HIV/AIDS and children: briefing

Social Development

21 September 1999
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Meeting report

WELFARE & POPULATION DEVELOPMENT PORTFOLIO COMMITTEE
22 September 1999
HIV/AIDS AND CHILDREN: BRIEFING

Document handed out:
HIV/AIDS and Children: outline of presentation

SUMMARY
The purpose of this briefing was to help the committee define how the Welfare & Population Portfolio Committee can play a more activist role on this issue. In the end, the goal is to have real interaction with all of the other relevant committees on this issue.

The first part of the presentation dealt with intervention strategy for dealing with the HIV/AIDS problem.

This was followed by an overview of how the law can intervene to assist in the epidemic as well as a look at the rights of these children and the ways that Parliament can assist. An effort must be made to adopt a children's rights approach to HIV/AIDS as there are issues of confidentiality, privacy, prohibition of mandatory testing and discrimination that need to be addressed.

MINUTES
Chairperson E Saloojee opened the meeting by saying that AIDS is seen not just as a problem of health. There is a large number of children being orphaned that are HIV+, which has huge implications on welfare. The question is how is the state going to cater to them? The purpose of the briefing is to help the committee define how the Welfare & Population Portfolio Committee can play a more activist role on this issue. In the end, the goal is to have real interaction with all of the other relevant committees on this issue.

Ms Sian Hasewinkel, a social worker for the Child Welfare Society (CWS), gave the first part of the presentation. She is the coordinator of the AIDS program at CWS. She said that there are many challenges that SA faces regarding this issue. Some of them include: care of the infected children, care of the orphaned children, mobilizing community support for families who are caring for infected/orphaned children, mobilizing community support for families with HIV, and resources.

There is an attitude in SA that the State should care for these children. However, she feels that no one organization can battle this epidemic alone. SA needs to mobilize itself to work through its own attitudes and assumptions regarding HIV. She said that 50% of her staff is anxious with the idea of working with children with HIV. Further, 47% of her staff harbours a concern that the HIV+ child would pass it on to children at school, despite the SA policy that HIV+ children should not be discriminated against at school.

She prefers to use the term "vulnerable children" over children with HIV because of the stigma attached to HIV. She reported that 88% of relatives are NOT willing to care for an infected child. This is problematic given that the number one placement and catch-net for these children is with a relative. USAID developed a 6 point intervention strategy for dealing with the HIV/AIDS problem. The steps include strengthening the capacity of the family to cope with the problem; stimulating and strengthening community based responses; ensuring government protects the most vulnerable child and provides essential services; building capacity of the child to support themselves; creating an enabling environment for affected children and adults by networking and involving businesses; and monitoring the impact of HIV/AIDS on children and families.

The U.S. Statistics Bureau reported that by 2005 14% of SA children younger than 15 will be orphaned (1 in every 7). The impact of HIV/AIDS will affect a range of areas including health care, provincial and local services, education, and women. So far as health care, hospitals have seen a huge increase in the number of children affected by HIV. Currently, 26-70% of the hospital beds are being occupied by HIV-related disorders. The challenge for welfare will be to find a way to fund medical support for those caring for these children, because it would be a tragedy to see these relationships fail. The welfare system needs to create a way of providing ready access to health care. One major issue of concern is burials. Who will carry the cost of the burials of either the family member or the child infected with HIV? On average, it takes a family two years to recover from the cost of a burial. Foster parents cannot pay without help.

Provincial and local services need to focus on issues like poverty, non-payment of services, and accessibility of grants. Children over seven are much harder to place than younger children. To exacerbate this, child support grants end when a child reaches seven, which means that many of these children end up on the street. SA needs to ask what types of grants do they want to have? Should SA opt to create a broader grant that is more inclusive of all aspects of child care? Additionally, there is the issue of foster care recruitment. Currently, the criteria for recruitment and acceptance is strict. The system cuts out people that are on grants or that do not have a high enough income. This cuts out a large percentage of possible foster parents. Should SA look to providing grants to people that are interested in foster care so as to broaden the number of people eligible to care for these children?

Finally, there is an issue regarding education. The fear is that there might be a problem with decreasing numbers of children going to school, because the families may not be able to afford to do so.

