Transcript Re-positioning Social Work in the Face of Global Challenges:

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.
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:
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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 HIVAIDS
A systems approach between the environment and
individual functioning is necessary in beginning to address
HIV-AIDS and children
Situating Children’s
Experiences:
 Demographic
 Socioeconomic
 Epidemiological context
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
Socioeconomic
Context
 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
Socioeconomic
Context 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.
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
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
HIV-AIDS – international context
 2.1 million children under the age of
15 years live with HIV-AIDS worldwide
 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
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 SubSaharan Africa
 Haiti (with a prevalence rate of 7.7%)
the most affected country
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
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
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
 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
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.
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.”
Survival strategy
 Child
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Severe abuse
Domestic violence
Abandonment
Family conflict
Escape residential
care
 Parent
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Illness
Imprisonment
Migration
Death
Substance abuse
Poverty
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 – siblingheaded households
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
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
Risk and vulnerability
 The child living on the streets has
increased vulnerability to HIVinfection
 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
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
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
Increased risks for the HIV-infected
child
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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.
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
Developmental Social Work
At its core, developmental social work
is concerned with social justice; it is
future oriented, value oriented and
systems oriented
 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 subsystems that must be targeted
Two levels of activity required
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
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
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
Resiliency vs. Vulnerability
 Building resiliency through street theatre,
group work, peer support schemes,
psychosocial counselling, developing skills
such as:
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Communication
Problem solving
Managing feelings and impulses
Literacy
Income generation and budget management
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
 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
 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
“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