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This publication is available from:<br />
UNODC<br />
Country Office for Pakistan<br />
P.O.Box 1051<br />
61-A, Jinnah Avenue<br />
11th Floor, Saudi Pak Tower<br />
Islamabad, Pakistan<br />
United Nations System in Pakistan Publication<br />
UN-PAK/UNODC/2004/1 - June 2004<br />
THE UNITED NATIONS SYSTEM IN PAKISTAN
Copyright© 2004 United Nations Office on Drugs and Crime<br />
All rights reserved<br />
United Nations System in Pakistan Publication<br />
No. UN-PAK/UNODC/2004/1<br />
Designed by: UNODC Country Office for Pakistan<br />
Disclaimer<br />
“The opinions, figures and estimates set forth in this publication do not<br />
necessarily reflect the views or carry the endorsement of the United<br />
Nations”<br />
ISBN 969-8567-07-0<br />
THE UNITED NATIONS SYSTEM IN PAKISTAN<br />
ISLAMABAD<br />
2004
This research study would not have been possible without the<br />
support and encouragement of Anti Narcotics Force (ANF),<br />
Government of Pakistan. We would like to extend our<br />
acknowledgment to all its collaborating partners, government<br />
facilities, service providers, non-governmental organization etc. For<br />
their support and help rendered during the entire phase of data<br />
collection. We would also like to thank Dr. Kamran Niaz, Regional<br />
Adviser, GAP, UNODC, Ankara, for his valuable comments and<br />
guidance during the conceptualisation, planning phase and<br />
reviewing of this study. Above all, our special gratitude is extended to<br />
all the street children who facilitated and participated in the Study.<br />
This study was conducted as part of UNODC funded project<br />
“District Level Drug Abuse Prevention” AD/PAK/02/F51.<br />
AIDS<br />
ANF<br />
CNS<br />
DU<br />
FGD's<br />
GIT<br />
GO's<br />
HIV<br />
IDU<br />
KI's<br />
NGO<br />
RTI<br />
SPSS<br />
UN<br />
UNICEF<br />
UNODC<br />
VSA<br />
Yrs.<br />
Acquired Immunity Deficiency Syndrome<br />
Anti Narcotic Force<br />
Central Nervous System<br />
Drug use<br />
Focus Group Discussions<br />
Gastro Intestinal tract<br />
Government Organizations<br />
Human Immuno Virus<br />
Injection drug use<br />
Key Informants<br />
Non Governmental Organization<br />
Respiratory Tract Infections<br />
Statistical Package for Social Sciences<br />
United Nations<br />
United Nations Children’s Fund<br />
United Nations Office on Drugs & Crime<br />
Volatile Substance Abuse<br />
Years.
Executive summary<br />
1. Background & Introduction<br />
1.1 Street Children<br />
1.2 Solvent Abuse<br />
01<br />
04<br />
2. Research & Methodologies<br />
2.1 Defining the problem<br />
2.2 Aims & Objectives<br />
2.3 Research Methodology & procedures<br />
2.3.1 Case Definition<br />
2.3.2 Subject Selection<br />
2.3.3 The Questionnaire<br />
2.3.4 Interview Procedures<br />
2.3.4.1 Focus Group Discussion<br />
2.3.4.2 Key Informant Interview<br />
2.3.5 Ethical Standards<br />
2.3.6 Data Management<br />
3.Results<br />
3.1 Demographic information<br />
3.1.1 Gender & Age<br />
3.1.2 Nationality & Migration Status<br />
3.1.3 Religion<br />
3.1.4 Family Information<br />
3.1.5 Educational Qualification<br />
3.1.6 Income, Source of Income & Spending<br />
08<br />
08<br />
09<br />
09<br />
09<br />
10<br />
10<br />
11<br />
11<br />
12<br />
12<br />
14<br />
14<br />
15<br />
16<br />
16<br />
17<br />
18
3.2 Living Conditions & group dynamics<br />
3.3 Medical & Health Problems<br />
3.4 Solvent Abuse<br />
3.4.1 Substances Abused<br />
3.4.2 Quantity used<br />
3.4.3 Effects of <strong>solvent</strong> <strong>abuse</strong><br />
3.4.4 Reasons for use<br />
3.4.5 Consequences of use<br />
3.4.6 Treatment<br />
3.5 Use of other drugs & HIV awareness<br />
3.5.1 Use of other drugs<br />
3.5.2 HIV Knowledge & Risk Practices<br />
3.5.2.1 HIV Knowledge<br />
3.5.2.2 HIV Risk Practices<br />
3.6 Magnitude of problem<br />
3.7 Key Informant interviews<br />
3.7.1 Police Station<br />
3.7.2 Drug <strong>abuse</strong> treatment facility<br />
Recommendations<br />
References<br />
19<br />
21<br />
21<br />
21<br />
23<br />
24<br />
25<br />
26<br />
28<br />
28<br />
28<br />
30<br />
30<br />
31<br />
32<br />
33<br />
34<br />
35<br />
37<br />
41<br />
3.1<br />
3.1.2a<br />
3.1.4<br />
3.1.5a<br />
3.2.1a<br />
3.3.1a<br />
3.3.3a<br />
3.3.6a<br />
3.4.1a<br />
3.4.1b<br />
3.4.1b<br />
3.4.2.2a<br />
3.6.1<br />
3.6.2<br />
Sampling distribution<br />
Major cities from where children flux into Lahore & Peshawar.<br />
Parental marital status<br />
Education Status<br />
Sleeping place at night<br />
Types of <strong>solvent</strong> <strong>abuse</strong>d and its daily cost in Pakistani rupees<br />
Frequency of use of <strong>solvent</strong>s<br />
Treatment history<br />
Various forms of tobacco used by street children<br />
Use of other drugs during past 30 days<br />
Prevalence of drug <strong>abuse</strong> in street children<br />
Use of condoms during sexual intercourse<br />
Study sites<br />
Estimated prevalence
A total number of 416 children with<br />
equal distribution from all four cities i.e.,<br />
Karachi, Lahore, Peshawar and Quetta<br />
participated in the study. Respondents were<br />
predominantly males, with only 07 girls (1.7%)<br />
included in the sample. The mean age of<br />
children using <strong>solvent</strong>s was 14.3 ± 2.52 years,<br />
with the children in Peshawar slightly younger<br />
(13.0 ± 2.33 yrs) than the children found in<br />
other cities. The maximum proportions of<br />
children were between 15 to 16 years of age.<br />
The largest proportions of children interviewed<br />
were Pakistani (81%), more than half of whom<br />
had migrated from smaller cities. 12.5% of the<br />
total children were Afghani followed by<br />
Bengalis (5.8%). One third of the children<br />
interviewed belonged to single parent families<br />
with large family size. Almost three quarters of<br />
the children were not currently living along<br />
with their families. These children prefer<br />
staying in groups, had no permanent place to<br />
live, had been sleeping in parks (50%), friends<br />
place(12%) and darbars (6.7%) etc. Seventy<br />
Six percent (76%) of the children never<br />
attended formal education. The remaining<br />
24% had 3.01 ± 1.97 years of educational<br />
attainment. The average daily income reported<br />
was Rs. 79.7 ± 44.7, which was sourced<br />
through cleaning cars, scavenging solid waste<br />
garbage and begging.<br />
Fifty five percent (55%) of the children<br />
complained of at least one medical problem<br />
that they were currently facing . The major<br />
problem reported were Respiratory tract<br />
infection; RTI's (30%), followed by Fever<br />
(19.7%), GIT upsets (18.7%) and skin<br />
infections (12.6%).<br />
Adhesive glues was the primary drug of<br />
choice consumed by 374 (90%) of the<br />
interviewed street children. Other <strong>solvent</strong>s<br />
<strong>abuse</strong>d include petrol (25.5%) and thinners<br />
(10.6%). Use of Petrol was significantly<br />
popular in Quetta (43%) and Peshawar (41%).<br />
In Karachi children were found to be involved<br />
with glue (95.2%), Thinners (27.6%), Petrol<br />
(13.3%), as well as Tincture(5.7%). An<br />
average amount of Rs. 39.7 ± 30.1 is being<br />
spent on these <strong>solvent</strong>s with minimal<br />
geographical variations. A little more than 60%<br />
of the children reported regular use of these<br />
substances for more than 2 years through<br />
various techniques. On Average they inhale<br />
almost 80 gm. Ninety Five percent (95%) of<br />
the children stated that <strong>solvent</strong>s are easily<br />
available from the local market. More than<br />
half of the times money is pooled in by various<br />
children and thereafter procurement is used in<br />
a group. Relief of tension, euphoria and<br />
drowsiness are the major effects reported to
e felt on use of the <strong>solvent</strong> drugs. In contrary,<br />
upon non-availability the feeling of anger,<br />
agitation, restlessness, irritability, and<br />
generalized aches were the major problems<br />
reported. The major factors leading a child into<br />
the use of <strong>solvent</strong>s were friends and peer<br />
pressure, reported by more than half of the<br />
children interviewed. Only 20% of the children<br />
had undergone any sort of treatment for drug<br />
<strong>abuse</strong> problem. More than two third of the<br />
children were unaware of any organization or<br />
facility where they could be detoxified and<br />
rehabilitated.<br />
Information regarding use of other drugs<br />
was also gathered. Hashish was found to be<br />
the most prevalent among the group as 62.5%<br />
children reported regular use during the past<br />
30 days. Other drugs used during the past 30<br />
days were Bhang (4%), Opium (3.6%) and<br />
Synthetic drugs (5.3%). Only one child<br />
conveyed use of heroin, while there was no<br />
injection drug use reported. 53.8% of the<br />
children had heard about HIV/AIDS. Among<br />
these, 62.5% knew that it is spread through<br />
sexual intercourse, while 19% knew that it can<br />
be transmitted by syringes contaminated with<br />
the virus. However, information regarding its<br />
prevention was inadequate, as 44.6% stated<br />
that sexual intercourse should be avoided<br />
altogether to protect oneself from HIV. 28% of<br />
the children thought that HIV can be avoided<br />
by using various medicines. A high HIV risk<br />
situation was noted, when sexual practices of<br />
these children were evaluated. The average<br />
age at the initiation of sexual activity was<br />
reported to be 10.6 ± 2.2 years, with a high<br />
number of sexual partners both males and<br />
females was found. Only 20% informed of<br />
using a condom, while the remaining 80% of<br />
the children reported never using a condom.<br />
One quarter of the children reported<br />
exchanging sex for money.<br />
Information gathered from the key<br />
informant interviews, documented a very<br />
unsatisfactory knowledge and awareness of<br />
issues related to street children, and more<br />
importantly the understanding of <strong>solvent</strong><br />
<strong>abuse</strong> among this extremely high-risk group.<br />
An overall lack of clarity was observed<br />
regarding detoxification of <strong>solvent</strong> <strong>abuse</strong> in the<br />
existing drug treatment facilities was noted,<br />
compounded by absolutely no rehabilitation<br />
program for these children.<br />
The report is structured in four major sections.<br />
Section 01 presents background and introduction of street children, as well as basic<br />
conceptual information on <strong>solvent</strong> <strong>abuse</strong> and the burden of the disease.<br />
Section 02 gives the aims and objectives of the study as well as a description of the<br />
research methodologies adopted. It provides information on subject selection, sampling<br />
procedure, data collection procedure and data analysis<br />
Section 03 reports the results of the study and is further distributed into 6 major<br />
subdivisions. Sub-Section 1 provides information on the socio-demographic<br />
characteristics of the children. Sub-Section 2 describes the group dynamics and current<br />
living arrangements of these children. Sub-Section 3 is related to information on drugs<br />
other than Solvents, HIV/AIDS knowledge and risk behaviours. Sub-Section 4 provides<br />
description regarding prevalence and related information on <strong>solvent</strong> <strong>abuse</strong>. The last subsection<br />
of this part provides information on the various drug treatment facilities, exists in<br />
the country.<br />
Section 04 provides recommendations and proposes various strategies to address the<br />
issues.