She concluded by highlighting some additional challenges that the community will face in dealing with children and HIV/AIDS. The models of change in rural communities may not work in urban areas where the perception is greater that the state needs to support these children. For example, in Soweto 60% of people feel that the state should support these children while only 29% of the people in KwaZulu-Natal feel that way. There is a need to understand the attitudes of the people in our local community regarding children orphaned because of HIV and how the community expects them to be cared for. If you want to mobilize the community to target these vulnerable children, then you need to call them vulnerable children rather than children infected with HIV because of the social stigma.

Mary Caesar gave the second part of the presentation. The research that she relied on was commissioned by the South African Law Commission. She provided an overview of how the law can intervene to assist in the epidemic. Children will be affected by HIV no matter if they are actually infected themselves or not. Statistics show that 30-35% of babies born to infected women will also be HIV+. HIV impacts on children both prior to the death of the parent and after. It can affect the child prior because they may have to leave school to help out at home or to get a job to provide additional income to the household. The child may be deprived of love and nurturing and no future plans of assistance may be made for them. Statistics show that by the year 2000, 197,000 - 278,000 children under the age of 15 will have lost a mother to AIDS.

The welfare needs of these children include care and protection, models of care, placement and HIV testing, protection from discrimination, custody/guardianship, and social assistance. The promotion and protection of human rights is key for preventing the transmission of HIV/AIDS and for helping to decrease the impact of the epidemic on SA.

There are several ways to protect human rights. It is possible to encourage voluntary HIV testing as to promote the individual responsibility for health. Helping to facilitate an environment without fear of reprisal or discrimination and voluntary behavioral changes are other ways to protect children's human rights.

The 1997 National Review (published by the Department of Health) reported that discrimination and exploitation of HIV status was widespread. In fact, it was reported that day care centers are refusing to accept children who are infected/affected with HIV/AIDS.

Ms Caesar also discussed the rights of these children and the ways that Parliament can assist. There must be an effort made to adopt a children's rights approach to HIV/AIDS. There are issues of confidentiality and privacy that need to be addressed as well as issues of mandatory testing. Access to information should be a fundamental right of the child. This is important to the issue of reproductive health. At what stage will children have access to information of reproduction? Legislation needs to be adopted to prohibit discrimination based on real or perceived HIV status and to prohibit mandatory HIV testing. It is also important to review existing laws or enact new legislation to protect children against sexual exploitation and abuse. Further, there needs to be a review of existing laws regarding the minimum age that children can access welfare.

Questions and comments by committee members
Mr Masutha (ANC) - There is no clear policy planning and implementation in government right now on this issue and without one there is no way that we can deal with the challenges surrounding HIV/AIDS. It is important to figure out the most effective way to plan and implement the role of Parliament in that process.

Ms Caesar responded by saying that each ministry/department is developing their own plan, but how these plans cross-over is still a problem that needs to be addressed.

Ms Makasi (ANC) - Has there been any research on limiting the rights of couples that have HIV from having children? Has there been any research done on how do you balance the issues of the reality of early sexuality versus the morality of distributing condoms at a particular age.

The presenters were not aware of any research done on the specific issue of couples with HIV having children. However, issues like sex education are being dealt with through the Life Skills classes, which are offered in school. These classes teach kids how to make the right choices in life.

Mr Solo (ANC) - Do the agencies (represented at this meeting) work with other agencies or churches? He commented that there should be a common approach with all of them together to maximise the practical nature rather than the intellectual nature of dealing with the problem.

Chair Mr E Saloojee closed the meeting by saying that the next step for the Committee would be to have the law commission and the other relevant departments come and give them a briefing. It is clear that there is a need for legislation and policy on this issue

Appendix 1:
HIV/AIDS and Children: outline of presentation
Presented by Sian Hasewinkel of Cape Town Child Welfare Society

INTRODUCTION
Graca Machel so aptly summed up the plight of children facing HIV/AIDS when she said the following at a conference in 1998 :

