**4. Discrimination and stigmatization**

Article 1 of the Universal Declaration of Human Rights speaks of the equality of all people. Right for health, which is enshrined in the status of WHO, i.e. the highest level of physical, mental and social well-being, reminds us all that HIV-infected people have the same right for equal treatment as well as the right to protect their civil, political, economic, social and cultural rights as all other members of human society do. The issue of human rights is given a priority position in the programs of such institutions as Council of Europe, UNICEF and many others. The next evidence of this priority is presented by the creation of the United Nations Program for the Fight against HIV/AIDS (UNAIDS), by a combination of powers and funding of six institutions of UNO.

The most inexorable form of discrimination against people with HIV/AIDS is that of popular or institutionalized retribution. This can go for mere avoidance to the refusal of medical treatment, imprisonment, ostracization or even physical assault against high-risk groups, such as gay people, commercial sex-workers, and intravenous drug users. All these forms of discrimination have been recorded in different parts of the world. A frequent prejudice is that people living with HIV/AIDS should be subject to legal controls or quarantined in order to stop the spread groups should be compulsorily tested for HIV. Such beliefs have influenced the enacting of laws, especially those relating to immigration and emigration. Such laws have, in turn, helped to define public attitudes towards those living with AIDS. (Shorter & Onyancha 1998)

questions imply the spiritual dimension. These questions are very real for children whose parents died of AIDS but they are suppressed from fear and because of the stigma

The child can have trouble finding help and support from peers and adults because there is a mysterious silence about everything, no one wants to talk about the death of his close relative or what so more, to talk about HIV / AIDS. The child feels fear and shame to share his feelings with others, or it makes the situation deteriorate. If somebody belongs to the Christian faith, who perceives AIDS as a consequence of the moral bankruptcy of the individual, it does not make the situation easier. While the church preaches to love sinners, at the same time it condemns the sin. From this perspective, PLHWA are responsible for their conditions, but they deserve compassion and assistance. The child could eventually find their harbour in the church, even if it offers a very mixed or negative image of people with HIV / AIDS. This point of view complicates the child´s spiritual interpretation. All life situations the child had already had to go through, such as the death of a parent, poverty, deprivation, sniffing the glue, violence, make the spiritual survival complicated and they burden his purity. HIV positivity present chaos, uncertainty, unpredictability to the child, it

The spirituality and religion can present a complicated issue. It is necessary to have the child explained his own responsibility for loss, death, disease, so that the child does not perceive these as his own sins. It is necessary to give them room, time and assistance in this direction. Religious rituals, in which the child can take part, can help and be one of the most significant is at the funeral. The child itself has to make the decision, whether he wants to be part of it or nor. Memorial mass, private rituals, lightning the candles, prayer, all of that can

Article 1 of the Universal Declaration of Human Rights speaks of the equality of all people. Right for health, which is enshrined in the status of WHO, i.e. the highest level of physical, mental and social well-being, reminds us all that HIV-infected people have the same right for equal treatment as well as the right to protect their civil, political, economic, social and cultural rights as all other members of human society do. The issue of human rights is given a priority position in the programs of such institutions as Council of Europe, UNICEF and many others. The next evidence of this priority is presented by the creation of the United Nations Program for the Fight against HIV/AIDS (UNAIDS), by a combination of powers

The most inexorable form of discrimination against people with HIV/AIDS is that of popular or institutionalized retribution. This can go for mere avoidance to the refusal of medical treatment, imprisonment, ostracization or even physical assault against high-risk groups, such as gay people, commercial sex-workers, and intravenous drug users. All these forms of discrimination have been recorded in different parts of the world. A frequent prejudice is that people living with HIV/AIDS should be subject to legal controls or quarantined in order to stop the spread groups should be compulsorily tested for HIV. Such beliefs have influenced the enacting of laws, especially those relating to immigration and emigration. Such laws have, in turn, helped to define public attitudes towards those living

causes lot of problems and on-going struggle. (Shorter & Onyancha, 1998)

associated with HIV positivity.

be a part of the therapy for the child.

**4. Discrimination and stigmatization** 

and funding of six institutions of UNO.

with AIDS. (Shorter & Onyancha 1998)

In the current phase of the unstoppable progress of HIV/AIDS pandemic and development of the fight against HIV/AIDS, is a systematic effort needed more than ever. Effort, which could counteract with the spreading of infection from the position of respecting human rights, in particular in these areas:


HIV/AIDS positive individuals have the same right to protect their rights as other members of the society. They have the right to work, have a job, right to obtain education, the right to attend a school, right for the social security and assistance, right for the protection against inhuman or degrading treatment or punishment. The most important and recognized principle is, that people or groups of people, who are at a higher risk of getting infected, in particular those, who are already infected or those who develop AIDS will not be discriminated.

Probably the most common reason for the discrimination is an irrational fear of and fear from contact with people infected by HIV/AIDS, fear from infection and from, the possible consequences of the disease, suffering and death. Based on ignorance, all of these factors cause discrimination tendency. It is also subconscious, but irrational. A significant percentage of discriminatory attitudes of the population are related to the fundamental ignorance, about HIV transmission routes. That is another reason for the necessary repetition of targeted informational and educational campaigns.

Another reason for discrimination is usually called *pre-existing discrimination,* i.e. disagreement or disapproval with the existence of certain opposition groups. Only few common people are aware that in this case, the discrimination itself presents a risk of further spreading infection. It is necessary to combat the discrimination as such, in all its forms and manifestations. Frequently, the reasons for this are certain social manifestations originating from certain professional attitudes. They usually manifest themselves in condemning people with certain lifestyle or still uncertain attitudes of some churches, based on intolerance. Daily preventive practice is therefore necessary, so that new social and other moments can be steadily implemented into plans of prevention to weaken the mentioned attitudes. (Mayer, 1999)

One group which has experienced overriding forms of discrimination is that of women. All over the world there is evidence that women have been coerced or pressured to have abortions or be sterilized because they are HIV-positive. Doctors have even exaggerated the rate of perinatal transmission of HIV to infants in order to convince women to terminate a pregnancy. Others have refused outright to offer reproductive health services to such women. In health care, there are reports of a refusal to treat HIV-positive patients and of discrimination against health workers who are HIV-positive. Health workers are also compromised because of their physical closeness to AIDS patients. Discrimination has occurred in the provision of funeral services. This includes the refusal to handle bodies of

Psychosocial Aspects of People Living with HIV/AIDS 183

they happen to realize, that their life will not last very long, they are confronted with the

Children, in particular, suffer from grief after losing their parents, when confronted with the fact that one becomes an orphan. Many of them never experienced, what it means to have a family. They may also suffer from grief, which is transmitted to them from their loved ones, family members and friends. People, who take care of these children and provide them with

Children lose their hope when they have to deal with the loss of their parents, siblings or

If their status becomes known to others e.g. peers, family members and the community it can have a very bad impact on the further development of a child. The child often gets isolated; he or she is excluded by the classmates, in many cases even by their own family members. It is therefore necessary to talk about HIV / AIDS in all its aspects and not make it a taboo topic. It has to be discussed among at all the groups of the society and HIV positive

Many children blame themselves from causing the disease of their parents and dying. They feel responsible for events that occurred. They blame themselves of not being caring enough, that they were evil and that is the reason for their parents´ death. They feel very

The feeling of guilt, anxiety and their fears can be so strong, which can lead to depression. It happens very seldom, but still, that a child may attempts to commit a suicide. An attempt to

• The concept of death is usually corresponds with age and mental maturity of a child. Even a seven-year old child is able to express the wish that it would rather like to be

