2004 Bridges Summer Research Report Katherine Schlaefer School of Public Health "Health Risk Behaviours of Street Kids in Ecuador"

Before coming to Berkeley for my Masters in Public Health, I spent a year volunteering with a nonprofit organization in Guayaquil, Ecuador that assists street kids around the country. The “problem” of street kids has long plagued many Latin American countries. Ecuador reputedly has the largest proportion of working kids in Latin America, and accordingly, has an endless list of organizations that provide a range of services for poor and working children. But for such a small country, it is also brimming with a large number of children that subsist on the street without the support of family or shelters. This subgroup of kids often experience the most severe health risks and harms, often falling into substance abuse, or learning to trade sex for drugs, shelter or food.

Over the course of the year, I spent time in shelters, in the streets, and even in the homes of the street boys. I thought I had a pretty good idea of what was going on in their houses, what they were facing in the streets and what they struggled with at various shelters; however, after treating dozens of kids between the ages of 8 and 15 for sexually transmitted diseases within the span of a few weeks, I realized that there was a lot more going on in their lives than most of us were aware. During that year, time left little opportunity to really explore the personal lives and pasts of the kids; scarce literature also offered few clues or insights.

In order to acquire a better understanding not only of the lives of these children, but also of the innumerable risks they take, I returned to the streets of Ecuador with the Robert and Alice Bridges Summer Research Travel Grant to interview 275 “hard core” street kids. By collecting and analyzing extensive data on the youth population in the streets, I hoped to be able to 1) more clearly identify and define their unique needs and 2) to use the information gathered to develop programming strategies to better meet those needs and to fill any gaps in the continuum of services offered by other organizations around the country. In order to qualify for the survey, the kids had to be living in and truly dependent on the streets. I was particularly interested in those that had found little support or stability within their homes and within shelters or other types of programming. All of the kids interviewed lived a minimum of one year on the street, although usually they had spent much more time there; they had not visited a shelter, home or family within the past month, and they fell within the age range of 8 to 24 years. Everyday, I ventured into the streets of many cities around the country looking for kids that simply did not fit in anywhere but there.

I designed a 125-question survey to better define and understand the kids’ risk behaviors and knowledge of substance abuse and sex. The questionnaire delves into familial relationships, health status and history, substance use, sexual behaviors, and knowledge and perceptions of sexually transmitted diseases (STDs) and family planning. Depending on the story, interviews lasted anywhere from half an hour to three hours. Often times, the intensity the kids experienced in sharing their haunting histories melded to intrigue and excitement with issues addressed during the interview. After sundown, in streets too scarcely lit to read or record responses, I took advantage of their newfound interest and eagerly answered their questions, entertaining them by explaining methods for preventing STDs or pregnancy among other things. I learned to plan for the impromptu workshops, employing a philosophy of risk reduction to topics ranging from family planning issues and sexual health, to HIV/AIDS and even human rights or job acquisition. Others who defined themselves by their connection to the streets frequently joined the perimeters of the group of street kids, and also in the question and answer sessions and workshops.

By night, I was offered an untainted glimpse of how street kids truly live and survive. I witnessed a range of events and activities, and soon I truly began to better understand the lifestyle—and the appeal—of the streets. Although the common philosophy of the streets is “Everyone for him- or herself,” kids young and old would come together and forge communal living situations. The older kids, who could earn income doing hard physical labor, would give the smaller ones, who made significantly less by begging, money to buy food for the entire group. They contrived a stove to cook rice, beans, meat or eggs by propping up metal bars and scraps over burning garbage. Some of them had very refined survival skills and were remarkably resourceful: selling the garbage they were paid to sort, using the sharp edges of broken glass or tin cans to cut vegetables or siphoning water from private or city sources to cook, do laundry or bathe themselves. Ironically, the kids that slept in the streets washed their clothes and showered habitually each morning, whereas the kids in shelters typically refused to expend energy to maintain any sort of hygiene.

Before I started conducting interviews, I thought I had a decent handle on what was happening in the streets, the responses to my questions proved otherwise. I thought, like many people do, that the substance most abused on the streets were inhalants, usually a form of glue, which the kids inhale for a high, and which also causes as much brain and pulmonary damage as cocaine and other traditionally hard drugs. It turns out that most of them are smoking crack cocaine throughout the day, every day. The most sought after high, the dessert after a dinner of drugs, was maduro con queso—marijuana mixed with crack cocaine. The most frustrating aspect of the project was only being able to sit and watch or attempt to talk to kids — who had yet to hit double digits in age — as they experienced withdrawal, frantically sought a fix and then desperately smoked up, bony fingers shaking and eyes too glazed to focus. More disturbing was that drug use was so common and addictive behaviors so prevalent, even among the youngest, that I became desensitized to the sight of an eight-year old smoking crack, using glue and then bargaining with an old drunk man, who approached him in the street, over the price of a blow-job.