&<br />
BACKGROUND<br />
Introduction Section one<br />
BACKGROUND<br />
& Introduction
BACKGROUND & INTRODUCTION<br />
Section one<br />
Street children are defined as<br />
“children who have to work on<br />
the streets because their families<br />
need money to survive, children<br />
from poor families who sleep on<br />
the streets, orphan and<br />
abandoned children whose<br />
parents have died because of<br />
illness or war or for whom it was<br />
simply impossible to look after<br />
their children”.<br />
1.1 Street Children<br />
st<br />
With the advent of the 21 century human<br />
population is going through the cycles of feast<br />
and famine. This can be observed especially<br />
in under developed countries and in<br />
developing nations like Pakistan. This<br />
population explosion not only gives rise to a lot<br />
of physical /environmental stresses such as<br />
shortage of food supply, fuel and energy,<br />
different type of pollutions etc but also the<br />
psychological ones. They can be anxiety,<br />
tension, worries, depressions several other<br />
psychopathologies due to deprivation of need<br />
fulfilment and coping with technological<br />
advancement. Such frustrations would be<br />
damaging for the inter personal relationships<br />
and the consequences have to be borne by<br />
both the individual and society disrupting the<br />
over all growth pattern. The consequences<br />
can be traced from the elementary unit of the<br />
society which is family such as disrupted and<br />
dysfunctional <strong>abuse</strong> of authority and power<br />
and gradually to the over all social structure.<br />
This can be an increasing rate of crime and<br />
violence. Such a malfunctioning society<br />
always strikes hard against the powerless<br />
including women and children.<br />
Children in particular are highly susceptible<br />
to these highly volatile situations. They face<br />
denial of their basic rights. The inequalities<br />
they face due to adults behavior are<br />
unimaginable, however the manifestations are<br />
the same in any setting. The circumstances<br />
faced are the same all over the world.<br />
Parents, friends and the physical environment,<br />
all play an active role in the development of a<br />
child's personality. Any neglect, deprivation,<br />
indifferent parental behavior possibly due to a<br />
disrupted relationship can cause serious and<br />
irreversible damage to the developing<br />
personality, pushing the child into deviant<br />
behavior. Many societies witnessed an influx<br />
of children ending up on the streets due to<br />
indifferent attitudes of their parents, family<br />
break-up or poverty. Alarmingly, the numbers<br />
have been constantly growing into significant<br />
epidemiological proportions. Societies have<br />
failed significantly in doing enough to follow<br />
through and to create secure environments for<br />
these displaced children known as “Street<br />
Children”.<br />
1<br />
Street children are defined as “children<br />
who have to work on the streets because their<br />
families need money to survive, children from<br />
poor families who sleep on the streets, orphan<br />
1
Section one<br />
and abandoned children whose parents have<br />
died because of illness or war or for whom it<br />
was simply impossible to look after their<br />
children”. They live, breath in the air<br />
poisonous for their survival but they find<br />
relieve in it. Their social or economical state<br />
compels them to involve in anti-social activities<br />
and they suffer critically due to drug and<br />
sexual <strong>abuse</strong> or similar other harmful factors.<br />
These children are deprived of the essential<br />
relationship with vital societal institutions that<br />
traditionally provide sources of support and<br />
ensure an individual's well being and<br />
happiness in society. They are at alarmingly<br />
high risk for a myriad of physical and<br />
psychological problems as a result of both the<br />
circumstances that preceded their<br />
homelessness, and as a direct consequence<br />
2.<br />
of life on the streets<br />
The United Nations estimates around 100-<br />
3<br />
140 million street children world wide. Out of<br />
these only 20 million children live on the street<br />
around the clock without their families. In<br />
South America at least 40 million, in Asia 25<br />
million, in Africa 10 million and in Eastern and<br />
Western Europe approximately 25 million<br />
children and youth live on the street 4,5<br />
. It is<br />
estimated that approximately 90 percent of<br />
street children in Central America sniff glue.<br />
Considering the situation in South Asia it is<br />
revealed that almost every country of this<br />
region suffers the same dilemma. In India, 18<br />
million children have been reported to live or<br />
work on the streets of urban India, labouring<br />
as porters at bus or railway terminals; as<br />
mechanics in informal auto-repair shops; as<br />
vendors of food, tea, or handmade articles; as<br />
street tailors; or as rag pickers, picking<br />
through garbage and selling usable materials<br />
7<br />
to local buyers . In Bangladesh, Nepal, Sri<br />
Lanka the issue is critically reported, due to<br />
illiteracy and deprivation of basic needs the<br />
8<br />
countries face the identical problem .<br />
Pakistan, which has a population of 140<br />
million, is no different from other South Asian<br />
countries as its urban settings portray the<br />
same bleak picture. The situation is worse in<br />
its biggest Metropolis city, Karachi that is<br />
home to more than 10,000 street living<br />
9<br />
children. The course of researches revealed<br />
many disturbing facts about these children.<br />
They brave extreme weather conditions and<br />
live in an extremely battered environment,<br />
exposed to any eventuality that comes their<br />
way. They usually form groups to protect<br />
themselves from exploitation and <strong>abuse</strong>,<br />
which is common in street culture. Their gang<br />
leaders are usually older boys who <strong>abuse</strong><br />
them in return for ensuring their safety . The<br />
gang leader who arranges for their meals and<br />
for their favourite distractions, (these children<br />
have been found addicted to a number of<br />
toxicants, including substances and<br />
chemicals) keeps whatever these children<br />
earn.<br />
These children are facing not only the<br />
scarcity of resources but are living<br />
under noisy, dirty, unsafe and<br />
impersonal environment<br />
which leads to frustration<br />
because their goals<br />
related to Subjective<br />
Well Being( SWB)<br />
are thwarted or<br />
blocked. Street<br />
children are those<br />
who are least able to<br />
protect themselves. In<br />
almost every aspect of their<br />
lives; they are subject to<br />
unconscionable violence, most often<br />
perpetrated by the very individuals charged<br />
with their safety and well being. This<br />
frustration leads to the feelings of hostility<br />
towards its source. But single handily they<br />
cannot achieve what they desire thus attach<br />
with similar others on the principle of<br />
reciprocity of liking. As being a part of group<br />
not only social but also emotional needs can<br />
be meet. Thus they become a staunch<br />
member and do whatever others do. This<br />
could be an explanation for their association<br />
with gang-crime which in turn build their<br />
courage to be involved in criminal activities<br />
and <strong>solvent</strong>/drug <strong>abuse</strong>.<br />
2<br />
3
Section one<br />
1.2 Solvent Abuse<br />
Defining Solvent Abuse has proven to be a<br />
far more arduous task than it has been for<br />
most other drugs. In broader terms <strong>solvent</strong><br />
<strong>abuse</strong> or more accurately called Volatile<br />
Substance Abuse (VSA) has been defined as<br />
the “deliberate inhalation of gases, chemical<br />
fumes or vapours for mind-altering and<br />
recreational purposes in order to get a “high”<br />
similar to the intoxication produced by<br />
alcohol”. Solvents are chemicals that change<br />
from liquid form into gases or vapours at<br />
ordinary room temperatures. Their <strong>abuse</strong><br />
potential is directly related to their ability to<br />
produce intoxication and repeated <strong>abuse</strong> may<br />
result in psychological dependence or other<br />
harmful health effects. The prevalence and<br />
public health effects of volatile substance<br />
<strong>abuse</strong> are often underestimated and local<br />
knowledge of the phenomenon is inadequate.<br />
The wide range of organic <strong>solvent</strong>s available<br />
in many common products further complicates<br />
the situation. Compounds such as diethyl<br />
ether, chloroform and nitrous oxide have been<br />
deliberately inhaled for recreational purposes<br />
since the early 1800s. Solvents from<br />
adhesives such as glues, (notably toluene),<br />
typewriter correcting fluids and thinners (1,1,1-<br />
trichloroethane), hydrocarbons such as those<br />
found in cigarette lighter refills [forms of<br />
liquefied petroleum gas (LPG), largely butane],<br />
aerosol propellants, halocarbon fire<br />
extinguishers and gases such as nitrous oxide<br />
are among the compounds or products which<br />
may be <strong>abuse</strong>d in this way. Petrol and its byproducts<br />
(gasoline) as well as Acetone<br />
(propanone) have also been reported to be<br />
<strong>abuse</strong>d, especially in developing communities.<br />
While the inhalation of volatile substances<br />
for mind-altering and recreational purposes is<br />
a long-standing problem in the developed<br />
world, the phenomenon appears to be of a<br />
recent origin in most countries in Asia and the<br />
Pacific region. Research has shown that VSA<br />
is primarily an adolescent phenomenon, with<br />
the highest levels of prevalence reported<br />
among 15 and 16 year olds. VSA gives rise to<br />
dose-related effects similar to those of other<br />
hypno sedatives. Small doses can rapidly lead<br />
to euphoria and other disturbances of<br />
behaviour similar to those caused by ethanol<br />
(alcohol), and may also induce delusions and<br />
hallucinations<br />
. 19,20,21,22,23,24.<br />
Inhalants can be breathed in through the<br />
nose or the mouth in a variety of ways, such<br />
as:<br />
<br />
<br />
<br />
<br />
“Sniffing” or “snorting” fumes from<br />
containers;<br />
“Bagging”sniffing or inhaling fumes<br />
from substances sprayed or<br />
deposited inside a plastic or paper<br />
bag;<br />
“Huffing” from an inhalant-soaked rag<br />
stuffed in the mouth;<br />
Spraying aerosols directly into the<br />
nose or mouth.<br />
Inhaled chemicals are rapidly absorbed<br />
through the lungs into the bloodstream and<br />
quickly distributed to the brain and other<br />
organs. Research has shown that the<br />
chemical substances found in inhalants<br />
produce acute effects similar to subanaesthetic<br />
concentrations of general<br />
anaesthetics, as well as to the effects of<br />
classical CNS depressant drugs, such as<br />
alcohol and the barbiturates. This is<br />
characterized by a rapid high that resembles<br />
alcohol intoxication with initial excitation<br />
followed by drowsiness, dis-inhibition, lightheadedness<br />
and agitation. Nearly all <strong>abuse</strong>d<br />
inhalants (other than nitrites) produce a<br />
pleasurable effect by depressing the CNS.<br />
There is evidence that toluene, a <strong>solvent</strong><br />
found in many commonly <strong>abuse</strong>d inhalants<br />
including glue, paint and nail polish removers,<br />
activates the brain's dopamine system. The<br />
dopamine system has been known to play a<br />
role in the rewarding effects of many drugs of<br />
<strong>abuse</strong>. Nitrites, in contrast, dilate and relax<br />
blood vessels rather than acting as<br />
anaesthetic<br />
agents. For<br />
the<br />
anaesthetics,<br />
evidence<br />
suggests<br />
that<br />
enhancement<br />
of<br />
GABAenergic<br />
inhibition may<br />
be an<br />
important<br />
cellular target for<br />
their acute effects, just as it is for alcohol and<br />
25,26<br />
other depressant drugs.<br />
Within minutes of inhalation, the user<br />
experiences intoxication along with other<br />
effects similar to those produced by alcohol.<br />
Alcohol-like effects may include slurred<br />
speech, an inability to coordinate movements,<br />
euphoria, and dizziness. In addition, users<br />
may experience light-headedness,<br />
hallucinations, and delusions, e.g., a feeling<br />
that they can fly. Because intoxication lasts<br />
4<br />
5
6<br />
only a few minutes to a maximum of about 45<br />
minutes, <strong>abuse</strong>rs frequently seek to prolong<br />
the high by continuing to inhale repeatedly<br />
over the course of several hours. Once the<br />
