CHAPTER family were under a (moral) obligation to

CHAPTER ONEINTRODUCTION OverviewThis chapter provides sufficient information for better understanding of the study. It examines the global context and then narrows down to the issues that the study will address. The chapter provides the background information, statement of the problem, research objectives and research questions that underpin the study, significance of the study, limitations of the study, theoretical framework and operational definitions of terms.1.1. Background of the studyHuman Immune deficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS), according to Coles (2014), are currently decimating African society, especially in Sub-Saharan Africa, tearing apart the extended family system, eliminating skilled workers and creating millions of orphans. The high incidence of HIV infection means that the impact of HIV and AIDS morbidity and mortality will be felt for decades.

According to Population Reports (2012), nine out of every ten children orphaned by AIDS are in Sub-Saharan Africa.In Africa, family members traditionally cared for orphaned and vulnerable children; historically, members of the same family were under a (moral) obligation to care for one another and children were certain of being cared for either by their own parents or by a family member. In recent years, however, care for children has become an insurmountable burden for many families, pushing them beyond their ability to cope. Extended family networks once the pride of African care for children have quite simply become overwhelmed by the vastly increasing number of children in need of alternative care. Since the availability of alternative care arrangements ensured by the government is limited, these developments initially led to a rise in the number of families headed by aunts or grandparents. However, from the early 1990s an unprecedented rise in the phenomenon of child-headed households has been witnessed. (Nyambedha, et al 2007).Foster (2013) observes that various definitions of child headed households are in use: in general terms, a child-headed household is an arrangement in which the oldest child has assumed most of the responsibilities of a parent.

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These households more often than not lack the capacity to provide for the children forming part of the household; children living in child-headed households are extremely vulnerable to abuse as well as to economic and sexual exploitation. Child headed household is a new phenomenon in many societies, mainly because in the past there were institutions like the extended family that took care of the orphaned children. Child headed household is defined as a family that is led by a child who is below the age of 18 years and who has assumed parental responsibilities. This family arrangement more often than not lack the capacity to adequately provide for the children forming part of the household; members living in such households are extremely vulnerable to abuse, as well as to economic and sexual exploitation (Progress for children, 2009).

Mbugwa (2009) estimates that more than 80% of all child-headed households are located in Sub-Saharan Africa. Sloth-Nielsen (2012) defined a child -headed household as any household where a child up to or under the age of 18 years is called upon to perform care giving responsibilities. Whereas Plan (2013) looks into a child headed household as an arrangement where the children are double orphans and is headed by a child that is recognized as being independent who along with other children is responsible for feeding and maintaining the household, caring for younger siblings and adopting de-facto adult/parent roles. In this study, child headed household was referred to as a household where a member who does not exceed the “teen” years fully or partially finances, controls, plans and implements the immediate management of the activities that affects the occupants of the household. This may be a child whose childhood period incorporates both the legal as well as the contextual definition of a child and who may be looking up for assistance for daily needs from any other direction apart from immediate biological parents and lives in this kind of household (Skinner et al., 2004 ;Tsegaye, 2007; Plan, 2010 ; MacLellan, 2005).

Barry and Garbarino (1997) emphasize that a child has the right to be raised in a manner, which provides him with the best possible development of his personality. There is a global consensus that this upbringing is (in principle) the primary responsibility of the child’s parents. According to UNAIDS (2010), HIV and AIDS has resulted in a substantial increase in the number of orphans internationally and UNICEF estimates that by 2020 40 million youths may have lost one or both parents to HIV and AIDS. Sub-Saharan Africa has been severely affected and accounts for over 80% of HIV and AIDS-orphaned youth. ( Roalkvam, 2013; UNICEF,2006) add that were it not for the AIDS epidemic, children in Sub-Saharan Africa would not have been orphaned forcing a great number of them to head households.UNAIDS (2012) observes that, worldwide, it is estimated that more than 15 million children under 18 have been orphaned because of AIDS. Around 11.

6 million of these children live in sub-Saharan Africa. It is estimated that 8% of the adult population in Kenya are HIV-positive, and approximately1.2 million children in Kenya have lost one or both parents to the disease. According to UNICEF (2010), the effects of HIV and AIDS on children who are orphaned, or in families where parents are living with the virus, not only include these calculable loses, but also the immeasurable effects of altered roles and relationships within families. Orphaned children are likely to be plunged to adult responsibilities for which they are ill prepared. In the past, aunts and uncles, grandmothers and grandfathers, or other relatives would care for these children after their parents died.Ayieko (1997) posits that extended family was the traditional social security system and its members were responsible for the protection of the vulnerable, care for the poor and sick and the transmission of traditional social values and education. However, the extended family mechanism has started to break down under the twin pressures of poverty and disease.

Other changes such as labor migration, the cash economy, demographic, formal education, and Westernization have also weakened the role of the extended family setting a stage for individualism so that larger proportions of orphans are sleft to cater for themselves. The problems and challenges facing child-headed households are grim. Moletsane (2004) observes that most of such children are faced with overwhelming and enormous challenges like having to drop out of school to work, and have to worry about their daily existence.

Nesangani (2008) adds that others are forced by economic circumstances to look for means of subsistence that increase their vulnerability to HIV infection by engaging in sexual activity, substance abuse, child labor, and other forms of delinquency. It is heartbreaking to witness the holocaust of our day – hordes of children being left to fend for themselves, without any parental support, love, and guidance. They are heading households and are vulnerable to challenges of psychological and emotional nature, stigmatization and discrimination, exploitation, poverty, marginalization from health care and educational services. The AIDS epidemic has led to many situations where both parents have died and left behind orphans.

The children may begin taking over their parent’s responsibilities before the last surviving parent is dead. When the parent is sick or too weak to work, the eldest children often have to stop going to school and get a job instead in order to gain income for the family (UNAIDS, 2012). A study by Creswell (2005) showed that, in Namibia, the average age of the children acting as parents in their families was 17; some were as young as 9 years old. The number of children heading households in sub-Saharan Africa has experienced an upward growth.

A survey in South Africa by Foster (2013) showed that 122,000 (0.67%) of the country’s children were living in child-headed households. The appearance of child headed households in communities affected by AIDS is a recent phenomenon with cases noted in the early 1990s in Nyanza region of Kenya, the Rakai district of Uganda ( Alden, Salole and Williamson, 2012) and Kagera region of Tanzania (Mukoyogo and Williams 2008).

In 1991, such households were also observed in Lusaka, Zambia, Manicaland, Zimbabwe and, for the first time, in six villages in the Masaka District of Uganda, where previously no such households had been noted (Naerland, 1993). In the United States, cases of teenagers caring for younger siblings after deaths of parents from AIDS were reported in 1993/94 (Levine, 2013). Nevertheless, in the Rakai District of Uganda, two per cent of orphans were living in households with a care- giver who was 18 years old or less and 97 per cent of orphan households had an adult of 17 years or more living in the household (UNICEF 1994; Nalugoda et al.

, 1997). While in Zimbabwe, it was es-timated that eight per cent of children under 15 years were motherless because of AIDS (Gregson et al., 2012)The AIDS epidemic is leading to a decreasing proportion of adults in the population and reduced incomes of affected households (Gregson et al., 2012; Leighton, 2011). Because of the impact of AIDS on communities, changes are taking place in care giving arrangements for affected children; an increasing proportion of orphans are now in the care of the elderly and the very young (Foster et al. 2009; Saoke, Mutemi ; Blair, 2010).The scourge, by concentrating on young adults and the middle-aged population (between 15 and 49) has minimized the pool of economically active blood relatives (UNICEF, 1999) and created a large number of helpless orphans (children below 15 years who have lost one or both of their parents (Central Bureau of Statistics, 2010).

The joint United Nations’ AIDS Program (UNAIDS), and Children’s Emergency Fund (UNICEF) report indicated that before the large-scale advent of HIV/AIDS related deaths in the late 1980s, only 2% of the Developing World’s children were orphans. By the end of 2002, over 14 million children in the whole of sub-Saharan African countries (or 12% of all children under the age of 15) were total orphans (UNAIDS/UNICEF, 2002). Kenya’s 1998 orphan figures indicated that 363, 593 were maternal orphans, 973,909 had lost their fathers and 1,220, 633 had lost either one of the parents (Bicego, Rutstein ; Johnson, 2013). Currently there are approximately 3.6 million children aged below18 years who have been orphaned or who are vulnerable (KAIS, 2012).According to KAIS (2014), HIV prevalence in Kisumu county stands at 21 percent with Seme Sub-County accounting for more than 12 percent of all the new incidences.

This implies that a better portion of the family savings will go into taking care of the family heads and other children who could have been born with HIV before they finally succumb to AIDS. This creates room for orphan crisis, depression and untold suffering as the young children who should be under the care of adults are suddenly turned into “parents” taking care of themselves and the rest of the surviving members of the family. This greatly affects their psychological and social wellbeing characterized by limited state involvement in social welfare structures and general absence of elaborate social institutions to take them in most of these orphans live alone either in their parent’s homes or find their way into streets to live as street children. 1.2 Statement of the ProblemWhile the visible face of HIV and AIDS dramatically highlights the social and economic hardships of children and adolescents whose right to basic needs are constantly violated, the psychosocial burden of the HIV and AIDS epidemic may seem less important, less urgent and less compelling. However, to the affected individuals, it is urgent and their psychosocial concerns are real; and require urgent intervention. The emotional and psychological demands on young people whose parents have died are enormous, less obvious and often go unnoticed or neglected.

In case of children and adolescents, changed behavior may be dismissed as a temporary disorder that will pass rather than an indicator of psychosocial trauma with possible long-term implications. Some of the commonest effects include; anxiety, stress, low self-esteem, frustrations and other behavioral changes. In Seme Sub County, how the orphans sustain their disrupted life after the loss of their parents is an extended family affair. Their situation is made worse by the fact that AIDS-related deaths in the communities have increased at an alarming rate. The multiplication of child headed households within the area of study was an indicator of the magnitude of the problem. From the literature reviewed, there was no indication that a similar study had been carried out in Seme Sub County.

