draft paper for research pdf

An investigation into the effectiveness of group therapy in reducing the fear of public
stigma among guardians of children living with HIV/ AIDS in Outapi district.
By
Elizabeth Hishishii Shilyomunhu
Submitted to the Faculty of Humanities and Social Sciences in the partial fulfilment of a
Bachelor of Arts degree in the Department of Human Sciences.
At the
University Of Namibia
Mentor: Ms. Emma Leonard
External Moderator: Prof. L.S. Terblanche
6 November 2012

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ABSTRACT
HIV/AIDS is a global challenge and its impact is evident. The devaluation of identity and
discrimination associated with HIV-related stigma do not occur naturally. Rather, they are
created by individuals and communities who for the most part, generate the stigma as a
response to their own fears. HIV-infected individuals, their loved ones for example family
members, friends and caregivers are often subjected to rejection by their social circles and
communities when they need support the most. Stigma associated with HIV/AIDS adversely
affects children and their caretakers/guardians in ways that have long-term negative
psychological and social effects. Because of the stigma, individuals, families and even whole
communities often discriminate against others in ways that cause great suffering.
A single-system study was undertaken to investigate the effectiveness of group therapy in
reducing fear of public stigma among guardian of children that are living with HIV/ AIDS in
Outapi District, Omusati region. Seven research respondents were selected by means of
purposeful non- probability sampling from the client files of the Outapi Communicable
Disease Clinic (CDC). Data was gathered through pre- and post-interviews categorised into
themes and analysed.
The study findings revealed that stigma is a major social challenge faced by guardians of
children living with HIV/AIDS. The guardians reported that disclosing the child’s status was
very difficult because they fear judgment and rejection from their community, friends, family
or even the children themselves. The findings showed a correlation between the literature and
the findings of the study. Social support programme example therapy group revealed by other
researchers emphasised the importance of these groups in addressing fear of stigma among
guardians/caretakers of children living with HIV/AIDS. Therapy groups help members to
become more assertive and develop new coping skills to cope with stigma in order to care for
the children under their care and for themselves, this was proven also by this study. There is
a general need for more research in specific communities such as Outapi District, which has
not received much attention, especially in the context of HIV/AIDS and guardians’ coping
mechanisms to HIV/AIDS stigma. The research findings can be helpful to Social Workers in
establish group therapy sessions for these guardians.

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Table of content
Pages
Abstract....................................................................................................................1
Table of content....................................................................................................... 2
Acknowledgments....................................................................................................4
Dedication................................................................................................................ 5
Chapter 1: Orientation to the study
1.1 Introduction........................................................................................................6
1.2 Definition of concepts........................................................................................7
1.3 Formulation of the problem................................................................................8
1.4 Aims and objectives............................................................................................9
1.4.1 Overall aim of the study................................................................................9
1.4.2 Objectives of the study..................................................................................9
Chapter 2: A guide through the literature reviewed
2.1 Introduction........................................................................................................10
2.2 Understanding the concept stigmatization.........................................................11
2.3 Dominance of women in caring role...................................................................13
2.4 Group intervention in addressing stigma.............................................................15
2.5 Conclusion...........................................................................................................19
Chapter 3: Research methodology
3.1 Introduction.........................................................................................................20
3.2 Research Question...............................................................................................20
3.3 Research Methodology.......................................................................................21
3.4 Sampling..............................................................................................................22
3.5 Data collection strategy........................................................................................23
3.5.1 Validity and Reliability..................................................................................24
3.6 Data analysis.......................................................................................................25
3.7 Ethical Issues......................................................................................................26

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3.8 Conclusion.........................................................................................................28
Chapter 4: Data analysis and Interpretation
4.1 Introduction...........................................................................................................29
4.2 Presentation of results............................................................................................29
4.2.1 Gender profile..................................................................................................29
4.2.2 Age profile........................................................................................................29
4.2.3 Relationship between guardians and children profile.......................................30
4.2.4 Results for pre-and post-interviews..................................................................31
4.3 Conclusion............................................................................................................31
Chapter 5: Conclusion and recommendation
5.1 Introduction............................................................................................................33
5.2 Discussion of results..............................................................................................33
5.3 Contribution of the results to the profession..........................................................34
5.4 Limitation of the current study...............................................................................34
5.5 Directions for future research.................................................................................35
5.6 Conclusion..............................................................................................................36
5.7 Recommendation....................................................................................................36
6. Reference...............................................................................................................38
7. LIST OF TABLE
7.1 Table 1: Age group.................................................................................................30
7.2 Table 2: Relationship between the guardians and children.....................................30
8. LIST OF GRAPH
8.1 Graph 1: Interpretation of result............................................................................31
9. Appendix
A. Questionnaire sample...........................................................................................41
B. Informed consent sample.....................................................................................44
C. Letter request permission to conduct study in the hospital..................................46

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ACKNOWLEDGEMENTS
My sincere appreciation is extended to the following:
God Almighty, who was my source of comfort when everything seemed gloomy.
I would like to thank my two supervisors, Ms. L.L Ndaendapo (field supervisor at the
Ministry of Health and Social Services Outapi District Hospital) and Ms. Leonard (my
mentor), for their guidance and encouragement throughout my study, this study would not
have been possible without you. Thanks for your tireless support and well-paced academic
guidance despite your work schedules. Your valuable insight into this study is highly
appreciated.
Special thanks to guardians who participated in this study, for sacrifice their time and
possibly endured emotional pain during this study, your contribution during my data
collection did not go unnoticed. Thank you very much for sharing.
To my family; for their never ending love and support many times and across the miles. I
love you all.
My sincere gratitude goes to the Indian Sisters and Priests at Anamulenge Mission (Outapi);
for your encouragements and spiritual support throughout my studies. Thank you.
To all my beloved friends; Thank you for always listening to me, encouraging me when I felt
down and unable to go on, and being my fun companion when I needed a break.
To Ministry of Health and Social Services, and Social Security Commission of Namibia for
their financial support during my study, thank you.
I acknowledge the support of the management and staff of Outapi District Hospital. Thank
you for the support you rendered me during my study.

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Dedications
This study is dedicated to the loving memory of my late paternal grandmother and to my two
lovely mothers (Elizabeth Sheehama and Emilia Benardu) with lots of love.

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Chapter one
Research Orientation
1.1 Introduction to the problem
The aim of this chapter is to draw an outline that will guide the researcher throughout the
study. As De Vos, Strydom, Fouche and Delport (2002, p.123) argued that the researcher
needs a plan in the same way that a builder needs a frame of reference to build a house.
With this in mind, the research question can be continuously clarified. The motivation for
this particular investigation is as follows.
Guardians of children living with HIV/AIDS face many challenges, such as depression,
fatigue, but moreover, the child’s illness is associated with additional stressors, such as
social stigma and isolation that may limit guardian’s willingness to seek assistance from
formal agencies, for them and the children under their care. Stigma can adversely affect
children and their guardians in ways that have long-term negative psychological and
social effects and because of this stigma, individuals, families and even the whole
communities often discriminate against others in ways that cause great suffering.
Diminished stamina and the physical demands of an HIV positive child leaves many
guardians without adequate time for self-care and counselling (Shepherd, 2007, p.20).
Many times guardians do not necessarily understand the impact that the child’s illness can
have on their life. This lack of information can create a potentially stressful situation
between the person being cared for and the person giving care. Research acknowledges
that this directly results in withdrawal of the guardian from his or her social network
because of what is perceived by the guardian as stigma surrounding HIV/AIDS and fear
to be discriminated and ostracism from the public (Heerden, 2006, p.97).
This research will focus on guardians who have the primary responsibilities for children
living with HIV/AIDS and are aged between two–eight years, in Outapi district, of
Omusati Region. In Namibia, it is estimated that there are 17,000 children living with
HIV/AIDS, and Omusati Region of the thirteen regions in the country (Namibia) is the
second highest region with HIV prevalence between 20-29% (Caplan, 2010, p.5).
HIV/AIDS epidemic has been generalized as primarily spread through heterosexual sex
and this has caused people who are HIV positive or living with someone who HIV