initial 'buzz' wears off, users experience<br />
symptoms similar to a hangover and often feel<br />
tired and drowsy. It is suggested that rather<br />
than using the term 'addiction' for <strong>solvent</strong><br />
<strong>abuse</strong>, 'dependence' is a more useful concept<br />
as this allows for two dimensions: both the<br />
physical and psychological effects. However,<br />
tolerance can develop with regular use of<br />
volatile substances so that increased<br />
inhalation is needed to get the same effect.<br />
The psychological effects of volatile substance<br />
<strong>abuse</strong> vary from person to person. However,<br />
there is always a general sense of euphoria<br />
and of omnipotence associated with the<br />
process. Chronic users may also experience<br />
difficulty with socialization and communication,<br />
which can result in a pattern of antisocial<br />
,27,28<br />
behaviour.<br />
Accidental death or injury can happen<br />
especially if users are in an unsafe<br />
environment such as near a busy road.<br />
Becoming unconscious also carries with it the<br />
risk of death through choking. In fact any<br />
method of use which hinders breathing (such<br />
as sniffing with a plastic bag over the head)<br />
increases the likelihood of death from<br />
29,30,31,32,33<br />
asphyxiation.<br />
RESEARCH methodologies<br />
Section two<br />
&<br />
&<br />
RESEARCH<br />
methodologies<br />
7
RESEARCH & METHODOLOGIES<br />
Section two<br />
2.1 Defining the Problem<br />
2.3 Research Methodology & Procedures:<br />
The National Assessment Study on the<br />
Drug Abuse Situation in Pakistan, 2000,<br />
documented that there are approximately<br />
500,000 chronic heroin users (including drug<br />
injectors) in the country. The study also<br />
highlighted an emerging problem of <strong>solvent</strong><br />
<strong>abuse</strong> among young people; street children in<br />
particular. Research has documented Street<br />
children to be one of the most vulnerable<br />
populations for various deviated behaviours<br />
such as substance <strong>abuse</strong>. Data from the<br />
study did not allow comment on the issue in<br />
any detail, but Solvent <strong>abuse</strong> was most<br />
commonly reported from urban areas in the<br />
major cities like Lahore Karachi, Rawalpindi<br />
and Peshawar.<br />
However, the extent to which this<br />
marginalized and vulnerable group is abusing<br />
<strong>solvent</strong>s deserves further attention, as does<br />
the wider question of what can be done to<br />
alleviate the drug and other social problems<br />
amongst this particularly needy group of<br />
young people.<br />
The following study is therefore designed in<br />
order to get a better understanding on <strong>solvent</strong><br />
<strong>abuse</strong> among adolescents in Pakistan, and<br />
utilize the results in the formulation of<br />
interventions for the street children with the<br />
<strong>solvent</strong> <strong>abuse</strong> problem.<br />
2.2 Aims & Objectives:<br />
The objectives of the study:<br />
To determine the …<br />
i) prevalence of <strong>solvent</strong> <strong>abuse</strong> among<br />
street children in Pakistan;<br />
ii) patterns and trends of <strong>solvent</strong> <strong>abuse</strong><br />
among street children in Pakistan;<br />
iii) level of awareness about adverse<br />
consequences of <strong>solvent</strong> and drug<br />
<strong>abuse</strong>;<br />
iv) the demographic and socio-economic<br />
profile of <strong>solvent</strong> <strong>abuse</strong>rs, living<br />
circumstances including group dynamics;<br />
v) health and social consequences of<br />
<strong>solvent</strong> <strong>abuse</strong>;<br />
vi) sources of financing <strong>solvent</strong> and drug<br />
<strong>abuse</strong>;<br />
vii) knowledge of HIV / AIDS and associated<br />
risk practices; and<br />
ix) the nature, extent and quality of<br />
treatment and rehabilitation facilities, if<br />
any, for street children abusing <strong>solvent</strong>s.<br />
2.3.1 Case Definition<br />
Reaching a case definition was a highly<br />
tedious task, primarily due to the scarcity of<br />
research undertaken on the subject in<br />
Pakistan, as well as the highly complicated<br />
dynamics of this vulnerable population. The<br />
task required defining 'street children' initially,<br />
followed by delineating '<strong>solvent</strong> <strong>abuse</strong>' and<br />
finally merging the two to reach a case<br />
definition to be used for the purposes of our<br />
study. Street children were defined as:<br />
“children for whom the family support base<br />
has become increasingly weakened and who<br />
must share in the responsibility of family<br />
survival by working on city streets and market<br />
places. Nevertheless, while the street<br />
becomes their daily time activity, the majority<br />
return home most nights.”. Based on the<br />
preceding, the eligibility criteria for subjects to<br />
be included in the study was described as:<br />
<br />
<br />
<br />
<br />
Street children spending a minimum of 10<br />
hours on the street, irrespective of<br />
residential status<br />
Either male or female<br />
Aged between 9 to 19 years<br />
using any of the products included in the<br />
list of abusive <strong>solvent</strong>s (annex 1) continuously<br />
for a minimum of past 6 month, not less<br />
than 3 times a week.<br />
Based on the above mentioned criteria, our<br />
case definition was:<br />
“All street children, either male/female, aged<br />
9 to 19 yrs, willing to participate in the study<br />
and had been regularly using <strong>solvent</strong>s in the<br />
past 6 month for not less than 3 times a week.”<br />
2.3.2 Subject selection<br />
The study was conducted in the four<br />
provincial capitals of Pakistan i.e., Karachi,<br />
Lahore, Peshawar and Quetta. Extensive<br />
efforts were made to achieve a representative<br />
sample of the study population. Thus, prior to<br />
the selection of study subjects, a<br />
comprehensive mapping of street children<br />
was done in the respective city, utilizing<br />
multiple resources. Thereafter, multiple sites<br />
with highest concentration of street children<br />
were selected in each city, from where equal<br />
proportions of study subjects were recruited.<br />
Subjects found eligible were otherwise<br />
excluded from the study but unwilling to<br />
participate.<br />
8<br />
9
Section two<br />
2.3.3 The Questionnaire<br />
A team of researchers including an<br />
epidemiologist, psychologist, social scientists<br />
and social workers working with street children<br />
developed the questionnaire. A 03 days<br />
training on data collection was conducted in<br />
Karachi, which included issues on subject<br />
selection, explaining the rationale and<br />
objectives of the study to the subjects,<br />
acquiring informed consent and a thorough<br />
understanding regarding each question. The<br />
training was followed by pre-testing of data<br />
collection technique and questionnaire<br />
implementation on 42 subjects (10% of overall<br />
sample) at 3 different sites.<br />
The questionnaire was pre-tested on a<br />
sample of 10% of the actual sample size,<br />
which was modified, and all required changes<br />
were incorporated. Information on various<br />
demographic and socio-economic variables,<br />
information related to the family of the child<br />
and current living arrangements, knowledge of<br />
the drug <strong>abuse</strong> problem and awareness of the<br />
consequences was collected. Information<br />
related to average daily income, sources of<br />
income and mode of spending were also<br />
noted. Information on drug use practices i.e.,<br />
severity and routes of administration etc.,<br />
Medical, social and psychological<br />
consequences of <strong>solvent</strong> <strong>abuse</strong> were<br />
obtained from the child. Knowledge related to<br />
HIV, its modes of transmission and prevention<br />
as well as an evaluation of high-risk HIV<br />
behaviour and practices was done at the end.<br />
2.3.4 Interview procedures<br />
Four data collection teams, each<br />
comprising of a field supervisor and three<br />
interviewers worked simultaneously in their<br />
targeted areas. All interviewers were social<br />
science graduates, having a minimum of 2-3<br />
years fieldwork experience. As already<br />
mentioned a three-day training of interviewers<br />
was held in Karachi. The work schedule of all<br />
interviewers was prepared by the field<br />
supervisor in such a way that each interviewer<br />
was assigned to conduct three interviews per<br />
day at various targeted sites. An equal<br />
number of children were selected on the basis<br />
of incidental sample for data collection from<br />
the identified sites. Furthermore, to capture<br />
the entire segments of the street children<br />
population, each site was visited on different<br />
days of the week as well as on different times<br />
of the day. Among children present at a<br />
selected site, one child was selected by the<br />
interviewer, after the drug <strong>abuse</strong> status was<br />
determined. This was followed by an informed<br />
consent and a structured interview, which took<br />
an average time of 35 minutes, was<br />
conducted.<br />
2.3.4.1Focus Group Discussions<br />
In addition to collecting questionnaire<br />
information, purposive sampling on the basis<br />
of stratified grouping was<br />
applied to hold seven<br />
Focus Group<br />
Discussions (FGD's).<br />
Each group consisted of<br />
Typical & Critical cases,<br />
and at least one child<br />
from each age bracket<br />
i.e., upto 10 yrs, 11 to 14<br />
yrs and more than14 yrs.<br />
A total number of 8 ± 1 member<br />
participated in each group discussion, which<br />
were conducted in Karachi (Jehangir Park),<br />
Quetta (Baldia Park, Railway station),<br />
Peshawar (General Bus stand, city station<br />
sara-e-pul) and Lahore (Abbot road, Ravi<br />
park). A total number of 58 children<br />
participated in this activity altogether. The<br />
purpose of FGD's was to indicate and<br />
illustrate:<br />
I.<br />
II.<br />
III.<br />
IV.<br />
antecedents of nurturance on<br />
behaviors and attitudes;<br />
reason of incomplete education;<br />
living conditions and group dynamics;<br />
effects, reasons and consequences<br />
of <strong>solvent</strong> <strong>abuse</strong>;<br />
2.3.4.2 Key Informant Interviews<br />
To acquire information about the existing<br />
services for the treatment and rehabilitation of<br />
street children, as well to comprehend the<br />
awareness of the service providers, 18 key<br />
informant<br />
interviews<br />
were<br />
conducted<br />
with<br />
individuals in<br />
a regular<br />
contact with<br />
these<br />
children<br />
frequently.<br />
Two major<br />
groups of<br />
people were<br />
interviewed<br />
i.e., people<br />
Box.4 Key Informants interviews<br />
Karachi<br />
<br />
<br />
<br />
<br />
Lahore<br />
Police station – Metha dar<br />
Police station – Darakhshan<br />
Azam Clinic - Pakistan Society<br />
Marie Adelaide Drug rehabilitation<br />
Programee<br />
Police station – Qilla Gujar Singh<br />
Police station – Naulakha<br />
Nighaban centre<br />
Nai Zindagi<br />
Model drug <strong>abuse</strong> treatment centre –<br />
Mayo Hospital<br />
Peshawar<br />
<br />
<br />
<br />
<br />
Quetta<br />
<br />
<br />
<br />
<br />
<br />
Police station - Hashtnagar<br />
Police station – Kabuly Bazar<br />
Dost Welfare Foundation<br />
Lady Reading Hospital<br />
Police station - Pushtoonabad<br />
Police station – City<br />
Milo Shaheed Trust<br />
Psychiatric Ward – Civil Hospital<br />
Edhi centre<br />
10<br />
11
Section three<br />
involved in providing drug detoxification and<br />
rehabilitation facilities, as well as police<br />
officials. Various government and non<br />
governmental organizations were selected to<br />
identify and recognize the existing resources<br />
available for drug detoxification and treatment<br />
of these children. Moreover, an evaluation of<br />
the knowledge and awareness as well as the<br />
skills of these providers is a requisite for<br />
developing interventions in future.<br />
On the other hand, police and law<br />
enforcement agencies are known to come into<br />
interaction with these children frequently.<br />
Moreover, these institutions play a key role in<br />
providing first hand information regarding the<br />
criminal involvement and illicit activities done<br />
by these children. It was equally important to<br />
know that if children are involved in such an<br />
activity, how frequent is such an involvement<br />
while at the same time, what sort of<br />
rehabilitation and rectification methods are in<br />
place.<br />
2.3.5 Ethical Standards<br />
(i)<br />
(ii)<br />
(iii)<br />
(iv)<br />
informed consent of the interviewee;<br />