It is in view of this that the researcher studied the Psychological implications of HIV and AIDS in child- headed households in Seme Sub-County. 1.3 Purpose of the studyThe study sought to investigate the implications of HIV and AIDS on child- headed households in Seme Sub-county, Kisumu County- Kenya. 1.4 Specific Objectives of the StudyThe specific objectives of the study were to: Examine the psychosocial effects of HIV and AIDS on child headed households in Seme Sub-County, Kisumu County.

Evaluate the implications of HIV and AIDS on school attendance and performance among child headed house- holds in Seme Sub-County, Kisumu County. Establish the effectiveness of the existing interventions to address the effects of HIV and AIDS on child headed households in Seme Sub-County, Kisumu County1.5 Research Questions of StudyThe study aimed at answering the following research questions:What are the psychosocial effects due to HIV and AIDS on child headed families in Seme Sub- County, Kisumu County?What are the effects of HIV and AIDS on school attendance and performance in child headed families in Seme Sub-County, Kisumu County?What is the effectiveness of the existing intervention measures against the effects of HIV and AIDS on child headed households in Seme Sub-County, Kisumu County? 1.6 Justification of StudyThe results of this study may prompt psychologists to play pivotal roles in supporting the school system in dealing with vulnerable children such as those living in child-headed households. Psychologists and other stakeholders may then become actively involved in intervention programs that may run in schools to assist adolescent primary and secondary school learners including those living in child-headed households.

Since this study directly involved the learners from such households, a better understanding of intervention measures that these learners employ was explored and appropriate support methods developed.Additionally, the information might be used to create an understanding amongst helping professionals, particularly counseling psychologists and nurses employed in primary health-care clinics, with regard to the needs of HIV and AIDS orphans so that appropriate care and support could be rendered to such orphans. The study may also help in addressing the effects of death in not only HIV and AIDS orphaned children but also all orphans from other causes.

Although various studies have focused on the psychosocial issues facing AIDS orphans both in Kenya and other countries, relatively few studies have focused on the implications of parent’s death from HIV and AIDS on the child headed house- holds in rural areas. The study may therefore unearth the experiences of such households, which in most cases go un- noticed, and through this; major stakeholders for the children rights may find better ways of serving children. The study captured the data from children’s own perspective. The issue of parental loss due to HIV and AIDS is a painful and sensitive topic that is difficult to discuss with orphaned children.

Painful as it may be, the children stood to benefit from free counseling that was offered as need arose. 1.7 Limitations of the StudyThe study findings need to be considered in the light of various potential limitations. Participants who were interviewed might have exaggerated their responses in the hope that this may move the researcher and major stakeholders like the Department of children services, church based organizations to consider some financial assistance to them. This is a common flaw of social surveys where responses are influenced by expectation-induced responses.

This was evidenced by pleas expressed during the interview requesting the researcher to intervene so that the government may advance financial assistance to all the orphans. Funding was a major constraint as only funding from the researchers own saving was obtained to conduct the research and the involvement of the research assistants for the pilot study and the main study. The scope of the study area further escalated the costs estimated earlier further limiting the study.

In the end, the researcher had to focus on the critical components of the study to be within available resources.The main disadvantage of case studies is that findings are based on a limited number of cases and can therefore not be generalized. The findings of this study are therefore generalizable to Seme Sub-County. However, the findings illuminate the structural constraints of the child-headed household, which can constrain the academic performance of students in similar settings in Kenya.1.8 Theoretical FrameworkThe current study was guided by family systems and ecological systems theory.1.

8.1 Family Systems TheoryThe study was guided by Family Systems theory by Bowen (1954), which posits that people do not exist in a vacuum, but in families and communities Every family member is connected to each other through a system of overlapping and intertwining relationships that can only be deciphered when all members work as one. This also applies to children affected or infected by AIDS. This theory sees different levels and groups of people as interactive systems where the functioning of the whole is dependent on the interaction between all parts. Family Systems Theory assisted the researcher in this study, to understand the educational and psychosocial factors that affect learners orphaned by AIDS. Whole systems can interact with other systems around them, for instance family may interact with schools, communities, education department and other government departments among other systems.

All parts of systems affect the system as a whole (Donald et al., 2009). If a system and sub-systems are affected, they disturb the smooth functioning of other sub-systems, and if they are intact, the whole system functions well. Different levels of the systems may influence learners in schools and in society. In this study, the parent’s illnesses and deaths due to AIDS, affect their children’s educational and psychosocial needs. AIDS orphans are not treated like any other orphans; they are discriminated against by their peers and are absent from school because some of them need to take care of their terminally ill parents. These factors affect other levels of the system such as community; whereby community members discriminate those who are affected or infected by AIDS; and school level whereby learners orphaned by AIDS are being discriminated by their classmates. If most of the learners are having difficulties to perform well in school due to the factors mentioned above, the entire education system will be affected.

For example, there will be high failure rate.There may possibly be an imbalance in the whole system because of the disturbances between each of the levels, and so it may be detrimental to view the challenge as being caused by the learners’ home factors, which in this study are their parents’ illnesses and deaths related to AIDS.1. 8.2 Ecological Systems theoryAnother theory that was relevant to this study is ecological systems theory propounded by Bronfenbrenner (1986) whose assumptions are based on the interdependence between different Organisms and their environments.

The relationships between organisms and their environments are seen holistically. In a family or household such as child headed households, every individual is essential to another in order to sustain the cycles between birth and death. Therefore, the links between organisms or people within their entire systems depend largely on one another. The theory sees different levels and groups of people as interactive systems where the functioning of the whole is dependent on the interactions between all the parts. Orphans as in this study, are part of a system that can be affected by different aspects such as members of the extended family, siblings, teachers, neighbours, peers, the curriculum and the school administration.

Interdependence here is highly dependent on the activities of each member. Therefore, it becomes vital to understand how children’s development is shaped by their social contexts (Bray et al., 2010). Bronfenbrenner (1986) explains fully how different levels within a system in the social context interact in child development.Interacting dimensions are central to this model, which covers personal factors (for example, one OVC’s temperament), process factors (forms of child-headed family interactions) contexts (members of the extended families, schools or local communities) and time (changes over time in the child and the environment).He explains reciprocal influences in families, peer groups, classrooms, schools and local communities covering four nested systems, namely the microsystem, mesosystem, exosystem and macrosystem, which all interact with the chrono-system.

Therefore, orphans are at the centre of it all. Reciprocal interactions with their peers, school administration, child headed households and the external community all impact on OVC, siblings and their community. For instance, the notion of residing in child headed house- holds can affect the exosystem, for example, a child headed household older sibling’s school interactions can affect other siblings’ ways of life, as most members of such households look to older “brothers” or “sisters” for care and support. Therefore, any frustrations at school can eventually affect entire system, which in turn affect all the OVC, their peers and the community. Eventually the whole macrosystem is affected either positively or negatively.

When there is a problem at one level, it will most probably affect other levels (Donald et al. 2009). The Joint Report of New Orphan Estimates and Framework for Action (2014) maintains that the reality of the current situation regarding children orphaned by AIDS is complex, inter-related on all levels of life, and cuts across all sectors of development. This is not a matter of individuals, societies and governing bodies locally and internationally. Estimates and Framework for Action (2004) further states that we are faced with a situation of an unprecedented nature that requires the trust and respect of communities, collaboration and commitment at all levels, and the sharing of lesson learned.

The two theories show collaboration by stakeholders in fighting the epidemic thus were relevant for this study.1.9. Operational Definition of TermsThe following terms were operationally defined as used in this studyA household: refers to a group of children sharing the same housing arrangementThe household head: is the child primarily responsible for the day-to-day running of the household, including sibling care, breadwinning and household supervision.A child: refers to any human being not under the care of parents’ due to HIV and AIDS related deathsChild headed household: refers to a house whose head is a child due to parental deaths resulting from HIV and AIDSOrphan: a person below 18years who has either lost one parent or bothAdolescent: An older child whose parent has died as a result of HIV and AIDSSub-County hospital: this refers to the health facility within the area of study where patients who can’t be treated in other health centers are referred.Division: refers an administrative headquarter consisting of several locations and headed by District Officer.Loss- a permanent disappearance that results from HIV and AIDS related deaths.

Attendance-Number or days present in school within a termPerformance-Total marks that a learner gets at the end of the term/semesterCHAPTER TWOLITERATURE REVIEW2.0 IntroductionThis chapter examines and explores what other researchers have written on the implications of HIV and AIDS in child headed families. The chapter is divided into three main parts; part one highlights the psychosocial implications of HIV and AIDS on child headed households, part two the implications of HIV and AIDS on school attendance and performance on child headed households and part three presents intervention measures which could be used to assist such families to deal with the identified challenges. 2.1 Psycho-social implications of HIV and AIDS Death of a parent is considered a crisis for any child (Dane, 2007). However, clinical reports indicate the grieving process may be particularly difficult for children orphaned by AIDS due to material and psychological stress that often accompany the parents’ illness and death (Wild, 2012).

Parental loss in childhood is one of the harshest experiences that is responsible for depression.In a study in Rwanda, clinical depression levels was common among youth (aged 13-24) who headed households. The heads of households who reported higher levels of depressive symptoms, social isolation, and/or lack of adult support were also more likely to report that children under 5 in the home were showing more signs of socio emotional disruption” (Boris et al., 2006,). In another study in Uganda, depression was found to be higher among orphans than matched non-orphans.

Depression among orphans were found to be associated with smaller household sizes, which suggests the potentially buffering function of a larger support system (Atwine et al., 2010).A study of psychosocial issues among 193 orphans in Rakai District of Uganda looked at locus of control in orphaned children (aged 6-20years) specifically between their external environment and their ability to adjust their behaviors to it. Using in-depth interviews including a 25-question depression index, the study found that about half of the orphans fell in the depressed range. The highest depression scores were among those living in child headed families, emphasizing the need of a family connection (Atwine et al, .2010).