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positive to be stigmatized in their societies (Campbell, Nair, Maimane and Sibiya, 2005,
p.12).
In Outapi district of Omusati Region, statistic shows that 838 children under the age of
fifteen are living with HIV/AIDS (Ms. Akuunda personal communication, March 16,
2012, senior data clerk officer, Outapi CDC). According to Ms. Shilongo (personal
communication, March 9, 2012 ), elder-adults who are mostly women in Outapi district
are increasingly playing the principal role in caring for children sick with HIV/AIDS and
for orphaned grandchildren, these adults are either the grandmother or the aunt to the
children.
According to Brown, Trujillo and MacIntyre, (2001, p.15 ) “Literature suggests that
social support group programs is an important buffer for caregivers of people living with
HIV/AIDS and have helped reduce fear of disclosing children status among the
caregivers”. Thus caregivers who had participated in these forms of group generated more
alternative solutions to problems, proposed ways of challenging stigma and were less
fearful than caregivers who didn’t participate. These groups don’t only improve their
adaptation in communities and family, but increase their self-esteem and enhance their
coping skills to stigma.
1.2 Definition of the main concept
For the purpose of this study, HIV, AIDS, Stigma, Fear, Guardian and Children were
defined as follows;
HIV: Pearsall (2002, p.674), explained HIV as the human immunodeficiency virus, the
virus that causes AIDS and breaks down the immune system that helps to keep the body
strong.
AIDS: stands for Acquired Immune Deficiency Syndrome, a disease caused by HIV
virus. AIDS is acquired and not inherited. It is caused by a virus that invades the body,
attacks the immune system and makes the body weak and ineffectual Heerden (2006,
p.90).

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Stigma: Goffman (1963, p.3) define stigma as an undesirable or discrediting attribute that
an individual possesses, thus reducing that individual’s status in the eyes of the society.
Goffman explanation of stigma focuses on society's attitude toward people who possess
attributes that fall short of public expectations. Stigma refers to all the negative thoughts
and feelings that people have about HIV/AIDS and guardians who are taking care of
HIV/AIDS children.
Fear: Campbell et al (2005, p.17) defined fear as distressing emotions aroused by
impending danger, evil, pain, or belief of perceived threat which may cause stress,
depression, pain and isolation.
Guardian; is any adult member of the household who has primary responsibility of
taking or giving care to children and often other household members (Heerden, 2006,
p.99).
Children: is a plural word for a child and a child is a young human being below the age
of full physical development (Pearsall, 2002, p245). Namibian constitution defined a
child as someone under the age of 18years (www.ombudsman.org.na). In this study, a
child is defined as someone between the ages of 2-7 years and lives under the care of a
guardian.
1.3 Problem statement
De Vos et al (2002, p. 233) emphasise that the identification of a research problem is the
first step in conducting a research study. Therefore a problem identified must be
researchable and it must demand an interpretation of the data leading to a discovery of
facts. It is crucial that the research problem be simple and specific as any complexity may
lead to further complication of the study.
Heerden (2006, p.97-99) explained that researches revealed stigma as slowing the
provision of care to children or people living with HIV/AIDS. Most children or people
living with HIV/AIDS and their families still fear the abuse and stigmatisation by their
communities. Stigma can adversely affect children and their guardians in ways that have
long-term negative psychological and social effects such as depression, grief and feelings

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of helplessness, withdrawal and isolation, despair and loss of hope for the future, anxiety,
frustration, and confusion.
In view of the above challenges, the question that is directing this research is;
How effective is group therapy on reducing fear of public stigmatisation on
guardians of children living with HIV/AIDS in Outapi district?
1.4 Aim/goal of the study
Attention will be given to the discussion of the aims and objectives of this study.
4.1.1 Overall aim of the study
The aim of the study is to study the effectiveness of group therapy interventions in
reducing fear of public stigma among guardians of children living with HIV/AIDS in
Outapi district.
4.1.2 Objectives of the study
In recognition to reduce the fear of public stigma among guardians of children living
with HIV/AIDS in Outapi District, the research objectives are:
 To describe the fear of public stigma faced by guardians of children living with
HIV/AIDS in Outapi district.
 Assess the impact of public stigma on guardians.
 To enhances guardians’ coping capacity, to cope with public stigmatization.

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Chapter Two
Literature Review
2.1 Introductions
The purpose of this section was to examine the relevant existing literatures and explore
available literature from the social work perspective on the impact of a therapeutic group
on guardians who are living in fear of being exposed to stigma or discrimination affiliated
for being affected by HIV/AIDS with specific focus of guardians of children living with
HIV/AIDS. According to Thompson (2006, p.14), the Social work profession is a multi-
cultural and vast profession that encompasses various aspects of working towards
facilitating individual, group and community well being. Social work operates as part of a
social welfare system which is located at the centre of contradictions arising from
dehumanising consequences. Social Workers although situated in a largely oppressive
organisational and professional context. They have the potential for recognising these
contradictions and through working at the point of interaction between people and their
social environment, of helping to increase the control by people over economic and
political structures.
The HIV and AIDS crisis is one of the greatest humanitarian and developmental
challenges facing the global community. In the years and decades ahead, the impact of
HIV and AIDS on children, their families and their communities will grow far worse
expanding to dimensions difficult to imagine at present (Stine, 2005, p.95). To date, the
number children living with HIV and AIDS in sub-Saharan Africa is estimated to be at
1,800,000 (UNAIDS, 2009). Like in many countries in Sub-Saharan Africa, HIV and
AIDS remains a critical public health concern in Namibia. The scale of new HIV
infections, the mortality rates that will occur in the main productive population, the rising
number of orphans and the burden on the productive and social sectors continues to
increase. Namibia has a population of approximately 2 million, and an estimated 200,000
people are living with HIV and AIDS. The number of women living with HIV and AIDS
is estimated to be about 110,000 while 14,000 children are said to be living with HIV and
AIDS. The number of children living with HIV/AIDS has greatly increased in Namibia
and the extended family system is overstretched due to the epidemic (UNAIDS 2009,
p.210).

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In Outapi district of Omusati Region, statistic shows that 838 children under the age of
fifteen are living with HIV/AIDS (Ms. Akuunda personal communication, March 16,
2012, senior data clerk officer, Outapi CDC). According to Ms. Shilongo (personal
communication, March 9, 2012 ), elder-adults in Outapi district are increasingly playing
the principal role in caring for children sick with HIV/AIDS and orphaned grandchildren.
These adults are either the grandmother or the aunt to the children.
Attention will now be paid to the discussion of stigma, women role in caring for sick
people and the existing literature on how group interventions reduce fear of stigma
associated with HIV/AIDS.
2.2 Understanding the concept stigmatisation
Mehta and Gupta (2001, p.15) explained that stigma has surrounded HIV/AIDS since the
beginning of the pandemic and this give a major distinction between HIV/AIDS and other
chronic or terminal illnesses. This stigma often stems from a lack of knowledge and
ignorance. Most important is to reduce the stigma and discrimination attached to
HIV/AIDS, so that those infected and affected can openly seek the support they need.
According to Moore and Williamson (2011, p.2), there are stories about individuals being
rejected and the whole families affected by AIDS, usually because of fear, confusion,
shame, anger, or blame. These attitudes need to be understood and change.
In order to understand stigma it is important to define it. Goffman (1963, p.3) define
stigma in general as an undesirable or discrediting attribute that an individual possesses,
thus reducing that individual’s status in the eyes of the society. He continues to explain
that stigma can result from particular characteristics, such as a physical deformity, or it
can stem from negative attitudes toward the behaviour of a group, such as commercial sex
workers or homosexuals. Goffman (1963, p.4) in his explanation of stigma focuses on
society's attitude toward people who possess attributes that fall short of public
expectations such as HIV/AIDS patients and their family, people with disability and
elderly. Heerden (2005, p.94) also agrees with Goffman (1963) that stigma is the social
disgrace that is attached to something that is seen as deviating from an ideal or
expectation of the community. It’s a fact that there is stigma associated with HIV/AIDS
in communities, but according to Heerden (2005), stigma is not related to the facts of
HIV- on the contrary, stigma is born from myths, misinformation and fear and people