ensuring privacy and confidentiality of<br />
personal information;<br />
non-inclusion of subject's personal<br />
information in data files;<br />
Presentation of results in aggregate;<br />
form, without individual identification.<br />
2.3.6 Data Management<br />
A data base was specifically designed in<br />
Fox Pro for the purposes of data entry. The<br />
completed questionnaires after field editing<br />
and checking by the field supervisors were<br />
received at the data management unit. All<br />
questionnaires were assigned a code number,<br />
and the forms were edited by the data<br />
manager. After editing, data set were double<br />
entered in the software designed for data<br />
entry, followed by data cleaning and analysis.<br />
STUDY results<br />
12<br />
To assure adherence to the ethical<br />
standards of epidemiological research,<br />
procedures followed included:<br />
STUDY results<br />
13
Solvent Abuse Among Street Children in Pakistan<br />
STUDY RESULTS<br />
Solvent Abuse Among Street Children in Pakistan<br />
Section three<br />
Four hundred and twenty three (423) interviews were conducted in the 4 target cities. 29<br />
eligible children refused to participate in the study (primarily girls 19), with an overall non<br />
response of 6.5%. The overall distribution of sample is given in Table 3.1<br />
yrs) and 21.2% (more than 17yrs) respectively. The city wide age distribution is given in Fig<br />
3.1.1a.<br />
The demographic and socio-economic<br />
profile of the street children who participated in<br />
the study is presented in this section.<br />
Table 3.1 Sampling Distribution<br />
Karachi Lahore Quetta Peshawar OVERALL<br />
n (%) n (%) n (%) n (%) N (%)<br />
Interviews conducted 110 110 110 110 440<br />
Non response 02 (1.8) 07 (6.3) 09 (8.1) 11 (10) 29 (6.5)<br />
Incomplete forms 05 (4.5) 01(
Section three<br />
from where these children have largely migrated<br />
are shown in Table<br />
3.1.2<br />
Table 3.1.2a. Major cities from where<br />
children influx into Lahore & Peshawar<br />
LAHORE<br />
3.1.3 Religion<br />
96.4 % of the children interviewed were<br />
Muslims. Of the remaining 3%, 12 were<br />
Christians and 1 child was reported to be a<br />
Hindu. Two children did not know about their<br />
religion. The figures reported are in accordance<br />
with national data.<br />
3.1.4 Family Information<br />
PESHAWAR<br />
City n City n<br />
Faisalabad 10 Mardan 8<br />
Gujranwala 10 Swat 7<br />
Sheikhupura 3 Charsada 5<br />
Karachi 3 Rawalpindi 4<br />
Sialkot 3 Kohat 4<br />
Seventy two percent (72%) of the<br />
respondents (300) were not currently living with<br />
their families. Of all the homeless children, 9.3%<br />
(28) did not know about their families. Out of the<br />
remaining, only 2% were in daily contact with the<br />
family. Almost one third were meeting the<br />
family at least once a month while a<br />
substantial percentage 43.6% had contact<br />
almost once every six months. 2.3% had lost<br />
complete contact with their families. The<br />
graphical presentation of the responses is<br />
given in Fig 3.1.4a.<br />
43.6<br />
Fig. 3.1. 4a<br />
Fre qu en cy of Fa mily C on tac t<br />
daily<br />
once or tw ice a w eek<br />
once or tw ice a month<br />
more than a monthbut less than 6 months<br />
no contact<br />
2.3<br />
2.2 7.6<br />
Further information regarding<br />
parents, and immediate family members was<br />
obtained. A high proportion of children were<br />
reported to belong to large families. The mean<br />
family size (immediate members) was<br />
reported to be 8.89 ± 2.45, with more than<br />
38% of the children belonging to families<br />
having 10 or more immediate members.<br />
Analysis of the birth order of the children<br />
interviewed revealed that 53.6% were middle<br />
born, 15.2% were elders while the remaining<br />
22<br />
30.4% were the youngest.<br />
Further information regarding the parents<br />
depicted that almost half of the children<br />
reported that their parents were living together.<br />
Approximately one third of the children<br />
belonged to single parent families. Thus either<br />
one of the parents was deceased or otherwise<br />
there was a marital disruption in the form of<br />
divorce or separation. Further details are<br />
provided in Table 3.1.4a.<br />
Table 3.1.4a<br />
Parental Marital status<br />
Marital status n (%)<br />
Currently living together 205 (49.3)<br />
Single parent 132 (31.7)<br />
Both parents died 50 (12.0)<br />
No information 29 (6.9)<br />
FGD's indicated that children complained<br />
about their parent's attitudes as indifferent<br />
towards them. A few statements as per<br />
verbatim are quoted to give a clear perception<br />
of their relations with parents;<br />
“my parents <strong>abuse</strong>d each other and in the<br />
end verbally and physically <strong>abuse</strong>d me as<br />
well”. According to another child “my father<br />
always demanded good grades in school but<br />
never gave money for stationary and books. If<br />
I was not doing good in my school, I was<br />
forced to work for living”. One of the child<br />
informed, “My father <strong>abuse</strong> drugs and under its<br />
influence used to beat us”.<br />
Information generated from the FGD's<br />
showed that the upbringing of most of these<br />
children was done in the parenting fashion<br />
”,<br />
called “rejecting-neglecting parenting style<br />
Most of the children further complained of<br />
larger family size and scarcity of resources.<br />
They were of the opinion that their family<br />
expenditures were more than their monthly<br />
earning, and their parents were always<br />
pushing them to contribute to the family<br />
income and share some of the financial<br />
responsibilities. Children also reported their<br />
family as a disrupted unit, in which the parents<br />
were always quarreling with each other and<br />
releasing their aggression and anxieties on<br />
children, infact cursing their existence.<br />
3.1.5 Educational Qualification<br />
Results of the analysis regarding<br />
educational attainment has shown that overall<br />
76% (316) of the total children interviewed<br />
never went to school. The situation was found<br />
to be the worst in Quetta, where 90% of the<br />
children never attended school. The mean<br />
16<br />
17
years of education completed by those who<br />
went to school was 3.01 ± 1.97. See table<br />
3.1.5a for details.<br />
Section three<br />
Karachi Lahore Quetta Peshawar OVERALL<br />
n (%) N (%) n (%) n (%) N (%)<br />
Never went to<br />
school 78 (74.3) 75 (68.8) 91 (90) 72 (72) 316 (76)<br />
Cannot read or<br />
writ e 82 (78) 83 (76.1) 91 (90) 67 (67) 316 (76)<br />
Mean years of<br />
education<br />
completed 2.8 ± 1.7 3.1 ± 1.7 5.0 ± 3.4 2.2 ± 1.2 3.0 ± 1.9<br />
Lack of interest (35%) followed by nonavailability<br />
of finances (23%), detestation for<br />
teacher (22%), required to work (10.5%) and a<br />
non-interest of parents in the child's education<br />
(6%) were the main reasons reported for the<br />
discontinuation of education.<br />
As already mentioned in the previous<br />
section, children regarded their families as<br />
broken and dysfunctional. Children reported<br />
under group discussions that the apathetic<br />
attitude of parents made them irritated and<br />
frustrated. This was further amplified by the<br />
teacher's attitude. They said: “Teachers beat<br />
us for being undisciplined, can't learn lessons<br />
properly or can't even study properly”. It can<br />
be added over here that children who are<br />
distilled and rejected are more likely to drop<br />
out from school, to develop emotional<br />
problems and to become juvenile delinquents.<br />
They are usually unhappy and are lonely,<br />
suffer from a higher incidence of both physical<br />
and mental disorder experiencing problems<br />
that range from poor health and adjustment to<br />
a higher rate of criminal activity to suicide<br />
conversely. It is well supported by various<br />
researches that such destitute children face<br />
38,39<br />
problems mentioned above.<br />
3.1.6 Income, Sources of income &<br />
Spending<br />
140<br />
120<br />
100<br />
80<br />
60<br />
40<br />
20<br />
0<br />
125<br />
Cleaning<br />
cars<br />
69<br />
Fig. 3. 1.4a<br />
57<br />
Begging<br />
50<br />
27<br />
Waiters<br />
So urc es o f Inc ome<br />
The primary source of income for the<br />
majority of children was cleaning / washing<br />
cars (30%), followed by scavenging garbage<br />
(16.7%) and begging (13.8%). Other sources<br />
of income included physical labor, selling of<br />
flowers, toys, balloons, combs etc., on the<br />
22<br />
13 13 13 12 15<br />
Pick<br />
pocketing<br />
Skilled<br />
Labor<br />
Misc<br />
street. A minor proportion of children (3%)<br />
reported involvement in minor crimes such as<br />
pick pocketing etc., Two of the children<br />
interviewed also reported of involvement in the<br />
peddling of drugs such as Hashish.<br />
A negligible fraction (3%) sourced their<br />
income from skilled<br />
work i.e.<br />
mechani<br />
cs,<br />
con<br />
structi<br />
on work<br />
etc. The<br />
various sources of<br />
income for the street children are given in Fig<br />
3.1.6a. The average daily income reported<br />
was Rs. 79.7 ± 44.7 earned after working for<br />
an average of 8.63 ± 5.74 hours per day.<br />
Using the provided estimates, an<br />
approximation of the average monthly income<br />
was found to be Rs. 2395. The mean daily<br />
income was significantly low for children<br />
interviewed in Peshawar (45.14 ± 16.18) while<br />
the remaining cities reported a mean daily<br />
income, which was almost double. Only<br />
30%(126) children informed that they share<br />
their income with their families.<br />
3.2 Living Conditions &<br />
Group Dynamics<br />
As already mentioned, 72% (300) of the<br />
respondents were not currently living with their<br />
families, and, 9.3% (28) out of these had<br />
completely lost contact with their families. The<br />
current living conditions and circumstances<br />
were further explored.<br />
Children were inquired about the place<br />
where they had been sleeping during the past<br />
30 days. Almost half of these children had<br />
been sleeping in the streets or parks in the last<br />
30 days. 12% reported staying the nights with<br />
their friends. Upon further exploration, this<br />
night stay was either at home or at the place<br />
where this friend works. Approximately 7% of<br />
the children reported sleeping at Darbars and<br />
shrines as well. The responses are given in<br />
Table 3.2.1a.<br />
Table 3.2.1a Sleeping place at night<br />
With the family<br />
Street/ Parks<br />
Friends<br />
Darbar / Shrines<br />
Work Place<br />
Others<br />
116 (28%)<br />
206 (49.5%)<br />
50 (12%)<br />
28 (6.7%)<br />
04 (1.0%)<br />
06 (1.4%)<br />
18<br />
19
Section three<br />
Results show that a large number of<br />
children interviewed had no permanent place<br />
to live/sleep and had been drifting around<br />
various places. It was interesting to note that<br />
all such children never spend nights alone, but<br />
had been sleeping in the company of other<br />
street children, and stay in groups. The groups<br />
are usually of a large size (60% of the children<br />
have reported sleeping at places where more<br />
than 10 children are present). Only 8% of the<br />
children have been sleeping in a group of less<br />
than 5 children. A group leader, who is usually<br />
an elder, either the strongest boy or the one<br />
who owns the place, almost always controls<br />
the group.<br />
Children under focus groups shared their<br />
feeling of dismay by pointing towards the<br />
ambience around them as disconsolate.<br />
According to them jungle rules prevail, as the<br />
one who is mighty or superior (in any form)<br />
surmounted others. Children were of the<br />
opinion that living in open places gives rise to<br />
the feeling of insecurity and they remain<br />
vulnerable to <strong>abuse</strong>, which extends from<br />
verbal to physical and even sexual. The main<br />
fears reported by the younger children were of<br />
sexual assault from the elder boys, while the<br />
elder children themselves were concerned<br />
about physical dangers. The majority of<br />
younger children informed that they were at an<br />
absolute loss to enjoy a sound sleep, as they<br />
are in constant state of anxiety from all the<br />
exposed dangers, which is not only from<br />
nature but more from their own kind. The<br />
formation of groups and the need to stay<br />
together could be explained in the light of this<br />
as well as the fact that being human beings,<br />
and for need fulfilment, they had to live<br />
together and became a part of group. Being a<br />
part of group they perform all the rituals and<br />
meet institutionalised norms of the group; the<br />
