Protection makes vulnerable : Working ethically in the best interest of the child

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Protection makes vulnerable.

Working ‘ethically’ in the best interest of the child.

D. Keppy (10184287)

MSc. International Development Studies Graduate school of Social Sciences

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“[A better society] will and must be measured by the happiness and welfare of the children, at once most vulnerable citizens in any society and the greatest of our

treasures.”

-Nelson Mandela’s Nobel Prize Acceptance Speech, 10 December 1993

Abstract

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3 prevention. HIV-education is supposed to address multiple perspectives on coping and creating the life skills in order to live with HIV or to cope with family or

community members who are infected. With this growing demand, it is important to explore how it works in practice, and how it could be improved if necessary. At the same time, there is a growing discussion on the definition and determination of the target group for this type of education. Children that are seen as the target group and are directly or indirectly affected by HIV are often described as: Orphans and other Vulnerable Children (OVCs) in international policy-making. However, in theory as well as in practice, the definition of an OVC appears to remain unclear. Through in-depth interviews and group discussions the perceptions of Child Counsellors (CC) and members of the board of a South African NGO operating in the township Khayelitsha in Cape Town are analysed, in order to get a view of their role, and the challenges and limitations they come across in their work. Results show that ethical dilemmas

problematize the work of the CC. It appears that the main ethical problem in the work of the organization is the (non) disclosure of the HIV status to children who are HIV-positive. This research aims contribute to the discussion on how to optimize the support given to OVCs by illustrating the interlinked relationship between wellbeing as a theory of development (WBA), the construct of Orphans and Vulnerable Children and ethics in practicing social work.

Keywords:

Orphans and (other) Vulnerable Children, HIV, ethics in social work, wellbeing

7.2 PERCEPTIONS OF CCS ON THE TENSION BETWEEN PARENT, NGO AND CC 63 7.2 CONCLUDING SECTION 66 8. CONCLUSION, DISCUSSION, REFLECTION AND RECOMMENDATIONS 68 8.1 PROVISION OF ANSWERS TO THE RESEARCH QUESTIONS 68 8.2 INTEGRATION OF FINDINGS AND THEORY, EMERGED TOPICS FOR DISCUSSION AND

RECOMMENDATIONS FOR POLICIES AND FUTURE RESEARCH. 69

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BIBLIOGRAPHY 77

APPENDICES 83

CHILD COUNSELLOR 85

Acknowledgement

From the first vague ideas about research topics, to the final editing of my master thesis many people have supported me. First and foremost I would like to thank my

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supervisor dr. Esther Miedema who encouraged me to choose a topic that is close to my heart and for her insightful academic advise. Secondly, I would like to thank my second reader Elizabeth Maber, for her enthusiasm and her patience.

Moreover, I would like to express my sincere gratitude to the people at Yabonga, for making this research possible by assisting me during my fieldwork period in Cape Town. In particular: Emily Rudolph, Nwabisa ‘Blossom’ Ndlokovane, Andiswa Dayi, Mfundo Ncapayi, Nomveliso, all the respondents that participated in this research and everyone who was willing to share their inspiring experiences with me.

Finally, I would like to acknowledge the great support of my family. My parents: Sylvia Bout and Herman Keppy for their unconditional love and support, and for always helping me to create the opportunities to chase my dreams. Esther Wils for revising my thesis, for listening to my concerns; and the many comforting and inspiring talks that followed. My South African family: Shaun, Pierre & Mila Van Wyk-Webb and Tilly Webb & Philip De Bruyn for being ‘my home away from home’.

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ART Antiretroviral therapy

ARV Antiretroviral (drugs)

CC Child Counsellor

HIV Human Immunodeficiency Virus

NGO Non-Governmental Organization

OVC Orphans and (other) Vulnerable Children

PEPFAR President’s Emergency Plan for AIDS Relief

UNAIDS Joint United Nations Programme on HIV &

AIDS

UNICEF The United Nations Children’s Fund

WBA Wellbeing Approach

1. INTRODUCTION

I would like to start this thesis with an anecdote from my fieldwork time in Cape Town. As I walked alongside one of Yabonga’s Child Counsellors through the area

Photo of CCs and children, Makhaza, 2015

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of Makhaza, Khayelitsha, a boy not older than the age of fourteen approached us. He was very friendly and the CC immediately recognized him. For a short while I observed them as they continued their conversation in Xhosa, which I did not understand of course. When they were finished I asked the CC who it was and why we left him behind with a somewhat, disappointed look on his face. The CC explained that this boy was ‘no longer an OVC’ because he was not enrolled in the program anymore. According to the organization’s guidelines he did not ‘tick all the boxes’ that determine the OVC status. Furthermore, the boy was already registered in a program from a different NGO, operating in the same area. In their short encounter, the boy had asked the CC to take him back into their program because he missed it. She had told him that she would try her best to see what was possible, but implicitly assured me that his chance of coming back was unlikely. Although I am unaware of the situation of this boy, this anecdote illustrates the vague understanding of an OVC in practice. He once was an OVC, and now he stopped being one? It also illustrates the implication of a social worker as the tension between ‘what is possible within her position and within the organization’ and ‘what is best for the child’ arises. This anecdote is an example of one of the central themes within this thesis: working ‘ethically’ in the best interest of the child.

1.1 Aim and relevance

Southern Africa is the worst HIV affected area in the world and contains one third of the global burden of HIV. The goal of the Joint United Nations Programme on HIV & AIDS (UNAIDS) is to reach the 90-90-90 target. This means that 90% of

HIV-positive people are informed about their status, 90% of the people receive treatment with Anti Retroviral Therapy (ART) and 90% of these should have fully suppressed viral loads (Williams et al., 2015). The success of this target depends largely on the successes made in the countries in Southern Africa. In all the designated areas significant progress has been made in controlling HIV. In some countries this is due to biomedical progress in making ART available to broader society. In some cases the success came before the biomedical interventions. All though it is hard to measure

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9 and to prove accurately, the progress in controlling HIV was due to relevant

prevention measures (Williams et al., 2015).

The fact that more people, who are infected with HIV, are able to receive proper antiretroviral medication resulted in a noticeable trend. The 90-90-90 approach of the UNAIDS resembles the transition in HIV from a terminal virus infection to a chronic disease. More people are able to live with HIV. This does not only imply a new approach from policy makers and medical institutions, but it also affects local and communal structures and ideas.

