solvent-abuse-pakistan

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Section three study subjects is presented in Fig 3.4.1b Table 3.4.1b Prevalence of drug use in street children 80 60 40 20 0 OVERALL Lahore Quetta Peshawar Karachi Hashish Alcohol Bhang Opium Heroin Synthetic drugs 3.5.2 HIV Knowledge & Risk Practices Drug use among street children is closely related to other health issues and risk-taking behaviour such as prostitution, sexual exploitation and unsafe sex practices, all of which have contributed to a growing incidence of AIDS/HIV among this particular group. In this study we have tried to evaluate the existing knowledge of the children regarding important aspects of HIV / AIDS as well as two of the risk practices i.e., Injection drug use and sexual practices. 3.5.2.1 HIV Knowledge children had heard about HIV/AIDS. Among those who had heard of the disease, three major sources of information were revealed Box 3.4.2a HIV related Knowledge Ways of HIV Transmission Sexual Intercourse (62.5%) Germs (10.6%) Syringes (18.7%) Blood exchange (2.9%) Razors (2.9%) Misc (5.8% ) Don’t now (6.7%) Methods to pro tect HIV transmiss ion Avoid sexual intercourse (44.6%) Medicines (27.7%) Use new syringes (8.9%) Medicines (4 .1%) Condoms (4%) Avoid drug use (2%) Don’t know (6%) .43.9% had heard of the disease from the television, followed by the local NGO's working against HIV/AIDS and its paramedic staff (32.7%). While the remaining had received their information via inter-personal communication i.e., friends and other acquaintances. infection is spread and the methods to protect themselves from getting infected. 62.5% of the children who had heard about HIV/AIDS knew that it is spread through sexual intercourse, but 44.6% stated that sexual intercourse should be avoided altogether to protect oneself from HIV. The detail of all responses is given in the Box.3.4.2a. 3.5.2.2 HIV Risk practices Two major HIV risk practices were explored including Injection drug use and Sexual practices. As already seen in the previous section, although drug use has been found to be a fairly common characteristic, none of the children interviewed reported that they had ever injected drugs. In contrast several risky sexual practices were highlighted, which puts these children at, a high risk for contracting HIV. high proportions (53.4%) of the children were found Question Table 3.4.2.2a Sexual Practices of street children mean ± sd Average age at initiation to sexual activit y* 10.6 ± 2.2 To be sexually active, with the highest level of sexual activity reported by children interviewed in Lahore (73.4%) in contrast to 37% in Peshawar. The average age at the initiation of sexual activity was reported to be 10.6 ± 2.2 years. A high number of sexual partners both males and females were found. The mean number of sexual partners both males & females are given in Table 3.5.2a. While a high number of sexual partners are seen, the use of condom was almost negligible. 80% of the children reported they had never ever used a condom. Only 7% informed of always using a condom, while the remaining 13% had been using condoms occasionally. The graphical presentation is given in Fig 3.4.2.2a. There has been evidence in which these children were found to be involved in commercial sex work, as 105 (25.5%) of the 416 children interviewed informed that they had exchanged sex for money. 13.7 Never Sometimes Always 7.2 Street children were asked about whether they knew about HIV/AIDS. 53.8% of the The subject was further explored by asking children whether they knew how the Current Number of sexual partners Females Males 2.6 ± 2.5 5.1 ± 6.1 79.1 30 31
Section three 3.6 Magnitude of the problem In Pakistan, reliable data on the prevalence of solvent abuse and related problems is extremely scarce. The issue is further complicated by the highly sensitive nature of the problem, difficulties in accessing this population, complicated group dynamics and ignorance of local authorities regarding the subjects. The methodology adopted for providing estimates of solvent abuse prevalence was based on direct and indirect estimation. Direct estimation was done by counting the exact number of street children in a specified location and determining proportions actually involved in solvent abuse. Prior to conducting this exercise, a mapping exercise was undertaken and a complete mapping of street children was done in all four cities. Thereafter, six sites where maximum mobilization of street children was recorded were subsequently selected for prevalence estimation in each city. Furthermore, to capture the entire segments of the street children population, each site was visited on different days of the week as well as on different times of the day. The detail on the locations from where data were collected is given in Table 3.6.1. Table 3.6.1 Karachi 1. Abdullah Shah Ghazi 2. Hussainabad 3. Jamshair Road 4. Korangi 5. Tariq Road 6. Saddar Lahore 1. Data Darbar 2. Circular Road 3. Larri Adda 4. Railway Station 5. Macleod Road 6. Multan Road Study sites from where prevalence estimates are generated Peshawar 1. Firdous Cinema 2. Haji Camp 3. Jhangi Mohalla 4. Kabuly Bazaar 5. Railway Station 6. Khyber Road Quetta 1. Habib Nala 2. Jinnah Road 3. Lower Karez 4. Pushtoon abad 5.Saryab Road 6. Indirect estimation was done by information gathered from Key informants. Regional police and public health personnel reported the estimated numbers of children involved with solvent abuse. NGO representatives, Government hospital staff, and people working with welfare organizations reported same figures. Ironically, the exact number of street children is unknown, as no formative research among street children had been conducted in the country to provide these estimates. Anecdotal information, however, is available with organizations working for the street children. According to the information gathered from these organizations, the approximate number of 34 street children in various cities is as follows: 1. Karachi 12,000 2. Lahore 8,000 3. Peshawar 4,500 4. Quetta 2,500 Based on these estimates the number of children involved with solvents abuse were calculated by multiplying the probability estimate with the total number of street children in each city. The details are provided in Table 3.6.2: Table 3.6.2 Estimated Prevalence of Solvent abuse among street children OVERALL Karachi Lahore Peshawar Quetta Estimated Prevalence 39.6 % 45.3% 36.9% 36.8% 41.7% Direct Estimates 95% CI 33.1 – 46.1% 32.0 – 58.6% 24.0 – 49.8% 23.9 – 49.7% 28.5 – 54.9% Indirect Estimates (range) - 50 - 60% 30-35% 25-30% 40-50% Total Number - 5,500 2,900 1,700 1,100 Care should be taken before extracting nation wide estimates from the prevalence reported from this study. The number represents a pictorial suggestion from the major cities, and takes account of chronic users only, and is based on self-reported data. Therefore the estimates can be biased downward due to a combination of under reporting and under coverage. Moreover, generalization of these results to smaller cities and females is not suggested due to nonresponse and non-participation by a significant proportion of females. 3.7 Key Informant Interviews As mentioned previously, 18 key informant interviews were conducted with individuals in a regular contact with these children frequently, to gather information about the existing services available for street children, as well as to comprehend the awareness of the service providers. The details on these interviews are given in box 4. Information generated from the key informant interviews documented very unsatisfactory knowledge and awareness of issues related to street children, and more importantly the understanding of solvent abuse among this extremely high-risk group. Moreover, the perceptions and knowledge of the interviewed people related to treatment, and rehabilitation 32 33
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Page 29 and 30: REFRENCES Section four Formative o

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