In the Mumbai and Thane districts of Maharashtra, India, Family Health International's Aastha Project aims to reduce the incidence of HIV and other sexually transmitted infections among 30,000 male, female, and transgender sex workers—a population considered at risk for HIV infection and transmission. Although interventions focus on sex workers, they include services for their children that offer the chance for a better life and an escape from a future in sex work.
Children of sex workers face discrimination and challenges in accessing their basics rights. They also have limited access to services. Often, they are not enrolled in school or they drop out because they experience social exclusion. In addition, the children tend to have underdeveloped psychosocial life skills and rarely see positive role models.
These factors contribute to children following their parents into sex work. Girls are particularly vulnerable, and may be forced into this work. Compounding all these challenges is the chance that children whose mothers are HIV-positive may contract the virus during the birth process or while breastfeeding.
The Aastha Project is working to decrease the challenges faced by children of sex workers and increase their choices and access to services. On average, 150 children each month obtain services from the project, including support for and guidance on school admission, whether to local, private, or boarding schools.
Aastha also supports immunization, checkups, and provision of basic medicines for the children; counseling and referral services for HIV-positive children and their families; and assistance through the rapid response system during times of crisis, such as when children are missing, kidnapped, hurt, or fighting with other children.
Another crucial service for children of sex workers is access to crèche facilities that provide day and night care. These constitute the safe space that is desperately needed by children while their parents are sleeping or working. Often, the crèche facilities form part of Aastha drop-in centers. Many community-based organizations working with Aastha have their own care facilities. Others refer children in need to nearby linked facilities, and follow up later to be sure the children are well cared for.
One of the children Aastha supports is Darshana, age 4, a bubbly, mischievous girl with a permanent sparkle in her eye. When not in a crèche facility, she follows her mother everywhere.
Geeta, 29, is a community nurse with Aastha as well as a sex worker who meets clients in a bar in Turbhe, New Mumbai. She learned she was HIV-positive when she was pregnant with Darshana and was subsequently abandoned by her husband. Geeta could only think about her child. She was able to face each day after Darshana also tested positive because of the support she received from Aastha Project staff.
As Geeta put it, "Aastha's project coordinator and advocacy officer used to visit me every day to give me courage and remind me that Darshana and I could live a long and happy life. They came with me when Darshana had to be tested, told me to refrain from breastfeeding, how to take care of her, and what to eat. The counselor came with me when we had to register for pre-antiretroviral treatment. Aastha also gave me some financial support when the medical bills were too much for me to manage, as well as some educational support."
Geeta ensures that Darshana's CD4 count remains high by paying close attention to her food intake. Though a school dropout, Geeta now reads English and completes her own reports because she received intense mentoring from the project nurse. Her new love of learning has been transferred to her daughter, who aspires to become a nurse and skips after her mother from a health camp to the project clinic.
Aastha's support can help Darshana realize her potential and dreams. This bright and determined four-year old says, "I will study hard and one day will become like Tara Sister (the project nurse) and make sure my mother has her medicines on time, always."
PHOTOS: (Top) Darshana, 4, playfully peeks out of a box in the Aastha Project's counseling room. (Bottom) Darshana and her mother, Geeta.
— Story and photos by Amrita Bhende, FHI/India