The effects of Stress, Burnout on Orphans and Care givers
Care givers may experience stress for a variety of reasons, which can gradually build up until a person can no longer cope. But whilst it is invariably, caregivers who tend to suffer stress or burn out in an environment where a Person Living With HIV (PLHIV) has to be cared for, or has just died, children in the home are prone to such stress as well.

Last week we looked at the effects of HIV on childre, and the need for psychosocial support to help them cope. Today, with the complimentns of ALLIANCE (UNAIDS), we bring you more on the Psychosocial effects of HIV/AIDS on caregivers, as well as orphans and other vulnerable children.

Key psychosocial effects of HIV/AIDS on children are:
1. The effects of stress. Stress is an emotional condition, experienced or felt when an individual has to cope with unsettling, frustrating or harmful situations. It is a disturbing sense of helplessness, which is uncomfortable and creates uncertainty and self-doubt.

2. The effects of parental death.
3. Poor sense of identity. This particularly affects those children and young people who are in institutions. They have no parent or adult relative who can help them develop their own identity, within their own culture.

4. Behavioral problems. Some children and young people react to stress by becoming aggressive, withdrawing, taking drugs or drinking alcohol. These may be the way in which these children and young people cope with the stress they are facing. These have been called ‘negative defence mechanisms’.

5. Poor management of change. Parents assist their children to cope with changes that occur in their lives. Children without parents may lack this support, particularly if they have little contact with family or community members. This is particularly a problem for children and young people living institutions.

In general, psychosocial effects of HIV/AIDS describe the feelings and reactions experienced by children and young people when they are affected by HIV/AIDS in some way.

Effects on Carers
In addition to the psychosocial effects of HIV/AIDS on children, there are also effects on their carers. Adult carers may experience the feelings described above.

This section section looks at issues relating to people who provide care for orphans and other vulnerable children. It also looks at who these people are and examines, in particular, the problems of stress and burnout.

Key points about carers of orphans and other vulnerable children are:

1. Most orphans and other vulnerable children in developing countries are cared for by family members in the local community. These family members include surviving parents, grandparents, other adults and brothers/sisters. These people are a child’s primary care givers.

2. Although men are often identified as a child’s formal guardian, the burden of care falls mainly on women.

3. Care givers may experience stress for a variety of reasons. In some situations, this stress gradually builds up until a person can no longer cope. Their physical and mental health, personal relationships and standards of care may all suffer. This is referred to as ‘burnout’.

Carers of orphans and other vulnerable children
Most orphans and other vulnerable children in developing countries are cared for by family members in the local community. These family members include surviving parents, grandparents, other adults and brothers/sisters. These people are a child’s primary care givers.

Stress and Burnout
Care givers may experience stress for a variety of reasons. In some situations, this stress gradually builds up until a person can no longer cope. Their physical and mental health, personal relationships and standards of care may all suffer. This is referred to as ‘burnout’. Primary care givers may experience stress and burnout, as well as volunteers and professional staff.

Stress
Stress is an emotional condition, experienced or felt when an individual has to cope with unsettling, frustrating or harmful situations. It is a disturbing sense of helplessness, which is uncomfortable and creates uncertainty and self-doubt. Different things cause stress. Some of them are called ‘primary stress factors’. These include death or sickness of a parent. These may be made worse by other factors, such as loss of home, worsening poverty, dropping out of school, stigma and discrimination and separation from brothers and sisters. These are called ‘secondary stress factors’. Children and young people who are stressed often feel anxious and lacking in confidence. They may have a low opinion of themselves. In some situations, children/young people may become depressed. Depression is a deep sadness with long-term, harmful effects on a child’s health and development.

Signs of stress include:
* Physical symptoms, such as inability to sleep and bowel disturbances.

* Emotional problems including feelings of inadequacy, helplessness and guilt.

* Withdrawing from other people.

* Reduced quality of care.

* Worsening relationships with other people.

Stress is caused by a number of factors including:

* Poverty and its effects, including lack of resources to meet survival needs of both the child and carer. This includes lack of food and medicines.

* Interpersonal and family conflict. This is common within families affected by HIV/AIDS because the virus spreads mainly through sex. This often leads to people being blamed for ‘bringing the virus into’ the family.

* Isolation and fear for the future.

* Excessive workload.

* Stigma and discrimination relating to HIV/AIDS.

* Excessive personal involvement in issues relating to the child.

* Poor organizational arrangements. This applies particularly to secondary care givers. Issues include lacking a voice in the way things are done, inadequate support and lack of clarity over roles.

Stress and burnout can be managed by developing personal coping mechanisms and organisational strategies. Religious faith may be important as part of personal coping mechanisms. Organisational strategies include:

* Recognising that caring is stressful and that stress and burnout are complex.

* Ways of dealing with problems that carers can not deal with.

* Finding ways of showing that carers are valued.

* Providing carers with training.

* Relieving poverty and ensuring that activities are reliably funded.

* Effective stress management measures including regular time off, realistic workload, team meetings and participation in decision-making.