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Keeping it Real: HIV Prevention and Street Involved Youth in Uzbekistan

Keeping it Real: HIV Prevention and Street Involved Youth in Uzbekistan

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Published by Richard Elovich

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Published by: Richard Elovich on Apr 03, 2011
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Keeping it Real: HIV Prevention and Street Involved Youth inUzbekistan
By Richard Elovich, MPHFor GFATM/UNDP/Republican AIDS Center, Tashkent UZ
A Child Quite Used to Neglect 
In the Central Asian countries of the former Soviet Union, such as Uzbekistan and Tajikistan,continued economic difficulties, joblessness, and social change are largely responsible forincreased heroin/opiate involvement (drug use and trafficking) and diminished contact betweenyouth and their parents. Adults struggle to make ends meet and have less time to spend withtheir children. Rural to urban migration has meant the fragmentation of families and kinshipnetworks once a strength and source of resilience among Central Asian cultures. There are morefemale single headed households due to the migration of men to other countries or cities insearch of work and economic opportunity. The financial difficulties within families have led todeclining school enrollment, and schools once free in the Soviet Union are now costly, as parentshave to pay teachers and pay for supplies. Youth have few if any recreational or vocationaloptions outside of school.Research shows that alcoholism in families and domestic conflict and abuse are associated withyouth moving out on their own. In Uzbekistan and Tajikistan, poor youth or those who arehomeless due to poverty, parental alcohol or drug involvement or domestic violence, or justabsence, are compelled to work for immediate survival, yet they have no rights to work and nopapers that allow them entry into legitimate economies. Throughout Central Asia there are nosocial services—housing, meals, healthcare, psychological counseling—for the thousands of street-involved youth who are living full or part-time on the street. In a real sense, amidstpolitical and economic upheaval and social disorganization in countries of the former SovietUnion, millions of youth are being socialized into risk.The means they find for their survival and escaping poverty are long bets, entailing gray andblack economies, criminal, underground or marginalized relationships and associations (oftenincluding adults), which further increases their isolation and alienation from normative structuresand support. This in turn increases their vulnerability to physical violence, sexual abuse, anddiseases such as HIV and hepatitis. It is fair to assert that their impoverished conditions,including the structural forces that constrain individual agency and limit access to resources, andtheir lack of rights and status by virtue of being children become embodied in the decisions streetinvolved youth make concerning risk.
Building Social Protections for Street Youth
While harm reduction programs targeted to vulnerable youth need to focus on reducingimmediate risk, and to be proactive by bringing services to youth in settings that are comfortablefor those most “hidden” or “hard-to-reach,” they also have to build or strengthen socialprotections, especially in countries where none exist. These kinds of structural interventionsinclude ways to build what sociologists call social capital-- tangible and intangible social, materialand affective support that, particularly in Central Asia, people could rely on through thick andthin. Historically, many had social capital by virtue of the family and village where they wereborn and would die. But today, with rural to urban migration within countries and across national
 
borders in search of work and jobs, fragmentation of families, and stresses on adults, socialcapital is something people have to consciously seek to survive and thrive. Robert and MindyFullilove and Lesley Green, U.S. social scientists, describe social capital as “resources that resultfrom social relationships, and that enhance an individual’s or a group’s ability to function andachieve a given set of goals and objectives.” They go on to make an important point for allworking with street youth: “in communities where social capital is abundant, children arestrongly supported in their efforts to adopt positive adult roles by their interactions with familymembers, neighbors, teachers, and the adults with whom they have contact.” 
Promising Practices
Programs in Central Asia adapted from the model of Street Kids International focus on bringpragmatic and realistic education to street involved youth on their own turf or ‘where they areat.’ This entails bring street youth together in a setting that is in close proximity to where theyhang out and in a physical and social environment which is easy for them to come in, safe,comfortable, and non-judgmental, and where adults, often adults who have been on the streetthemselves, are empathic. To be empathic means (1) setting aside one’s moral or personaljudgments about how youth ‘should be’ or how people ‘should’ live or what is right and wrong;(2) accepting the young person for who they are at the moment and giving them the benefit of the doubt that they have come with their best solutions at this time; (3) tuning in (as if to afrequency on a radio) and actively listening and encouraging them to talk about theirperspectives on their experiences.Often young people feel uncomfortable when confronted with a lot of questions, especially fromadults. However, they may feel more empowered to participate if other youth like themselves arepresent and if they can help set the agenda and speak for themselves rather than in response toa series of survey like questions. This can be effectively accomplished through role plays or skitsthat the youth organize and enact themselves in front of the group. They can describe what isgoing on in the skit and how they feel in the roles they are playing or in the situations in whichthey are involved. From here, they can be encouraged to discuss how situations come to happenin this way, what works for them and what doesn’t. If they treat the skit like a scripted situationin which they have acted before, they can look critically at particular bits of scenes in the scriptand suggest possible changes and different outcomes of the scene, all from their perspective.They can reenact the scene, even change actors, or replace one another, and they can actuallysee for themselves how realistic it is to change how a scene plays out, how they play their ownrole, and whether outcomes can be different.An analogy here is that the adults who are running the program are not in a sense inviting theyouth to a meal and ordering the food for them, but instead inviting them to prepare their ownmeal. While this involve a process and requires skills, reflection, and patience on the part of theadult, it has been demonstrated to lead to development of thinking, attitudes, and behaviors thatyouth are more likely to use when they are back out on the street and on their own. In a sense,the program is not creating an educational or behavior change product for the youth to consume,but instead fostering a learning environment in which individually and as a group, youth areidentifying their own problems in their own words and organizing themselves to respond moreeffectively to get their needs met: they are creating the product that they will consume.This is in part based on the philosophy of Street Kids International where staff made a distinctionbetween giving youth a game or puzzle or something to construct from fixed assortment of pieces and where all the instructions were spelled out on the inside cover of the box or on a
 
