solvent-abuse-pakistan

This publication is available from:
UNODC
Country Office for Pakistan
P.O.Box 1051
61-A, Jinnah Avenue
11th Floor, Saudi Pak Tower
Islamabad, Pakistan
United Nations System in Pakistan Publication
UN-PAK/UNODC/2004/1 - June 2004
THE UNITED NATIONS SYSTEM IN PAKISTAN

Copyright© 2004 United Nations Office on Drugs and Crime
All rights reserved
United Nations System in Pakistan Publication
No. UN-PAK/UNODC/2004/1
Designed by: UNODC Country Office for Pakistan
Disclaimer
“The opinions, figures and estimates set forth in this publication do not
necessarily reflect the views or carry the endorsement of the United
Nations”
ISBN 969-8567-07-0
THE UNITED NATIONS SYSTEM IN PAKISTAN
ISLAMABAD
2004

This research study would not have been possible without the
support and encouragement of Anti Narcotics Force (ANF),
Government of Pakistan. We would like to extend our
acknowledgment to all its collaborating partners, government
facilities, service providers, non-governmental organization etc. For
their support and help rendered during the entire phase of data
collection. We would also like to thank Dr. Kamran Niaz, Regional
Adviser, GAP, UNODC, Ankara, for his valuable comments and
guidance during the conceptualisation, planning phase and
reviewing of this study. Above all, our special gratitude is extended to
all the street children who facilitated and participated in the Study.
This study was conducted as part of UNODC funded project
“District Level Drug Abuse Prevention” AD/PAK/02/F51.
AIDS
ANF
CNS
DU
FGD's
GIT
GO's
HIV
IDU
KI's
NGO
RTI
SPSS
UN
UNICEF
UNODC
VSA
Yrs.
Acquired Immunity Deficiency Syndrome
Anti Narcotic Force
Central Nervous System
Drug use
Focus Group Discussions
Gastro Intestinal tract
Government Organizations
Human Immuno Virus
Injection drug use
Key Informants
Non Governmental Organization
Respiratory Tract Infections
Statistical Package for Social Sciences
United Nations
United Nations Children’s Fund
United Nations Office on Drugs & Crime
Volatile Substance Abuse
Years.

Executive summary
1. Background & Introduction
1.1 Street Children
1.2 Solvent Abuse
01
04
2. Research & Methodologies
2.1 Defining the problem
2.2 Aims & Objectives
2.3 Research Methodology & procedures
2.3.1 Case Definition
2.3.2 Subject Selection
2.3.3 The Questionnaire
2.3.4 Interview Procedures
2.3.4.1 Focus Group Discussion
2.3.4.2 Key Informant Interview
2.3.5 Ethical Standards
2.3.6 Data Management
3.Results
3.1 Demographic information
3.1.1 Gender & Age
3.1.2 Nationality & Migration Status
3.1.3 Religion
3.1.4 Family Information
3.1.5 Educational Qualification
3.1.6 Income, Source of Income & Spending
08
08
09
09
09
10
10
11
11
12
12
14
14
15
16
16
17
18

3.2 Living Conditions & group dynamics
3.3 Medical & Health Problems
3.4 Solvent Abuse
3.4.1 Substances Abused
3.4.2 Quantity used
3.4.3 Effects of solvent abuse
3.4.4 Reasons for use
3.4.5 Consequences of use
3.4.6 Treatment
3.5 Use of other drugs & HIV awareness
3.5.1 Use of other drugs
3.5.2 HIV Knowledge & Risk Practices
3.5.2.1 HIV Knowledge
3.5.2.2 HIV Risk Practices
3.6 Magnitude of problem
3.7 Key Informant interviews
3.7.1 Police Station
3.7.2 Drug abuse treatment facility
Recommendations
References
19
21
21
21
23
24
25
26
28
28
28
30
30
31
32
33
34
35
37
41
3.1
3.1.2a
3.1.4
3.1.5a
3.2.1a
3.3.1a
3.3.3a
3.3.6a
3.4.1a
3.4.1b
3.4.1b
3.4.2.2a
3.6.1
3.6.2
Sampling distribution
Major cities from where children flux into Lahore & Peshawar.
Parental marital status
Education Status
Sleeping place at night
Types of solvent abused and its daily cost in Pakistani rupees
Frequency of use of solvents
Treatment history
Various forms of tobacco used by street children
Use of other drugs during past 30 days
Prevalence of drug abuse in street children
Use of condoms during sexual intercourse
Study sites
Estimated prevalence

A total number of 416 children with
equal distribution from all four cities i.e.,
Karachi, Lahore, Peshawar and Quetta
participated in the study. Respondents were
predominantly males, with only 07 girls (1.7%)
included in the sample. The mean age of
children using solvents was 14.3 ± 2.52 years,
with the children in Peshawar slightly younger
(13.0 ± 2.33 yrs) than the children found in
other cities. The maximum proportions of
children were between 15 to 16 years of age.
The largest proportions of children interviewed
were Pakistani (81%), more than half of whom
had migrated from smaller cities. 12.5% of the
total children were Afghani followed by
Bengalis (5.8%). One third of the children
interviewed belonged to single parent families
with large family size. Almost three quarters of
the children were not currently living along
with their families. These children prefer
staying in groups, had no permanent place to
live, had been sleeping in parks (50%), friends
place(12%) and darbars (6.7%) etc. Seventy
Six percent (76%) of the children never
attended formal education. The remaining
24% had 3.01 ± 1.97 years of educational
attainment. The average daily income reported
was Rs. 79.7 ± 44.7, which was sourced
through cleaning cars, scavenging solid waste
garbage and begging.
Fifty five percent (55%) of the children
complained of at least one medical problem
that they were currently facing . The major
problem reported were Respiratory tract
infection; RTI's (30%), followed by Fever
(19.7%), GIT upsets (18.7%) and skin
infections (12.6%).
Adhesive glues was the primary drug of
choice consumed by 374 (90%) of the
interviewed street children. Other solvents
abused include petrol (25.5%) and thinners
(10.6%). Use of Petrol was significantly
popular in Quetta (43%) and Peshawar (41%).
In Karachi children were found to be involved
with glue (95.2%), Thinners (27.6%), Petrol
(13.3%), as well as Tincture(5.7%). An
average amount of Rs. 39.7 ± 30.1 is being
spent on these solvents with minimal
geographical variations. A little more than 60%
of the children reported regular use of these
substances for more than 2 years through
various techniques. On Average they inhale
almost 80 gm. Ninety Five percent (95%) of
the children stated that solvents are easily
available from the local market. More than
half of the times money is pooled in by various
children and thereafter procurement is used in
a group. Relief of tension, euphoria and
drowsiness are the major effects reported to

e felt on use of the solvent drugs. In contrary,
upon non-availability the feeling of anger,
agitation, restlessness, irritability, and
generalized aches were the major problems
reported. The major factors leading a child into
the use of solvents were friends and peer
pressure, reported by more than half of the
children interviewed. Only 20% of the children
had undergone any sort of treatment for drug
abuse problem. More than two third of the
children were unaware of any organization or
facility where they could be detoxified and
rehabilitated.
Information regarding use of other drugs
was also gathered. Hashish was found to be
the most prevalent among the group as 62.5%
children reported regular use during the past
30 days. Other drugs used during the past 30
days were Bhang (4%), Opium (3.6%) and
Synthetic drugs (5.3%). Only one child
conveyed use of heroin, while there was no
injection drug use reported. 53.8% of the
children had heard about HIV/AIDS. Among
these, 62.5% knew that it is spread through
sexual intercourse, while 19% knew that it can
be transmitted by syringes contaminated with
the virus. However, information regarding its
prevention was inadequate, as 44.6% stated
that sexual intercourse should be avoided
altogether to protect oneself from HIV. 28% of
the children thought that HIV can be avoided
by using various medicines. A high HIV risk
situation was noted, when sexual practices of
these children were evaluated. The average
age at the initiation of sexual activity was
reported to be 10.6 ± 2.2 years, with a high
number of sexual partners both males and
females was found. Only 20% informed of
using a condom, while the remaining 80% of
the children reported never using a condom.
One quarter of the children reported
exchanging sex for money.
Information gathered from the key
informant interviews, documented a very
unsatisfactory knowledge and awareness of
issues related to street children, and more
importantly the understanding of solvent
abuse among this extremely high-risk group.
An overall lack of clarity was observed
regarding detoxification of solvent abuse in the
existing drug treatment facilities was noted,
compounded by absolutely no rehabilitation
program for these children.
The report is structured in four major sections.
Section 01 presents background and introduction of street children, as well as basic
conceptual information on solvent abuse and the burden of the disease.
Section 02 gives the aims and objectives of the study as well as a description of the
research methodologies adopted. It provides information on subject selection, sampling
procedure, data collection procedure and data analysis
Section 03 reports the results of the study and is further distributed into 6 major
subdivisions. Sub-Section 1 provides information on the socio-demographic
characteristics of the children. Sub-Section 2 describes the group dynamics and current
living arrangements of these children. Sub-Section 3 is related to information on drugs
other than Solvents, HIV/AIDS knowledge and risk behaviours. Sub-Section 4 provides
description regarding prevalence and related information on solvent abuse. The last subsection
of this part provides information on the various drug treatment facilities, exists in
the country.
Section 04 provides recommendations and proposes various strategies to address the
issues.