" Who feels the overall impact of HIV the most? Surely it is the children; the children who are HIV+ and die before they reach their 5th birthdays; the children who must care for sick and dying parents; the children who must cope with the tragedy of parental death; the children who must struggle to survive in an adult world that more likely than not will discriminate against them in all sorts of ways because they have been orphaned by HIV/AIDS. These are all burdens that even healthy, happy adults would find hard to bear; we cannot expect children to do it alone. To give them the support that would help most we need to change our mindsets and see HIV/AIDS not as an adult problem but as a children's problem. HIV/AIDS is a problem for today's children as they cope with the grim reality of being orphaned; it is a problem for tomorrow's children for the same reason. And it will be a problem for these children when they are adults and find that the extended family system which protected their parents and grandparents, no longer exists. They will find, too, that the social welfare system which should step in to fill the gaps may not have the capacity or resources to cope as extensively as they need. The children affected by HIV/AIDS know all too well the complex web of problems that entangles them and makes life so hard. But how well do the rest of us understand this complexity?"

The challenges facing Child Welfare Society, and indeed all communities, in preparation for the orphan crisis are:
- The care of infected children who are not able to live with their own families . This could be due to abandonment, ill health or death of the parents.

- The care of orphaned children. These children will have experienced suffering and loss, and both physical and psychological needs will have to be addressed, as well as protection from exploitation, neglect and abuse.

- Mobilising community support for those families who are caring for infected and orphaned children, particularly those families that are struggling to feed, clothe and educate the children.

- Mobilising community support for those parents or caretakers who are HIV+ and struggling to rear their children.

- Securing resources to ensure the survival of programmes.

It is clear that, given the increase in number of children who will become vulnerable, current systems of ensuring the protection of children will have to change. Guiding principles in developing an effective model have been those that are outlined in current welfare policy, most notably sustainability, accountability, accessibility, appropriateness and ubuntu.

South Africa is fortunate to be able to learn from the experiences of other countries in Africa who are further along the AIDS continuum. However, caution is called for because models that work well in one area of Africa may not be appropriate or work as well in South Africa. Research in South Africa shows a tendency towards an attitude of greater dependency on the state to support individuals under circumstances of urban poverty, which makes it imperative that programmes have a good understanding of localised attitudes towards the care of affected children. Understanding pre-existing patterns of informal care helps to put AIDS orphan care into context. All the literature from Africa stresses that models of care, to be appropriate, cost effective and sustainable, must be based on existing acceptable local models of care. A pilot project to determine attitudes and needs of communities around the care of children will be undertaken by Cape Town Child Welfare Society.

Countries in Africa have clearly opted for a developmental approach to coping with the orphan crisis.

The number of children who will be at risk in South Africa clearly tells us that currently practised models of professional intervention, removal and alternative placements or institutionalisation will reach only a very small proportion of children at risk, therefore we need to consider developmental models as well.

Basic intervention strategies that have been developed in Africa from experience with overwhelming numbers of orphans, is that extended families are the first and most important catchnet for children. Only if this is truly not possible, do children become the responsibility of unrelated caretakers. This is usually on an informal basis, and only occasionally are children more formally fostered. Given South Africa's rapidly increasing HIV prevalence rates, and limited financial resources in the welfare budget, it is clear that work also has to be done in this country to strengthen families and communities to provide the major catchnet of care, and find creative solutions to place those children for whom no family or informal community placement can be found.

USAID has been involved in 23 countries world-wide to study the effects of the AIDS epidemic on children . From their experience, they have developed a six point intervention strategy to support children isolated by HIV/AIDS.

Strengthen the capacities of families to cope with their problems
Extended family relationships are the first catchnet, and the majority of orphans are being cared for this way. However, the greatest stress falls on women, and they need to have access to credit and income generating schemes, whilst community-based day care schemes need to be established as a support for her and a health back up for the children. Information about nutrition and child health needs to disseminated more widely than to parents, as increasingly grandparents and older children need this information.

Stimulate and strengthen community based responses
This is the second safety net. Communities need to join together to support and assist families. Generally these groups develop spontaneously out of a need, and do not rely on outside help for funding.

Ensure that governments protect the most vulnerable children and provide essential services.
The most vulnerable children are those who cannot be accommodated by family or the community, and it is the responsibility of the government to ensure that services are developed, and children are protected from neglect, exploitation and abuse, attend school, and have access to safe water and health. Advocacy around appropriate legislation needs to occur.

