ON
“BURNING
CHILDHOOD-THE CHILD ON CHILDHOOD-THE STREET”
Documented by: Dr. P. Deeksha Medical Director PSH Project,
Vasavya Home & Community Based Care & Support for people living with HIV / AIDS
Staff of PSH Project Vasavya Mahila Mandali
INDEX
1.
Children in Media
2.
Presidents View
3.
The Child on the Street
4.
Basic Informations
5.
Reproductive Health
6.
Care & Support for HIV Positive Children
7.
Child Rights
8.
Building Tomorrows
- Responsible Citizens
- As a Home Maker
- As Change Agents
- Leaders in CBO
- As Employees
- Children and Savings
9.
Advocacy
President’s view
Vasavya is working for the benefit of orphans and vulnerable children (OVC) since three decades as a comprehensive development of the family. Vasavya recognized the potential and importance of children’s views in the developmental activities. So, focus on initiatives specially designed for children with their participation in the program has taken a shape.
Three categories of children are identified by Vasavya under OVC- Children on the streets, children of torture victims and children affected with HIV / AIDS.
Different aspects of children like Reproductive health, child rights and life skill development with behavior change are being focused with positive results among children on the streets.
Vasavya is working for reproductive health among street children with the assistance of APSACS – ‘Partnership in Sexual Health’ programme since 5 years.
We not only worked for sexual health but gave a different dimension to the program with community resource mobilization, advocacy and lobbying. Our strength is the strong Peer Educator System and the commitment of the staff and the management.
I take pleasure in presenting an Operational research on “BURNING
CHILDHOOD-THE CHILD ON THE STREET” with a consolidated work of 5
years among children on the streets of Vijayawada.
THE CHILD ON THE STREET……….
Chiranjeevi, Nagarjuna, Venkatesh, Shahrukh, Basha, John and so on … are the names given to the ‘fresh’ street child by the ‘experienced’ children living on the streets of Vijayawada. The names from their past lives are forgotten and they try to live for today. They all belong to the same situation of insecurity and struggle for existence. The innocence is replaced with tact and their intelligence is the key to exist on the streets. Less experienced and less intelligent children are taken care of by the brave ones.
CHILD — ADULT
They share everything which includes- food, shelter, clothes, ideas, thoughts and their sorrows. They become ‘adults’ at the age of 10 – 12 years. They try to accommodate in communal living, which they threw away in their own biological families when they came onto the streets.
ATTRACTIONS OF VIJAYAWADA
The three main attractions of Vijayawada are, • Good and cheap food.
• Availability of water to drink and bathe. • Availability of job opportunities.
These children have the capacity to earn and live on their own. They don’t demand monitory help but crave for love and affection. They want to relish home made food. Like any other child, they also demand attention of adults.
OCUPATION AND MOBILITY
The mobility among the children is 70% due to their occupation. Unfavorable circumstances like torture or rift with other children and job opportunities make them mobile.
The main occupations are, • Rag picking
• Railway bogie cleaning • Hotel work
• Automobile work • Truck cleaning
EARNING
The children share the available work as each earns for three days in a week, giving a chance to others to make money to live. Each child has the capacity and opportunity to earn 40-70 INR per day for 3 days in a week. Their attitude towards others is very commendable and broad minded which demands respect.
INSECURITY
Food and shelter insecurity is visible. They have no place to keep their belongings. The money with them is a focus for thefts by other children and also police and they are forced to starve. So, the money is spent immediately on recreation like, video games, Movies, drugs, sexual activities and so on. All the clothes they have are on them and all are soiled at a time.
SEXUAL BEHAVIOR
The sexual activity is precocious. Hetero sexual and also homo sexual attitudes are prevalent. The dominant partner is an elderly boy and passive partner is a younger boy. They are closely associated with sex workers. Exposure to Sexually Transmitted Infections (STI) is very high. They solicit sex workers and are exposed to the different aspects of the trade.
VIOLENCE— TORTURE——CRIME
The child on the street is subjected to torture by police, violence by big boys and organized criminals. The younger boys are forced by the crime oriented persons as feelers and co culprits. They are victimized and targeted by the police.
