Psychosocial Adjustment among Orphan Children Living with HIV/AIDS

AIDS is the final stage of infection with the retro-virus HIV. This disease not only affects the individuals’ physical health, but it also affects the psychological health and the adjustment of an individual towards oneself and his surrounding environment. The objective of the present study is to understand the level of psychosocial adjustment among orphan and non-orphan children living with HIV/AIDS. Adjustment inventory was administered to 400 orphan and non-orphan children living with HIV/AIDS. Results indicated that orphan children with HIV/AIDS were having lower level of adjustment than non-orphan children with HIV/AIDS. Within the orphan children with HIV/AIDS the girl and rural children were having lower level adjustment compared to the boy and urban children. The study suggested the need for specific interventions to improve adjustment of the orphan children with HIV/AIDS.

developments in treatment take place (Altman, 2002). According to National Aids Control Organization (NACO) report 2009-10, India has 2.27 million HIV-infected persons, the third highest in the world after South Africa and Nigeria. The Karnataka State Aids Prevention Society's (KSAPS) Consolidated ART report July 2012, the scenario of Karnataka state is 0.223 million adult and 0.016 million children are registered for Anti Retroviral Therapy (ART).
AIDS is the final stage of infection with the retro-virus HIV. This virus gradually impairs the immune system which is crucial for the suppression of infections, viruses and bacteria. As the immune systems weakens, HIV infected person becomes infected with opportunistic infections. HIV/AIDS is a chronic disease and without treatment persons will eventually die. According to Tate et al. (2003), the new advances for treatment of HIV using Highly Active Antiretroviral Therapy (HAART) have dramatically improved disease prognosis. Antiretroviral therapy (ART) in children preserves or restores immune function; provides sustained suppression of the viral load; promotes or restores normal growth and development; improves the quality of life; prevents complicating infections and cancers; and prolongs the child's life. Yet an outright cure remains elusive, leaving persons with the challenges of living with a chronic medical condition. Orphan children with HIV positive can live a longer life because of medical advances like ART, but treatment programs have not been able to eradicate the virus and cure the disease. As a result, orphan children are living longer with a chronic condition that continuously presents physical, psychological and social challenges. Like all patients with chronic medical disorders, HIV-infected children also are at increased risk for specific psychiatric and psycho-social adjustment problems.

Adjustment
The term adjustment is often used as a synonym for accommodation and adaptation. Strictly speaking, the term denotes that the results of equilibrium, which may be affected by either of these processes (Monroe, 1990). It is used to emphasize the individual's struggle to get along or survive in his or her social and physical environment. Several factors are thought to influence the psychosocial adjustment of orphan children born with HIV infection.
These factors include (a) the presence of HIV in the central nervous system during fetal development and throughout childhood, (b) co-occurring medical conditions and complications of HIV disease, including body image issues, (c) teratogenic effects of drug and alcohol during the prenatal period, (d) cognitive and neurological deficits, (e) other psychosocial factors (maternal illness, multiple separations, transitions, and losses), (f) whether the child knows his or her HIV status and (g) environmental factors (Brown et al., 2000;Gaughan et al., 2004;Lwin and Melvin, 2001;Mellins et al., 2003). Environmental factors affecting families living with HIV include poverty, violence, racism, overcrowding, single-parent households (Armistead and Forehand, 1995). Such factors also would likely increase the risk of psycho-social adjustmental problems in orphan children living with HIV/AIDS. Orphan children living with HIV/AIDS are considered as highly deprived class of society. These children are left helpless, abandoned, neglected by the parents/ caregivers due to social, economic and personal reasons like gender, domicile, age, etc. They are deprived of one or more necessities of life. Early separation from parents, deprivation of parental care, love, affection, warmth, security, acceptance and discipline during childhood disrupts their normal educational development resulting in adjustmental problems. Makame, Ani and McGregor (2002) found that orphans had increased internalizing problems compared with non-orphans. In Ethiopia, Bhargava (2005) found that Children orphaned by AIDS showed more emotional and social adjustment problems, and girls reported higher levels of difficulties than boys. Atwine et al. (2005) found that rural orphans were more likely to be anxious, depressed and to display anger, showed significantly higher scores for feelings of hopelessness and suicidal ideation.
A study in Uganda had observed also girls with HIV/AIDS have lower education adjustment, knowledge, self-confidence and self-esteem (FAWE, 2000). However, it was also observed that school drop-out rates were higher among females students (7.6%) compared to males (6%) in Uganda (Baguma and Muhanguzi, 2000). Most of the reasons for female school dropout were due to family socio-cultural reasons including illness of parents due to HIV/AIDS or orphan hood due to HIV/AIDS or other causes (Baguma and Muhanguzi, 2000). Other sociocultural reasons included the gender inequality accorded to girls (Uganda Bureau of statistics, 2006). Boys were generally provided with the opportunities to continue with their education uninterrupted, while girls were usually requested by their families to stay at home to continue providing household services in the event of illnesses or demise of their parents (Baguma and Muhanguzi, 2000;Uganda Bureau of Statistics, 2006). It should be noted here that, orphan hood due to HIV/AIDS has been one of the greatest effects of HIV/AIDS on school girls' education in Africa leading to school absenteeism during their parents' illnesses and emotional stress manifested in inappropriate behavior (Baggaley and Needham, 1997;Yun, 2001;Wahl, 2001). Therefore, based on these supporting findings, it can be said that the emotional support within the fostering family will play a crucial role in the development of children.
So it becomes necessary to know whether HIV infected children who are devoid of family life with the emotional warmth grow up normally? How well they are able to cope with themselves and adjust to the demands of the environment/society around them? In this context the present study attempts to know the level of psychosocial adjustment of orphan children living with HIV/AIDS. Outcome of investigation will provide the way and need for appropriate counselling, guidance, care and support to overcome their adjustment problems.  Table 1: shows the mean SD and t values for psychosocial adjustment of the orphan and the nonorphan children living with HIV/AIDS. On social adjustment the orphan children (Mean=12.53; SD= 1.835) scored higher than the non-orphan children (Mean=11.96; SD=1.790) and t value (3.117; p<.002) indicating a high significant difference. The orphan children were having significantly lower adjustment than the non-orphan children in social adjustment. On emotional adjustment the orphan children (Mean=14.68; SD= 1.701) scored higher than the non-orphan children (Mean=14.11; SD=1.869) and the t value (3.219; p<.001) indicating a high significant difference. The orphan children were having significantly lower adjustment than the non-orphan children in emotional adjustment. On educational adjustment the orphan children (Mean=13.33; SD= 1.818) scored higher than the non-orphan children (Mean=12.43; SD=1.820) and the t value (4.948; p<.001) indicating a high significant difference. The orphan children were having significantly lower adjustment than the non-orphan children in educational adjustment.

