Children of female sex workers and injection drug users: a review of vulnerability, resilience, and family-centered models of care in low and middle-income countries

This item is archived in the repository for materials published for the USAID supported Orphans and Vulnerable Children Comprehensive Action Research Project (OVC-CARE) at the Boston University Center for Global Health and Development.Background: Injection drug users and female sex workers are often categorized as two of the populations most at risk for becoming infected with HIV in countries with concentrated epidemics. Many of the adults who fall into these categories in low and middle income contexts are also parents, but little is known about the vulnerabilities faced by their children, their sources of resilience, or programs providing services to these often fragile families. Methods: We reviewed the peer-reviewed and gray literature to synthesize current knowledge on the situation of these children and families, and interventions currently in place in low and middle income countries. Organizational websites and references of all relevant sources were manually searched, and key informants from service organizations were contacted by phone and email. Results: A large amount of literature assessing the vulnerability and resilience of children of drug users and alcoholics in developed countries was found. Their children can face unique risks, stigma, and discrimination, but child vulnerability and resilience are associated in the substance abuse literature with the physical and mental health of parents and family context. Research on the situation of the children of sex workers is extremely limited. Interventions have been implemented in low and middle-income contexts but they tend to be small, piecemeal, struggling to meet demand; and undocumented, and most have not been evaluated. We present preliminary descriptive data from an organization working with pregnant and new mothers who are drug users in Ukraine and an organization providing services to sex workers and their families in Zambia. Discussion: Because parents’ drug use, sex work, or same sex relationships are often illegal and hidden, identifying their children can be difficult and may increase their vulnerability and marginalization. Therefore, researchers and service providers must proceed with caution when attempting to reach this population. Promising components of family-centered care include: strengthening family caring capacity through home visitation and peer support, providing early childhood development programs and crèches or drop-in centers for children; economic strengthening and job skills training for parents. Integration of legal assistance with health and other social services is also gaining increased international attention.The USAID | Project SEARCH, Orphans and Vulnerable Children Comprehensive Action Research (OVC-CARE) Task Order, is funded by the U.S. Agency for International Development under Contract No. GHH-I-00-07-00023-00, beginning August 1, 2008. OVC-CARE Task Order is implemented by Boston University. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the funding agency