Multiple vulnerabilities
Qualitative data for the study of
orphans and vulnerable children
in South Africa
Alicia Davids, Nkululeku Nkomo, Sakhumzi Mfecane,
Donald Skinner & Kopano Ratele
Edited by Donald Skinner & Alicia Davids
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Compiled by the Social Aspects of HIV/AIDS and Health Research Programme,
Human Sciences Research Council
Published by HSRC Press
Private Bag X9182, Cape Town, 8000, South Africa
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© 2006 Human Sciences Research Council
First published 2006
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Semi-structured interviews 7
Research instrument 7
Sampling method 7
Sample Kopanong 8
Sample Kanana 8
Observations 9
Analysis 9
Chapter 4 Qualitative Report Of Ovc Living
Conditions And Services In The
Kopanong Municipality, Free State
Province —
Sakhumzi Mfecane, Donald Skinner
and Alicia Davids
11
Geographical context 12
Economic situation 14
Poverty and unemployment 14
Situation of youth 15
Situation of HIV/AIDS 17
Context of people living with HIV/AIDS 21
Context of OVC 24
Support systems for OVC 30
Challenges facing government departments 35
NGO, CBO and FBO support structures 37
Challenges facing NGOS/CBOS 39
Discussion 40
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Chapter 5 Qualitative Report Regarding
The Situation Of Orphans And
Vulnerable Children (Ovc) In Kanana

Tables
Table 1 Ethnic composition in 2001 compared with the average for the district
in 1996 11
Table 2 Education levels for persons 20 years and older, 2001 12
Figures
Figure 1 Map of the Kopanong Municipality 13
v
LIST OF TABLES AND FIGURES
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vi
Alicia Davids,
Health Promotion and Behavioural Intervention Research Unit, Medical Research Council
Nkululeku Nkomo,
Social Aspects of HIV/AIDS and Public Health, Human Sciences Research Council
Sakhumzi Mfecane,
WISER, University of the Witwatersrand
Donald Skinner,
Social Aspects of HIV/AIDS and Public Health, Human Sciences Research Council
Kopano Ratele,
Dept of Psychology, University of the Western Cape
AUTHORS
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vii
This report reflects a collaborative endeavour involving many people. Although the list
below is not an exhaustive one, we wish to thank the following people and organisations
for their participation and unstinting support in this study:
• The WW Kellogg Foundation for their financial support and making this study possible
• The Nelson Mandela Children’s Fund, our partner for this project in South Africa.
• Our colleagues from the HSRC who assisted in providing information, doing

Representatives from NGOs who granted interviews.
Finally, we would like to thank all the people who participated and provided information,
including those OVC and their carers without whose generosity this study would not have
been possible. Their participation is testimony that if we all put our energies together
we can obtain the information necessary to tackle the epidemic that confronts us all and
provide the much-needed care for orphaned and vulnerable children.
ACKNOWLEDGEMENTS
vii
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viii
ACRONYMS AND ABBREVIATIONS
AIDS acquired immunodeficiency syndrome
ARV antiretroviral drugs
CBO Community based organisation
DoA Department of Agriculture
DoE Department of Education
DoH Department of Health
DSD Department of Social Development
FBO Faith based organisation
GDP gross domestic product
GMC Grace Mokgomu Clinic
HIV human immunodeficiency virus
IDP integrated development plan
KOSH District of Klerksdorp, Orkney, Stilfontein and Hartebeesfontein
NGO non-governmental organisation
OVC orphans and vulnerable children
PLWHA people living with HIV/AIDS
PMTCT prevention of mother-to-child transmission
STI sexually transmitted infection
RDP reconstruction and development programme

roads between the towns are untarred. The poor roads and long distances between towns
make community development and the provision of services more complicated.
Kanana, in the North West province, is a large, densely populated township close to
Orkney that constitutes part of a series of towns servicing the gold mines. The towns
comprise many migrant workers from across the country, their families and many others
who have come to seek work or income. There are a large number of informal houses in
the district, which contain their own health threats. The industry in the area is threatened
as the gold price comes under increasing pressure.
HIV/AIDS is a significant concern in the communities. The respondents all felt that the
poverty in the area was the most serious contributor, with the high levels of substance
abuse and the silence around and fear of HIV/AIDS also being serious. In Kopanong
particularly, there were very few HIV/AIDS interventions because even the large national
campaigns such as LoveLife did not have a presence there. A particular problem noted
was alcohol abuse among both youth and adults, which was regarded as resulting from
inactivity and pessimism about the future, as career prospects within the area are limited.
Alcohol abuse was felt to have multiple negative consequences, for example, engaging in
unsafe sex and wasting already limited financial resources.
A number of factors were felt to be contributing to children feeling vulnerable. Both
communities were reported already to have large numbers of children who had been
orphaned by HIV/AIDS, as well as by other causes. The number of fathers who were
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x
x
absent made this worse. Concern was already being raised that there are insufficient
caretakers to look after the children who are in need of assistance. At the time of the
research, it appeared that virtually all of the children were living with a caretaker, with
few child headed households.
A number of the other contextual variables were given as contributing to the vulnerability
of children living in these areas. Prevalence of HIV/AIDS was already seen as high in
the communities, with respondents feeling that the figures were rising steeply. A further,

