1 Introduction........................................................................................................10

2.2 Understanding the concept stigmatization.........................................................11

2.3 Dominance of women in caring role...................................................................13

2.4 Group intervention in addressing stigma.............................................................15

2.5 Conclusion...........................................................................................................19

Chapter 3: Research methodology

3.1 Introduction.........................................................................................................20

3.2 Research Question...............................................................................................20

3.3 Research Methodology.......................................................................................21

3.4 Sampling..............................................................................................................22

3.5 Data collection strategy........................................................................................23

3.5.1 Validity and Reliability..................................................................................24

3.6 Data analysis.......................................................................................................25

3.7 Ethical Issues......................................................................................................26

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3.8 Conclusion.........................................................................................................28

Chapter 4: Data analysis and Interpretation

4.1 Introduction...........................................................................................................29

4.2 Presentation of results............................................................................................29

4.2.1 Gender profile..................................................................................................29

4.2.2 Age profile........................................................................................................29

4.2.3 Relationship between guardians and children profile.......................................30

4.2.4 Results for pre-and post-interviews..................................................................31

4.3 Conclusion............................................................................................................31

Chapter 5: Conclusion and recommendation

5.1 Introduction............................................................................................................33

5.2 Discussion of results..............................................................................................33

5.3 Contribution of the results to the profession..........................................................34

5.4 Limitation of the current study...............................................................................34

5.5 Directions for future research.................................................................................35

5.6 Conclusion..............................................................................................................36

5.7 Recommendation....................................................................................................36

6. Reference...............................................................................................................38

7. LIST OF TABLE

7.1 Table 1: Age group.................................................................................................30

7.2 Table 2: Relationship between the guardians and children.....................................30

8. LIST OF GRAPH

8.1 Graph 1: Interpretation of result............................................................................31

9. Appendix

A. Questionnaire sample...........................................................................................41

B. Informed consent sample.....................................................................................44

C. Letter request permission to conduct study in the hospital..................................46

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ACKNOWLEDGEMENTS

My sincere appreciation is extended to the following:

God Almighty, who was my source of comfort when everything seemed gloomy.

I would like to thank my two supervisors, Ms. L.L Ndaendapo (field supervisor at the

Ministry of Health and Social Services Outapi District Hospital) and Ms. Leonard (my

mentor), for their guidance and encouragement throughout my study, this study would not

have been possible without you. Thanks for your tireless support and well-paced academic

guidance despite your work schedules. Your valuable insight into this study is highly

appreciated.

Special thanks to guardians who participated in this study, for sacrifice their time and

possibly endured emotional pain during this study, your contribution during my data

collection did not go unnoticed. Thank you very much for sharing.

To my family; for their never ending love and support many times and across the miles. I

love you all.

My sincere gratitude goes to the Indian Sisters and Priests at Anamulenge Mission (Outapi);

for your encouragements and spiritual support throughout my studies. Thank you.

To all my beloved friends; Thank you for always listening to me, encouraging me when I felt

down and unable to go on, and being my fun companion when I needed a break.

To Ministry of Health and Social Services, and Social Security Commission of Namibia for

their financial support during my study, thank you.

I acknowledge the support of the management and staff of Outapi District Hospital. Thank

you for the support you rendered me during my study.

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Dedications

This study is dedicated to the loving memory of my late paternal grandmother and to my two

lovely mothers (Elizabeth Sheehama and Emilia Benardu) with lots of love.

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Chapter one

Research Orientation

1.1 Introduction to the problem

The aim of this chapter is to draw an outline that will guide the researcher throughout the

study. As De Vos, Strydom, Fouche and Delport (2002, p.123) argued that the researcher

needs a plan in the same way that a builder needs a frame of reference to build a house.

With this in mind, the research question can be continuously clarified. The motivation for

this particular investigation is as follows.

Guardians of children living with HIV/AIDS face many challenges, such as depression,

fatigue, but moreover, the child’s illness is associated with additional stressors, such as

social stigma and isolation that may limit guardian’s willingness to seek assistance from

formal agencies, for them and the children under their care. Stigma can adversely affect

children and their guardians in ways that have long-term negative psychological and

social effects and because of this stigma, individuals, families and even the whole

communities often discriminate against others in ways that cause great suffering.

Diminished stamina and the physical demands of an HIV positive child leaves many

guardians without adequate time for self-care and counselling (Shepherd, 2007, p.20).

Many times guardians do not necessarily understand the impact that the child’s illness can

have on their life. This lack of information can create a potentially stressful situation

between the person being cared for and the person giving care. Research acknowledges

that this directly results in withdrawal of the guardian from his or her social network

because of what is perceived by the guardian as stigma surrounding HIV/AIDS and fear

to be discriminated and ostracism from the public (Heerden, 2006, p.97).

This research will focus on guardians who have the primary responsibilities for children

living with HIV/AIDS and are aged between two–eight years, in Outapi district, of

Omusati Region. In Namibia, it is estimated that there are 17,000 children living with

HIV/AIDS, and Omusati Region of the thirteen regions in the country (Namibia) is the

second highest region with HIV prevalence between 20-29% (Caplan, 2010, p.5).

HIV/AIDS epidemic has been generalized as primarily spread through heterosexual sex

and this has caused people who are HIV positive or living with someone who HIV

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positive to be stigmatized in their societies (Campbell, Nair, Maimane and Sibiya, 2005,

p.12).

In Outapi district of Omusati Region, statistic shows that 838 children under the age of

fifteen are living with HIV/AIDS (Ms. Akuunda personal communication, March 16,

2012, senior data clerk officer, Outapi CDC). According to Ms. Shilongo (personal

communication, March 9, 2012 ), elder-adults who are mostly women in Outapi district

are increasingly playing the principal role in caring for children sick with HIV/AIDS and

for orphaned grandchildren, these adults are either the grandmother or the aunt to the

children.

According to Brown, Trujillo and MacIntyre, (2001, p.15 ) “Literature suggests that

social support group programs is an important buffer for caregivers of people living with

HIV/AIDS and have helped reduce fear of disclosing children status among the

caregivers”. Thus caregivers who had participated in these forms of group generated more

alternative solutions to problems, proposed ways of challenging stigma and were less

fearful than caregivers who didn’t participate. These groups don’t only improve their

adaptation in communities and family, but increase their self-esteem and enhance their

coping skills to stigma.

1.2 Definition of the main concept

For the purpose of this study, HIV, AIDS, Stigma, Fear, Guardian and Children were

defined as follows;

HIV: Pearsall (2002, p.674), explained HIV as the human immunodeficiency virus, the

virus that causes AIDS and breaks down the immune system that helps to keep the body

strong.

AIDS: stands for Acquired Immune Deficiency Syndrome, a disease caused by HIV

virus. AIDS is acquired and not inherited. It is caused by a virus that invades the body,

attacks the immune system and makes the body weak and ineffectual Heerden (2006,

p.90).

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Stigma: Goffman (1963, p.3) define stigma as an undesirable or discrediting attribute that

an individual possesses, thus reducing that individual’s status in the eyes of the society.

Goffman explanation of stigma focuses on society's attitude toward people who possess

attributes that fall short of public expectations. Stigma refers to all the negative thoughts

and feelings that people have about HIV/AIDS and guardians who are taking care of

HIV/AIDS children.

Fear: Campbell et al (2005, p.17) defined fear as distressing emotions aroused by

impending danger, evil, pain, or belief of perceived threat which may cause stress,

depression, pain and isolation.

Guardian; is any adult member of the household who has primary responsibility of

taking or giving care to children and often other household members (Heerden, 2006,

p.99).