FOCUS OF AREAS OF HIGH PREVALENCED STREET CHILDREN
• Railway Station • Rama Talkies Center
• Bus Stand • Hanumanpet
• Gandhi Nagar • Samba Murthy Road
• Auto Nagar • Pinnamaneni Poly Clinic Road • Kaleswararao Market • Prakasam Barrage
• Darsipet • Raja Rajeswari pet
• Ranigari Thota • Sindhu Nagar • Sand Quarry • Govt. Hospital Road • Jayaram Center • Ajit Singh Nagar
Focus Areas in Vija y a wada * Gra y Color Areas
Basic information
Initiation of PSH Project - 1999
The children on the streets are divided into 3 categories,
C1 –children who have continuous touch with their parents / relatives C2- Children with periodical contact with family
C3- Children without contact with family or orphans
Main Focus of Vasavya is on C3 Category
Focus of Vasavya
Reproductive
Health
Human Rights
Care&
Support to HIV
positive Children
Building
Tomorrows
Different stake holders in the program Primary stake holder-Children External stake holder from community Sexual Health Service Providers-Doctors Staff & Management of Vasavya NGOs & Service organizations Law enforcing Personnel- Police APSACS TRU
STRATEGY
•
Outreach
•
Needs Identification
•
Direct Services – Medical care
Incentives
•
Peer Educator System
•
Advocacy
•
Networking
•
Lobbying
•
Documentation
REPRODUCTIVE HEALTH
Goal: To enhance the sexual health of the street children from high risk behavior
to low risk behavior in Vijayawada.
Objectives:
• To bring about behavior change by imparting knowledge on STD/ HIV/ AIDS to 25000 street children in Vijayawada.
• To ensure safer sex practice among the street children
• To improve the health seeking behavior for STDs among children. • To ensure practice of consistent and correct use of condoms among the
street children belonging to the age group of 12-18 years.
• To develop adequate support system both internal and external to sustain behavior change towards improved sexual health.
Doctors Meet
Total Outreach of Primary Stake Holder (PSH) in 5 years = 59,437
Category Year 1 Year 2 Year 3 Year 4 Year 5
C 1 - - 6441 2168 6288 C 2 - 5469 2975 3066 1228 C 3 4762 8541 5132 9898 3469 Total 4762 14010 14548 15132 10985
MAIN COMPONENTS
STD Care
Condom
Promotion
Behavior Change
Communication
Enabling
Environment
STI Identification and confirmation
Category wise confirmed STD Cases
186 301 948 0 200 400 600 800 1000 C1 C2 C3
Category wise STDs Identification
226 364 1146 0 500 1000 1500 C1 C2 C3
• C3 category is focused from the first year and identification is high in this group.
• Confirmation of STI in the identified group in C1 82.3%
C2 82.6% C3 82.7%
Prevalence of STI among PSH
# Type of STI Prevalence
1 Gonorrhea 44% 2 Syphilis 34.4% 3 Chancroid 11.9% 4 Scabies 1.1% 5 Herpes 1.4% 6 Candyloma Accuminata 0.2% 7 Multiple STDs 5.4% 8 Warts 0.2% 9 UTI 1.0% 10 BUBO 0.3%
• Gonorrhea and Syphilis are the two major STI identified. • Minor STI are identified less as they are treated by general
practitioners.
• Surgical treatment is less accessible to PSH even in Government Hospital.
Follow up of STI
Follow up is a challenge among street children due to, • High mobility
• Lack of knowledge on complications • Irresponsibility
• Low treatment completion behavior
Category wise follow up of STD cases
C3 60% C1 12% C2 28%
• Follow up in C3 category is more as outreach is more. • Follow up is corresponding to the number of identified STI.
Referrals
STD Cases referred to Govt & Private
Hospitals
Private Hospital 94% Govt. Hospital 6%• Accessibility and availability of medical services of private sector is more. • Private Doctors are more sensitive to the issue of children on the streets. • Vasavya is having a good network of doctors and so quality medical
services are available.
• Children’s acceptance is less towards government hospital due to the attitude in the approach by medical service providers in government sector.
Comments
• Definite improvement in treatment seeking behavior increased over 5 years. • Self reporting increased by 25.9 %
• Multiple STI decreased
• Treatment completion improved
CONDOM PROMOTION
Condoms were distributed to decrease STI and HIV prevalence not only to street children but also other high risk groups.
