We know that we don't know enough!

Thoughts on Street Children and HIV/AIDS in Durban, South Africa

One thing that we can be sure about on the issue of HIV/AIDS and street children in Durban is that we do not know enough! There is no statistic on the number of street children with HIV. There are no statistics on the number of children arriving in the streets affected by HIV. It is a tough subject to document and doing so would create some major ethical dilemmas. However, there are some trends that we are seeing at street level that are interesting and enlightening. However, they are simply observation.

Over the last few years we have seen a rise in the number of cases of children coming to the streets from home scenarios that could be related to HIV/AIDS. For example: children whose parents are sick and unable to provide or have perhaps died and others who live with a grandmother who is unable to cope.  These types of scenarios are not definitely HIV related but when you see more and more cases like this it suggests that HIV is contributing to the number of children on the streets.  There does seem to be more children on the streets who are orphaned or have lost a parent. The numbers have increased over the years, not hugely, but steadily. When we add the number of children that have been taken off the streets by organisations like Umthombo (the Durban Street Team) and ICARE and then look at the number of children still on the streets, we begin to see that it is a large number of children, more and more of whom have family scenarios that are definitely related to HIV/AIDS or that suggest HIV/AIDS as a determining factor. If a child has lost both parents to TB, does this automatically suggest HIV/AIDS? Many would assume so but the child will always remember the parent dying of TB. Can we be sure that the determining factor was HIV? No. However we should be taking illnesses often related to AIDS such as TB as seriously as HIV.

We think that HIV has influenced the increase of children on the streets. Not in the apocalyptic way that some of us had prophesied! There was a paranoid suggestion often heard a few years of these waves of children rolling into the streets from HIV/AIDS affected areas. Citizens were panicking about a modern day Lord of the Flies situation taking over public spaces in the cities. It was the suggested mayhem that seemed to cause more anxiety than the tragedy of the children. Thankfully the city has not been overrun with street children, although, by the letters and articles you read in the Durban media, you may be forgiven for thinking that it had!

When AIDS arrived as an issue, it swamped many other social issues that were relegated to being secondary. Everything seemed to pale into insignificance in light of AIDS. It is easily forgotten that if HIV did not exist, the issue of street children would still be a social tragedy and an indictment on society.  However, HIV/AIDS has impacted children on the streets. Although we do not have any statistics to prove this we are seeing definite trends. Street children live in one of the highest categories possible for contracting the disease. They generally become sexually active as soon as they arrive in the streets, they are often raped, girls are almost always found a “boyfriend” who helps them survive the streets together and both girls and boys can get caught up in prostitution. Also, there is poor healthcare for street children and they help each other deal with their bloody wounds. This lifestyle puts them at great risk. When you look at the type of food that they have access to you realise that they are not even able to give themselves a nutritional foundation to strengthen themselves. However, they do seem to have some resilience. We see more and more young people dying of AIDS related diseases on the streets. Sarafina was 15 when she died of AIDS related TB. Many in their early twenties have died under similar circumstances in the Point area of Durban in the last few years. Those who have died of these types of illnesses recently tend to be in the 15-25 age group. Although we are aware of many of the street children being HIV+ we have not seen any of the young children on the streets die of AIDS related diseases. Many of those who have died are also using drugs like “sugars” (a mixture that includes the dregs of heroin, Cocaine and even rat poison), which have hideous affects on most people’s health. The children are certainly not dropping like flies once they get HIV. Street children infected with HIV are generally living with HIV for the moment. However, the lifestyle that they live as children is the same tragedy that it was before the advent of AIDS. The fact that they are living with HIV gives even more fuel to the argument that empowering children to be able to leave the streets and live in healthier and more caring environments is crucial. After all, to live positively for extended periods of time they will need access to good nutrition, good healthcare and a stable environment to take antiretroviral drugs at the appropriate time. Although it seems as if younger children are living on the streets with HIV it also seems to be that their life expectancy is drastically reduced if you look at the fact that many of those who are dying in the twenties are yesterdays young street children.

Sonwabisi is a classic example. He died of AIDS related illnesses last year at the age of twenty-one. I knew him as a small boy of eleven on the streets. He only knew the streets as his mother had been a fruit seller on the streets and had brought him to town with her as a small child. He grew up to be one of the toughest children in the area but also had a compassionate streak that made him most likeable. In his prime, about two years before his death he had a frame of an athlete, with very defined and large muscles. He looked a picture of health. Within two years he lost energy, strength, and his independence. He eventually lay, a bundle of skin and bones, being cared for inside the notorious squat in Point Road called Tong Lok/Rockworld. He soon passed away.

But what of the anomalies? How about S’lindile* who is now aged twenty-one. At aged eleven I had to physically pick her up on the streets. She was so thin and sick that we assumed that she was about to die. She was HIV+ She had taken the test. We assumed that our role was to give her love and dignity in her dying days. Not so. A local shelter had placed her back with her mother and after a while she recovered and came back to the streets. She has never had access to ARV’s for any extended period of time and has lived back on the streets in an unhealthy environment, is still involved in prostitution and yet today, ten years later looks absolutely healthy. What about Thandiwe* who is about twenty-four now? She was sick with HIV related TB nine years ago and lost weight to the extent that we assumed she was about to die. Her CD4 count must have been super low. Yet, today we see her looking as healthy as can be. Both of these girls must still be HIV+ yet have bounced back from what we assumed was near-death and lived on, unassisted for up to ten years so far. These two are not the only ones. What does this mean?

Ultimately, until there is real research on the health of street children in Durban and until humans understand the disease itself more we can only react to these trends. HIV/AIDS does seem to be compounding the tragedy of the street-life experience. It is real. We need to step-up our services to street children both in light of HIV/AIDS and because no child deserves to have so few options that street-life could appear the best one. We do seem to be seeing more HIV/AIDS affected children arriving in the streets. The children on the streets themselves are living in a high-risk category for contracting the disease. Street youth are losing their lives to HIV related diseases. Stories like that of  S’lindile and Thandiwe and the fact that children on the streets infected with HIV do seem to be surviving, at least, for the meantime are not meant to detract from the seriousness of the threat of HIV/AIDS but are encouraging and are real stories. They just go to show that one thing that we can be sure about on the issue of HIV/AIDS and street children in Durban is that we do not know enough!

Tom Hewitt (Chair of Umthombo)
November 2007
Durban, South Africa