&
BACKGROUND
Introduction Section one
BACKGROUND
& Introduction

BACKGROUND & INTRODUCTION
Section one
Street children are defined as
“children who have to work on
the streets because their families
need money to survive, children
from poor families who sleep on
the streets, orphan and
abandoned children whose
parents have died because of
illness or war or for whom it was
simply impossible to look after
their children”.
1.1 Street Children
st
With the advent of the 21 century human
population is going through the cycles of feast
and famine. This can be observed especially
in under developed countries and in
developing nations like Pakistan. This
population explosion not only gives rise to a lot
of physical /environmental stresses such as
shortage of food supply, fuel and energy,
different type of pollutions etc but also the
psychological ones. They can be anxiety,
tension, worries, depressions several other
psychopathologies due to deprivation of need
fulfilment and coping with technological
advancement. Such frustrations would be
damaging for the inter personal relationships
and the consequences have to be borne by
both the individual and society disrupting the
over all growth pattern. The consequences
can be traced from the elementary unit of the
society which is family such as disrupted and
dysfunctional abuse of authority and power
and gradually to the over all social structure.
This can be an increasing rate of crime and
violence. Such a malfunctioning society
always strikes hard against the powerless
including women and children.
Children in particular are highly susceptible
to these highly volatile situations. They face
denial of their basic rights. The inequalities
they face due to adults behavior are
unimaginable, however the manifestations are
the same in any setting. The circumstances
faced are the same all over the world.
Parents, friends and the physical environment,
all play an active role in the development of a
child's personality. Any neglect, deprivation,
indifferent parental behavior possibly due to a
disrupted relationship can cause serious and
irreversible damage to the developing
personality, pushing the child into deviant
behavior. Many societies witnessed an influx
of children ending up on the streets due to
indifferent attitudes of their parents, family
break-up or poverty. Alarmingly, the numbers
have been constantly growing into significant
epidemiological proportions. Societies have
failed significantly in doing enough to follow
through and to create secure environments for
these displaced children known as “Street
Children”.
1
Street children are defined as “children
who have to work on the streets because their
families need money to survive, children from
poor families who sleep on the streets, orphan
1

Section one
and abandoned children whose parents have
died because of illness or war or for whom it
was simply impossible to look after their
children”. They live, breath in the air
poisonous for their survival but they find
relieve in it. Their social or economical state
compels them to involve in anti-social activities
and they suffer critically due to drug and
sexual abuse or similar other harmful factors.
These children are deprived of the essential
relationship with vital societal institutions that
traditionally provide sources of support and
ensure an individual's well being and
happiness in society. They are at alarmingly
high risk for a myriad of physical and
psychological problems as a result of both the
circumstances that preceded their
homelessness, and as a direct consequence
2.
of life on the streets
The United Nations estimates around 100-
3
140 million street children world wide. Out of
these only 20 million children live on the street
around the clock without their families. In
South America at least 40 million, in Asia 25
million, in Africa 10 million and in Eastern and
Western Europe approximately 25 million
children and youth live on the street 4,5
. It is
estimated that approximately 90 percent of
street children in Central America sniff glue.
Considering the situation in South Asia it is
revealed that almost every country of this
region suffers the same dilemma. In India, 18
million children have been reported to live or
work on the streets of urban India, labouring
as porters at bus or railway terminals; as
mechanics in informal auto-repair shops; as
vendors of food, tea, or handmade articles; as
street tailors; or as rag pickers, picking
through garbage and selling usable materials
7
to local buyers . In Bangladesh, Nepal, Sri
Lanka the issue is critically reported, due to
illiteracy and deprivation of basic needs the
8
countries face the identical problem .
Pakistan, which has a population of 140
million, is no different from other South Asian
countries as its urban settings portray the
same bleak picture. The situation is worse in
its biggest Metropolis city, Karachi that is
home to more than 10,000 street living
9
children. The course of researches revealed
many disturbing facts about these children.
They brave extreme weather conditions and
live in an extremely battered environment,
exposed to any eventuality that comes their
way. They usually form groups to protect
themselves from exploitation and abuse,
which is common in street culture. Their gang
leaders are usually older boys who abuse
them in return for ensuring their safety . The
gang leader who arranges for their meals and
for their favourite distractions, (these children
have been found addicted to a number of
toxicants, including substances and
chemicals) keeps whatever these children
earn.
These children are facing not only the
scarcity of resources but are living
under noisy, dirty, unsafe and
impersonal environment
which leads to frustration
because their goals
related to Subjective
Well Being( SWB)
are thwarted or
blocked. Street
children are those
who are least able to
protect themselves. In
almost every aspect of their
lives; they are subject to
unconscionable violence, most often
perpetrated by the very individuals charged
with their safety and well being. This
frustration leads to the feelings of hostility
towards its source. But single handily they
cannot achieve what they desire thus attach
with similar others on the principle of
reciprocity of liking. As being a part of group
not only social but also emotional needs can
be meet. Thus they become a staunch
member and do whatever others do. This
could be an explanation for their association
with gang-crime which in turn build their
courage to be involved in criminal activities
and solvent/drug abuse.
2
3

Section one
1.2 Solvent Abuse
Defining Solvent Abuse has proven to be a
far more arduous task than it has been for
most other drugs. In broader terms solvent
abuse or more accurately called Volatile
Substance Abuse (VSA) has been defined as
the “deliberate inhalation of gases, chemical
fumes or vapours for mind-altering and
recreational purposes in order to get a “high”
similar to the intoxication produced by
alcohol”. Solvents are chemicals that change
from liquid form into gases or vapours at
ordinary room temperatures. Their abuse
potential is directly related to their ability to
produce intoxication and repeated abuse may
result in psychological dependence or other
harmful health effects. The prevalence and
public health effects of volatile substance
abuse are often underestimated and local
knowledge of the phenomenon is inadequate.
The wide range of organic solvents available
in many common products further complicates
the situation. Compounds such as diethyl
ether, chloroform and nitrous oxide have been
deliberately inhaled for recreational purposes
since the early 1800s. Solvents from
adhesives such as glues, (notably toluene),
typewriter correcting fluids and thinners (1,1,1-
trichloroethane), hydrocarbons such as those
found in cigarette lighter refills [forms of
liquefied petroleum gas (LPG), largely butane],
aerosol propellants, halocarbon fire
extinguishers and gases such as nitrous oxide
are among the compounds or products which
may be abused in this way. Petrol and its byproducts
(gasoline) as well as Acetone
(propanone) have also been reported to be
abused, especially in developing communities.
While the inhalation of volatile substances
for mind-altering and recreational purposes is
a long-standing problem in the developed
world, the phenomenon appears to be of a
recent origin in most countries in Asia and the
Pacific region. Research has shown that VSA
is primarily an adolescent phenomenon, with
the highest levels of prevalence reported
among 15 and 16 year olds. VSA gives rise to
dose-related effects similar to those of other
hypno sedatives. Small doses can rapidly lead
to euphoria and other disturbances of
behaviour similar to those caused by ethanol
(alcohol), and may also induce delusions and
hallucinations
. 19,20,21,22,23,24.
Inhalants can be breathed in through the
nose or the mouth in a variety of ways, such
as:
“Sniffing” or “snorting” fumes from
containers;
“Bagging”sniffing or inhaling fumes
from substances sprayed or
deposited inside a plastic or paper
bag;
“Huffing” from an inhalant-soaked rag
stuffed in the mouth;
Spraying aerosols directly into the
nose or mouth.
Inhaled chemicals are rapidly absorbed
through the lungs into the bloodstream and
quickly distributed to the brain and other
organs. Research has shown that the
chemical substances found in inhalants
produce acute effects similar to subanaesthetic
concentrations of general
anaesthetics, as well as to the effects of
classical CNS depressant drugs, such as
alcohol and the barbiturates. This is
characterized by a rapid high that resembles
alcohol intoxication with initial excitation
followed by drowsiness, dis-inhibition, lightheadedness
and agitation. Nearly all abused
inhalants (other than nitrites) produce a
pleasurable effect by depressing the CNS.
There is evidence that toluene, a solvent
found in many commonly abused inhalants
including glue, paint and nail polish removers,
activates the brain's dopamine system. The
dopamine system has been known to play a
role in the rewarding effects of many drugs of
abuse. Nitrites, in contrast, dilate and relax
blood vessels rather than acting as
anaesthetic
agents. For
the
anaesthetics,
evidence
suggests
that
enhancement
of
GABAenergic
inhibition may
be an
important
cellular target for
their acute effects, just as it is for alcohol and
25,26
other depressant drugs.
Within minutes of inhalation, the user
experiences intoxication along with other
effects similar to those produced by alcohol.
Alcohol-like effects may include slurred
speech, an inability to coordinate movements,
euphoria, and dizziness. In addition, users
may experience light-headedness,
hallucinations, and delusions, e.g., a feeling
that they can fly. Because intoxication lasts
4
5