Total # of condoms distributed in 5 years=247,087
Channel Year 1 Year 2 Year 3 Year 4 Year 5 Total
ORW 1420 9659 11070 10473 15508 48130 PE 443 5669 8531 7092 16626 38361 ESH 393 7796 7822 7305 14365 37681 Outlets 987 15215 18625 26290 43061 104178 SHSP 335 335 Mass event 2500 2500 PSH 455 455 others 66 5133 5199 Demonstrations 10248 10248
Channel wise Condom Distribution 0% 1% 2% 0% 4% 19% 16% 15% 43% ORWs PEs ESHs Outlets SHSPs Mass Event PSHs Others Demonstrations
• Condoms distributed through ORW, PE & ESH are reaching the specific group.
• Outlets are very useful for children and general population also. • Condom distribution in mass events, demonstrations, PSH and other
BEHAVIOUR CHANGE AND COMMUNICATION
Behavior pattern is identified and high risk group also is noticed by the staff during the sessions. Mapping of the high prevalence areas and high risk groups is one methodology used.
Comments: 5 years consolidation is,
• Out reach of PSH in one to one sessions- 18,964 • Out reach of PSH in group sessions – 35,776 • Number of group sessions – 9738
• Camps conducted for PSH – 28 • PSH attended to the camps – 1327
• Number of PSH with visible behavior change- 1801 • Number of PSH with reduced partners – 344
• Number of STI reduced over 5 years and multiple STI also reduced significantly.
Group Assesment
Interaction with Staff Recreation for PEs
ENABLING ENVIRONMENT
An enabling environment is created for PSH to get the required change in their behavior. Different programs organized are,
• Rehabilitation – 250 were rehabilitated • Reunification – 83 were with their families • Job placements – 35 were job holders now • 2603 PSH’s general health was taken care. • 32 health camps were conducted at field areas • 161 STI were identified and treated in these camps • 419 times linkages with GO / NGO were utilized. • 107 Advocacy meetings were organized
ROLE OF PEER EDUCATORS (PE) AND EXTERNAL STAKE HOLDERS (ESH)
Peer Educators and External stake holders play a major role in identification, motivation for treatment seeking behavior for STI, in condom promotion and in encouraging sustained behavior change.
PE are from the children living on the streets and the ESH are the people who are accessible and available to PSH at community levels like – Pan shop owners, Petty business owners, Mobile Ironing person and so on.
The various trainings they were given are, • Knowledge on STI / HIV / AIDS • Counseling
• Condom Demonstration • Condom outlet maintenance • Identification of PSH and PE • Identification of ESH
• Needs identification
The success of Peer Educator System with strong ESH network is guiding the program towards community owning of the activities and acceptance of the children on the streets.
OUR PEER EDUCATORS ARE THE STRENGTH OF THE PROGRAM
CARE AND SUPPORT FOR
HIV POSITIVE CHILDREN ON THE STREET
Vasavya Home and Community Based Care and Support program, a unit of Vasavya Mahila Mandali, is extending the services to 3 HIV positive children on the streets identified by PSH staff. The children are provided with,
• Psycho social support • Medical Care and Follow up • Care of Nutrition
• Recreation Camps
• Prevention of HIV with condom promotion • Sensitization of Peer group
CHILD RIGHTS
The child on the street is exposed to various influences like crime, organized criminals and also political groups. With these influences the child is victimized and stigmatized. The adventure and thrill he feels initially do have sequelae and the outcome is violation of child rights and torture at the hands of law enforcing agencies.
The different problems the child faces are, • Torture by law enforcing agents
• Violence by other street children- non organized • Violence by Organized criminals
• Violence by Political groups • Violence at work place
• Groups among street children • Violence by drug dealers.
Vasavya is working to improve the knowledge levels on child rights through workshops, seminars and participatory community assessment and reviews. Violence at work place is dealt by lobbying, advocacy and sensitization of the adults at work place.
Frequent monitoring of the situation on drug abuse is a way of giving knowledge on the problems of the specific drugs / addiction agents.
TOGETHER AGAINST TORTURE
Vasavya Rehabilitation Center for Torture Victims (VRCT), a unit of Vasavya Mahila Mandali, is working to protect the rights of people related to torture. The services provided by VRCT are,
• Identification and registering the victims of torture
• Psychosocial support
• Rehabilitation is planned with improving Skills in various fields and also giving an opportunity with livelihood options.