unemployment, limited resources, poor roads and infrastructure, and for many, problems
of access to services. Direct access to individual services varied. Most children had access
to health services, with virtually all living within accessible distance of a clinic. Difficulties
in talking about HIV made services for treatment and prevention in this area difficult to
reach. For example services are difficult to deliver as service providers are expected to
travel long distances on poor roads. The municipality of Kopanong is dispersed, which
exacerbates the slowness of service delivery.
Multiple vulnerabilities
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xi
Government departments and NGOs/CBOs are doing their best to address local
problems but are often limited, particularly the NGOs/CBOs, by lack of funds and other
infrastructural constraints. Both communities have battled to sustain NGOs, a more
serious problem in Kopanong given the small towns and distances between them.
However, despite these problems, there is hope and commitment to improving the lives
of OVC and services offered to them. The HSRC and NMCF will work closely with the
communities and their representatives to try and address limitations expressed in the
delivery of services for OVC.

Executive Summary
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11
CHAPTER 1
Introduction
Donald Skinner and Alicia Davids
South Africa is one of the countries in sub-Saharan Africa with the highest HIV
prevalence. A national study on HIV prevalence by Shisana et al. (2002) showed that
approximately 11% of South Africans are living with the HI virus. The Department of
Health Annual Antenatal surveys (2004) showed national figures among pregnant women

both parents. This could be due to AIDS, other illnesses, violence or other causes of death.
Drawing on this research the definition of what makes a child vulnerable is more complex
and focuses on contexts that centre around three core areas of concern (Skinner et al., 2004):
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2
• material problems, including access to money, food, clothing, shelter, health care
and education;
• emotional problems, including insufficient caring, love, support, space to grieve and
containment of emotions;
• social problems, including lack of a supportive peer group, of role models to follow,
or of guidance in difficult situations, and risks in the immediate environment.
The situation of OVC in South Africa
By extension from this definition the situation of children is described, drawing on available
information from the literature on the epidemiological distribution of the factors of concern.
Evidence is drawn from the literature to describe the prevalence in South Africa of a
number of the conditions that are felt to contribute to the vulnerability of children.
Orphan status and care
In line with the report on the definition of OVC (Skinner et al., 2004), drawn from the
communities where the project is being done, found that the loss of either parent put
strain on the child, as the loss of the mother often means loss of the direct carer, while the
loss of the father puts the household in a difficult financial situation. HIV/AIDS stands out
as a cause of orphanhood, in that if one parent is infected with HIV, the probability that
the spouse too is infected is high (Bray, 2003). Migrant labour also constitutes a particular
form of loss of a parent for a period of time while they go in search of income.
Orphans and deserted children are very dependent on the availability and quality of
replacement carers for their ongoing support. With children taken in by extended families
or members of the community, pressure can be put on these families due to the increase
in the size of the households. The number of people per household does not provide
an accurate measure of children per carer, but is a guide. According to census 2001,
households of seven or more people constitute 13.9% of the population. (Statistics South

