Re-positioning Social Work in the Face of Global Challenges: The Case of HIV-affected Children in the Republic of Trini

1. Re-positioning Social Work in the Face of Global Challenges: The Case of HIV-affected Children in the Republic of Trinidad and Tobago Subject area:Research Title: Re-positioning Social Work in the Face of Global Challenges: The Case of HIV-affected Children in the Republic of Trinidad and Tobago Author: Dr. Adele Jones About the author: See the Contributors section located on the Home Page for more about the author.

2. Re-positioning Social Work in the Face of Global Challenges: The Case of HIV-affected Children in the Republic of Trinidad and Tobago • Target Audience:HIV-AIDS Programme co-ordinators/ personnel, Social Workers, Policy makers • Transferable Lessons: • Children represent one of the most vulnerable groups worldwide with respect to HIV-AIDS • Gender inequality exacerbates this vulnerability • Several factors including culture (for example, gender roles and sexual myths), parental factors (for example, death, substance abuse, poverty, incarceration and migration) and child factors (for example, abuse and abandonment) all contribute to the vulnerability children face regarding HIV-AIDS • A systems approach between the environment and individual functioning is necessary in beginning to address HIV-AIDS and children

3. Situating Children’s Experiences: • Demographic • Socioeconomic • Epidemiological context

4. Demographic Context • Total population about 1.2 million • Just over 400,000 children and young people (36.5%) • Diverse population: African 37.5%, East Indian 40.0%, other/mixed 20.5% • Colonized by the Spanish, French and British – inflows of people • Constant migration both inter-regionally and internationally – outflows of people

5. SocioeconomicContext • Globalization -expansion of capitalism and cross border exchange, interaction and interdependence across all forms of social, economic and political life aided by unprecedented technological advances • Impacts the poor, the environment, gender, culture, political and social structures

6. SocioeconomicContext continued • Leading trading nation among the English speaking CARICOM • One of the wealthiest countries in the region • Primarily industrialised, the economy is based largely on petroleum and petrochemicals although tourism is an area of expansion.

7. Macro socioeconomic indicators • Rise in infant and neonatal mortality rates • Shifts in the pattern of general mortality • Growth in chronic “lifestyle” diseases such as heart disease, diabetes, some forms of cancer, cerebro-vascular diseases and HIV-AIDS

8. HIV-AIDS -a global challenge • Undermines economic, social and human development – sets back progress • Affects large swathes of a population in a relatively short period of time • Forms of transmission pervade all sectors of society • Wide-scale loss of human potential and productivity • Affects every region in the world • The most serious threat to the life chances and future of children in the developing world

9. HIV-AIDS – international context • 2.1 million children under the age of 15 years live with HIV-AIDS world-wide • 15 million children orphaned • By 2010 this figure will exceed 25 million • In the Caribbean - half a million person infected with the virus; 22000 children under 15years

10. A Caribbean Pandemic • Numbers affected relatively low compared to other parts of the world, however • Regional pandemic is second in magnitude only to that in Sub-Saharan Africa • Haiti (with a prevalence rate of 7.7%) the most affected country

11. Trinidad and Tobago • 13,000 recorded HIV cases and 4500-5,000 AIDS deaths since virus first discovered • 1700 new HIV cases recorded in 2003 • Mode of sexual transmission - largely heterosexual • The epidemic has shifted to younger populations • Young women 15-19 years 3 times more likely to be exposed to the virus than young men in the same age group

12. Gender • Gender inequalities, social norms, domestic violence and sexual coercion • Women more vulnerable to infection for biological reasons • Females living with the virus and also those dying from AIDS-related causes outnumber males • Both groups are dying at an increasingly rapid rate • In 1985 the percentage of child deaths due to AIDS was 0.15% and by 2000, the figure was 4.52% (232) with the largest number (61%) in the 0-4 year age group • Increased rate of deaths due to AIDS across all age groups

13. The perfect host • Internationally, a complex interplay of poverty, gender inequality and stigma and discrimination have been found to facilitate the spread of the virus

14. Set against this backdrop are specific cultural factors: • gender roles • sexual myths • Social sanctioning of multiple partnering (in some sections of society at least) • Status of children

15. Street Children • Street children emerged as one of the most vulnerable groups affected by HIV-AIDS in Trinidad and Tobago and yet relatively little is known about them.

16. Who is a street child? “At the end of every school year a new batch of street children appears, the numbers are growing and the faces are getting younger each year. No one seems to care about these children who from day to day can be subjected to abuse and rape from people who should be responsible for their protection.”

