LAUSR

Abstract Background Orphan-hood is a major consequence of the Acquired Immune Deficiency Syndrome (AIDS) pandemic globally. In South Africa most children who are AIDS orphans live in township communities. They are often uncared for and unsupported by the community, and experience recurrent psychological trauma and much personal suffering. Identifying the “barriers to” and “recommendations for” providing care and support to these vulnerable children is vital to enable the development of comprehensive implementations to meet these children’s unique care and support needs. Objective Using empirical data from health and social care professionals and cluster analysis to identify “barriers to” and “recommendations for” providing care and support to children living as AIDS orphans in township communities in Nelson Mandela Bay South Africa. Design Data was collected using a descriptive phenomenology research design incorporated an exploratory, contextual and descriptive approach. In-depth unstructured interviews were used to collect data from participants. Participants The primary health care nurses (PN) (n = 10) and social workers (SW) (n = 8) were selected using criterion-based purposive sampling, whilst snowball sampling was used to select psychologists (Psy) (n = 6). Participants are referred to as health and social care professionals. Setting Participants were selected using purposive sampling (nurses and social workers) and snowball sampling (psychologists) from four primary health care clinics and twelve satellite health care clinics, all located in township communities in Nelson Mandela Bay, South Africa. The participants were all caring for and supporting children who are AIDS orphans living in these communities. Methods In-depth individual interviews occurred between April and Nov 2013 which were recorded and transcribed verbatim. All data was then analysed using cluster analysis to identify “barriers to” and “recommendations for” providing care and support to these vulnerable children as identified by these research participants. Results All “barriers to” and “recommendation for” are represented in this cluster analysis. There were six identified clusters illustrating “Barriers to” and four visualised clusters illustrating “Recommendations for”. The barriers can be identified using the following broad themes; B1, fundamental barriers; B2, primarily related to legislative and policy frameworks, B3, lack of human and financial resources also included stigma and communication. B4, grief, high risk behaviours and cumbersome bureaucratic processes and included loss of trust in adults; B5, barriers related to poverty B6, barriers related to poverty also included non-disclosure of HIV status. Regarding the “recommendations for” these can be identified using the following broad themes; R1, developing the resilience of health and social care professionals. R2, developing interventions, to meet the unique needs of these AIDS orphans. R3, developing, empowering and capacitating professionals and R4, facilitating an empowering working environment for professionals. Conclusions Significant clusters emerged and the “barriers to” and “recommendations for” were identified in this research which could be used to inform the development of an intervention to provide “best practice” care and support to these vulnerable children living in these township communities.