“I Survive Because of Them”: A Community-Based Approach to Supporting AIDS Orphans in Rural Lesotho

Background/ Purpose: Lesotho, a small mountainous country surrounded by South Africa, has been deeply scarred by the effects of the HIV/AIDS pandemic. Lesotho has the third highest infection rate in the world, with a 24 percent prevalence rate among adults (UNAIDS, 2008). HIV/AIDS has created new challenges for families as the number of healthy adult caregivers has decreased and the number of children in need of care has increased. The purpose of this paper is to examine the efficacy of community-based organizations (CBO) in responding to the needs of AIDS orphans and their families in ways that are culturally sensitive and that help to strengthen pre-existing networks of care within rural African communities.

Methods: This research is the result of 12 months of ethnographic fieldwork conducted between June 2007 and 2009, with a small CBO in Mokhotlong, Lesotho called Mokhotlong Children's Services (MCS). MSC serves the needs of children and families impacted by HIV/AIDS through a safe home and an outreach visiting program that provides nutritional support, transportation funds, and general health support. Ethnographic techniques include: participant observation, field notes, semi-structured interviews, archival data collection, and participatory action research (PAR) methods. Data were analyzed using EpiInfo, an epidemiological database, and Atlas.ti, a qualitative data analysis program. The sample was a convenience sample which consisted of the clientele of MCS.

Results/Findings: Analysis of the data show that a community-based approach to supporting AIDS orphans and their families is most beneficial in rural African communities affected by high rates of HIV. Specifically, a) MCS helped to decrease child mortality by encouraging and monitoring HIV-treatment and good nutrition through monitoring and nutritional support, b) an outreach visiting program in remote rural villages increased the accountability of caregivers, improving care for orphans, c) enrollment in MCS services also increased enrollment with other services in the community such as the World Food Program and Social Welfare through improved knowledge about, and access to, these services, d) collaboration of MCS with village health workers improved referrals to other services, as well as monitoring of child health and nutrition, e) children and caregivers enrolled in MCS were more likely to initiate antiretroviral treatment (ART), and to adhere to that treatment through the support of outreach workers, e) finally, MCS decreased the likelihood of a child needing institutionalized care by helping to identify caregivers within the extended family network and support them in the care of the child.

Implications: International and local social workers have the ability to successfully strengthen African CBO's in the support of AIDS orphans and their families. Intervention strategies should work to collaborate with local organizations in order to provide culturally appropriate care that maximizes the pre-existing networks of care within the extended family and community, including an outreach visiting program, training about nutritional monitoring, and training about HIV-testing and treatment regimens.