HIV/AIDS-affected children’s need for psychological counseling in response to difficulties in learning

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This article focuses on the study of the psychological difficulties of 322 HIV/AIDSaffected children and evaluated differences among various groups in psychological difficulties. The study’s results provide an important basis to help psychologists propose appropriate measures to meet the need of HIV/AIDS-affected children to help them overcome the difficulties arising in learning.

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HNUE JOURNAL OF SCIENCE DOI: 10.18173/2354-1075.2017-0186 Educational Sciences, 2017, Vol. 62, Iss. 12, pp. 165-175 This paper is available online at http://stdb.hnue.edu.vn HIV/AIDS-AFFECTED CHILDREN’S NEED FOR PSYCHOLOGICAL COUNSELING IN RESPONSE TO DIFFICULTIES IN LEARNING Pham Van Tu Faculty of Social Work, Hanoi National University of Education Abstract. This article focuses on the study of the psychological difficulties of 322 HIV/AIDS- affected children and evaluated differences among various groups in psychological difficulties. On this basis, the article analyzes the need for psychological counseling of HIV/AIDS-affected children, assesses the relationship between children’s psychological difficulties of learning and the need for psychological counseling for learning as well as gender differences in the need for psychological counseling when facing difficulties in study, expectations of HIV/AIDS-affected children on the form and method of psychological counseling. The study’s results provide an important basis to help psychologists propose appropriate measures to meet the need of HIV/AIDS-affected children to help them overcome the difficulties arising in learning. Keywords: Psychological counseling, need for counseling, psychological counseling for learning, HIV/AIDS-affected children. 1. Introduction The right to assess to education of children in general and HIV/AIDS-affected children in particular has received special attention from the Communist Party of Vietnam and the Vietnamese Government so that to assist this group of children may integrate better at school. The national action plan for HIV/AIDS-affected children to 2010 and by 2020 of the Ministry of Labor, Invalids and Social Affairs has underlined the right to education of this group [18]. Article 10 of the Education Act 2005 states that: "… Educational institutions are prohibited from performing the following actions to HIV-positive people: Refusal to accept HIV-infected students; taking disciplinary actions against students and/or expelling students from schools because they are infected with HIV” [9]. Although the right to education has been specified in the law, HIV/AIDS-affected children have difficulty in attending classes together with non-HIV infected children. Many parents do not easily agree on their children studying with HIV-infected children, although this act violates the law. This is one of the factors causing pressure on the education sector in ensuring the right to education for HIV/AIDS- affected children. In our study, HIV/AIDS-affected children who face psychological difficulties were children in their transitional period from primary school to junior high school. Being affected by HIV/AIDS makes them more venerable to stigmatization and discrimination in learning. As a result, they were unable to solve their psychological difficulties in learning but they need psychological counseling. There is a research on related issues from authors Cooper, Risley, Drake & Bundy (2007) showing that in classes, the children affected by HIV/AIDS are stigmatized and discriminated. Their teachers Received: November 17, 2017. Revised: December 21, 2017. Accepted: December 23, 2017. Contact: Pham Van Tu, e-mail address: tupv@hnue.edu.vn 165
Pham Van Tu and classmates are insensitive to the needs of them. Thus, these children are vulnerable, ashamed and have deteriorated health which affects to their attendance frequency. Outside the classes and schools, the HIV affected-children have difficulties in accessing entertainment activities in comparison with their peers [4]. The authors Bezuidenhoudt (Namibia University), Elago (Namibia University Science and Technology), Kalenga (Namibia University), Salome Klazen (Namibia University Science and Technology), Nghipondoka (Namibia University) and Ashton (Namibia University) concentrated on psychological effects of HIV/AIDS viruses to the people living with it and their caregivers. Another research has also shown the effects on the children affected by HIV/AIDS which are feelings of fear, worry, sometimes blaming on themselves because they don’t understand their living circumstances, feeling the burden on their shoulders, angry or careless, poor learning or drop out etc. [2] Another research on 800 children including 400 ones living with HIV/AIDS and 400 other without HIV/ AIDS by Ravikumar and Sampathkumar (2012) found out that the children living with HIV/AIDS have more social, emotional and educational problems than those without HIV/AIDS. Girls and children living with HIV/AIDS in rural areas have more social and emotional problems than boys and children living in urban areas [15]. A study on the needs of HIV/AIDS affected children in Scotland