Practical guidelines: Practical advice for AIDS educators working with street children

'Survival sex', international sex tourism, and sexual abuse affect the lives of millions of children living in poverty worldwide. Children often become victims of adult sexual exploitation and are sexually active amongst themselves. Since street children are therefore at increasing risk from HIV, they have become a subject of concern to AIDS educators.

Very little information is available on the lifestyles, health and rate of HIV infection among street children, although isolated studies indicate HIV is a problem. But, as with other sectors of society, the time to start preventing further spread of HIV is now. Community outreach workers, health promoters and street educators should work together to develop appropriate methods of health education and improve access to existing services: in most cities, street children do not have access to treatment for their health problems because they do not have identification papers or a permanent address, are not accompanied by an adult, or are simply unable to pay for treatment. Educating street educators and street leaders, so that they can become street-based health promoters, is of central importance.

Dr. Judith Ennew from Streetwise International provides some practical advice for AIDS educators and others planning to work with street children:

There are three main principles to remember when planning educational programmes with children who survive on the streets:

· the main obstacle to successful programmes is our own attitudes;

· the main resource in any programme is the children themselves;

· AIDS education can only succeed in the context of overall personal development: you cannot expect children to protect themselves if they have no sense of their own worth.

Starting with yourself

· Examine your own, and your society's, attitudes and prejudices towards street children, their sexual and other behaviour and AIDS. What do your colleagues believe and say about these children?

· Find out what the children think and believe about themselves! Don't be afraid of approaching the children: it's OK to say 'hello.'

· Recognise that sexual intercourse takes place between children, as well as in the sexual exploitation of children by adults. Be aware that sexual abuse takes place in families, orphanages and prisons. Do not deny the children's sexuality or sexual experience, or lower their self-image, by making them feel 'bad' because they earn money by prostitution or engage in homosexual relationships.

· Beware of creating special groups. For example, many projects make the mistake of separating girls from boys, giving food, shelter and clothing only to the girls. This encourages female dependency. If you make differences between groups of children, you must have good reasons for doing so. Discuss these with the children.

· Remember that street children should not be seen as passive recipients of care. They are survivors in their own right and must be respected as such.

· Beware of creating dependency. Most projects start with the idea of providing food and shelter. You do not have to give food unless children are hungry, and they may have no need for special buildings. As one project director, Fabio Dallape, points out: 'Be cautious in presenting yourself as Father Christmas with your hands full of gifts. Nothing is free in life and the children know it. Do not put them in a world of dreams' [your dreams].

· Finally, examine your motivation for working with street children, as well as that of other volunteers. Avoid allowing the vulnerability of these children to satisfy the emotional needs of the adults concerned.

Use local resources

· Remember that the children themselves are the main resource. Programme staff must get to know and understand them.

· Use the children themselves as educators. Identify the 'gang' leaders, or street educators who have spent years on the streets themselves. Don't assume that you must start with videos and comics because children enjoy these. Personal contact is the best way for messages to be passed on and remembered. People of all ages who are not accustomed to learning with posters, books and videos often have a different perception of two-dimensional media. If you want to use video, or slides, why not make your own with the children?

· You do not need vast amounts of money or large purpose-built premises to start up a local programme. Use existing local resources (a church-run day centre?) and involve families and communities. Some organisations may be willing to provide resources or funding e.g. medical associations, business community or the national Red Cross.

· Share resources and experiences with other projects. Children have a range of problems and require a range of services. Many of these services already exist. The problem may be one of access. Sometimes street children are chased away from hospitals and clinics because of their bad reputation. Avoid providing parallel services, but try to ease access to, and delivery of, existing services. This will often involve adapting existing services and working to change the attitudes of staff.

· Pass on your own experience of working with street children to other health professionals and educators.

Discussing health and sex

· Work towards improving the general health and self image of the children. Like most children living in poverty, their health will already be poor. Giving them the knowledge and the facilities to improve this will increase their self-respect, as well as help resistance to infection and/or the development of AIDS.

· Discuss safer sex in the context of the children's other concerns, such as broader health issues, personal safety, economic survival, job skills, legal and other rights, housing, drug taking and so on.

· When you encourage condom use in sexual relationships, emphasise that this applies to sexual contact with friends as well as with adults/clients/strangers.

· Help the children gain access to condoms and teach them how to use them. Showing a picture of a penis gives very little idea to a child who may not identify with body parts drawn in outline, especially if the rest of the body is not drawn. Discussion and practical demonstration, using a banana or piece of wood carved to look like a penis, works much better. Allow the children to play with condoms and become familiar with them. They might blow them up as balloons! Turn their play into education.

· Be prepared to discuss anal intercourse with all the children, not just the boys. There is widespread evidence that girls practise anal intercourse to avoid pregnancy. Bring topics like this into the general discussion of sex and reproduction.

· Don't emphasise death as the worst thing about AIDS. Although death is a very real threat to street children (they live violent and dangerous lives), they are more concerned with day-to-day survival. Ana Filgueiras, a project worker in Brazil, suggests: 'If you tell them AIDS makes you very weak, that's something they're afraid of. They know that when they're weak, they can't survive on the street.'

· Above all, don't over-publicise the issue of street children being a 'risk group' for HIV infection/AIDS. This will only increase discrimination against them.

Further information: Streetwise International, The Old Maltings, Green Lane, Linton, Cambridge CB1 6JT, United Kingdom