Abstract
BackgroundInjection drug users and female sex workers are 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 are also parents, but little is known about the vulnerabilities faced by their children, their children's sources of resilience, or programmes providing services to these often fragile families. This review synthesizes evidence from disparate sources describing the vulnerabilities and resilience of the children of female sex workers and drug users, and documents some models of care that have been put in place to assist them.ReviewA large literature assessing the vulnerability and resilience of children of drug users and alcoholics in developed countries was found. Research on the situation of the children of sex workers is extremely limited. Children of drug users and sex workers can face unique risks, stigma and discrimination, but both child vulnerability and resilience are associated in the drug use literature with the physical and mental health of parents and family context. Family-centred interventions have been implemented in low- and middle-income contexts, but they tend to be small, piecemeal and struggling to meet demand; they are poorly documented, and most have not been formally evaluated. We present preliminary descriptive data from an organization working with pregnant and new mothers who are drug users in Ukraine and from an organization providing services to sex workers and their families in Zambia.ConclusionsBecause parents' drug use or sex work is often illegal and hidden, identifying their children can be difficult and may increase children's vulnerability and marginalization. Researchers and service providers, therefore, need to proceed with caution when attempting to reach these populations, but documentation and evaluation of current programmes should be prioritized.
Highlights
Injection drug users and female sex workers are two of the populations most at risk for becoming infected with HIV in countries with concentrated epidemics
Female sex workers (FSWs) and injection drug users (IDUs) are often categorized as two of the four populations “most at risk” for becoming infected with HIV due to behaviours that heighten their vulnerability to the virus
This review aims to synthesize evidence from disparate sources describing the vulnerabilities and sources of resilience of the children of female sex workers and drug users, and to document the two selected models of care in low-and middle-income countries that have been put in place to assist these groups
Summary
Methodological and ethical challenges In order to understand the vulnerabilities faced by the families of drug users and sex workers and provide interventions designed to mitigate risks and fulfill needs, identification of individuals or communities and analysis of their specific situation are necessary first steps. Identification of children whose parents use illegal drugs or sell sex may land parents in rehabilitation centres or prison, effectively leaving their dependent children to be incarcerated with their parents or placed in protection centres These institutions are often impersonal, providing little in the way of care, and may not separate juvenile inmates from adults or offer HIVprevention education or harm-reduction services.
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