Children: is a plural word for a child and a child is a young human being below the age

of full physical development (Pearsall, 2002, p245). Namibian constitution defined a

child as someone under the age of 18years (www.ombudsman.org.na). In this study, a

child is defined as someone between the ages of 2-7 years and lives under the care of a

guardian.

1.3 Problem statement

De Vos et al (2002, p. 233) emphasise that the identification of a research problem is the

first step in conducting a research study. Therefore a problem identified must be

researchable and it must demand an interpretation of the data leading to a discovery of

facts. It is crucial that the research problem be simple and specific as any complexity may

lead to further complication of the study.

Heerden (2006, p.97-99) explained that researches revealed stigma as slowing the

provision of care to children or people living with HIV/AIDS. Most children or people

living with HIV/AIDS and their families still fear the abuse and stigmatisation by their

communities. Stigma can adversely affect children and their guardians in ways that have

long-term negative psychological and social effects such as depression, grief and feelings

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of helplessness, withdrawal and isolation, despair and loss of hope for the future, anxiety,

frustration, and confusion.

In view of the above challenges, the question that is directing this research is;

How effective is group therapy on reducing fear of public stigmatisation on

guardians of children living with HIV/AIDS in Outapi district?

1.4 Aim/goal of the study

Attention will be given to the discussion of the aims and objectives of this study.

4.1.1 Overall aim of the study

The aim of the study is to study the effectiveness of group therapy interventions in

reducing fear of public stigma among guardians of children living with HIV/AIDS in

Outapi district.

4.1.2 Objectives of the study

In recognition to reduce the fear of public stigma among guardians of children living

with HIV/AIDS in Outapi District, the research objectives are:

To describe the fear of public stigma faced by guardians of children living with

HIV/AIDS in Outapi district.

Assess the impact of public stigma on guardians.

To enhances guardians’ coping capacity, to cope with public stigmatization.

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Chapter Two

Literature Review

2.1 Introductions

The purpose of this section was to examine the relevant existing literatures and explore

available literature from the social work perspective on the impact of a therapeutic group

on guardians who are living in fear of being exposed to stigma or discrimination affiliated

for being affected by HIV/AIDS with specific focus of guardians of children living with

HIV/AIDS. According to Thompson (2006, p.14), the Social work profession is a multi-

cultural and vast profession that encompasses various aspects of working towards

facilitating individual, group and community well being. Social work operates as part of a

social welfare system which is located at the centre of contradictions arising from

dehumanising consequences. Social Workers although situated in a largely oppressive

organisational and professional context. They have the potential for recognising these

contradictions and through working at the point of interaction between people and their

social environment, of helping to increase the control by people over economic and

political structures.

The HIV and AIDS crisis is one of the greatest humanitarian and developmental

challenges facing the global community. In the years and decades ahead, the impact of

HIV and AIDS on children, their families and their communities will grow far worse

expanding to dimensions difficult to imagine at present (Stine, 2005, p.95). To date, the

number children living with HIV and AIDS in sub-Saharan Africa is estimated to be at

1,800,000 (UNAIDS, 2009). Like in many countries in Sub-Saharan Africa, HIV and

AIDS remains a critical public health concern in Namibia. The scale of new HIV

infections, the mortality rates that will occur in the main productive population, the rising

number of orphans and the burden on the productive and social sectors continues to

increase. Namibia has a population of approximately 2 million, and an estimated 200,000

people are living with HIV and AIDS. The number of women living with HIV and AIDS

is estimated to be about 110,000 while 14,000 children are said to be living with HIV and

AIDS. The number of children living with HIV/AIDS has greatly increased in Namibia

and the extended family system is overstretched due to the epidemic (UNAIDS 2009,

p.210).

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In Outapi district of Omusati Region, statistic shows that 838 children under the age of

fifteen are living with HIV/AIDS (Ms. Akuunda personal communication, March 16,

2012, senior data clerk officer, Outapi CDC). According to Ms. Shilongo (personal

communication, March 9, 2012 ), elder-adults in Outapi district are increasingly playing

the principal role in caring for children sick with HIV/AIDS and orphaned grandchildren.

These adults are either the grandmother or the aunt to the children.

Attention will now be paid to the discussion of stigma, women role in caring for sick

people and the existing literature on how group interventions reduce fear of stigma

associated with HIV/AIDS.

2.2 Understanding the concept stigmatisation

Mehta and Gupta (2001, p.15) explained that stigma has surrounded HIV/AIDS since the

beginning of the pandemic and this give a major distinction between HIV/AIDS and other

chronic or terminal illnesses. This stigma often stems from a lack of knowledge and

ignorance. Most important is to reduce the stigma and discrimination attached to

HIV/AIDS, so that those infected and affected can openly seek the support they need.

According to Moore and Williamson (2011, p.2), there are stories about individuals being

rejected and the whole families affected by AIDS, usually because of fear, confusion,

shame, anger, or blame. These attitudes need to be understood and change.

In order to understand stigma it is important to define it. Goffman (1963, p.3) define

stigma in general as an undesirable or discrediting attribute that an individual possesses,

thus reducing that individual’s status in the eyes of the society. He continues to explain

that stigma can result from particular characteristics, such as a physical deformity, or it

can stem from negative attitudes toward the behaviour of a group, such as commercial sex

workers or homosexuals. Goffman (1963, p.4) in his explanation of stigma focuses on

society's attitude toward people who possess attributes that fall short of public

expectations such as HIV/AIDS patients and their family, people with disability and

elderly. Heerden (2005, p.94) also agrees with Goffman (1963) that stigma is the social

disgrace that is attached to something that is seen as deviating from an ideal or

expectation of the community. It’s a fact that there is stigma associated with HIV/AIDS

in communities, but according to Heerden (2005), stigma is not related to the facts of

HIV- on the contrary, stigma is born from myths, misinformation and fear and people

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infected and affected by HIV/AIDS are being stigmatised because stigma is born from

fear, ignorance and social judgement about HIV/AIDS. People are more fearful of stigma

rather than the disease itself.

According to Brown et al (2001, p.90-94) there are three concepts that are helpful in

understanding stigma as it relates to the paediatric HIV population which are; associative

stigma, internalized stigma, and stigma management.

2.1.1 Stigma is associative when it affects people because of their association with a

stigmatized person, such as a person living with HIV. Associative stigma may

affect caregivers who help care for infected children or affected children whose

parents have died from the disease. Children may be affected by associative

stigma if their parents are publicly known to be infected with HIV. Other

examples include being friends with an HIV-positive person and attending a social

or fundraising event aimed at people living with HIV.

2.1.2 Internalised stigma can be particularly damaging. Such stigma occurs when a

person is aware of a social stigma and accepts, or internalises, society’s negative

views. Doing so damages the person’s self-esteem and gives him or her negative

sense of self-worth. Internalized stigma has a large effect on the paediatric

population through its influence on parents’ decisions to disclose. If parents or

caregivers have internalised the stigma and negative views of HIV/AIDS, their

likelihood of telling the child about his or her diagnosis decreases significantly. If

adolescents internalise the stigma regarding their diagnosis, they are more likely

to become depressed and engage in denial regarding their HIV status. Adolescents

may fear disclosing their status to others and feel shameful regarding their

condition.

2.1.3 Stigma management is a way of coping with stigma by being aware of possible

negative reactions and finding ways to minimise them. People living with HIV

practice stigma management by choosing and limiting whom they disclose to in

order to minimize the chance of negative reactions or rejection. They may also

“test” potential friends or loved ones they wish to disclose to by discussing HIV

education or using probing questions to discern the person’s understanding and

personal opinions regarding people living with HIV.