finding is well supported by several<br />
researches conducted on personality<br />
,<br />
development . This is an extremely important<br />
point, which needs consideration and can be<br />
utilized when preventive packages are<br />
formulated for these children.<br />
3.3 Medical & Health<br />
problems<br />
Evaluation of the medical status had shown<br />
that 55% of the children complained of at least<br />
one medical problem that they were facing<br />
currently. The major problems reported were<br />
Respiratory Tract Infection (30%), followed by<br />
Fever (19.7%), GIT upsets (18.7%) and Skin<br />
Infections (12.6%). Other complaints included<br />
Headaches, Generalized Myalgias,<br />
Weakness, Eye Infections etc.<br />
Among those who complained of prevailing<br />
illness, 47% had sought medical treatment. Of<br />
the remaining 53%, the lead reason reported<br />
for not seeing a doctor was lack of finances<br />
(39%). Other important reasons reported were<br />
a fear of injection (20%), don't know a doctor<br />
(9.8%), don't want to go because doctors are<br />
not cooperative with them (9.9%) and self<br />
treatment (3.3%). The health seeking<br />
behaviour needs to be considered when any<br />
primary health care interventions are designed<br />
for this group.<br />
3.4 Solvent Abuse<br />
3.4.1 Substance <strong>abuse</strong>d<br />
The use of various <strong>solvent</strong>s by the<br />
respondents is in conformity with what is seen<br />
12-14,17<br />
internationally. Adhesive glues is the<br />
primary drug of choice consumed by 90%<br />
(374) of the interviewed street children. This<br />
feature has been found to be uniformly<br />
distributed across all the four cities from where<br />
data were collected. A high proportion of<br />
samples reported use of other <strong>solvent</strong>s as<br />
well, including petrol (25.5%) and thinners<br />
(10.6%). Slight differences were noticed in the<br />
use of these secondary <strong>solvent</strong>s across cities.<br />
The use of Petrol along with adhesive glues<br />
was significantly popular in Quetta (43%) and<br />
Peshawar (41%), while the practice was<br />
almost negligible in Lahore, where only 7<br />
children reported the adjunct use of petrol<br />
along with adhesive glues. As a matter of fact,<br />
a significant proportion of children found in<br />
Peshawar were involved in the use of petrol<br />
alone (26%), without getting involved with the<br />
use of adhesive glues. Karachi has reported a<br />
more complicated picture, where children have<br />
been found to be involved with multiple<br />
20<br />
21
Section three<br />
substances. Thus while glue is the main drug<br />
used (95.2%) children have also been using<br />
Thinners (27.6%), Petrol (13.3%) and a minor<br />
proportion (5.7%) has reported use of Tincture<br />
as well.<br />
Table 3.3.1a<br />
Solvents <strong>abuse</strong>d<br />
Adhesive Glues<br />
Petrol & related<br />
products<br />
Thinners<br />
Miscellaneous<br />
Average Daily cost<br />
(mean ± sd)<br />
Types of Solvents <strong>abuse</strong>d<br />
and its daily cost in Pak Rs.<br />
Karachi Lahore Quetta Peshawar OVERALL<br />
n (%) N (%) n (%) n (%) n (%)<br />
100<br />
(95.2)<br />
14 (13.3)<br />
29 (27.6)<br />
07 (6.7)<br />
47.5 ±<br />
36.5<br />
107<br />
(98.2)<br />
07 (6.4)<br />
02 (1.8)<br />
01 (0.9)<br />
41.6 ±<br />
26.3<br />
94 (92.2)<br />
44 (43.1)<br />
10 (9.8)<br />
05 (4.9)<br />
38.7 ±<br />
26.2<br />
73 (73)<br />
41 (41)<br />
03 (3)<br />
01 (1)<br />
30 ± 28<br />
374<br />
(89.9)<br />
106<br />
(25.5)<br />
44 (10.6)<br />
14 (3.3)<br />
39.7 ±<br />
30.1<br />
Results have shown that an average<br />
amount of Rs. 39.7 ± 30.1 is being spent on<br />
these <strong>solvent</strong>s, which forms almost 50% of<br />
their average earning. (see section 3.1.6).<br />
Slight geographical differentiations were<br />
noticed; children in Peshawar reported to have<br />
spent an average daily amount of Rs.30 on<br />
buying these substances in contrast to Rs.47<br />
spent by a child living in Karachi. The numbers<br />
are however in parallel to their average<br />
income.<br />
Further analysis revealed that the<br />
maximum proportions (62%) of children<br />
interviewed had been using these substances<br />
for periods greater than 2 years. A minor<br />
Box 3.3---- Techniques used for i nhaling<br />
Adhesive Glues<br />
It should be noted that it is the vapor<br />
given off by the product that is used and<br />
the product its elf, e.g. glue, is not<br />
ingested into the body. Abusers have<br />
reported 3 different techniques through<br />
which they inhale the product :<br />
The most practiced technique is the use<br />
of a <strong>solvent</strong> from a soaked cloth reported<br />
by 80% (329) of the respondents.<br />
Typically some of the mat erial (20 gms)<br />
is poured into the cloth, which is then<br />
rolled in the sh ape of glove. Thi s in local<br />
terms is known as ‘Dum’. The ‘dum’ is<br />
then sniffed, or kept in the mouth and<br />
the fumes are inhaled.<br />
The second favourite technique is the<br />
inhalation of drug in a plastic bag<br />
[17%(71)]. The plasti c bag containi ng the<br />
glue is then held over the face and nose<br />
and the fumes are inhaled.<br />
Inhaling the fumes by putting the <strong>solvent</strong><br />
in a bott le was also descr ibed by 35<br />
(8.4%) of the respondents. Again the<br />
substance is po ured into a bott le, and<br />
the bottle is then brought closed to the<br />
nose and the fumes are inhaled. In some<br />
instances a plast ic pipe (straw) is place d<br />
above the level of the <strong>solvent</strong>, the other<br />
end is placed in the mouth and the whole<br />
substance is breathed in.<br />
Finally, 6.5% (27) of the respondents<br />
reported using the <strong>solvent</strong> directly from<br />
the can (tube in rare instances) The<br />
majority of cases have reported making a<br />
small hole in the can, and then after<br />
holding it close to the nose or face and<br />
inhaling the fumes until the whole<br />
substance is breathed in.<br />
proportion initiated drug use in the past year<br />
(18.2%) and a similar number (19.7%) had<br />
been using it for more than 1 year but not<br />
more than 2 years. This is suggestive of the<br />
fact that the practice is not a very new<br />
phenomenon, but most of the children<br />
interviewed were chronic users. However,<br />
since a strict case selection criteria was also<br />
used, all experimental and sporadic drug<br />
users were screened and excluded from the<br />
study. 95% of the children stated that they do<br />
not face any difficulty in procuring the<br />
<strong>solvent</strong>s, and it is easily available from the<br />
local market at standard rates. As described<br />
by the respondents it is just as simple as going<br />
to a shop and asking for an inhalant. More<br />
than half of the times (54%) the activity is<br />
reported to be a group based activity, in which<br />
the money is pooled in by all members of the<br />
group and one of the member then buys the<br />
substance for the entire group. Box 3.3.<br />
describes the various techniques used for<br />
inhaling adhesive glues. The illustrations of<br />
the mechanism are given in Figures 3.3.3<br />
A & b.<br />
3.4.2 Quantity used<br />
Analysis has shown that on an average 80<br />
gms of adhesive glues is being used each<br />
day during the past one month. Further<br />
analysis revealed that the maximum proportion<br />
of children (45.2%) have reported using 280<br />
gms of glue followed by 750 gms (24.8%),<br />
40 gms (19.2%) and<br />
80 gms (10.8%)<br />
respectively.<br />
Children<br />
were<br />
inquired<br />
about<br />
the<br />
frequenc<br />
y of use,<br />
the<br />
answers to<br />
which are<br />
provided in<br />
table 3.3.3a.<br />
approximately 20% of<br />
the<br />
children informed that they have been using<br />
the <strong>solvent</strong>s only once daily. Almost one fourth<br />
of the children reported using these drugs 2 to<br />
five times daily, while another 32% reported<br />
use upto 10 times a day. A substantial portion<br />
of the children (15%) reported that using<br />
<strong>solvent</strong>s round the clock. These children use<br />
the <strong>solvent</strong> through a cloth, which always stays<br />
with them in their hands, or pocket, and they<br />
are continuously busy in inhaling the fumes of<br />
the <strong>solvent</strong>, which is poured into this cloth.<br />
22<br />
23
3.4.3 Effects of Solvent <strong>abuse</strong><br />
Research has shown that the chemical<br />
substances found in the inhalants produce<br />
acute effects similar to sub-anaesthetic<br />
concentrations of general anaesthetics, as<br />
well as to the effects of classical CNS<br />
depressant drugs, such as alcohol and<br />
barbiturates. Children were inquired of the<br />
feeling experienced after <strong>solvent</strong>s are inhaled;<br />
the responses are given in Fig 3.3.3a.<br />
140<br />
120<br />
100<br />
80<br />
60<br />
40<br />
20<br />
0<br />
117<br />
Relief of<br />
tension<br />
Fig. 3.3.3a<br />
111<br />
Euphoria<br />
65<br />
Drowsiness<br />
Feelings experienced on using Solvents<br />
36 33 31<br />
Confident &<br />
Strong<br />
Cannot<br />
express<br />
Light<br />
headedness<br />
19 16 16<br />
A typical episode of <strong>solvent</strong> <strong>abuse</strong> as<br />
described by children themselves is a mixed<br />
Table 3. 3.3a. Frequency of use of <strong>solvent</strong>s<br />
Frequency of use n (%)<br />
Once daily<br />
02 to upto 05 times daily<br />
06 to upto 10 times daily<br />
All the time<br />
Agression<br />
Section three<br />
Nostalgia<br />
80 (19.2)<br />
97 (23.3)<br />
136(32.7)<br />
103(14.7)<br />
Others<br />
feeling of euphoria and contentment and a<br />
relaxed mood followed by a sound peaceful<br />
sleep. Children describe the feelings as<br />
ones that make<br />
them forget their<br />
worries and<br />
tensions, and feel<br />
happy about<br />
whatsoever<br />
situation they are<br />
into. A few<br />
children told the<br />
interviewers that<br />
they are unable<br />
to define the<br />
feelings, but<br />
generally it is a nice feeling. A large number<br />
of children reported that use of <strong>solvent</strong>s<br />
made them feel strong and powerful enough<br />
to overcome all the worries and problems in<br />
their lives. A minor proportion also described<br />
the feelings as nostalgic which reminded<br />
them of their home and the good times of<br />
their lives.<br />
One of the biggest hazards of<br />
compulsive drug use is that it fosters drug<br />
dependence and addiction. Users continue<br />
to take drugs despite adverse social and<br />
medical consequences, and behave as if the<br />
effects of the drugs are needed for continued<br />
well-being. Although research suggests that<br />
the physiological dependence is rare with<br />
<strong>solvent</strong>s, the magnitude of the need to<br />
repeated usage can vary from a mild desire to<br />
a craving or compulsion to use the drug. The<br />
respondents were inquired about the feelings<br />
they undergo if the <strong>solvent</strong>s are not taken. The<br />
responses are shown in Fig 3.3.3b.<br />
160<br />
140<br />
120<br />
100<br />
80<br />
60<br />
40<br />
20<br />
0<br />
142<br />
Anger &<br />
Agitation<br />
Fig. 3.3.3b<br />
69<br />
Restlessness &<br />
Irritability<br />
Symp toms r epo rted upo n un availib ility o f solv ents<br />
3.4.4 Reasons for Use<br />
54<br />
Generalized<br />
Aches<br />
38<br />
Inability to work<br />
33 30<br />
Abdominal<br />
cramps & GIT<br />
upsets<br />
The respondents were inquired about the<br />
various factors associated with the aetiology of<br />
<strong>solvent</strong> <strong>abuse</strong>. The major factor to lead into<br />
the use of <strong>solvent</strong>s reported by more than half<br />
of the children (53.4%) was friends and peers.<br />
Among other factors reported, neglect, group<br />
violence, a way to forget about the past and<br />
curiosity were significant as shown in fig 3.3.4.<br />
The issue was further explored in groups'<br />
discussions, which focused on not only the<br />
Headache<br />
22<br />
Depression<br />
14 15<br />
Semiconsciousness<br />
Others<br />
reasons which led to the initiation of <strong>solvent</strong><br />
use, but also discussing factors leading to the<br />
continuation of these agents. The role-played<br />
by peers and group membership not only<br />
emerged strongly as the factor initiating the<br />
use of <strong>solvent</strong>s but also acted as the leading<br />
reason to the continuation of the habit. A large<br />
number of children reported that they started<br />
drugs as to meet the social norms, which gave<br />
them immediate gratification in response. The<br />
importance of group membership was<br />
highlighted for survival among street children<br />