by Cree (2009, granted by the AIDS Foundation Elton John) revealed that the more people infected by HIV, the more children affected by HIV obviously. Thus, the direct and non-direct policies on HIV and services for children need to meet the requirements of them [5]. Results of Mhaka- Mutepfa’s study (2010) on 105 orphaned children and AIDS, HIV/AIDS affected children (50 elementary and 55 secondary students), 49 boys and 56 girls (average age 13.2) showed that orphans can get educational support in the form of fees from cathedral and civil organizations as well as social welfare funds, or medical and material assistance [10]. The Community-Based HIV/AIDS Relief Program of PWDS-Alliance and India offers direct services to AIDS affected-children such as psychological support, health care, food and nutritional supports, economic and educational supports [16]. In Vietnam, there are some related researches. The typical one is Nguyen Thi Phuong Trang’s study (2010) on psychological counseling needs of children affected by HIV/AIDS (orphans) living in the center for at-risk children in Da Nang City (Hy Vong Village). This shows that this group of children has the most difficulties in learning. The counseling expectation level of these children is much higher than the rate of the children who don’t want to be counseled [17]. Another group of authors Nguyen Van Cư, Pham Van Tu (2012) confirmed that HIV affected-children meet a lot of psychological difficulties including psychological difficulties in learning. Based on that conclusion, the authors evaluated their counseling needs to solve these problems. They also studied the difficulties encountered by children affected by HIV/AIDS when participating in inclusive education [6, 7]. With similar researching orientation, an article entitled “The needs and the responses of health care for children who are infected and affected by HIV/AIDS in Soc Son district, Hanoi” by Phan Van Tuong, Pham Thi Hong and Nguyen Nguyen Ngoc (2012) has identified the needs and responses for HIV affected-children. They also found out some barriers affecting the fulfillment of their needs as well as counseling needs of those children [19]. There have been several investigations on psychological counseling on coping with learning difficulties for students, particularly HIV affected-children (Pham Thanh Binh, Pham Thanh Binh, Pham Thanh Dang Hoa, et al., Nguyen Thi Mui, Nguyen Thi Thanh Hong, Nguyen Thi Hai Thien, Tran Van Thanh, Do Thi Hanh Phuc, Nguyen Thi Hang Phuong, Nguyen Thi Phuong Trang, Women Research Center, Hanoi National University, Dinh Thi Hong Van) [3, 8, 11-14, 17, 20]. Accordingly, 166
HIV/AIDS-affected children’s need for psychological counseling when facing difficulties in learning it is advised that these kinds of students should be supported by counselors when they are under pressure and family expectations. In addition, areas that they have the most difficulties are concentrating ability, applying knowledge to do exercises because of over-load knowledge; they can’t understand and remember what they learn in classes. (Pham Thanh Binh, Duong Dieu Hoa et al., Do Thi Hanh Phuc) [3, 8, 12]. From above mentioned studies, there are obviously some international and Vietnamese studies related to the difficulties of HIV/AIDS affected-children’s lives, including learning difficulties. There are also some studies mentioning psychological counseling needs of those children but they are not systematic and deep enough. This article will discuss the psychological counseling needs of HIV/AIDS affected-children who have learning difficulties. 2. Content 2.1. Research methods This study was conducted on a sample of 332 HIV/AIDS-affected children aged 10 to 16. The main method was survey with two data collection tools: questionnaires combined with in-depth interviews to explore psychological difficulties in studying of HIV/AIDS-affected children and the need for psychological counseling of this group of children in learning. 2.2. Basic concepts Basic concepts used in this study include: - Psychological counseling: the process of psychological assistance based on positive interaction between the counselor and the client (individuals, families or groups). Counselors use professional knowledge and skills to understand clients’ feelings, thoughts and behaviors, help clients recognize their problems, resources and potentials in order to solve their problems effectively by themselves. - Demand for psychological counseling: eagerness to seek psychological support of individuals or groups when encountering psychological difficulties in cognition, attitudes and behaviors in decision making and implementation. Clients cannot overcome such difficulties by themselves so they need to share their problems with a psychologist for assistance in finding and implementing the best solution to their problems. - HIV/AIDS-affected children: including HIV-positive children and children at high risk of HIV infection (i.e. children having parent(s) dying of HIV/AIDS, children living with parents or caregivers infected with HIV, drug-abused children, sexually abused children, children of gender workers and drug users, children who are victims of human trafficking, street children, orphans; children living in social protection centers and reformatories) [1]. - HIV/AIDS-affected children’s psychological difficulties in learning: the shortage of psychological qualities which are necessary for learning activities, hindering learning activities. - Demand on psychological counseling for learning of HIV/AIDS-affected children: HIV/AIDS- affected children’s desire to be supported psychologically when they encounter difficulties in learning. They have a need to share their problems with psychologists to help resolve difficulties in learning with the most effective way based on exploiting their potentials and mobilizing surrounding resources to solve the difficulties in learning. 167