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According to Willis (2002, p.28), and Friedland, Renwick and McColl (1996) as

cited in Mabusela (2010, p.47), both infected and uninfected caregivers working

in the HIV/AIDS arena are stigmatised. The WHO (2002, p.40) explained that, for

people living with HIV/AIDS and their family members, the stigma, fear and

discrimination often associated with the illness can create barriers to effective

care. The WHO report further revealed isolation, fear and discrimination as

common themes that were related to HIV/AIDS. The study also acknowledged

that teaching health and social service personnel about universal precautions is not

sufficient to reduce stigma behaviour (WHO 2002, p.49). Caregivers on the other

hand are at times avoided or ostracised because they work with people living with

HIV/AIDS, and therefore they are deprived of much needed support.

2.2 Dominance of women in the caring role

Throughout the world it is mostly women who carry the burden of caring for sick

people, including people living with HIV/AIDS. According to Mohammad and

Gikonyo (2005, p.4), the burden of caring for people living with HIV/AIDS rests

disproportionately with women, including girls and older women, as primary

caregivers and volunteers. This is evident in cases where people living with HIV/AIDS

are released from hospitals; they are normally cared for by women in the communities

or at home. In the study of Mohammad and Gikonyo, (2005) older women expressed

feeling overwhelmed with the magnitude and multiplicity of tasks they had to perform,

many suffered from exhaustion, malnourishment, depression, and psychological

distress, loneliness and isolation, as care giving kept them within the house for most of

the day (p.12).

Several studies highlight the common problem of family members becoming primary

caregivers despite the availability of assistance from a formal community home-based

care centre, caregiver, such as a nurse, doctor, or trained volunteer. Lemelle,

Harrington and Leblanc, (2000, p.120) termed the family caregivers as (informal

caregiver) and home-based caregivers as (formal caregivers); Formal caregivers

include professionals and specialists such as physicians, pharmacists, medical social

workers, occupational and speech therapists, doctors and nurses. This category of

caregivers also includes trained volunteers, spiritual volunteers, spiritual counsellors

associated with AIDS service organisations, and AIDS care teams and hospice

14

programmes. Informal caregivers comprise relatives, spouses or partners and friends

who provide at-home care on an unpaid basis. They are in some cases not trained at all,

or have received very little training. Respected traditional healers in various

communities, especially in sub-Saharan Africa, also provide care for people living with

HIV/AIDS (p.121). This study, which focuses on guardians, refers to the informal

category, namely informal caregivers.

In areas with few or no palliative care facilities, when a person become ill from AIDS

the care is usually a woman’s responsibility. In Omusati Region in Namibia for

example, two thirds of all caregivers for children living with HIV/AIDS are women

who are mostly their aunties or grandmothers. This care giving is usually in addition to

many other tasks that women perform within the household, such as cooking, cleaning,

and caring for other children and the elderly (Ms. Gosbertus, personal communication

April 24, 2012). Caring for children living with HIV/AIDS, guardians are unpaid for

the work they are doing and can increase guardian’s workload by up to a third.

Women mostly are struggling to bring in an income whilst providing care and

therefore many families affected by AIDS suffer from poverty (Mehta & Gupta, 2001,

p. 24).

With this dominance of women in care giving, it is important that men should be

encouraged to join women in the role of care giving for sick people especially children

living with HIV/AIDS. This gender balance is very important in providing care,

especially to male children who are very ill. According to Leake (2009), caregivers

may risk their physical health – for example, when they are assisting a patient who is

heavier than themselves with simple tasks such as getting out of bed, moving around

and so on.

2.3 The Impact of Group Intervention in reducing fear of stigma

Corney and Jenkins (1995) explained counselling as a skilled and principled use of

relationships to develop self-knowledge, emotional acceptance and growth, and

personal resources. The overall aim is to live more fully and satisfyingly. Counselling

may be concerned with addressing and resolving specific problems, making decisions,

coping with crisis, working with feelings or inner conflict or improving relationships

with others. The counsellor’s role is to facilitate the client’s work in ways that respect

15

the client’s values, personal resources and capacity for self-determination while aiming

to develop a therapeutic alliance with the client and to convey acceptance and

understanding of the client and empathy with her/his situation.

The counsellor structures the process to allow the client’s time and freedom to explore

thoughts and feelings in an atmosphere of trust and respect and aims to deepen the

understanding of his or her situation and ways of dealing with it. Thus enables choices

and decisions to be based on insights gained rather than advice and directives of others

(Corney and Jenkins, 1995 p.18). Counselling skills, in particular, the cores skills of

listening, reflecting and empathy, are at the heart of counselling. Therefore, the

therapist or counsellor uses a range of specific skills to help the clients learn to manage

their lives more efficiently and effectively (Corney and Jenkins, 1995, 23).

An opposing view of this would be an article on counselling written over the past years

called “Let’s do away with counselling” as cited by Corney and Jenkins (1995),

Kubler-Ross (1997) argues that it is difficult to understand what counsellors have to

offer apart from “time, sympathy and willingness to help” and that these qualities

appear to be more important in counselling relationship than the theory or method of

counselling. With no common understanding of what counselling means, there is no

way in which its value can be assessed. Sympathy can be inhibiting or destructive and

a willingness to help is not always associated with the ability to do so (Kubler-Ross,

1997, p.17).

A study by Vyavaharkar, Moneyham,Corwin, Saunders, Annang, and Tavakolthe

(2002) yielded results that indicated that a supportive environment that accepts a

woman affected by HIV stigma and provides positive experiences that can build their

self-esteem and self-efficacy while reducing psychological distress including

depression that are caused by stigma. This finding highlighted the importance of

having more individuals in support networks for rural women affected by HIV stigma.

The findings of our study suggested that if a woman had several sources of support that

she could turn to if needed, it might alter and decrease her perceptions of HIV-related

stigma, as well as internalized stigma. This may minimize the psychological stress

associated with having HIV and possibly reduce negative psychological outcomes and

symptoms. Because depressive symptoms may indicate the presence of other mental

16

health issues, health care professionals should consider referring women with positive

depression screenings for further assessment of their reported symptoms to rule out

other psychological co-morbidities. Additionally, they should also consider referring

women to support groups when necessary. In the end, this will result in better

management of stigma surrounding HIV/AIDS pandemic and improve the overall

quality of life for rural informal caregiver of people living with HIV disease.

According to Brown et al (2001, p.15) who shared the same view as that of

Vyavaharkar et al (2002), in their study they explained that social support group

programs is an important buffer for caregivers of people living with HIV/AIDS. They

helped reduce fear of disclosing children status among the caregivers. Therefore

caregivers who had participated in these forms of group generated more alternative

solutions to problems. Caregivers also proposed ways of challenging stigma through

sharing their own experiences and develop ways on how to disclosure their children

status and cope with stigma. This group helped members to be less fearful than

caregivers who didn’t participate. These groups don’t only improve their adaptation in

communities and family, but increase their self-esteem and enhance their coping skills

to stigma.

In a study which was conducted by Mabusela (2010, p.103), his study has found that

most of the research participants in this study who were formal caregivers of people

living with HIV/AIDS in Mamelodi town seemed to resort to sharing their fears,

anxieties and most work-related challenges with fellow caregivers, in a form of

informal support groups. Even if members know that sometimes not much can be done

by fellow caregivers, simply sharing their experiences provides some comfort, reduce

anxieties and fear, as they have similar experiences and they know confidentiality will

be maintained in their group.