A response to this trend has been to shift tasks and de-professionalize HIV care. For example having nurses initiate the antiretroviral treatment (ARV or ART) on their own, allowing counsellors to test a patient through finger pricks and asking community health workers to serve as the front line of care provision. These changes illustrate the way in which HIV/AIDS is seen as a long-term condition, which has to be managed as much in the family as in the clinic (Colvin, 2011).

The quote by Mandela, at the beginning of this chapter could be interpreted as an idea that creating a better society depends largely on the successes made in the future generation: the children. Considering the children who are already affected by HIV, the epidemic in sub-Saharan Africa has already orphaned a generation of children, and in 2005 UNICEF stated that it was projected that by 2010, 18 million African children under the age of 18 were likely to be orphans from this single cause (UNICEF, 2005, The state of the Worlds Children: Childhood under threat. New York: UNICEF). Children and adults with a background in low-income countries live in environments of diverse trauma exposure. This is mainly caused by exposure to violence (war and domestically related) and secondly because some are orphaned by AIDS. All of these factors increase human vulnerability (Shetty & Powell, 2003). The orphans and vulnerable children are at greater risk of developmental problems. These include cognitive and psychological problems on the individual level, but they also contain problems on a societal and communal level (Murray et al., 2014).

Therefore, the medical innovations in HIV-treatment, which made the shift from terminal to chronic possible, needed a response on the educational focus of international policy-makers as well. Education on HIV required more than simply the basics of informing people how to prevent infection. Educational programs and alternative curricula initially focussed on the information about HIV and the aspects to prevent further infection. Currently there is a higher demand of educational content

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that does not only concern the informative aspect of HIV, but addresses multiple perspectives on coping and creating the life-skills in order to live with HIV or to cope with family or community members who are infected (Colvin, 2011).

This educational content is usually not included in formal school curricula. Therefore, an alternative educational program is needed. In recent literature much is written about interactive and peer-education, however, not all programs assessed to inform children about HIV have lived up to their potential (Miedema, 2013). This research aims to look beyond the content of HIV-education but intents to take it a step further by identifying how the ‘alternative approach’ to educating children about HIV is done in practice and to analyse possible problems in implementing this policy. It is important to determine how extra curricular HIV-education works in practice, and how it could be improved if necessary.

The OVC program of the South African organization Yabonga tries to provide alternative education to address the practicalities and life skills that vulnerable children need in order to survive or cope with their disease (more information about the program can be found in the contextual chapter, and on the website

www.yabonga.org).

During fieldwork however, it became clear that it could be discussed that in each form of social work, ethics play an important role. This research does not cover all ethical complications in social work, but exemplify the importance of the

discussion as described in the introduction of this chapter, by portraying the perceptions of people who have to face these conflicting ideas on a daily basis. The aim of this research is to identify the perceptions of child counsellors (CCs) and members of the Yabonga board on the definition of Orphans and (other) Vulnerable Children (OVCs), what vulnerabilities the children in the program encounter and how the role of the CC in the lives of these children is perceived. Secondly, this research intents to analyse the ethical complications that CCs encounter while trying to work in the best interest of the child. The perceived definition of an OVC and their

vulnerabilities and identifying the ethical issues that CCs encounter in their work contributes to the academic debate on the tension that exists when working with and for OVCs and the debate on how to work in the best interest of the child. For the contribution to the academic debate it is important to take into account what people in

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11 practice perceive as the best interest of the child, versus what the literature states as being most beneficial for their development.

1.2. Research and sub questions

In view of the issues lined above, the research question of this thesis is:

In order to answer the research question, I had focused on different forms of analysis in different stages in time. Before leaving for the field I studied different bodies of theory related to the research topic to be informed and prepared for the situations I would encounter in South Africa. This theoretical backdrop had helped to formulate a research question. However, this theoretical analysis was never set in stone, but functioned merely as a practical framework, which was altered and reshaped during the research process, and used to critically analyse the findings in the research. The theoretical framework can be found in chapter 2, as well as the conceptual scheme, which represents the first stages from theory to practice. The process as described above also helped me to determine a research location. It was at this stage where I contacted multiple, relevant, NGO’s in the Netherlands, who worked with the topic in Southern Africa and asked them to cooperate. Via Orange Babies I came in touch with Yabonga, who were willing to assist me in my research.

The second phase of the research aimed to bridge the gap between theory and practice. During this phase a research methodology was developed by choosing relevant research methods and by identifying the research location, respondents and scope. Because the topic of my research is sensitive, and it concerns children in a rather ‘unsafe’ area, it was important to focus specifically on research ethics and possible fieldwork challenges. The research methodology, methods, location, respondents, ethical considerations and reflections on challenges in the field can be found in Chapter 3. Chapter 4 aims to identify the main contextual characteristics within this research to develop better understanding of the location, cultural

characteristics, the current situation related to HIV, and provides general information about Yabonga.

How does a Child Counsellor (CC) support Orphans and (other) Vulnerable Children (OVCs) to cope with HIV-status and related vulnerabilities, and what are the perceived ethical issues in conducting their work?

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The third phase of the research concerns the time of fieldwork in Cape Town. It focused on reflecting the perceptions of the respondents related to the determination of the concept of Orphans and (other) Vulnerable Children and their related

vulnerabilities. Thus, Chapter 5 answers the following sub questions: What are the perceptions of CCs and members of the board of the NGO, regarding the definition of an OVC? What are (according to the members of the board and the CCs) the main vulnerabilities of OVCs in Khayelitsha and do they correspond with recent literature? The third phase of the research tried to look beyond the determination of vulnerabilities by developing a deeper insight into the perceived role of the Child Counsellor in the lives of these children. This focus was integrated to develop a better understanding on the support of the Child Counsellor. In this phase, the perceptions and opinions of the children are reflected as well. Chapter 6 therefore answers the question: What are the perceptions of CCs, members of the Yabonga board and the OVCs, on the role of the CC in the lives of OVCs?

The final phase of this study was ‘unplanned’ by forehand, but later occurred to be a very important aspect within the research. Whilst still in the field I analysed my first findings and found a central theme, which I had not taken into account before speaking to the respondents. All (adult) respondents highlighted the same problems while working with- and supporting the children. It became clear that these problems all somehow relate to ethical issues in social work. Because this seemed a pertinent notion in the data I had decided to include this in my research even though this

required new theoretical perspectives in the framework. To strengthen my preliminary findings I have tried to include perceptions of other actors as well: parents and Child Counsellors active in different communities. Thus Chapter 7 focuses on problems that occur while working with the OVCs and answers the following question: What are the experiences of ethical dilemmas (in social work) that CCs face in their work, and how do they manage them?