• The perception of oneself, the consciousness of one´s own value. Feelings of guilt, lack of adequate self-appreciation, excessive underestimation from the others, unfavourable comparisons with others - lead to the idea of making an end to all of it. Feelings and expressions of depression begin to appear, such as, loss of social interest, feelings of sadness and emptiness, eating and sleep disorders, decreased activity, feelings of

• Familiar environment of the child has great impact on him, the idea of a complete family, the fact of experiencing the death of the parents; all of this plays a significant

• Form of discrimination is the child experiencing, if it is stigmatized and isolated, what

A specific situation is on in which children living with HIV/AIDS are a most vulnerable group. There are some specific psycho-social issues, counsellors have to deal with. Most of them are experiencing fear, anxiety, lethargy and quietude. Some children are segregated by the guardians, who fear their children might also contract the virus when they will play together, sleep together or eating together by sharing the utensils. Some parents have feared to send their children to school; they don't go to school, as some schools don't allow them to play with the rest. There is also high risk, possibility of dropping from school due to ill health. They don't get well balanced food; there is poor access to medication. Some HIV/AIDS positive children already lost their parents; some older children take on the roles

are the social ties. (Spitze, 1991 as cited in Brabec, 1991)

commit a suicide can be according to Spitz affected by several elements, such as:

daily support and assistance, can observe a continual comedown of these children.

other relatives. And these are the greatest wounds none of which are ever healed.

people have to be showed, how to live with this disease.

dead, since his life is meaningless,

loneliness, stubbornness.

role,

of the parents.

fear from their own death.

guilty.

people known or suspected to be HIV-positive, the imposition of an extra fee, etc. (Shorter & Onyancha 1998)

The most common forms of discrimination experienced by people living with HIV/AIDS, we could include:


One apparent consequence of discrimination for people living with AIDS is the break-up of families. On learning that their wives are HIV-positive, many husbands desert tem and marry other women. His not only deprives women of the love and care due from their spouses, but also promotes the spread of the disease via their husbands. Another shocking phenomenon is the extent to which infants who are HIV-positive are abandoned in hospitals by their parents. Parents, who cannot face up to the dilemma which the epidemic poses for their children, often abandon their parental responsibility altogether. Various organizations have been set up to deal with the problem, but the battle is still far from being won. Most foster homes are reluctant to take HIV-positive children, claiming that thy do not have the resources to care for them. In some cases, even members of extended families are reluctant to care for HIV/AIDS members for fear of being infected. In such cases, these people are left lonely and desperate. ((Shorter & Onyancha 1998)

Discrimination is closely linked with the concept of *stigma.* Stigma can be distinguished into two basic types. The first category is called *felt stigma*, which distinguishes the individual sensitivity to the potential of negative attitudes and fear of discrimination based on HIV status. Repeated or *enacted stigma* presents a real discrimination experience based on HIV status. For example, an individual may intentionally avoids a HIV test because of the fear that the community would react negatively to any disclosure of its positivity. Should his positivity be disclosed, the patient fears that he would be rejected from the community by his family as well.

#### **5. Children as the most vulnerable group**

Children infected with HIV live almost their whole life with some fear. Many of them first experience fear from loss of their parents. Many of them have to watch by, as one or both parents suffer from the AIDS, and they take care of them and spend time with them during the process of dying. After death of one of the parents many of the children must deal with other fears and concerns. In many cases the children guess, that they are sick themselves, too and this fact results in other further concerns. They are constantly confronted with the burden of evidence, which they carry with them for the rest of their life. Some of them will experience a hospitalization associated with many changes, which have to be adapted. If

people known or suspected to be HIV-positive, the imposition of an extra fee, etc. (Shorter &

The most common forms of discrimination experienced by people living with HIV/AIDS,

• ignoring or avoiding people with HIV/AIDS, because a person does not know how to

• unwillingness to disclose HIV status to someone other because of the fear from

• inability to discuss the sexual behaviour, personal preferences and desires, as these

• refusal or neglecting of discussion about the guidance by the risk behaviour and HIV

• inability and unwillingness to accept a person with AIDS and their families with

One apparent consequence of discrimination for people living with AIDS is the break-up of families. On learning that their wives are HIV-positive, many husbands desert tem and marry other women. His not only deprives women of the love and care due from their spouses, but also promotes the spread of the disease via their husbands. Another shocking phenomenon is the extent to which infants who are HIV-positive are abandoned in hospitals by their parents. Parents, who cannot face up to the dilemma which the epidemic poses for their children, often abandon their parental responsibility altogether. Various organizations have been set up to deal with the problem, but the battle is still far from being won. Most foster homes are reluctant to take HIV-positive children, claiming that thy do not have the resources to care for them. In some cases, even members of extended families are reluctant to care for HIV/AIDS members for fear of being infected. In such cases, these people are left

Discrimination is closely linked with the concept of *stigma.* Stigma can be distinguished into two basic types. The first category is called *felt stigma*, which distinguishes the individual sensitivity to the potential of negative attitudes and fear of discrimination based on HIV status. Repeated or *enacted stigma* presents a real discrimination experience based on HIV status. For example, an individual may intentionally avoids a HIV test because of the fear that the community would react negatively to any disclosure of its positivity. Should his positivity be disclosed, the patient fears that he would be rejected from the community by

Children infected with HIV live almost their whole life with some fear. Many of them first experience fear from loss of their parents. Many of them have to watch by, as one or both parents suffer from the AIDS, and they take care of them and spend time with them during the process of dying. After death of one of the parents many of the children must deal with other fears and concerns. In many cases the children guess, that they are sick themselves, too and this fact results in other further concerns. They are constantly confronted with the burden of evidence, which they carry with them for the rest of their life. Some of them will experience a hospitalization associated with many changes, which have to be adapted. If

Onyancha 1998)

we could include:

• refusal of care,

discrimination,

prevention,

his family as well.

• condemnation, isolation,

handle an unpleasant situation during the meeting,

understanding and without prejudices,

lonely and desperate. ((Shorter & Onyancha 1998)

**5. Children as the most vulnerable group** 

topics are accompanied by unpleasant feelings of shame or guilt,

they happen to realize, that their life will not last very long, they are confronted with the fear from their own death.

Children, in particular, suffer from grief after losing their parents, when confronted with the fact that one becomes an orphan. Many of them never experienced, what it means to have a family. They may also suffer from grief, which is transmitted to them from their loved ones, family members and friends. People, who take care of these children and provide them with daily support and assistance, can observe a continual comedown of these children.

Children lose their hope when they have to deal with the loss of their parents, siblings or other relatives. And these are the greatest wounds none of which are ever healed.

If their status becomes known to others e.g. peers, family members and the community it can have a very bad impact on the further development of a child. The child often gets isolated; he or she is excluded by the classmates, in many cases even by their own family members. It is therefore necessary to talk about HIV / AIDS in all its aspects and not make it a taboo topic. It has to be discussed among at all the groups of the society and HIV positive people have to be showed, how to live with this disease.

Many children blame themselves from causing the disease of their parents and dying. They feel responsible for events that occurred. They blame themselves of not being caring enough, that they were evil and that is the reason for their parents´ death. They feel very guilty.

The feeling of guilt, anxiety and their fears can be so strong, which can lead to depression. It happens very seldom, but still, that a child may attempts to commit a suicide. An attempt to commit a suicide can be according to Spitz affected by several elements, such as:


A specific situation is on in which children living with HIV/AIDS are a most vulnerable group. There are some specific psycho-social issues, counsellors have to deal with. Most of them are experiencing fear, anxiety, lethargy and quietude. Some children are segregated by the guardians, who fear their children might also contract the virus when they will play together, sleep together or eating together by sharing the utensils. Some parents have feared to send their children to school; they don't go to school, as some schools don't allow them to play with the rest. There is also high risk, possibility of dropping from school due to ill health. They don't get well balanced food; there is poor access to medication. Some HIV/AIDS positive children already lost their parents; some older children take on the roles of the parents.