According to Primo (2007) as cited in Mabusela (2010, p.51), Primo points out that

through talking, sharing feelings or releasing them through crying, laughing, dancing

together with other caregivers as they have the same work demands, can help one to

cope better with feelings such as isolation, anger, sadness or grief etc that come with

care giving for people living with HIV/AIDS. Social workers are good at to connect

caregivers so that they can form spiritual and counselling support groups. The

17

caregiver‘s mental and physical health is vital to the people living with HIV/AIDS,

making it critical that the caregiver must be able to strike a balance between taking

care of him-/herself first, so as to be able to take care of other people. This can be done

through rest and exercise, enough sleep and eating well. Primo continues to explain

that caregivers need to be provided with an opportunity to express their fear,

uncertainties and prejudices in an environment that is conducive for them to express

themselves. In this way they can overcome negative emotions and learn more about the

experiences and challenges facing caregivers and people living with HIV/AIDS. Less

support/without support to caregivers of HIV/AIDS patients they may experience

burnout and it will be difficult for them to give compassionate care to themselves and

patients (Mabusela, 2010, p.108).

Many researches acknowledge the importance of group therapy in addressing the fear

of HIV/AIDS stigma among the caregivers of people living with HIV/AIDS. Edward

and Marthas (1990) with his notion of “group think” disagreed that group work is good

in addressing fear of stigma. His “group think” notion is based on the examination of

governmental decision making groups by Kubler-Ross (1997) who introduced this

term. The term refers to the tendency within many groups to eschew conflict and adopt

a normative pattern in which the group member is loyal to the group’s leader and other

members, never really challenging or seriously doubting the leaders or the groups’

wisdom in matters of decision making (Edward and Marthas, 1990, p.79). The group

think typically leads to ineffective group functioning. Alternatives are never seriously

considered by the group; members are too afraid to bring up a different possibility to

openly challenge the serene loyalty that is normatively demanded. Members are

accustomed to follow groupthink norms, refusing to provide any other alternatives not

related to what they would perceive the group will consider good (p.79-81).

Pennington, C. D. (2002) further criticise the notion of groupthink. He explained that t

groups operate better than individuals counselling and that decision making is likely to

result in higher quality decisions than decisions made by individuals. Social workers

are the people who mainly facilitator this type of groups and are responsible for

conducting counselling. Social workers as described by Thompson, N. (2006) are

mediators between their clients and the wider state apparatus and social order. This

position of mediator is a crucial one, as it means that social workers are in the pivotal

18

position in terms of the relationship between the state and its citizens. The relationship

is a double-edged one, one that can lead to potential empowerment or potential

oppression, social work interventions can help or hinder, empower or impress. Which

aspect is to the fore, which element or tendency is reinforced depends largely on the

actions of the social workers concerned (p. 14).

Kubler-Ross (1997) also challenge this notion of group think again strongly by

claiming that group think occurs when members of the group seek concurrence,

consensus and unanimity among themselves than critically looking at all the options

and deciding upon the best possible alternative. This phenomenon is likely to be

evidenced in groups that are highly cohesive. Ironically, group cohesion is one of the

main ingredients for a group to be able to work together (p.179-180). It has been

proven that if cohesiveness in a group becomes extremely high, the individuals in the

group will tend to do anything to maintain this. Jacobs, Masson, Harvill, and Schimmel

(2012) also stated that groups are indeed more efficient and they offer more resources

and viewpoints. Other reasons they found useful for employing a group approach

include the feeling of commonality, the experience of belonging, and the chance to

practice new behaviours, the opportunity for feedback, the opportunity for vicarious

learning by listening and observing others, the approximation to real-life encounters,

and the pressure to uphold commitments.

2.4 Conclusions

There is ample research that indicates that caretakers of people living with HIV/AIDS

experience many challenges, particularly stress, as result of stigma. Though literature,

acknowledges that care giving is demanding but rewarding, many caretakers

experiences stigma and their reactions to stigma include emotional exhaustion,

despair, depression and helplessness.

Many studies recognise the importance of social support system for individuals living

with HIV. However many researchers explained that there is also a necessity to

understand the need for such a system for the caregiver. Providing care for someone

with HIV can be a stressful experience and this makes a network of caregivers a

crucial component of buffering the process of giving care. This shows the importance

of social support group programme for caregivers of people living with HIV/AIDS.

19

There is a need for more access to psycho-social support and economic assistance to

help caregivers to sustain their physically and emotionally draining. It’s difficult for

caregiver to provide emotional support to a sick person, if they do not feel supported

themselves. With this in mind the different research acknowledge the importance of

counselling support group interventions to caregivers. Researchers also emphasized

that social workers play an important role in counselling groups, as their skills can be

employed in this type of group to connect caregivers together in order for them to

share their experience with each other and challenge HIV/AIDS stigma. The

caregivers’ mental and physical health is vital to the people living with HIV/AIDS,

making it critical that the caregiver must be able to strike a balance between taking

care of him-/her first, so as to be able to take care of other people.

The next chapter will cover the research methodology employed in this study.

20

Chapter Three

Methodology

3.1 Introduction

This chapter will present the research methodology employed in this study. A

methodology is a general approach to studying a research topic and establishes how one

will go about studying a specific phenomenon (Creswell 1998, p.248). Methods are

specific research techniques, which are used in research, for example, statistical

correlations, observation, interviewing and audio recording. This chapter focuses on the

research questions that directed the study, the research design, which is single system

design in nature, and provides information about the sampling method used. The process

of data collection through pre- and post-questionnaires interviews as methods of

collecting data is discussed. This chapter further gives a detailed discussion of the data

analysis and the relevant themes that emerged during this process.

The last sections of this chapter cover the relevant ethical considerations pertaining to the

study, as well as the rights of the research respondents during the study.

3.2 Research question

A research problem is an interrogative sentence or statement that asks what relations exist

between two or more variables (Christensen 2007, p.129). There are three criteria that

good problems must meet. Firstly, the variables in the problem should express a

relationship. The second criterion is that the problem should be stated in a question form.

The third criterion and the one that most frequently distinguishes a researchable from a

non-researchable problem is that “The problem statement should be such as to imply

possibilities of empirical testing (Christensen 2007, p.130).

For this study the following question was formulated: how effective is the group therapy

on reducing the fear of public stigma among guardians of children living with HIV/AIDS

in Outapi district?

3.3 Research design

A research design refers to an outline, plan, or strategy specifying the procedure to be

used in seeking an answer to the research question (Christensen, 2007, p.20).

21

This study followed the single system design as the most suitable method to provide

explanations on how effective group therapy is in addressing fear of stigma among the

guardians of children living with HIV/AIDS in Outapi district. Rubin and Babbie (2011,

p.292) define single-system design as a time-series design, for evaluation of the effect of

interventions or policy changes on individual cases or systems. The design involves

obtaining repeated measures of a client system with regard to particular outcome

indicators of a target problem.The design has single unit of analysis that are repeatedly

measured over time. The unit of analysis in a single- system design can be an individual,

a couple, a small group, a family, a community, or society as a whole, which in this study

it was a small group of women who are the guardians of children living with HIV/AIDS

in Outapi district.

Single-system design is just one of several names for a research methodology that allows

researchers especially researchers from the field of human science (social workers,

psychologist) to track systematically the progress within a client or client unit. With

increasingly rigorous applications of this methodology, practitioners can also gain

knowledge about effective interventions (www.single-system.htm).