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infected and affected by HIV/AIDS are being stigmatised because stigma is born from
fear, ignorance and social judgement about HIV/AIDS. People are more fearful of stigma
rather than the disease itself.
According to Brown et al (2001, p.90-94) there are three concepts that are helpful in
understanding stigma as it relates to the paediatric HIV population which are; associative
stigma, internalized stigma, and stigma management.
2.1.1 Stigma is associative when it affects people because of their association with a
stigmatized person, such as a person living with HIV. Associative stigma may
affect caregivers who help care for infected children or affected children whose
parents have died from the disease. Children may be affected by associative
stigma if their parents are publicly known to be infected with HIV. Other
examples include being friends with an HIV-positive person and attending a social
or fundraising event aimed at people living with HIV.
2.1.2 Internalised stigma can be particularly damaging. Such stigma occurs when a
person is aware of a social stigma and accepts, or internalises, society’s negative
views. Doing so damages the person’s self-esteem and gives him or her negative
sense of self-worth. Internalized stigma has a large effect on the paediatric
population through its influence on parents’ decisions to disclose. If parents or
caregivers have internalised the stigma and negative views of HIV/AIDS, their
likelihood of telling the child about his or her diagnosis decreases significantly. If
adolescents internalise the stigma regarding their diagnosis, they are more likely
to become depressed and engage in denial regarding their HIV status. Adolescents
may fear disclosing their status to others and feel shameful regarding their
condition.
2.1.3 Stigma management is a way of coping with stigma by being aware of possible
negative reactions and finding ways to minimise them. People living with HIV
practice stigma management by choosing and limiting whom they disclose to in
order to minimize the chance of negative reactions or rejection. They may also
“test” potential friends or loved ones they wish to disclose to by discussing HIV
education or using probing questions to discern the person’s understanding and
personal opinions regarding people living with HIV.

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According to Willis (2002, p.28), and Friedland, Renwick and McColl (1996) as
cited in Mabusela (2010, p.47), both infected and uninfected caregivers working
in the HIV/AIDS arena are stigmatised. The WHO (2002, p.40) explained that, for
people living with HIV/AIDS and their family members, the stigma, fear and
discrimination often associated with the illness can create barriers to effective
care. The WHO report further revealed isolation, fear and discrimination as
common themes that were related to HIV/AIDS. The study also acknowledged
that teaching health and social service personnel about universal precautions is not
sufficient to reduce stigma behaviour (WHO 2002, p.49). Caregivers on the other
hand are at times avoided or ostracised because they work with people living with
HIV/AIDS, and therefore they are deprived of much needed support.
2.2 Dominance of women in the caring role
Throughout the world it is mostly women who carry the burden of caring for sick
people, including people living with HIV/AIDS. According to Mohammad and
Gikonyo (2005, p.4), the burden of caring for people living with HIV/AIDS rests
disproportionately with women, including girls and older women, as primary
caregivers and volunteers. This is evident in cases where people living with HIV/AIDS
are released from hospitals; they are normally cared for by women in the communities
or at home. In the study of Mohammad and Gikonyo, (2005) older women expressed
feeling overwhelmed with the magnitude and multiplicity of tasks they had to perform,
many suffered from exhaustion, malnourishment, depression, and psychological
distress, loneliness and isolation, as care giving kept them within the house for most of
the day (p.12).
Several studies highlight the common problem of family members becoming primary
caregivers despite the availability of assistance from a formal community home-based
care centre, caregiver, such as a nurse, doctor, or trained volunteer. Lemelle,
Harrington and Leblanc, (2000, p.120) termed the family caregivers as (informal
caregiver) and home-based caregivers as (formal caregivers); Formal caregivers
include professionals and specialists such as physicians, pharmacists, medical social
workers, occupational and speech therapists, doctors and nurses. This category of
caregivers also includes trained volunteers, spiritual volunteers, spiritual counsellors
associated with AIDS service organisations, and AIDS care teams and hospice

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programmes. Informal caregivers comprise relatives, spouses or partners and friends
who provide at-home care on an unpaid basis. They are in some cases not trained at all,
or have received very little training. Respected traditional healers in various
communities, especially in sub-Saharan Africa, also provide care for people living with
HIV/AIDS (p.121). This study, which focuses on guardians, refers to the informal
category, namely informal caregivers.
In areas with few or no palliative care facilities, when a person become ill from AIDS
the care is usually a woman’s responsibility. In Omusati Region in Namibia for
example, two thirds of all caregivers for children living with HIV/AIDS are women
who are mostly their aunties or grandmothers. This care giving is usually in addition to
many other tasks that women perform within the household, such as cooking, cleaning,
and caring for other children and the elderly (Ms. Gosbertus, personal communication
April 24, 2012). Caring for children living with HIV/AIDS, guardians are unpaid for
the work they are doing and can increase guardian’s workload by up to a third.
Women mostly are struggling to bring in an income whilst providing care and
therefore many families affected by AIDS suffer from poverty (Mehta & Gupta, 2001,
p. 24).
With this dominance of women in care giving, it is important that men should be
encouraged to join women in the role of care giving for sick people especially children
living with HIV/AIDS. This gender balance is very important in providing care,
especially to male children who are very ill. According to Leake (2009), caregivers
may risk their physical health – for example, when they are assisting a patient who is
heavier than themselves with simple tasks such as getting out of bed, moving around
and so on.
2.3 The Impact of Group Intervention in reducing fear of stigma
Corney and Jenkins (1995) explained counselling as a skilled and principled use of
relationships to develop self-knowledge, emotional acceptance and growth, and
personal resources. The overall aim is to live more fully and satisfyingly. Counselling
may be concerned with addressing and resolving specific problems, making decisions,
coping with crisis, working with feelings or inner conflict or improving relationships
with others. The counsellor’s role is to facilitate the client’s work in ways that respect

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the client’s values, personal resources and capacity for self-determination while aiming
to develop a therapeutic alliance with the client and to convey acceptance and
understanding of the client and empathy with her/his situation.
The counsellor structures the process to allow the client’s time and freedom to explore
thoughts and feelings in an atmosphere of trust and respect and aims to deepen the
understanding of his or her situation and ways of dealing with it. Thus enables choices
and decisions to be based on insights gained rather than advice and directives of others
(Corney and Jenkins, 1995 p.18). Counselling skills, in particular, the cores skills of
listening, reflecting and empathy, are at the heart of counselling. Therefore, the
therapist or counsellor uses a range of specific skills to help the clients learn to manage
their lives more efficiently and effectively (Corney and Jenkins, 1995, 23).
An opposing view of this would be an article on counselling written over the past years
called “Let’s do away with counselling” as cited by Corney and Jenkins (1995),
Kubler-Ross (1997) argues that it is difficult to understand what counsellors have to
offer apart from “time, sympathy and willingness to help” and that these qualities
appear to be more important in counselling relationship than the theory or method of
counselling. With no common understanding of what counselling means, there is no
way in which its value can be assessed. Sympathy can be inhibiting or destructive and
a willingness to help is not always associated with the ability to do so (Kubler-Ross,
1997, p.17).
A study by Vyavaharkar, Moneyham,Corwin, Saunders, Annang, and Tavakolthe
(2002) yielded results that indicated that a supportive environment that accepts a
woman affected by HIV stigma and provides positive experiences that can build their
self-esteem and self-efficacy while reducing psychological distress including
depression that are caused by stigma. This finding highlighted the importance of
having more individuals in support networks for rural women affected by HIV stigma.
The findings of our study suggested that if a woman had several sources of support that
she could turn to if needed, it might alter and decrease her perceptions of HIV-related
stigma, as well as internalized stigma. This may minimize the psychological stress
associated with having HIV and possibly reduce negative psychological outcomes and
symptoms. Because depressive symptoms may indicate the presence of other mental