6
only a few minutes to a maximum of about 45
minutes, abusers frequently seek to prolong
the high by continuing to inhale repeatedly
over the course of several hours. Once the
initial 'buzz' wears off, users experience
symptoms similar to a hangover and often feel
tired and drowsy. It is suggested that rather
than using the term 'addiction' for solvent
abuse, 'dependence' is a more useful concept
as this allows for two dimensions: both the
physical and psychological effects. However,
tolerance can develop with regular use of
volatile substances so that increased
inhalation is needed to get the same effect.
The psychological effects of volatile substance
abuse vary from person to person. However,
there is always a general sense of euphoria
and of omnipotence associated with the
process. Chronic users may also experience
difficulty with socialization and communication,
which can result in a pattern of antisocial
,27,28
behaviour.
Accidental death or injury can happen
especially if users are in an unsafe
environment such as near a busy road.
Becoming unconscious also carries with it the
risk of death through choking. In fact any
method of use which hinders breathing (such
as sniffing with a plastic bag over the head)
increases the likelihood of death from
29,30,31,32,33
asphyxiation.
RESEARCH methodologies
Section two
&
&
RESEARCH
methodologies
7

RESEARCH & METHODOLOGIES
Section two
2.1 Defining the Problem
2.3 Research Methodology & Procedures:
The National Assessment Study on the
Drug Abuse Situation in Pakistan, 2000,
documented that there are approximately
500,000 chronic heroin users (including drug
injectors) in the country. The study also
highlighted an emerging problem of solvent
abuse among young people; street children in
particular. Research has documented Street
children to be one of the most vulnerable
populations for various deviated behaviours
such as substance abuse. Data from the
study did not allow comment on the issue in
any detail, but Solvent abuse was most
commonly reported from urban areas in the
major cities like Lahore Karachi, Rawalpindi
and Peshawar.
However, the extent to which this
marginalized and vulnerable group is abusing
solvents deserves further attention, as does
the wider question of what can be done to
alleviate the drug and other social problems
amongst this particularly needy group of
young people.
The following study is therefore designed in
order to get a better understanding on solvent
abuse among adolescents in Pakistan, and
utilize the results in the formulation of
interventions for the street children with the
solvent abuse problem.
2.2 Aims & Objectives:
The objectives of the study:
To determine the …
i) prevalence of solvent abuse among
street children in Pakistan;
ii) patterns and trends of solvent abuse
among street children in Pakistan;
iii) level of awareness about adverse
consequences of solvent and drug
abuse;
iv) the demographic and socio-economic
profile of solvent abusers, living
circumstances including group dynamics;
v) health and social consequences of
solvent abuse;
vi) sources of financing solvent and drug
abuse;
vii) knowledge of HIV / AIDS and associated
risk practices; and
ix) the nature, extent and quality of
treatment and rehabilitation facilities, if
any, for street children abusing solvents.
2.3.1 Case Definition
Reaching a case definition was a highly
tedious task, primarily due to the scarcity of
research undertaken on the subject in
Pakistan, as well as the highly complicated
dynamics of this vulnerable population. The
task required defining 'street children' initially,
followed by delineating 'solvent abuse' and
finally merging the two to reach a case
definition to be used for the purposes of our
study. Street children were defined as:
“children for whom the family support base
has become increasingly weakened and who
must share in the responsibility of family
survival by working on city streets and market
places. Nevertheless, while the street
becomes their daily time activity, the majority
return home most nights.”. Based on the
preceding, the eligibility criteria for subjects to
be included in the study was described as:
Street children spending a minimum of 10
hours on the street, irrespective of
residential status
Either male or female
Aged between 9 to 19 years
using any of the products included in the
list of abusive solvents (annex 1) continuously
for a minimum of past 6 month, not less
than 3 times a week.
Based on the above mentioned criteria, our
case definition was:
“All street children, either male/female, aged
9 to 19 yrs, willing to participate in the study
and had been regularly using solvents in the
past 6 month for not less than 3 times a week.”
2.3.2 Subject selection
The study was conducted in the four
provincial capitals of Pakistan i.e., Karachi,
Lahore, Peshawar and Quetta. Extensive
efforts were made to achieve a representative
sample of the study population. Thus, prior to
the selection of study subjects, a
comprehensive mapping of street children
was done in the respective city, utilizing
multiple resources. Thereafter, multiple sites
with highest concentration of street children
were selected in each city, from where equal
proportions of study subjects were recruited.
Subjects found eligible were otherwise
excluded from the study but unwilling to
participate.
8
9

Section two
2.3.3 The Questionnaire
A team of researchers including an
epidemiologist, psychologist, social scientists
and social workers working with street children
developed the questionnaire. A 03 days
training on data collection was conducted in
Karachi, which included issues on subject
selection, explaining the rationale and
objectives of the study to the subjects,
acquiring informed consent and a thorough
understanding regarding each question. The
training was followed by pre-testing of data
collection technique and questionnaire
implementation on 42 subjects (10% of overall
sample) at 3 different sites.
The questionnaire was pre-tested on a
sample of 10% of the actual sample size,
which was modified, and all required changes
were incorporated. Information on various
demographic and socio-economic variables,
information related to the family of the child
and current living arrangements, knowledge of
the drug abuse problem and awareness of the
consequences was collected. Information
related to average daily income, sources of
income and mode of spending were also
noted. Information on drug use practices i.e.,
severity and routes of administration etc.,
Medical, social and psychological
consequences of solvent abuse were
obtained from the child. Knowledge related to
HIV, its modes of transmission and prevention
as well as an evaluation of high-risk HIV
behaviour and practices was done at the end.
2.3.4 Interview procedures
Four data collection teams, each
comprising of a field supervisor and three
interviewers worked simultaneously in their
targeted areas. All interviewers were social
science graduates, having a minimum of 2-3
years fieldwork experience. As already
mentioned a three-day training of interviewers
was held in Karachi. The work schedule of all
interviewers was prepared by the field
supervisor in such a way that each interviewer
was assigned to conduct three interviews per
day at various targeted sites. An equal
number of children were selected on the basis
of incidental sample for data collection from
the identified sites. Furthermore, to capture
the entire segments of the street children
population, each site was visited on different
days of the week as well as on different times
of the day. Among children present at a
selected site, one child was selected by the
interviewer, after the drug abuse status was
determined. This was followed by an informed
consent and a structured interview, which took
an average time of 35 minutes, was
conducted.
2.3.4.1Focus Group Discussions
In addition to collecting questionnaire
information, purposive sampling on the basis
of stratified grouping was
applied to hold seven
Focus Group
Discussions (FGD's).
Each group consisted of
Typical & Critical cases,
and at least one child
from each age bracket
i.e., upto 10 yrs, 11 to 14
yrs and more than14 yrs.
A total number of 8 ± 1 member
participated in each group discussion, which
were conducted in Karachi (Jehangir Park),
Quetta (Baldia Park, Railway station),
Peshawar (General Bus stand, city station
sara-e-pul) and Lahore (Abbot road, Ravi
park). A total number of 58 children
participated in this activity altogether. The
purpose of FGD's was to indicate and
illustrate:
I.
II.
III.
IV.
antecedents of nurturance on
behaviors and attitudes;
reason of incomplete education;
living conditions and group dynamics;
effects, reasons and consequences
of solvent abuse;
2.3.4.2 Key Informant Interviews
To acquire information about the existing
services for the treatment and rehabilitation of
street children, as well to comprehend the
awareness of the service providers, 18 key
informant
interviews
were
conducted
with
individuals in
a regular
contact with
these
children
frequently.
Two major
groups of
people were
interviewed
i.e., people
Box.4 Key Informants interviews
Karachi
Lahore
Police station – Metha dar
Police station – Darakhshan
Azam Clinic - Pakistan Society
Marie Adelaide Drug rehabilitation
Programee
Police station – Qilla Gujar Singh
Police station – Naulakha
Nighaban centre
Nai Zindagi
Model drug abuse treatment centre –
Mayo Hospital
Peshawar
Quetta
Police station - Hashtnagar
Police station – Kabuly Bazar
Dost Welfare Foundation
Lady Reading Hospital
Police station - Pushtoonabad
Police station – City
Milo Shaheed Trust
Psychiatric Ward – Civil Hospital
Edhi centre
10
11