in the previous section (see section 3.2).<br />
However, while the peer pressure and social<br />
circumstances played a strong role in initiating<br />
drug use, the effects of the <strong>solvent</strong>s<br />
themselves helped continuous <strong>solvent</strong> <strong>abuse</strong>.<br />
The feeling of euphoria and happiness that<br />
was immediately experienced made the<br />
children forget all worries and helped relieve<br />
the tension, which these children face. The<br />
CNS depressing effects of the drugs made the<br />
children enjoy sound sleep for longer duration.<br />
Thus it can be deduced that, <strong>solvent</strong> or<br />
drug <strong>abuse</strong> work as an anaesthesia,<br />
decreases physical and emotional pain, induce<br />
sleep, decrease appetite (one of the factors<br />
leading to malnutrition), increases energy<br />
levels and adds excitement. It also provides<br />
24<br />
25
Section three<br />
Fig. 3.3.4a<br />
Etiology of Solvent Abuse<br />
Curiosity Forget the past Relatives<br />
Enviornment Neglection Domestic Voilence<br />
Group Violence Peer/Friends Misc<br />
53.6<br />
Them with a sense of belonging to the ingroup<br />
and gives them courage to commit<br />
crimes and higher levels of violence.<br />
3.4.5 Consequences of Use<br />
4.3<br />
A range of negative consequences and<br />
problems can arise from persistent use of<br />
<strong>solvent</strong>s. When explored in FGD, the children<br />
revealed various medical and social problems<br />
they have been facing over the past two years.<br />
Although youth is generally a time of relatively<br />
good health, but, the nature of continuous<br />
exposure to the streets and the associated<br />
lifestyles makes street children vulnerable to a<br />
range of health and other problems which are<br />
4.3<br />
8.4<br />
8.7<br />
5<br />
2.6<br />
3.1<br />
9.9<br />
not typically experienced by other young<br />
people. The majority of children did not<br />
report any severe medical problems that<br />
they faced, however minor ailments and<br />
health problems have been reported.<br />
Although use of <strong>solvent</strong>s has its own<br />
untoward effects on the health of the<br />
Box 3.<br />
Medical Consequences of Solvent Abuse<br />
Chest Infections & Breathing<br />
(16.4%)<br />
Fever (16%)<br />
Generalized Weakness & Myalgia<br />
(8.9%)<br />
Skin Infections (3.6%)<br />
Gastric upsets (3.8%)<br />
Headache (2.6%)<br />
Urinary Infections (1.9%)<br />
Semi-consciousness (1.0%)<br />
Misc (5.5%)<br />
individual, but the results of surveys of<br />
chronic <strong>solvent</strong> <strong>abuse</strong>rs are reassuring that<br />
physical organ damage is not a significant or<br />
widespread problem for most <strong>abuse</strong>rs. The<br />
degree and duration of <strong>abuse</strong> required<br />
producing harm to heart, brain, kidneys and<br />
liver is unknown because several years of<br />
35,43,17<br />
regular <strong>abuse</strong> appears to be necessary.<br />
157 children (37.7%) reported that they<br />
had been facing problems due to <strong>solvent</strong><br />
<strong>abuse</strong>. The number one social problem quoted<br />
was neglect, hatred and non-acceptance by<br />
the society (46.5%). Incidences have been<br />
reported where children were cast out from<br />
their families (4%) and lost jobs (2.3%) due to<br />
their involvement with <strong>solvent</strong>s. In depth<br />
Box 3.<br />
Social Consequences of<br />
Abuse<br />
Neglect ion & Hatred (46.5%)<br />
Group Violence (21.7%)<br />
Police threats (12.9%)<br />
Out casted from family (4.1%)<br />
Living in non hygienic<br />
condition (3.5%)<br />
Lost jobs (2.3%)<br />
Others (9.9%)<br />
FGD's revealed that children viewed their<br />
parents as impassive who else would take<br />
care of them. People considered them<br />
rebellions, runaways and apathetic towards<br />
others. They are generally thought to have no<br />
values (moral, social, religious or ethical) and<br />
are largely gangsters involved in crime that<br />
extended from simple theft to drug paddling or<br />
even commercial sex. Children reported that<br />
such negative attitude of the society inculcated<br />
a feeling of hatred, neglect and denial of care.<br />
They pointed out that everyone around hated,<br />
manipulated and exploited them so they would<br />
also do the same to them. Such kind of<br />
negativity when expressed and exposed took<br />
the shape of violence, which according to the<br />
children is a reciprocation of what they have<br />
received.<br />
Amazingly, the children were positive that<br />
to repay society they needed strength not only<br />
from outside but from their own selves, which<br />
could only be achieved through <strong>abuse</strong> of<br />
<strong>solvent</strong>s or other drugs. This façade terrified<br />
others around them so at least for the time<br />
being helped in their survival without many<br />
efforts and courage and so the vicious cycle<br />
continues. Thus it is difficult to comment<br />
whether spending time on the street made<br />
them so or the <strong>abuse</strong> of <strong>solvent</strong>s/drugs gave<br />
rise to such consequences. The effect could<br />
be reciprocal. The principle of trial and error<br />
was the first step towards a long journey<br />
without a destination.<br />
26<br />
27
Section three<br />
3.4.6 Treatment<br />
When asked if they ever tried to break the<br />
habit of <strong>solvent</strong> use, and how it could be done,<br />
only 20.7% of the respondents reported to<br />
have undergone any sort of treatment, and<br />
that too was a self-treatment in more than half<br />
of the incidences. Approximately 70% of the<br />
children were unaware of any organization /<br />
institution where they could be treated and<br />
rehabilitated.<br />
The results are summarized in table<br />
3.3.6a.<br />
Table 3.3.6a<br />
Treatment History<br />
Question n (%)<br />
3.5 Use of other Drugs<br />
& HIV awareness<br />
3.5.1 Use of other Drugs<br />
The relationship between the use of<br />
Solvents and other drugs is a complex one.<br />
Although a possibility can be linked, but<br />
research is unable to answer whether the<br />
use of <strong>solvent</strong>s leads to <strong>abuse</strong> of more<br />
potent addictive drugs, such as heroin etc,<br />
44<br />
in future.<br />
A lifetime prevalence of tobacco use was<br />
seen among these children, in all provinces.<br />
The various forms of tobacco use were<br />
2<br />
categorized as Cigarettes, Pan & Gutka.<br />
Cigarette smoking is an extremely prevalent<br />
(87%) characteristic found in all the four<br />
cities, while eating Pan (filled with tobacco)<br />
120<br />
100<br />
80<br />
60<br />
40<br />
20<br />
0<br />
87<br />
39<br />
17<br />
Cigarette Pan Gutka<br />
95 96<br />
20<br />
2<br />
76<br />
74<br />
8 4<br />
0<br />
82<br />
60<br />
56<br />
OVERALL Lahore Quetta Peshawar Karachi<br />
is a common practice in Peshawar among<br />
street children abusing <strong>solvent</strong>s. As seen in<br />
our research, Karachi presented a<br />
complicated picture, where all forms of<br />
tobacco were being used. It was seen that<br />
these children become involved with tobacco,<br />
start smoking at a very young age (the mean<br />
age ± sd of the children at starting smoking<br />
was found to be 9.89 ± 8.6). Cigarette<br />
smoking appears to be the first addictive agent<br />
that has been used by the majority of these<br />
children, before they start experimenting and<br />
getting involved with other drugs as well as<br />
<strong>solvent</strong>s.<br />
Information about other drugs including<br />
hashish, opium, marihuana and heroin use<br />
was also gathered. The respondents were<br />
initially asked about the use as “ever used”<br />
which in case of a positive reply was followed<br />
by regular use of the drug during the last 30<br />
days. Information on alcohol intake was also<br />
gathered.<br />
Use of hashish was found to be significantly<br />
prevalent among this group. While 68.8%<br />
children reported that they had “ever used”<br />
hashish, an overall 62.5% children reported<br />
regular use during the past 30 days. The<br />
citywide distribution was fairly uniform, with<br />
the highest prevalence noticed in Quetta<br />
(80.4%) followed by Lahore (73.4%), Karachi<br />
(65.7%) and surprisingly Peshawar (55%).<br />
Although only 8.9% of the total reported<br />
regular use of alcohol, yet by contrast, street<br />
children from Quetta rated as the highest<br />
users of alcohol (21.4%).<br />
Table 3.4.1 b Use of other drugs during past 30<br />
days<br />
Alcohol<br />
Hashish<br />
Opium<br />
Bhang<br />
Heroin<br />
Synthetic drugs<br />
8.9%<br />
62.5%<br />
3.6%<br />
4.1%<br />
0.2%<br />
5.3%<br />
A minor proportion of children reported<br />
involvement in other drugs during the past 30<br />
days i.e., Bhang (4%), Opium (3.6%) and<br />
Synthetic drugs (5.3%). Only one child<br />
reported regular use of heroin. It is worth<br />
noting here that the overall research<br />
conducted in the country has shown a similar<br />
27<br />
picture in which Hashish is the most common<br />
drug of <strong>abuse</strong> among drug users, with varying<br />
proportions of drug <strong>abuse</strong>rs reporting use of<br />
other drugs. The drug use situation of street<br />
children is not different, from the overall drug<br />
<strong>abuse</strong> picture in the country. However<br />
additional research is required to develop a<br />
sound understanding of the subject, as well as<br />
to study the aetiology of substance <strong>abuse</strong>.<br />
Citywide distribution of drugs ever used by the<br />
2. Local form of tobacco which is kept in mouth and chewed.<br />
28<br />
29
Section three<br />
study subjects is presented in Fig 3.4.1b<br />
Table 3.4.1b Prevalence of drug use in street children<br />
80<br />
60<br />
40<br />
20<br />
0<br />
OVERALL Lahore Quetta Peshawar Karachi<br />
Hashish Alcohol Bhang Opium Heroin Synthetic drugs<br />
3.5.2 HIV Knowledge & Risk Practices<br />
Drug use among street children is closely<br />
related to other health issues and risk-taking<br />
behaviour such as prostitution, sexual<br />
exploitation and unsafe sex practices, all of<br />
which have contributed to a growing incidence<br />
of AIDS/HIV among this particular group. In<br />
this study we have tried to evaluate the<br />
existing knowledge of the children regarding<br />
important aspects of HIV / AIDS as well as two<br />
of the risk practices i.e., Injection drug use and<br />
sexual practices.<br />
3.5.2.1 HIV Knowledge<br />
children had heard about HIV/AIDS. Among<br />
those who had heard of the disease, three<br />
major sources of information were revealed<br />
Box 3.4.2a HIV related Knowledge<br />
Ways of HIV Transmission<br />
Sexual Intercourse (62.5%)<br />
Germs (10.6%)<br />
Syringes (18.7%)<br />
Blood exchange (2.9%)<br />
Razors (2.9%)<br />
Misc (5.8% )<br />
Don’t now (6.7%)<br />
Methods to pro tect HIV transmiss ion<br />
Avoid sexual intercourse (44.6%)<br />
Medicines (27.7%)<br />
Use new syringes (8.9%)<br />
Medicines (4 .1%)<br />
Condoms (4%)<br />
Avoid drug use (2%)<br />
Don’t know (6%)<br />
.43.9% had heard of the disease from the<br />
television, followed by the local NGO's<br />
working against HIV/AIDS and its paramedic<br />
staff (32.7%). While the remaining had<br />
received their information via inter-personal<br />
communication i.e., friends and other<br />
acquaintances.<br />
infection is spread and the methods to protect<br />
themselves from getting infected. 62.5% of the<br />
children who had heard about HIV/AIDS knew<br />
that it is spread through sexual intercourse,<br />
but 44.6% stated that sexual intercourse<br />
should be avoided altogether to protect<br />
oneself from HIV. The detail of all responses is<br />
given in the Box.3.4.2a.<br />
3.5.2.2 HIV Risk practices<br />
Two major HIV risk practices were explored<br />
including Injection drug use and Sexual<br />
practices. As already seen in the previous<br />
section, although drug use has been found to<br />
be a fairly common characteristic, none of the<br />
children interviewed reported that they had<br />
ever injected drugs.<br />
In contrast several risky sexual practices<br />
were highlighted, which puts these children at,<br />
a high risk for contracting HIV. high<br />
proportions (53.4%) of the children were found<br />
Question<br />
Table 3.4.2.2a<br />
Sexual Practices of street children<br />
mean ± sd<br />
Average age at initiation to sexual activit y* 10.6 ± 2.2<br />
To be sexually active, with the highest level of<br />
sexual activity reported by children interviewed<br />
in Lahore (73.4%) in contrast to 37% in<br />
Peshawar. The average age at the initiation of<br />
sexual activity was reported to be 10.6 ± 2.2<br />
years. A high number of sexual partners both<br />
