DRC: Reducing the HIV risk of girls living on the street
KINSHASA, 8 May 2012 (IRIN) - Sarah, 16, started sleeping on the streets of Kinshasa, capital of the Democratic republic of Congo (DRC), when she was only eight years old. She doesn't remember how she came to live on the streets, but thinks it was soon after her mother died.
Sarah is one of an estimated 20,000 children living rough on Kinshasa's streets, many from homes too poor to feed them, some after being thrown out of their homes because they were accused of sorcery, while others end up on the streets as a result of the divorce and remarriage of a parent whose new partner won't accept them. According to NGOs, about one-third of these children are girls, and around 80 percent of girls on the street make a living from sex.
"Some men take you by force, and if you scream for help they beat you," Sarah told IRIN/PlusNews. "Younger girls can be taken advantage of and get only about US$1 for sex, but if you negotiate, you can get $10 for one whole night... sometimes you go to a hotel, sometimes you just find a dark place to do it."
Sarah's face and arms are marked by scars from a fight with a group of girls who cut her with a razor. "When it's night you have to find somewhere to sleep. If it rains, your usual place may be flooded, and we're always running from the police," she said. "If you have no money and have to borrow some to eat, you will pay forever, because a debt on the street is never finished."
Girls regularly experience violence, but help for street children, particularly girls, is very limited. An international NGO, Doctors of the World (Médecins du Monde), and their local partners, including the NGO, Aide à l'Enfance Défavorisée (AED) - Help for Disadvantaged Children - run a programme that seeks to protect girls up to the age of 21 living on the street from sexual and gender-based violence, unwanted pregnancy and sexually transmitted infections (STIs), including HIV.
"Our partners have ambulances that go out on the streets and provide basic primary healthcare and referral for street children, and sexual and reproductive health services for girls, including contraceptives and condoms," said Pascale Barnich-Mungwa, country coordinator for Doctors of the World
With Doctors of the World reporting HIV prevalence among girls they have tested at 12-15 percent, the provision of healthcare is crucial. "We teach them and help them with their drugs - ARV coverage is already difficult in the DRC, but now you have minors living on the street and at risk of theft of their drugs, which makes adherence tough," she said.
AED also runs a drop-in centre where girls can access healthcare and take time to rest, as well as learn tailoring and other skills, and even music.
"Activities like music help to build self-esteem. Many of these girls are raped as often as twice a week, so rape becomes the norm, and they survive by building a wall between themselves and their bodies. Activities like dance help them to take charge of their bodies again, somehow," said Barnich-Mungwa. Rape is one of the rituals girls go through when being initiated into sex work on the street, usually supervised by an older girl known as a 'yaya', or older sister, she said.
Doctors of the World's main aim is risk-reduction, rather than reintegration of the girls into their families. Many girls run away from abusive homes, and families often want no more to do with children they sent away. "If we have girls below 12, reintegration may be possible if they've been on the streets for short periods, but once they have been raped and are already involved in sex work, it becomes much more difficult,” Barnich-Mungwa said.
"So at first, with our partners, we work to reduce the risks linked to their situation through education, user groups, etc. Once we've increased the risk awareness towards sexual behaviour and/or violence, we work at reducing it through contraception, condom use, and so on," she said.
One organization that does aim at reintegrating girls with their families is War Child, which runs a similar programme in a different part of the city. "Our ambulances accept anyone on the street for first aid, provision of condoms and advice, but we specifically target girls aged 17 and under," said Michel Gratton, the War Child country director in DRC.
|Some men take you by force, and if you scream for help they beat you. Younger girls can be taken advantage of and get only about US$1 for sex
“We invite them into the ambulance, where they talk to a counsellor one-on-one to see if they have any desire to return home. We try to convince them to come to our transit centre, where they have access to literacy classes, life skills and psychosocial services. If the girls are keen to return home, we start to look for their families and begin a process of medication, with regular follow-up of the girls who do go back home.”
Reintegration into families is rarely easy. "It's more difficult if the girls are pregnant, because not only has the girl's bride price value gone down, but the families have to pay for expensive healthcare, especially if they have to have a caesarean section [because they are very young]."
There are a number of girls in the AED drop-in centre compound, known as Bomoyi Bwa Sika, meaning ‘New Life’ in the local Lingala language. Some look as young as 10, several are pregnant or carrying babies. The centre has a primary healthcare centre as well as a sexual and reproductive health centre where pregnant girls come for antenatal care.
"We receive about 50 girls every day - today it's not even midday and we have received 53, and 14 slept here last night," said Mama Francoise Nzeza, the director of the centre. "When the police are patrolling and picking up girls, we can get up to 80 per day."
Nzeza says she would love to see the girls off the street and out of sex work, but they do not have the funds to offer them alternative accommodation and income-generating activities, and reintegration is often impossible. "We can't tell them to stop sex work because we can't give them an alternative - what we can do is give them condoms and contraception to prevent disease and unwanted pregnancy, but we can't judge or moralize about their situation."
One of the drop-in centre's key challenges is changing social behaviour. "Many of the girls on the street are violent - the streets make them hard and aggressive. We try to socialise them, so that if they get the chance they can live in mainstream society," Nzeza said.
Reducing the number of children who end up on Kinshasa's streets must be a society-wide effort. "It must involve a reduction in poverty and joblessness, so that parents can look after their children. It must involve conversations with churches, many of which are involved in these accusations of sorcery. It must involve sensitizing parents about their responsibility to their children, even after divorce," she said. "In addition, we must insist that the laws to protect children are implemented."