• Advocacy through V-Voice, a monthly e news letter and publications in international magazines
• Networking at regional and international level
• Lobbying with police about the situation of torture among children in particular through sensitization workshops for police.
Tortured & broken boy to a goal setting young man :
A young boy aged 14 years was unable to walk due to swelling of both knees and feet. He was tortured by police with baton and belt on the suspicion of theft. He was kept in police station for three days and was forced to do menial work like cleaning toilets and the surroundings. He was orally abused and was threatened of dire consequences if seen in the vicinity. VRCT provided medical treatment, Psycho social support and skill development in four wheeler driving.
Now he is earning in a decent way as an auto driver with a permanent driver license provided by VRCT & PSH project. He is an active peer educator and refers torture victims to the center. A confident young man with a goal in his life is a fitting example to others.
BUILDING TOMORROWS
The young boys can build tomorrows with proper guidance and by increasing the skills. The child on the street does not have a plan or ambition for tomorrow. So the important step is to imbibe a thought about tomorrow and to make tomorrow acceptable and interesting. The thrill to see a better tomorrow can be a reason to live for tomorrow. After sustained behavior change the child
turns into a young man as a Responsible Citizen, as a Home Maker and as a change agent.
If a hope is not given, the street child becomes a street adult. So, Vasavya
AS A RESPONSIBLE CITIZEN
Responsibility increases if a chance is given to prove themselves with skill development and livelihood support. Vasavya focuses on the comprehensive development of the child through,
Skill development in Garment Making, Driving, Masonry work and Carpentry. Livelihood support through financial support to buy Pulling carts, Cobbler
kits, Iron Box and to do Petty business.
250 children were given skills and livelihood support “With a pulling cart I started a new life”—————
Mr Ramesh is a young boy of 16 years living on the streets since he was 10 year old. He started to live on the streets of Vijayawada following the older children and learning life skills and also some bad habits like smoking, addiction to opium and precocious sexual habits.
He was treated for multiple STI and with counseling his marketing capacities were noticed. So, a pulling cart was given to do fruit vending and he is successful in his venture.
He is living a life with plans for future.
AS A HOME MAKER
Marriage: The strength of Marriage institution was established by encouraging
the men to live with a wife and so reducing the prevalence of STI / HIV.
One young man wedded a young girl and a reception was organized at Vasavya to encourage others also.
Family reunion: 83 children were reunited with their families with direct
interaction and support of Vasavya and also recently with child line services. Some children are maintaining regular contact with Vasavya.
Victim of circumstances and reunion with family——
17 years old Mr. Seshu, is from a middle class background loosing his parents and two brothers to Tuberculosis. He was afraid of TB and his uncle planned to take over his nephew’s property and at his resistance he planned to kill the boy. So, Seshu ran away from home and was a victim of drug addiction, Precocious sexual habits and rag picking.
He had multiple STI and was treated. After many interactions, he started to have contact with his family and he was trained in driving a four wheeler. He is a very good Peer Educator and was a great asset to Vasavya.
He was reunited with his family and his uncle bought him an Auto rickshaw and is marrying him to his own daughter. Seshu brought his uncle to Vasavya and Vasavya was thrilled for the future of Seshu.
AS CHANGE AGENTS:
The children became change agents and are setting themselves as role models for other children on the streets.
PEER EDUCATOR (PE) : 114 PE are developed to make a difference in the lives of thousands of children with an insiders view.
PE are trained, to do sessions, to identify STI, Provides psycho social support, Referrals, linkages& livelihood options
PE is a changed child with a goal to change others also. Rag picker to Peer educator in the field——
Mr. Prabhu, 17 years, is a child living on the streets of Vijayawada, with habits like- addiction to ghutka, smoking and having erroneous sexual practices with 18 sex workers. He contacted Syphilis, Chancroid and Herpes at different periods. He was a rag picker and a drifter.
He became a wonderful person after a pain taking slow rehabilitation with a
skill giving in driving and training in “Participation Site Assessment training” organized by APSACS. He is presently undergoing training in “Picturing Hope” photography training with inputs from a world renowned
photographer, Mr. Craig Bender, Paris. He is an active Peer Educator and is an asset to Vasavya PSH project.
His travel from a rag picker to a photographer is a long and successful journey which is a good example to other children on the streets.