Rafael and Russell (2005, p.228) identified different types of single-system design, which

are; the basic single-system (AB), basic experimental, multiple, changing intensity and

successive intervention, and complex and combined designs. In this study, a single-

system design through the use of the AB design was chosen, because the design involves

obtaining repeated measures of a client system with regard to particular outcome

indicators of a target problem. The researcher deployed both the pre and post- testing,

before and at the end of the group intervention as a way of determining the baseline and

intervention. The researcher used self- administered questionnaire to be completed by the

respondents.

The AB design includes a baseline phase (represented by A) with repeated measurements

and an intervention phase (represented by B) continuing the same measures. Rubin and

Babbie (2011, p.296) stated that, the AB Design is a two phase design which consist of a

no-intervention baseline phase (A) and an intervention phase (B). The design allows for

evaluation of pre-intervention and intervention problem status. The design it is a quasi-

experimental design, meaning that the existence of a no intervention baseline allows for

22

the establishment of a relationship between intervention and outcome. If a change in the

dependent measure occurs at the onset of the intervention, a relationship between the

independent variable (intervention) and dependent variable (problem) has been

established (Rafael and Russell, 2005, p.228-229).

3.4 Sampling

Ideally one wants to study is the entire population. However, usually it is impossible or

unfeasible to do this and therefore one must settle for a sample. A sample is a subset of

the population considered for actual inclusion in the study, the characteristics are

generalised to the whole population that is represented, and therefore a sample is seen as

representative of the population that it is taken from (De Vos et al, 2011, p.223).

There are two major goals that sampling can achieve; the first is to establish the

representativeness of what we are studying conversely to reduce biasness. The second is

to be able to make inferences from findings based on a sample to the larger population

from which that sample was drawn (Baker, 1998, p.122). According to De Vos et al

(2011, p.228) there are two different kinds of sampling available to the researcher;

probability whereby each person in the population has the same known probability to be

representatively selected and non-probability which means selecting a particular

individuals are not known because the researcher doesn’t know the population size or the

members of the population. The procedure used for selecting the respondents in this

study was non-probability sampling specifically using the purposive non-probability

sampling, because there was no a sampling frame and the probability of including each

element could not be determined.

Rubin and Babbie (2011, p.367) define purposive sampling as a type of sample that based

entirely on the judgement of the researcher, and the sample is composed of elements that

contain the most characteristic of the population that serve the purpose of the study best.

The respondents in the study were selected by means of the researcher’s personal choice

rather than through mathematical chance. For this study, the sample consisted of 7

guardians. Two of these guardians had grand children under their care who are on Anti-

Retro Viral medications (ART). On the other hand, the other four guardians had nephews

and one guardian had a niece under their care who are/is on ART. This information was

23

established from the hospital records in comparison with the information that the

researcher had established through her case records.

The researcher targeted a particular set of respondents namely guardians particularly for

children living with HIV and on treatment. A population of guardians between the age of

thirty five and sixty years with fear of public stigma were selected to form a sample.

3.5 Data collection

Data collection is a specific and systematic activity that seeks to avoid haphazardness and

vagueness (Henderson and Thomas, 2005, p.328). It is a process of gathering and

measuring information on variables of interest in an established systematic fashion that

enables one to answer stated research question, test hypothesis and evaluate outcomes

(www.balencedscorecard.org).

For the purpose of this study, and in order to achieve the objectives of the study, data was

collected from both primary and secondary data. The secondary data contributed toward

the formation of the background information of the research, needed by the researcher in

order to build constructively background of the study from different literatures. This was

done through studying and analysing different studies.

The data collection was done through self-administered questionnaires, consisting of

scaling type of questions. Structured interviews were in a form of pre- and post-test

questionnaires that was conducted during the initial stage of the group and ending stage of

the group therapy. The researcher collected data for pre-test on the first two sessions of

the group therapy, where by the researcher tested the level of fear of public stigma in

guardians of children living with HIV/AIDS in Outapi district. The post-test was done on

the termination stage of the group therapy, after the intervention has been implemented to

evaluate whether the intervention was effective in reducing the fear of public stigma

among the guardians. While completing the questionnaires for this therapy group, the

researcher was present in person to give necessary support through the process.

Questionnaires were translated into Oshiwambo, because only two respondents were able

to read and understand English, so respondents who were unable to read English concept

were translated and respond effectively.

24

The variable ages were categorized by using the different levels of measurement. The

group therapy covered the following five domains; effects of stigma (both on children and

guardians), their perceptions about HIV/AIDS stigma and coping skill. The group meet

for approximately ten sessions

3.5.1 Validity and Reliability

To ensure validity of the research a pilot study was done to test on a group of ten

guardians in Outapi district who are not members of the group therapy, but who are

taking care of children living with HIV/AIDS and also have fear of public stigma. The

purpose of the pilot study was to eliminate vague, ambiguous or unclear questions,

identify problems in the structuring or wording of the questions and conduct a mock

analysis before actual data collection was undertaken. The findings for the pilot study

shows that 99% of the respondents were female and 1% male.

Reliability is the accuracy or precision of an instrument. In general, reliability refers to

the extent to which the independent administration of the same instrument consistently

yields the same results under comparable conditions (De Vos, 2002). Questions were

structured in such a way that reliable information could be obtained from the respondents.

The questionnaire was simple and the researcher provided immediate support to the

respondents when clarifications were required by the respondents. Further, respondents

who could not speak English were helped through a translator to understand the concepts

in the questionnaire and respond effectively.

3.6 Data analysis

According to Kirst-Ashman and Hull (2012, p.385), data analysis is the actual process of

assessing the nature and significance of the results obtained.

The data collected was analysed manually. The researcher analysed the result for this

study through visual analysis. Visual analysis is the process of looking at a graph of the

data points to determine whether the intervention has altered the subject’s pre-

intervention pattern of scores (Rafael and Russell, 2008, p.218). Tables and graphs were

used to deduce the data. Visuals were displayed in a graph format to analyse the changes

in the participants’ behaviour (fear toward public stigmatization), before the intervention

and after the intervention. The visual presentations were made by means of simple

25

graphics or plotting. Plotting gave or shows improvement in the fear of public

stigmatization (problem) from the baseline to termination of the treatment or

interventions. The different phases on the graph were differentiated from one another by

means of a vertical line which connected the two points in the graph together.

The researcher used a composite questionnaire, which consisted of 8 questions. A code

sheet based on the 8 questions that were measured was prepared after data have been

collected. As the researcher used the scaling questionnaire, the data were translated

through the coding process, so that the computer can read and manipulate the data. Data

reduction which is the process of aggregating the information contained in larger data sets

into manageable (smaller) information nuggets was used.

3.7 Ethical issues

Researchers need to be aware of ethical issues before entering the field (De Vos et al

2011, p.), especially when dealing with sensitive topics such as those that are HIV/AIDS-

related and touch on the emotional and psychological aspects of all human spheres in

society. The following ethical issues were considered in this study:

3.7.1 Consent and voluntary participation

The researcher obtained consent form each respondent who participated in the

study. According to De Vos (2002, p.166), respondent need to receive a full non-

technical and clear explanations of what is expected of them so that they can

make informed choices to participate voluntarily, or not. An information session

(preliminary session) was arranged with potential respondent, where the

researcher explained what was expected of them, including all the steps to be

followed during the research, and informed them of their right to discontinue

their participation at any time despite giving initial consent.

Respondents were granted the opportunity to accept or decline their participation

in the study, rendering consent on a voluntary and informed basis. Consent

forms (in English appendix B) were given to all volunteering participants to fill in

and return during the first interview. All the respondents who were interviewed

handed in their signed consent form to the researcher prior to the

commencements of the interview.