17. Child Severe abuse Domestic violence Abandonment Family conflict Escape residential care Parent Illness Imprisonment Migration Death Substance abuse Poverty Survival strategy

18. Additional factors (HIV-AIDS) • Orphaned because of death of parent/s due to AIDS • Rejection within the wider family or community • To support other family members affected by the disease • Lack of adult supervision – sibling-headed households

19. Children ‘on’ the street • Work on the street but tend to return to their families at night • Children that live as members of squatter communities • Work the streets for money in the mornings and attend school in the afternoons • Part of the informal economy - supplement the family budget • In some cases, provide the foundation on which the family functions

20. Children ‘of’ the street • Abandoned children, and those who have run away • Children whose families are also homeless • Responsible for themselves • They live and work on the street • Without adult control, protection or support

21. Risk and vulnerability • The child living on the streets has increased vulnerability to HIV-infection • For the HIV-infected child, life on the streets will expose them to increased risks which may hasten the onset of AIDS, severe illnesses and early death

22. Increased vulnerability • Commercial sex work - common among street children places them at risk of violence, rape and coercion • More likely to have been sexually abused • Increased risk of STD’s = increased risk of HIV • More exposure to drug use and involvement in drug trafficking • Drug use related to a reduction in sexual inhibition and is thought to be implicated in sexual offences • Drug dependency negatively affects general health status - mineral and vitamin deficiencies may contribute to reducing their resistance to infections • Young women at risk of passing the virus on through pregnancy

23. Prevention and education • Most street children do not attend school and do not have access to information about sexual health education • Where information is available, this assumes a higher level of literacy than is found among most street children • Condoms are difficult to access • Many organisations working with street children are faith-based and morally opposed to the provision of condoms

24. Increased risks for the HIV-infected child • Street children more likely than other children to experience malnutrition and poor health • Access to health facilities, medicine and preventive treatments severely impaired • Low standards of hygiene and unsanitary living conditions exposed street children to a range of diseases such as tuberculosis and scabies • HIV-infected children in these conditions more vulnerable to opportunistic infections • ARVT require a high level of adherence – this is difficult for children living on the streets • Face increasing bouts of progressively more severe illnesses without access to adequate health care • Face early death without the support of even a close relative.

25. Social Work Response to HIV-AIDS In the face of HIV-AIDS and in relation to particularly vulnerable children, Social Work can be said to be benevolent at best and benign at worst

26. Developmental Social Work At its core, developmental social work is concerned with social justice; it is future oriented, value oriented and systems oriented

27. Systems approach - relationship between the environment and individual functioning • Targets the range of systems that impact upon clients’ lives i.e. families, groups, communities, schools • For street children there are sub-systems that must be targeted

28. Human Development: equity/equality participation disaggregating and consideration of the range of needs capacity building at the individual and family level Social Development: policy development capacity building at the community level a focus on infrastructure and resources to meet social needs Integration of principles of sustainability Two levels of activity required

29. For this presentation, focus is on two areas: • capacity building at the individual and family levels • infrastructure and community-based resources to meet social needs

30. Community ‘Community’ re-defined as those places habitually frequented by children. May range from family home to NGO’s to shelters to the street itself

31. Resiliency vs. Vulnerability • Building resiliency through street theatre, group work, peer support schemes, psychosocial counselling, developing skills such as: • Communication • Problem solving • Managing feelings and impulses • Literacy • Income generation and budget management

32. Reducing risks through infrastructure and resources • Prevention • Voluntary, rapid, confidential testing with child-centred pre & post-test counselling • Treatment • Schooling • Skill development • Care • Family reunification • Family Support – poverty alleviation

33. Recruitment of street children for training as peer educators/support workers • Places for street children offering: peer education and support, condoms, counselling, testing, STD detection and treatment, medication for opportunistic infections, ART, food and clothing, family finding, respite and palliative care for children who need it • Outreach awareness – condom distribution and behaviour change communication in places street children congregate

34. Every HIV-AIDS child statistic represents the life of a human being facing the most adverse of circumstances • The street child is most likely a child no-one is willing to claim • The street child is most likely male, of African descent, the survivor of abuse, illiterate and poor • He is stigmatized because he lives on the streets • He is fair game for sexual predators • If he has AIDS he is doubly stigmatized • His life and his death are without dignity • His rights are easy to recognise and enshrined in the most powerful international agreement that exists yet disregarded at every level of society

35. “Outside of the box” The concept of developmental social work provides the framework for thinking and practice outside of the box Our professional commitment to the worth of every human being provides the mandate