Section three
involved in providing drug detoxification and
rehabilitation facilities, as well as police
officials. Various government and non
governmental organizations were selected to
identify and recognize the existing resources
available for drug detoxification and treatment
of these children. Moreover, an evaluation of
the knowledge and awareness as well as the
skills of these providers is a requisite for
developing interventions in future.
On the other hand, police and law
enforcement agencies are known to come into
interaction with these children frequently.
Moreover, these institutions play a key role in
providing first hand information regarding the
criminal involvement and illicit activities done
by these children. It was equally important to
know that if children are involved in such an
activity, how frequent is such an involvement
while at the same time, what sort of
rehabilitation and rectification methods are in
place.
2.3.5 Ethical Standards
(i)
(ii)
(iii)
(iv)
informed consent of the interviewee;
ensuring privacy and confidentiality of
personal information;
non-inclusion of subject's personal
information in data files;
Presentation of results in aggregate;
form, without individual identification.
2.3.6 Data Management
A data base was specifically designed in
Fox Pro for the purposes of data entry. The
completed questionnaires after field editing
and checking by the field supervisors were
received at the data management unit. All
questionnaires were assigned a code number,
and the forms were edited by the data
manager. After editing, data set were double
entered in the software designed for data
entry, followed by data cleaning and analysis.
STUDY results
12
To assure adherence to the ethical
standards of epidemiological research,
procedures followed included:
STUDY results
13

Solvent Abuse Among Street Children in Pakistan
STUDY RESULTS
Solvent Abuse Among Street Children in Pakistan
Section three
Four hundred and twenty three (423) interviews were conducted in the 4 target cities. 29
eligible children refused to participate in the study (primarily girls 19), with an overall non
response of 6.5%. The overall distribution of sample is given in Table 3.1
yrs) and 21.2% (more than 17yrs) respectively. The city wide age distribution is given in Fig
3.1.1a.
The demographic and socio-economic
profile of the street children who participated in
the study is presented in this section.
Table 3.1 Sampling Distribution
Karachi Lahore Quetta Peshawar OVERALL
n (%) n (%) n (%) n (%) N (%)
Interviews conducted 110 110 110 110 440
Non response 02 (1.8) 07 (6.3) 09 (8.1) 11 (10) 29 (6.5)
Incomplete forms 05 (4.5) 01(

Section three
from where these children have largely migrated
are shown in Table
3.1.2
Table 3.1.2a. Major cities from where
children influx into Lahore & Peshawar
LAHORE
3.1.3 Religion
96.4 % of the children interviewed were
Muslims. Of the remaining 3%, 12 were
Christians and 1 child was reported to be a
Hindu. Two children did not know about their
religion. The figures reported are in accordance
with national data.
3.1.4 Family Information
PESHAWAR
City n City n
Faisalabad 10 Mardan 8
Gujranwala 10 Swat 7
Sheikhupura 3 Charsada 5
Karachi 3 Rawalpindi 4
Sialkot 3 Kohat 4
Seventy two percent (72%) of the
respondents (300) were not currently living with
their families. Of all the homeless children, 9.3%
(28) did not know about their families. Out of the
remaining, only 2% were in daily contact with the
family. Almost one third were meeting the
family at least once a month while a
substantial percentage 43.6% had contact
almost once every six months. 2.3% had lost
complete contact with their families. The
graphical presentation of the responses is
given in Fig 3.1.4a.
43.6
Fig. 3.1. 4a
Fre qu en cy of Fa mily C on tac t
daily
once or tw ice a w eek
once or tw ice a month
more than a monthbut less than 6 months
no contact
2.3
2.2 7.6
Further information regarding
parents, and immediate family members was
obtained. A high proportion of children were
reported to belong to large families. The mean
family size (immediate members) was
reported to be 8.89 ± 2.45, with more than
38% of the children belonging to families
having 10 or more immediate members.
Analysis of the birth order of the children
interviewed revealed that 53.6% were middle
born, 15.2% were elders while the remaining
22
30.4% were the youngest.
Further information regarding the parents
depicted that almost half of the children
reported that their parents were living together.
Approximately one third of the children
belonged to single parent families. Thus either
one of the parents was deceased or otherwise
there was a marital disruption in the form of
divorce or separation. Further details are
provided in Table 3.1.4a.
Table 3.1.4a
Parental Marital status
Marital status n (%)
Currently living together 205 (49.3)
Single parent 132 (31.7)
Both parents died 50 (12.0)
No information 29 (6.9)
FGD's indicated that children complained
about their parent's attitudes as indifferent
towards them. A few statements as per
verbatim are quoted to give a clear perception
of their relations with parents;
“my parents abused each other and in the
end verbally and physically abused me as
well”. According to another child “my father
always demanded good grades in school but
never gave money for stationary and books. If
I was not doing good in my school, I was
forced to work for living”. One of the child
informed, “My father abuse drugs and under its
influence used to beat us”.
Information generated from the FGD's
showed that the upbringing of most of these
children was done in the parenting fashion
”,
called “rejecting-neglecting parenting style
Most of the children further complained of
larger family size and scarcity of resources.
They were of the opinion that their family
expenditures were more than their monthly
earning, and their parents were always
pushing them to contribute to the family
income and share some of the financial
responsibilities. Children also reported their
family as a disrupted unit, in which the parents
were always quarreling with each other and
releasing their aggression and anxieties on
children, infact cursing their existence.
3.1.5 Educational Qualification
Results of the analysis regarding
educational attainment has shown that overall
76% (316) of the total children interviewed
never went to school. The situation was found
to be the worst in Quetta, where 90% of the
children never attended school. The mean
16
17

years of education completed by those who
went to school was 3.01 ± 1.97. See table
3.1.5a for details.
Section three
Karachi Lahore Quetta Peshawar OVERALL
n (%) N (%) n (%) n (%) N (%)
Never went to
school 78 (74.3) 75 (68.8) 91 (90) 72 (72) 316 (76)
Cannot read or
writ e 82 (78) 83 (76.1) 91 (90) 67 (67) 316 (76)
Mean years of
education
completed 2.8 ± 1.7 3.1 ± 1.7 5.0 ± 3.4 2.2 ± 1.2 3.0 ± 1.9
Lack of interest (35%) followed by nonavailability
of finances (23%), detestation for
teacher (22%), required to work (10.5%) and a
non-interest of parents in the child's education
(6%) were the main reasons reported for the
discontinuation of education.
As already mentioned in the previous
section, children regarded their families as
broken and dysfunctional. Children reported
under group discussions that the apathetic
attitude of parents made them irritated and
frustrated. This was further amplified by the
teacher's attitude. They said: “Teachers beat
us for being undisciplined, can't learn lessons
properly or can't even study properly”. It can
be added over here that children who are
distilled and rejected are more likely to drop
out from school, to develop emotional
problems and to become juvenile delinquents.
They are usually unhappy and are lonely,
suffer from a higher incidence of both physical
and mental disorder experiencing problems
that range from poor health and adjustment to
a higher rate of criminal activity to suicide
conversely. It is well supported by various
researches that such destitute children face
38,39
problems mentioned above.
3.1.6 Income, Sources of income &
Spending
140
120
100
80
60
40
20
0
125
Cleaning
cars
69
Fig. 3. 1.4a
57
Begging
50
27
Waiters
So urc es o f Inc ome
The primary source of income for the
majority of children was cleaning / washing
cars (30%), followed by scavenging garbage
(16.7%) and begging (13.8%). Other sources
of income included physical labor, selling of
flowers, toys, balloons, combs etc., on the
22
13 13 13 12 15
Pick
pocketing
Skilled
Labor
Misc
street. A minor proportion of children (3%)
reported involvement in minor crimes such as
pick pocketing etc., Two of the children
interviewed also reported of involvement in the
peddling of drugs such as Hashish.
A negligible fraction (3%) sourced their
income from skilled
work i.e.
mechani
cs,
con
structi
on work
etc. The
various sources of
income for the street children are given in Fig
3.1.6a. The average daily income reported
was Rs. 79.7 ± 44.7 earned after working for
an average of 8.63 ± 5.74 hours per day.
Using the provided estimates, an
approximation of the average monthly income
was found to be Rs. 2395. The mean daily
income was significantly low for children
interviewed in Peshawar (45.14 ± 16.18) while
the remaining cities reported a mean daily
income, which was almost double. Only
30%(126) children informed that they share
their income with their families.
3.2 Living Conditions &
Group Dynamics
As already mentioned, 72% (300) of the
respondents were not currently living with their
families, and, 9.3% (28) out of these had
completely lost contact with their families. The
current living conditions and circumstances
were further explored.
Children were inquired about the place
where they had been sleeping during the past
30 days. Almost half of these children had
been sleeping in the streets or parks in the last
30 days. 12% reported staying the nights with
their friends. Upon further exploration, this
night stay was either at home or at the place
where this friend works. Approximately 7% of
the children reported sleeping at Darbars and
shrines as well. The responses are given in
Table 3.2.1a.
Table 3.2.1a Sleeping place at night
With the family
Street/ Parks
Friends
Darbar / Shrines
Work Place
Others
116 (28%)
206 (49.5%)
50 (12%)
28 (6.7%)
04 (1.0%)
06 (1.4%)
18
19