Build the capacity of children to support themselves.
Children in child headed household need to be protected, enabled to stay in school and learn vocational skills.

Create an enabling environment for affected children and families.
This entails networking with other organisations to develop strategies that will make it easier for children, families and communities to cope with the effects of AIDS. They believe that the success of projects will depend on this. Awareness, education, and protection of legal rights of HIV+ people and their families are important. Private sector commitment needs to be nurtured, and governments must prioritise children's welfare.

Monitor the impact of HIV/AIDS on children and families.
Monitoring provides essential information to guide programme and policy making. Community members should ideally collect the data to become familiar with the problem and thus help with the solution.


THE WAY AHEAD:

Mobilise ourselves

Training to impart knowledge and work through attitudes is vitally important. Research done at Cape Town Child Welfare Society showed that 50% of the staff were anxious about working with HIV+ people; 47% believed that HIV+ children put other children at risk in a school setting; 21% linked promiscuity to infection, 24% had accurate information concerning universal precautions. The research has helped shaped a training programme which all staff are expected to attend. We cannot mobilise and educate communities unless we are educated first, and have the opportunity to work through more negative attitudinal perceptions.

Mobilise communities .To be discussed in this presentation.

Mobilise partnerships between the State, business, service providers and communities. All sectors of society need to co-operate in order to provide effective services to children, their families and their caretakers.

IMPLICATIONS OF HIV FOR CHILDREN AND FAMILIES
Statistics :
The US Bureau of the Census, which has as its responsibility the projection of world-wide HIV/AIDS figures for the United Nations, in 1996 estimated that in 2005 South Africa will have 1,132,182 orphans, which is 14% of children under the age of 15 (or 1 in every 7 children). Children orphaned due to AIDS will account for 75% of this total.

Health care
- 26 -70% hospital beds occupied by HIV related disorders

- Impact on hospital budgets, reduced medical services, impact on families and professionals who are struggling to care for sick children.

- Cost to family budgets
Medical support services to caretakers : must be accessible and affordable and be part of the back up support service. Programmes that do not take into account the importance of appropriate support to caretakers, will fail, and the children will be placed at increasing risk of neglect or abandonment.

Costs to a family for burials: Research in Africa shows that it can take up to 2 years for a family to financially recover from a death.

Who will pay burial costs for children in care, whether formal or informal? Public/private partnership? Speedy payment is essential if costs are initially covered by agency such as Child Welfare Society.

Provincial and local services
- Poverty, non-payment of services, crisis for local government

- Future of foster grants? Impact on recruitment inducements

- Recruitment strategies must dovetail with state policy

Issues around grants:
The disability grant for a person with AIDS needs to be more speedily processed

Children older than 7 very vulnerable because families will not be able to access the child support grant

Future of the foster grant? Impossible to place all vulnerable orphaned children in foster care, so who will qualify and who will not? Currently have a situation whereby families are trying to access the foster grant rather than the child support grant, because it is worth so much more

Need a more inclusive grant that takes into account all aspects of care i.e. foster care, subsidised adoptions, child support and support for child headed households

It is important to sort this out as state policies and foster care recruitment strategies must dovetail

Mothers caring for HIV+ children have difficulty working because of the needs of their sick children especially when day care arrangements are compromised. HIV must be considered a disability in order to access the care dependency grant

Vulnerable children and child headed households
Illness results in chronic stress in households

Child-headed households study in Zimbabwe: 88% relatives unwilling to care because:

- Afraid of dropping standards

- Adherence to nuclear family concept

- Aids stigmatisation
- Not wanting adolescents

- Leaving status quo

- Preference of children or parent

- Death of caretaker

- Protection of resources for own children (Malawi: 25% had later been evicted because of scarce resources)

Early warning system of saturation in community

Child headed households are the most vulnerable group of children:

- More accidents to younger children

- Care and discipline problems

- Stunted and malnourished

- Substandard clothing and accommodation

- Education halted

- Chronic psychological problems / poor or no adult role models : maladjustment to society

- Delinquency, prostitution, abuse, street children

- More vulnerable to becoming next generation of infected

Exposure to more than one caretaker who dies

Women will take the brunt of care for children. But they are also caring for the ill, and in many cases also providing an income.