the death of the parents. The child becomes seen as a threat or an indictment by the
surrounding community. Stigma can affect children in multiple ways, but in particular,
they are excluded from community support, and can begin to internalise the stigma
leading to the entrenchment of a highly damaged self image (Skinner & Mfecani, 2005).
Other health impacts on children include malnutrition and illness. In 1999, 21.6% of
children one to nine years of age were stunted, 10.3% were underweight and 3.7% were
wasted. Deficiencies in micronutrients, with implications for development, are also a
common problem. (Solarsh and Goga, 2004) Diseases of threat include TB, cholera,
measles, influenza and malaria. Disability among children is one area that warrants
separate attention. Both physical and mental disabilities are important to consider. It is
difficult here to give clear figures, as problems of definition are found again. In 1999,
a survey by the Community Agency for Social Enquiry (CASE, 1999) found a 5.9%
prevalence of disability in children.
Poverty
Wealth, disposable income, and other assets of the household are closely linked to child
health and welfare, which would be expected to be compromised in households losing
men and women at ages of prime economic activity (Bicego et al., 2003). Poverty impacts
on children in that they are deprived of clothing, adequate nutrition, access to services,
proper housing, etc. The impact is pervasive over time and throughout the country,
although certain provinces are worse than others. Poverty affects entire communities,
with children living in generally deprived contexts. The situation is worse on farms and
in rural areas, which are often also more invisible. There are varying constructions of
poverty, but using a straight World Bank approach of ‘a dollar a day’ (World Bank, 2000),
indications are that at least 45% of South Africans live in absolute poverty (Hill and Smith,
2003).
In 2002 one estimate found that 11 million children lived on less than R200 per
month (Streak, 2002).
Housing does have specific implications of its own, as poor informal housing is highly
associated with a range of negative health impacts including HIV infection and such
residents are more likely to be disadvantaged regarding access to services (Shisana and

money in order to survive (Perschler-Desai, 2001) or may be forced by gangs into
prostitution (Molo Songololo, 2000).
Violence and substance abuse in communities
The principle problems of violence in communities relate to crime, the presence of
gangs, community and political violence, sexual violence and also domestic violence
(Standing, 2003; Anderson and Mhatre, 2003). Gender and domestic violence constitute a
particular problem as the impact of this is felt directly in the homes and is witnessed and
experienced directly by children. Problems are accentuated by the acceptance in many
communities that this is normal and the inadequate responses by police, although the
latter is being addressed within the SAPS (Jackson, 1997).
Substance abuse has been, and is, a consistent problem across South Africa. The problem
of excessive alcohol use is well established (Parry, 1997), but there is evidence of large
increases in the use of illegal drugs (Leggett, 2001; Ryan, 1997), especially with the
opening of the country’s borders following establishment of democracy. If the carers
themselves are abusing substances, it heightens the problems for children as resources are
wasted and the caretakers are often out of the house and incapable of providing care.
Overall vulnerability of children
Many of the factors contributing to vulnerability in children overlap. So if a child is
vulnerable in one context, they are more likely to be vulnerable in other contexts. Thus,
children who have lost their parents to HIV are also more likely to become part of a
household that is overcrowded and poor. In turn they are more likely to be subjected
to stigma and disease themselves. These contributions cannot simply be summed using
an arithmetic basis, but compound the problems and obstacles for children to find safe
spaces for healing and integration and to allow for the development of coping strategies.
The actual impact of orphanhood as a result of HIV/AIDS, plus the other sources of
vulnerability, need to be thoroughly examined.
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55
CHAPTER 2
Background and aims of the project

a census survey and a directed survey of OVC at this site. This information informs
both intervention plans being developed to assist OVC and indicators for monitoring
the interventions. At the end of the project the baseline research processes will be
repeated. This, together with process evaluations, will be used to assess the effect of the
interventions. This report is concerned with the qualitative research component, which
took place between 2003 and 2004.
Aims of the research
Qualitative research was conducted primarily to seek the views of the residents of
Kopanong and Kanana about the general living circumstances of OVC, the levels and
impact of HIV/AIDS, social problems present in the community, and the services available
to address the needs of OVC as well as of the general community. The latter included
government and non-government services. Secondly, this process also served as an
entry into the field. Through interactions with key stakeholders and certain community
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6
members, researchers sought to create an atmosphere conducive for the subsequent
survey and interventions.
Multiple vulnerabilities
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77
CHAPTER 3
Methodology
The focus of the qualitative research was on semi-structured interviews with a diverse
range of participants, but additional information was obtained from observations while
in the field.
Semi-structured interviews
Semi-structured interviews were guided by an interview schedule that was developed on
the basis of the objectives of the study and agreed upon by all researchers from the three
countries. The aim of the interview schedule was firstly, to ensure similarity of issues
discussed in all interviews and secondly, to ensure a certain amount of control over