Psychosocial Aspects of People Living with HIV/AIDS 185

occupy in the familiar environment. Their educational opportunities are limited due to domestic responsibilities, or lack of funds to purchase books and uniforms. Suffer physical and psychological support and protection, as well as lack of parental attention and their absence. Orphans - girls are more vulnerable because of sexual abuse and are at greater risk of HIV transmission and continuing spreading of infection. Sometimes orphaned boys are rejected more often than their sisters because the girls are more useful in the household. The situation gets worse, when the orphans have to live on the street and they are exposed to the danger of abuse. Street-girls in their early adolescent age were tested for a small study of Undugu association, and the outcome showed, that more than one quarter is HIV positive. Some of the tested girls suffered from syphilis, gonorrhoea or some other

The social situation of each orphaned child is always difficult and it can have long-lasting and traumatic effects. The situation of AIDS orphans presents some more specific problems which are specific only for this type of group of children, It is necessary to eliminate and to get to know, the stigma associated with AIDS which interfered with the lives of many orphans and it is necessary to satisfy the basic needs of children using the practical interventional programs. There are slight socio-economic differences amongst the orphans in Kenya, even though the majority of them live in extreme poverty. HIV/AIDS, combined with the problem of poverty presents a significant stress for the traditional structure of assistance, as well as for the complete set-up of the household. Satisfaction of all the demands of the family plays a priority role for the orphans despite of significant limitation of financial resources. It is very difficult to discuss the long-term consequences of pandemics, but it is clear, that adaptability, power and the survival of a Kenyan family is

In the developing counties the services for HIV/AIDS children are often provided by professionals coming from western countries. Most of the approaches, used in Europe, are based on local traditions, religion, and mentality and so on. Using of these approaches in other parts of the world can cause problems, or, can cause their non-efficiency. There is strong necessity to adapt the European standards of care to local standards and search for appropriate range of services. An adaptation of educational and therapeutic approaches is necessary due to significant differences, in upbringing, such as the use of punishments, and

**5.1.1 Psycho-social aspects of children living in developing country, who have lost** 

A majority of men, who are also fathers become infected and die before their wives. Along with the death of the father, who presents the male element of the family, the family loses the social and physical protection associated with male authority. A woman as a head of the family in the developing countries does not have any right of property inheritance, because the relationships to her husband's family are weakened. The mother has to manage her time to be a parent and to satisfy the needs of the family. Children usually help to run the household. In rural areas children work on family farms in order to help the family to

These households often bear an additional burden, the commitment to pay for the treatment and care of the dead father; the family must deal with the loss of income, which was supplied by him. Children usually stop going to school and are forced to look for a job, which is depressing for them. They are exposed to abuse as workers, who work for the

infections. (Guest, 2001)

seriously threatened in the social system.

so on. (Botek & Kovalcikova, 2008)

**their father due to HIV/AIDS** 

survive.

They are experiencing stigma and discrimination as well as the adults, even more. Counselling psychologists believe that the age when a child can know the HIV status varies. What is important is the amount of build-up activities related to the disclosure either of the child's status or of a very close relative. The older the child the better and easier it is thought, but this doesn't guarantee easiness with status disclosure.

The care of HIV/AIDS suffering children requires high quality synchronisation and combination of health and social services with taking account on special needs these children. The mail goal is to lengthen and to improve children live and life of their families. (Botek et al., 2005)

Every child is unique in his own way and has special attributes that must be honoured, respected and used carefully. They need help to create the necessary support they need to live with the reality about disclosure of their or other significant people's status in their lives. They are encouraged through their parents/guardians to join support groups that help to reduce the impact of the shocks they receive.

#### **5.1 Psycho-social aspect of children living in developing country, whose parents died due to HIV/AIDS**

Organizations such as WHO and UNICEF had assumed that the number of orphans will double every 6 to 9 months and in many developing countries it happened. Many of them stay on the street and they become victims of discrimination. Orphans, who live on the street, so called "street-children" become often victims of sexual abuse, and in the case, they did not get infected, it can happen very quickly.

The majority of them suffer from lack of proper care and supervision. Most of them live with their relatives or grandparents, who themselves suffer from a lack of income and have a problem and take care of themselves. Some of them start to run their own household and take care of their younger siblings. For example 1996 in Kenya, up to 58% of all orphans who survive were aged from 10 to 14 years, 19% are 15 or more. Up to 58% of orphans are dependent on their relatives or on the community to be able to survive. 32% of the orphans depend on the sale of vegetables, roasted corn or collection of paper, and iron for living and 10% survive only thanks to begging. (Shorter & Onyancha, 1998)

In the research study from Nairobi in Kenya in 2008 shows, that nearly 20% of street children were complete orphans, 10% had only their fathers and 59% only their mothers alive. These survey results show that most street children have single parents, predominantly the mother. (Fabianova et.al, 2010)

Children whose parents died of AIDS are discriminated against, the society often treats them as potential carriers of HIV virus and they are expected to lead a promiscuous life following the way of life of their parents. These children live in real poverty, in an extraordinary situation including the lack of basic resources and lack of access to services, which would help them to resolve the difficult situation. The wider family usually takes care of orphans, but the rapid increase of the number of orphans needing care requires extended possibility apart from family. In many cases, the orphans are taken care of by their grandparents, sometimes elder children take care of their younger siblings, and surprisingly, their age is about 10 to 12. In some cases, children live completely outside of the family structure and very often on the street.

The death of one or of both parents, who died of AIDS triggers many sociological, economic and psychological changes for the orphaned child. Orphans are exposed to a large number of problems, such as malnutrition which is associated with a lack of food or poor position to

They are experiencing stigma and discrimination as well as the adults, even more. Counselling psychologists believe that the age when a child can know the HIV status varies. What is important is the amount of build-up activities related to the disclosure either of the child's status or of a very close relative. The older the child the better and easier it is

The care of HIV/AIDS suffering children requires high quality synchronisation and combination of health and social services with taking account on special needs these children. The mail goal is to lengthen and to improve children live and life of their families.

Every child is unique in his own way and has special attributes that must be honoured, respected and used carefully. They need help to create the necessary support they need to live with the reality about disclosure of their or other significant people's status in their lives. They are encouraged through their parents/guardians to join support groups that

**5.1 Psycho-social aspect of children living in developing country, whose parents died** 

Organizations such as WHO and UNICEF had assumed that the number of orphans will double every 6 to 9 months and in many developing countries it happened. Many of them stay on the street and they become victims of discrimination. Orphans, who live on the street, so called "street-children" become often victims of sexual abuse, and in the case, they

The majority of them suffer from lack of proper care and supervision. Most of them live with their relatives or grandparents, who themselves suffer from a lack of income and have a problem and take care of themselves. Some of them start to run their own household and take care of their younger siblings. For example 1996 in Kenya, up to 58% of all orphans who survive were aged from 10 to 14 years, 19% are 15 or more. Up to 58% of orphans are dependent on their relatives or on the community to be able to survive. 32% of the orphans depend on the sale of vegetables, roasted corn or collection of paper, and iron for living and

In the research study from Nairobi in Kenya in 2008 shows, that nearly 20% of street children were complete orphans, 10% had only their fathers and 59% only their mothers alive. These survey results show that most street children have single parents,

Children whose parents died of AIDS are discriminated against, the society often treats them as potential carriers of HIV virus and they are expected to lead a promiscuous life following the way of life of their parents. These children live in real poverty, in an extraordinary situation including the lack of basic resources and lack of access to services, which would help them to resolve the difficult situation. The wider family usually takes care of orphans, but the rapid increase of the number of orphans needing care requires extended possibility apart from family. In many cases, the orphans are taken care of by their grandparents, sometimes elder children take care of their younger siblings, and surprisingly, their age is about 10 to 12. In some cases, children live completely outside of

The death of one or of both parents, who died of AIDS triggers many sociological, economic and psychological changes for the orphaned child. Orphans are exposed to a large number of problems, such as malnutrition which is associated with a lack of food or poor position to

thought, but this doesn't guarantee easiness with status disclosure.

help to reduce the impact of the shocks they receive.

did not get infected, it can happen very quickly.

predominantly the mother. (Fabianova et.al, 2010)

the family structure and very often on the street.