Pressure on women must be taken into account when planning programmes

Research done through UCT has shown that women are empowered to cope more effectively when they can work collectively, have a small, regular supply of income, and work is done to improve self image.

Pressure to remain on men for maintenance when indicated.

ISSUES AND CHALLENGES WHEN PLANNING PROGRAMMES
Models based on rural communities in Eastern Africa may not be appropriate for urban South Africa

- Stronger community ties and access to food production are strengths of rural commubities

- Urban poverty often more dire, coupled with crime and high mobility

- Greater dependence on the state to support individuals in an urban setting


When planning models:

- Need to understand pre-existing patterns of informal care

- Community attitudes to care

- Extent of current care to establish saturation levels

- Need baseline, localised data


Models of care must be based on existing acceptable local models of care to be appropriate, cost effective and sustainable

Target all vulnerable children

- Prevents stigmatisation

- May well be other more vulnerable children requiring support e.g. handicapped children

- Aids not so visible yet and thus not a community priority

Use time to identify and strengthen informal and formal systems of care, and develop an awareness of the coming problem


Don't overlook psychological needs: "the urgent mustn't drive out the important"

- Be aware of early warning indicators to moderate widespread trauma

- Responding to severe trauma is too late, and too costly

- Train community volunteers to monitor and counsel children and refer to professionals only if necessary
Deal with the problem from a developmental rather than welfare perspective

- Must assess, monitor and enhance the capacity of existing mechanisms to develop sustainable models of community based care

- Most successful solutions are community driven initiatives, that are enhanced by NGO support

South Africa is in a position to proactively manage the impending orphan crisis, unlike most African countries that have had to develop programmes whilst in the midst of the problem. The focus therefore needs to be on understanding the traditional catchnets of care, strengthening them, and on understanding the impact that attitudes around HIV/AIDS will have on these systems. Cape Town Child Welfare Society is doing research into how many of these vulnerable children are currently being cared for by people other than their parents i.e. the traditional and informal catchnet for children .The research should also indicate at what point the community will be saturated and unable to absorb the care of more children.

How much can we expect saturated communities to cope without some form of financial assistance?

Expectations of support
There is a tendency towards a greater dependence on the State to support individuals under circumstances of urban poverty. Research conducted by Hackland in Soweto showed that 60.9% of respondents believed it was the Government's responsibility to care for the children compared to 20% who believed that it was the family's responsibility.

McKerrow, as part of his research into models of care in communities in the Pietermaritzburg area, found that 27% of households were caring for children in distress, (15% of households in peri-urban communities compared to 50% in rural communities) and 29.4%, mostly from the poorer communities, saw responsibility lying with the state. Encouragingly, 73.5% of families would care for related AIDS orphaned children with support, but this figure drops to 49.5% who would care for a friend's children, to 42% who would care for unknown children. McKerrow cautions however that these figures might be even lower in time as families might not be as keen once they are faced with the reality of caring for children

The discrepancy in findings between these two studies points to the importance of research being conducted in localised areas to have a good understanding of community attitudes and dynamics, a picture of current systems of accepted community care for vulnerable children, and numbers of children who are already being accommodated by caretakers other than parents. Understanding pre-existing patterns of informal foster care helps to put AIDS orphan care into context. All the literature from Africa stresses that models of care, to be appropriate, cost effective and sustainable, must be based on existing acceptable local models of care.

KEY POINT
The reality is that in a few years time the majority of children requiring the attention of an organisation such as Child Welfare Society may well be affected by HIV/AIDS in one form or another given the rapid spread of the disease. Currently however, the Western Cape is in the throes of the HIV epidemic, and we can expect an increase in orphans in 3 - 4 years time. Until then, communities are unlikely to identify these children as a problem, and would be more likely to mobilise around a more general programme targeting vulnerable children. The intervening time can be used to identify and strengthen informal and formal systems of care, and develop an awareness in communities of the impending problem.