Pham Van Tu 2.3. Research results Psychological difficulties in learning and the need for psychological counseling in learning of HIV/AIDS- affected children Learning is always an important activity in personality development of HIV/AIDS- affected children at adolescence. The most common manifestations of learning that can lead to the need for psychological counseling are scientific management of time, grade pressure, exam stress, preoccupation with identifying personal strengths and weaknesses in learning. Besides, children also face difficulties in forming learning habits and improving learning skills, for example, how to understand lectures, pay attention to lectures, exchange knowledge with their teachers and friends, apply gained knowledge to solve exercises, remember the content learned in class, speak boldly to contribute to lectures, combine hearing and taking notes, etc. a) HIV/AIDS-affected children’s expressions of psychological difficulties in learning To evaluate HIV/AIDS-affected children’s expression of psychological difficulties in learning, we conducted a survey with 322 HIV/AIDS-affected children. They were asked about their expressions of psychological difficulties in learning, including 7 different expressions. The results are shown in the following table: Table 1. HIV/AIDS-affected children’s expressions of psychological difficulties in learning Percentage Expressions of psychological Not Somewhat Very Mean SD Difficult difficulties in learning difficult difficult difficult (3) (1) (2) (4) 1. Concentrating on lectures in 1.88 0.85 37.6 41.8 15.8 4.8 class 2. Understanding lectures 2.08 0.92 29.7 41.8 19.4 9.1 3. Confidentially exchanging knowledge with teachers and 1.99 0.99 39.4 31.5 19.4 9.7 friends 4. Making use of obtained 2.02 0.92 31.5 44.2 14.5 9.7 knowledge to solve exercises 5. Remembering contents of 1.91 0.87 37.0 41.2 15.8 6.1 lectures in classroom 6. Speaking boldly to 1.96 1.02 41.8 32.7 12.7 12.7 contribute to lectures 7. Combining hearing and 1.76 0.92 52.1 25.5 17.0 5.5 taking notes Group mean 1.94 0.69 Note: Lowest point = 1, Highest point = 4; higher point means more psychological difficulties children have Table 1 showed that, in general, HIV/AIDS-affected children faced medium psychological difficulties in learning (mean=1.94). Among 7 expressions of HIV/AIDS-affected children’s psychological difficulties in learning, the most difficulty lay in "understanding lectures" (mean = 2.08). There were many reasons for having difficulty in understanding lectures: inability to join group learning due to preoccupation with earning money for the family, limited learning ability, inability to 168
HIV/AIDS-affected children’s need for psychological counseling when facing difficulties in learning understand lectures, etc. Thus, both subjective and objective factors caused HIV/AIDS-affected children’s difficulty in "understanding lectures". The next difficulty was difficulty in "applying learnt knowledge to solve exercises" at the mean of 2.02. The third common difficulty was difficulty in "being confident on exchanging knowledge with teachers and friends" (mean = 1.99), and the last one was difficulty in "combining hearing to and taking notes" (mean = 1.76). Interviews with children revealed that they usually practiced taking notes while listening to lectures. As a result, this activity posed less difficulty for children. Expressions of psychological difficulties in learning are shown in the following chart: 2.1 2.08 2.02 2.05 1.99 1.96 2 1.91 1.95 1.88 1.9 1.85 1.76 1.8 1.75 1.7 1.65 Concentrating Understa- Being confident on Taking use of Rememb- Speaking boldly Combining 1.6 to class lectures nding exchanging learnt ering learnt to build hearing to and Tập trung Hiểu bài Tự tinknowlegd lectures trao Vậnwith dụng Ghi nhớ nộitoMạnh knowledge dạn Phốilectures contents hợp recording nghe giảng giảng đổi kiếnteachers thức kiến andthức dung học phát biểu nghe và ghi solve lectures friends xây dựng bài chép Chart 1. Level of HIV/AIDS-affected children’s psychological difficulties in learning (mean) Differences in assessment of HIV/AIDS-affected children in psychological difficulties After learning about the differences in assessment of HIV/AIDS-affected children in psychological difficulties, we obtained the following results (Table 2): Table 2. Differences in assessment of HIV/AIDS-affected children in psychological difficulties Difference in means (d) between Male Living with HIV-positive two groups of subjects and family and and HIV- female living in high-risk Psychological difficulties in learning (d1) center children (d2) (d3) 1. Concentrating on class lectures 0.35** *** *** 2. Understanding lectures 0.25 0.61 0.33* 3. Being confident in exchanging knowledge with 0.38*** teachers and friends 4. Making use of learnt knowledge to solve exercises 0.26*** 5. Remembering learnt contents 0.16* 6. Speaking boldly to contribute to lectures 7. Combining hearing and taking notes Group mean 0.19*** 0.55** 0.33** Note: The table indicates only statistically significant indexes with d* when P < 0.5; d** when P