26

3.7.2 Compensation: this is when the researcher tries to buy the participants in order

for the participant to take part in the study, not on their own will, but because of

the incentives which participants will get if they participate in the study.

According to Babbie and Mouton (2001, p.520), participants must be informed

that they should not expect any special rewards in the participating in the study.

Clarity on that was also provided during the preliminary session, to avoid

creating any possible expectation of being rewarded.

3.7.3 No harm to participants according to Babbie and Mouton (2001, p.522), social

research should never harm or injure people participating in the study. The

researcher ensured that the participants were not exposed to any danger.

Interviews were held at the hospital rehabilitation centre room, an environment

they are familiar with and which is safe.

3.7.4 Confidentiality according to De Vos (2002, p.166), in the consent form that the

participants sign, they must be assured of the parameters of confidentiality of the

information they will supply. Part of the information shared with respondents

during the information session (preliminary session) included the confidentiality

parameters relevant for this study, which were also included in the consent form

in (Appendix B in English). In this study no names and addresses are used,

guardians participated in this are study addressed only as research respondent

when referring to them. Information provided by respondents were handled with

care and regarded highly confidential to minimize any risk to the respondents.

Respondents were informed before the study that the results and finding will be

published as part of the partial fulfilment of the researcher’s degree program.

3.7.5 Deceiving subjects: this ethical component involves withholding information or

offering incorrect information in order to ensure the participation of subjects

when participates would otherwise possibly refuse to take part (De Vos et al,

2011, p.). Therefore the researcher identified herself as well as the purpose of the

study prior to the study. This enabled the respondents to feel open and

comfortable in participating in the study.

27

3.7.6 Analysis and reporting “In any rigorous study, the researcher should be more

familiar than anyone else with the study’s technical shortcoming and failures”

(Rubi & Babbie 2012, P. 84). Thus it is the researcher’s obligation to make these

shortcomings known to the readers as outlined in chapter five of this study.

3.7.7 Institutional review board It is very important that a panel of faculty & others

review all research proposals involving human subjects and rule on their ethics

(Rubi & Babbie, 2012). The research proposal served before the Social Work

Section, particularly to Ms. Leonard for review to ensure that the rights of

respondents are protected prior to fieldwork being undertaken.

3.8 Conclusion

This chapter describes the methods followed to do the empirical work. Attention was paid

to the method used during this study i.e. purposeful non- probability through the single-

system design; pre- and post-testing of the scaling questionnaire as well as measures to

ensure reliability, validity and ethical concerns.

The next chapter (chapter 4) discusses the findings of this study.

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Chapter Four

Data Analysis

4.1 Introductions

This chapter presented the detailed account of the results of the fieldwork of which the

methodology was explained in the previous chapter. The detailed analysis and

interpretation of the findings are transformed into comprehensive descriptions and

presentations. The chapter will focus on the statistical analysis and interpretations of data

collected. The researcher used tables, and graphs to convert the findings into readable

results.

4.2 Presentation of results

The guardians studied were female caring for children living with HIV/AIDS aged

between age of 35 years and older. Each guardian was either grandmother or aunt to the

child aged between 5-7 years old. The study was conducted in Outapi District of Omusati

region.

4.2.1 Gender profile

In this study 7 research respondents were interviewed and all of them were female.

This reflects the overall female domination in the caring role in caring for sick

people in Namibia, as it is worldwide. At least one third of caregiver of children

living with HIV/AIDS in Outapi district are women (Ms. Shikongo, June 2012) and

this explain the need to entrench gender stereotypes due to the traditional roles of

women, which explains why caregivers are usually women and young girls.

4.2.2 Age profiles

The majority of the guardians (4) were aged between 30-40years old, while two

guardians were in the 41-50 age category and one guardian in the 51 and older age

category. However it is important to note that performing the duties and roles of a

care giving as well as a treatment supporter for a child living with HIV/AIDS may

demand a lot more than what a 50 year old adult may be able to offer. Figure 1

below shows the age groups of the guardians who were the respondents in this

study.

29

Table 2: Age groups of the guardians

Age group Number Percentages (%)

31-40 4 57%

41-50 2 29%

51 and older 1 14%

Total 7 100

4.2.3 Findings related to the relationship between the caregivers and the children

living with HIV/AIDS.

Table 3: Relationship between child and caregivers

Number Percentages (%)

Aunt n=5 71%

Grandmother n=2 29%

Total N=7 100%

Results of this study indicate that 71% of the guardians taking care of children living

with HIV/AIDS are aunties and approximately 29% are grandmothers to the

children. The extended family system in many studies are explained as continued to

play a vital role in caring for children, after the parents died of AIDS or suffering

from HIV/AIDS, in which the care of relatives is presumed important than if the

children are cared by people they are not related to. It is also favoured by

communities that relatives takeover the care of children living with HIV/AIDS than

giving them to palliative care facilities that care for people living with HIV/AIDS.

While this is true, it is always not easy to care for a child living with HIV/AIDS as

they are usually assumed as additional responsibilities considering that caregivers

also have their own children (Thompson, 2006, p.24).

4.2.4 Results for the pre- and post-interviews

The X- axis represents; 1- pre testing & 2- post testing, while the Y- axis represents

the level of fear which was addressed during the group therapy.

30

Graph no.1: results for the pre-and post- interviews

The graph above indicates that the dependent variable (fear) was measured

(observed) at two points. This was done at a time before the interventions,

respondents fear was measured (point 1) and after the interventions (point 2). The

graph indicates that the respondents had an average of 4% at a baseline and an

average of 2% after intervention. The graph shows that there was a decrease in the

level of fear during group intervention which was conducted with the respondents.

As Corney and Jenkins (1995) explained group counselling as a skilled and

principled use of relationships to develop self-knowledge, emotional acceptance and

growth, and personal resources, this graph shows that group therapy/counselling

intervention can be effective strategy when addressing fear of public stigma among

guardians of children living with HIV/AIDS.

The results for each question in the pre- and post-questionnaire paper

4. Sometimes I feel that I am being talked down because am looking after someone with

HIV/AIDS. The findings indicated 4 % baseline and 1.6% intervention phase.

According to Thompson (2006, p.23) explained that caregivers or family members of

people living with HIV/AIDS suffers from associative stigma. Brown (2001, p.91)

defined associative stigma as stigma that affects people because of their association with

stigmatized person.

1 2

0

0.5

1

1.5

2

2.5

3

3.5

4

observation points (interviews)

level

of

fear

Pre- and post- interview

Series1

31

5. I do not feel bad about having to look after a child leaving with HIV/AIDS. The results

for the study indicate 3% baseline and 4% intervention.

6. I worry about telling people I take care of a child whose HIV positive. The study finding

indicates 4.3% baseline and 1.3% intervention. According to Willis et al (2002)

explained that caregivers at times are avoided or ostracised because they are working

with people living with HIV/AIDS and deprived much needed support.

7. I am scared of how other people will react if they find out that am looking after a child

living with HIV/AIDS. Finding indicated 4.3% baseline and 1.3% intervention.

According to Brown et al (2001) explained that caregivers and people living with

HIV/AIDS practice stigma management. They choose and limit whom to disclose the

HIV/AIDS status in order to minimise the chance of negative reactions or rejections.

8. I do not mind people in my neighbourhood knowing that am taking care of a child living

with HIV/AIDS. Findings indicate 1.7% and 2% intervention. The sources about care

giving explain (Leake 2009) that some caregivers see care giving as a rewarding job.

9. I feel the need to hide the HIV status of the child under my care from the child. The

results indicate that the baseline shows 2.7% and intervention 1.3%.