All data chapters (Chapter 5, 6, 7) are critically analysed by using the theoretical framework in Chapter 2. Chapter 8 integrates all data chapters and literature and provides suggestions for policies, and future research. For privacy reasons pseudonyms are used.

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2. THEORETICAL FRAMEWORK

In this chapter the key concepts underpinning the research will be elaborated. Vulnerabilities of HIV-affected children, the definition of an OVC, ethics in social work and life-skill education as part of the job scope of CCs are explained according to relevant theories and recent publications. In section 2.1 a summary is given of relevant and recent theories on the definition of OVCs. Section 2.2 aims to provide the reader with an overview of literature on vulnerabilities. Section 2.3 explains the wellbeing approach and argues why this approach is an important element of the development of OVCs. Section 2.4 elaborates on life-skill education and how it differs from earlier teaching methods concerning HIV-prevention. In section 2.5 an historical overview is given on the ethics of social workers, and the inclusive model

‘The CCs teach me who can

touch my body, and who cannot.’

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of ethical decision-making is introduced as a framework. Section 2.6 summarizes the most important theoretical findings, and aims to (inter-)link them.

2.1 Defining Orphans and (other) Vulnerable Children (OVC)

With an estimated figure of 6,2 million people infected with HIV, South Africa is the worst affected country of Africa (Campion, 2015) causing a high rate of orphaned (by HIV) children. It is of no wonder that international humanitarian aid particularly targets this group, since the country has never faced such an escalation in parental illness and mortality as the one faced now during the HIV/AIDS epidemic.

Various scholars have emphasized that solely targeting orphaned children in

policymaking is too narrow for the scope of children that is affected by HIV (see for example: Meintjes & Giese (2006) and Meijntjes et al., 2010).

The singular focus on orphanhood in HIV/AIDS discourse contributes to a

one-dimensional view of the effect that the HIV/AIDS epidemic has on children. Meijntjes and Giese (2006) draw attention to how the notions of ‘the orphan’ can obscure vulnerabilities of ‘non-orphaned’ children who are living in poverty.

Furthermore, the definition of ‘the orphan’ is unclear (Skinner et al., 2006 and Meijntjes & Giese, 2006). National governments, international organizations and NGOs tend to focus solely on orphan related statistics in policy-making. Orphans are generally defined as maternal orphans (mother deceased or unknown vital status, father alive), parental orphans (mother alive, father deceased or unknown vital status), and double orphans (both parents deceased or unknown vital status) (Meijntjes et al., 2010). Various scholars emphasise how the definition of orphanhood is culturally determined. In some cases children are missing one parent (or both) immediately which gives them the orphan status whereas the common stigma and stereotype of an orphan may not even be applicable because these children are well taken care of (Meijntjes and Giese, 2006, Meijntjes et al, 2010, and Kang and Kang, 2013). Children who lost their parents or do not know whether their parents are still alive, and children who live with relatives or are fostered by other people in the community are not often defined as orphans in different cultures. Meijntjes & Giese (2006) use the example of a UNICEF report from 2003 to illustrate their argument. UNICEF quickly defined vulnerable children as orphans whereas a closer look at the findings showed that many of these children had a living parent. Therefore, in general

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15 terminology these children were not orphaned and thus not seen as a priority in

political interventions whereas their need for help and support was just as necessary. The shallow focus on orphans only, demanded a terminology that is more inclusive. . Since the beginning of this decade, participants in international and national policy, whose work has been related to children in the context of HIV/AIDS, started to recognize the way in which children, other than those who are orphaned, had been affected by HIV/AIDS (Meijntjes & Giese, 2006). This did not only generate a different focus on policymaking, but simultaneously shifted the general discourse from ‘children orphaned by aids’ and ‘orphans and other children affected by HIV/AIDS’ to the broader definition: Orphans and (other) Vulnerable Children’ (OVC) (Meijntjes and Giese, 2006). This term is widely used and implicitly refers to HIV/AIDS related problems. According to Skinner et al. (2006) the term OVC was introduced due to the ambiguousness of the definition of the construct ‘orphanhood’ and the limited usefulness for policy-making. Associated with HIV/AIDS, OVCs are considered most in need and prioritized in developmental program

However, scholars do question the inclusiveness of the term OVC; there is no doubt that OVCs are in need of help and special care, yet, it is easy to miss out on children who have similar vulnerabilities but are not classified as an OVC.

Many theorists have pointed out that any child living in poverty is a vulnerable child who needs help and prioritization in policy- and decision-making (Andrews et al., 2006, and Meijntjes & Giese, 2006). Meijntjes and Giese (2006) argue that even though this term implies a more inclusive discourse, it has not resulted in a more inclusive response in policies and interventions. Children who are burdened by the social, economic, physical and emotional effects of HIV/AIDS are not included within this general focus (Meijntjes and Giese, 2006). The term OVC works therefore as a theoretical construct but does need situation-based alterations and explanations (Skinner et al., 2006). As explained before, orphanhood, and childhood are culturally determined. Thus, a policy-plan for OVCs has to be altered according to the situation and adjusted to the (cultural) context.

These considerations are not intended as a claim to problematize the definition or whether or not the term should be used. They are only meant to raise awareness to be attentive when using those definitions.

However, for the need of an operationalization in the research the theory of Chapman (2014) is used. The author addressed the indicators for OVCs and stated

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that there are two variables that illustrate a child’s situation and determine whether a child can be labelled as an OVC: child wellbeing and the household wellbeing. Child wellbeing is determined by a number of factors; according to the author these can equally be incorporated in the dimensions of wellbeing as stated above. The first indicator is the child’s health, for example whether the child is malnourished, sick or clear reports exists on irregular food intake. This could be related to the material problems and wellbeing as stated in the previous section. The second indicator for child wellbeing is the access to formal institutions,services and support. These include basic shelter, love and support and school enrolment. The household

wellbeing as a variable for determining an OVC is indicated by the absence of basic support, such as someone who provides emotional support, by access to money and family needs and whether a family is living with food insecurity or not.

The dimensions, variables and indicators will be further elaborated in the operationalization section in the appendices (appendix number 1).

2.2 Vulnerabilities of HIV-affected children

‘The complexity […of determining vulnerabilities of HIV-affected children] increases when it is considered that this definition needs to guide work with children in multiple contexts around the world, and needs to avoid being construed as stigmatizing.’ (Skinner et al, 2006:620).

