Situation Assessment on Care and Protection

8/19/2019 Situation Assessment on Care and Protection

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SITUATION ASSESSMENT CHETONA PROJECT 1


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Report Summary

Situation Assessment Chetona Project

care andprotection

needs of children of sex workersand children affected by HIV/AIDS

SITUATION ASSESSMENTon

Prepared By

Child Protection Sector

Save the Children

2013


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4 SITUATION ASSESSMENT CHETONA PROJECT SITUATION ASSESSMENT CHETONA PROJECT 5

This report sets out to explore the day-to-day

protection issues the children of female sex workers

in Bangladesh have to face. The paper explores the

vulnerability of children affected or infected with HIV/

AIDS, their economic and social needs and the physical

suffering they must burden as a socially stigmatized

group in their communities.

OBJECTIVES

OF THE STUDY

The objective of this study is to generate

a clear understanding of the care and

protection needs of two extremely vulnerable

groups of children, children of sex workers

(ChSW’s) and children infected/affected by

HIV/AIDS. An additional objective is to better

understand community attitudes and perceptions,

social protection needs and the specic types

of care required for these children as well as to

understand existing and lacking national policies

for the protection of these children.

METHODOLOGY

Th

The study used content analysis of existing

literature as well as eld data analysis. The

selected content analysis looked at published

writings examining sex workers, the children of

sex workers and children infected/affected by

HIV/AIDS. The analysis is used to settle on the

instruments and guidelines of the study tools. The

eld data analysis focuses largely on qualitative data

with some attention on quantitative information.

The study was conducted in Dhaka and Rajbari.

The target group in Dhaka is children infected/

affected by HIV/AIDS, and in Rajbari the target

group is children of oating sex workers. In both

regions, the purpose of the study is to gain a

comprehensive understating of the difculties and

needs these children face.

P h o t o : T a n v i r A h m e d


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F

loating Sex Workers (FSW) of Rajbari are among the lowest earning group of the

country and are considered as ‘poor’ as per the international economic standard scale

for measuring poverty. FSW’s often have no more than one client a day due to the nature

of their constant mobility (having no permanent place for clients to visit). Income of the

interviewed working mothers ranges from 150-300 TK a day (2-4 USD a day).

As a result of their parents’ profession, the children of sex workers face unique

risks, stigma and discrimination. A study conducted by Save the Children in 2010,

illustrated various situations where children of sex workers were being denied a safe

home, proper child-care, access to health care facilities and education. As a result, children

of sex workers suffer living a life of malnutrition, facing unwanted pregnancies and various

mental health problems. They also face gender-based violence and abuse, as trafcking

is a common phenomenon when they enter adolescence. Many face ill treatment when

sold as infants and are ultimately forced into sex-trade and drug trafcking. Various

factors directly contribute to their vulnerability and marginalization; these include a

lack of education, inaccessibility to basic services, proper safe housing, etc. The following

discussion will address these issues in detail.

CHILDREN OF

SEX WORKERS

ECONOMIC STATUSOF CHILDREN OF SEX WORKERS


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HEALTH

ISSUES OFCHILDREN OF SEX

WORKERS

For the FSW’s of Rajbari, of the 25 sex workers

interviewed, none have been tested for HIV/

AIDS. Approximately 56% of the respondents (14

out of 25) sex workers are familiar with the concept

of HIV/AIDS but not in detail. Furthermore, none

of children of the FSW’s have previously received

any form HIV/AIDS testing.

Identifying children who are in danger of contracting

HIV/AIDS is only possible through routine medical

testing’s, ideally in services for Preventing Mother-

to-Child Transmission (PMTCT) or maternal and

child health. Unfortunately, the children of FSW

of Rajbari, are out of reach of any specialized

healthcare facilities related to HIV/AIDS and so

are their mothers.

EDUCATIONOF CHILDREN OF

SEX WORKERS

In Rajbari, all the mothers interviewed indicated

wanting their child to have a proper education.

Out of the 13 male children in this study, 10 were

enrolled in school, 2 dropped out and 1 was not

enrolled. For female children, 9 out of the 14 were

enrolled in school, 4 dropped out and 1 was not

enrolled. The enrollment rate is comparatively

lower for girls than for the boys. The study also

revealed that as the child progressed higher in

grade, the dropping out rate increased. As the

child of a sex worker matures, he/she may need to

take responsibility caring for siblings and may even

begin to engage in the sex-trade industry when

coming of adolescence age.