Leaders in Community Based Organization (CBO)
2 CBOs are formed to make the children travel into the main stream of the society and to increase the acceptance of the community.
A leader is made to help other vulnerable children——
Mr. Narayana is a rag picker and is a victim of torture and violence on the street. He is a frail looking young man who experienced all types of humiliations from the community.
Vasavya analyzed his capacities and found a leader in him. With the financial & technical assistance he initiated a CBO with 20 children with bio manure and rag collection center. Deputy Commissioner of Police inaugurated the center and gave moral support and this sensitized the police to reduce torture also. He was provided with a shoe polish kit to support himself at initial stages and now he is supporting many children and the center became a strong change center.
This CBO is life for many children and is being replicated by many organizations. Vasavya salutes the spirit of these children.
CBOs are giving job opportunities to other children along with self employment. The attitudinal change in the members of CBOs is commendable.
Inauguration of CBO
Working in CBO Recreation to CBO by Vasavya from Member of Parliament
AS EMPLOYEES:
After skill development children are being employed as regular workers which is a recognition to their sustained behavior change. More and more children are living in rented houses with dignity. A slow but study increase in such a change is very encouraging.35 children were referred for good job placements.
Rag picker to auto
driver———-Mr. Suresh, 10th standard street child is rag picking and is very intelligent. He learned the skill to live on the streets and is very successful. He came with Gonorrhea which was duly attended and Vasavya assessed his needs. His interest in driving is the starting for Vasavya in initiating driving training for street children.
He was provided with learners and permanent license and is now earning a respectable 100-150 rupees and is a happy and responsible young man who is guiding other children. He is an active change agent and is increasing
the knowledge levels of STI / HIV among children. His attitude changed towards a positive thinking.
CHILDREN AND SAVINGS
For a better tomorrow children should learn to save their earnings. But they are not allowed to open bank accounts as they don't have an address. So Vasavya initiated the savings concept by a bank account with separate books for each child issued by Vasavya. Till now 81 children saved Rs.
4,841/-The savings money is used for,
• New Cloths
• Reunion with family
• To share with their parents/brothers/sisters
• Marriages
• To get payment driving licences
• Medical expenditure
• To start business
It is very good to see the attitudinal change with savings concept. They are developing,
• Self esteem
• Confidence
• Positive Out Look
ADVOCACY
Vasavya’s strength is Advocacy and Networking with Government and Non-Governmental agencies for program delivery and also policy initiatives. The following are the people / organizations,
• APSACS & TRU
• People’s Representatives Corporator Member of Parliament Mayor • Government Sector District collector,
Joint Collector & Sub Collector
District Nodal Officer for AIDS control Municipal Commissioner
Commissionerate of Police
• Child Line • Other NGO s
• Service Organizations
Rotary, Lions, Inner wheel clubs • Sports Authorities of Krishna District • Indian Medical Association of Bezawada • Many more organizations and people.
Field Study on
“Prevalence of STI among Street Children” Study done by - PSH Project,
Vasavya Mahila Mandali
Study Period - May 2004
Sample Area - Vijayawada City
AIM: To know the prevalence of STI among people living on the streets between age groups 12-24 years and to plan treatment channels.
Sample Size - 1000 people living on the street between age group of 12-24 years
Sample Group - People living on the streets between 12-24 years of age were included in this study.
High-risk groups were neither isolated not preferred, to get, • General prevalence of STI
• Treatment seeking behavior • Channels of treatment
Methodology:
• One to One interaction at random on the streets of Vijayawada
Survey formats:
• Printed formats with required information
Capacity Building:
The format was analyzed by staff and management and inputs were give about the importance of the study.
BASIC INFORMATION 75 780 0 200 400 600 800 Below 12 13-18 19-24 Age Pattern
Prevalence of STI in Age group
0 277 99 0 50 100 150 200 250 300 Below 12 13-18 19-24
• Boys between 13-18 years are more willing to share the information on STI •
Prevalence of diseases
Diseases Age Group
Below 12 13-18 19-24 Gonorrhea 0 135 39 Syphilis 0 69 31 Chancroid 0 45 17 Scabies 0 21 5 Herpes Simplex 0 6 7 Candiloma 0 0 0 UTI 0 1 0 BUBO 0 0 0 Total 0 277 99
• Gonorrhea is the most common STI followed by Syphilis and Chancroid. • Herpes Simplex is on rise.