In a related study in Namibia, there were significant levels of suicidal ideation among child headed households (Ruiz-Casares, 2010). Nevertheless, like adults, children are grieved by the loss of their parents. However, unlike adults’ children often do not feel the full impact of the loss simply because they may not immediately understand the finality of death.

This prevents them from going through the grieving process, which is necessary to recover from the loss. Children therefore are at risk of growing up with unresolved negative emotions that are often expressed with anger and depression. Adults may also experience negative emotions in times of bereavement, but, unlike children, adults have the intellectual ability, life experience and emotional support that enable them to control their anger and depression .Unfortunately, adults do not seem to appreciate that children are also adversely affected by bereavement even though they may not have an adult’s understanding of death. Little attention is therefore given to children’s emotions. Children are denied the required support and encouragement to express their emotions nor are they guided to deal with them.

For example, children are not always talked to, nor listened to, and therefore their emotions are misunderstood. When they have no appetite for food or when they have no strength for house chores, or lack the strength to attend school, or when they become inattentive in class, they are simply punished. (Brodzinsky, Gormly & Ambron 2010) However multiple studies in sub-Saharan Africa have demonstrated that HIV and AIDS orphan- hood is associated with emotional distress – particularly with regard to symptoms of anxiety, depression, and post-traumatic stress (Atwine, Cantor-Graae, & Bajunirwe, 2010; Bhargava, 2009; Cluver &Gardner, 2014; Nyamukapa et al., 2008). Similar findings have been obtained in China (Zhao, Li, Fang, Zhao, Yang, & Stanton, 2007)and the United States (Forehand et al.

, 2015). Studies by Cluver et al., (2014) indicate that HIV and AIDS-orphaned youth are at greater risk of these internalizing problems even when compared with youth orphaned by other causes and that these negative mental health outcomes are maintained longitudinally (over a four-year period) .These findings have resulted in calls in the Stigma, anxiety, and depression in HIV and AIDS-orphaned youth for international literature for a focus on the psychosocial support needs of orphans and vulnerable children ( Skinner , 2010)2.

1.1 Multiple losses in Child-headed house- holdsHIV is majorly transmitted sexually; young people who lose one parent to AIDS will most likely lose the other parent as well (Dane 2010, Wild 2011). Young siblings who might be infected through the mother may also die. Once a parent dies, children are likely to be moved from family home and may be moved from their school to another, thus depriving them of friendship.Given the high prevalence of HIV in the community, orphans are likely to experience other losses as relatives die. This is a common experience in Kenya among the cultures that practice wife inheritance (Nyambedha et al.

, 2007). Additionally, when care giving is by elderly grandparents; chances are that the grandmother has only a few years to live exposing the orphans to further loss. Exposing children and adolescents to multiple losses threatens their emotional wellbeing during the course of change in the household, both before and after the parent dies. In densely populated slum area of Korogocho in Nairobi Kenya, aside from economic deprivation, orphans identified needs as love, care guidance and recreation (Human Rights Watch, 2001). Generally, it is observed that children and adolescents who lose their mother suffer immense grief over the loss of love and nurturing, whilst the loss of the father is more directly related to decline in their standard of living (Fox et al., 2010). In many instances, death is not discussed with young people, so they are left to draw their own conclusions as to what is happening until the time when the parent dies, causing them to lose a sense of security.

Where only one parent remains, the children may live in fear of losing the remaining parent (Fox .2013).2.

1.2 Stigma and discrimination on child-headed house holdsPeople living with HIV and AIDS experience stigma in different ways and at different levels. These levels include and are not limited to family setting, the health clinics and at the community level as a whole. Stigma and discrimination are communicated in different forms but are based on poor understanding of the mode of transmission of the HIV virus reported by The East African Standard News Paper (May 12, 2006) where an orphaned youth by HIV and AIDS was hacked to death by his uncle when he went to his home to seek help. Stigma can be defined as an act of identifying, labeling, or attributing undesirable qualities, targeted towards those who are perceived as being deviant from a social ideal, and as an attribute that is significantly discrediting and used to set the affected persons or groups apart from the moralized social order.

Alonzo and Reynolds (2010), define discrimination as an action or treatment based on stigma and directed towards the stigmatized. The negative attitude and judgment projected towards persons with AIDS, their partners and children and rejection by their extended family, friends and the society may lead the affected individuals to withdraw from social support networks because of the ramification of disclosure (Herek & Glunt 2011). In Kisumu county and other neighboring counties, many would not admit that a relative had died of AIDS.

Orphans are perhaps the most tragic long -term legacy of the HIV and AIDS pandemic because even though HIV and AIDS infections are going down, the orphan populations continue to rise. The stigma attached to HIV and AIDS exacerbates the trauma already experienced and hampers the bereavement process due to the secrecy of AIDS deaths .The bereaved in most cases lack the necessary emotional support because they would not want to disclose to other people the pain and sorrow for fear that other people will learn the cause of their relative’s death. Even though awareness of HIV and AIDS is now high in most of Sub Saharan Africa nevertheless many children whose parents have died of the virus still face stigma and discrimination (Ayieko, 2007).Stigmatized persons lose social status; they are discounted, discredited and reduced in the minds of others from being whole and acceptable individuals to those whose identities are spoilt and tainted. Some families may fear taking these children because they suspect them to be HIV positive and hence fear for themselves and their own children.

However, Bennell (2009) defines stigma as a social process or a related personal experience characterized by exclusion, rejection, of blame or evaluation that result from experience of reasonable anticipation of an adverse social judgment about a person or group identified with a particular health problem. Being shunned from society can lead to self-loathing and self-deprecation to these children. Studies have established feeling disgraced can make some persons to withdraw from society, relationships, and the work place. Isolation often leads to extreme distress and emotional instability leading to loss of self- esteem and confidence .The stigma that faces children heading households can have an impact on their social lives, their emotional well-being, and their self-perception (Foster & Williamson 2013).Children in the USA often reported anxiety about having to maintain secrecy regarding HIV and AIDS in a context that stigmatizes and discriminates against people with HIV and AIDS In a study done in Uganda, it was found that orphans experienced significantly higher levels of anxiety than matched non-orphans (Atwine et al.

, 2010). Stigma is a common experience among many child headed households, because their parents are assumed to have died of AIDS (Segu &Wolde-Yohannes, 2009). This is associated with the experience of social exclusion – in a Rwandan study, 86% of orphans indicated that they felt “rejected by the community” (Thurman et al., 2008). Moreover, in Zimbabwean study, it was found that children in child headed households experienced a significant amount of fear about the future (Walker, 2010). Half of the children were fearful about losing their house, a quarter feared living in poverty for the rest of their lives and a fifth was afraid that life would become increasingly difficult. Some children were afraid of becoming ill or dying of AIDS. Children feared being separated from each other, a concern that was particularly prominent in the Chiastolite study (2008).

Research from both the developed world and sub-Saharan Africa (Campbell, Skovdal, Mupambireyi, &Gregson, 2010; Maughan Brown, 2010) has demonstrated that being affected by HIV and AIDS is associated with social rejection and exclusion.There is a qualitative evidence from South Africa that HIV and AIDS-orphaned youth experience bullying, discrimination, gossip, taunting, and verbal abuse referencing deceased either parents or sick caregivers (Cluver & Gardner, 2010). Additionally, quantitative research has demonstrated that HIV and AIDS-related stigma is a significant risk factor for the development of internalizing problems amongst HIV and AIDS-orphaned youth (Cluver et al., 2008; Cluver & Orkin, 2009; Wang et al., 2012). A study done in South Africa demonstrated that the proportion of HIV and AIDS orphaned youth who scored in the clinical range for an internalizing disorder (anxiety, depression, or posttraumatic stress) was nearly three times higher when youth were not only HIV and AIDS-orphaned but also experienced HIV and AIDS-related stigma (Cluver & Orkin, 2009). Similarly, a recent Chinese study reported that HIV and AIDS-related stigma was positively associated with symptoms of depression in a sample of 755 HIV and AIDS-orphans. While data from South Africa has demonstrated that HIV and AIDS-related stigma is a significant mediator of the relationships between HIV and AIDS-orphan-hood and symptoms of depression, post -traumatic stress, and peer problems (Cluver et al.

, 2008). However, the foregoing studies are all limited by their reliance on cross-sectional data that precludes interpretations regarding the direction of associations, as well as potential long-term associations between HIV and AIDS-orphan-hood, stigma, and mental health outcomes. There is thus a clear need for longitudinal data to clarify relationships between HIV and AIDS-orphan-hood, stigma, and psychological distress over time. According to Foster and Williamson (2010), HIV and AIDS orphans are usually silent about their parents’ illness and fear of stigmatization. They mourn silently in secret and suffer the pain of witnessing their parents dying. As a result, they are unable to discuss their parents’ illness with adults prior to their parents’ death, or to express their grief and to say farewell to their loved ones.

Hence, they do not have sufficient time to grieve and come to terms with their loss, leading to problems with resolution of grief, learning difficulties at school, problems with confiding in people, behavioral changes, loneliness and isolation. Those who are adopted develop anxiety because of re-starting life in unfamiliar surroundings in a new location, often in a new school, and about where or how HIV and AIDS will strike the family again. Foster and Williamson, (2010) reported that community members who fear orphans are HIV positive or feel that their families have brought shame to the community, often discriminate against the children and deny them social, emotional, economic and educational support. Learners affected by HIV and AIDS experience being stigmatized and discriminated against, suffer teasing by other children, ostracism and teachers’ insensitivity to their loss and emotional deprivation. Children and young people affected by HIV and AIDS are often not able to go to school or continue their education. They may not be able to enroll because they are caring for sick relatives or orphaned siblings.

Girls, who marry early or resort to prostitution, either attend school irregularly or drop out of school entirely. Psychosocial needs of children are the most neglected area. Children are affected by the changes in their parents’ emotional and physical state. They may not know what is happening to their parents and become confused and frightened. When a parent becomes terminally ill, older siblings are often obliged to fulfill a parental role for the younger sibling/s and at the same time take care of the sick parent.