16
health issues, health care professionals should consider referring women with positive
depression screenings for further assessment of their reported symptoms to rule out
other psychological co-morbidities. Additionally, they should also consider referring
women to support groups when necessary. In the end, this will result in better
management of stigma surrounding HIV/AIDS pandemic and improve the overall
quality of life for rural informal caregiver of people living with HIV disease.
According to Brown et al (2001, p.15) who shared the same view as that of
Vyavaharkar et al (2002), in their study they explained that social support group
programs is an important buffer for caregivers of people living with HIV/AIDS. They
helped reduce fear of disclosing children status among the caregivers. Therefore
caregivers who had participated in these forms of group generated more alternative
solutions to problems. Caregivers also proposed ways of challenging stigma through
sharing their own experiences and develop ways on how to disclosure their children
status and cope with stigma. This group helped members to be less fearful than
caregivers who didn’t participate. These groups don’t only improve their adaptation in
communities and family, but increase their self-esteem and enhance their coping skills
to stigma.
In a study which was conducted by Mabusela (2010, p.103), his study has found that
most of the research participants in this study who were formal caregivers of people
living with HIV/AIDS in Mamelodi town seemed to resort to sharing their fears,
anxieties and most work-related challenges with fellow caregivers, in a form of
informal support groups. Even if members know that sometimes not much can be done
by fellow caregivers, simply sharing their experiences provides some comfort, reduce
anxieties and fear, as they have similar experiences and they know confidentiality will
be maintained in their group.
According to Primo (2007) as cited in Mabusela (2010, p.51), Primo points out that
through talking, sharing feelings or releasing them through crying, laughing, dancing
together with other caregivers as they have the same work demands, can help one to
cope better with feelings such as isolation, anger, sadness or grief etc that come with
care giving for people living with HIV/AIDS. Social workers are good at to connect
caregivers so that they can form spiritual and counselling support groups. The

17
caregiver‘s mental and physical health is vital to the people living with HIV/AIDS,
making it critical that the caregiver must be able to strike a balance between taking
care of him-/herself first, so as to be able to take care of other people. This can be done
through rest and exercise, enough sleep and eating well. Primo continues to explain
that caregivers need to be provided with an opportunity to express their fear,
uncertainties and prejudices in an environment that is conducive for them to express
themselves. In this way they can overcome negative emotions and learn more about the
experiences and challenges facing caregivers and people living with HIV/AIDS. Less
support/without support to caregivers of HIV/AIDS patients they may experience
burnout and it will be difficult for them to give compassionate care to themselves and
patients (Mabusela, 2010, p.108).
Many researches acknowledge the importance of group therapy in addressing the fear
of HIV/AIDS stigma among the caregivers of people living with HIV/AIDS. Edward
and Marthas (1990) with his notion of “group think” disagreed that group work is good
in addressing fear of stigma. His “group think” notion is based on the examination of
governmental decision making groups by Kubler-Ross (1997) who introduced this
term. The term refers to the tendency within many groups to eschew conflict and adopt
a normative pattern in which the group member is loyal to the group’s leader and other
members, never really challenging or seriously doubting the leaders or the groups’
wisdom in matters of decision making (Edward and Marthas, 1990, p.79). The group
think typically leads to ineffective group functioning. Alternatives are never seriously
considered by the group; members are too afraid to bring up a different possibility to
openly challenge the serene loyalty that is normatively demanded. Members are
accustomed to follow groupthink norms, refusing to provide any other alternatives not
related to what they would perceive the group will consider good (p.79-81).
Pennington, C. D. (2002) further criticise the notion of groupthink. He explained that t
groups operate better than individuals counselling and that decision making is likely to
result in higher quality decisions than decisions made by individuals. Social workers
are the people who mainly facilitator this type of groups and are responsible for
conducting counselling. Social workers as described by Thompson, N. (2006) are
mediators between their clients and the wider state apparatus and social order. This
position of mediator is a crucial one, as it means that social workers are in the pivotal

18
position in terms of the relationship between the state and its citizens. The relationship
is a double-edged one, one that can lead to potential empowerment or potential
oppression, social work interventions can help or hinder, empower or impress. Which
aspect is to the fore, which element or tendency is reinforced depends largely on the
actions of the social workers concerned (p. 14).
Kubler-Ross (1997) also challenge this notion of group think again strongly by
claiming that group think occurs when members of the group seek concurrence,
consensus and unanimity among themselves than critically looking at all the options
and deciding upon the best possible alternative. This phenomenon is likely to be
evidenced in groups that are highly cohesive. Ironically, group cohesion is one of the
main ingredients for a group to be able to work together (p.179-180). It has been
proven that if cohesiveness in a group becomes extremely high, the individuals in the
group will tend to do anything to maintain this. Jacobs, Masson, Harvill, and Schimmel
(2012) also stated that groups are indeed more efficient and they offer more resources
and viewpoints. Other reasons they found useful for employing a group approach
include the feeling of commonality, the experience of belonging, and the chance to
practice new behaviours, the opportunity for feedback, the opportunity for vicarious
learning by listening and observing others, the approximation to real-life encounters,
and the pressure to uphold commitments.
2.4 Conclusions
There is ample research that indicates that caretakers of people living with HIV/AIDS
experience many challenges, particularly stress, as result of stigma. Though literature,
acknowledges that care giving is demanding but rewarding, many caretakers
experiences stigma and their reactions to stigma include emotional exhaustion,
despair, depression and helplessness.
Many studies recognise the importance of social support system for individuals living
with HIV. However many researchers explained that there is also a necessity to
understand the need for such a system for the caregiver. Providing care for someone
with HIV can be a stressful experience and this makes a network of caregivers a
crucial component of buffering the process of giving care. This shows the importance
of social support group programme for caregivers of people living with HIV/AIDS.

19
There is a need for more access to psycho-social support and economic assistance to
help caregivers to sustain their physically and emotionally draining. It’s difficult for
caregiver to provide emotional support to a sick person, if they do not feel supported
themselves. With this in mind the different research acknowledge the importance of
counselling support group interventions to caregivers. Researchers also emphasized
that social workers play an important role in counselling groups, as their skills can be
employed in this type of group to connect caregivers together in order for them to
share their experience with each other and challenge HIV/AIDS stigma. The
caregivers’ mental and physical health is vital to the people living with HIV/AIDS,
making it critical that the caregiver must be able to strike a balance between taking
care of him-/her first, so as to be able to take care of other people.
The next chapter will cover the research methodology employed in this study.

20
Chapter Three
Methodology
3.1 Introduction
This chapter will present the research methodology employed in this study. A
methodology is a general approach to studying a research topic and establishes how one
will go about studying a specific phenomenon (Creswell 1998, p.248). Methods are
specific research techniques, which are used in research, for example, statistical
correlations, observation, interviewing and audio recording. This chapter focuses on the
research questions that directed the study, the research design, which is single system
design in nature, and provides information about the sampling method used. The process
of data collection through pre- and post-questionnaires interviews as methods of
collecting data is discussed. This chapter further gives a detailed discussion of the data
analysis and the relevant themes that emerged during this process.
The last sections of this chapter cover the relevant ethical considerations pertaining to the
study, as well as the rights of the research respondents during the study.
3.2 Research question
A research problem is an interrogative sentence or statement that asks what relations exist
between two or more variables (Christensen 2007, p.129). There are three criteria that
good problems must meet. Firstly, the variables in the problem should express a
relationship. The second criterion is that the problem should be stated in a question form.
The third criterion and the one that most frequently distinguishes a researchable from a
non-researchable problem is that “The problem statement should be such as to imply
possibilities of empirical testing (Christensen 2007, p.130).
For this study the following question was formulated: how effective is the group therapy
on reducing the fear of public stigma among guardians of children living with HIV/AIDS
in Outapi district?
3.3 Research design
A research design refers to an outline, plan, or strategy specifying the procedure to be
used in seeking an answer to the research question (Christensen, 2007, p.20).