Pham Van Tu - In terms of gender: The results in the above table showed that there were statistically significant differences in the expressions of psychological difficulties in learning between boys and girls (difference in means = 0.19, P
HIV/AIDS-affected children’s need for psychological counseling when facing difficulties in learning Chart 2. HIV/AIDS-affected children’s need for psychological counseling in learning (mean) The above chart shows that, in general, when facing psychological difficulties in learning, HIV/AIDS-affected children had a moderate need for psychological counseling, with the mean >2. HIV/AIDS-affected children’s most prominent need for psychological counseling was in "Applying their learnt knowledge to solve exercises" (mean = 2.5). This is a very important skill in learning process of HIV/AIDS-affected children. If done well, this skill will help them a lot in learning at school. Therefore, children sought psychological counseling in order to help them apply learnt knowledge to solve exercises. In an in-depth interview, a pupil named N.V.N of 8th grade in the province of Quang Ninh (who lived with his grandmother; his parents had died because of HIV/AIDS), said that "I do not face many difficulties in learning, but I still want to be involved in psychological counseling, particularly counseling to help me apply my knowledge to solve exercises, since sometimes although I understand lectures but I encounter many difficulties when applying it to solve exercises". The children’s second highest need for psychological counseling was in "understanding lectures" (mean = 2.47). Children looked for psychological counseling to be able to understand lectures in class. The third highest need for psychological counseling was "Concentrating to lectures in classroom" (mean = 2.45). The lowest need for psychological counseling was "combining hearing and taking notes" (mean = 2.18).  HIV/AIDS-affected children’s need for psychological counseling when having difficulties in learning To learn about the relationship between psychological difficulties in learning and the need for psychological counseling in learning of HIV/AIDS-affected children as well as gender differences in the need for psychological counseling in learning, we assessed the level of need for psychological counseling and obtained the following results: 171
Pham Van Tu Table 3. HIV/AIDS-affected children’s need for psychological counseling when having difficulties in learning (%) Level of needs for Low Middle High psychological N % N % Significance counseling N % Criteria 28.6 50.0 21.4 Low 8 14 6 14.3 7.1 11.1 Levels of 23.7 63.4 12.9 Middle 48 128 266 P < 0.001 difficulty 85.7 64.6 48.1 0.0 71.8 22.8 High 0 56 22 0.0 28.3 40.7 12.7 64.6 22.8 Male 20 102 36 35.7 51.5 66.7 Gender P < 0.01 24.0 64.0 12.0 Female 56 198 54 64.3 48.5 33.3 Note: In column (%): line 1 indicates % by row, line 2 indicates % by column Comparing the percentage of different groups of HIV/AIDS-affected children who need psychological counseling when facing difficulty in learning, we found no statistically significant difference in the level of difficulty in learning. This means that: Children encountering many psychological difficulties in learning would have a high (22.8%) or moderate (71.8%) need for psychological counseling. Children encountering few psychological difficulties in learning would still have a high need for psychological counseling (21.4%). In terms of gender, we found a significant difference in the need for psychological counseling in learning between boys and girls, in which boys needed psychological counseling more than girls (22.8% versus 12%). This result was consistent with the finding that boys were more troubled psychologically than girls.  The influence of forms and methods of psychological counseling on the need for psychological counseling in learning of HIV/AIDS-affected children The need for psychological counseling may be satisfied through various forms and methods of psychological counseling, such as direct counseling (i.e. psychological counseling to individuals, families, groups, communities), indirect counseling are shown in Table 4. Table 4 showed that among the forms and methods of psychological counseling, children had the highest need for "Direct through common activities, learning, playing" (mean = 2.87). Although our study on HIV/AIDS-affected children mainly in their early adolescence, they still want direct 172
