Perceptions of factors contributing to psychological distress in HIV positive children on antiretroviral therapy in Mochudi, Botswana : a family caregiver and health care worker analysis
Background: The repercussions of being HIV positive coupled by the complications of antiretroviral therapy are likely to cause distress, emotional and psychological problems particularly among children infected by the virus. The limited support services for children experiencing distress intensify the urgency to address this challenge. Despite the availability of social workers and nurses' interventions currently in place, the number of children in need of psychological care continues to increase. This is particularly true at Deborah Retief Memorial (DRM) hospital, one of the main antiretroviral therapy facilities in Kgatleng district, Botswana. Method: The purpose of this study was to explore and describe the perceptions of social workers, nurses and caregivers on key factors contributing to psychological distress of HIV positive children. A descriptive, exploratory qualitative study design that employed the use of in-depth interviews was used to conduct this study. Participants included four caregivers of HIV positive children who seek antiretroviral therapy at DRM hospital Infectious Diseases Control Clinic, together with five nurses and two social workers who worked in the same clinic. Conventional content analysis was used to analyse the in-depth interview transcripts. Results: Perceived psychological stressors for HIV positive children included disclosure of HIV status, orphanhood, social problems, lifelong treatment, stigma, poor caregiver-child relationship and lack of caregiver‟s love, care and support. However the caregivers did not fully understand the psychological distress the HIV positive children were experiencing, hence were unable to recognize it in these children. The study highlighted that major challenges faced by the health-workers included lack of qualified personnel, lack of adequate knowledge and skills, and a non-conducive working environment required to effectively assist children with psychological distress. The findings also indicated the need for education and support of caregivers and HIV positive children by the educators, family and health-worker systems. Conclusion: The profile of key stressors of psychological distress, the challenges and support needs suggested by the participants in this study can provide a framework for improving the existing services for HIV positive children with psychosocial problems. This information is important for use in training nurses and social workers involved with children with psychological behaviours.