10% survive only thanks to begging. (Shorter & Onyancha, 1998)

(Botek et al., 2005)

**due to HIV/AIDS** 

occupy in the familiar environment. Their educational opportunities are limited due to domestic responsibilities, or lack of funds to purchase books and uniforms. Suffer physical and psychological support and protection, as well as lack of parental attention and their absence. Orphans - girls are more vulnerable because of sexual abuse and are at greater risk of HIV transmission and continuing spreading of infection. Sometimes orphaned boys are rejected more often than their sisters because the girls are more useful in the household.

The situation gets worse, when the orphans have to live on the street and they are exposed to the danger of abuse. Street-girls in their early adolescent age were tested for a small study of Undugu association, and the outcome showed, that more than one quarter is HIV positive. Some of the tested girls suffered from syphilis, gonorrhoea or some other infections. (Guest, 2001)

The social situation of each orphaned child is always difficult and it can have long-lasting and traumatic effects. The situation of AIDS orphans presents some more specific problems which are specific only for this type of group of children, It is necessary to eliminate and to get to know, the stigma associated with AIDS which interfered with the lives of many orphans and it is necessary to satisfy the basic needs of children using the practical interventional programs. There are slight socio-economic differences amongst the orphans in Kenya, even though the majority of them live in extreme poverty. HIV/AIDS, combined with the problem of poverty presents a significant stress for the traditional structure of assistance, as well as for the complete set-up of the household. Satisfaction of all the demands of the family plays a priority role for the orphans despite of significant limitation of financial resources. It is very difficult to discuss the long-term consequences of pandemics, but it is clear, that adaptability, power and the survival of a Kenyan family is seriously threatened in the social system.

In the developing counties the services for HIV/AIDS children are often provided by professionals coming from western countries. Most of the approaches, used in Europe, are based on local traditions, religion, and mentality and so on. Using of these approaches in other parts of the world can cause problems, or, can cause their non-efficiency. There is strong necessity to adapt the European standards of care to local standards and search for appropriate range of services. An adaptation of educational and therapeutic approaches is necessary due to significant differences, in upbringing, such as the use of punishments, and so on. (Botek & Kovalcikova, 2008)

#### **5.1.1 Psycho-social aspects of children living in developing country, who have lost their father due to HIV/AIDS**

A majority of men, who are also fathers become infected and die before their wives. Along with the death of the father, who presents the male element of the family, the family loses the social and physical protection associated with male authority. A woman as a head of the family in the developing countries does not have any right of property inheritance, because the relationships to her husband's family are weakened. The mother has to manage her time to be a parent and to satisfy the needs of the family. Children usually help to run the household. In rural areas children work on family farms in order to help the family to survive.

These households often bear an additional burden, the commitment to pay for the treatment and care of the dead father; the family must deal with the loss of income, which was supplied by him. Children usually stop going to school and are forced to look for a job, which is depressing for them. They are exposed to abuse as workers, who work for the

Psychosocial Aspects of People Living with HIV/AIDS 187

find a partner in many third-world countries. They sometimes must handle the fact that they have to raise their children alone, which presents a new created phenomenon and is a

Children are social beings since the early stages of development. The tendency of social handling is not learnt, but it is probably a part of the biological equipment of a man. A strong primary motivation to be as close to the mother as possible for the child is natural. The mother presents a fundamental source of security for a child and she is a source of future relations to peers and partners, as demonstrated in recent years in long-term studies. Mother - child relationship are characterized by a strong emotional relationship, trying to be each other as much close as possible in the intimate contact. This condition it is not static, but it is a constant interaction of mother and child, it is performed repeatedly many times a day, it constantly changes, improves and strengthens weakens, depending on the proper/improper approach, which means life security and safety for the child. It is the basis for individual orientation and in the environment and getting to know the surroundings

The close relationship of mother and child develops instantly after the birth and has a wide variety of forms. It is initiated by the mother – intimate contact, smile, voice signals and some games and by an overall positive and joyful relationship. Sensitivity to the needs of the child is expected. Interaction dynamics between mother and child has several phases for

The whole cycle repeats constantly, the child goes on to discover the environment, comes

A number of studies showed, that children, who develop a strong attachment to their mother, develops much better emotionally, socially and in the cognitive area. This is obvious in the early years, but also in the age of 6 years and more. It is the same relationship, when the child is stressed when the mother leaves, but it calms down, when she returns and makes lively contact with her. There is a clear difference in response to the mother and foreign persons. Relationship created in such a way is beneficial for the child and in most cases it is associated with the next development of other positive stages in its

A number of situations and life circumstances undermine and weaken the bonding process.

• Privacy: meaning living conditions in which no bonding could be created, because after the birth the child and the mother were separated, or the mother is unable to take care of the child. The damage of the development is usually significant which mostly

• Deprivation meaning the conditions in which the relationship was being built, but they were interrupted by a negative interference. It can be primarily a disease of a mother, or

The impact of similar situations might not be so critical if a solution were found, which is

significant deviation from a traditional family life for the majority of men.

approximately from the second year of age of a child.

• feeling of security in the presence of the mother,

• child leaves the mother to play or to get to know the environment, • there is a growing sense of insecurity in the absence of mother, • the child looks for its mother and also the safety and security,

• reunion with the mother is associated with satisfaction. (Dunovsky, 1999)

a small child:

back again and so on.

development. (Dunovsky, 1999)

We distinguish two basic situations:

child's long-term hospitalization.

good for the life of a child.

causing irreparable changes in the development.

minimum wage and it does not cover their basic need at all. This fact strengthens the difficult situation and the family sinks into poverty.

In the developing countries in the majority of families, in which the father dies, the widow after the funeral rites returns from the countryside, where he was buried, to the city. These Kenyan widows, if not previously employed, often begin with to sell smuggled good, such as illegal alcohol to keep their household supplied with needed stuff. The children usually help or try to help in other ways to replace the father. In some cases they are forced to sell their body, because the income of the mother is insufficient. In such cases children stay with their grandparents from the mother´s side in the country, while she tries to make some money in the city. Women leave their children primarily because of economic reasons. If the mother comes from a monogamous relationship, children usually stay with their grandparents from her husband's side. If a widow comes from a polygamous relationship, children are often taken care of by the first wife, who usually becomes head of the family after the death of her husband. In Kenya children living with grandparents from the father's side suffer from lack of care, and so they tend to find the grandparents of the mother's side. It is still difficult for the children to live with the uncle, because they are often perceived by their relatives as a potential candidate for the property inheritance and they are abused mainly for work. But reality shows that orphans are traditionally excluded from oldparental inheritance.

The impact of negative living conditions is significant and influences the child's mental state. We can talk of *psychological deprivation* if the child does not have sufficient amount of stimuli and such living conditions, which are necessary for its satisfaction of basic needs and healthy emotional development*.* 

We can thus conclude that a child who has lost his father experiences this situation to its full extent. The amount of stressful situations increases and they often overlap. Death of a parent is a frustrating situation for each child and threatens its existence. It becomes a long-term stress factor in his life. The loss of the mother is equally stressing for the child.