21
This study followed the single system design as the most suitable method to provide
explanations on how effective group therapy is in addressing fear of stigma among the
guardians of children living with HIV/AIDS in Outapi district. Rubin and Babbie (2011,
p.292) define single-system design as a time-series design, for evaluation of the effect of
interventions or policy changes on individual cases or systems. The design involves
obtaining repeated measures of a client system with regard to particular outcome
indicators of a target problem.The design has single unit of analysis that are repeatedly
measured over time. The unit of analysis in a single- system design can be an individual,
a couple, a small group, a family, a community, or society as a whole, which in this study
it was a small group of women who are the guardians of children living with HIV/AIDS
in Outapi district.
Single-system design is just one of several names for a research methodology that allows
researchers especially researchers from the field of human science (social workers,
psychologist) to track systematically the progress within a client or client unit. With
increasingly rigorous applications of this methodology, practitioners can also gain
knowledge about effective interventions (www.single-system.htm).
Rafael and Russell (2005, p.228) identified different types of single-system design, which
are; the basic single-system (AB), basic experimental, multiple, changing intensity and
successive intervention, and complex and combined designs. In this study, a single-
system design through the use of the AB design was chosen, because the design involves
obtaining repeated measures of a client system with regard to particular outcome
indicators of a target problem. The researcher deployed both the pre and post- testing,
before and at the end of the group intervention as a way of determining the baseline and
intervention. The researcher used self- administered questionnaire to be completed by the
respondents.
The AB design includes a baseline phase (represented by A) with repeated measurements
and an intervention phase (represented by B) continuing the same measures. Rubin and
Babbie (2011, p.296) stated that, the AB Design is a two phase design which consist of a
no-intervention baseline phase (A) and an intervention phase (B). The design allows for
evaluation of pre-intervention and intervention problem status. The design it is a quasi-
experimental design, meaning that the existence of a no intervention baseline allows for

22
the establishment of a relationship between intervention and outcome. If a change in the
dependent measure occurs at the onset of the intervention, a relationship between the
independent variable (intervention) and dependent variable (problem) has been
established (Rafael and Russell, 2005, p.228-229).
3.4 Sampling
Ideally one wants to study is the entire population. However, usually it is impossible or
unfeasible to do this and therefore one must settle for a sample. A sample is a subset of
the population considered for actual inclusion in the study, the characteristics are
generalised to the whole population that is represented, and therefore a sample is seen as
representative of the population that it is taken from (De Vos et al, 2011, p.223).
There are two major goals that sampling can achieve; the first is to establish the
representativeness of what we are studying conversely to reduce biasness. The second is
to be able to make inferences from findings based on a sample to the larger population
from which that sample was drawn (Baker, 1998, p.122). According to De Vos et al
(2011, p.228) there are two different kinds of sampling available to the researcher;
probability whereby each person in the population has the same known probability to be
representatively selected and non-probability which means selecting a particular
individuals are not known because the researcher doesn’t know the population size or the
members of the population. The procedure used for selecting the respondents in this
study was non-probability sampling specifically using the purposive non-probability
sampling, because there was no a sampling frame and the probability of including each
element could not be determined.
Rubin and Babbie (2011, p.367) define purposive sampling as a type of sample that based
entirely on the judgement of the researcher, and the sample is composed of elements that
contain the most characteristic of the population that serve the purpose of the study best.
The respondents in the study were selected by means of the researcher’s personal choice
rather than through mathematical chance. For this study, the sample consisted of 7
guardians. Two of these guardians had grand children under their care who are on Anti-
Retro Viral medications (ART). On the other hand, the other four guardians had nephews
and one guardian had a niece under their care who are/is on ART. This information was

23
established from the hospital records in comparison with the information that the
researcher had established through her case records.
The researcher targeted a particular set of respondents namely guardians particularly for
children living with HIV and on treatment. A population of guardians between the age of
thirty five and sixty years with fear of public stigma were selected to form a sample.
3.5 Data collection
Data collection is a specific and systematic activity that seeks to avoid haphazardness and
vagueness (Henderson and Thomas, 2005, p.328). It is a process of gathering and
measuring information on variables of interest in an established systematic fashion that
enables one to answer stated research question, test hypothesis and evaluate outcomes
(www.balencedscorecard.org).
For the purpose of this study, and in order to achieve the objectives of the study, data was
collected from both primary and secondary data. The secondary data contributed toward
the formation of the background information of the research, needed by the researcher in
order to build constructively background of the study from different literatures. This was
done through studying and analysing different studies.
The data collection was done through self-administered questionnaires, consisting of
scaling type of questions. Structured interviews were in a form of pre- and post-test
questionnaires that was conducted during the initial stage of the group and ending stage of
the group therapy. The researcher collected data for pre-test on the first two sessions of
the group therapy, where by the researcher tested the level of fear of public stigma in
guardians of children living with HIV/AIDS in Outapi district. The post-test was done on
the termination stage of the group therapy, after the intervention has been implemented to
evaluate whether the intervention was effective in reducing the fear of public stigma
among the guardians. While completing the questionnaires for this therapy group, the
researcher was present in person to give necessary support through the process.
Questionnaires were translated into Oshiwambo, because only two respondents were able
to read and understand English, so respondents who were unable to read English concept
were translated and respond effectively.

24
The variable ages were categorized by using the different levels of measurement. The
group therapy covered the following five domains; effects of stigma (both on children and
guardians), their perceptions about HIV/AIDS stigma and coping skill. The group meet
for approximately ten sessions
3.5.1 Validity and Reliability
To ensure validity of the research a pilot study was done to test on a group of ten
guardians in Outapi district who are not members of the group therapy, but who are
taking care of children living with HIV/AIDS and also have fear of public stigma. The
purpose of the pilot study was to eliminate vague, ambiguous or unclear questions,
identify problems in the structuring or wording of the questions and conduct a mock
analysis before actual data collection was undertaken. The findings for the pilot study
shows that 99% of the respondents were female and 1% male.
Reliability is the accuracy or precision of an instrument. In general, reliability refers to
the extent to which the independent administration of the same instrument consistently
yields the same results under comparable conditions (De Vos, 2002). Questions were
structured in such a way that reliable information could be obtained from the respondents.
The questionnaire was simple and the researcher provided immediate support to the
respondents when clarifications were required by the respondents. Further, respondents
who could not speak English were helped through a translator to understand the concepts
in the questionnaire and respond effectively.
3.6 Data analysis
According to Kirst-Ashman and Hull (2012, p.385), data analysis is the actual process of
assessing the nature and significance of the results obtained.
The data collected was analysed manually. The researcher analysed the result for this
study through visual analysis. Visual analysis is the process of looking at a graph of the
data points to determine whether the intervention has altered the subject’s pre-
intervention pattern of scores (Rafael and Russell, 2008, p.218). Tables and graphs were
used to deduce the data. Visuals were displayed in a graph format to analyse the changes
in the participants’ behaviour (fear toward public stigmatization), before the intervention
and after the intervention. The visual presentations were made by means of simple

25
graphics or plotting. Plotting gave or shows improvement in the fear of public
stigmatization (problem) from the baseline to termination of the treatment or
interventions. The different phases on the graph were differentiated from one another by
means of a vertical line which connected the two points in the graph together.
The researcher used a composite questionnaire, which consisted of 8 questions. A code
sheet based on the 8 questions that were measured was prepared after data have been
collected. As the researcher used the scaling questionnaire, the data were translated
through the coding process, so that the computer can read and manipulate the data. Data
reduction which is the process of aggregating the information contained in larger data sets
into manageable (smaller) information nuggets was used.
3.7 Ethical issues
Researchers need to be aware of ethical issues before entering the field (De Vos et al
2011, p.), especially when dealing with sensitive topics such as those that are HIV/AIDS-
related and touch on the emotional and psychological aspects of all human spheres in
society. The following ethical issues were considered in this study:
3.7.1 Consent and voluntary participation
The researcher obtained consent form each respondent who participated in the
study. According to De Vos (2002, p.166), respondent need to receive a full non-
technical and clear explanations of what is expected of them so that they can
make informed choices to participate voluntarily, or not. An information session
(preliminary session) was arranged with potential respondent, where the
researcher explained what was expected of them, including all the steps to be
followed during the research, and informed them of their right to discontinue
their participation at any time despite giving initial consent.
Respondents were granted the opportunity to accept or decline their participation
in the study, rendering consent on a voluntary and informed basis. Consent
forms (in English appendix B) were given to all volunteering participants to fill in
and return during the first interview. All the respondents who were interviewed
handed in their signed consent form to the researcher prior to the
commencements of the interview.