Section three
Results show that a large number of
children interviewed had no permanent place
to live/sleep and had been drifting around
various places. It was interesting to note that
all such children never spend nights alone, but
had been sleeping in the company of other
street children, and stay in groups. The groups
are usually of a large size (60% of the children
have reported sleeping at places where more
than 10 children are present). Only 8% of the
children have been sleeping in a group of less
than 5 children. A group leader, who is usually
an elder, either the strongest boy or the one
who owns the place, almost always controls
the group.
Children under focus groups shared their
feeling of dismay by pointing towards the
ambience around them as disconsolate.
According to them jungle rules prevail, as the
one who is mighty or superior (in any form)
surmounted others. Children were of the
opinion that living in open places gives rise to
the feeling of insecurity and they remain
vulnerable to abuse, which extends from
verbal to physical and even sexual. The main
fears reported by the younger children were of
sexual assault from the elder boys, while the
elder children themselves were concerned
about physical dangers. The majority of
younger children informed that they were at an
absolute loss to enjoy a sound sleep, as they
are in constant state of anxiety from all the
exposed dangers, which is not only from
nature but more from their own kind. The
formation of groups and the need to stay
together could be explained in the light of this
as well as the fact that being human beings,
and for need fulfilment, they had to live
together and became a part of group. Being a
part of group they perform all the rituals and
meet institutionalised norms of the group; the
finding is well supported by several
researches conducted on personality
,
development . This is an extremely important
point, which needs consideration and can be
utilized when preventive packages are
formulated for these children.
3.3 Medical & Health
problems
Evaluation of the medical status had shown
that 55% of the children complained of at least
one medical problem that they were facing
currently. The major problems reported were
Respiratory Tract Infection (30%), followed by
Fever (19.7%), GIT upsets (18.7%) and Skin
Infections (12.6%). Other complaints included
Headaches, Generalized Myalgias,
Weakness, Eye Infections etc.
Among those who complained of prevailing
illness, 47% had sought medical treatment. Of
the remaining 53%, the lead reason reported
for not seeing a doctor was lack of finances
(39%). Other important reasons reported were
a fear of injection (20%), don't know a doctor
(9.8%), don't want to go because doctors are
not cooperative with them (9.9%) and self
treatment (3.3%). The health seeking
behaviour needs to be considered when any
primary health care interventions are designed
for this group.
3.4 Solvent Abuse
3.4.1 Substance abused
The use of various solvents by the
respondents is in conformity with what is seen
12-14,17
internationally. Adhesive glues is the
primary drug of choice consumed by 90%
(374) of the interviewed street children. This
feature has been found to be uniformly
distributed across all the four cities from where
data were collected. A high proportion of
samples reported use of other solvents as
well, including petrol (25.5%) and thinners
(10.6%). Slight differences were noticed in the
use of these secondary solvents across cities.
The use of Petrol along with adhesive glues
was significantly popular in Quetta (43%) and
Peshawar (41%), while the practice was
almost negligible in Lahore, where only 7
children reported the adjunct use of petrol
along with adhesive glues. As a matter of fact,
a significant proportion of children found in
Peshawar were involved in the use of petrol
alone (26%), without getting involved with the
use of adhesive glues. Karachi has reported a
more complicated picture, where children have
been found to be involved with multiple
20
21

Section three
substances. Thus while glue is the main drug
used (95.2%) children have also been using
Thinners (27.6%), Petrol (13.3%) and a minor
proportion (5.7%) has reported use of Tincture
as well.
Table 3.3.1a
Solvents abused
Adhesive Glues
Petrol & related
products
Thinners
Miscellaneous
Average Daily cost
(mean ± sd)
Types of Solvents abused
and its daily cost in Pak Rs.
Karachi Lahore Quetta Peshawar OVERALL
n (%) N (%) n (%) n (%) n (%)
100
(95.2)
14 (13.3)
29 (27.6)
07 (6.7)
47.5 ±
36.5
107
(98.2)
07 (6.4)
02 (1.8)
01 (0.9)
41.6 ±
26.3
94 (92.2)
44 (43.1)
10 (9.8)
05 (4.9)
38.7 ±
26.2
73 (73)
41 (41)
03 (3)
01 (1)
30 ± 28
374
(89.9)
106
(25.5)
44 (10.6)
14 (3.3)
39.7 ±
30.1
Results have shown that an average
amount of Rs. 39.7 ± 30.1 is being spent on
these solvents, which forms almost 50% of
their average earning. (see section 3.1.6).
Slight geographical differentiations were
noticed; children in Peshawar reported to have
spent an average daily amount of Rs.30 on
buying these substances in contrast to Rs.47
spent by a child living in Karachi. The numbers
are however in parallel to their average
income.
Further analysis revealed that the
maximum proportions (62%) of children
interviewed had been using these substances
for periods greater than 2 years. A minor
Box 3.3---- Techniques used for i nhaling
Adhesive Glues
It should be noted that it is the vapor
given off by the product that is used and
the product its elf, e.g. glue, is not
ingested into the body. Abusers have
reported 3 different techniques through
which they inhale the product :
The most practiced technique is the use
of a solvent from a soaked cloth reported
by 80% (329) of the respondents.
Typically some of the mat erial (20 gms)
is poured into the cloth, which is then
rolled in the sh ape of glove. Thi s in local
terms is known as ‘Dum’. The ‘dum’ is
then sniffed, or kept in the mouth and
the fumes are inhaled.
The second favourite technique is the
inhalation of drug in a plastic bag
[17%(71)]. The plasti c bag containi ng the
glue is then held over the face and nose
and the fumes are inhaled.
Inhaling the fumes by putting the solvent
in a bott le was also descr ibed by 35
(8.4%) of the respondents. Again the
substance is po ured into a bott le, and
the bottle is then brought closed to the
nose and the fumes are inhaled. In some
instances a plast ic pipe (straw) is place d
above the level of the solvent, the other
end is placed in the mouth and the whole
substance is breathed in.
Finally, 6.5% (27) of the respondents
reported using the solvent directly from
the can (tube in rare instances) The
majority of cases have reported making a
small hole in the can, and then after
holding it close to the nose or face and
inhaling the fumes until the whole
substance is breathed in.
proportion initiated drug use in the past year
(18.2%) and a similar number (19.7%) had
been using it for more than 1 year but not
more than 2 years. This is suggestive of the
fact that the practice is not a very new
phenomenon, but most of the children
interviewed were chronic users. However,
since a strict case selection criteria was also
used, all experimental and sporadic drug
users were screened and excluded from the
study. 95% of the children stated that they do
not face any difficulty in procuring the
solvents, and it is easily available from the
local market at standard rates. As described
by the respondents it is just as simple as going
to a shop and asking for an inhalant. More
than half of the times (54%) the activity is
reported to be a group based activity, in which
the money is pooled in by all members of the
group and one of the member then buys the
substance for the entire group. Box 3.3.
describes the various techniques used for
inhaling adhesive glues. The illustrations of
the mechanism are given in Figures 3.3.3
A & b.
3.4.2 Quantity used
Analysis has shown that on an average 80
gms of adhesive glues is being used each
day during the past one month. Further
analysis revealed that the maximum proportion
of children (45.2%) have reported using 280
gms of glue followed by 750 gms (24.8%),
40 gms (19.2%) and
80 gms (10.8%)
respectively.
Children
were
inquired
about
the
frequenc
y of use,
the
answers to
which are
provided in
table 3.3.3a.
approximately 20% of
the
children informed that they have been using
the solvents only once daily. Almost one fourth
of the children reported using these drugs 2 to
five times daily, while another 32% reported
use upto 10 times a day. A substantial portion
of the children (15%) reported that using
solvents round the clock. These children use
the solvent through a cloth, which always stays
with them in their hands, or pocket, and they
are continuously busy in inhaling the fumes of
the solvent, which is poured into this cloth.
22
23

