Table of Content Pages
2 Structural Factors to HIV/AIDS Intervention and Behavioural Change Approach.
3 Definition of Street Children.
4 General Conditions of Ethiopian Street Children .
4.1. Gender, Age and Living Area of Street Children..
5 Factors Pushing Children to Street life..
6 Survival Coping Methods of Street Children.
7 HIV/AIDS and Street Children in Ethiopia
Ethiopia is located in eastern Africa. Ethiopian state is formed through reconsolidation and expansion of an indigenous empire . (James et al. 2002:1) It is one of the oldest countries in the world. With a total area of 1.22 million km2, Ethiopia lies in the northeastern part of the horn of Africa. The country is landlocked, sharing borders with Eritrea to the north and northeast, Djibouti to the east, Somalia to the east and southeast, Kenya to the south, and Sudan to the west. (AQUASTAT Survey 2005:1, Tronvoll 2000: 6)
The Ethiopian people are ethnically heterogeneous, comprising more than 100 groups. The 84 languages and 200 dialects spoken in the country are divided into four major language groups. Amharic is the official national language of Ethiopia and the Oromo make up Ethiopia’s largest ethnic group (Vaillancourt et al. 2005:3). In its1994 census the Central Statistics Authority identified seven ethnic groups have population larger than one million. The seven ethnic groups in alphabetical order are Amhara, Gurage, Oromo, Somalie, Sidama, Tigre and Wolita. Amharas ( 30.1 per cent) and Oromos (32.2 percent) together made up about two thirds of the Ethiopian population. (CSA 1994 cited in Degefe & Nega 1999/2000:65).
Ethiopia is one of the poorest countries in the world. The major economic activity is farming. Agriculture constitutes about 40% of Ethiopia’s Gross Domestic Product and 90% of all export incomes, with coffee the leading export product. About 40 percent of the country's farming population did not produce enough food and income to meet their basic nutritional needs. The Human Development Index (HDI) for Ethiopia is 0.371, which gives Ethiopia a rank of 170th out of 177 countries. Ethiopia per capita GDP is $114 which is amongst the lowest in the world. The GDP per capita annual growth rate was 1.5 % in the year between1990-2004. GDP was 11.2 billion US dollars in the year 2005 (World Bank 2006) and PPP was 529 US dollars in the year 2004 (UNDP 2006: 334).
The percentage of population getting an income below 1 US$ dollar a day from the year 1990-2004 was 23.0 percent and 77.8 percent earn an income below 2US$ dollar per day (UNDP 2006:294). The state of poverty is one of appalling human suffering and persistent deprivations. The evidence of recent periods shows that 40-50 per cent of households in Ethiopia live in abject poverty and that it has been persistent over time.(Geda et al.2006: 3) HIV/AIDS is one of the significant challenges facing the country.
Ethiopia has the third largest number of people living with HIV/AIDS in the world. (National AIDS Council 2001: 7) The national adult prevalence rate of HIV/AIDS in Ethiopia in the year 2003 was 4.4%. (Federal Ministry of Health 2004: 7) In 2005 it was estimated that a total of 1,320,000 people were living with HIV/AIDS in Ethiopia. It was estimated that in the year 2005, a total of 137,500 new AIDS cases, 128,900 new HIV infections, including 30,300 HIV positive births, and 134,500 AIDS deaths (including 20,900 in children under the age of 15) occurred. The estimated total number of persons requiring ART in the year 2005 was 277,800 including 43,100 children. AIDS accounted for an estimated 34% of all young adults’ death in Ethiopia and 66.3% of all young adults’ death in urban Ethiopia. (FMoH 2006: 6-7)
Ethiopia has a population of 75.5 million with a potential to grow at the rate of 2.7 per cent per year. Provided the population continues to grow at this rate demographers estimate that by the year 2022 it has the potential to reach to a size of 120 million. The total fertility rate is 5.9, 85% of the population dwells in rural areas while the remaining 15% are urban resident (UNDP 2006:300). In the year 2005, 48 percent of the population was under the age of 15. Forty-nine percent of the population is in the age group between15-64 and about 4 percent are over 65 (CSA & ORC Macro 2006:14).
The percentage of child school attendance is very low. Among children aged between 5 and 17 years, about 33 per cent of children attended formal school, while 5 per cent of children attended informal schools such as religious schools. About 56 per cent of children had never attended school. There are various reasons for lack of school attendance among children including the need of children to help with household chores and because they are needed to generate household income (Woldehanna et al. 2005:14).