If the children do not get proper support upon their parents’ death, they experience a profound sense of loss, grief, hopelessness, fear and anxiety (Family Health International 2001). One of the most severe consequences of stigma is that it impedes children’s access to education. When care giving, families experience financial shortage, orphans are the first to be withdrawn from school; Girls may be taken in by relatives or sent to other households in exchange for house hold work or caring for other sick relatives or agricultural labor (Clay &Bond 2009). These girls may be encouraged by their relatives to sell sex to earn money for food. The Zimbert project in Zambia investigated the experiences of 80 Zambian children aged 13-18yeras (Hworth ,2011).

This research confirmed that orphaned children and youths are blamed for things that go wrong in families that house them.2.1.3 Emotional effects of HIV& AIDS on child headed familiesA study of child-headed households in the Free State province of South Africa found that some children experienced a feeling of vulnerability, the absence of a feeling of security (Leatham, 2006). They feared for their safety, worrying about being physically attacked or mobbed. The children compensated by being careful to be home before dark, avoiding drug and alcohol use and having fewer friends.

There are reports that child headed households are in fact vulnerable, as robbers perceive them as having large amounts of cash from their parent’s policies (Khupiso, 2007). In the Chiastolite study (2008), three out of 61 children reported having been victims of crime during the past year (two of whom were mugged) and ten reported that they were abused in the previous six months. Children receive a lot of social, physical and psychological security from parents, but a lack of this assurance makes a child feel handicapped, uncertain of his own abilities, fearful and therefore on the defensive. When failing to provide emotional security to the children, parents cause unhappiness, lack of loyalty and tension (Wanda 2007).

Children from child-headed households are likely to miss this kind of security. They develop defense mechanisms to protect themselves such as aggressive behavior when they play with other children. The remote awareness that they have to stand up for themselves makes them aggressive in order to control the situations around them.

This way they become bullies. As Crosson-Tower highlights the residual effects of family maltreatment leads to having difficulty trusting others, having low self -esteem, anger, impaired objects relation, impaired parenting abilities, lowered intelligence, impaired development, verbal inaccessibility, inability to play, difficulty with relationships, abuse of alcohol and drugs and perception of powerlessness (Crosson, 2010). However, children from child-headed households are also targets of child trafficking where they become domestic workers or used as sex pets.

When perceived to be desperate and in need of basic needs, they become more vulnerable to this predatory behavior. As noted by other scholars, such children are vulnerable to being misused because, ‘In an attempt to preserve what resources they retain, they become passive or withdrawn and tend to seek reassurance from others’ (Dattilio & Freeman, 2010). The people who entice such children either employ them directly or give them out to work for other people while receiving the payment on behalf of the child. In the end, they do not use this money to benefit these children.

Loss of human dignity brought by these experiences of abuse interferes with the self- worth and self -concept of children. Although past victims demonstrate an ability to survive despite incredible odds, they lack a true sense of trust in themselves. Not only have they lacked encouragement and stimulation to develop a positive self- image but they have modeled themselves as parents who thought little of themselves also (Crosson, 2010). Children are in several cases forced to go without some basic provisions, something that compromises their dignity. For example, some female children do not wear inner linen or use sanitary towels because of the opportunity costs involved. They are forced to choose between buying food and other basic provisions and their personal needs.

Such difficult situations can make children grow up with feelings of bitterness and may be at times overwhelmed when faced with other challenges.2.2 Effects on school attendance and performance Children belonging to child-headed households may be excluded from the education system, frequently compelled to leave school, as a consequence of poverty or in order to comply with the responsibilities of household heads (Meintjes et al,. 2010). When a parent becomes ill, the education of a child is disrupted. Children may be unable to go to school because there is no money to pay for books and fees or because they experience rejection or discrimination. Some must leave school to help care for younger children or to earn an income to help support the household (Government of Kenya, 2004).Children that are deprived schooling are generally hampered in their ability to achieve their full potential, and would not contribute effectively to the society because of lack of knowledge and skills.

A good school education can give children a higher self-esteem, better job prospects and economic independence. As well as lifting children, out of poverty, such an education can also give children a better understanding of HIV and AIDS, decreasing the risk that they will become infected (Bennel, 2012; Subbarao & Raney, 2011). The abolition of school fees in Kenya is a step in the right direction that will help keep children in school (Sara, Fatuma & Wawire, 2009).

However, other associated costs such as the school uniform, activity fund and miscellaneous expenses that keep children out of school need to be addressed if children are to remain in school. For example, in 2003, when the Government of Kenya eliminated user fees, it brought over 1.5 million children (a third of which were girls) to school.A study on child headed households in Uganda (Gilborn et al., 2010) shows that 26 percent of children reported a decline in school attendance and 25 percent reported a decline in school performance when parents became ill.

It was observed from this study that parental illness detracts from school attendance because children stay home to care for sick parents; they have increased household responsibilities and need to care for younger children. The greatest challenge that these children are likely to experience is the lack of parental involvement in their education. Children who are orphans may also not get much attention from teachers who are aware that there is no parent to follow up on the academic performance of the child. The children may also be ridiculed by others during play and may be intimidated when others laugh at them for not having parents.

A better picture was provided by data gathered from all countries in South of Sahara in a study sponsored by UNICEF (2010). The study compared orphans and non-orphan’s attendance at school and found out that the number of orphaned children in attendance was lower than those of non- orphans. Absenteeism from school is motivated by a multiple of needs and concerns that the affected youth has to address on a daily basis in order to maintain a semblance of physical wellbeing.

Household structure and relationships affect the probability of orphans attending school: This conclusion is based on one study of demographic surveys in 10 African countries by (Case et al., 2010). It found that issues of limited social connectedness, bias, and discrimination within the household, including blended households, are negatively associated with orphan hood schooling: the probability of school enrollment is inversely proportional to the degree of relatedness of the child to the household head and older siblings.Bicego, Rustein &Johnson (2008) found out that more than a quarter of orphans’ performance had dropped significantly, partly because of the frequent interruptions and partly due to the psychological stress arising from sickness of their parents or caregiver. It is believed that orphans, who manage to remain in school, are more likely not to be in their appropriate grades. In this instance, due to ignorance on how HIV and AIDS are influencing student’s performance, the student is likely to be labeled as a low achiever.

A consequence of this negative labeling is loss of one’s self-confidence resulting in poor self-esteem, which ultimately may cause the student to drop out of school. AIDS orphans usually lack parental care and financial resources for education ( HYPERLINK “http://www.ncbi.nlm.nih.

gov/pmc/articles/PMC2811335/” l “R22” Ntozi, Ahimbisibwe, Odwee, Ayiga, & Okurut, 2009) therefore; AIDS-related parental deaths could influence orphans’ school attendance, school performance and school completion. However, the majority of existing studies regarding AIDS orphans’ education have mainly focused on the issue of school attendance. Results from these studies indicated that AIDS orphans were more likely to lose opportunities to attend school. There was a negative relationship between being orphaned and access to school education (Muller & Abbas, 2009).

Children of HIV-positive parents (e.g. children facing the potential of losing parents) were also less likely to be attending school than children of HIV-negative parents (Mishra, Arnold, Otieno, Cross, & Hong, 2010 ). There was a substantial decrease in primary school participation following a parental death from AIDS, especially for those children whose mother died or who had a low baseline academic performance (Evans & Miguel, 2010). Orphans were less likely to be enrolled at school than non-orphans living in the same households Double orphans – children who lost both parents to AIDS were more likely to be disadvantaged in school attendance compared with single orphans-children who lost one parent to AIDS ( HYPERLINK “http://www.ncbi.nlm.” l “R20” Monasch &Boerma, 2011).Previous studies also found that the effect of parental death on children’s schooling was not only on the enrolment itself, but also on the timing of enrolment. A study by Mondah & Ngongah (2010), noted that despite free primary education in Kenya, many children aged between five and nine were not attending school for various reasons including mockery from other children and the persistence of teachers that children should bring their parents to school for various reasons. It was also noted in the same study that most of the children who were socially withdrawn during child play were children from child-headed households. Out of 180 children observed, 57 were socially withdrawn and 32 of them were from child-headed households.In other cases, they also noted that older children had to forfeit their own education to allow younger ones to attend school, not because they understand the significance of education in the lives of their siblings, but because of certain factors articulated by respondents at the interviews.

First, older children get time to engage in psycho-economic activities without thinking of the safety of the younger ones who may wander off to play. Second, those engaged in dehumanizing and embarrassing activities like child prostitution do not want to expose it to younger children. Moreover, some schools have feeding programs that assure some children of eating at least one meal a day, simply by being there. As studies in other parts of the country have shown, ‘The effects of the school meal program on the well-being of rural Kenyans cannot be overstated. Through providing daily meals, schools are able to meet immediate food needs, provide future safety nets, and offer long-term assistance and empowerment to children, families, and communities’ (Langinger, 2011).Child heads suffer emotional distress that interferes with school, and they have less money for school expenses. In a study of children in Uganda (Sengendo and Nambi, 2007), it was found that among children 15–19 years of age whose parents had died, only 29 percent had continued schooling undisrupted; 25 percent had lost school time, and 45 percent had dropped out of school.

In Uganda, 61% of children heading a household do not attend school, in most cases as a result of their responsibilities as primary caregiver. Other reasons include the inability to pay school fees, uniforms and scholastic material.However, In Namibia, the school attendance of children living in a child-headed household suffers due to a number of factors, the main being care duties and hunger, as well as pregnancies, often because of transactional sex (UNICEF 2012). Nevertheless, in Rwanda, the dropout rate of children belonging to child-headed households is high, especially where it concerns the head child.

Although primary education (until the age of 12) is free, there are enrolment fees to be paid, uniforms and school material to be purchased and sometimes other contributions are required. Even when child-headed households receive benefits to cover these expenses, the household head usually lacks the time to attend school, being too occupied with the responsibilities of caring for siblings and having to generate an income to supply food and other essentials for the family. An estimated 72% of child heads of school going age do not attend school.Demographic and Health Survey data from eight high and two low prevalence African countries (Niger and Ghana) and covering 2005–2010 looked at children aged 14 and below. The results found a statistically significant difference in mean school enrollment rate between orphans and non-orphans.