3.4.3 Effects of Solvent abuse
Research has shown that the chemical
substances found in the inhalants produce
acute effects similar to sub-anaesthetic
concentrations of general anaesthetics, as
well as to the effects of classical CNS
depressant drugs, such as alcohol and
barbiturates. Children were inquired of the
feeling experienced after solvents are inhaled;
the responses are given in Fig 3.3.3a.
140
120
100
80
60
40
20
0
117
Relief of
tension
Fig. 3.3.3a
111
Euphoria
65
Drowsiness
Feelings experienced on using Solvents
36 33 31
Confident &
Strong
Cannot
express
Light
headedness
19 16 16
A typical episode of solvent abuse as
described by children themselves is a mixed
Table 3. 3.3a. Frequency of use of solvents
Frequency of use n (%)
Once daily
02 to upto 05 times daily
06 to upto 10 times daily
All the time
Agression
Section three
Nostalgia
80 (19.2)
97 (23.3)
136(32.7)
103(14.7)
Others
feeling of euphoria and contentment and a
relaxed mood followed by a sound peaceful
sleep. Children describe the feelings as
ones that make
them forget their
worries and
tensions, and feel
happy about
whatsoever
situation they are
into. A few
children told the
interviewers that
they are unable
to define the
feelings, but
generally it is a nice feeling. A large number
of children reported that use of solvents
made them feel strong and powerful enough
to overcome all the worries and problems in
their lives. A minor proportion also described
the feelings as nostalgic which reminded
them of their home and the good times of
their lives.
One of the biggest hazards of
compulsive drug use is that it fosters drug
dependence and addiction. Users continue
to take drugs despite adverse social and
medical consequences, and behave as if the
effects of the drugs are needed for continued
well-being. Although research suggests that
the physiological dependence is rare with
solvents, the magnitude of the need to
repeated usage can vary from a mild desire to
a craving or compulsion to use the drug. The
respondents were inquired about the feelings
they undergo if the solvents are not taken. The
responses are shown in Fig 3.3.3b.
160
140
120
100
80
60
40
20
0
142
Anger &
Agitation
Fig. 3.3.3b
69
Restlessness &
Irritability
Symp toms r epo rted upo n un availib ility o f solv ents
3.4.4 Reasons for Use
54
Generalized
Aches
38
Inability to work
33 30
Abdominal
cramps & GIT
upsets
The respondents were inquired about the
various factors associated with the aetiology of
solvent abuse. The major factor to lead into
the use of solvents reported by more than half
of the children (53.4%) was friends and peers.
Among other factors reported, neglect, group
violence, a way to forget about the past and
curiosity were significant as shown in fig 3.3.4.
The issue was further explored in groups'
discussions, which focused on not only the
Headache
22
Depression
14 15
Semiconsciousness
Others
reasons which led to the initiation of solvent
use, but also discussing factors leading to the
continuation of these agents. The role-played
by peers and group membership not only
emerged strongly as the factor initiating the
use of solvents but also acted as the leading
reason to the continuation of the habit. A large
number of children reported that they started
drugs as to meet the social norms, which gave
them immediate gratification in response. The
importance of group membership was
highlighted for survival among street children
in the previous section (see section 3.2).
However, while the peer pressure and social
circumstances played a strong role in initiating
drug use, the effects of the solvents
themselves helped continuous solvent abuse.
The feeling of euphoria and happiness that
was immediately experienced made the
children forget all worries and helped relieve
the tension, which these children face. The
CNS depressing effects of the drugs made the
children enjoy sound sleep for longer duration.
Thus it can be deduced that, solvent or
drug abuse work as an anaesthesia,
decreases physical and emotional pain, induce
sleep, decrease appetite (one of the factors
leading to malnutrition), increases energy
levels and adds excitement. It also provides
24
25

Section three
Fig. 3.3.4a
Etiology of Solvent Abuse
Curiosity Forget the past Relatives
Enviornment Neglection Domestic Voilence
Group Violence Peer/Friends Misc
53.6
Them with a sense of belonging to the ingroup
and gives them courage to commit
crimes and higher levels of violence.
3.4.5 Consequences of Use
4.3
A range of negative consequences and
problems can arise from persistent use of
solvents. When explored in FGD, the children
revealed various medical and social problems
they have been facing over the past two years.
Although youth is generally a time of relatively
good health, but, the nature of continuous
exposure to the streets and the associated
lifestyles makes street children vulnerable to a
range of health and other problems which are
4.3
8.4
8.7
5
2.6
3.1
9.9
not typically experienced by other young
people. The majority of children did not
report any severe medical problems that
they faced, however minor ailments and
health problems have been reported.
Although use of solvents has its own
untoward effects on the health of the
Box 3.
Medical Consequences of Solvent Abuse
Chest Infections & Breathing
(16.4%)
Fever (16%)
Generalized Weakness & Myalgia
(8.9%)
Skin Infections (3.6%)
Gastric upsets (3.8%)
Headache (2.6%)
Urinary Infections (1.9%)
Semi-consciousness (1.0%)
Misc (5.5%)
individual, but the results of surveys of
chronic solvent abusers are reassuring that
physical organ damage is not a significant or
widespread problem for most abusers. The
degree and duration of abuse required
producing harm to heart, brain, kidneys and
liver is unknown because several years of
35,43,17
regular abuse appears to be necessary.
157 children (37.7%) reported that they
had been facing problems due to solvent
abuse. The number one social problem quoted
was neglect, hatred and non-acceptance by
the society (46.5%). Incidences have been
reported where children were cast out from
their families (4%) and lost jobs (2.3%) due to
their involvement with solvents. In depth
Box 3.
Social Consequences of
Abuse
Neglect ion & Hatred (46.5%)
Group Violence (21.7%)
Police threats (12.9%)
Out casted from family (4.1%)
Living in non hygienic
condition (3.5%)
Lost jobs (2.3%)
Others (9.9%)
FGD's revealed that children viewed their
parents as impassive who else would take
care of them. People considered them
rebellions, runaways and apathetic towards
others. They are generally thought to have no
values (moral, social, religious or ethical) and
are largely gangsters involved in crime that
extended from simple theft to drug paddling or
even commercial sex. Children reported that
such negative attitude of the society inculcated
a feeling of hatred, neglect and denial of care.
They pointed out that everyone around hated,
manipulated and exploited them so they would
also do the same to them. Such kind of
negativity when expressed and exposed took
the shape of violence, which according to the
children is a reciprocation of what they have
received.
Amazingly, the children were positive that
to repay society they needed strength not only
from outside but from their own selves, which
could only be achieved through abuse of
solvents or other drugs. This façade terrified
others around them so at least for the time
being helped in their survival without many
efforts and courage and so the vicious cycle
continues. Thus it is difficult to comment
whether spending time on the street made
them so or the abuse of solvents/drugs gave
rise to such consequences. The effect could
be reciprocal. The principle of trial and error
was the first step towards a long journey
without a destination.
26
27

Section three
3.4.6 Treatment
When asked if they ever tried to break the
habit of solvent use, and how it could be done,
only 20.7% of the respondents reported to
have undergone any sort of treatment, and
that too was a self-treatment in more than half
of the incidences. Approximately 70% of the
children were unaware of any organization /
institution where they could be treated and
rehabilitated.
The results are summarized in table
3.3.6a.
Table 3.3.6a
Treatment History
Question n (%)
3.5 Use of other Drugs
& HIV awareness
3.5.1 Use of other Drugs
The relationship between the use of
Solvents and other drugs is a complex one.
Although a possibility can be linked, but
research is unable to answer whether the
use of solvents leads to abuse of more
potent addictive drugs, such as heroin etc,
44
in future.
A lifetime prevalence of tobacco use was
seen among these children, in all provinces.
The various forms of tobacco use were
2
categorized as Cigarettes, Pan & Gutka.
Cigarette smoking is an extremely prevalent
(87%) characteristic found in all the four
cities, while eating Pan (filled with tobacco)
120
100
80
60
40
20
0
87
39
17
Cigarette Pan Gutka
95 96
20
2
76
74
8 4
0
82
60
56
OVERALL Lahore Quetta Peshawar Karachi
is a common practice in Peshawar among
street children abusing solvents. As seen in
our research, Karachi presented a
complicated picture, where all forms of
tobacco were being used. It was seen that
these children become involved with tobacco,
start smoking at a very young age (the mean
age ± sd of the children at starting smoking
was found to be 9.89 ± 8.6). Cigarette
smoking appears to be the first addictive agent
that has been used by the majority of these
children, before they start experimenting and
getting involved with other drugs as well as
solvents.
Information about other drugs including
hashish, opium, marihuana and heroin use
was also gathered. The respondents were
initially asked about the use as “ever used”
which in case of a positive reply was followed
by regular use of the drug during the last 30
days. Information on alcohol intake was also
gathered.
Use of hashish was found to be significantly
prevalent among this group. While 68.8%
children reported that they had “ever used”
hashish, an overall 62.5% children reported
regular use during the past 30 days. The
citywide distribution was fairly uniform, with
the highest prevalence noticed in Quetta
(80.4%) followed by Lahore (73.4%), Karachi
(65.7%) and surprisingly Peshawar (55%).
Although only 8.9% of the total reported
regular use of alcohol, yet by contrast, street
children from Quetta rated as the highest
users of alcohol (21.4%).
Table 3.4.1 b Use of other drugs during past 30
days
Alcohol
Hashish
Opium
Bhang
Heroin
Synthetic drugs
8.9%
62.5%
3.6%
4.1%
0.2%
5.3%
A minor proportion of children reported
involvement in other drugs during the past 30
days i.e., Bhang (4%), Opium (3.6%) and
Synthetic drugs (5.3%). Only one child
reported regular use of heroin. It is worth
noting here that the overall research
conducted in the country has shown a similar
27
picture in which Hashish is the most common
drug of abuse among drug users, with varying
proportions of drug abusers reporting use of
other drugs. The drug use situation of street
children is not different, from the overall drug
abuse picture in the country. However
additional research is required to develop a
sound understanding of the subject, as well as
to study the aetiology of substance abuse.
Citywide distribution of drugs ever used by the
2. Local form of tobacco which is kept in mouth and chewed.
28
29