#### **5.1.2 Psycho-social aspect of children living in developing country, who have lost their mother due to HIV/AIDS**

Men, who have lost their wives get, married as soon as possible which is reasoned by wanting the best for their children. Most children, however, do not perceive this fact as favourable, on the contrary, father's protection and support decreases with the arrival of a step-mother. These new circumstances cause a tense situation and relationships at home, the children miss the attention they used to get from their mother. It happens sometimes, that the step-mother is the same age as the children and is unable to take care of them, which makes the family situation even worse.

Children are rarely able to re-create the same emotional connection to the new mother. It is often an unsecure, uncertain and chaotic relationship of the child to its step-mother and it is filled with ambivalent feelings. With the arrival of the step - mother many children experience regular physical attacks and unbearable punishment. Many of them must follow strict rules regarding the access to food; they are discriminated in comparison to her children, who are preferred by her for the food supply. The children do not get enough of protection from their father and they are forced to seek shelter at their dead mother´s family. Men, widowers who have not had the chance to marry after the death of the wife yet, are trying in the majority of cases to do so as quickly as possible. Only in few cases, stays the father with his children alone. Spreading epidemics may cause problems for a widower to

minimum wage and it does not cover their basic need at all. This fact strengthens the

In the developing countries in the majority of families, in which the father dies, the widow after the funeral rites returns from the countryside, where he was buried, to the city. These Kenyan widows, if not previously employed, often begin with to sell smuggled good, such as illegal alcohol to keep their household supplied with needed stuff. The children usually help or try to help in other ways to replace the father. In some cases they are forced to sell their body, because the income of the mother is insufficient. In such cases children stay with their grandparents from the mother´s side in the country, while she tries to make some money in the city. Women leave their children primarily because of economic reasons. If the mother comes from a monogamous relationship, children usually stay with their grandparents from her husband's side. If a widow comes from a polygamous relationship, children are often taken care of by the first wife, who usually becomes head of the family after the death of her husband. In Kenya children living with grandparents from the father's side suffer from lack of care, and so they tend to find the grandparents of the mother's side. It is still difficult for the children to live with the uncle, because they are often perceived by their relatives as a potential candidate for the property inheritance and they are abused mainly for work. But reality shows that orphans are traditionally excluded from old-

The impact of negative living conditions is significant and influences the child's mental state. We can talk of *psychological deprivation* if the child does not have sufficient amount of stimuli and such living conditions, which are necessary for its satisfaction of basic needs and

We can thus conclude that a child who has lost his father experiences this situation to its full extent. The amount of stressful situations increases and they often overlap. Death of a parent is a frustrating situation for each child and threatens its existence. It becomes a long-term

**5.1.2 Psycho-social aspect of children living in developing country, who have lost** 

Men, who have lost their wives get, married as soon as possible which is reasoned by wanting the best for their children. Most children, however, do not perceive this fact as favourable, on the contrary, father's protection and support decreases with the arrival of a step-mother. These new circumstances cause a tense situation and relationships at home, the children miss the attention they used to get from their mother. It happens sometimes, that the step-mother is the same age as the children and is unable to take care of them, which

Children are rarely able to re-create the same emotional connection to the new mother. It is often an unsecure, uncertain and chaotic relationship of the child to its step-mother and it is filled with ambivalent feelings. With the arrival of the step - mother many children experience regular physical attacks and unbearable punishment. Many of them must follow strict rules regarding the access to food; they are discriminated in comparison to her children, who are preferred by her for the food supply. The children do not get enough of protection from their father and they are forced to seek shelter at their dead mother´s family. Men, widowers who have not had the chance to marry after the death of the wife yet, are trying in the majority of cases to do so as quickly as possible. Only in few cases, stays the father with his children alone. Spreading epidemics may cause problems for a widower to

stress factor in his life. The loss of the mother is equally stressing for the child.

difficult situation and the family sinks into poverty.

parental inheritance.

healthy emotional development*.* 

**their mother due to HIV/AIDS** 

makes the family situation even worse.

find a partner in many third-world countries. They sometimes must handle the fact that they have to raise their children alone, which presents a new created phenomenon and is a significant deviation from a traditional family life for the majority of men.

Children are social beings since the early stages of development. The tendency of social handling is not learnt, but it is probably a part of the biological equipment of a man. A strong primary motivation to be as close to the mother as possible for the child is natural. The mother presents a fundamental source of security for a child and she is a source of future relations to peers and partners, as demonstrated in recent years in long-term studies. Mother - child relationship are characterized by a strong emotional relationship, trying to be each other as much close as possible in the intimate contact. This condition it is not static, but it is a constant interaction of mother and child, it is performed repeatedly many times a day, it constantly changes, improves and strengthens weakens, depending on the proper/improper approach, which means life security and safety for the child. It is the basis for individual orientation and in the environment and getting to know the surroundings approximately from the second year of age of a child.

The close relationship of mother and child develops instantly after the birth and has a wide variety of forms. It is initiated by the mother – intimate contact, smile, voice signals and some games and by an overall positive and joyful relationship. Sensitivity to the needs of the child is expected. Interaction dynamics between mother and child has several phases for a small child:


The whole cycle repeats constantly, the child goes on to discover the environment, comes back again and so on.

A number of studies showed, that children, who develop a strong attachment to their mother, develops much better emotionally, socially and in the cognitive area. This is obvious in the early years, but also in the age of 6 years and more. It is the same relationship, when the child is stressed when the mother leaves, but it calms down, when she returns and makes lively contact with her. There is a clear difference in response to the mother and foreign persons. Relationship created in such a way is beneficial for the child and in most cases it is associated with the next development of other positive stages in its development. (Dunovsky, 1999)

A number of situations and life circumstances undermine and weaken the bonding process. We distinguish two basic situations:


The impact of similar situations might not be so critical if a solution were found, which is good for the life of a child.

Psychosocial Aspects of People Living with HIV/AIDS 189

are often an obstacle for a potential husband. In a situation, when a brother takes care of younger siblings, his role is of the man in the family. This role is associated with the enforcement of the authority and leading positions often by the use of physical violence. He tries to provide an income and to keep the household running. Usually he avoids doing the so-called "female" work, such as preparation of food; such activities are to be done by

Perhaps the children of prostitutes find themselves in the most difficult situation. After the death of their mother, they are left alone, with a huge psychological trauma. Most of these orphans stay temporarily with their grandparents, who live often in extreme poverty; those children do not usually have any possibility to attend school. What happens to children after the death of grandparents is questionable, but it is clear that they are exposed to many risks. Most of them are neglected and face hostility from all people. The girls are sometimes taken care of by other family members with the intent to have somebody for house work or marry the girl to anybody, who would bring them some profit. Some of the girls make the same mistake as their mother did and they sell their body almost for nothing, which provides them some income for their living. Many of them are from 12 to 16 years of the age,

The death of a parent means in particular a relational loss. It means the end of all opportunities to be in contact, to communicate, to have common experiences, to love, or have in some way the emotional and physical presence of the mother or father. The fact that

The death is probably the most significant loss, which may affect a person's life. It is therefore normal that the child feels profound grief, the child feels abandoned, desperate and helpless. This is a real and deep crisis for them. Mourning after the death of a parent in many aspects resembles some kind of an illness; it is in fact not an illness, but a natural way of processing a loss. It presents a complex of psychological, social and somatic reactions to

The children react to death and to the loss of a loved one with strong emotions, which often remain hidden. Around the age of 7 to 9 years appears more realistic understanding of the death and reaction of children may appear as those of the adults. Around the age of 10 a child starts to understand the death in its social and biological context. In the first years of life the loss of a parent has the biggest potential impact on the pathological personality development, but can serve as the basis of psychiatric problems in the later years. For children in the age from 3 to 4 years of age, his death of a parent of the same gender is the most critical. The overall behaviour of younger children may seem incomprehensible and unbounded to the tragic event. It is definitely necessary to know, that the child at this time

The following outlines the most common demonstrations of emotion in children losing their

• Concerns that may be caused by insecurity. The child asks questions like ("What is going to happen to me? What am I supposed to do all alone?"), but also questions about the meaning of life, they are confronted with the own mortality, especially with the fear

in its life will have a new surge of emotions.(Vizinova & Preiss, 1999)

younger sisters.

the loss.

parents:

• Sadness, grief and sorrow,

of its own death,

presuming that they are not HIV positive.

