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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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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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