The Other Railway Children, Chapter 9 (more extracts) "Street Children and AIDS"

One of the consultants working with Eliazar Rose at New Hope had a real concern about the risks of street children becoming infected with HIV/AIDS and persuaded us to seek funding from the Elton John AIDS Foundation to build a hospice for many of the street children infected who would otherwise be abandoned to die, stigmatised, in the gutter.

We’d organised a small conference in Calcutta with our partners and a few expert speakers to discuss the risks to street children from their exposure to the infection and possible systems to support such children and, in the words of one of the key speakers, hoped this was not yet another conference without resulting action. We discussed the difficulties of testing street children without parental or guardian permission and the limited capacity of special hospitals or hospices for children who were HIV+. We came forward with the idea of a number of treatment centres cum hospices which could test and diagnose children, provide medication for those infected, provide temporary beds for those suffering from an AIDS related illness and finally, a caring hospice for those children whose illness was terminal.

We had talked to the Methodist Relief & Development Fund who provided us with some funding for such a pilot development and were pleased to receive a grant from the Elton John AIDS Foundation of £100,000 spread over two years which was in two parts. The first was to fund Project Concern International (PCI), one of our Delhi partners, who had experience of AIDS programmes for adults, to train all of our Indian NGO partners in incorporating education about AIDS in the outreach to platform children and specifically to mount an HIV/AIDS protection programme around the Delhi station where they operated, at Nizamuddin.

Secondly, the grant enabled New Hope at Visakhapatnam to be fully funded to develop the hospice ‘hub’ concept. They had land in a rural village, Kottavalasa, about a dozen miles from the city, and I carried out (under instruction) the ritual of digging the first sod – involving cracking open a coconut and pouring the juice and oil into the foundations, before the site was blessed.

In addition to the building of a twenty bed hospice and treatment centre, a boys’ home was built nearby to try to integrate the children and avoid separation and stigma being attached to the HIV+ children. The children wore small ribbons of different colours to enable staff to be aware of the identity of the infected children so that due precautions could be made for their own safety and that of the other children, but the children did not realise the meaning of the colours and thought that it was to do with the teams or houses they belonged to.

One of the early inhabitants of the hospice was a young boy called Sreenu. He had obviously developed AIDS when still very young, if not at birth, and had been found by a member of New Hope, abandoned in the gutter of the city. Unable to find any organisation to take him in, initially the man had taken him into his own home, then finding an old people’s home which was the only residential centre that would accept him. Sreenu subsequently spent very happy years at the New Hope hospice with many other children, but died suddenly from a related illness a couple of years later. He was just eight years old. At least during the last two years he had been cared for and loved.

I visited the hospice on a visit just a few weeks after its opening, met and played cricket with Sreenu and the other boys and spent time with the nurses in the hospice with children who were too ill to play outside. The hospice had 20 beds, but 26 children had been already admitted, with the overflow accommodated in a building being developed for children from the city slums to spend a few days in the country working in the community’s fields and playing in the fresh air. Some of the children admitted had picked up the disease at birth from their mothers – I spent some time with a rather bewildered little boy who was not much more than a year old, and I was quite upset when holding the hands of an eight year old girl, all skin and bone, who looked no more than four or five while the nurse tenderly examined her. I looked into her huge brown eyes staring from the sunken face and just hoped that her suffering did not last too long. It was just too painful to look at her.

Back in the north, I talked to the American Director of PCI, and Rajesh Singh, the Indian Assistant Director there. The direct work they were undertaking in the community was going well, although only one boy out of 100 tested was found to be infected. The aim was to prevent the infection spreading through those most at risk. The government had prioritised truckers and sex workers and education of children through schools, but of course, street children missed this almost by definition, and were highly vulnerable through drug use and sexual abuse and activity. PCI had discovered that using 14-15 year old boys as peer educators was the most effective way of raising awareness of the dangers and risks among the community and they gained respect not just from other street children, but also from adults in their locality.

We had asked PCI to use their trained staff to educate the front line street educators and social workers in our other partners but we ran into some difficulty on this. For some reason there was a strange reluctance of some NGOs to be ‘trained’ by a peer organisation rather than Railway Children, even though they had more experience. A couple of NGOs opted out implying that they knew the risks and didn’t need further training, so after the first year we hired a couple of trainers for the Indian based Railway Children organisation and got PCI to train these to deliver the AIDS element as part of an integrated outreach training programme.

In hindsight, this has worked much better without the sexual element being pulled out as something special. A lot of the platform workers had been reluctant to focus on sexual behaviour with the children as they found it difficult to discuss – a taboo area in their culture. This is where the PCI approach in Delhi worked, using peer educators as children seemed to have no such inhibitions.