Family economic strengthening and non-kin support networks for children orphaned by HIV/AIDS living in low resource communities in Uganda: A mixed methods approach

Abstract

This dissertation examined the extent to which a family-based economic strengthening intervention that utilizes child development accounts (CDAs) is associated with the creation and strengthening of relationships between non-kin support networks, defined as relationship ties not based on blood and marriage –for children orphaned by HIV/AIDS living in low resource communities in Uganda. This study draws from asset theory (Sherraden, 1991), which posits, in part, that asset-ownership creates an “asset effect.” The argument is that when individuals accumulate assets, society responds to them in a more positive way, leading to the creation of social capital in the form of social contacts and social networks. These social networks constitute a locus of access to resources, which in turn, determine and influence the individual’s social, economic and health outcomes (Coleman, 1988). For orphaned children living in low resource communities, with no public safety nets–where extended families are already overwhelmed by high numbers of children and poverty, informal sources of support, including those formed outside the extended family, may be one of the very few viable options to the survival and wellbeing of orphaned children. Therefore, based on the premise of asset theory, one would be justified to posit that an asset-based intervention may create an “asset effect” that would allow poor orphaned children to acquire social networks, including non-kin relationships, that might help them in times of need. This dissertation utilized a mixed methods approach. Specifically, longitudinal quantitative survey data collected from a NICHD-funded randomized clinical trial known as Bridges to the Future (2011-2016) in Uganda, designed to evaluate the efficacy of a family-based economic strengthening intervention for orphaned children in Uganda was analyzed. A total of 1410 orphaned children (average age of 12.7) participated in the Bridges intervention. Binary logistic regression analyses were performed, using data collected at baseline, 12-months and 24-months post intervention initiation. In-depth interviews were conducted with a sample of 38 participants selected from the same Bridges study, providing additional understanding and interpretation of the quantitative findings. Results from the study indicate the following: 1) orphaned children are socially isolated and the threshold for non-kin supportive services is so low –that usual care services provided to the control condition appear instrumental in children’s lives; 2) the intervention seems to have helped to strengthen the existing relationships with family members, and to ease the financial burden of taking care of orphaned children by providing financial resources, educational opportunities and health promotion resources to mitigate the risks of poverty and HIV/AIDS; 3) social support networks for orphaned children are very small, tend to vary by gender, and usually consist of individuals with similar economic situations and challenges; and 4) caregivers play an important role in the relationships their children form outside of their families. However, poverty, coupled with community mistrust and the stigma attached to orphanhood and seeking support outside of a family setting, limit orphaned children from participating in social relationships, as well as accessing and tapping into existing supportive community resources. Findings from this study indicate that the extended family system is still the primary and a major source of social support to orphaned children in poor communities heavily affected by the HIV epidemic. Therefore, in the absence of public safety-nets and public social welfare programs, building social assets over and above the provision of economic resources that could support extended families that are increasingly taking in orphaned children is critical.