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Reaching out to substance using street kids
Realities and programme priorities for South Asia
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South Asia is home to 1.4 billion people, or roughly one-fifth of the global population, and is one of the most densely populated regions in the world. The region's impressive technological and economic advances of the last decade have not always reached the general population, leaving millions living in poverty with inadequate health care (UNICEF 2007).
South Asia also has 584 million children, the largest number of people under the age of 18 of any region of the world. Child poverty and deprivation in South Asia are among the worst in the world, affecting as many as 330 million children or 57 per cent of the child population.
Vulnerabilities of street children Street children constitute a marginalized group in most societies. Exposed to some of the worst forms of insecurity and abuse, they have no homes to go to for protection and no one to depend on for love and care. The continuous exposure to harsh environments and the nature of their lifestyles make them vulnerable to substance use and this threatens their mental, physical, social and spiritual wellbeing. Most of these children use alcohol and other psychoactive substances. In addition, these children are confronted with discrimination and view health and social services with suspicion.
Living in a risky environment often leads to a casual attitude towards danger and a desire for instant gratification that comes from a lack of hope and optimism. This, in turn, results in impulsiveness and risk-taking behaviours. Some aspects of street life such as extreme mobility, low knowledge on HIV, recreational sex, lack of adequate responsible adult protection and supervision compounds their risks and vulnerabilities.
Lifestyle Street children live a transitory life style and are vulnerable to inadequate nutrition, physical injuries, substance use, and health problems including sexual and reproductive health problems. These factors reduce the effectiveness of interventions that target street children. In addition, these children do not access services as they view health and social services with suspicion and are often confronted with discrimination.
Although street children support themselves in many different ways, they need the assistance of caring adults and services provided by government or non-government organizations. Despite peer solidarity and support through charitable services, street children experience high rates of morbidity, disability and mortality.
HIV among kids in South Asia Very little data is available on street children living with HIV/AIDS in South East/ Asia because: data on this group is not disaggregated out of data for 15-19 year olds that are usually collected by national surveys; street children per se (unlike 'sex workers' and 'injecting drug users' etc.) are not 'core transmitters' and therefore are not specifically tested to determine levels of HIV; it is assumed that those street children who are most at risk (i.e. sell sex to the most number of partners or have the most unsafe injecting behaviour) will be captured in sex worker and injecting drug user estimates.
The latest HIV/AIDS estimates indicate that there were 36,000 new infections among the South Asian region's children (0-14 years) in 2005, and that out of the 100,000 children living with HIV/AIDS, 30,000 were in need of anti-retroviral therapy (ART) but less than 100 were receiving it (UNICEF 2007).
Factors that facilitate HIV transmission among street children
Many street children, child sex workers and working children are also using different substances which are associated with their risk behaviour patterns. Having unprotected sex with substance users can lead to sexual and reproductive health problems. Substance users who are injecting are at risk of contracting HIV and can pass it on to their sexual partners. In addition, the substance users are also more likely to engage in risky sexual behaviour, due to their intoxication. Street children spend a lot of time in settings where casual sexual encounters occur (street corners, lonely places such as warehouses, taverns etc.) Their risk of acquiring blood borne diseases, STIs and HIV, is heightened by the fact that they often have sex with persons who practice risky behaviours (like multiple sexual partners) or those sharing injecting equipment.
Intervening with substance using street children Intervening with substance using street kids is challenging. Interventions, even where available are often not directed at addressing the needs and risks of substance using kids. Some of the challenges are:
Substance using street children are a hidden population and therefore hard to reach. They are sexually active and sexually exploited at a very early age and some have multiple sexual partners. They are stigmatised by society for being drug users as well as street children. Agencies which work with street children often do not have mechanisms in place to address the needs of substance use among street children. Since the target group is very mobile it is difficult to carry out follow-ups and complete any intervention with street kids.
There is a lack of a comprehensive package of services for addressing HIV prevention for street kids (child friendly services like voluntary counselling and Testing Centres, appropriate outreach etc.). Motivating kids to go for detoxification (where available, since very few detoxification facilities are available for kids) is also very challenging since the fee charged for detoxification is reported to be high.
Reaching out to substance using kids
In order to reach out to street kids effectively, a community based peer led intervention is suggested. The intervention should be designed to bring about a change at four levels: Individual, interpersonal (between self and other persons in the social network of the drug using street children, norms of a sub-group), community and socio-political.
Any
prevention strategy for street kids should consider the following:
Create awareness on risks associated with drug use and HIV by delivering 'key messages' on risk reduction strategies, information on drugs, HIV and life skills using peer driven mechanisms; it should aim at developing 'child friendly' IEC (Information, Education and Communication) packages; Make drug treatment centres 'child friendly', approachable, accessible and create more 'child friendly' outreach services (using a peer led approach).
Through better referral and linkages between NGOs, connect substance using street children to treatment and rehabilitation services (including vocational services). NGOs working with street kids should be trained on appropriate knowledge, attitude and skills to address drugs and HIV concerns of street children in tune with emerging trends and needs.
In order to design any intervention or programme for substance using street kids, a wholistic approach may prove useful. This should also take into account basic needs like food, clothing, shelter, and access to health services etc.