males and females were found. The mean<br />
number of sexual partners both males &<br />
females are given in Table 3.5.2a. While a high<br />
number of sexual partners are seen, the use of<br />
condom was almost negligible. 80% of the<br />
children reported they had never ever used a<br />
condom. Only 7% informed of always using a<br />
condom, while the remaining 13% had been<br />
using condoms occasionally. The graphical<br />
presentation is given in Fig 3.4.2.2a.<br />
There has been evidence in which these<br />
children were found to be involved in<br />
commercial sex work, as 105 (25.5%) of the<br />
416 children interviewed informed that they<br />
had exchanged sex for money.<br />
13.7<br />
Never Sometimes Always<br />
7.2<br />
Street children were asked about whether<br />
they knew about HIV/AIDS. 53.8% of the<br />
The subject was further explored by<br />
asking children whether they knew how the<br />
Current Number of sexual partners<br />
Females<br />
Males<br />
2.6 ± 2.5<br />
5.1 ± 6.1<br />
79.1<br />
30<br />
31
Section three<br />
3.6 Magnitude of the<br />
problem<br />
In Pakistan, reliable data on the prevalence<br />
of <strong>solvent</strong> <strong>abuse</strong> and related problems is<br />
extremely scarce. The issue is further<br />
complicated by the highly sensitive nature of<br />
the problem, difficulties in accessing this<br />
population, complicated group dynamics and<br />
ignorance of local authorities regarding the<br />
subjects.<br />
The methodology adopted for providing<br />
estimates of <strong>solvent</strong> <strong>abuse</strong> prevalence was<br />
based on direct and indirect estimation. Direct<br />
estimation was done by counting the exact<br />
number of street children in a specified<br />
location and determining proportions actually<br />
involved in <strong>solvent</strong> <strong>abuse</strong>. Prior to conducting<br />
this exercise, a mapping exercise was<br />
undertaken and a complete mapping of street<br />
children was done in all four cities. Thereafter,<br />
six sites where maximum mobilization of street<br />
children was recorded were subsequently<br />
selected for prevalence estimation in each city.<br />
Furthermore, to capture the entire segments of<br />
the street children population, each site was<br />
visited on different days of the week as well as<br />
on different times of the day. The detail on the<br />
locations from where data were collected is<br />
given in Table 3.6.1.<br />
Table 3.6.1<br />
Karachi<br />
1. Abdullah Shah Ghazi<br />
2. Hussainabad<br />
3. Jamshair Road<br />
4. Korangi<br />
5. Tariq Road<br />
6. Saddar<br />
Lahore<br />
1. Data Darbar<br />
2. Circular Road<br />
3. Larri Adda<br />
4. Railway Station<br />
5. Macleod Road<br />
6. Multan Road<br />
Study sites from where prevalence estimates are generated<br />
Peshawar<br />
1. Firdous Cinema<br />
2. Haji Camp<br />
3. Jhangi Mohalla<br />
4. Kabuly Bazaar<br />
5. Railway Station<br />
6. Khyber Road<br />
Quetta<br />
1. Habib Nala<br />
2. Jinnah Road<br />
3. Lower Karez<br />
4. Pushtoon abad<br />
5.Saryab Road<br />
6.<br />
Indirect estimation was done by<br />
information gathered from Key informants.<br />
Regional police and public health personnel<br />
reported the estimated numbers of children<br />
involved with <strong>solvent</strong> <strong>abuse</strong>. NGO<br />
representatives, Government hospital staff,<br />
and people working with welfare<br />
organizations reported same figures.<br />
Ironically, the exact number of street<br />
children is unknown, as no formative<br />
research among street children had been<br />
conducted in the country to provide these<br />
estimates. Anecdotal information, however,<br />
is available with organizations working for<br />
the street children. According to the<br />
information gathered from these<br />
organizations, the approximate number of<br />
34<br />
street children in various cities is as follows:<br />
1. Karachi 12,000<br />
2. Lahore 8,000<br />
3. Peshawar 4,500<br />
4. Quetta 2,500<br />
Based on these estimates the number of<br />
children involved with <strong>solvent</strong>s <strong>abuse</strong> were<br />
calculated by multiplying the probability<br />
estimate with the total number of street<br />
children in each city. The details are provided<br />
in Table 3.6.2:<br />
Table 3.6.2<br />
Estimated Prevalence of<br />
Solvent <strong>abuse</strong> among street children<br />
<br />
OVERALL<br />
Karachi<br />
Lahore<br />
Peshawar<br />
Quetta<br />
Estimated<br />
Prevalence<br />
39.6 %<br />
45.3%<br />
36.9%<br />
36.8%<br />
41.7%<br />
Direct Estimates<br />
95% CI<br />
33.1 – 46.1%<br />
32.0 – 58.6%<br />
24.0 – 49.8%<br />
23.9 – 49.7%<br />
28.5 – 54.9%<br />
Indirect<br />
Estimates<br />
(range)<br />
-<br />
50 - 60%<br />
30-35%<br />
25-30%<br />
40-50%<br />
Total<br />
Number<br />
-<br />
5,500<br />
2,900<br />
1,700<br />
1,100<br />
Care should be taken before extracting<br />
nation wide estimates from the prevalence<br />
reported from this study. The number<br />
represents a pictorial suggestion from the<br />
major cities, and takes account of chronic<br />
users only, and is based on self-reported data.<br />
Therefore the estimates can be biased<br />
downward due to a combination of under<br />
reporting and under coverage. Moreover,<br />
generalization of these results to smaller cities<br />
and females is not suggested due to nonresponse<br />
and non-participation by a significant<br />
proportion of females.<br />
3.7 Key Informant Interviews<br />
As mentioned previously, 18 key informant<br />
interviews were conducted with individuals in a<br />
regular contact with these children frequently,<br />
to gather information about the existing<br />
services available for street children, as well<br />
as to comprehend the awareness of the<br />
service providers. The details on these<br />
interviews are given in box 4. Information<br />
generated from the key informant interviews<br />
documented very unsatisfactory knowledge<br />
and awareness of issues related to street<br />
children, and more importantly the<br />
understanding of <strong>solvent</strong> <strong>abuse</strong> among this<br />
extremely high-risk group. Moreover, the<br />
perceptions and knowledge of the interviewed<br />
people related to treatment, and rehabilitation<br />
32<br />
33
Section three<br />
of these children was far below the optimal<br />
level.<br />
3.7.1 Police stations<br />
Street children come into conflict with the<br />
law in many ways. Some children may be<br />
coerced into involvement in illegal activities,<br />
from bag snatching and petty theft to drug<br />
peddling. On the other end of the spectrum,<br />
these children are often stigmatised by police<br />
and the public, who believe they are doing<br />
something wrong even if they are playing,<br />
reinforcing the perception of street children as<br />
criminals. Children are not always taken into<br />
justice systems when in conflict with the law,<br />
but may be dealt with “informally” when they<br />
are perceived to have behaved wrongly.<br />
Children worldwide are subject to harassment<br />
by police including beatings, <strong>abuse</strong> and other<br />
violence, including sexual violation (ref- Asia<br />
Pacific report).<br />
Inquiry into the criminal history showed<br />
that 49.3% of the children has been arrested<br />
at least once in their lifetime by the police.<br />
According to the children this arrest was a part<br />
of the routine police raids, which is observed<br />
once or twice every year. Further exploration<br />
into the reasons for which children were<br />
arrested revealed that the maximum number<br />
of arrests were done on account of minor<br />
thefts (40%), followed by <strong>solvent</strong> use(26%),<br />
violence and street fights (10%) and drug<br />
peddling (5%). Interestingly 12.7% did not<br />
know the reason why they were arrested.<br />
Based on the above reasons, we<br />
ensured to visit various police officials and<br />
gather information on street children from<br />
their perspective. The key points are<br />
summarized as such:<br />
All police officials contacted<br />
documented the presence of street children<br />
abusing <strong>solvent</strong>s in their respective area.<br />
The numbers reported were in accordance<br />
with the prevalence estimates provided by<br />
the direct estimation method used. The<br />
estimates provided by police officials are<br />
also given in Table 3.6.2 under indirect<br />
estimation.<br />
Police officials were asked about<br />
their perception on why street children use<br />
<strong>solvent</strong>s. According to most, easy availability<br />
was the sole reason, which has led to an<br />
increas use of <strong>solvent</strong>s among children.<br />
100% of the officers interviewed<br />
raised concern over involvement of these<br />
children (30 - 50%) in minor criminal<br />
activities such as pick pocketing, minor theft,<br />
and shop lifting. This feature was in<br />
agreement with the information obtained by<br />
the children themselves, where it was seen<br />
that the police had arrested almost half of the<br />
children at least once in lifetime.<br />
Another growing concern was the<br />
mounting proportions of these children getting<br />
involved in prostitution, and drug trafficking,<br />
which was informed by officials in Lahore and<br />
Karachi. The number of children involved in<br />
such activities was feared to be reaching up to<br />
20%, with numbers consistently increasing.<br />
Half of the police officials reported to<br />
have taken such children into police custody<br />
occasionally, but due to the absence of any<br />
available facilities, no remedial action could be<br />
taken. Thus these children are kept under<br />
custody for a few days, and are later set free.<br />
Only one official in Peshawar<br />
reported that children involved with substance<br />
<strong>abuse</strong> have been referred to a drug<br />
detoxification centre for treatment.<br />
3.7.2 Drug <strong>abuse</strong> treatment facilities<br />
Among drug <strong>abuse</strong> treatment facilities<br />
visited, 4 (40%) were government facilities<br />
while the remaining were non-governmental<br />
organizations (NGO's). Based on the<br />
information collected, the key issues are<br />
summarized as under:<br />
By and large, the core staff consulted<br />
was not found to be very familiar with all<br />
phases of preventive services (i.e., primary<br />
prevention, treatment and rehabilitation) for<br />
this sub group of drug using population. Thus,<br />
while the majority of staff members met were<br />
comfortable with the issues of treatment and<br />
rehabilitation of other drugs e.g., heroin, an<br />
obvious deficiency was noted in the translation<br />
of this concept to children/adolescents<br />
treatment and <strong>solvent</strong> <strong>abuse</strong>. The issue of<br />
<strong>solvent</strong> <strong>abuse</strong> is still alien to the drug<br />
treatment service providers, and henceforth<br />
there either are no services available, or those<br />
that do exist do not provide it in an appropriate<br />
manner.<br />
All of the facilities visited were found<br />
to have tailored their services for treatment of<br />
heroin addicts, which is the leading cause of<br />
admission in these facilities. The government<br />
facilities visited in Peshawar (Lady Reading<br />
hospital) and Quetta (Civil hospital) informed<br />
that they had admitted children involved with<br />
<strong>solvent</strong>s recently, but the proportions were<br />
negligible (< 5%) as compared to patients<br />
admitted for treatment of other drugs. Twelve<br />
chronic <strong>solvent</strong> <strong>abuse</strong>rs were undergoing<br />
detoxification in Azam clinic (Pakistan society)<br />
Karachi, but the management authorities<br />
reported a lack of clarity regarding their<br />
34<br />
35
Section four<br />
36<br />
treatment methodology and a rehabilitation<br />
program for these children was non existent.<br />
Furthermore, none of the facilities<br />
mentioned had any staff members specifically<br />
trained in Paediatric practice, child or<br />
adolescent health, as well to deal with<br />
treatment issues of <strong>solvent</strong> <strong>abuse</strong>. More than<br />
half of the key informants interviewed (60%)<br />
expressed lack of knowledge and non existent<br />
resources to combat this form of substance<br />
<strong>abuse</strong>.<br />
However, an interest was shown to<br />
work for provision of services for this segment<br />
of population. Upon inquiry regarding what<br />
sort of support is required by the facilities to<br />
work against the issue of <strong>solvent</strong> <strong>abuse</strong> in<br />
street children, all facilities focused on<br />
provision of training of their staff members on<br />