The annual education expenses of a child vary

from 500-1000 TK. Although the school provides

books and there are no tuition fees, parents are

expected to purchase school supplies and pay fees

for examination fees. These costs often bear solely

on the mother who is a sex worker. The childrenof sex workers also face a lack of space to study at

home and are unable to pay for additional tutoring,

as their mother cannot assist them due to literacy

limitations and her working hours.

SOCIAL

STATUS OFCHILDREN OF SEX

WORKERS

The social status of ChSW’s is shaped by the

professional identity of their mothers. The

social rank of these children is marginalized and

excluded. There are various underling issues that

keep these children stigmatized. As sex-trade is

illegal in Bangladesh, the local police and authorities

often expose mothers who are sex workers

and their children to harassment, extortion and

violence. The utilization of a legal system to benet

the sex worker as a result becomes impossible.

The informality of the sex worker’s trade and

living in a ‘red light district’ area denies them

employment security, access to a bank account,

medical insurance and other basic services. Many

of the mothers prefer for their child to grow up

in a safe environment and therefore send them

to a relative’s house, safe home or institution, but

very few of them can manage such alternative

residence due to nancial and social barriers.

In many cases, girls of sex workers enter the

sex trade industry themselves at early stages of

adulthood. Boys also end up becoming male sex

worker, pimps or engage in criminal activities.

Often, the father of the sex worker’s child is a

client and as a result detaches themselves from

the family. When a sex worker does not know the

name of her child’s father, or the father is unwilling

to be part of the child’s life, the mother cannot

properly get birth registration (which requires

both the parents names), which leads to other

social complications in the child’s future.

Photo: ..................


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SOCIO-

CULTURAL

ATTITUDESTOWARDS HIV/AIDS

PATIENTS

As mentioned earlier, the topic of sex and

sexuality in Bangladesh is considered taboo.

Moreover, a woman is accused to be a wrongdoer/

sinner if she contracted an STI or an STD (even if

it was transmitted to her by her husband). Female

sex workers in Bangladesh are largely uneducated

and unaware of the spread of STI’s/STD’s, HIV/

AIDS. This as a result puts their children in danger

of contracting it themselves.

Due to the prevalence of male dominance in

Bangladesh, women do not have say over the

practice of contraception or family planning. If a

man has entered into pre and/or extra marital

unprotected sex and contracted HIV/AIDS,

the man could unknowingly transfer the HIV/

AIDS then to their wives, thus later, unknowingly

transfer it to a child if impregnated.

To a large extent, the greater population in

Bangladesh still believes that HIV/AIDS is spread

due to the mischief of people. If contracted, it is

rare to get support of any kind from family, service

providers and the greater community. According

to many respondents, it is the children with HIV/

AIDS who become the constant sufferers of such

discriminatory perception and attitudes. They are

deserted from their circle of friends and even

barred from their educational institution at times.

Children, due to the overall situation, can fall into

tremendous physical and mental vulnerability.

HIV/AIDS

AWARENESS

In Bangladesh, there is a lack of awareness in

regards to HIV/AIDS, which in turn leads to a

widespread discrimination against those who are

infected/affected by the disease. A majority believes

that HIV/AIDS is spread through physical contact

such as hand shaking, sharing foods, sneezing, etc.

This misconception creates a social barrier that

excludes HIV/AIDS positive individuals from

mainstream society. This goes as far as doctors

and nurses refusing treatment to HIV/AIDS

positive persons out of fear of contracting it. Many

respondents have reported that they were turned

away by doctors or pharmacies when seeking

treatment for fever or a cold because they had

knowledge of them having HIV/AIDS.

HIV/AIDS

In Bangladesh, a lack of awareness as to HIV/AIDS

largely exists due to the stigma associated to sex

and sexuality. This puts children and young girls

in grave danger, as they will refrain from speaking

about contracting STI, STD or HIV/AIDS and even

refrain from getting tested/seeking treatment

for it because of the social stigma. Although the

prevalence of HIV/AIDS in Bangladesh is 0.1%

according to the UNAIDS Country Progress

Report (2012), the actual gure is expected to be

much higher.