• Minor STI are being treated by Private Practitioners. • Multiple STI is negligible.
• 48.7% of Gonorrhea is recorded in 13-18 years age group. • 39.4% of Gonorrhea is in 19-24 years age group.
• A significant 9.1% more prevalence of Gonorrhea is seen in 13-18 years age group.
Treatment Pattern
Channel of treatment
60% 22% 18% NGO GO Self• NGOs are main channel of treatment providers.
• Self financed treatment is incomplete and not specific.
• Government sector utilization is less due to the attitudinal problems from both stake holders and also less sensitivity of medical service providers towards Street children.
• Role of NGOs is visible in the study in improving the reproductive health of children on the streets.
KEY FINDINGS
• Boys below 12 years are not showing significant prevalence of STI. • Group between 13-18 years are having active sexual life .
• 19-24 years group was included to know the pattern of STI. • Gonorrhea is the single most common STI recorded.
• Significant prevalence of Syphilis and Chancroid is seen.
• Treatment provided by NGO is quality oriented and the services are visible.
Recommendations
1. More programs to be planned for the age group below 12 years to reduce STI in their later age.
2. Intensive programs for boys above 13 years with interaction with children infected with HIV should be planned.
3. Easily curable and single dose treatment for Gonorrhea like Cap. Azithromycin 1 gram should be used for better results.
4. Long treatment necessary for Syphilis and Chancroid should have financial support in the budget.
Acknowledgements:
Doctors
Dr. G. Samaram, M.B.B.S,Dr. Meher.N.Prasad, M.B.B.S,M.D, Professor of medicine,
Dr. P. Deeksha, M.B.B.S, D.D Dr. Raja Gopal, M.B.B.S, DD,Dr. Ashok Kumar, B.A.M.S. Dr. Rama Rao, B.A.M.S,
Dr. Bramheswara Rao, B.A.M.S,Dr. Nageswara Rao, B.A.M.S, Dr. M.D. Rafi, M.B.B.S, Dr. Krishna Rao,M.B.B.S, M. S,
Dr. Chenna Mallappa, M. S. Dr. P.G. Babu, R.M.P Dr. K.Kalidas, R.M.P ,Dr. Ch. Venkateswara Rao, R.M.P, P.M.P Dr. K. Govinda Rao, R.M.P,Sk. Mastan, R.M.P, Dr. Sk. Khadhar, B.A.M.S Dr.Babu Srinivas MAMS, Dr. Prasada Rao MBBS, Dr.Ashok Surya BAMS, Dr. P. Ram Babu, M.D.Dr. Ananda Rao, RMP, Dr. Sk. Gandhi, RMP, Mr. Sadiq, Vasavya Laboratory.
Philanthropists:
Mr.Chnnupati Seshagiri Rao, Mr.Ch. Vazeer, Dr. P. Deeksha, Dr. P. Meher Prasad, Dr. G. Samaram, Dr. G. Maru, Mrs. IAL Sarojini, Mr. Vishnu Rao, Mrs. M. Padmaja, Mr. M. Nagerswararao, Mrs. Sudha Rani
Service organizations:
Rotary clubs in Vijayawada, Lion clubs in Vijayawada, Indian Medical Association, Inner-wheel club, Red-cross Society, Vasavya Mahila Mandali
Government Officials:
Collector, joint collector, sub-collector, Krishna, commissioner of police, Commissioner, Municipal Corporation, District Medical & Health Officer, District nodal officer for AIDS control, Chief Medical Officer, Vijayawada Municipal Corporation, Deputy transport commissioner, Divisional Railway Manager, Superintendent, Vijayawada railway zone
Program Support:
Mr. Jeff Foster, ABBOTT laboratories, Vasavya Rehabilitation Center for Torture Victims and Vasavya HCBCS program
Financial support: Andhra Pradesh State AIDS Control Society, DFID Technical support: State Management Agency, Technical Resource Unit We acknowledge the services of staff of Vasavya
AMMA AND NANNAGARU (Mother & Father to all the children)
VASAVYA MAHILA MANDALI
40-9/1-16, VASAVYA NAGAR, BENZ CIRCLE VIJAYAWADA, ANDHRA PRADESH, INDIA. 520010