In both countries, double orphans showed the highest mean difference of school enrollment compared to non-orphans, followed by paternal orphans. Being a maternal orphan in these countries showed no impact in Niger and a positive association in Ghana on school enrollment. These low prevalence country specific findings align with the general conclusions of the analysis of all ten African countries.

The study estimated that overall single orphans were about 5% less likely to be enrolled in school than non-orphans, and that double orphans were 12% less likely. Lower enrollment for orphans was accounted for not solely by wealth, but also by the degree of relatedness to their caretakers (Case et al., 2010). A larger study of 102 national surveys from 51 countries worldwide found that the relationship between orphan status and child school enrollment varies significantly among low-income countries. The evidence is clear that there is no statistically significantly positive impact of double orphan hood on school enrollment (Ainsworth & Filmer, 2009).In a study conducted in India (Pradhan & Sundar, 2010), caretakers of 360 children 15–18 years old from HIV-affected households and 1981 from non-affected households were interviewed about enrollment.

While differences were small for ever being enrolled in school (92% compared to 97%), they were larger for being currently enrolled: only 67% of those from HIV households were currently enrolled, compared to 81% in non-HIV households. For 15–18 year old children, this current enrollment gap was larger for girls living in rural areas (61%:79%) than for rural boys (69%:80%), urban girls (67%:80%), or urban boys (69%:83%). Adolescent girls (15–18 years) in HIV affected households were twice as likely to drop out of school as adolescent girls in non-HIV households: 34% of adolescents in HIV affected households reported dropping out of school compared to 17% of girls in non-HIV households. Adolescent boys (26%) in HIV-affected households reported dropping out of school compared to 16% of adolescent boys in non-HIV households (Pradhan & Sundar, 2010). A majority of the orphans noted poor academic performance (66.

25%) in school, while 15% ranged between good and very good academic outcomes despite the status as orphans. Notable was the 19.25% indicating note being sure of their academic performance as it was sometimes good and other times poor.2.

2.1. Absenteeism from school Majority of the orphans 78.5% reported being absent from school with 63.5% indicating being absent very often. 19.5% opined that they were absent sometimes, while 13% were rarely absent.

Only 3.75% reported never being absent from school. Majority of pupils reporting abseentism reported that they will eventually drop out of school to seek a source of income so as to take care for their younger siblings. Pradhan & Sundar’s (2010) study in India also investigated the reasons for dropping out of school: the study indicated no difference in “could not afford” as the reason for dropping out, either among children 6–14 or those 15–18. However, the study showed increased responsibilities for children in HIV-affected households is a major reason for leaving school.Children 15–18 years of age living in HIV–affected households were more likely to drop out to take care of younger siblings or household chores, to take a job, or take care of ill family members (36% compared to 21% in the comparison group).

This gap is larger for girls (32%:13%) than for boys (39%:29%), and girls drop out to take over household tasks, whereas boys drop out to take a job.The rate of non-attendance amongst children heading households in South Africa is high. The primary factor leading to children discontinuing their schooling is the lack of funds for school fees, books and other school essentials. Despite legal provisions for exemption for poor and vulnerable children, children are known to have been suspended from school for failing to pay fees. The inability to produce birth certificates or identification documents results in schools refusing to register children. Other reasons are the care for siblings and/or a sick parent, remote location of the school and emotional problems. Children heading a household may have trouble in focusing on their own education while bearing the responsibility for a household.

However, a study by Wandah & Munya (2011) contradicts the findings of the majority of researches and suggests that the attendance rate of children living in child-only households was not found to be significantly lower.2.3 The effectiveness of the existing measures against the effects of HIV and AIDS on child headed house holdsChild headed households employ a number of measures in order to cope with the effects of their circumstances.

In Kenya, the extended family network is seen and upheld as the traditional social security system and its members are responsible for the protection of the vulnerable and for providing care to the old, the poor and the sick. This family setting was in the past times responsible for the transmission of traditional values and education. In the 21st Century, as in other African countries the extended family unit has disintegrated due to factors such as migration to cities in search of paying jobs. There has been an increase in population resulting in insufficient land resource to sustain the traditional large extended families making it necessary for families to migrate in search of land and pasture for their livestock and livelihoods.

Labor migration and urbanization have led to a reduction in frequencies of contact with relatives and encouraged social and economic dependency and possessions are no longer owned communally (Ayieko 2007). Education about social values that was obtained through traditional mechanism is no longer possible; the younger generation has to depend on the interaction with peers in schools. Despite the external and internal pressures exerted on the extended family network, this unit remains the pre-dominant caring unit for sick relatives and orphans throughout Africa and specifically Kenya (Foster et al.2010).

The extended family responsibility towards members of the family was without a limit even where a family did not have sufficient resources. This was the basis of the assertion that traditionally, “there is no such thing as orphan” in Africa. Even during the current crisis precipitated by HIV and AIDS, it is expected that orphans be under the supervision of an extended family member even when they are not adopted and living under the same roof. This way of coping and adaptation to change presented by AIDS illustrates the strength, resilience and adaptability of the extended family. The phenomenon of child headed house- holds appearing in communities affected by AIDS is an indication of the saturation of the traditional extended family networks for orphans coping mechanism. This development should be seen as a coping mechanism meant to address the orphan crisis within the communities and not an abandonment of their responsibility to care for orphans within the family (Ansell &Young 2013).In a study that analyzed the factors associated with the establishment of child headed households in Monical and Zimbabwe, Forester et al., (2010) observed that the extended families were supportive and paid regular visits and provided smaller amounts of money and material support.

This coping mechanism is commendable in that it kept the orphans together in their family home enabling them to gain comfort from siblings and peers. However, this coping strategy may have serious flaws in the absence of an organized system that ensures proper care and protection. The orphans need emotional support and assurance; they need counseling and education on the new role as house heads.

They need support and encouragement to go on with school. The burden of household chores coupled with schoolwork is stressful; youth orphans need direct interventions not only to sustain them in school but also to minimize negative psychological impacts that such a role may have on the young person.In reaction to their parent’s deaths 50 percent felt very sad and helpless, while another 22 percent were too young to express themselves. The study reported that adolescents losing a parent are more likely to experience a special case of identity loss (Sengendo & Nambia 2010).Atwine, Cantor-Graaea, and Bajunirwe (2010) in Uganda compared 123-orphaned children (Age 11-15 years) who had lost one or both parents to AIDS and 110 children of similar age and sex living in intact families in the same neighborhood. Symptoms of psychological distress were assessed using Beck Youth Inventories of Emotional and Social Impairment. A multivariate analysis of factors with possible relevance for outcomes on these inventories found that orphan status was the best predictor of distress. Orphans had greater risks for higher levels of anxiety, depression, and anger.

The study further observed that the children had both fears and hopes about their future. Some children feared that their life would be worthless now that they did not have their parents, support and protection. Most felt pessimistic about the future, while one fifth of the participants expressed the strongest hope if they get good jobs in future, others hoped they could complete their education or attend vocational education.2.3.1 Perceived Social supportWhen a household begins to feel the effect of HIV and AIDS, families provide the most immediate source of support; psychological, economic and social (Foster & Jiwli 2008). Families are the best hope for orphans, but they require support from outside sources for both immediate survival needs and the longer term.

It is therefore important to assist building the capacity of families to improve their economic standing, provide psychosocial support to the affected orphans and strengthen young people’s life skills. The capacity of families to protect the rights of orphans and vulnerable in their care depends largely on their economic strength.Possible interventions should aim to enhance the economic resilience of the household, such initiatives as conditional cash transfer, insurance, direct subsidies and material assistance can help alleviate the urgent needs of the most vulnerable house hold (Landgren, 2009). Long term interventions should include studying closely what was left behind by their departed parents and assist orphans to increase family production in terms of land, livestock and provision of professional advice on how to access micro –credit to start small business, for those who can’t continue with school or college. Vocational education should be made available as well for those orphaned youths who have been made to drop out of school.2.

3.2 Providing Psychosocial SupportInterventions to orphans due to HIV and AIDS tend to focus on education and material needs and ignore the psychosocial needs. These needs are in most cases misunderstood and are difficult to assess. HIV and AIDS undermines and destroys the fundamental human attachments to normal family life and youth development as observed by Foster & Jiwli (2012). Youth affected by HIV and AIDS suffer fear and anxiety during parental illness then grief and trauma with the death of the parent.

These problems are further compounded by traditional taboos surrounding discussion of AIDS and death. Children and youths orphaned by AIDS cannot cope without support; they need plenty of opportunity to express their feelings without fear of stigma, discrimination or exclusion. (Levine & Foster 2009; REPSSI, 2013).Programs addressing the psychosocial needs of the orphans should be incorporated into other programs /activities. Peer support, individual counseling, and group approaches are needed.

The school counseling and social welfare programs, faith based organizations, community volunteer groups, all should be sensitized and equipped to offer psychosocial support to children orphaned by AIDS. Teachers, health care workers and other stake- holders interested with the welfare of the children should be trained to identify signs of distress and take appropriate actions (REPSSI 2010).2.3.

3 Providing the orphaned children with life and survival skillsIn the absence of parental guidance and support, young people who have taken parental responsibility do so without much skill and preparations. Young people require training to enable them cope with the demands of their new responsibilities, they need new and strengthened skills in areas including household management, caring for young siblings, budgeting and accessing other important services. Vocation and apprenticeship are key to enhancing their ability to generate income.

Further the orphans must be equipped with social and inter personal skills necessary to make informed decisions, communicate effectively and develop coping and self-management mechanisms that will enable them to protect themselves from HIV infections and other risks. These young people should be encouraged to participate actively in planning and implementing all programs that involve their welfare as explained by Williamson (2010), that by involving young people in the fight against HIV &AIDS their confidence and self -esteem is improved as they feel responsible as partners.2.3.4 Community supportWhen families cannot adequately meet the basic needs of the orphans and the vulnerable in their care, the larger community becomes the safety net in providing essential support. Local leaders, including traditional and religious leaders, administrators, women groups, prominent citizens, journalist, teachers and others need to be sensitized to the impact of HIV and AIDS and to the circumstance of orphans within their community. This sensitization program should encourage leaders and their communities to take action in support of the affected house -holds and monitor the most vulnerable.

