**4. Conclusion**

Children in sub-Saharan Africa are disproportionately affected and infected by HIV/AIDS. Many of them experience physical deprivation such as a lack of basic needs, social disruption when they have to change their living situation and they face psychosocial challenges, particularly cultural silence and stigma. Local, national and international efforts have made some progress in reducing the physical vulnerability of children affected by HIV/AIDS for example by providing food and school uniforms; they have also made progress in providing access to ART for children infected by HIV/AIDS. However, in terms of psychosocial support, particularly in tackling stigma, there is still much to be done.

#### **5. References**

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many others who have not necessarily had severe or direct experience of being stigmatised. This fear of stigma then leads to HIV- affected people adopting coping strategies of secrecy and silence (Ruora, et al., 2009). Shame, another direct cause for secrecy (Duffy, 2005), has its roots in the culture of blame - blame for breaching morality - which is frequently attributed to women (LeClerc-Madlala, 2001). LeClerc-Madlala (2001: 45) contends that this process of blaming women "both reflects and contributes to women's already marginalised and subordinate status in society". The underlying causes of shame are power relations, culture and morality. Cultural norms may be at the root of blame-related stigma and shame when HIV/AIDS is associated with immoral and avoidable behaviour (LeClerc-Madlala, 2001; Ruora, et al., 2009). Social constraints lead to isolation and the secrecy adopted for fear of

Silence deprives HIV positive children of potential help as they cannot ask neighbours for support without disclosing the reason why. Smith et al. (2008, p. 1268), whose study concerns adults rather than children, note the strong relationship between social support and public openness about HIV status: "people cannot actually receive social support until disclosure occurs. On the other hand, individuals must perceive social support will exist before they make the decision to disclose." Smith et al. (2008) link the fear of stigma-related rejection to limited social networks and low self-esteem; and several studies note that keeping a secret increases stress and anxiety (Duffy, 2005; Smith, et al., 2008). Menon et al (2007: 349) conclude that "interventions to promote disclosure could facilitate access to emotional and peer support". Shame is frequently associated with blame which implies a moral judgement situating the underlying cause within society's culture and morality. Blystad & Moland (2009) show that feelings of guilt and shame lead to isolation, marginalisation, uncertainty and adversity for mothers of HIV positive children, limiting the social support they so desperately need. In order to support and include mothers of HIV positive children it is these underlying causes that should be tackled. Secrecy and silence are the products of shame and the fear of stigma. Both secrecy and silence worsen the experiences of HIV positive children and add to their adversities. Providing ART to HIV

positive children is a start and should be seen as part of a much larger process.

Children in sub-Saharan Africa are disproportionately affected and infected by HIV/AIDS. Many of them experience physical deprivation such as a lack of basic needs, social disruption when they have to change their living situation and they face psychosocial challenges, particularly cultural silence and stigma. Local, national and international efforts have made some progress in reducing the physical vulnerability of children affected by HIV/AIDS for example by providing food and school uniforms; they have also made progress in providing access to ART for children infected by HIV/AIDS. However, in terms of psychosocial support, particularly in tackling stigma, there is still much to be done.

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**10** 

Lenka Fabianova

*Slovakia* 

**Psychosocial Aspects** 

**of People Living with HIV/AIDS** 

*Trnava University, Faculty of Health Care and Social Work, Trnava* 

The chapter reports on psycho-social aspects of people living with HIV/AIDS and their responses. Besides identifying particular issues like fear, loss, grief, hopelessness and helplessness syndrome, guilt and self-esteem, anxiety and depression, denial, anger, aggression and suicide attempts are also identified. The objective is also to analyse the spiritual needs, discrimination and stigmatization of HIV positive people. Special remark is directed towards children, as a most vulnerable group, especially in the situation when they

Discussion on HIV/AIDS is in many third-world countries still accompanied by taboo, misunderstandings, shame, guilt and rejection. Culturally conditioned silence about sexuality, sexual behaviour conceals risky sexual behaviour and sexual abuse and especially sexual abuse of children. Due to cultural, religious and legal aspects of the topic is HIV/AIDS, death, sexuality, the discussion is led only by a small group of experts. Rejection or lack of awareness about HIV/AIDS significantly limits the ability of effective and decent care for HIV-positive people and their families. It is very important to speak about HIV/AIDS loudly, to speak about the feelings and reactions of people living with

The research study rivets at psycho-social aspects of HIV/AIDS people living in Nairobi, in

People living with HIV/AIDS (PLWHA) feel uncertainty and they have to cope with the situation. Feelings of insecurity have its origin in the fear from the upcoming future and the people focus on their families and their fob. They feel even more uncertain and are more concerned because of the quality of life and life expectancy as well the treatment´s outcome and the reaction of the society. All concerns are unpredictable, and therefore they should be

The situation is very special for children, who have lost their family and home. The HIV positive child must react to this uncertainty and make several decisions to adapt to the current situation. Even if it seems, that the child does not react at all, it can be the very adaptation to the illness by denying it. People begin their adaptation process from the day they learnt about it. Their daily life reflects the tension between uncertainty and coping with

are orphaned and need to cope with the dead and dying.

Kenya, who received voluntary counselling and testing services.

discussed. Above all, positive thinking and faith of is recommended.

**1. Introduction** 

HIV/AIDS.

**2. Psychosocial responses** 