10. I feel the need to hide the HIV status of the child under my care from my friends. The

baseline indicates 4.3% and intervention 1.6%.

11. I feel the need to hide the HIV status of the child under my care from the whole

community. The findings indicate the baseline of 4.6% and intervention indicated 1.9%.

For question 9, 10, and 11 results showed what Brown et al (2001, p.90-94) called

internal stigma. Brown et al (2001) explained that caregivers internalise the stigma and

negative views about HIV/AIDS which decrease their likelihood to disclose about their

children status to the children, family members or community members.

4.3 Conclusions

This chapter presented and discussed the findings of this study. It gave a detailed account

of the effectiveness of group therapy in reducing the fear of public stigma among

guardians of children living with HIV/AIDS.

The findings highlighted the importance of group therapy interventions in helping the

guardians to cope with stigma in daily basis as they give support to children living with

HIV/AIDS which encompasses the rewarding experiences as well as difficult ones that

require interventions. It is clearly articulated that care giving is rewarding, yet very

32

emotional for the guardians as they experienced negative and positive emotions in caring

for this children, thus there is a need for providing therapy for caretakers of HIV/AIDS

patients.

The following chapter concludes this study. It further gives recommendations based on

the findings of the study.

33

Chapter 5:

Conclusions and Recommendations

5.1 Introduction

In this chapter the researcher will present this study‘s conclusion and recommendations

for interventions based on the data that was collected, analysed and interpreted and

recommendations for future research. This study has shed some light to better

understand the importance of group therapy on addressing fear of stigma among the

guardians of children living with HIV/AIDS.

5.2 Discuss the results

5.2.1 Characteristics of research participants

One of the most salient findings to emerge from this study is that the entire

research population consisted of women being carers. A conclusion drawn on

this fact is that care giving seems to attract more women than men, a view that

authors such as Leake (2009), Mehta & Gupta (2001) as well as Mohammad and

Gikonyo (2005) support in their studies. The study further showed that the

research respondents were all close family members to the children under their

care, something which Thompson (2006) explained in his study. He explained

that the extended family system in many community continue to play a vital role

in caring for children, after the parents died of AIDS or suffers from HIV/AIDS,

in which the care of relatives is presumed important than if the children are cared

by people that are not related to them.

5.2.2 Stigmatisation

The findings in graph no.1 (see chapter 4) revealed stigma as slowing guardians’

provision of care to the children. HIV/AIDS related stigma persists in Namibia;

many respondents fear isolation and alienation from their communities and

families. Guardians has become associated with “having AIDS,” causing many

of them to be reluctant to disclose the child’s HIV status. Guardian’s services to

the children are sometimes not utilized because of this stigma. Many guardians

refuse to disclose the child’s status because “once you disclose the status,

everybody in the community knows that the child is an AIDS patient” (Metha

and Gupta, 2001). Although more tolerant attitudes towards HIV/AIDS have

been promoted through many programmes in the country, discriminatory

34

attitudes among family members still exist to a small degree. Mabusela (2010)

explained that disclosure is the key to good relations between the caretakers and

the person living with HIV/AIDS and better care that may impact on the general

well-being of the patient, thereby improving the general health status of the

patient. Most the guardians still fear the abuse and stigmatisation by their

communities, families and friends associated with HIV/AIDS, especially in

cases where the guardians want to disclose the child’s HIV status. Caretakers

should be encouraged to share their patient’s status so that they can be cared for

effectively, and so that caretakers/givers can also ensure protection of both the

patient and themselves.

5.2.3 Group therapy in addressing fear of stigmatisation

The findings revealed that group therapy are important in reducing fear of stigma

among guardians of children living with HIV/AIDS. As many researchers has

emphasised the need for group intervention the result of this study shows the

importance group therapy/counselling in addressing fear of public stigma among

the guardians of children living with HIV/AIDS. Due to stigma, guardians of

HIV/AIDS children find it hard to disclose their children status.

Corney and Jenkins (1995) explained counselling as a skilled and principled use

of relationships to develop self-knowledge, emotional acceptance and growth,

and personal resources. The overall aim is to live more fully and satisfyingly. In

the group therapy which was conducted with the respondents, they were

encouraged to share the status of the children especially to the children, relatives

and close friends so that they can be supported effectively both the patient and

themselves, and so that children can also play a role in his/her treatment.

5.3 Contribution of the research to the social work practice and profession

Information established by this study would be helpful in the planning,

implementation and monitoring of programme and interventions aimed at addressing

fear of public stigma among guardians/caretakers of children/people living with

HIV/AIDS. It will be useful in helping the social workers in strengthening the coping

capabilities of the guardians themselves, and the children living with HIV/AIDS with

stigma associated with their illness. In addition, this information can be used to

35

support the establishment and strengthening of structures, systems, and policies on

stigma to support children living with HIV and their guardians.

The finding of this study will also help the Social Worker to realise the importance of

group work intervention in the profession. It’s important for Social Workers

especially Medical Social Workers to introduce formal group either therapy,

counselling or support at their respective work place, where both the people living

with HIV/AIDS and their caregivers i.e. mostly family members can share their

caring experiences with each other, because peer networks can also help in addressing

stigma associated with HIV/AIDS in Namibia.

5.3 Limitations of the Current Research Project

The findings of this study have identified and recognised the following as limitations:

According to De Vos et al (2011, p.168-169), the implementation of the single system

design can be very time consuming and generalisations cannot be drawn from single-

system designs. In the case of this study, the sample size in this study was small, so it’s

difficult to generalise the findings and the findings can only be suggestive.

Time was too long (10 sessions for group intervention with the respondents) and one

cannot fully say the interventions which were implemented caused change in the

respondents, as other factors that happens in the respondent’s life might have caused the

change.

The group sessions were conducted in Oshiwambo and this was difficult for the

researcher to translate group work theories and other words which were used in

oshiwambo. The study put less emphasis on the coping mechanisms of guardians, as

more time was spent on understanding the fear of guardians regarding stigma.

5.4 Directions for future study

It is recommended that further research be undertaken to investigate the importance of

group therapy in addressing the fear and more emphasise of coping mechanism to

overcome this fear of guardians of children living with HIV/AIDS in Outapi District.

Such a study will enable the researcher to draw a more generalised conclusion about

36

guardians in Outapi District and can suggest a community-based approach to support the

guardians. This would therefore address the first limitation of this study.

More research should be considered on the impact of the stigma on both the guardians

and children in order for Social Workers to develop possible programme which can help

in addressing this issue. This kind of research will enable Social Workers to have a

better understanding of the impact of HIV/AIDS stigma on caregivers of people living

with HIV/AIDS, thereby improving the kind of services rendered to both the caretakers

and patients, which will enhance their well-being and enhancing the quality of life.

Future research can also try to include key informant such as social workers, nurses, and

children in their study in order to get different perspectives.

5.5 Conclusions

The finding shows that there was a decrease from 3.6% to 1.27% average of respondents

respect to their fear of HIV/AIDS. In this study, it has been observed that most

respondents are afraid to disclose the child’s status either to the child, family or

community members, because of the fear to be stigmatised by the public. As disclosure

is the ingredients to a healthy relationship between the patient and caretakers, the study

results show the importance of group interventions in reducing the fear of public stigma

among the guardians of children living with HIV/AIDS. The group therapy emphasised

the importance of disclosure in management of HIV and AIDS. The extended families

are now overburdened with the care of orphans and vulnerable children and the

provision of quality care is not an easy task at all. There is a growing need to establish

group therapy programmes strengthen the caretakers to provide psycho-social support so

as to ensure that they take care of themselves and children in HIV/AIDS arena.