ECONOMIC

STATUS OF HIV/AIDS PATIENTS

Most of the mother’s of the children in this

study are between 25-35 years old, have

more than 1 child and have spent at least 10 years

as a sex worker. Over time, the sex workers lose

their physical appeal to clients and in turn, are

forced to nd an alternative source of income. Asthey are labeled as ‘sex workers’, their professional

possibilities are limited and even if alternative

employment is possible, they are likely to be paid

lower then other women.

The existing treatments of HIV/AIDS in Bangladesh

are unaffordable for the poor and middle class

of Bangladesh. According to the organizations

providing treatments to HIV/AIDS patients in

Bangladesh, one needs 18,000 TK a month for

the 1st line treatment (the initial stage of HIV/

AIDS) and 22,000 TK for the 2nd line treatment

(the secondary stage of HIV/AIDS). If the female

sex worker is the primary breadwinner, her health

will progressively deteriorate and her ability to

continue working while paying for treatment and

supporting her family becomes impossible.

The nutritional needs of an HIV/AIDS positive

child are far more demanding than of an HIV/AIDS

positive adult. As the female sex worker earns a

modest income, the child’s nutritional needs may

be neglected. As a result, children who are infected

with HIV/AIDS become more vulnerable to the

illness as the mother is unable to care for them

adequately.

Photo: Kelley Lynch


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In Bangladesh, the only treatment available f or

HIV/AIDS patients is Antiretroviral Therapy

(ART). Although treatment can be free to patients,

the waiting list for this is quite lengthy and

immediate treatment cannot be guaranteed for

most. Even if a patient is able to receive ART, it

demands a continuous supply of nutritional food,

which many cannot afford. And as mentioned

earlier, as an infected child, the lack of nutritional

food has much greater impact on their overall

health.

ART is generally a combination of different types

of medicine, unfortunately, it is timely impossible

to test the effectiveness of the prescribed

combination to the patient prior to beginning

the treatment. In addition, the unavailability of

certain drugs in rural areas makes the prescribed

combination less effective for the patient.

In a recent pilot program titled ‘Prevention of

Parent to Child Transmission’ (PPTCT), UNICEF

provided anti-retroviral prophylaxis treatment

and support for HIV positive pregnant women.

This treatment helped reduce the percentage of

infants being born with HIV and the program will

continue to its next implementation stage.

Concluding Recommendations

Children of sex workers face stigmatization and marginalization due to the profession of their

mother. In order to help children who are infected/affected by HIV/AIDS, it is important for us to

help keep this information condential so as to avoid further social discrimination and promote inclusion

through awareness and the child’s education. The following are concluding notes and recommendations:

AVAILABLE TREATMENTS

for HIV/AIDS Patients


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l Scaling up a mass awareness program regarding issues of HIV/AIDS in detail.

l Engaging the media on these issues will bring a wider reach of awareness and

mobilization of people in the country.

l Strengthening the family care capacity through intervention and peer support. This

includes providing counseling, parenting skill training and monitoring of the child’s

welfare.

l If possible, encourage and assist with additional income generation activities such as

vegetable cultivation, poultry and cattle raising (with the option of milk production).

l Equip children 14 and older with technical training and if possible, engage them with

part-time work so that they assist with the nances at home while continuing to

study.

l Providing children with not only medicine, but also with required nutrition support.

l If applicable, providing mothers with training for alternative/additional income

generating activities and nancially support them in the early stages.

l Implement an awareness program at educational institutions with the specic

participation of teachers, students and guardians. This will help those involved have

a better understanding of what the child is going through and tackle barriers of

discrimination.

l Children infected/affected by HIV/AIDS should receive admission assistance to school

as well as assistance in continuing education for as long as possible.

l Introduction of vocational training courses for children, particularly adolescent girls,

to prevent them from entering the sex-trade industry.

l A need for a child DIC with educational facilities and exible hours for the female

sex-workers.

l Issues of children in Bangladesh are addressed in the 2011 National Children Policy.

However, as the protection of children infected/affected by HIV/AIDS is a major

concern, policy makers have failed to identify it as a multi-faceted problem. Social,

educational, vocational, nutritional and income generating programs are addressed

in the Policy paper but no attention is given to the specics of children affected or

infected with HIV/AIDS.


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Situation Assessment on Care and Protection

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