their involvement in OVC and HIV-related work and their experiences of either caring for
OVC or being an orphaned / vulnerable child themselves. Other categories of participants
(community members and community leaders) were selected on the basis of their
knowledge of community issues and involvement in community development initiatives.
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8
In South Africa interviews were carried out with representatives from local government,
NGOs, OVC, OVC carers and general community members and leadership. The emphasis
was first on selecting OVC and secondly, their carers, but it was often difficult to contact
and establish these interviews. Purposive sampling was used to ensure an adequate
distribution of respondents in the study. The number of interviews decided upon also
depended on the size and distribution of the target communities, the number of NGOs in
the communities and OVC-related state services in the region.
Sample Kopanong
The sample in Kopanong consisted of 30 interviews. The breakdown of participants
were as follows:
• Seven government officials from the: DoH; DoE; Department of Agriculture;
DSD (three) and the Kopanong municipality.
• Five Non-governmental Organisations: Oranje Vrou Vereeneging, Philani Victim
Support Centre, Lekomo HIV/AIDS Consortium; Bokolokong HIV Support group,
Bokomoso HIV Consortium.
• Four community members: the participants in this category included youth and
adults based in Kopanong referred to the research assistant as possible interviewees
by our contact people in their towns.
• Four community leaders: community leaders representing five towns were selected
on the basis of their availability and willingness to share their opinions about the
research topic. Due to limitations in sample and vastness of the municipality, leaders
from all nine towns could not be interviewed.
• Six carers based in Philipolis (four) and Springfontein (two): they were also selected
by the research assistant who was familiar to them, based on their willingness to

visiting the communities. We paid particular attention to housing structures, nature of
roads and accessibility of each town, levels of poverty, commercial activities and other
issues relevant for a better understanding of the context. Some interviews took place
inside households, so the living situations inside the house could be observed. Data
collected through observation was recorded by means of note taking.
Analysis
A thematic content analysis method was used to identify the major themes and discourses
that emerged from the transcriptions. For the analysis of the Kopanong data, Atlas ti was
used. Quotes that were considered representative of the analysis were selected. These
also allowed the community members more of a voice. Names and identifying details
were changed to protect informants where necessary.
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1111
CHAPTER 4
Qualitative Report of OVC
living conditions and services
in the Kopanong Municipality,
Free State province
Sakhumzi Mfecane, Donald Skinner and Alicia Davids
Xhariep district is composed of three local municipalities, i.e. Kopanong, Mokohare and
Letsemeng. Kopanong is the biggest of the three municipalities with a total population
of 55 942, followed by Letsemeng (42 979) and then Mokohare (36 316). Xhariep district
has a total of 17 towns and nine of them fall under the Kopanong local municipality.
These are Trompsburg, Edenberg, Reddersburg, Springfontein, Gariep Dam, Jagersfontein,
Fauresmith, Bethulie and Philipolis. Bethulie is the biggest of the towns, with a total
population of 12 374 and Gariep Dam has the smallest population size (1179). In terms
of spatial occupation, Xhariep district is regarded as the biggest in South Africa, yet it has
the lowest population density in the Free State province. The district covers an area of
34 131.55 km

schooling
Some
primary
Complete
primary
Some
secondary
Grade 12 Higher
qualification
Kopanong 20.94% 25.12% 8.52% 27.74% 13.02% 4.66%
Letsemeng 25.25% 26.16% 7.85% 24.32% 12.40% 4.02%
Mohokare 22.61% 30.40% 8.64% 22.54% 11.13% 4.67%
Xhariep 22.74% 26.86% 8.34% 25.28% 12.32% 4.46%
Source: Stats SA 2003.
As can be seen, the majority of people in the district have some primary school education,
but less than 9% have completed it. Less than 5% have an education beyond grade 12,
while only 12% have reached grade 12.
Geographical context
The community is difficult to work in due to the large size and the distribution of
the population across nine small towns. This is exacerbated by undeveloped road
infrastructure. Although the district is easily accessed through the national road and other
main roads, travelling within this district from one town to the next requires driving
on gravel roads. For residents of the Kopanong municipality, access to different towns
is further restricted by a lack of public transportation. They rely on taxis travelling to
Bloemfontein, which are unreliable and expensive. Other options are hiring a private car,
which is even more expensive.
The difficulty of driving long periods of time on gravel roads has implications for
service delivery by both government and NGOs. For example, social workers do not
have quality time to monitor the well-being of the children that they have placed. They
reported spending more time driving to certain places than attending to the needs of

Economic situation
Kopanong Municipality makes the largest contribution to the total Gross Domestic
Product (GDP) of the district (42.41%), followed by Letsemeng (29.84%) and Mohokare
(27.75%) Municipalities (Xhariep District Municipality, 2005). The economy of the district
is dependent primarily on agriculture, which contributes 35.91% to the GDP of the
district, followed by government (16.17%). Mining contributes to the GDP by 6.35%.
The dependence on agriculture means that the economy of the district is at risk due to
the decline of the agricultural sector in the past few years. A long drought and the rise
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