COMMUNITY MOBILISATION

KEY ELEMENTS OF A PROPOSED MODEL FOR COMMUNITY STRATEGIES
Child care committees
As has already been mentioned, the only way to cope with the numbers of vulnerable children is to develop community based care, based on the ethic of "ubuntu", where the community takes responsibility for the care of the majority of the children, with NGO's like Child Welfare Society assisting communities to mobilise through the establishment of child care committees, helping the community to develop effective support mechanisms, protecting those children who are not absorbed by the community, and being available to render professional services when requested.

Establishment of Child Care Committees
Child Welfare Society's goal is to set up child care committee structures in as many communities, or preferably sub communities, as possible.

The Society probably has two years grace until the orphan crisis becomes acute. In this time work can be done within targeted communities to canvass community leaders, recruit interested community members and begin the process of establishing and training child care committees. It is very important that men and influential people in the community be part of these committees.

AIDS awareness training, and workshops around potential strategies for dealing with infected and affected children should be a central part of training.

Tasks of child care committees
Based on the development of child care committees in other areas, the Society's ultimate aim for these committees, with respect to AIDS related issues, would be:

- identifying vulnerable children within their areas

- keeping a register of AIDS orphans, and child headed households

- identifying and tracing extended families who can care for related children

- identifying potential foster parents

- identifying alternative care mechanisms that are appropriate to their community

- supervising placements to ensure that the children are receiving the standard of care that is acceptable to that community

- identifying people within the community who could become community counsellors in child related issues e.g. offer bereavement counselling to children

- channelling material assistance to families that they have identified as needing the most assistance

- developing and maintaining a support network for families or foster parents caring for children

- networking with other organisations offering services e.g. home based care and referring families for assistance.

Setting up committees will be time consuming, and in communities without a coherent structure, more difficult. Initially the Society will be heavily involved in the running of these committees, but by 2005 the aim is for committees to be self sufficient.

If this model is implemented, there will be implications for statutory services, and liaison with other state departments will be necessary. It is clear that there will be too many children to require statutory foster services of children's court enquiries, supervision and regulatory orders, but nevertheless many will be vulnerable and requiring supervision at a more grass roots level.

Networking to create resources
Child Welfare Society needs to network with as many organisations as possible to recruit suitable people for child care committees, or as volunteers.

Formal and informal creches, school committees and religious bodies are important resources to tap when developing awareness about child care committees and recruiting membership . In addition each could play an important role in the catchnet of services for children.

Redefining the role of social work, and the use of volunteers
Social workers will not be able to cope with the numbers of children using the traditional methods of investigation, therapy and alternative placements. There has to be a shift into development work and the recognition that most of this work must be done by community volunteers. The professional's role should become that of recruitment, training, monitoring and support of volunteers, and to render more sophisticated services to families when referred by volunteers who feel that they cannot cope with particular problems. This shift will be hard on social workers who are used to working within a very different paradigm, but the process is beginning with the work being done around how the agency uses volunteers. Agency processes will mirror community processes. As the community grapples with the problem of caring for orphans and has to come up with solutions that work for them, so will social workers face the realisation of adaptation as caseloads become more unmanageable.

Support services to caretakers
Caretakers will need support to care for children, to ensure that they are able to meet the physical and emotional needs of children until they reach independence. Child Welfare Society will need to develop and manage support mechanisms for families to prevent children being rejected and living in child-headed household or on the streets because their caretakers ultimately could not cope. Ailing parents will also need support to care for their children as long as possible.

Support needs to be in the form of:

- day care or after school care that is affordable. This gives the caretaker a break from child care, but more importantly allows the woman to involve herself in

- income generating activities;

- community volunteers who visit, encourage, counsel and steer resources towards needy families;

- Medical support services to caretakers who are caring for infected children.

It is suspected that the pilot research will establish that families living on the breadline will not have resources enough to care for additional children, even with the best will in the world to do so. Themes arising from work conducted by U.C.T's social work department has established that women are empowered to cope better when they are able to work collectively, be assured of a regular supply of income, however small, and receive input to improve their self esteem. Part of the strategy may well be representation and advocacy to the State, nationally and provincially, to provide some sort of grant that will empower women, in communities whose resources are already saturated, to assume more responsibilities and cope. Children older than six are going to be especially vulnerable as the child support grant cannot be accessed.