Section three
study subjects is presented in Fig 3.4.1b
Table 3.4.1b Prevalence of drug use in street children
80
60
40
20
0
OVERALL Lahore Quetta Peshawar Karachi
Hashish Alcohol Bhang Opium Heroin Synthetic drugs
3.5.2 HIV Knowledge & Risk Practices
Drug use among street children is closely
related to other health issues and risk-taking
behaviour such as prostitution, sexual
exploitation and unsafe sex practices, all of
which have contributed to a growing incidence
of AIDS/HIV among this particular group. In
this study we have tried to evaluate the
existing knowledge of the children regarding
important aspects of HIV / AIDS as well as two
of the risk practices i.e., Injection drug use and
sexual practices.
3.5.2.1 HIV Knowledge
children had heard about HIV/AIDS. Among
those who had heard of the disease, three
major sources of information were revealed
Box 3.4.2a HIV related Knowledge
Ways of HIV Transmission
Sexual Intercourse (62.5%)
Germs (10.6%)
Syringes (18.7%)
Blood exchange (2.9%)
Razors (2.9%)
Misc (5.8% )
Don’t now (6.7%)
Methods to pro tect HIV transmiss ion
Avoid sexual intercourse (44.6%)
Medicines (27.7%)
Use new syringes (8.9%)
Medicines (4 .1%)
Condoms (4%)
Avoid drug use (2%)
Don’t know (6%)
.43.9% had heard of the disease from the
television, followed by the local NGO's
working against HIV/AIDS and its paramedic
staff (32.7%). While the remaining had
received their information via inter-personal
communication i.e., friends and other
acquaintances.
infection is spread and the methods to protect
themselves from getting infected. 62.5% of the
children who had heard about HIV/AIDS knew
that it is spread through sexual intercourse,
but 44.6% stated that sexual intercourse
should be avoided altogether to protect
oneself from HIV. The detail of all responses is
given in the Box.3.4.2a.
3.5.2.2 HIV Risk practices
Two major HIV risk practices were explored
including Injection drug use and Sexual
practices. As already seen in the previous
section, although drug use has been found to
be a fairly common characteristic, none of the
children interviewed reported that they had
ever injected drugs.
In contrast several risky sexual practices
were highlighted, which puts these children at,
a high risk for contracting HIV. high
proportions (53.4%) of the children were found
Question
Table 3.4.2.2a
Sexual Practices of street children
mean ± sd
Average age at initiation to sexual activit y* 10.6 ± 2.2
To be sexually active, with the highest level of
sexual activity reported by children interviewed
in Lahore (73.4%) in contrast to 37% in
Peshawar. The average age at the initiation of
sexual activity was reported to be 10.6 ± 2.2
years. A high number of sexual partners both
males and females were found. The mean
number of sexual partners both males &
females are given in Table 3.5.2a. While a high
number of sexual partners are seen, the use of
condom was almost negligible. 80% of the
children reported they had never ever used a
condom. Only 7% informed of always using a
condom, while the remaining 13% had been
using condoms occasionally. The graphical
presentation is given in Fig 3.4.2.2a.
There has been evidence in which these
children were found to be involved in
commercial sex work, as 105 (25.5%) of the
416 children interviewed informed that they
had exchanged sex for money.
13.7
Never Sometimes Always
7.2
Street children were asked about whether
they knew about HIV/AIDS. 53.8% of the
The subject was further explored by
asking children whether they knew how the
Current Number of sexual partners
Females
Males
2.6 ± 2.5
5.1 ± 6.1
79.1
30
31

Section three
3.6 Magnitude of the
problem
In Pakistan, reliable data on the prevalence
of solvent abuse and related problems is
extremely scarce. The issue is further
complicated by the highly sensitive nature of
the problem, difficulties in accessing this
population, complicated group dynamics and
ignorance of local authorities regarding the
subjects.
The methodology adopted for providing
estimates of solvent abuse prevalence was
based on direct and indirect estimation. Direct
estimation was done by counting the exact
number of street children in a specified
location and determining proportions actually
involved in solvent abuse. Prior to conducting
this exercise, a mapping exercise was
undertaken and a complete mapping of street
children was done in all four cities. Thereafter,
six sites where maximum mobilization of street
children was recorded were subsequently
selected for prevalence estimation in each city.
Furthermore, to capture the entire segments of
the street children population, each site was
visited on different days of the week as well as
on different times of the day. The detail on the
locations from where data were collected is
given in Table 3.6.1.
Table 3.6.1
Karachi
1. Abdullah Shah Ghazi
2. Hussainabad
3. Jamshair Road
4. Korangi
5. Tariq Road
6. Saddar
Lahore
1. Data Darbar
2. Circular Road
3. Larri Adda
4. Railway Station
5. Macleod Road
6. Multan Road
Study sites from where prevalence estimates are generated
Peshawar
1. Firdous Cinema
2. Haji Camp
3. Jhangi Mohalla
4. Kabuly Bazaar
5. Railway Station
6. Khyber Road
Quetta
1. Habib Nala
2. Jinnah Road
3. Lower Karez
4. Pushtoon abad
5.Saryab Road
6.
Indirect estimation was done by
information gathered from Key informants.
Regional police and public health personnel
reported the estimated numbers of children
involved with solvent abuse. NGO
representatives, Government hospital staff,
and people working with welfare
organizations reported same figures.
Ironically, the exact number of street
children is unknown, as no formative
research among street children had been
conducted in the country to provide these
estimates. Anecdotal information, however,
is available with organizations working for
the street children. According to the
information gathered from these
organizations, the approximate number of
34
street children in various cities is as follows:
1. Karachi 12,000
2. Lahore 8,000
3. Peshawar 4,500
4. Quetta 2,500
Based on these estimates the number of
children involved with solvents abuse were
calculated by multiplying the probability
estimate with the total number of street
children in each city. The details are provided
in Table 3.6.2:
Table 3.6.2
Estimated Prevalence of
Solvent abuse among street children
OVERALL
Karachi
Lahore
Peshawar
Quetta
Estimated
Prevalence
39.6 %
45.3%
36.9%
36.8%
41.7%
Direct Estimates
95% CI
33.1 – 46.1%
32.0 – 58.6%
24.0 – 49.8%
23.9 – 49.7%
28.5 – 54.9%
Indirect
Estimates
(range)
-
50 - 60%
30-35%
25-30%
40-50%
Total
Number
-
5,500
2,900
1,700
1,100
Care should be taken before extracting
nation wide estimates from the prevalence
reported from this study. The number
represents a pictorial suggestion from the
major cities, and takes account of chronic
users only, and is based on self-reported data.
Therefore the estimates can be biased
downward due to a combination of under
reporting and under coverage. Moreover,
generalization of these results to smaller cities
and females is not suggested due to nonresponse
and non-participation by a significant
proportion of females.
3.7 Key Informant Interviews
As mentioned previously, 18 key informant
interviews were conducted with individuals in a
regular contact with these children frequently,
to gather information about the existing
services available for street children, as well
as to comprehend the awareness of the
service providers. The details on these
interviews are given in box 4. Information
generated from the key informant interviews
documented very unsatisfactory knowledge
and awareness of issues related to street
children, and more importantly the
understanding of solvent abuse among this
extremely high-risk group. Moreover, the
perceptions and knowledge of the interviewed
people related to treatment, and rehabilitation
32
33