**5.2 When a child survives the death of his parents** 

this is a permanent loss is particularly difficult.

Other negative moments and deviations from normal development ("turning points" as they are called in evolutionary psychology) can be:


Bratska states that the worst impact is caused by a long-term hospitalization of children within 7-12 months of age. In the case, that during this period the child lacks an emotional contact with his mother, the proper relationship to his mother cannot be created, which gives basis for the social relationships of the child. (Bratska, 2001)

In a later child´s and also of adults' development, significant turning points appear which are watched by the developmental psychology, focused on the length of life (life history). They can be presented by a series of events for the child, which modifies his life. These include: experience with violence, an accident, illness, serious moments associated with the maturity process of the child in various stages of its development, experience with the start of puberty and first sexual partner or relationship.

#### **5.1.3 Children who lost both parents due to HIV/AIDS**

Most of the children whose parents died of AIDS find their new place in their wider family network. But even if someone gives them a shelter, they usually do not have the feeling that they had a real home. The decision of someone from their wider family to take care of the orphan is not just an economic issue. It usually happens that the richer family is very rarely in contact with the orphans; on the contrary, the orphans are taken care of by the family, which lives in poverty.

The new family that decides to take care of those children has to deal with many reactions and their own emotions. Many family members show and feel compassion; they show the children their sympathy and understanding. But for many of them it is also a shock situation, which is filled with fear. Some families tend to blame the deceased parents, blame them for irresponsibility and children have to listen to wide variety of remorse. In such households, these children are often excluded from equal distribution of family resources. The substitute family expects and counts on the fact, that the orphans will work themselves for their living. Many of these children state that they do not have the same rights in the foster family; they have limited food supply, because they may eat after the other family members have finished their meals.

Most of the orphans prefer therefore to stay at their own home, even without an adult member. In these cases, the oldest child tends to adopt the role of head of the family, regardless of the gender. Girls take over the role of mother, trying to provide food for other children. When there is not enough food, they are the ones that eat as the last, if their mother did so. They are responsible for the household with all the things that are associated with it.

These young girls grow up without parental assistance and they gain knowledge about the world, the family, about sex from their peers, who are also low educated and are discovering the world only by them. Most of them have minimal education, they are starting too early with the intimate life and soon after that they usually have to take care of their own child. They miss the premature loss of parental love and they seek emotional support; they are an easy victim of sexual abuse. They would like to be married, but younger siblings

Other negative moments and deviations from normal development ("turning points" as they

• *Long-term or repeated hospitalization of a child* without a mother (during this period of time an anxiety connection or substitution connection to some other person is often

• *Changes in the child´s environment*: mother's long-term illness, change of environment, loss of a loved one, death of someone in the family, associated with a strong child's grief

Bratska states that the worst impact is caused by a long-term hospitalization of children within 7-12 months of age. In the case, that during this period the child lacks an emotional contact with his mother, the proper relationship to his mother cannot be created, which

In a later child´s and also of adults' development, significant turning points appear which are watched by the developmental psychology, focused on the length of life (life history). They can be presented by a series of events for the child, which modifies his life. These include: experience with violence, an accident, illness, serious moments associated with the maturity process of the child in various stages of its development, experience with the start

Most of the children whose parents died of AIDS find their new place in their wider family network. But even if someone gives them a shelter, they usually do not have the feeling that they had a real home. The decision of someone from their wider family to take care of the orphan is not just an economic issue. It usually happens that the richer family is very rarely in contact with the orphans; on the contrary, the orphans are taken care of by the family,

The new family that decides to take care of those children has to deal with many reactions and their own emotions. Many family members show and feel compassion; they show the children their sympathy and understanding. But for many of them it is also a shock situation, which is filled with fear. Some families tend to blame the deceased parents, blame them for irresponsibility and children have to listen to wide variety of remorse. In such households, these children are often excluded from equal distribution of family resources. The substitute family expects and counts on the fact, that the orphans will work themselves for their living. Many of these children state that they do not have the same rights in the foster family; they have limited food supply, because they may eat after the other family

Most of the orphans prefer therefore to stay at their own home, even without an adult member. In these cases, the oldest child tends to adopt the role of head of the family, regardless of the gender. Girls take over the role of mother, trying to provide food for other children. When there is not enough food, they are the ones that eat as the last, if their mother did so. They are responsible for the household with all the things that are associated with it. These young girls grow up without parental assistance and they gain knowledge about the world, the family, about sex from their peers, who are also low educated and are discovering the world only by them. Most of them have minimal education, they are starting too early with the intimate life and soon after that they usually have to take care of their own child. They miss the premature loss of parental love and they seek emotional support; they are an easy victim of sexual abuse. They would like to be married, but younger siblings

are called in evolutionary psychology) can be:

created, for example a sensitive nurse),

of puberty and first sexual partner or relationship.

**5.1.3 Children who lost both parents due to HIV/AIDS** 

gives basis for the social relationships of the child. (Bratska, 2001)

and so on.

which lives in poverty.

members have finished their meals.

are often an obstacle for a potential husband. In a situation, when a brother takes care of younger siblings, his role is of the man in the family. This role is associated with the enforcement of the authority and leading positions often by the use of physical violence. He tries to provide an income and to keep the household running. Usually he avoids doing the so-called "female" work, such as preparation of food; such activities are to be done by younger sisters.

Perhaps the children of prostitutes find themselves in the most difficult situation. After the death of their mother, they are left alone, with a huge psychological trauma. Most of these orphans stay temporarily with their grandparents, who live often in extreme poverty; those children do not usually have any possibility to attend school. What happens to children after the death of grandparents is questionable, but it is clear that they are exposed to many risks. Most of them are neglected and face hostility from all people. The girls are sometimes taken care of by other family members with the intent to have somebody for house work or marry the girl to anybody, who would bring them some profit. Some of the girls make the same mistake as their mother did and they sell their body almost for nothing, which provides them some income for their living. Many of them are from 12 to 16 years of the age, presuming that they are not HIV positive.

#### **5.2 When a child survives the death of his parents**

The death of a parent means in particular a relational loss. It means the end of all opportunities to be in contact, to communicate, to have common experiences, to love, or have in some way the emotional and physical presence of the mother or father. The fact that this is a permanent loss is particularly difficult.

The death is probably the most significant loss, which may affect a person's life. It is therefore normal that the child feels profound grief, the child feels abandoned, desperate and helpless. This is a real and deep crisis for them. Mourning after the death of a parent in many aspects resembles some kind of an illness; it is in fact not an illness, but a natural way of processing a loss. It presents a complex of psychological, social and somatic reactions to the loss.