In the year 2000 the total children population of the country in the age group of 5-17 was 18,197,783. Out of this, 9,483,611 children are engaged in productive activities, consisting 52.1% of the child population in the given age group. (Save the Children Denmark 2003: 9- 10) In the same year children up to age of 18 years comprise 50% of the population of the country and 20% of them live in extremely difficult circumstances. They are exposed to disease and exploitation. These children include orphan victims of armed conflict, abused and neglected child workers, destitute children with or without families, street children, prostitutes and juvenile delinquents. (Ibid:10)
Estimates of the number of Ethiopian street children vary, but most estimates tend to be in the range of 150,000-200,000 by far the largest number of children live in Addis Ababa with the an estimated number of 60,000 - 100,000 (U.S. Department of State 2006). Organizations and government offices engaged with the problems of street children believe that the number of street children has increased in the last five years. Poverty is the major cause, exacerbated by drought, AIDS, war, and family violence and breakdown. (Williamson 2000: 4)
In Ethiopia many children work both with pay, and informally without pay, generally within the household. The incidence of children working within the family rises sharply with age; almost half of all 5 to 14 year olds being involved in some kind of economic activity in the year 2001.(Woldehanna et al. 2008a: viii) Children work in shoe shining, selling lottery tickets, selling food items and assisting taxi drivers. Prostitution, begging, weaving and other work performed by children were identified as hazardous. (Save the children Denmark 2003: 39-40) The commercial sexual exploitation of children is increasing in Ethiopia, particularly in urban areas. Most of the child prostitutes are below the age of fifteen. (Ibid: 41)While living and working on the street, children are exposed to excessive heat or cold, are physically beaten at the working place, exploited with little payment, exposed to alcohol abuse and early sexual experience which expose them to other health problems including HIV/AIDS. (Save the Children Denmark 2003: 39) The severity of the harsh living conditions is often amplified for young girls who face sexual abuse by adults exposed to rape, unwanted pregnancy and early motherhood.
This paper presents a multi-level framework for analysis of the links between homelessness and HIV. It assesses the relation of homelessness with structural macro factors like lower socio-economic status, limited power in the society and individual level factors stressors unique to the homelessness context including depleted psychosocial resources and low use of health services. This paper utilises and presents those elements of the framework that are relevant to the street children in Ethiopia.
2. Structural Factors to HIV/AIDS Intervention and Behavioural Change Approach
HIV/AIDS cannot be cured, due to the absence of pharmacological, immunological and medical intervention for prevention; nevertheless the spread of the disease can be contained by adopting an integrated socio-behavioral communication approach. (Ellis et al. 2003: 13) Therefore behavioural change has been recognized as the only possible way to contain the spread of the disease. Early preventive activities are absolutely critical for avoiding the economic, social and psychological costs caused by the epidemic (Cohen 1993).
Behavioural change can be effectively achieved through recognizing the problem and the impact of HIV/AIDS. Besides, individuals must be motivated to act as well as to acquire the knowledge and skill to perform the action (Ellis et al. 2003: 13). Several factors including the form of intercourse, physical factors for example the presence of some other Sexually Transmitted Infection (STI) affect the average probability of transmission of HIV/AIDS during unprotected intercourse (Clark et al. 2003: 9). The number of occasions of unprotected intercourse or the number of condom failures during protected sex determine the possible number of exposures. Therefore, sexual behaviour is a key factor in determining exposure to HIV and probability of transmission. Pertains to this, HIV prevention should focus on influencing individual behaviour as well as the environment that gives rise for the promotion of behaviour which can expose people to the HIV virus (Ellis et al. 2003: 13). To bring about behavioural change, personal perception and social environment are influential in reinforcing and shaping the beliefs that determine behaviour. A change in any of these components influences the other two (Bandura 1986: 18). In this respect personal modifying factors are interconnected with personal or individual level elements which include individual knowledge and awareness, attitude, motivation and intentions, beliefs, perceptions and skill. Knowledge and awareness refer to knowledge about HIV risk, condom effectiveness, condom availability, availability of services, HIV tests and HIV test results, i.e. one’s own and that of the partner. Attitude, motivation and intentions include like attitudes towards condoms and safe sex, use of condoms or refraining from sex and attitudes towards HIV sero status of one’s own and that of one’s partner (Ellis et al. 2003: 13). Beliefs and perceptions are related to perceived vulnerability to HIV, perceived social norms or peer norms regarding safe sex. Beliefs as a personal modifying factor represent individuals’ beliefs about the seriousness of HIV, self-efficacy such as belief in one’s own ability to effect change, self-esteem such as belief in one’s own worth, cultural and religious beliefs about sexual practices. Skills include communication skills, sexual negotiation skills, condom usage skills and sexual assertiveness skills (Ellis et al. 2003: 14).
The environmental factors include social factors such as community or peer norms regarding safe sex such as attitudes towards using condoms, attitudes towards abstinence, cultural and religious beliefs and practices. A broad social attitude encompasses discrimination or stigmatization related to the epidemic. Organizational factors include the structures and the functions of organizations which provide services and their capacity to sustain prevention programmes. These include the availability of health services, for example the availability of HIV testing facilities, accessibility of condoms, provision of care, support and treatment for opportunistic infection (Ellis et al. 2003: 14). The policy level intervention includes the existence of policy and legal protection in the area of HIV/AIDS.