Section three
of these children was far below the optimal
level.
3.7.1 Police stations
Street children come into conflict with the
law in many ways. Some children may be
coerced into involvement in illegal activities,
from bag snatching and petty theft to drug
peddling. On the other end of the spectrum,
these children are often stigmatised by police
and the public, who believe they are doing
something wrong even if they are playing,
reinforcing the perception of street children as
criminals. Children are not always taken into
justice systems when in conflict with the law,
but may be dealt with “informally” when they
are perceived to have behaved wrongly.
Children worldwide are subject to harassment
by police including beatings, abuse and other
violence, including sexual violation (ref- Asia
Pacific report).
Inquiry into the criminal history showed
that 49.3% of the children has been arrested
at least once in their lifetime by the police.
According to the children this arrest was a part
of the routine police raids, which is observed
once or twice every year. Further exploration
into the reasons for which children were
arrested revealed that the maximum number
of arrests were done on account of minor
thefts (40%), followed by solvent use(26%),
violence and street fights (10%) and drug
peddling (5%). Interestingly 12.7% did not
know the reason why they were arrested.
Based on the above reasons, we
ensured to visit various police officials and
gather information on street children from
their perspective. The key points are
summarized as such:
All police officials contacted
documented the presence of street children
abusing solvents in their respective area.
The numbers reported were in accordance
with the prevalence estimates provided by
the direct estimation method used. The
estimates provided by police officials are
also given in Table 3.6.2 under indirect
estimation.
Police officials were asked about
their perception on why street children use
solvents. According to most, easy availability
was the sole reason, which has led to an
increas use of solvents among children.
100% of the officers interviewed
raised concern over involvement of these
children (30 - 50%) in minor criminal
activities such as pick pocketing, minor theft,
and shop lifting. This feature was in
agreement with the information obtained by
the children themselves, where it was seen
that the police had arrested almost half of the
children at least once in lifetime.
Another growing concern was the
mounting proportions of these children getting
involved in prostitution, and drug trafficking,
which was informed by officials in Lahore and
Karachi. The number of children involved in
such activities was feared to be reaching up to
20%, with numbers consistently increasing.
Half of the police officials reported to
have taken such children into police custody
occasionally, but due to the absence of any
available facilities, no remedial action could be
taken. Thus these children are kept under
custody for a few days, and are later set free.
Only one official in Peshawar
reported that children involved with substance
abuse have been referred to a drug
detoxification centre for treatment.
3.7.2 Drug abuse treatment facilities
Among drug abuse treatment facilities
visited, 4 (40%) were government facilities
while the remaining were non-governmental
organizations (NGO's). Based on the
information collected, the key issues are
summarized as under:
By and large, the core staff consulted
was not found to be very familiar with all
phases of preventive services (i.e., primary
prevention, treatment and rehabilitation) for
this sub group of drug using population. Thus,
while the majority of staff members met were
comfortable with the issues of treatment and
rehabilitation of other drugs e.g., heroin, an
obvious deficiency was noted in the translation
of this concept to children/adolescents
treatment and solvent abuse. The issue of
solvent abuse is still alien to the drug
treatment service providers, and henceforth
there either are no services available, or those
that do exist do not provide it in an appropriate
manner.
All of the facilities visited were found
to have tailored their services for treatment of
heroin addicts, which is the leading cause of
admission in these facilities. The government
facilities visited in Peshawar (Lady Reading
hospital) and Quetta (Civil hospital) informed
that they had admitted children involved with
solvents recently, but the proportions were
negligible (< 5%) as compared to patients
admitted for treatment of other drugs. Twelve
chronic solvent abusers were undergoing
detoxification in Azam clinic (Pakistan society)
Karachi, but the management authorities
reported a lack of clarity regarding their
34
35

Section four
36
treatment methodology and a rehabilitation
program for these children was non existent.
Furthermore, none of the facilities
mentioned had any staff members specifically
trained in Paediatric practice, child or
adolescent health, as well to deal with
treatment issues of solvent abuse. More than
half of the key informants interviewed (60%)
expressed lack of knowledge and non existent
resources to combat this form of substance
abuse.
However, an interest was shown to
work for provision of services for this segment
of population. Upon inquiry regarding what
sort of support is required by the facilities to
work against the issue of solvent abuse in
street children, all facilities focused on
provision of training of their staff members on
the problem of street children and solvent
abuse.
None of the facilities visited informed
of any primary prevention activities taken up
for these children.
Reviewing the existing services for the
treatment of solvent abuse in the country, the
situation is extremely dissatisfying. The core
fact, which is of significant importance, is that
the majority of health services have been
developed for adults. Many such services
rarely recognize the unique issues of young
people, particularly those of street children,
and rarely try to accommodate for their age
specific behaviours. Therefore, many young
people view health services as unfriendly,
threatening, mystifying, unhelpful and
inappropriate. Thus even when facilities do
exist, specialist drug services tend to poorly
understand issues pertinent to young
people. Young people tend to be treated as
mini-adults, and their particular needs get
ignored.
RECOMMENDATIONS
RECOMMENDATIONS
37

RECOMMENDATIONS
Section four
Recommendations
Based on results of this study, it is suggested
that Modified Social Stress Model (MSSM) be
applied to have an ABC analysis (Antecedent,
Behaviour, Consequences) of solvent abuse
among street children. A dichotomous strategy
should be designed to achieve such an
analysis, which aims to minimize (if not
eradicate) and to prevent the probability of
occurrence with a short and long term
perspective.
There is an urgent need for the
development of a comprehensive national
strategy, for the control and prevention of
solvent abuse. The strategy should
concentrate on bringing together government
entities (both national and provincial),
international agencies (UNODC, UNICEF,
UNAIDS et al) key stakeholders, community
based organizations (CBO's), nongovernmental
organizations (NGOs),
empowering the target community itself to
enable holistic programming and excellence in
prevention, care and support. The overall
national strategy developed should
encompass the following:
Owing to the lack of awareness of the
issue among the general public and drug
abuse service providers, an extensive
population based awareness campaign is
suggested, which aims on raising the
general public awareness about this
emerging problem in terms of national
development, stability and integrity. Various
communication channels including mass
media, print media and local communication
channels need to be mobilized for an
effective impact of the activities.
Components of the campaign
should address the street children as well,
providing them information on drug abuse
especially Solvents, the untoward
consequences, motivation for treatment, and
awareness regarding HIV risk behaviours
and safe practices.
Secondary prevention activities
should take the form of providing drug
treatment & rehabilitation services to the
children involved with solvents or other
drugs. While designing such programmes,
the issue of solvent abuse need to be
addressed in a broader perspective as
opposed to merely a mental health problem.
Special importance should be given to the
dynamics of this population that is very
different from other high-risk populations. The
differences between solvent abuse and other
forms of addiction should be kept in mind,
when treatment plans are devised. Thus if
existing drug treatment facilities need to be
utilized, up-gradation of the material resources
and training of the staff on issues of solvent
abuse and especially the needs of street
children needs be considered. Training
modules should be designed and on going
training packages for capacity building should
be provided to GO's, NGO's, CBO's and
people dealing or in contact with these
children.
Special emphasis should be laid on
the rehabilitation of these children. The
rehabilitation programme should have
components on education, social skills, skill
development in the form of vocational
trainings, and placement of these children in
their families
In addition to the formal treatment
and rehabilitation activities, various outlets (in
the shape of shelter homes or drop in centres)
need to be established in areas that are
accessible to street children, possible regular
contact with the service providers and
motivational sessions could be conducted.
These shelter homes or DIC's would
encompass :
The task of educating street children
in basic interpersonal and social skills.
Empowering children with civic
sense
Enhancing their capability to
communicate and comprehend messages
effectively like simple arithmetic and
vocabulary.
Training in self defence to avoid
risky behaviour and practices
Knowledge about rights and duties
Moreover, these centres can act as
sources of information dissemination and
contact points for these children. The centres
need to be linked to the chain of drug
treament and rehabilitation services and
proper referral can be made when and where
required.
Outreach services need to be
provided in the form of mobile units linked with
a network of health and legal facilities. In an
ideal scenario, the outreach services need to
be connected with the DIC's and shelter
homes for maximum effectiveness.
38
39

REFRENCES
Section four
Formative ongoing research to
thoroughly understand population dynamics,
behaviour and practices as well as underlying
beliefs which lead to the behaviours, aetiology
of solvent abuse etc., are issues which need
be studied further. There is a need to involve
women in these research studies, and
ascertain baseline situation in smaller cities.
An important avenue for epidemiological
and behavioural research is the risk
assessment of this population for HIV
prevention and control.
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