The quote by Skinner et al. (2006) illustrates the importance of cultural sensitiveness and contextualization in defining vulnerabilities. It explains the dynamic aspect of this definition. What may be vulnerable in one type of context might be of less relevance in a different setting. Thus, generalizing in terms of defining vulnerabilities of OVCs is problematic, yet necessary in terms of international policy-making. The next sections of this paragraph aim to give a broad, general definition that can be measured.

The vulnerability of HIV-affected children could be seen in terms of illness, future perspectives such as unemployment, increased criminal activities and other social (economic) problems (Skinner et al., 2006; Bray, 2003). In their research, Skinner et al, (2006) tried to find a definition of vulnerabilities from the perspective of the vulnerable child him-/herself and his/her community. The authors explain how

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17 but the degree of vulnerability was determined by a balance of aspects in the context the child is living in. If one component is missing, for example the caretaker, this could have considerable effects on the suffering of a child. In this sense the notion of vulnerability is not determined by the child alone, but is also intensified by outside, social factors.

Where the term OVC used to only encompass orphans, the new, more inclusive approach gives attention to other children as well. Besides orphans, other children also face the vulnerabilities that are caused by HIV/AIDS. The new approach to HIV-affected children therefore expands beyond the ‘orphaned status’. According to Andrews et al. (2006) these include: children who have an ill parent, live in poor households and are discriminated because of their own, or their parental HIV status. This statement implies that HIV/AIDS has joined a host of other factors that indicate vulnerability such as extreme poverty, conflict and exploitation.

According to Skinner et al. (2004), the vulnerability of a child is centred around three corner areas of dependence. The first that is described are the material problems. These include: having no access to money, insufficient nutrition, not enough clothing, lack of shelter, no access to health care and education. The second area concerns emotional problems including: the lack of experience of caring, no sense of love or support, no space to grieve and containment of emotions. The third and last area of dependence concerns social problems. These include the lack of a supportive peer group, the lack of a role model and/or someone who could provide guidance in difficult situations and risks in the communal environment. Bray (2003) argues that the predictions for the social consequences lie deeper. The author states that the complexities of orphanhood will cause vulnerability to social problems that will make these children unable to live within society’s moral codes, which makes them prone to anti-social behaviour such as criminality. Eventually these children will be excluded from their communities (Bray, 2003).

To simplify the measurement and determination of vulnerability, textbox 1 summarizes the main indicators for ‘a vulnerable child’ according to Skinner et al. (2004) and Andrews et al. (2006).

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2.3 Wellbeing and OVCs

The framework for measuring and determination of vulnerability by Skinner et al. (2004) can be related to the Wellbeing Approach (WBA) as described by White (2010), Pouw (2014) and McGreggor (2007). In this section a broad overview of the WBA is given. It also explains a frequently used theory for development by Amartya Sen (1989) and why this capabilities approach is not sufficient to determine the wellbeing and development of OVCs.

The WBA draws from the theories of Sen (1989) and Doyal & Gough (1991). The capability approach of Sen (1989) and the theory of human needs by Doyal & Gough (1991) both emphasise individual agency and individual capabilities. Both theories assume that the wellbeing of an individual entails more than economic prosperity. In the capability approach the main focus is on five components (textbox 1).

Textbox 1: measurement and determination of vulnerability

Measurement and determination of vulnerability can be done according to a set of variables:

• Death of or desertion by parents • Severe chronic illness of parents • Illness of a child

• Disability of the child

• Poverty, including access to grants • Poor housing

• Access to services, schooling, health and social services • Emotional problems

• Abuse

• Substance abuse by caregivers or the child

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19 Wellbeing is seen as a multidimensional phenomenon (McGreggor, 2006). The

capability approach emphasises the importance of freedom of choice and individual responsibility. Which means that the individual is responsible for adapting towards a way out of poverty. Sen (1989) views poverty as a deprivation of any of the

capabilities as described in the previous textbox. The critique that is often placed on the theory of Sen (1989), is that his focus merely focuses on the individual

responsibility of people living in poverty. For this reason Sen (1994) altered his latest version of the capabilities approach and states that there are five categories of

instrumental freedoms that indicate human capabilities: Political freedom, economic facilities, social opportunities, transparency guarantees and protective security (Clark, 2005). Nussbaum (2000) builds on this idea and specifies the capabilities that are necessary for the wellbeing of individuals: life; bodily health; bodily integrity; senses; imagination and thought; emotions; practical reason, affiliation; play; social relations; and control over ones environment.

In addition to the individual approach of the capabilities theory, the human needs theory by Doyal and Gough (1991) complements the theory of Sen and Nussbaum. Two central categories are distinguished in the theory of basic human needs: health and autonomy. In line with Sen (1989) a deprivation of either of these dimensions is thought to result in ‘ill-being’, on the contrary of wellbeing. In line with Sen (1989), Doyal and Gough (1991) add the importance of the social aspect of wellbeing by stating that ill-being due to a deprivation in the dimensions of wellbeing has an effect on social participation. A person who is unable to participate in society

Textbox 2: Components of the capabilities approach (Sen, 1989) 1. The importance of freedoms in the assessment of a person’s advantages 2. Individual differences in the ability to transform resources into valuable activities

3. The multi-variety nature of activities giving rise to happiness

4. A balance of materialistic and non-materialistic factors in evaluating human wellbeing

5. Concern for the distribution of opportunities within society.

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is neglected in their wellbeing. Thus, wellbeing is seen as a product of social interaction and relationships (McGreggor 2006).

Considering the focus of this study, OVCs, the theory of Sen (1989;1994) is not sufficient. Children are often unable to collect the resources for their development as described by Sen. Therefore, a less individual approach on development is

necessary. For this reason, the WBA is elaborated in the next section.

Drawing from the theories that are stated above and the dimension of wellbeing by White (2011), Nicky Pouw (2014) developed a new framework on the measurement of wellbeing. To make wellbeing ‘easier’ to measure distinction is made between three dimensions: material, relational and subjective dimensions of wellbeing (White, 2011; Pouw, 2014). The material dimension is identified by assets, welfare and standards of living (White, 2010).

The relational dimension is divided into the social sphere: social relations and access to public goods, and the human sphere, which consist of attitudes to life and personal relationships. The third dimension is the subjective. This includes people’s perceptions of their positions and their cultural values, ideologies and beliefs (White, 2010). In figure 1 these dimensions are depicted in a triangular shape to clarify the importance of the relation between the dimensions. If there is an absence of any of the dimensions, the consequences on the other dimensions are the same (White, 2010). For example, if an individual does not have the material resources to sustain his wellbeing, it implicitly influences the relational dimension, as material resources often determine someone’s social relationships.