The children react to death and to the loss of a loved one with strong emotions, which often remain hidden. Around the age of 7 to 9 years appears more realistic understanding of the death and reaction of children may appear as those of the adults. Around the age of 10 a child starts to understand the death in its social and biological context. In the first years of life the loss of a parent has the biggest potential impact on the pathological personality development, but can serve as the basis of psychiatric problems in the later years. For children in the age from 3 to 4 years of age, his death of a parent of the same gender is the most critical. The overall behaviour of younger children may seem incomprehensible and unbounded to the tragic event. It is definitely necessary to know, that the child at this time in its life will have a new surge of emotions.(Vizinova & Preiss, 1999)

The following outlines the most common demonstrations of emotion in children losing their parents:


Psychosocial Aspects of People Living with HIV/AIDS 191

Even if all the processing of grief and death is unique and individual, it is possible to distinguish several phases that are not always in the same order but they stand side by side

The process of mourning is described by different authors, for example. Kubler-Ross

These phases often overlap; they can last a different period of time and can happen parallel or do not exist at all. There is some specificity identified for children´s experience when

1. **Phase of shock, denial and isolation**. Immediately after the loss of a parent, the child, responds by feeling confused numb, stunned and shocked. He usually denies the whole situation, does not want to believe that it had happened. ("No, it cannot be true! I don´t believe it!") Children convince themselves, that it is not possible. They reject and deny the reality, which is actually a psychological defensive reaction. They attenuate the effects of negative news. They try not to face the fact. At the same time, they show that they still do not handle their own pain and the child seems emotionally overloaded. Some children tend to play various games, e.g. they are being cruel to animals to express the sadness and pain. 2. **Self-control phase**, which is a pretence that lasts until the evening of the funeral day. Preparation and organization of the burial ceremony makes it impossible for the surviving family to fully succumb to the grief. After the mourners have left, the surviving family are able to surrender and feel the pain of their loss to its full extent. This process may be experienced in some other way by the children, since they usually are not involved in organizing of the funeral, the shock phase may be extended to a longer period of time. Some children idealize the deceased parent at this phase of the mourning process. For some children everything that reminds them of the death parent becomes important. Objects reminding children of the dead mother or father reminds them of having a nice time that they had together. The younger children sometimes show strong desire to amalgamate with the deceased parent. Some children might to wear clothes of the deceased parent or to have the same job. At this stage of the process, children without stable identity are in danger, that

3. **Regression phase**, which may take from one to three months. The lamentation and mourning phase takes often the most extended period of time. The mourning child often cries, elements of regression can be found in his behaviour, these children are apathetic, closed up into his own inner world, they are anxious and desperate. The disorganizing of behaviour is obvious; the surviving family is not able to function normally in everyday life. They are unable to get their life back and they retreat from their social contacts. Many children may suffer from sleeping disorders and lack of appetite. The children sometimes switch from their idealizing of the deceased parent to his/her disparaging. Their pain is mixed with anger and rage that they have been left alone. Negative evaluation of the deceased parent is an attempt of child to let go. If the idealization of the deceased partner happens too soon, there is a danger for the child not to be able to let go. Only a realistic

5. Stage of acceptance and reconciliation with death. (Kubler-Ross, 2003)

Kubickova talks about 4 phases experienced by children: (Kubickova 2001)

the development of their own "self" will be negatively influenced.

and often can be repeated.

3. Stage of negotiations 4. Stage of depression

handling this situation.

divided the period of 5 phases:

2. Stage of anger and aggression,

1. Stage of shock, denial and negation of death,


It is perfectly natural and normal that a child experiences such a combination of emotions and reactions. It is important for the child to have the opportunity to express and to talk about what the child is going through and it is also very important that the child has someone, who would help him to overcome this difficult and traumatic situation.

#### **5.2.1 The process of mourning of children: The stages of handling the death of a parent**

Mourning is a consequence of the loss, which the individual realizes. It is considered a natural, normal and necessary mechanism for handling the loss in life. To what extent is this process successful depends on how one handles the tasks of mourning.

Between the mourning steps we can include: acceptance of loss of life, acute mourning, adaptation to the environment without the lost object, redirecting power to the second object, overcoming fear of change, finding new and the meaning of life. Signs of mourning can be seen in the following areas:


Even if all the processing of grief and death is unique and individual, it is possible to distinguish several phases that are not always in the same order but they stand side by side and often can be repeated.

The process of mourning is described by different authors, for example. Kubler-Ross divided the period of 5 phases:


190 Social and Psychological Aspects of HIV/AIDS and Their Ramifications

• Anger, wrath and aggression, these negative emotions can be addressed to all the other, e.g. the medical staff ("Why could the doctors not help my parent somehow? Why couldn´t he is saved?") Or these emotions can be addressed to the deceased ("How could he/she done that to me? Why did he/she leave me here alone?"), but also to

• Feeling of loneliness the children experience, when they are left by the other parent and

• Feeling of relief especially if the child watched the parent suffer, the idea that the parent

• Somatic problems of children are demonstrated in particular, by exhaustion, fatigue,

• Disorganization of daily life and daily routines, the child is excluded from activities that he or she used to do and life of the child has stopped to run as it usually did. • Impulsive, chaotic handling. These are common symptoms caused by stress and fear

• The child is having imaginings/fantasies about the deceased parent, the child may

• The child identifies himself or herself with the deceased parent. The children may take over certain behavioural models and patterns of deceased parent, they use his/her

• Avoidance of social contact, the child has the feeling that nobody understands him. It can often cause irritability and hostility, especially in the presence of strangers. It is perfectly natural and normal that a child experiences such a combination of emotions and reactions. It is important for the child to have the opportunity to express and to talk about what the child is going through and it is also very important that the child has

someone, who would help him to overcome this difficult and traumatic situation.

• Emotional (grief, anger, feelings of guilt, anxiety, helplessness, indifference).

process successful depends on how one handles the tasks of mourning.

oneself to oneself, out from society, scary dreams).

**5.2.1 The process of mourning of children: The stages of handling the death of a** 

Mourning is a consequence of the loss, which the individual realizes. It is considered a natural, normal and necessary mechanism for handling the loss in life. To what extent is this

Between the mourning steps we can include: acceptance of loss of life, acute mourning, adaptation to the environment without the lost object, redirecting power to the second object, overcoming fear of change, finding new and the meaning of life. Signs of mourning

• Vegetative (tension, sensitivity to noise and light, shortness of breath, dry mouth,

• Cognitive (mistrust, confusion, obsessive deal with memories of lost object, forgetfulness, disorders in new memory, hallucinations, difficulty in concentrating

• Lifestyle and behaviour disorders (sleep disorder, loss of appetite, secretiveness', keep

themselves ("Why didn´t I do something? Why was I so bad?"), and so on. • Feelings of guilt, arising from the own survival ("Why didn´t I die instead?")

they are left all alone or with their siblings.

that the child is experiencing.

can be seen in the following areas:

asthenia).

attention).

**parent** 

does not suffer anymore is comforting for the child

anorexia and by an overall weakness of the organism.

imagine, they see, hear and feel the deceased parent.

words, gestures, and ways of speaking and so on.


These phases often overlap; they can last a different period of time and can happen parallel or do not exist at all. There is some specificity identified for children´s experience when handling this situation.

Kubickova talks about 4 phases experienced by children: (Kubickova 2001)

1. **Phase of shock, denial and isolation**. Immediately after the loss of a parent, the child, responds by feeling confused numb, stunned and shocked. He usually denies the whole situation, does not want to believe that it had happened. ("No, it cannot be true! I don´t believe it!") Children convince themselves, that it is not possible. They reject and deny the reality, which is actually a psychological defensive reaction. They attenuate the effects of negative news. They try not to face the fact. At the same time, they show that they still do not handle their own pain and the child seems emotionally overloaded. Some children tend to play various games, e.g. they are being cruel to animals to express the sadness and pain.

2. **Self-control phase**, which is a pretence that lasts until the evening of the funeral day. Preparation and organization of the burial ceremony makes it impossible for the surviving family to fully succumb to the grief. After the mourners have left, the surviving family are able to surrender and feel the pain of their loss to its full extent. This process may be experienced in some other way by the children, since they usually are not involved in organizing of the funeral, the shock phase may be extended to a longer period of time. Some children idealize the deceased parent at this phase of the mourning process. For some children everything that reminds them of the death parent becomes important. Objects reminding children of the dead mother or father reminds them of having a nice time that they had together. The younger children sometimes show strong desire to amalgamate with the deceased parent. Some children might to wear clothes of the deceased parent or to have the same job. At this stage of the process, children without stable identity are in danger, that the development of their own "self" will be negatively influenced.