5.6 Recommendations

This section covers recommendations for intervention by Social Worker in the Ministry

of Health and Social Services Outapi District.

Implementation of educational programme to demystify HIV/AIDS, with the goal of

alleviating the fear and stigma associated with the disease among guardians of children

living with HIV/AIDS in Omusati region. The Ministry of Health and Social Services

need to provide a closer collaboration with household members, through educational

37

interventions regarding care giving, safety, and decreasing the burden of care giving on

women. Strengthen referral networks between formal health services (nurse, doctors and

community counsellor at CDC) and caregivers of people living with HIV/AIDS. Social

Worker needs to provide additional psychosocial and emotional support for caregivers

through introducing therapy groups for guardians of people living with HIV/AIDS. As

peer networks can also help guardians from the surrounding villages in Outapi District

to interact with others with the same problem and share their feelings and experiences.

There is a general need for more research in other specific communities such as Outapi

District, which has not received much attention, especially in the context of HIV/AIDS

and guardians’ coping mechanisms to HIV/AIDS stigma. This will help Social Workers

to establish more group therapy sessions for these guardians.

38

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41

CONFIDENTIAL

My name is Elizabeth Hishishii Shilyomunhu. I am pursuing my Bachelor of Arts Degree in

Social Work at the University of Namibia. I am currently conducting a research study on the

effectiveness of group therapy in addressing the fear of public stigma among guardians of

children living with HIV/AIDS in Outapi District. Your kind co-operation to complete this

questionnaire will be highly appreciated.

Please note that all information collected will be treated with confidentiality. Your honesty in

answering the questions in this questionnaire will play an important role in the findings of

this research.

Respondent no.................... (Write your date of birth e.g.07)

Please read the following questions carefully before you answer. Indicate your answer

by ticking the answer that applies in the spaces provided.

SECTION A – IDENTIFYING INFORMATION

1. What is your gender?

Male

Female

2. Kindly indicate your age group by ticking the appropriate answer

30-40

41-50

51 and older

42

3. Kindly indicate your relationship with the child under your care by ticking

Aunt

Grandmother

Section B- This questionnaire will take you about 10 minutes to complete. Carefully read

each of the 8 statements listed below and on a scale of one to five (1-5) with one being less

often and five very often, how would you rate your fear of public stigma.

NB: Circle the right number

4. Sometimes I feel that I am being talked down to because am looking after someone with

HIV/AIDS.

1 2 3 4 5

5. I do not feel bad about having to look after a child leaving with HIV/AIDS.

1 2 3 4 5

6. I worry about telling people I take care of a child whose HIV positive.

1 2 3 4 5

7. I am scared of how other people will react if they find out that am looking after a child

living with HIV/AIDS.

1 2 3 4 5

8. I do not mind people in my neighbourhood knowing that am taking care of a child living

with HIV/AIDS.

1 2 3 4 5

9. I feel the need to hide the HIV status of the child under my care from the child.

43

1 2 3 4 5

10. I feel the need to hide the HIV status of the child under my care from my friends

1 2 3 4 5

11. I feel the need to hide the HIV status of the child under my care from the whole

community.

1 2 3 4 5

THANK YOU FOR YOUR PARTICIPATION!

44

RESEARCH PARTICIPANT INFORMATION AND CONSENT FORM

TITLE: “An investigation on the effectiveness of group therapy in reducing fear of public

stigma among guardian of children that are living with HIV/ AIDS in Outapi district.”

PRINCIPAL INVESTIGATOR

Ms. Elizabeth Hishishii Shilyomunhu

P.O.Box 544

Outapi, Ombalantu,

Namibia

264 (0) 813601231

PURPOSE: To evaluate the effectiveness of group therapy interventions in reducing fear of

public stigma on guardians of children living with HIV/AIDS in Outapi district.

PROCEDURES: Respondent will be required to attend ten sessions of a therapy group.

Whereby structured interview will be conducted in a form of pre- and post-test questionnaires

that will be conducted during the initial stage of the group and ending stage of the group

therapy, during this interview the researcher will test the level of fear of public stigma in each

guardian. During this time of group therapy, both the researcher and guardians will focus on

various topics pertaining HIV/AIDS stigma in order for the researcher to gain more

understanding about guardians fear of public stigma and guardians will acquire new

knowledge and skills to overcome their fear.

RISKS AND BENEFTIS:

Your participation in this study may contribute to knowledge that may be used to reduce fear

of public stigmatization among caretakers of children living with HIV/AIDS in Outapi

district and the whole Namibia at large. If you choose to participate in this study which

contains minimal risk, you do not have to talk about any subjects you do not want to talk

about, and you can stop the group interview at any time.

CONFIDENTIALITY:

In order to minimize any risk to you, all information you provide will be regarded as highly

confidential and will be used only in ways that preserve its confidentiality. The researcher

45

will not tell anyone the answers you give the researcher, however, information from the study

and the consent form signed by you may be looked at or copied for research purposes by the

researcher or my supervisor. The questionnaires are anonymous, and you are not asked for

any identifying information, such as your name or hometown. Findings will be presented in a

way that preserves the confidentiality of the participants, and will be framed in terms of

recommendations that may enhance future benefits for other guardians who are taking care of

children living with HIV/AIDS.

OTHER INFORMATION

Your participation in this study is completely voluntary, and you may choose not to

participate without any penalty. Approximately eight (7) guardians are expected to

participate. If you change your mind, you may stop participating at any time by simply

declining to complete the group interview. If at any time you are uncomfortable answering

any question on any questionnaire, or in an interview session, you may skip it and go on to

the next. Your participation is confidential.

SUBJECT’S STATEMENT:

I have read the information in this consent form and have had an opportunity to ask questions

and to have them answered satisfactorily. I agree to participate in this study with the title ―

An investigation on the effectiveness of group therapy in reducing fear of public stigma

among guardian of children that are living with HIV/ AIDS in Outapi district. I hereby

acknowledge that I am participating in this group research voluntarily, am aware that I can

stop the interview at any time, and am not obliged to answer questions and disclosure

information that I am not comfortable with. I agree that the researcher can take note of

information shared in the group interview on condition that anonymity and confidentiality be

maintained.

Kindly receive my gratitude for your agreeing to participate in this study in advance.

Ms Elizabeth Shilyomunhu

.......................................... Date..............................................................

Researcher

46

P.O.Box 544

Outapi

Ombalantu, Namibia

Cell: 0813601231

E-mail: shilyomunhue@yahoo.com

04 June 2012

Private Bag 504

Outapi Hospital

Outapi, Namibia

Dear Dr. Njunguna

Re: Requesting for approval to conduct a research project in Outapi District

I am a registered student of the University of Namibia studying towards a Bachelor

(Honours) of Arts in Social Work. In order to complete my study, I have to do a research

project. I proposed to do a research on guardian’s of children living with HIV/AIDS in

Outapi district by conducting a study with the title- “An investigation on the effectiveness of

group therapy in reducing fear of public stigma among guardian of children that are living

with HIV/ AIDS in Outapi district.”

This study is targeting the guardians of children who get treatment from the Communicable

Disease Clinic (CDC) in Outapi hospital as a place for recruiting participants for the study. In

this study I would like to conduct a group therapy with these guardians for a period of ten

sessions. For more information about the proposed therapy group, please see the group work

proposal attached.

I would like to ask for the permission to recruit my research participants from the CDC clinic,

so that I can continue with my research project.

Thanking you in advice.

Yours Faithful

……………………………

Elizabeth Shilyomunhu

(Researcher)