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21 Figure 1: Adapted from White (2010)

To draw on that argument, the three dimensions of wellbeing described above, closely relate to the material, social and emotional problems as described by Skinner (2004) in the previous paragraph. OVCs are often vulnerable because there are problems in at least one of these dimensions. In this sense, the vulnerability of a child is determined by the lack of one or several of the dimensions as stated in the

wellbeing theory. Material problems occur when there is a lack of material wellbeing, emotional and social problems occur when there is a lack of relational and subjective wellbeing.

2.4 Life skills in HIV/AIDS related education

In this section the concept of life-skills in education is further elaborated as a component of the work of a child counsellor. One of the key components of the education given by counsellors is related to teaching life-skills that are required when living with HIV (UNICEF, 2006). Bearing in mind that HIV/AIDS is classified as a chronic disease, the importance of life-skill education in addition to prevention- and general information is strengthened.

In the past 20 years, life-skills education has been one of the key components in HIV/AIDS related education for young people. Despite its popularity in

developmental programs, the definition of life-skills remains unclear and neither is the effectiveness significantly proven (Yankah and Aggleton, 2008). The lack of measurable outcomes of effects is probably due to the fact that there is no common notion of what life-skills are and the way they should be applied in education. Why does the popularity remain, in spite of these weaknesses. And what is the difference with general education on HIV/AIDS?

According to UNICEF (2007, 2005) life-skills are meant to enable economic and political participation, ameliorate gender inequalities, enhance parental skills, and to reduce criminal behaviour and enhance socialization qualities. UNICEF further states that life-skills education can be seen as an instrument that helps young people to develop critical thinking and problem solving skills (UNICEF, 2003). According to Yankah & Aggleton (2008) in relation to HIV/AIDS, life-skills are meant to facilitate knowledge about the risk and vulnerability related to the epidemic. In this case life-skills are supposed to enable people to communicate openly about their HIV-status,

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their sexuality and their drug use. In addition they should provide an open

environment where people can discuss their preferences and what they would wish to avoid (Yankah and Aggleton, 2008). Life-skills in HIV education are mostly

emphasised by donor-driven organizations, in particular the World Health

Organization (WHO). Policy-making on life-skill education and HIV prevention has been targeted mostly in high prevalence regions. A lack of clear evidence of its effectiveness and the absence of measurable outcomes have made it difficult to motivate the use of this type of education.

What distinguishes HIV/AIDS related skill education from regular life-skill education is the content of the topics that are covered. To increase knowledge and supportive norms through teaching skills and stimulating intentions to change behaviour is the central goal of this HIV/AIDS based life-skill education Frequently measured life-skills include communication and listening skills, problem-solving skills and coping and self-management skills (UNICEF, 2006, in: Yankah & Aggleton, 2008). In addition to these general skills, related to HIV/AIDS the

importance of condom use, the ability to obtain condoms and other service provision and the ability of the pupils to negotiate with their sexual partners are emphasized as well (Yankah & Aggleton, 2008, UNICEF, 2007).

In the projects of Yabonga, the organization where this research was conducted, the teaching of life-skills and the creation of an environment for open dialogue are facilitated by child counsellors. Although they are not the same age as the children, their program is said to be provided by peer-educators. The basis of the peer-relationship between the child counsellors and the children is best described by Damon (1984) who states that the main aspect of peer education is that a common characteristic exists between educator and educated which creates mutual respect and affinity between them. In the case of the child counsellors and the children of

Yabonga, the shared characteristic would be that the child counsellors are infected with HIV and were part of a Yabonga programme themselves.

To be able to identify and recognize the indicators of life skills within (informal) education, a general framework for teaching life skills is used for this study. In the operationalization section a clear distinction is made between the teaching of individual life-skills and the community based/socially related life-skills. Further clarification can be found in the operationalization table (appendix 1).

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23 2.5 Ethical dilemmas in social work

During fieldwork, it became clear that the tension between the NGO, parents and children was problematic. The main issue that arose was one of ethical origin. In this paragraph an overview is given of the ethical debate in social work. In this research, an elaboration of ethics in social work is specifically intended to exemplify the ethical dilemmas and issues that CCs and board members of Yabonga could come across in their work.

Various scholars emphasize that ethical decision-making is defined as ‘the process of critical reflection, evaluation and judgement through which a practitioner resolves ethical issues, problems and dilemmas’ (AASW, 1999, p.22 in McAuliffe & Chenowith, 2008). Others simply describe ethics as the cognitive process regarding ‘what is good and what is bad’, how we as humans want to be treated and how we treat each other (Banks, 2004). The central questions within ethics is ‘what should I/we do’ and ‘How should I/we live?’. Banks (2004) describes how professional ethics one the one hand conflict with moral philosophy on ethics, but on the other hand relate in the field of professional ethics. The author states that the academic literature and practice guidance on ethics both draw on concepts and theories of moral philosophy. Yet, this relation between academics and practice is problematic.

2.5.1 Theory of virtue ethics

The philosophical theory that I mostly referred to is the virtue theory. This paragraph aims to briefly explain the main ideas, how it is referred to in practice, and where it clashes in the professional sphere.

The virtue theory draws on the ideas of Aristotle (Oakley, 1996). The original idea of the virtuous person is a person with ideal character traits. These traits partly stem from a person’s nature, but they also require nurture aspects. Yet these will become stable over time. Ethics, according to virtue theorists, require questions such as ‘How should we live?’ and ‘what is important for my social relationships?’

In the twentieth century virtue ethics had a revival and developed in three directions: Eudaimomism, agent-based theories and the ethics of care. Eudaimomism refers to virtues in human flourishing, as it is equated with performing one’s distinctive, specialized function well and the traits that are necessary to do so. Agent-based theories emphasise that virtues are determined by common-sense intuitions. These

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intuitions are what we view as admirable traits in other people. As the observer we take into account that this behaviour will eventually result in us behaving the same way. It thus has a more nurtured foundation. The third direction is the ethics of care. It is widely used by feminists who claim a response to the idea that ethics focus solely on justice and autonomy. It argues that classified feminine traits such as caring and nurturing should be considered as well. Ethics of care thus claims a more ‘feminine’ way of looking at morals (Oakley, 1996; Trianosky, 1997).