Training lay counsellors
It is important that there are community based programmes in place to meet the emotional and psychological needs of children and their caretakers.

HIV+ children
It is interesting that in the literature, very little is written about specific programmes dealing with the care of infected children. In Africa it is the responsibility of the parents and the family. The focus of programmes is on the care of orphaned children. However, Child Welfare Society is facing a growing crisis in the numbers of HIV+ children who will need placement, whether through abandonment, relinquishment for adoption, sexual abuse or parental neglect due to illness.

The focus must be on finding and placing these children with family members, and failing that, foster parents. The Society will be more successful in this if members of the community volunteer to trace extended families and establish whether they are suitable caretakers according to the norms of that community. This could be an important function of a child care committee.

Recruitment of foster parents
Networking

Linking foster care to Relief programmes
Child Welfare Society needs to develop a professional foster parent programme for caretakers of unrelated or HIV+ children, and broaden the criteria for acceptance as a foster parent. This programme should be linked with the concept of "employing" these parents. In this way unemployed women, who have a knowledge of or interest in children, can be recruited and trained in child care and HIV issues. Funding could be sourced from poverty relief programmes for those potential parents who live under financially difficult circumstances.

It may also be necessary to link this programme with one whereby accommodation is supplied (e.g. a container or wendy house) by Child Welfare Society with the understanding that the foster mother manages financially on income from the foster grants. Two or more women could live together and rear children, particularly if they were HIV+ themselves. Efforts should be made to access land or accommodation from authority structures.

If Child Welfare Society is successful in this regard, then the Department of Welfare and the Department of Justice will need to be lobbied to approve these parents and their circumstances. Currently foster parents need to have some form of income not grant related to be approved.

Social workers will need to critically assess criteria for acceptance as a foster parent, the content of the training programme, and how much training must occur once the children have been placed. A contract between the foster parent and the agency needs to take into account appropriate standards, supervision and training.

Community initiatives
Although the aim should be to have as many children placed in their original communities as possible, some children will have to be placed elsewhere. The Adoption Centre has an emergency care programme for HIV+ children based on the response of a church in the Southern Suburbs. As many of these resources need to be tapped as possible, particularly until community programmes are functional.

Religious groups could also play an important supportive role. If foster parents and carers are not adequately supported, the programmes will fail. Churches could be twinned with particular areas to financially or materially support foster parents living there. More people therefore have the potential to be involved.

A major role of the Society will be to assist community initiatives to establish themselves, as these will play an important part in the overall catchnet of services to children.

Conclusion
The thrust of the programme proposed for Child Welfare Society can be summarised as follows:

- The future of this Society's services to children lies in empowering volunteers through effective recruitment, training, support, and supervision programmes.

- These committees should ultimately be in a position to assist vulnerable children within their Child Welfare needs to build upon the strengths of its Isolabantwana project to develop child care committees in localised areas.

- area to recruit, place and supervise children, assist families materially, offer support to caretakers, or render a counselling service.

- All vulnerable children are the focus of the programme, not only those affected by HIV/AIDS.

- The role of professional staff will thus alter, to managing this process and dealing with referrals of children the community feel unable to handle. Workshops and focus group discussions with the staff are a part of this process.

- Creative foster care recruitment options need to be explored; criteria to become a foster parent needs to be re-evaluated by the Society and State Departments; foster parent programmes need to be linked with State Poverty Relief and Alleviation programmes.

- Residential and Educare resources need to be repositioned to maximise their benefit to their community

- Pilot research projects will be run in selected areas, looking at different aspects of this programme.

- The programme, to be manageable and successful, will be completed in phases. By 2005 committees should be self sufficient in managing vulnerable children.

- This programme can only be successful through linking and networking with other organisations and communities.

We are in a process of finding out what will and will not work, and we have to be prepared to be creative and flexible in our strategies, remembering that we will only protect children adequately if all sectors of society collaborate their skills, resources and energies.

Thank you for listening to the presentation. Should you have any queries, I am available at: e- mail : hasewink@mweb.co.za

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