26
3.7.2 Compensation: this is when the researcher tries to buy the participants in order
for the participant to take part in the study, not on their own will, but because of
the incentives which participants will get if they participate in the study.
According to Babbie and Mouton (2001, p.520), participants must be informed
that they should not expect any special rewards in the participating in the study.
Clarity on that was also provided during the preliminary session, to avoid
creating any possible expectation of being rewarded.
3.7.3 No harm to participants according to Babbie and Mouton (2001, p.522), social
research should never harm or injure people participating in the study. The
researcher ensured that the participants were not exposed to any danger.
Interviews were held at the hospital rehabilitation centre room, an environment
they are familiar with and which is safe.
3.7.4 Confidentiality according to De Vos (2002, p.166), in the consent form that the
participants sign, they must be assured of the parameters of confidentiality of the
information they will supply. Part of the information shared with respondents
during the information session (preliminary session) included the confidentiality
parameters relevant for this study, which were also included in the consent form
in (Appendix B in English). In this study no names and addresses are used,
guardians participated in this are study addressed only as research respondent
when referring to them. Information provided by respondents were handled with
care and regarded highly confidential to minimize any risk to the respondents.
Respondents were informed before the study that the results and finding will be
published as part of the partial fulfilment of the researcher’s degree program.
3.7.5 Deceiving subjects: this ethical component involves withholding information or
offering incorrect information in order to ensure the participation of subjects
when participates would otherwise possibly refuse to take part (De Vos et al,
2011, p.). Therefore the researcher identified herself as well as the purpose of the
study prior to the study. This enabled the respondents to feel open and
comfortable in participating in the study.

27
3.7.6 Analysis and reporting “In any rigorous study, the researcher should be more
familiar than anyone else with the study’s technical shortcoming and failures”
(Rubi & Babbie 2012, P. 84). Thus it is the researcher’s obligation to make these
shortcomings known to the readers as outlined in chapter five of this study.
3.7.7 Institutional review board It is very important that a panel of faculty & others
review all research proposals involving human subjects and rule on their ethics
(Rubi & Babbie, 2012). The research proposal served before the Social Work
Section, particularly to Ms. Leonard for review to ensure that the rights of
respondents are protected prior to fieldwork being undertaken.
3.8 Conclusion
This chapter describes the methods followed to do the empirical work. Attention was paid
to the method used during this study i.e. purposeful non- probability through the single-
system design; pre- and post-testing of the scaling questionnaire as well as measures to
ensure reliability, validity and ethical concerns.
The next chapter (chapter 4) discusses the findings of this study.

28
Chapter Four
Data Analysis
4.1 Introductions
This chapter presented the detailed account of the results of the fieldwork of which the
methodology was explained in the previous chapter. The detailed analysis and
interpretation of the findings are transformed into comprehensive descriptions and
presentations. The chapter will focus on the statistical analysis and interpretations of data
collected. The researcher used tables, and graphs to convert the findings into readable
results.
4.2 Presentation of results
The guardians studied were female caring for children living with HIV/AIDS aged
between age of 35 years and older. Each guardian was either grandmother or aunt to the
child aged between 5-7 years old. The study was conducted in Outapi District of Omusati
region.
4.2.1 Gender profile
In this study 7 research respondents were interviewed and all of them were female.
This reflects the overall female domination in the caring role in caring for sick
people in Namibia, as it is worldwide. At least one third of caregiver of children
living with HIV/AIDS in Outapi district are women (Ms. Shikongo, June 2012) and
this explain the need to entrench gender stereotypes due to the traditional roles of
women, which explains why caregivers are usually women and young girls.
4.2.2 Age profiles
The majority of the guardians (4) were aged between 30-40years old, while two
guardians were in the 41-50 age category and one guardian in the 51 and older age
category. However it is important to note that performing the duties and roles of a
care giving as well as a treatment supporter for a child living with HIV/AIDS may
demand a lot more than what a 50 year old adult may be able to offer. Figure 1
below shows the age groups of the guardians who were the respondents in this
study.

29
Table 2: Age groups of the guardians
Age group Number Percentages (%)
31-40 4 57%
41-50 2 29%
51 and older 1 14%
Total 7 100
4.2.3 Findings related to the relationship between the caregivers and the children
living with HIV/AIDS.
Table 3: Relationship between child and caregivers
Number Percentages (%)
Aunt n=5 71%
Grandmother n=2 29%
Total N=7 100%
Results of this study indicate that 71% of the guardians taking care of children living
with HIV/AIDS are aunties and approximately 29% are grandmothers to the
children. The extended family system in many studies are explained as continued to
play a vital role in caring for children, after the parents died of AIDS or suffering
from HIV/AIDS, in which the care of relatives is presumed important than if the
children are cared by people they are not related to. It is also favoured by
communities that relatives takeover the care of children living with HIV/AIDS than
giving them to palliative care facilities that care for people living with HIV/AIDS.
While this is true, it is always not easy to care for a child living with HIV/AIDS as
they are usually assumed as additional responsibilities considering that caregivers
also have their own children (Thompson, 2006, p.24).
4.2.4 Results for the pre- and post-interviews
The X- axis represents; 1- pre testing & 2- post testing, while the Y- axis represents
the level of fear which was addressed during the group therapy.

30
Graph no.1: results for the pre-and post- interviews
The graph above indicates that the dependent variable (fear) was measured
(observed) at two points. This was done at a time before the interventions,
respondents fear was measured (point 1) and after the interventions (point 2). The
graph indicates that the respondents had an average of 4% at a baseline and an
average of 2% after intervention. The graph shows that there was a decrease in the
level of fear during group intervention which was conducted with the respondents.
As Corney and Jenkins (1995) explained group counselling as a skilled and
principled use of relationships to develop self-knowledge, emotional acceptance and
growth, and personal resources, this graph shows that group therapy/counselling
intervention can be effective strategy when addressing fear of public stigma among
guardians of children living with HIV/AIDS.
The results for each question in the pre- and post-questionnaire paper
4. Sometimes I feel that I am being talked down because am looking after someone with
HIV/AIDS. The findings indicated 4 % baseline and 1.6% intervention phase.
According to Thompson (2006, p.23) explained that caregivers or family members of
people living with HIV/AIDS suffers from associative stigma. Brown (2001, p.91)
defined associative stigma as stigma that affects people because of their association with
stigmatized person.
1 2
0
0.5
1
1.5
2
2.5
3
3.5
4
observation points (interviews)
leveloffear
Pre- and post- interview
Series1