The main critique on virtue ethics is that it provides no guidelines on how to behave. It simply relies on intuitions and emotions (Banks & Williams, 2005). It is therefore difficult to imply in real life situations. But how will it work in practice? Banks and Williams (2005) describe how textbooks of professional ethics provide event-based information. The article is an elaboration of cases, where the moral guidance is simply given by examples of behaviour in such situations. The cases are analysed by the author or presented for analysis by the reader. In their research, Banks and Williams (2005) took a different starting point, where they asked social welfare workers about their experiences in ethical dilemmas. Through their experiences they try to treat their knowledge as a topic for descriptive inquiries into what is accountable as an ethical issue for social welfare practitioners (Banks & Williams, 2005).

Considering the constructivist ontological stance stated in the methodology chapter, this research aims to do the same. Although the next paragraph includes a model of ethical decision making, the current study still aims to represent the perceptions of the CCs and board members. The model presented here simply functions as a way to understand the process of ethical decision making in social work.

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25 ‘A common criticism of ethical decision making models is that ethical dilemmas often happen ‘out of the blue’ and such models do not allow for those circumstances in which a decision needs to be made quickly’ (McAuliffe & Chenowith, 2008:47) As said before, this paragraph aims to give a view on ethics in practice. The inclusive model of ethical decision-making solely functions as a summary of the process. In relation to the work of the CCs, ethical dilemmas could have consequences on the way in which CCs practice their work. To visualize the process of ethical decision making, the inclusive model of ethical decision making by McAuliffe & Chenowith (2008) is used. This model was initially designed in response to the growing

awareness of ethical decision-making in social work. The platforms that rest on these models are: Accountability, Consultation, Cultural Sensitivity and Critical reflection. Accountability refers to being open, transparent and honest. It is the platform that is therefore closely linked to critical reflection. Critical reflection is needed to evaluate a person’s action to lead to better future practice. Critical reflection also functions a cornerstone of good practice.

A person who is critically aware is thought to be more able torecognize value patterning and the impact that personal values have on decisions. Cultural sensitivity interlinks with critical

reflection, as it requires an open view on the world, and respect for the worldview of others. If cultural sensitivity is not taken into account in social practices,

discrimination is a possible result that

can lead to devastating outcomes (McAuliffe & Chenowith, 2008). Consultation is the final platform. In the view of McAuliffe & Sudberry (2005) consultation is often forgotten as a part of ethical decision-making. It is often seen as ‘unprofessional’ to seek help from others. Yet it impedes the usage of wisdom and counsel of others to

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assist the practitioner to uphold important values in the interest of integrity and prudence.

According to the authors, these platforms need to be taken into account at each stage of ethical decision-making. Textbox 3 provides an overview of the stages and the questions that are asked during each stage.

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27 Textbox 3: The process of ethical decision-making in chronological

stages

1. Defining the ethical dilemma

- Can I clearly define competing ethical principles in this situation?(consultation)

- Is it my role to make a decision, or should this situation be referred to someone with higher authority? (accountability)

- Is this situation familiar to me or do I need new knowledge? (reflection)

(McAuliffe & Chenoweth, 2008: 43-44)

2. Mapping legitimacy

- Who has legitimacy in this situation? (cultural sensitivity)

- Is it appropriate to share this ethical dilemma with others? (consultation, accountability, critical reflection)

(McAuliffe & Chenoweth, 2008: 44)

3. Gathering information

- What guidance is provided by professional codes of ethics, protocols, policies or procedures, and are there any legal considerations? (accountability)

- Are there any conflicts between personal values, professional

requirements and organizational mandates, and are these conflicts likely to present problems for the decision-maker or others? (critical reflection)

- Are there other resources that could shed light on this dilemma such as research, literature or the experiences of others? (consultation, critical reflection)

- Who could be consulted at this stage for the acquisition of new knowledge, or for clarification of positions taken by ethical codes, policies or law? (consultation)

- Is specific cultural knowledge required, and if so, who should be consulted for this? (cultural sensitivity)

(McAuliffe & Chenoweth, 2008: 45)

4. Alternative approaches and action

- . What are the available courses of action now that I have gathered knowledge and information and considered the range of value positions? (accountability) .

- On what basis will I make this decision and how will I justify my actions? (accountability) .

- Am I missing other alternatives, and how can I be sure that I have weighed up all the options? Who can I talk to about this and can someone else play ‘devils advocate’ to help me clarify my position? (consultation) .

- Are any of these options culturally discriminatory or insensitive? (cultural sensitivity) .

- How do I feel about the decision I have come to, and is there anything I need to do differently? Can I live with this decision and can I justify it if called upon? How do I implement and document this decision? (critical reflection; accountability)

(McAuliffe & Chenoweth, 2008: 45-46)

5. Critical analysis and evaluation

- Do I feel confident that I acted in a culturally sensitive manner throughout the process or were there any aspects of culture that I neglected to explore? (cultural sensitivity)

- Did I use consultation and support wisely, and who did I choose to talk with about the ethical dilemma? Were there others that I could, or should, have contacted for information? (consultation) .

- Are there issues that I need to bring attention to in relation to deficits in organizational policies/procedures, ethical codes or other processes that impact negatively on service users? At the end of the day, can I own my decision and confidently discuss my actions and take responsibility for my own part in the decision-making process? (accountability)

- What have I learnt from this situation about the way I make decisions and have I changed my behavior from previous decision-making patterns? (critical reflection) .

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2.6 Disclosure of HIV-status as example of ethical implication

The inclusion of ethics in social work in the theoretical framework was due to the fact that this was a topic that frequently arose in the interviews. Ethical decision-making was a main issue that was found in the data. The main example that was mentioned and which can be found in chapter seven was the (non) disclosure of the HIV-status to children by parents or caregivers. Therefore, additional theoretical tools were

necessary. This section addresses relevant theory on the issue of informing children about their HIV-status, and argues the right of the child to know about their health situation.

As described in the introduction, the shift in emphasis from HIV as terminal to chronic illness has its consequences in policy-making, theory and practice. One of the consequences is the pressing issue of disclosure of diagnosis as a challenge for

parents and caregivers of children with HIV (Brown et al., 2000).