HIV/AIDS-affected children’s need for psychological counseling when facing difficulties in learning psychological counseling through common activities, learning, playing. This might help them easily overcome psychological difficulties in learning. Table 4. HIV/AIDS-affected children’s need based on forms and methods of psychological counseling (%) Level of needs for psycho Percentage % -logical counseling Mean SD No Low Moderate High Form and method of desire desire Desire desire psychological counseling 1. Indirect by mail 1.99 0.98 38.5 34.6 16.7 10.3 2. Indirect via telephone 2.25 1.01 28.8 29.5 29.5 12.2 3. Indirect via radio 1.76 0.92 50.6 30.1 12.2 7.1 4. Indirect via Internet 2.6 1.13 35.3 23.1 22.4 19.2 5. Direct to individual at home 2.51 1.11 24.4 25.0 26.3 24.4 6. Direct to group 2.29 1.05 28.8 28.8 26.3 16.0 7. Direct to individual at office, 2.35 1.08 27.6 29.5 23.7 19.2 center 8. Direct through common activities, 2.87 1.99 11.5 21.8 35.3 31.4 learning, playing The second highest demand for psychological counseling was in the form of "direct to individual" (mean = 2.51). From in-depth interviews with children, we received similar answers. They wanted to seek psychological counseling to individuals at home because they were afraid of disclosing secrets of their own. At home, they would have more advantages to share their secret with people doing counseling. "Direct to individuals at office, center" (mean = 2.35) was the third popular form of psychological counseling chosen by children. A N.T.T in Ha Long, Quang Ninh province, in an in-depth interview, revealed "I look forward to meeting experts in the social protection centre who would give me useful advice and help me solve the difficulties in learning and in my life. I wish that the centre is located nearly my home so that I may easily go there for psychological counseling and the psychological counseling to children is free of charge”. "Indirect via radio" was least likely chosen (mean = 1.76). The reason the children gave was because they had no radio and they did not have a habit of listening to the radio; they felt shy and were worried of being mocked or having their secrets disclosed if they had to ask experts through the radio, etc. When investigating the need for HIV/AIDS-affected children’s psychological counseling in learning, in addition to understand the need based on forms and methods of psychological counseling, understanding about their expectations for the counselor is also very important. This is the basis for those who do psychological counseling for HIV/AIDS-affected children 173
Pham Van Tu 3. Conclusion The findings revealed that HIV/AIDS-affected children facing psychological difficulties in learning at the average level. There are differences in gender for psychological difficulties in learning where boys face more psychological difficulties than girls. There are differences in living places for psychological difficulties in learning where children living with family face more psychological difficulties than those living in the social protection centers. HIV-infected children are more psychologically troubled than HIV-high-risk children. When facing psychological difficulties in learning, children have the need for counseling to address such difficulties. In general, children need psychological counseling at a moderate level. There is a significant difference in the need for psychological counseling between boys and girls (boys need psychological counseling in learning more than girls), difference in the degree of psychological difficulty in learning (higher psychologically troubled children have higher need for psychological counseling). HIV/AIDS-affected children also seek appropriate forms and methods of psychological counseling. Their most popular desire is to be psychologically counseled directly at home. Based on these results, psychologists can propose appropriate psychological measures to meet the needs for psychological counseling in learning of HIV/AIDS-affected children. This might help them overcome difficulties in study, integrate into the community and reduce stigma and discrimination by schools and communities in order to achieve the objectives of the National Action Plan for HIV/AIDS-affected children in the period 2014-2020. REFERENCES [1] Nguyen Le Hoai Anh, 2010. Situation of child care for HIV/AIDS affected children in Vietnam. Journal of Education and Communication, No 1, pp. 69-71. [2] Bezuidenhoudt, C., Elago, H., Kalenga, E., Klazen, S., Nghipondoka, K., Ashton, D., 2006. The Psychological Impact of HIV/AIDS: People are more than statistics. Future Leaders Summit. pp.18-23 [3] Pham Thanh Binh, 2014. The psychological counseling needs of Secondary school students, PhD thesis in psychology, Hanoi. [4] Cooper, E.S; Risley, C.L; Drake, L.J; Bundy D., 2007. HIV as part of the life of children and youth, as life expectancy increases: Implications for Education. Journal of International Cooperation in Education, Vol 10, pp.101-113. [5] Cree, V. E. & Shidhva, D., 2011. Children and HIV in Scotland: Findings from a Cross – sector Needs Assessement of children and young people infected and affected by HIV in Scotland. British journal of social work advance access, 4/2011, pp.1-18. [6] Nguyen Van Cu, Pham Van Tu, 2012. Inclusive education for HIV/AIDS-affected children. Journal of Education. No 284. [7] Nguyen Van Cu, 2011. Interventions and Solving methods to the problems of HIV / AIDS Affected Children, Code: B2010-17-270TĐ. [8] Duong Dieu Hoa et al, 2007. Psychological difficulties and counselling needs of high-school students, Journal of Psychology, No 2, pp36-42. [9] Education Law. 2005. Publishing House of Labour, Hanoi. 174
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