3. **Regression phase**, which may take from one to three months. The lamentation and mourning phase takes often the most extended period of time. The mourning child often cries, elements of regression can be found in his behaviour, these children are apathetic, closed up into his own inner world, they are anxious and desperate. The disorganizing of behaviour is obvious; the surviving family is not able to function normally in everyday life. They are unable to get their life back and they retreat from their social contacts. Many children may suffer from sleeping disorders and lack of appetite. The children sometimes switch from their idealizing of the deceased parent to his/her disparaging. Their pain is mixed with anger and rage that they have been left alone. Negative evaluation of the deceased parent is an attempt of child to let go. If the idealization of the deceased partner happens too soon, there is a danger for the child not to be able to let go. Only a realistic

Psychosocial Aspects of People Living with HIV/AIDS 193

In stressful situations, each person reacts differently. Each has his own defence mechanisms which help to reduce tension and anxiety. These mechanisms function on the subconscious level and they deny or distort the reality. The most common defence mechanisms occurring in different types of situations, which are stressful for the child, such as HIV / AIDS thus

• **Repression –** according to S. Freud repression is one of the most important defence mechanisms. During displacement memories or impulses are causing stress (pain,

• **Suppression** – is presented by purposeful self-control, during which a person controls his impulses and desires or temporarily removes all painful memories, especially when

• **Projection** – requires looking for causes of their own failures in other people,

• **Reactive creation** – presents acquiring attitudes and behaviour that are the very

• **Fixation** – is presented by persistence and focus on areas, which are typical for certain period of development for long time after the person should move to the next level or

• **Regression** - a return to the ways of behaviour, that were adequate to an earlier

• **Inversion** – shows a sort of "reverse behaviour. The person in crisis reacts exactly in the

• **The types of rationalization** – a person reasons and apologizes for the motives for original handling by rational argument to keep self-confidence and good judgement of him. In these mechanisms can be included: is one of belittlement, which reduces and disparages the value, the aim one did not reach and the next mechanism is relativization, which rationalizes the worries comparing them to previous worries one was able to solve successfully. Another form of relativisation is the acquisition of overview; comparison with the future ("what is this in comparison with what is

• **Substitution and compensation**- the original object, who satisfied one´s needs is replaced for an analogic one by substitution and substitution by compensation.

Defence mechanisms are often used by adults, but almost by all children. An acceptable level of use is considered normal. Only when it becomes the predominant way of response, when the child uses this mechanism electively, it signalizes a bad adaptation. The reason for that is because: they prevent the child in dealing with the world in a realistic way. They waste energy that could be used more efficiently. When they fail, the resulting anxiety can

Coping with difficult life situations, describes various coping strategies. Unlike defence mechanisms, which falsify the reality, coping strategies – respect the reality. We can define "coping" as behavioural, cognitive or social response of an individual whose aim is to control internal or external pressures stemming from the individual interactions with the

• **Identification** - when a person agrees with the behaviour of others.

environment. We can distinguish two basic coping strategies:

**6. Forms of defence and adaptation mechanisms** 

frustrating in situations, include the following: (Bratska, 2001)

anxiety, guilt) and thus pushed out of consciousness.

opposite of the actual thoughts and feelings.

phase.

ahead").

developmental stages.

opposite way one would expect. "

present for the child serious difficulties.

he needs to concentrate the effort on a particular activity.

accrediting their own unacceptable impulses to another person.

picture of the deceased, accepting of all sides of his/her personality can become basis for the child to converge to his deceased partner on other level.

4. **Adaptation phase**. It usually takes up to one year, depending on the next development of the situation after the death of a parent. This is a period of reconciliation with past events, the child does not forget, but starts getting used to the absence of the parent. We must not overlook, that the process of handling grief is a long, painful process and it needs a lot of energy. Therefore a child needs time without sadness and when it rejects the sadness, when it wishes the deceased parent to be alive again. The last period of mourning is called a phase of a new relationship to children themselves and to the world, which reflects the fact that something new starts, something totally different from what the child has been accustomed to.

The time course of the mourning process cannot be predicted. At its end stands rapprochement to the deceased parent on a qualitatively new level. Mourning ends, but is not completed yet. The child is usually able to find a more mature relationship to the deceased parent. The deceased father or deceased mother are not physically present, but tend to be very clearly present "spiritually". The children may still feel sorrow and pain. The scars remain. The loss cannot be erased. The adult can show the children, how to treat these wounds and how to live with them.

It would be ideal if we could provide each child, whose the parent died with the following**:** 


There are various different types of care for orphaned and abandoned children, which differ from country to county. In many third-world countries the concept of "adoption" does not exist in the same sense as in Europe. Orphans are taken care of by some relatives in order to avoid a total disappearance of a father´s household.

In Kenya, for example, each household belonging to the given tribe is valuable and therefore it should be protected by the tribe. Although the desire to survive as a family is very strong, poor economic and social circumstances lead to the separation of some orphans. Four categories of households with orphaned children can be distinguished according to practice:


picture of the deceased, accepting of all sides of his/her personality can become basis for the

4. **Adaptation phase**. It usually takes up to one year, depending on the next development of the situation after the death of a parent. This is a period of reconciliation with past events, the child does not forget, but starts getting used to the absence of the parent. We must not overlook, that the process of handling grief is a long, painful process and it needs a lot of energy. Therefore a child needs time without sadness and when it rejects the sadness, when it wishes the deceased parent to be alive again. The last period of mourning is called a phase of a new relationship to children themselves and to the world, which reflects the fact that something new starts, something totally different from what the child has been accustomed

The time course of the mourning process cannot be predicted. At its end stands rapprochement to the deceased parent on a qualitatively new level. Mourning ends, but is not completed yet. The child is usually able to find a more mature relationship to the deceased parent. The deceased father or deceased mother are not physically present, but tend to be very clearly present "spiritually". The children may still feel sorrow and pain. The scars remain. The loss cannot be erased. The adult can show the children, how to treat these

It would be ideal if we could provide each child, whose the parent died with the following**:** 

• Respect for the needs of the child to maintain the connection to the deceased parent

There are various different types of care for orphaned and abandoned children, which differ from country to county. In many third-world countries the concept of "adoption" does not exist in the same sense as in Europe. Orphans are taken care of by some relatives in order to

In Kenya, for example, each household belonging to the given tribe is valuable and therefore it should be protected by the tribe. Although the desire to survive as a family is very strong, poor economic and social circumstances lead to the separation of some orphans. Four categories of households with orphaned children can be distinguished according to practice: • Foster families: children are taken care of by some relative from the father´s family,

• Orphans leading their own household: when there is nobody, who could take care of those children, they usually stay alone. This forces immature children to start an adult life with full responsibility for their lives and lives of their younger siblings. Many

• Households employing orphans: some families employ children - orphans as cheap

child to converge to his deceased partner on other level.

wounds and how to live with them.

• Provision of basic needs,

(Dane & Levine, 2002)

mostly an aunt or uncle.

hand in the household.

• Relevant information adequate their age, • Open communication about the death, • Supported expressing of their feelings,

• As stable and safe environment as possible,

avoid a total disappearance of a father´s household.

• Support and relief in the pleasant memories of the deceased parent, • Involvement of the child in the preparations of the funeral rites,

• Caretakers of the third generation: presented by the grandparents

orphans - girls become mothers in their teenage years.

to.