Not surprisingly, I had also underestimated the prevalence of sexual activity amongst the kids. Most literature alludes to sexual experiences between the boys on the streets, whereas I found that many were violated at home, long before learning to barter sex for food, drugs, money or shelter in the streets. All of the girls—a total of 10 out of the 275 kids interviewed—had been violently sexually abused in their homes. And all of the girls, except one that was just eleven and had yet to have her first menstruation, were pregnant, living in the streets and using an assortment of drugs. Only about ten of all the kids interviewed were actually virgins. The rest learned fast that sex can be a valuable commodity on the streets. Many kids shared their most private sexual experiences, talking of gringas on the beach who invited them to try new drugs, then showed them the details of intercourse. Others talked about being violated by adult men in the streets—or worse in their own homes. Still others proudly reported the number of times people have offered to pay them for a sexual act. Despite casually selling sex, the boys also frequented the districts of sex workers to buy their own pleasures either with money or drugs. Some even admitted to raping women when they had neither a “woman of their own,” nor the resources to buy or trade for sex.

The means and methods of sexual activity revealed the wealth of health risks that they face, although they may or may not recognize the risk or suffer from their harmful consequences. Culturally, condom use is considered weird, even perverse. Such misperceptions have also trickled down to the kids on the streets. The majority of kids are having unprotected sex with a wide range of people from different cross-sections of the population. More and more kids are testing positive for diseases like HIV and gonorrhea, and more and more kids are giving birth to or fathering their own kids. When street kids get sick or their health deteriorates beyond tolerance, they head to shelters for help or care. In this way, shelters are integral to the survival strategies of the streets; however, shelters either provide shelter without healthcare, refuse sick kids, fearing that they will infect others or send them to the hospital. At the hospital, kids often learn that they are infected with diseases like HIV or tuberculosis — stigmatizing diseases that they do not understand. Many kids leave the hospital and return to the streets even more lost and distraught than they previously were, struggling with the shame and confusion of such devastating diagnoses.

Each day generated collections of stories that maintain their shock value for the general public, but they drain you emotionally and physically when you are so deeply entrenched in tragedy, illness and (sometimes seemingly futile) hope without pause. Working in the streets is like working in a “story-factory,” as my mentor once described. Every day is packed full of hearing amazing, astounding, heart-wrenching and deplorable narratives, as well as witnessing accounts of substance abuse, violence, robbery and survival sex.

One meager source of hope in this seemingly hopeless and overwhelmingly complex situation is that many kids acknowledged their addictions, recognized their risk behaviors, and accepted that they lacked information and skills to deal with the risks inherent in their lifestyle. They often explained that they desperately wanted to change their lives, and had sometimes tried to change it, but failed. Without the basic resources of identity papers or even the ability to read or write their own names, the kids have little opportunity to leave the streets on their own. Another obstacle the kids mentioned was the draw of the streets. It was not necessarily the drugs they struggled to leave behind; rather the lifestyle of the street proved to be the real addiction.

To help fund the research, I also worked as a consultant for a multidirectional nonprofit organization that supported existing shelters and orphanages, founded a multidisciplinary rural community development program and lobbied for children’s rights with local political officials. The experience provided me with the opportunity to do needs assessments and evaluations of some of the most well-known shelters, programs and orphanages in Guayaquil. I was even afforded the chance to cook dinners at some of the sites, events that I coupled with hands-on nutrition workshops for the hired cooks.

As a result of this pilot project made possible by the Bridges Summer Research Travel Grant, I have compiled a comprehensive database of the health history of street kids of statistical value. The data will serve as a baseline to compare and evaluate future interventions within the population. During this coming year, I will be able to analyze the data, highlighting the trends and risk factors of various aspects of health, and publish articles and recommendations for those working with street kids in Ecuador and around the world. The work this past summer will also serve as the foundation of my master’s thesis in Public Health.

After graduation in the spring, I will join the efforts of people working around the globe on behalf of street kids. Currently, the multitude of organizations working with kids in the street offer preventative programming, after-school programs, alternative schooling and alternatives to working in the streets, vocational training, or family building and reintegration. Although the plethora of organizations offer aid in many areas along the way of becoming and being a street kid, there still exist a few gaps in service.

Judging from the responses of the survey and casual conversations with kids around the country, two types of service are notably lacking: 1) Treatment and support for youth (under the age of 16) struggling with substance abuse issues and 2) Transitional guidance for older kids desperately trying to leave the streets. In order to help fill the gaps in addressing the plight of street kids, I officially registered my own NGO, Calle a Cambio, with which I will continue to work after graduation. I founded the organization with a foundation of internationally trained professionals in law, psychology and social work. Nascent in form and activity, the organization will complement existing programs by providing the opportunity for older kids — male and female — to transition off the streets and a means of treating youth struggling with substance abuse.

Hopefully, the “story-factory” will someday churn out more tales of health, recovery, pride and success, than accounts of addiction, rape, shame, murder and addiction.