Talking about HIV and the disclosure of the HIV status often implies controversial and emotionally charged issues amongst both the healthcare workers and parents and caregivers of these children (Wiener et al., 2007). The importance of breaking the taboo increases when parents and caregivers are unwilling to disclose the HIV-status to their children. However, in a sense it is, without undermining the importance of disclosure, understandable why parents and caregivers are hesitant in telling their child. HIV diagnosis disclosure entails communication about potentially life

threatening stigmatized and transmissible illness (Wiener et al., 2007; Waugh, 2003). Many caregivers fear that such communication may create distress for the child (Wiener et al., 2007). Michaud et al, (2009) present two reasons why adolescents are hesitant in disclosing their own status to friends and family members, this is similar to the argument of the fear that parents and caregivers have regarding the future of their children. The first argument they give is that young people are hesitant to reveal their situation because they are afraid of the reaction from their peers, their peers’ parents, or other adults. Secondly, they may be indecisive in disclosing their status because they find it difficult to accept that they have HIV and are unable to be viewed like any other, in their eyes, ‘normal’ adolescents (Michaud et al., 2009). The fear that parents have regarding the outcomes of the disclosure often outweighs the reasons to disclose. The parents fear that the children will accidently reveal the status of the parent by informing others (Waugh, 2003) and try to protect the children from the

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29 discrimination, stigmatization and exclusion from communities that are often

associated with an HIV-positive status (Wiener et al, 1998; Kouyoumdjian, et al., 2005)

A growing recognition of children’s rights (article 24, UN Convention on the rights of the Child, 1989) promotes early disclosure. In her PhD research on the right to health of the child in international health and human rights law (2012), Spronk (2012) highlights the importance of child friendly healthcare which includes children’s autonomy and decision-making. She argues that it is a right of young children to have their privacy respected and have the opportunity for confidential counselling and to participate in health-related decisions if this is in their best interest (Spronk, 2012). The Committee on the Rights of the Child (CRC) emphasises the importance of the right for children to be informed about their health status and medical treatment. Even very young children have the right to be directly informed about the medical treatment they are undergoing, even in short wordings (CRC article 12,13).

Considering the OVCs in this research who are HIV positive, being informed about their medical treatment, could contribute to being healthy, since they understand the earnestness of taking the ARV treatment steadily.

However, it is debatable from what age children should be involved in the decision-making process that relates to their health.

Because of the shift of HIV from terminal to chronic illness, parents and caregivers experience the growing pressure to inform their child and to emphasize the need toensure a child’s cooperation with aversive treatment regimes in HIV

medication (Lipson, 1994; Brown et al., 2000).

However, without a doubt, the disclosure of HIV-status is of great importance for the following reasons:

According to the article of Mellins et al. (2002) children who are informed before the age of six years old do not experience the shock, fear and sense of betrayal that is observed among children who learn the truth at an older age. Bacha, Smith and Poeroy (1998) reported that children who were informed, knew their HIV status, had a higher self-esteem and seemed less depressed than children who were unaware of their illness. Lipson (1994) and Mellins et al.(2002) argue that disclosure to school-age children, is beneficial to their wellbeing. As long as informing the child is treated as a process that focuses on the children’s concerns and understanding of their illness.

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Regarding this study, the ethical dilemma is that NGOs like Yabonga are not allowed to inform the child.

2.7 Concluding section

In the first section, the definition of OVCs was analysed according to the most relevant and recent literature and practical policy documents. The main point that arose within that section was the discussion on the transition of OVCs solely determined by ‘orphan- status’ to a more inclusive approach. However, including ‘other vulnerable children’ does not mean that the definition is clarified. This is because the meaning of both OVCs and HIV-related vulnerabilities is contextually determined. The new approach to HIV affected children expands beyond the status of being orphaned but cannot be seen as a blueprint in any given situation. Included in the new terminology are: children who have an ill parent, children who live in apoor household and children who are discriminated because of their, or their parental HIV status. Vulnerabilities can be categorized into 3 areas: material, emotional and social vulnerabilities. These closely relate to the 3 dimensions of the WBA. The WBA is a development theory that draws from the capabilities theory of Sen (1989) but looks beyond the focus on individual responsibility as emphasized by Sen. This is important for this study, given the research population, which involves children who do not have the necessary means to be individually responsible for their development.

In the third section the theoretical perceptions on life-skill education were highlighted in order to get a better understanding of the work that is done by Yabonga and its importance in relation to the amelioration of the vulnerabilities of OVCs.

The fourth section was dedicated to ethics in social work. A brief overview was given of the main thoughts in ethical decision-making. Virtue ethics are mostly used yet insufficient because of their unpractical nature. The tension between academic literature and practice still persists. To reduce that gap, the inclusive model of ethical decision-making (McAuliffe & Chenoweth, 2008) was used. This model was initially developed in response to the growing awareness of ethical issues in social work. In this study the model functions as a way to understand the process according to the different stages. In the last section of this chapter, relevant theoretical work was discussed, with regard to the disclosure of HIV-status to children. It was briefly

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31 illness. Concluding, the last section opens the discussion about the autonomy of the child. Children should have the right to make health-related decisions, and this includes being informed about their health status.

2.8 Conceptual scheme

The conceptual scheme displayed in figure 3, visualizes the theoretical concepts that have guided my research.

Figure 3: Conceptual scheme

The arrow between the Child Counsellors and the vulnerabilities of OVCs depicts the influence that the work of the CCs could have on the determining factors of

vulnerability, as presented in the operationalization table (appendix 1). The influence of the ethics in social work, on the work of the CCs, is portrayed with an arrow from the bottom. The bottom-left section represents the categories of theconcept of wellbeing. The arrow that lead from this box, depict the two-way influence that the work of the CCs do, has on the wellbeing of OVCs and the influence that

vulnerabilities of OVCs has on their material, subjective and relational wellbeing. The box that surrounds the conceptual scheme portrays the context of the research,

because it is important to take the context into account. For example: as explained in the theoretical framework, vulnerabilities are contextually determined. The graphic

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surrounding the conceptual scheme does add the chronic aspect of the disease, but as an overarching ‘fact’ in the research context. The transition from terminal virus to chronic disease does not necessarily need to be a concept as such, but should illustrate the relevance of the research and should motivate the assumption about the relevance of the work and influence of the CC.

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3. RESEARCH METHODOLOGY

3.1 Introduction

The main purpose of this study is to explore the perceptions of CCs, OVCs and members of the Yabonga board, on the concepts as described in the theoretical framework. Moreover, the influence of the work of the CCs on the vulnerabilities of OVCs is examined according to the perceptions of the actors in the research. In line with the qualitative nature of this study, the aim is to gain in-depth knowledge on OVCs and their wellbeing and the ethical issues of the CCs. In this chapter the methodological approach will be discussed according to the epistemological and ontological stance. Furthermore, the research methods, location and scope are addressed, as well as the data- collection and analysis. To conclude this section, the research challenges, limitations and ethical considerations will be discussed.