31
5. I do not feel bad about having to look after a child leaving with HIV/AIDS. The results
for the study indicate 3% baseline and 4% intervention.
6. I worry about telling people I take care of a child whose HIV positive. The study finding
indicates 4.3% baseline and 1.3% intervention. According to Willis et al (2002)
explained that caregivers at times are avoided or ostracised because they are working
with people living with HIV/AIDS and deprived much needed support.
7. I am scared of how other people will react if they find out that am looking after a child
living with HIV/AIDS. Finding indicated 4.3% baseline and 1.3% intervention.
According to Brown et al (2001) explained that caregivers and people living with
HIV/AIDS practice stigma management. They choose and limit whom to disclose the
HIV/AIDS status in order to minimise the chance of negative reactions or rejections.
8. I do not mind people in my neighbourhood knowing that am taking care of a child living
with HIV/AIDS. Findings indicate 1.7% and 2% intervention. The sources about care
giving explain (Leake 2009) that some caregivers see care giving as a rewarding job.
9. I feel the need to hide the HIV status of the child under my care from the child. The
results indicate that the baseline shows 2.7% and intervention 1.3%.
10. I feel the need to hide the HIV status of the child under my care from my friends. The
baseline indicates 4.3% and intervention 1.6%.
11. I feel the need to hide the HIV status of the child under my care from the whole
community. The findings indicate the baseline of 4.6% and intervention indicated 1.9%.
For question 9, 10, and 11 results showed what Brown et al (2001, p.90-94) called
internal stigma. Brown et al (2001) explained that caregivers internalise the stigma and
negative views about HIV/AIDS which decrease their likelihood to disclose about their
children status to the children, family members or community members.
4.3 Conclusions
This chapter presented and discussed the findings of this study. It gave a detailed account
of the effectiveness of group therapy in reducing the fear of public stigma among
The findings highlighted the importance of group therapy interventions in helping the
guardians to cope with stigma in daily basis as they give support to children living with
HIV/AIDS which encompasses the rewarding experiences as well as difficult ones that
require interventions. It is clearly articulated that care giving is rewarding, yet very

32
emotional for the guardians as they experienced negative and positive emotions in caring
for this children, thus there is a need for providing therapy for caretakers of HIV/AIDS
patients.
The following chapter concludes this study. It further gives recommendations based on
the findings of the study.

33
Chapter 5:
Conclusions and Recommendations
5.1 Introduction
In this chapter the researcher will present this study‘s conclusion and recommendations
for interventions based on the data that was collected, analysed and interpreted and
recommendations for future research. This study has shed some light to better
understand the importance of group therapy on addressing fear of stigma among the
5.2 Discuss the results
5.2.1 Characteristics of research participants
One of the most salient findings to emerge from this study is that the entire
research population consisted of women being carers. A conclusion drawn on
this fact is that care giving seems to attract more women than men, a view that
authors such as Leake (2009), Mehta & Gupta (2001) as well as Mohammad and
Gikonyo (2005) support in their studies. The study further showed that the
research respondents were all close family members to the children under their
care, something which Thompson (2006) explained in his study. He explained
that the extended family system in many community continue to play a vital role
in caring for children, after the parents died of AIDS or suffers from HIV/AIDS,
in which the care of relatives is presumed important than if the children are cared
by people that are not related to them.
5.2.2 Stigmatisation
The findings in graph no.1 (see chapter 4) revealed stigma as slowing guardians’
provision of care to the children. HIV/AIDS related stigma persists in Namibia;
many respondents fear isolation and alienation from their communities and
families. Guardians has become associated with “having AIDS,” causing many
of them to be reluctant to disclose the child’s HIV status. Guardian’s services to
the children are sometimes not utilized because of this stigma. Many guardians
refuse to disclose the child’s status because “once you disclose the status,
everybody in the community knows that the child is an AIDS patient” (Metha
and Gupta, 2001). Although more tolerant attitudes towards HIV/AIDS have
been promoted through many programmes in the country, discriminatory

34
attitudes among family members still exist to a small degree. Mabusela (2010)
explained that disclosure is the key to good relations between the caretakers and
the person living with HIV/AIDS and better care that may impact on the general
well-being of the patient, thereby improving the general health status of the
patient. Most the guardians still fear the abuse and stigmatisation by their
communities, families and friends associated with HIV/AIDS, especially in
cases where the guardians want to disclose the child’s HIV status. Caretakers
should be encouraged to share their patient’s status so that they can be cared for
effectively, and so that caretakers/givers can also ensure protection of both the
patient and themselves.
5.2.3 Group therapy in addressing fear of stigmatisation
The findings revealed that group therapy are important in reducing fear of stigma
among guardians of children living with HIV/AIDS. As many researchers has
emphasised the need for group intervention the result of this study shows the
importance group therapy/counselling in addressing fear of public stigma among
the guardians of children living with HIV/AIDS. Due to stigma, guardians of
HIV/AIDS children find it hard to disclose their children status.
Corney and Jenkins (1995) explained counselling as a skilled and principled use
of relationships to develop self-knowledge, emotional acceptance and growth,
and personal resources. The overall aim is to live more fully and satisfyingly. In
the group therapy which was conducted with the respondents, they were
encouraged to share the status of the children especially to the children, relatives
and close friends so that they can be supported effectively both the patient and
themselves, and so that children can also play a role in his/her treatment.
5.3 Contribution of the research to the social work practice and profession
Information established by this study would be helpful in the planning,
implementation and monitoring of programme and interventions aimed at addressing
fear of public stigma among guardians/caretakers of children/people living with
HIV/AIDS. It will be useful in helping the social workers in strengthening the coping
capabilities of the guardians themselves, and the children living with HIV/AIDS with
stigma associated with their illness. In addition, this information can be used to

35
support the establishment and strengthening of structures, systems, and policies on
stigma to support children living with HIV and their guardians.
The finding of this study will also help the Social Worker to realise the importance of
group work intervention in the profession. It’s important for Social Workers
especially Medical Social Workers to introduce formal group either therapy,
counselling or support at their respective work place, where both the people living
with HIV/AIDS and their caregivers i.e. mostly family members can share their
caring experiences with each other, because peer networks can also help in addressing
stigma associated with HIV/AIDS in Namibia.
5.3 Limitations of the Current Research Project
The findings of this study have identified and recognised the following as limitations:
According to De Vos et al (2011, p.168-169), the implementation of the single system
design can be very time consuming and generalisations cannot be drawn from single-
system designs. In the case of this study, the sample size in this study was small, so it’s
difficult to generalise the findings and the findings can only be suggestive.
Time was too long (10 sessions for group intervention with the respondents) and one
cannot fully say the interventions which were implemented caused change in the
respondents, as other factors that happens in the respondent’s life might have caused the
change.
The group sessions were conducted in Oshiwambo and this was difficult for the
researcher to translate group work theories and other words which were used in
oshiwambo. The study put less emphasis on the coping mechanisms of guardians, as
more time was spent on understanding the fear of guardians regarding stigma.
5.4 Directions for future study
It is recommended that further research be undertaken to investigate the importance of
group therapy in addressing the fear and more emphasise of coping mechanism to
overcome this fear of guardians of children living with HIV/AIDS in Outapi District.
Such a study will enable the researcher to draw a more generalised conclusion about

36
guardians in Outapi District and can suggest a community-based approach to support the
guardians. This would therefore address the first limitation of this study.
More research should be considered on the impact of the stigma on both the guardians
and children in order for Social Workers to develop possible programme which can help
in addressing this issue. This kind of research will enable Social Workers to have a
better understanding of the impact of HIV/AIDS stigma on caregivers of people living
with HIV/AIDS, thereby improving the kind of services rendered to both the caretakers
and patients, which will enhance their well-being and enhancing the quality of life.
Future research can also try to include key informant such as social workers, nurses, and
children in their study in order to get different perspectives.
5.5 Conclusions
The finding shows that there was a decrease from 3.6% to 1.27% average of respondents
respect to their fear of HIV/AIDS. In this study, it has been observed that most
respondents are afraid to disclose the child’s status either to the child, family or
community members, because of the fear to be stigmatised by the public. As disclosure
is the ingredients to a healthy relationship between the patient and caretakers, the study
results show the importance of group interventions in reducing the fear of public stigma
among the guardians of children living with HIV/AIDS. The group therapy emphasised
the importance of disclosure in management of HIV and AIDS. The extended families
are now overburdened with the care of orphans and vulnerable children and the
provision of quality care is not an easy task at all. There is a growing need to establish
group therapy programmes strengthen the caretakers to provide psycho-social support so
as to ensure that they take care of themselves and children in HIV/AIDS arena.
5.6 Recommendations
This section covers recommendations for intervention by Social Worker in the Ministry
of Health and Social Services Outapi District.
Implementation of educational programme to demystify HIV/AIDS, with the goal of
alleviating the fear and stigma associated with the disease among guardians of children
living with HIV/AIDS in Omusati region. The Ministry of Health and Social Services
need to provide a closer collaboration with household members, through educational