the problem of street children and <strong>solvent</strong><br />
<strong>abuse</strong>.<br />
None of the facilities visited informed<br />
of any primary prevention activities taken up<br />
for these children.<br />
Reviewing the existing services for the<br />
treatment of <strong>solvent</strong> <strong>abuse</strong> in the country, the<br />
situation is extremely dissatisfying. The core<br />
fact, which is of significant importance, is that<br />
the majority of health services have been<br />
developed for adults. Many such services<br />
rarely recognize the unique issues of young<br />
people, particularly those of street children,<br />
and rarely try to accommodate for their age<br />
specific behaviours. Therefore, many young<br />
people view health services as unfriendly,<br />
threatening, mystifying, unhelpful and<br />
inappropriate. Thus even when facilities do<br />
exist, specialist drug services tend to poorly<br />
understand issues pertinent to young<br />
people. Young people tend to be treated as<br />
mini-adults, and their particular needs get<br />
ignored.<br />
RECOMMENDATIONS<br />
RECOMMENDATIONS<br />
37
RECOMMENDATIONS<br />
Section four<br />
Recommendations<br />
Based on results of this study, it is suggested<br />
that Modified Social Stress Model (MSSM) be<br />
applied to have an ABC analysis (Antecedent,<br />
Behaviour, Consequences) of <strong>solvent</strong> <strong>abuse</strong><br />
among street children. A dichotomous strategy<br />
should be designed to achieve such an<br />
analysis, which aims to minimize (if not<br />
eradicate) and to prevent the probability of<br />
occurrence with a short and long term<br />
perspective.<br />
There is an urgent need for the<br />
development of a comprehensive national<br />
strategy, for the control and prevention of<br />
<strong>solvent</strong> <strong>abuse</strong>. The strategy should<br />
concentrate on bringing together government<br />
entities (both national and provincial),<br />
international agencies (UNODC, UNICEF,<br />
UNAIDS et al) key stakeholders, community<br />
based organizations (CBO's), nongovernmental<br />
organizations (NGOs),<br />
empowering the target community itself to<br />
enable holistic programming and excellence in<br />
prevention, care and support. The overall<br />
national strategy developed should<br />
encompass the following:<br />
<br />
Owing to the lack of awareness of the<br />
issue among the general public and drug<br />
<strong>abuse</strong> service providers, an extensive<br />
population based awareness campaign is<br />
suggested, which aims on raising the<br />
general public awareness about this<br />
emerging problem in terms of national<br />
development, stability and integrity. Various<br />
communication channels including mass<br />
media, print media and local communication<br />
channels need to be mobilized for an<br />
effective impact of the activities.<br />
Components of the campaign<br />
should address the street children as well,<br />
providing them information on drug <strong>abuse</strong><br />
especially Solvents, the untoward<br />
consequences, motivation for treatment, and<br />
awareness regarding HIV risk behaviours<br />
and safe practices.<br />
Secondary prevention activities<br />
should take the form of providing drug<br />
treatment & rehabilitation services to the<br />
children involved with <strong>solvent</strong>s or other<br />
drugs. While designing such programmes,<br />
the issue of <strong>solvent</strong> <strong>abuse</strong> need to be<br />
addressed in a broader perspective as<br />
opposed to merely a mental health problem.<br />
Special importance should be given to the<br />
dynamics of this population that is very<br />
different from other high-risk populations. The<br />
differences between <strong>solvent</strong> <strong>abuse</strong> and other<br />
forms of addiction should be kept in mind,<br />
when treatment plans are devised. Thus if<br />
existing drug treatment facilities need to be<br />
utilized, up-gradation of the material resources<br />
and training of the staff on issues of <strong>solvent</strong><br />
<strong>abuse</strong> and especially the needs of street<br />
children needs be considered. Training<br />
modules should be designed and on going<br />
training packages for capacity building should<br />
be provided to GO's, NGO's, CBO's and<br />
people dealing or in contact with these<br />
children.<br />
Special emphasis should be laid on<br />
the rehabilitation of these children. The<br />
rehabilitation programme should have<br />
components on education, social skills, skill<br />
development in the form of vocational<br />
trainings, and placement of these children in<br />
their families<br />
In addition to the formal treatment<br />
and rehabilitation activities, various outlets (in<br />
the shape of shelter homes or drop in centres)<br />
need to be established in areas that are<br />
accessible to street children, possible regular<br />
contact with the service providers and<br />
motivational sessions could be conducted.<br />
These shelter homes or DIC's would<br />
encompass :<br />
The task of educating street children<br />
in basic interpersonal and social skills.<br />
Empowering children with civic<br />
sense<br />
Enhancing their capability to<br />
communicate and comprehend messages<br />
effectively like simple arithmetic and<br />
vocabulary.<br />
Training in self defence to avoid<br />
risky behaviour and practices<br />
Knowledge about rights and duties<br />
Moreover, these centres can act as<br />
sources of information dissemination and<br />
contact points for these children. The centres<br />
need to be linked to the chain of drug<br />
treament and rehabilitation services and<br />
proper referral can be made when and where<br />
required.<br />
Outreach services need to be<br />
provided in the form of mobile units linked with<br />
a network of health and legal facilities. In an<br />
ideal scenario, the outreach services need to<br />
be connected with the DIC's and shelter<br />
homes for maximum effectiveness.<br />
38<br />
39
REFRENCES<br />
Section four<br />
Formative ongoing research to<br />
thoroughly understand population dynamics,<br />
behaviour and practices as well as underlying<br />
beliefs which lead to the behaviours, aetiology<br />
of <strong>solvent</strong> <strong>abuse</strong> etc., are issues which need<br />
be studied further. There is a need to involve<br />
women in these research studies, and<br />
ascertain baseline situation in smaller cities.<br />
An important avenue for epidemiological<br />
and behavioural research is the risk<br />
assessment of this population for HIV<br />
prevention and control.<br />
REFERENCES<br />
1. A One-Way Street? Report on Phase I of<br />
the Street Children Project. World Health<br />
Organization. July 1993 (WHO/PSA/93.7)<br />
2. Feldman J, Middleman AB. Homeless<br />
adolescents: common clinical concerns. Semi<br />
Pediatric Infect Dis. 2003 Jan; 14(1): 6-11.<br />
3. Children at Risk: UNICEF. United<br />
Nations, New York 1998.<br />
4. Phyllis Kilburn. Street children. MARC<br />
publications,1997.<br />
5. United Nations Development Program,<br />
Human Development Report .New York.<br />
Oxford University Press, 1996.<br />
6. http:// www.casa-alianza.org/EN/streetchildren/drugs/overview.phtml<br />
date:<br />
18Mar2004<br />
7. United Nations Development Programme<br />
(UNDP), Human Development Report, 1993<br />
(New York: Oxford University Press, 1993), p.<br />
24.<br />
8. (ILO-IPEC, Sri Lanka Country Report,<br />
October 1998, citing Plan of Action for<br />
Children in Sri Lanka) www.globalmarch.org<br />
9. Street Children in Karachi: A Situational<br />
Analysis. Azad Foundation. June, 2001.<br />
10. Children at Risk: UNICEF. United<br />
Nations, NewYork 1998.<br />
11. Phyllis Kilburn. Street children. MARC<br />
publications,1997.<br />
12. United Nations Development Program,<br />
Human Development Report .New York .<br />
oxford University Press, 1996. ADB study<br />
13. World Bank report-reference<br />
14. Reference India<br />
15. Reference, Nepal etc<br />
16. Reference UN shortlising street children as<br />
issue<br />
17. CSRD reference<br />
18. Street Children in Karachi: A Situational<br />
Analysis. Azad Foundation. June, 2001.<br />
19. Kozel N, Sloboda Z, and De La Rosa M.<br />
(eds.), Epidemiology of Inhalant Abuse: An<br />
International Perspective. 1995. National<br />
Institute on Drug Abuse Research Monograph<br />
148. Dh18.HS Publication No. NIH 95-3831.<br />
Washington, DC: U.S.<br />
40<br />
41
Section four<br />
20. Research Report Series - Inhalant<br />
Abuse, revised 2001. National Institute on<br />
Drug Abuse. National Institute of Health.<br />
21. Kurtzman TL, Otsuka KN, Wahl RA.<br />
Inhalant <strong>abuse</strong> by adolescents. J Adolesc<br />
Health. 2001 Mar; 28(3): 170-80. Review<br />
22. Neumark YD, Delva J, Anthony JC. The<br />
epidemiology of adolescent inhalant drug<br />
involvement. Arch Pediatr Adolesc Med.<br />
1998 Aug; 152(8): 781-6.<br />
23. Anderson CE, Loomis GA. Recognition and<br />
prevention of inhalant <strong>abuse</strong>. Am Fam<br />
Physician. 2003 Sep 1; 68(5): 869-74.<br />
24. Flanagan RJ, Ives RJ. Volatile substance<br />
<strong>abuse</strong>. Bull Narc. 1994;46(2):49-78. Review.<br />
25. Balster, R.L. Neural basis of inhalant<br />
<strong>abuse</strong>. Drug Alcohol Depend. 1998 Jun-<br />
Jul;51(1-2):207-14. Review.<br />
28. Jansen P, Richter LM, Griesel RD. Glue<br />
sniffing: a comparison study of sniffers and<br />
non-sniffers. J Adolesc. 1992 Mar;15(1):29-<br />
37.<br />
29. Bland JM, Taylor J.Deaths from accidental<br />
drug poisoning in teenagers. Deaths due to<br />
volatile substance misuse are greatly<br />
underestimated. BMJ. 1998 Jan<br />
10;316(7125):146.<br />
30. Esmail A, Meyer L, Pottier A, Wright S.<br />
Deaths from volatile substance <strong>abuse</strong> in<br />
those under 18 years: results from a national<br />
epidemiological study. Arch Dis Child. 1993<br />
Sep;69(3):356-60.<br />
31. Bowen SE, Daniel J, Balster RL.Deaths<br />
associated with inhalant <strong>abuse</strong> in Virginia<br />
from 1987 to 1996. Drug Alcohol Depend.<br />
1999 Feb 1;53(3):239-45.<br />
34. Drug <strong>abuse</strong> in Pakistan : Results from<br />
the year 2000 National Assessment.<br />
UNODC. United Nations, New York 2002.<br />
35. Working with Street Children: A Training<br />
Package on Substance Use, Sexual and<br />
Reproductive Health, including HIV/AIDS<br />
and STDs. World Health Organization, 2000.<br />
36. Bootzin RR, Gordon HB, Jenniger C,<br />
Elizabth H. Psychology Today- An<br />
introduction. 7th edition. 1991. McGraw- Hill,<br />
inc.<br />
37. Stephen LF. Social Psychology;<br />
International edition. 2003. McGraw Hill<br />
higher education.<br />
38. Sampson RJ, Lamb JH. Crime in the<br />
making path ways and turning points<br />
through life. Cambridge, M.A 1993. Harvard<br />
university Press.<br />
41. KulikJA, Mehler HM, Earnest A. Social<br />
comparison and affiliation under threat. Going<br />
beyond the affiliated choice paradigm. J Pers<br />
Soc Psych. 1994 : 68; 301-309.<br />
42. (Meadows R, Verghese A. Medical<br />
complications of glue sniffing. South Med J.<br />
1996 May;89(5):455-62.<br />
43. Devathasam G, Low D, Toeh PC.<br />
Complications of chronic glue (toluene) <strong>abuse</strong><br />
in adolescents. Aust N Z J Med. 1984 Feb;<br />
14(1): 39-43.<br />
44. Ginzler JA, Cochran BN, Domenech-<br />
Rodriguez M, Cauce AM, Whitbeck LB.<br />
Sequential progression of substance use<br />
among homeless youth: an empirical<br />
investigation of the gateway theory. Subst Use<br />
Misuse. 2003 Feb-May; 38(3-6): 725-58.)<br />
26. Evans EB, Balster RL. CNS depressant<br />
effects of volatile organic <strong>solvent</strong>s. Neurosci<br />
Biobehav Rev. 1991 Summer;15(2):233-41.<br />
Review<br />
27. Cairney S, Maruff P, Burns C, Currie B. 27.<br />
The neuro-behavioral consequences of petrol<br />
(gasoline) sniffing. Neurosci Biobehav Rev.<br />
2002 Jan;26(1):81-9. Review.<br />
32. Anderson HR, Dick B, Macnair RS,<br />
Palmer JC, Ramsey JD. An investigation of<br />
140 deaths associated with volatile<br />
substance <strong>abuse</strong> in the United Kingdom (33.<br />
1971-1981). Hum Toxicol. 1982<br />
Jul;1(3):207-221.<br />
33. Shepherd RT. Mechanism of sudden<br />
death associated with volatile substance<br />
<strong>abuse</strong>. Hum Toxicol. 1989 Jul;8(4):287-91.<br />
39. Baumeister RF, Leary MR. The need to<br />
belong Desire for interpersonal attachments<br />
as a fundamental human motivation. Psych<br />
Bull 1995; 117:497-529.<br />
40. Bunk, B.P and Ybena J.F selective<br />
evolution and coping with stress: Making one's<br />
situation cognitively more livable. J. Appl Soc<br />
Psych. 1995; 25:1499-1517.<br />
42<br />
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