3.2 Methodological approach

To be able to define the research methodology, I have to keep in mind that the basic assumptions about obtaining knowledge must be made explicit. In the following section I will define my basic assumptions by my epistemological and ontological stance, which will together inform the methods used. According to Sumner and Tribe (2008) ontology can be best described as ‘a theory or set of assumptions concerning what ‘exist’. Thus, what is ‘nature’ or perceived ‘reality’. Epistemology on the contrary is ‘a set of assumptions concerning how we can perceive what ‘exists’. From an epistemological stance, this research is based on aspects of interpretivism. Interpretation is necessary in defining the perceptions of CCs, and identifying their encountered problems.

Regarding the ontological stance, this research requires deeper understanding of people’s social behaviour. It has been my intention to interpret the world and social reality of the OVCs and CCs from a hermeneutic and phenomenological perspective. This perspective is based on the idea that people’s reality is constructed through their own interpretation, which determines their social behaviour. It is therefore that I will follow a constructivist approach by looking at the meanings and explanations of social interactions. Constructivism defines social concepts as continually changing

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and underlines the notion that these concepts are accomplished by social actors (Bryman, 2015). According to this epistemology, people themselves socially

construct social objects. (Bryman, 2015). In other words, people are co-producers of their social reality, rather than independent objects (Bryman, 2015). In this research the constructivist ontology is reflected in the measurement of the concepts. The definition of the concepts is done according to the perceptions of the respondents and knowledge is obtained according to their view on life.

During my fieldwork and my fieldwork analysis, I became more fully aware of the importance of adopting a reflexive stance in research. I discovered that my ontological and epistemological stance closely relate to the argument of Alvesson and Skoldberg (2009). In this argument, it is stated that there is an unstable relationship between reality ‘the way it is’ or is ‘out there’ and that our knowledge of that reality has a rhetoric nature. This implies that social reality can never exist on its own, separated from the research population, or from the researcher (Alvesson and Skoldberg, 2009). In the context of Khayelitsha, the Xhosa culture, working with an NGO and the sensitive topics that were discussed during this research, it is of great importance to be reflexive as a researcher. I have attempted to continually reflect on how my presence, beliefs and previously obtained assumptions influenced the research. I am aware that the language used in this final thesis and the selection process of which data to include or exclude may influence the empirical data and might not be reflective. Yet, I have tried to analyse the data from different angles (Alvesson and Skoldberg, 2009) in order to be creative and critical during the analysis and the thesis writing.

I have encouraged myself to adopt the reflexive methodological approach to be able to critically reflect and constantly be aware of my position as a researcher during the entire research process.

3.3 Research methods and data analysis, scope and locations

In this paragraph I will address how I have collected the data using a range of

research methods. All research was done in Khayelitsha, the biggest township in Cape Town. Khayelitsha will be further described in the chapter on the research context. For this research I have used purposive sampling. According to Bryman (2004) this

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35 relevance to my research. To get into contact with my respondents I have made use of the contacts at the NGO that I had obtained before leaving for South Africa. In general, everybody working at the NGO was very willing to help me and to talk to me whenever necessary.

As mentioned in the previous paragraph, based on the reflexive methodology, my research is primarily qualitative. I have combined multiple research methods in order to be able to triangulate my research findings in line with the argument made by Bryman (2004) on the validity of the data. The most important method I have used is conducting semi-structured interviews, which were in depth and open ended. The main advantage of this method is the emphasis on how the interviewee ‘frames and understands issues and events’ (Bryman 2004: 238). Besides the interviews I have used group discussions, (participatory) observations and participatory methods. A detailed research activities table can be found in the appendices (appendix 3).

In regard to the role of the CC I was able to conduct 8 interviews with CCs from the area I was working in. To strengthen my interview data I observed the CCs during their daily activities with the children. In order to find out more about the interaction between the children and the CCs I documented 6 (participatory) observations. Furthermore, to get a clear idea of the required role of the CCs, I interviewed 2 members of the Yabonga board. Moreover, I attended a group meeting of all 25 CCs about their experiences during a family meeting. After analysing my first data, I decided it would be important to ask the CCs more about these visits because it became clear that these visits could give more clarification about the communication between parent/caregiver and the NGO. Therefore, I organized a group interview after the meeting. For privacy reasons I was not able to attend any family visits, yet I was able to go to a parental support group. This gave me the opportunity to

triangulate/verify the findings from the group interview.

To represent the attitudes and perceptions of the OVCs, I conducted 20 semi-structured interviews with children who attend Yabonga. If the child was too shy or unwilling to speak I had asked them to write down their answers, which was

immediately translated by a female gap year student (21 years old) who functioned as my interpreter in Xhosa on the days of these interviews.

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My data analysis is based on transcriptions and research notes. All interviews were recorded with a voice recorder and most of them were transcribed on the same day. Moreover, I kept a research diary that was updated after every interview or activity. This way I was able to make elaborate notes on the interviews that I worked out the same day or at least within 24 hours. For the accuracy of the transcriptions, they were checked against the recordings. The focus group discussion was not recorded, yet detailed notes were developed on the responses of the participants.

For the writing down of my (participatory) observations I used an observation form and elaborate notes. These were transcribed within 24 hours.

The data was analysed with an open-coding scheme, which made it possible to later organize the data into ‘themes’. These themes emerged from highlighted sections in annotated transcripts. Examples of the themes are: ‘Ethical issuess’, ‘HIV-related education’, ‘Difference between boys and girls’ etcetera. The first interviews, which were the longest, were coded digitally with the help of a program called AtlasTi. The rest of the interviews were analysed manually. With this process, it was possible to categorize the data into the different themes and to summarize the data. This made it possible to check for differences between actors (which was specifically interesting for Chapter 6, OVCs and CCs). An example of the coding process is given in appendix 4.

3.4 Limitations and research challenges

The findings in my research cannot be generalized because of its qualitative character and the limited time frame of the research. This research should be viewed as a mere exploration of perceptions present in townships in South Africa, and the actions and challenges that these people have to deal with in their day-to-day lives.

Before leaving for fieldwork, I had presented a comprehensive research proposal, which stated some research challenges that I could encounter in the field. Although most of these challenges remained the same, the real understanding of these

challenges came to me during fieldwork. I had never realised that limitations could influence my research in such a way that I was required to improvise during the data gathering on location. In textbox 1 have presented an example. Yet this improvisation may have influenced the initial answers I was aiming for. Considering all methods

Protection makes vulnerable : Working ethically in the best interest of the child