Their role should be to ensure such orphans are under supervision of adults, that they are enrolled in school, have their basic needs met and can access most of the essential services. Of particular importance is alerting leaders to the risks the children are exposed to, for forced marriages for girls. Leaders should create a culture in which abuse of any kind is unacceptable and violations are dealt with effectively, this heightened awareness can provide attention to the young people made vulnerable by AIDS and simulates locally driven action in response to identified needs as observed by William (2012)2.3.5 Supporting Cooperative activitiesThe rural poor communities provide examples of utilizing locally available resources to help children and house- holds made vulnerable by HIV and AIDS. Community groups can provide direct help to the orphans.

They are better placed to assist AIDS affected families in monitoring and visiting the affected house- holds and the provision of volunteer programs that provide much needed psychosocial support, communal gardens, community childcare services, community schools, pooling of funds to provide material assistances, youth clubs and recreational programs. The Kenyan community is known for its innovative ways of dealing with issues that threaten its cohesive nature. Specifically, the Luo of Nyanza are known for addressing community issues by forming community –based organizations or groupings to address issues such as funerals, school fees problems, hospital bills and any other threatening issue to the families, this can be seen through the common fundraisers-commonly referred to as harambees. On recognizing the increasing vulnerability of orphans in the communities; groups are responding by ingenuity; such attempts are meant to provide support for the orphans within their locale. Most community initiatives grow out of the concerns of a few motivated individuals who work together to support the orphans. These initiatives spring from a sense of obligation to care for those in need.CHAPTER THREERESEARCH METHODOLOGY3.

0 IntroductionThis chapter describes methods and procedures used to gather data. The chapter presents; the research design, location of study, target population, sampling procedure and sample size, data collection instruments, pilot study, data analysis and presentation and ethical considerations of the participants.3.1 Research DesignA research design is a plan of execution of a research. Yin (1989) states that research design of a study is the logical sequence that connects the data to a study’s research questions and hypothesis and ultimately its conclusions. The study used descriptive research design to summarize and organize data in an effective and meaningful way.

Mugenda and Mugenda (2003) notes that a descriptive survey research attempts to collect data from members of a population in order to determine the status of that population with respect to one or more variables. This study was a descriptive survey as it set out to describe and interpret a situation (Etemesi 2013). According to Best and Kahn (1993), descriptive research is also concerned with conditions or relationships that exist, practices that prevail, beliefs, point of view, or attitudes that are held by people, processes that are going on, effects that are being felt, or trends that are developing. It is concerned with what exists and related to preceding event that has influenced or affected a present condition or event. The advantage of this method in the current study is to gather information on the specific personal characteristics features of the child headed households; see some of the cognitive characteristics of orphans such as anxiety, depression and stress; and understand how these relate to HIV and AIDS The design is widely accepted as a key tool for conducting and applying basic social science research methodology.This design helped the researcher to obtain information concerning the status of the orphans at that point in time. Emphasis was on qualitative methods allowed the study to be descriptive and contextual.

The quantitative part of the research design (content analysis) examined the association between independent variables such as sexual abuse, child labor, ill health, stigma, school attendance, hunger and domestic responsibilities, and academic performance the dependent variable. The qualitative part of the research design (life story narratives and unstructured interviews) explored why the child-headed household influenced academic performance. Thus, the research design ensured a holistic understanding of the impact of the child-headed household on academic performance.3.

2 Location of studyThe area of study, Seme sub-county is in Kisumu county, Nyanza region. It covers an area of about 200 km2and lies between longitude 340 24′ 30”E to 340 33′ 00” and latitude 00 1’00”S to 00 11′ 30”S. Seme sub county is bordered by Emuhaya Division to the NE, Winam division to the East, Rarieda division to the West and Wagai division to the NW.It is administratively divided into four locations namely South Central Seme (51Km2), North Central Seme (43 Km2), South West Seme (33 km2) and West Seme (33 km2). These locations are divided into 21 sub-locations which are further subdivided into 168 villages (WRP-USAMRU Kombewa).

The area has five sub-locations that cover the landing beaches. Those who live in the beaches are majorly fishermen. The beaches are characterized by a lot of emigration/immigration from/to various beaches, which make them more vulnerable to Sexually Transmitted Infections including HIV and AIDS worsened by lack of health facilities along the beaches. The area has trading centers, which are rural oriented except for Kombewa that is the divisional headquarter where there are different professionals residing.

The area of study has limited health facilities; including a Sub County hospital, two public health centers and a number of dispensaries. Dispensaries are limited in terms of service provision to HIV and AIDS care, therefore services are offered only at health centers or at the Sub- County hospital. According to a census carried out by the USAMRU & W RP which are American organizations based in Kombewa, it was found that there are some 59,764-people living in the area of study, aged <5years to 50+years., with the age group 10-20years accounting for the highest numbers. The main economic activities in the area include fishing and small trading business.3.

3 Target PopulationA population is the complete aggregation of cases that form part of a designated set of criteria. . A target population is grouped as all members of a given population to which end the investigation is related, (Mugenda and Mugenda, 1989). A target population, therefore, cumulative of cases about which an investigator seeks to make generalizations. The phenomenon under investigation is the child-headed household in Seme sub county.

Primary school pupils living in child-headed households, and Community Based Organizations formed the unit of analysis. Age 9-18 years’ range was picked on because they were considered to be mature enough for a valid interview and they also meet the standard definition of child according to Kenyan Law. Community based organizations were picked because they are considered the authority in the community and have personal information on orphaned children in the community. In order to participate in the study, the participants were required have met the following criteria; either male or female and aged 9–18 years heading a house hold, living in Seme Sub- County, orphaned as a result of a parent or loved one caring for them, who died as a result of an HIV-related illness, orphaned for a minimum of 6 months and able to understand and converse in English or Dholuo. There are approximately 2347 primary schools with pupil population of 36,000.