People are not always rational while they are taking actions. Even when they take action on a rational basis since it depends upon on the reasoning skill, knowledge and information they have, they are likely to make faulty judgments when they have inadequate information or fail to consider the full consequences of their various choices (Bandura 1986: 19). Therefore people need to be provided with information regarding the epidemic so that they can develop risk reduction skill and increase their self-efficiency in implementing new behaviour. In addition, there should be a conducive and encouraging environment including a social norm, available policy framework and services which could reinforce their efforts towards behavioural change, which enable them to act accordingly and adopt new behaviour (Ibid).
Towards that end, health promotion and public health intervention such as Behavioral Change Communication (BCC) with the aim of changing the modifying factors which influence risk behavior will be useful. BCC is a basic strategy to bring about positive behavioral change among individuals and the society. For a particular individual or population, a range of modifying factors required to be addressed. Associated with that, BCC can be delivered at different levels and strata like individual, group, community and socio-political levels. They have to be defined by their aims reflecting the modifying factors which they are attempting to address in specific settings, taking into consideration the situation of the target population and the availability of resources. It can be also delivered across several levels with the aim of addressing a range of modifying factors simultaneously (Ellis et al. 2003: 14).
Behavioural change interventions approaches address the structural factors which expose individuals or particular group to HIV/AIDS risk which are shaped or caused by the economic, social, policy and organizational environmental conditions in a particular setting. Thus HIV related structural factors are defined as barriers to, or facilitators of, an individual to practise HIV risk behaviours. Structural factors, in particular those that correspond to the displacement, poverty, homelessness and luck of power correlated with behaviours which increase the likelihood for HIV and STI transmission (Marshall et al. 2009).
Homelessness amongst the structural factors associated with HIV/AIDS virus exposure and development of AIDS cases. Thus, the dynamic and complex role of being homeless as determinants of HIV-related vulnerability is still a major issue for social science research. Homeless children and youth developed behaviors that are directly or indirectly increase their risk to be exposed to various health related problems including HIV/AIDS. ( Halc´on & Lifson 2004:71) Several findings indicate the vulnerabilities of homeless towards the epidemic. (Ibid: 78)
3. Definition of Street Children
Street children are young people who are living and/or working on the streets of major cities. The term “Street Children” has been described by different countries and agencies in various ways but the definition reinforce each other.
Three types of street children have been identified by UNICEF typology of street children categorizing system. The first categories are children on the street. These children come on the streets to work in order to assist their families’ financially and they will return back home to their families at night time. Many of them attend school on the part-time basis. They are often found working in the street during the day, returning to their family home at night. The second categories of street children are, children of the street. This type of children live, eat and sleep in the street. They are not only economically engaged in street life, but are also socially centered on the street. The street may be considered as their main home. The third category is the abandoned child. This child lives and works on the street and has absolutely no supporter or provider beyond him or herself. This category includes orphans, runaways, refugees and others who have no contact with significant careers. In terms of lifestyle and daily activities, abandoned children are very similar to the children of the street. What makes them different is their family contact have ceased. (Ennew 1996 cited in Lalor et al. 2003: 343)
Nevertheless this categorization is too inflexible because it is not in consistent with the realities found in most big cities. First, street children neither form a homogeneous group, nor do their life circumstances remain constant. Besides through the natural transition from childhood to adolescence and adulthood, children's involvement in street life and family ties varies. Furthermore, streets children at different times of their lives and careers may be represented in one or more of the three categories listed above. Being conscious of the complication of its own definition of children “on” versus children “of” the street, since the 1990s, UNICEF has been grouping all working children, either working on city streets or elsewhere, as “working children.” It apply the term “street children” to specify the smaller number of largely abandoned children and youths for whom the city streets are home(Lewis & Heinonen 2003: 2).
Heinonen (2000) classified Addis Ababa street children into three broad categories namely: street working children, working children, and street children. The classification is based on the differences between school attendance, street related activities such as begging or working, age and gender differences, and family dynamics. According to Heinonen , street working children are children who live at home, attend school part time, and work or trade in the street the rest of the time. Working children are children living at home, aged eight and older, who do not beg, do not attend school and work full time in the street. Working children and street working children provide economic support for their family survival. Nevertheless their sustenance at home and their career in the street depend heavily on the presence of adults particularly their mothers.
Street children are aged five to eighteen, do not attend school, and beg full time in the street. Those who are under eight years of age most of them alternate between home and street life. At the time when they reach at the age of ten, most join loosely knit social groups of same-sex or mixed-gender gangs. What differentiate them from home-based working children is their lack of family ties and family support. Almost all homeless street children knew the whereabouts of their families, but had intentionally preferred either to completely break the relation they have or to limit the type and amount of contact they had with their relatives.(Ibid:8)