37
interventions regarding care giving, safety, and decreasing the burden of care giving on
women. Strengthen referral networks between formal health services (nurse, doctors and
community counsellor at CDC) and caregivers of people living with HIV/AIDS. Social
Worker needs to provide additional psychosocial and emotional support for caregivers
through introducing therapy groups for guardians of people living with HIV/AIDS. As
peer networks can also help guardians from the surrounding villages in Outapi District
to interact with others with the same problem and share their feelings and experiences.
There is a general need for more research in other specific communities such as Outapi
District, which has not received much attention, especially in the context of HIV/AIDS
and guardians’ coping mechanisms to HIV/AIDS stigma. This will help Social Workers
to establish more group therapy sessions for these guardians.

38
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41
CONFIDENTIAL
My name is Elizabeth Hishishii Shilyomunhu. I am pursuing my Bachelor of Arts Degree in
Social Work at the University of Namibia. I am currently conducting a research study on the
effectiveness of group therapy in addressing the fear of public stigma among guardians of
children living with HIV/AIDS in Outapi District. Your kind co-operation to complete this
questionnaire will be highly appreciated.
Please note that all information collected will be treated with confidentiality. Your honesty in
answering the questions in this questionnaire will play an important role in the findings of
this research.
Respondent no.................... (Write your date of birth e.g.07)
Please read the following questions carefully before you answer. Indicate your answer
by ticking the answer that applies in the spaces provided.
SECTION A – IDENTIFYING INFORMATION
1. What is your gender?
Male
Female
2. Kindly indicate your age group by ticking the appropriate answer
30-40
41-50
51 and older

42
3. Kindly indicate your relationship with the child under your care by ticking
Aunt
Grandmother
Section B- This questionnaire will take you about 10 minutes to complete. Carefully read
each of the 8 statements listed below and on a scale of one to five (1-5) with one being less
often and five very often, how would you rate your fear of public stigma.
NB: Circle the right number
4. Sometimes I feel that I am being talked down to because am looking after someone with
HIV/AIDS.
1 2 3 4 5
5. I do not feel bad about having to look after a child leaving with HIV/AIDS.
1 2 3 4 5
6. I worry about telling people I take care of a child whose HIV positive.
1 2 3 4 5
7. I am scared of how other people will react if they find out that am looking after a child
living with HIV/AIDS.
1 2 3 4 5
8. I do not mind people in my neighbourhood knowing that am taking care of a child living
with HIV/AIDS.
1 2 3 4 5
9. I feel the need to hide the HIV status of the child under my care from the child.

43
1 2 3 4 5
10. I feel the need to hide the HIV status of the child under my care from my friends
1 2 3 4 5
11. I feel the need to hide the HIV status of the child under my care from the whole
community.
1 2 3 4 5
THANK YOU FOR YOUR PARTICIPATION!

44
RESEARCH PARTICIPANT INFORMATION AND CONSENT FORM
TITLE: “An investigation on the effectiveness of group therapy in reducing fear of public
stigma among guardian of children that are living with HIV/ AIDS in Outapi district.”
PRINCIPAL INVESTIGATOR
Ms. Elizabeth Hishishii Shilyomunhu
P.O.Box 544
Outapi, Ombalantu,
Namibia
264 (0) 813601231
PURPOSE: To evaluate the effectiveness of group therapy interventions in reducing fear of
public stigma on guardians of children living with HIV/AIDS in Outapi district.
PROCEDURES: Respondent will be required to attend ten sessions of a therapy group.
Whereby structured interview will be conducted in a form of pre- and post-test questionnaires
that will be conducted during the initial stage of the group and ending stage of the group
therapy, during this interview the researcher will test the level of fear of public stigma in each
guardian. During this time of group therapy, both the researcher and guardians will focus on
various topics pertaining HIV/AIDS stigma in order for the researcher to gain more
understanding about guardians fear of public stigma and guardians will acquire new
knowledge and skills to overcome their fear.
RISKS AND BENEFTIS:
Your participation in this study may contribute to knowledge that may be used to reduce fear
of public stigmatization among caretakers of children living with HIV/AIDS in Outapi
district and the whole Namibia at large. If you choose to participate in this study which
contains minimal risk, you do not have to talk about any subjects you do not want to talk
about, and you can stop the group interview at any time.
CONFIDENTIALITY:
In order to minimize any risk to you, all information you provide will be regarded as highly
confidential and will be used only in ways that preserve its confidentiality. The researcher

45
will not tell anyone the answers you give the researcher, however, information from the study
and the consent form signed by you may be looked at or copied for research purposes by the
researcher or my supervisor. The questionnaires are anonymous, and you are not asked for
any identifying information, such as your name or hometown. Findings will be presented in a
way that preserves the confidentiality of the participants, and will be framed in terms of
recommendations that may enhance future benefits for other guardians who are taking care of
children living with HIV/AIDS.
OTHER INFORMATION
Your participation in this study is completely voluntary, and you may choose not to
participate without any penalty. Approximately eight (7) guardians are expected to
participate. If you change your mind, you may stop participating at any time by simply
declining to complete the group interview. If at any time you are uncomfortable answering
any question on any questionnaire, or in an interview session, you may skip it and go on to
the next. Your participation is confidential.
SUBJECT’S STATEMENT:
I have read the information in this consent form and have had an opportunity to ask questions
and to have them answered satisfactorily. I agree to participate in this study with the title ―
An investigation on the effectiveness of group therapy in reducing fear of public stigma
among guardian of children that are living with HIV/ AIDS in Outapi district. I hereby
acknowledge that I am participating in this group research voluntarily, am aware that I can
stop the interview at any time, and am not obliged to answer questions and disclosure
information that I am not comfortable with. I agree that the researcher can take note of
information shared in the group interview on condition that anonymity and confidentiality be
maintained.
Kindly receive my gratitude for your agreeing to participate in this study in advance.
Ms Elizabeth Shilyomunhu
.......................................... Date..............................................................
Researcher

46
P.O.Box 544
Outapi
Ombalantu, Namibia
Cell: 0813601231
E-mail: shilyomunhue@yahoo.com
04 June 2012
Private Bag 504
Outapi Hospital
Outapi, Namibia
Dear Dr. Njunguna
Re: Requesting for approval to conduct a research project in Outapi District
I am a registered student of the University of Namibia studying towards a Bachelor
(Honours) of Arts in Social Work. In order to complete my study, I have to do a research
project. I proposed to do a research on guardian’s of children living with HIV/AIDS in
Outapi district by conducting a study with the title- “An investigation on the effectiveness of
group therapy in reducing fear of public stigma among guardian of children that are living
with HIV/ AIDS in Outapi district.”
This study is targeting the guardians of children who get treatment from the Communicable
Disease Clinic (CDC) in Outapi hospital as a place for recruiting participants for the study. In
this study I would like to conduct a group therapy with these guardians for a period of ten
sessions. For more information about the proposed therapy group, please see the group work
proposal attached.
I would like to ask for the permission to recruit my research participants from the CDC clinic,
so that I can continue with my research project.
Thanking you in advice.
Yours Faithful
……………………………
Elizabeth Shilyomunhu
(Researcher)

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