piece of paper that came with the game or where along with the assortment of pieces, they weregiven instructions to make a choice from a set of possible solutions, and where youth acquiresome knowledge and practice in a practical way and then are empowered to create or constructsomething where they can apply the knowledge or principals, practice this, learn by trial, error,and reflection, and then be able to synthesize this knowledge into their own toolkit and integrateor adapt it to the realities in which they live, i.e. if they know what they are doing, they cancreate something from what is available to them in a given situation.In this model of working with youth, on survival or life skills, on HIV prevention, on HIV testing,the professionals or peer educations act as facilitators not powerful experts. They rely on theprocess they are facilitating to create an enabling social environment, where youth feelcomfortable gathering together formally or informally, where individually and as a group they feelencouraged to identify situations, experiences, and problems as they see it, and where thefacilitators are able to assist the youth in prioritizing their concerns and creating a tool kit of practical information, concepts and skills that can help them back out on the street to ensure thatthey have food, clothing, and shelter from day to day, that they are physically as safe as theycan be, and that they can be more competent in the everyday life world where they sociallyinteract, do business, and find emotional and psychological comfort and support.This programmatic approach interests youth because it is action oriented, allows them to interactwithin a peer group, and provides them with experience where they can immediately acquirestreet and business skills-- the toolkit-- that equips and strengthens their resilience in thechallenging street life and family life in which they are more than likely to be on their own and tohave to do thinking and make decisions like adults.
The Story of an HIV Prevention Program for Street Youth
The history of a street youth program called “Safe Horizons” offers another example. At a timewhen the crack cocaine epidemic was at its peak in NY and HIV infection rates were still climbing,Edith Springer, a social worker and early harm reduction advocate, and Rod Sorge, a youngpioneer and activist in needle exchange when it was still illegal, helped develop an outreachprogram among street involved youth who were using crack and were engaged in sex work.Street involved youth were paid a small but meaningful weekly stipend to do outreach work andHIV prevention within their peer networks and to participate in a weekly group meeting andtraining. Over months, assisted by Springer and Sorge, but facilitated by revolving groupmembers, the group developed their own contract for how the group would function, which wasthen agreed to and followed by its members. Group meetings included plans or preparation of food of the food they would consume together during the meeting (to ensure that at least once aweek they ate well), debriefing from the week’s outreach, discussion of personal issues, largergroup concerns, and problem solving.In this program, the young people were seen as “workers” who came into the program from aposition of strength individually and collectively as helpers rather than as needing help or as“problems” themselves. This was important because many of the youth had troubled histories of asking for help from adults. At the same time, Springer noted that she was in a helping ortherapeutic relationship with her young workers. As trust built among members, within thegroup, and with her, it became more okay to ask for and rely on help. The youth had peers butnow they also had a constant adult presence who respected them, earned their trust, andmirrored back to them, a loving and affirmative (positive) view of themselves.The groups showed a similarly flexible approach, and positive results, when it came to drugs.While the groups were not drug-free, members learned to come to the group, in a sense,” fit for

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