Critical Learning From A Street Cum Slum Children And Adolescent Project Of Kolkata, India

Background(s)
This NGO-led project aimed to analyze the uniqueness of the socio-cultural environment and its impact on the physical and mental health of street cum slum children & adolescent (9-19 years) located at selected low socio-economic zone of Kolkata.

Method(s)
The project was implemented through provision of need based SRH services which included BCC within community outreach activities, free clinical services for general illnesses & SRH problems with counseling. Other interventions of the project: engagement of key community stakeholders, life skill education and advocacy to protect their rights.

Result(s)
Key observations during intervention: frequent negligence & domestic violence at the families, early school drop outs; premature and forcible induction to employments, early sexual debut; visit to sex workers due to easy money & peer pressure, sexual abuse at workplaces and by elderly peers, early marriage, alcoholism, poor awareness on safe sex, STIs and RTIs, psychosexual problems including myths & misconceptions around sexual beliefs and practices.

Conclusion(s)
There should be effective and sustainable programs for the street and slum children & adolescent with life skill education, inculcation of responsible sexual behavior, appropriate SRH care, de-addiction and adequate legal protection within the would-be launched Urban Health Mission of India.

Reaching Them When They Move, Meeting Them When They Hide

Issue: Growing industrialization, increasing mobile men with money, strict administrative vigilance, disintegration of large brothels are pushing sex workers into widely scattered geographic areas including rural areas. Invisible soliciting is popularized through mobile phones, internets, escorts and other legally accepted entertainment services.

Project: Hotel, tourism, entertainment and transportation industries are not sufficiently engaged in current HIV projects. Punitive law against condom-carrying sex workers is hampering the region’s fight against AIDS. Modifying risky behavior of mobile clients is hugely challenging because of absence of appropriate outreach strategies and programs. Opportunities to propagate ‘safe sex’ messages through internet and mobile technology remain untapped. Current advocacy is not yet fully effective to modify the religious sensitivity and socio-cultural intolerance towards sex workers.

Results: Till now, only 20% of sex workers are estimated to have access to basic HIV prevention services in the region. Persistently high STI prevalence and low condom use are still prominent features including alarming increase of HIV transmission among sex workers in certain parts of SE Asia.

Lessons learnt: Strategies to reach indirect, mobile and hidden sex workers and address their issues are not sufficiently established in the current HIV projects of SE Asia, thus a large portion of sex workers are still being missed.

Sugata Mukhopadhyay

 

Challenges Of STI Case Reporting In The Context Of South-East Asia Region

Issue:  South-East Asia is lacking in adequacy and standardization of STI case reporting.

Project: STI services are mostly project based, dependent on funding from different donors with variable donor specific reporting requirements, available in multi-centric facilities like govt. hospitals, NGO run health clinics meant specially for high risk groups, private doctors,  unqualified practitioners & pharmacists, so collecting regular uniform case reporting from those facilities and their centralized compilation to produce standardized and comprehensive country report is extremely challenging. Initiative from national programs to engage private providers in STI management and reporting is in nascent stage. Many STI patients receive treatment at private sectors, thus remains chronically missing in country reports. Stigma, marginalization and criminalization hinder health seeking, mostly with MSM and transgender.

Result: As per global estimate nearly 500,000 curable STIs occur daily in Asia. Inadequacies in case reporting hamper our understanding about exact nature of STI morbidity and evolving pattern of service utilization and safe sex practices, especially among high risk groups, in the region.

Lessons learnt: Selected high volume STI clinics, located at govt. and non-govt. sectors and recognized by national programs can be utilized as STI sentinel sites with adequate resources and technical support to improve and standardize STI case reporting.

Sugata Mukhopadhyay