Community based organizations number about 74Sampling Procedures and Sampling A criterion-based purposive sampling strategy was used to select participants for this study. It is a form of non-probability sampling in which decisions concerning the individuals to be included in the sample were taken by the researcher, based upon a variety of criteria, which may include specialist knowledge of the research issue, or capacity and willingness to participate in the research. When using a purposive sampling technique, researchers rely on their experience, ingenuity and, or previous research findings to obtain a research sample deliberately in such a way that the sample may be regarded as representative of the relevant population (Welman et al., 2010). Purposive sampling technique helped the researcher to pick on orphaned children who have common characteristics he was interested in. At the same time, the researcher used a simple random sampling to select sample from the pool of orphaned children. This was done by scribbling 1-160 on pieces of paper and those who picked on even numbers were included in the study. Another sample of 20 respondents were from Community based organizations.3.4.2 Sample size The sample size was determined using the fishers (1991) formula as follows:N=Z2Pq,d2WhereN = Desired sample size when population is more than 10,000.Z= Standard normal deviation, usually set at 1.96 which corresponds to 95% confidence level.P = the proportion of the target population estimated to have a particular characteristic reasonable estimate, from the WHO data stating prevalence of 7.6 %. q = 1-Pd = the degree of accuracy desired. Usually set at 0.05Z= 1.96P=0.277Therefore N=Z2Pq= 1.96 x 1.96 x0.076 x 0.86= 100 subjects d2 (0.05)2The sample matrix showing the sample size for the study is shown in Table 1Table 3.1: Sample matrix______________________________________________________________________Target population Sample size Orphans CBOs Orphans CBOs 160 40 80 20Total 160 40 80 20_______________________________________________________________________The sample size for the study was 100 respondents out of which there were 80 orphans selected through simple random sampling from 160 child-headed households and 20 personnel from CBOs working with orphans selected.3.5.Data Collection InstrumentsThe data collection instrument is a tool used by the researcher to collect the required data from the respondents. The nature of the present study required that an interview schedule be used. Interview is a face-to-face interpersonal situation in which one person the interviewer, asks another person being interviewed, the interviewee, questions designed to obtain answers pertinent to the research problem (Kerlinger,1973). While Cohen and Marion(1994) see interview as a research technique that is normally considered one of a range of qualitative methods – the purposes of the interview in the wider context of life are many and varied. An unstructured interview consists of guidelines on pertinent issues to be discussed rather than structured questions to be asked every respondent (Denzin & Lincoln, 2000). This allowed respondents to openly disclose their thoughts, feelings and perceptions (Ritchie & Lewis, 2003) regarding the impact of the child-headed household on their academic performance. The unstructured interviews also allowed the researcher to probe extensively for sensitive issues such as sexual abuse and child labor. In this regard, unstructured interviews enabled the researcher to obtain in-depth data from the perspectives of the child-household heads. The interview schedule was administered to 80 child household heads and 20 community-based organizations. The researcher concluded interviews when themes became saturated.3.6. Pilot studyPiloting helps to ascertain how well a research instrument will work in the actual study byIdentifying potential problems and areas that may require adjustments. Where an interview isused as the research instrument, a pilot study helps to do the following: highlight ambiguities and difficult and unnecessary questions and discard or modify same, record the time taken to complete the interview to determine whether it is reasonable and Establish whether replies can be properly interpreted in relation to the information required(van Teijlingen & Hundley, 2001)A pilot study was conducted in North Central Seme to check validity and reliability of the research instruments. Since the data collection instruments were all in English, they were pilot-tested to validate their appropriateness to the rural situation in Seme before actual data collection.3.6.1. Validity of the research instruments Validity is the ability of a chosen instrument to measure what it is supposed to measure. According to Fawcett (2013), a test is considered valid when it succeeds in measuring what it purports to measure. The interview schedule was shared with the supervisors to ascertain if the contents were valid to address the study objectives. The major aim being to approve the instrument with respect to face, construct and content validity in relation to its ability to measure the desired constructs. Face validity is achieved on an instrument if it appears valid on the face of it (Jonson, 2009). By observation or examination, an expert conclude that it measures a particular relevant trait. Construct validity is concerned with the degree to which a test measures a theoretical construct or trait. The trait in question must be given an operational definition in a measurable and observable manner (Mugenda, 2014). Content validity refers to whether the test logically samples content or expected behavior. It refers to the extent to which sample of items are representative of the whole / total content domain. (Mugenda, 2014). According to some researchers Content validity refers to the degree to which a measure seems to cover the entire range of meanings within a concept (Rubin & Babbie, 2016). Face validity is usually established by a panel of experts (Kraska-Miller, 2014) and likewise to content validity (Jackson, 2016).Reliability of the research instrument Reliability is the extent to which research results would be consistent if the same technique is repeatedly used (Jonson, 2009, Jackson, 2011). Test – retest reliability was used in which case the test tool was used in two occasions on the same subjects in North Seme. The scores on the two occasions were then correlated and a coefficient stability of 0.8 was achieved.3.8 Data collection procedureThe researcher got an introduction letter from the Board of Post Graduate Studies of Kisii University that was used to obtain the research permit from the NACOSTI. The authorization letter from NACOSTI was used to get consent from the County director of education, the Sub-County director of security and interior to carry out the study in Seme.The permission of the Sub County administrator of social services was also obtained who then directed the other ward administrators to assist the researcher in the community entry process to enable for data collection. The researcher met the relevant sub county ward officers with the request to provide information about the CBOs and child headed orphaned households. The officers then organized with the community members in charge of the villages where the data was collected. The researcher visited the villages to explain to the in-charges the objectives of the study and then administered the instruments to the orphans and the CBO personnel dealing with OVC issues in the villages of Seme Sub County, allowing explanation of all the contents to the respondents. This aided in dealing with bias that could have been introduced if the researcher did not explain the issues of the contents.Data AnalysisData Analysis is the process of systematically applying statistical and/or logical techniques to describe and illustrate, condense and recap, and evaluate data. According to Shamoo and Resnik (2008) various analytic procedures “provide a way of drawing inductive inferences from data and distinguishing the signal (the phenomenon of interest) from the noise (statistical fluctuations) present in the data”.The selection of data analysis method is an important aspect to achieve the research aim and objectives successfully. The analysis was conducted with the thematic analysis method where the data was analyzed by the researcher utilizing the Windows SPSS Version 20.0 computer statistical tool. The data was be assessed for completeness, consistency, and missing values. The study variables were then analyzed using descriptive statistics appropriate for the scale of measurement. Finally, the results were presented in tables, figures and bar charts.3.10 Ethical considerationsResearch approval was obtained from Kisii University’s Postgraduate research Committee and NACOSTI prior to conducting the research. The research participants have been exposed to too much harm by becoming and being AIDS orphans. The researcher was aware of their vulnerability and the need for protection against further harm. The researcher strived to conduct the study in such a way that the ethical principles of no harm, confidentiality, privacy and anonymity are upheld as much as possible.The respondents gave consent after the introductions made by the village elders and the researcher on the purpose of the study. All the information about the aims of the study, including procedures of the study as well as the possible advantages of the study, were disclosed to the participants. They were informed about the reason for their inclusion in the study, the duration of the study and how the results would be published. The participants had the freedom to consent or to decline to take part in the study and were also informed of their freedom to withdraw from the study at any time. Trustworthiness were ensured via criteria of credibility, transferability, dependability and conformability. Just as quantitative research can’t be considered as valid unless it is reliable, a qualitative study cannot be called transferable unless it is credible, and it cannot be deemed credible unless it is dependableCHAPTER FOUR.RESULTS, ANALYSIS, PRESENTATION, INTERPRETATION AND DISCUSSION4.0 IntroductionThis chapter presents demographic data of respondents, results, interpretations, discussions and the findings of the current study. To assess the prevalence of psychological implications of HIV and AIDS in child headed households in Seme Sub-County, the researcher sought to administer questionnaire to pupils and interview schedule to the CBOs personnel in Seme Sub-County. The results, interpretations and discussions are presented under different themes based on the objectives of the study.4.1. Demographic information of child headed house- holdsSixty-two point five (62.5%) of the 80 house hold heads analysed were male and the rest (37.5%) were female (Figure 1), a ratio of almost 2:1. This was indicative that the number of orphan male-headed households are almost double when compared with orphan female headed in Seme Sub County. N=80 : Source; field dataFigure 4.1. Gender differences of the orphans4.1.1. Age of orphansAges of orphans are indicated in the Figure 2 below. Those aged below 10 years old comprised 6.25% while those aged 10 to 14 years were the majority at 58.75%. Those above 15years constituted 35% of the respondents. This shows that parents die when their children are in the junior years of primary schooling and thereby leaving tem destitute, which can be very traumatizing for a young child whose understanding of death is not fully developed.Figure 4.2 Orphans age groups (Source: field data) 4.1.2 Demographics of the CBOs personnelAs indicated in figure 3, the male respondents working in the community-based organizations totaled 65% of the respondents with the remaining 35% being female respondents. The ages of the respondents ranged between 19 and 55 years, with those aged below 21 years being only 3.5% of the study respondents. These were mostly field and outreach officers. Those aged between 22 and 29 years were the majority in the study at 35% and generally comprised research officers. Workers aged 30 to 39 years constituted 25% and mostly worked as program officers, while those between 40 and 49 years old comprised 15% and were at management levels. There were only 1.25% respondents aged above 50 years. This indicates that young people who are still energetic and can conduct effective outreach programs and the research necessary to help the orphans manage most CBOs in the Sub County. How effective their approaches can only be understood from the psychosocial sequels experienced by the orphans in the community. The elderly are very few in the CBO sector and may be involved in advisory services in the community but their expertise and experience is still essential in the management of CBOs. Figure.4.3. Gender, Age and work experience of CBO personnel (Source: field data)4.2. Psychosocial effects due to HIV and AIDSTable 4.1: Psychological reactions of orphans (Source: field data) ______________________________________________________________________Reaction PercentageAnxiety 36.25Depression 23.25Suicidal ideation 20Panic attacks 15Others 5.5__________________________________________________________________________As noted above in Table 4.1. Anxiety accounts for (36.25%) of the psychological sequel experienced by the orphans. The symptomology of anxiety presented itself in various forms, with 45% of the orphans reporting being restless often and 35% noting being restless sometimes. Only 25% reported not being restless.Forty five Percent reported never having panic attacks, with only 15% percent noting them. Fifty percent sometimes feel that something bad is going to happen to them, while forty percent have the feeling often. Being scared with a reason sometimes was noted by forty percent of the orphans, with fifteen percent being afraid often. However, forty-five percent are not scared without reason.Low energy levels were highlighted by (35%) of the orphans and was the most frequently reported depressive symptom resulting from excessive stress noted. Other symptoms of depression presented themselves in the form of suicidal thoughts and self-blame at 20% respectively. Feeling trapped, hopelessness and loss of interest in the surroundings were rare among the respondents.4.2.1 The effects of HIV and AIDS on school attendance and performanceFigure 4. 4. School attendance and performance (source: study data)According to the Figure 4.4 above, the orphans reporting to have attended school constituted about 90 %, (72) of the respondents. However, only 61.25% (49) reported being currently enrolled in formal schooling. Those currently enrolled in school were those aged above the age of ten years. The performance of the children in school was noted as being generally poor (66.25%). Some of factors cited by the orphans include losing interest in their studies, becoming depressed, and even dropping out of school because of taunts by peers. The findings highlighted that in some cases teachers actively discriminate and even mistreat affected children in the classroom by neglecting or abusing them hence leading to poor self-concepts and low concentration in academics. The dropout rate was higher more among girls interviewed. The factors that may have led to the high dropout rates among the girls include household chores and indifference to girl’s education in the community. In many instances, the girl child is viewed as property to be married off at their early ages and hence education is not a priority. Other factors that may lead to early dropouts is the need to find employment to sustain the child headed households that may not be receiving support from the extended family members. The children also reported that ostracism and humiliation by their peers were their concerns of dropping out. These results were similar to studies in China that compared attendance for children orphaned by AIDS. Enrollment rates were high overall, and no differences were seen among children living in HIV and AIDS affected households and unaffected children. Children orphaned by AIDS had lower attendance but the difference was not significant (Jainhua et al., 2006). In another study conducted in Lao PDR, 115 children aged 6–18 years, of which 69% were HIV affected and 31% were not: 95% had ever been to school, and 83% were currently attending. In low prevalence Africa Nations, it has been reported that enrollment rates are generally not as high as in Asia, there are small differences in enrollment. A cross-sectional study interviewing 1013 children in Benin found 77% of orphans and vulnerable children 6–18 years old being enrolled compared to 82% of non-orphans (GECA , 2005) 4.3. Absenteeism from schoolFigure 4.5. Absenteeism from school (Source field data)Figure 4.5 shows that abseentism from school is closely linked to dropout and poor academic performance as indicated in Figure 4.5 above. The factors that lead to abseentism such as seeking part time employment to sustain the family and ostracism by other pupils and teachers are closely interrelated. The abseentism rate in the schools studied were as high as 78.5% and were very often as indicated by the 63.5% of those studied. 