1. Children Corners or Warehouses? The Quest for Psychosocial Support to OVC’s Eric Umar College of Medicine Community Health Department

2. Orphan Care Models Community Based Community Based Institutional Based Institutional Based

3. Program Evaluation Surrounding the child Surrounding the child Health Health Education Education Psychosocial Psychosocial Livelihood Livelihood

4. Orphan and Vulnerable Children situation in Malawi 650,000 AIDS orphans 650,000 AIDS orphans Representing 65 % of Orphans Representing 65 % of Orphans Vulnerable children Vulnerable children Orphans and children on the brink Orphans and children on the brink Adolescents living with HIV Adolescents living with HIV

5. Adolescent Living with HIV The roll-out of anti-retroviral treatment programs has made it possible for perinatally infected infants to live through adolescence and adulthood The roll-out of anti-retroviral treatment programs has made it possible for perinatally infected infants to live through adolescence and adulthood Worries about illness revolve around: Worries about illness revolve around: Disclosing their HIV status to friends Disclosing their HIV status to friends People finding out that they live with HIV People finding out that they live with HIV Living situations Living situations Sexuality Sexuality infecting someone else with HIV infecting someone else with HIV

6. Emotional impact Children on the brink – experience negative changes Children on the brink – experience negative changes start to suffer neglect, long before they are orphaned start to suffer neglect, long before they are orphaned Suffer the death of their parent(s) – leading to emotional trauma Suffer the death of their parent(s) – leading to emotional trauma Adjustment challenges Adjustment challenges new situations - with little or no support new situations - with little or no support may suffer exploitation and abuse may suffer exploitation and abuse Studies have found high levels of psychological distress in OVCs Studies have found high levels of psychological distress in OVCs Anxiety, Depression, Anger Anxiety, Depression, Anger Suicidal - wish they were dead (12 % vs 3 % in Uganda) Suicidal - wish they were dead (12 % vs 3 % in Uganda) Psychological problems more severe when child is forced to separate from their siblings Psychological problems more severe when child is forced to separate from their siblings > half of orphans no longer live with all of their siblings (Zambia) > half of orphans no longer live with all of their siblings (Zambia)

7. Psychosocial Support There is a huge need for emotional support and counseling There is a huge need for emotional support and counseling Help them deal with loss, trauma Help them deal with loss, trauma Adjust to new situations Adjust to new situations Support them become resilient Support them become resilient Set goals for their lives Set goals for their lives Take up new roles Take up new roles Looking after siblings Looking after siblings Take their medication – ARVs etc Take their medication – ARVs etc Deal with family – property grabbers Deal with family – property grabbers

8. Children’s Corner Support children cope with psychosocial problems Support children cope with psychosocial problems Establish children problems that might affect them psychosocially and intervene where possible Establish children problems that might affect them psychosocially and intervene where possible

9. Limitations Huge numbers of children Huge numbers of children both orphans and non orphans come to the corners both orphans and non orphans come to the corners Disorderly nature of the activities Disorderly nature of the activities Difficult to identify children with problems Difficult to identify children with problems Weekly meetings Weekly meetings Few poorly trained “facilitators” Few poorly trained “facilitators” Two facilitators Two facilitators Communities unable to provide food etc Communities unable to provide food etc

10. Conclusions Children corners provide some form of psychosocial support Children corners provide some form of psychosocial support The support is too inadequate The support is too inadequate

11. The End! Sikomo

12. Recommendations There is need for attention to mental health problems faced by OVCs There is need for attention to mental health problems faced by OVCs Need for well designed and monitored psychosocial support research interventions in resource-poor settings. Need for well designed and monitored psychosocial support research interventions in resource-poor settings.