RESULTS AND DISCUSSION
On the overall adjustment the orphan children (Mean=40.47; SD= 3.995) scored higher than the non-orphan children (Mean=38.48; SD=4.364) and the t value (4.948; p<.001) indicating a high significant difference. The orphan children were having significantly lower adjustment than the non-orphan children in overall adjustment. Therefore, the formulated H 1 ; the orphan children with HIV/AIDS have lower social, emotional and educational adjustment than the non-orphan children with HIV/AIDS, is accepted.  .581) and the F value (31.813; p<.001) indicating a high significant difference. The rural orphan children were significantly lower than the urban orphan children in social adjustment. The interaction effect between gender and domicile on social adjustment (F=15.583; p<.001) is also found to be highly significant. Table 3: shows the mean SD and F values for emotional adjustment of boys/girls and rural/urban orphan children with HIV/AIDS. On the emotional adjustment the orphan girls (Mean=15.29; SD= 1.409) scored higher than the orphan boys (Mean=14.07; SD=1.754) and the F value (29.008; p<.001) indicating a high significant difference. The orphan girls were significantly lower than the orphan boys in emotional adjustment. On the emotional adjustment the rural orphan children (Mean=14.97; SD= 1.749) scored higher than the urban orphan children (Mean=14.39; SD=1.607) and the F value (5.715; p<.018) indicating a high significant difference. The rural orphan children were significantly lower than the urban orphan children in emotional adjustment. The interaction effect between gender and domicile on emotional adjustment (F=.931; p<.336) is found non-significant.    p<.001) indicating a high significant difference. The orphan girls were significantly lower than the orphan boys in overall adjustment. Therefore, the formulated H 2; the orphan girls with HIV/AIDS have lower social, emotional and educational adjustment than the orphan boys with HIV/AIDS, is accepted.

Table 3: shows the mean, SD and F values for Emotional Adjustment of boys/girls and rural/urban orphan children with HIV/AIDS.
On the overall adjustment of orphan rural children (Mean=41.81; SD= 4.498) scored higher than the orphan urban children (Mean=39.13; SD=2.866) and the F value (27.686; p<.001) indicating a high significant difference. The orphan rural children were significantly lower than the orphan urban children in overall adjustment. Therefore, the formulated H 3 the orphan rural children with HIV/AIDS have lower social, emotional and educational adjustment than the orphan urban children with HIV/AIDS, is accepted. The interaction effect between gender and domicile on overall adjustment (F=14.118; p<.001) were highly significant. Therefore, the formulated H 4 ; there is an interaction effect between gender and domicile on social, emotional and educational adjustment of the orphan children with HIV/AIDS, is accepted.
The overall result indicates that the orphan children have lower social, emotional and educational adjustment than the non-orphan children living with HIV/AIDS. When we consider only orphan