4.4. The effectiveness of existing interventions to address the effects of HIV and AIDS on child headed households This sub section looked into the effectiveness of some interventions which has been used to address the effects of HIV and AIDS4.4.1. Support by siblingsFigure 4.6 below indicates the support orphans reported receiving from their grown up siblings. Some of the orphans had siblings who were married (26.5%) and reported that they received some kind of support (11.25%) from them. The kind of support offered to the orphans by their married siblings as indicated in the Figure 6 denotes that food (80%) was the main support. Clothing (8.75%). upkeep money (8%) and schooling support (7.5%) were also reported by the orphans. To a minor extent the elder siblings contributed to medical and accommodation support at 3.75%. Financial upkeep and medical support is noted as being minimal at 8% and 3.75% respectively. These findings illustrate that the extended familial system once prevalent in the luo community and many similar communities in Africa is slowly being eroded by modernization. The support reported by the orphans in Seme Sub County is a reflection of what is more prevalent in town and city life with the socio-economic hardships encountered in these settings. However, in a rural setting like the study geographical area, the support is supposed to be much higher than represented by the findings, as many relatives are assumed to reside in the rural setting. The support towards the orphans accommodation and related matters including education that is currently highly subsidized by the government of Kenya for both primary and day secondary education should be much higher. Figure 4.6. Support by siblings (source: field data) 4.4.2 Support from CBOs As illustrated in Figure 4.7 below, majority( 60%) of the community, based organizations reported legal and advocacy services as their forte. 35% and 25% respectively noted education and food provision as the service they engaged in. medical services accounted for 20% of the service provision, while 15% respectively engaged in shelter, clothing and other services. However, it was noted that there were organizations that engaged in cross cutting service provision such as medical and nutrition services or legal aid together with education. The reasons for the selective support provision by the Community based organizations was reported as limited donor funding to the CBOs. They opined that the donors were keener to support the big Non-governmental organizations in Seme Sub County as compared to the CBOs that are mostly family and communal outfits.Figure 4. 7. Support provided by CBOs (Source field data) 4.4.3 Health servicesFigure.4.8. Health service provision (Source; field data)Figure 4.8 shows the attendance at health facilities that was reported by 86.25% of the orphans. Most of them noted that they were not surcharged for the services rendered (92.5%). They further confirmed that they had received the requisite vaccinations (88.75%) and the same applied for their siblings (90%). The government of Kenya approach to free comprehensive vaccination of children until age five is a major milestone of health service provision in the country and the orphans have been beneficiaries of the same. The free treatment offered to OVCs in faith based health facilities in many parts of the country needs to be encompassed by the government health facilities to help these vulnerable children.4.4.4 Income generating activities Figure 4.9. Sources of income (Source; field data)Figure 4.9 points out that 26.5% of the respondents reported farm work as their main source of income followed closely with fishing (22%) in Lake Victoria. Herding livestock (19%) for neighbors was another source of income for the orphans. Other paid labor (15%) included touting, small-scale mechanical work (“Jua kali”), household domestic work. There were also incidences of labor for food (9%). Other sources (7%) of income included begging in the streets.Other studies have also reported the shift of responsibilities for children affected by HIV as being compelled to engage in domestic, agricultural, or wage work (Webb, 2004, Alkenbrack et al., 2004). 4.4.5. Individual coping strategiesTable 4.2. Individual Coping strategies (Source; field data)Coping strategy PercentageActs as if nothing has happened (denial) 55Keeps to self. 30Drink alcohol 20Increased work activity 20Yells/shouts at siblings 15Avoids people 15 Drinking alcohol and abuse of other substances, especially solvents with friends (20%) was a preferred coping mechanism among the orphans aged above 15 years old. While others sometimes keep to themselves (30%) whenever stressed. Throwing tantrums was reported by 10% of the orphans, while 15% noted that they shout at their siblings when undergoing stress. 20% opined that they vent stress by increased work activity. Another 15% noted avoidance of people with 55% act as if nothing has happened. These symptomology presented by orphans is source of life long post-traumatic stress disorder that would require clinical psychological management. It would be very unfortunate if the PTSD is not managed as it could result in conduct problems such as alcoholism and increased crime rates among other social dysfunctionality in the community when the orphans come of age. These findings were consistent with results from a review of coping and psychosocial adjustment. The review summarizes evidence that children of HIV-positive mothers have an increased risk for psychosocial adjustment problems compared to children of non-infected women (Brandt, 2005). Data summaryThe data obtained indicated that psychological effects of HIV and AIDS, especially in child headed homes were negative to the growth and holistic development of these children in Seme Sub-County. It further clarified that many orphans dropout of school when their parents die due to HIV and AIDS. The school performance of those who remain in school drops drastically and very few make good grades after the death of their parents. Interventions being carried out to addresss the Orphan hood problem in child headed households were mainly advocacy. Other approaches included educational and medical support. A few engaged in basics such as food security and shelter in Seme Sub-County.CHAPTER FIVESUMMARY, CONCLUSIONS AND RECOMMENDATIONS5.0 IntroductionThe following section presents the major conclusions of the study. It also outlines various recommendations that were formulated based upon the results of the study and the central themes that were identified. Summary of the StudyThe study sought to understand the psychological implications of HIV and AIDS orphaned headed households in Seme Sub -County and the findings indicate that there is a problem that needs address. It found that orphaned siblings are sent to different households and experience a second profound loss through this separation. Many foster families are poor and have to stretch already inadequate resources to provide for both the orphans and their own children. In addition, the children lack basic socio-economic facilities that include adequate shelter, education and need to work for their upkeep. The psychological sequel to this state of affairs can only be summarized as a precursor to lifelong post-traumatic stress disorder syndrome among these orphaned children..5.2. ConclusionsObjective 1: Examine the psychosocial effects due to HIV and AIDS in the child headed households in Seme Sub-County.The general conclusion is that orphans and vulnerable children experience increased levels of psychological and emotional distress. There is a wide variation among these children regarding levels of psychological distress as indicated in Table 4.1 and Table 4.2. Furthermore, the factors that are inherently part of the reasons that children are affected by HIV and AIDS appear to cause psychological stress in orphans and vulnerable children may also be the result of conditions other than HIV and AIDS. Physical and verbal abuse, level of psychological distress of the guardians, and health status of the guardians are all significant predictors of psychological distress in orphans and vulnerable children, these predictors may also be caused by phenomena other than HIV and AIDS and thus apply to other children as well.Other factors associated with increased children’s vulnerability and psychosocial stresses include early marriage, girls trafficked into sex, sexual abuse, child labor, homelessness and poverty. To the extent stigma related to HIV and AIDS is linked to other factors, such as moral judgments about reasons for infections, poverty, social class, etc., then removing stigma and discrimination in the community becomes more difficult.Objective 2: Evaluate the implications of HIV and AIDS on school attendance and performance among child headed house- holds in Seme Sub-County, Kisumu County.One of the strongest indicators that orphaned children are suffering in Seme Sub County is their absence from school, and the education and sense of security it can provide. The impact of orphan status on school enrollment and school completion rates has been noted to depend on the socioeconomic and cultural context that includes the role of extended families, the Luo community in Seme Sub County, and their norms about responsibility to their siblings. As indicated in Figure 4.4, Figure 4.5, and Figure 4.6, the abseentism and dropout rates of orphans is high in Seme Sub county. The performance of the pupils is also shown as being dismal due to a variant of factors that range from discrimination, ostracism and the need to fend for their fellow siblings through employment. The support offered by the CBOs needs to be escalated with a major focus on education of orphans as a major priority area.Objective 3: Identify the existing intervention measures to address the effects of HIV and AIDS in child headed households in Seme Sub-County, Kisumu CountyIn African communities, the extended families takes in the overwhelming majority of orphans who lose both parents. Children affected by HIV and AIDS in Seme Sub County are at serious risk of exploitation, including labor and sexual abuse. Isolated from emotional connections with the family, some have been forced to live on the market places and beaches either begging or engaging in petty crime as a means to survive. While most of these children, especially the girls were born free of HIV, they are highly vulnerable to HIV infection while in the markets or beaches. The work by the community based organizations in the Sub- County as indicated in Figure 4.8, focus on legal and advocacy services with limited focus on education and food provision. Medical services account for 20% of the CBO service provision with the Ministry of health playing a major role in health care provision of these orphans. Their shelter, clothing and other services are mainly sourced from their hard earned labor with very little CBO contribution.Children affected by HIV and AIDS appear to need interventions that help them cope on an individual level and as a group, and they need interventions that educate and inform their communities. Given the strong effects of stigma (secrecy, avoidance, and withdrawal), a multifaceted approach will most likely be necessary. Stigma is a social construct and not an attribute of the individual, so consideration of stigma must be within the social context. Nevertheless, victims of stigma need not be passive agents.A variety of interventions to increase protection of children affected by HIV and AIDS have beenImplemented by non-governmental organizations and many have been successful on an individual basis, based on limited funding. However, without systematic evaluation, it is difficult to state that these are the most appropriate and effective interventions in Seme sub County, Kisumu County.RecommendationsState support may take the form of exemption from school fees, school feeding schemes, grants, or free health care. Even when support is available, for example policies that on paper provide free universal primary education, the reality is that many children have dropped out of school. Children drop out of school because fees were not paid despite government policies to ensure their protection and right to education, or school levies and other school expenses are imposed, which the family is unable to afford. The researcher therefore proposes that:There should be easily accessible psychosocial services to help mitigate the effects of HIV and AIDS on children. These should include counseling and mentoring of children and/or caretakers, self-help groups, and various types of community mobilization. In some cases, psychosocial interventions may be designed specifically for children and youth. Self-help groups such as weekly clubs and after-school programs where children can discuss their concerns with individuals similar to themselves can also been implemented. An important area needing attention is focusing on material and financial issues.Promotion of policies and practices that favor gender equity and nondiscrimination, school attendance, and holistic support for HIV/AIDS orphans.Establish systems at the school level for recording (and regularly updating) basic information on Orphans and on these children’s home circumstances. This information can and must inform action; for example, assisting decisions by those teachers responsible for monitoring vulnerable children and for making appropriate referrals.Provide a social protection system through regular and predictable cash transfers to families living with Orphans in order to encourage fostering and retention of Orphans within their families and communities, and to promote their human capital developmentReview of current policies and processes that support orphans (e.g., no school fees, assistance with uniforms, etc.).Inform all members of the community about legislative protection available to HIV and AIDS orphans, and, in particular, make efforts to inform community leaders, women, and children.Mechanisms be put in place to ensure that the support is accessed by these children and/or their caregivers and that it does indeed benefit the children concerned (e.g., does their nutrition improve when food parcels are provided to households caring for OVC). .Schools and teachers are critical to the development of OVC, especially in the wake of the loss of parents and parenting. 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