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PROJECT PROPOSAL Protection of Nomad Children against STIs and Hepatitis B

Background: Pakistan Paediatric Association (PPA) is a registered professional body and the sole representative of more than 1,500 paediatricians of the country. t is affiliated !ith nternational Paediatric Association and "AA#$ Paediatric Association. ts $hild #ights % Abuse $ommittee ($#A$) is !orking for the rights of children as enshrined in the &' $onvention on the #ights of the $hild ($#$, 1()(). *or the past fifteen years, its focus of !ork is child abuse prevention and management. $#A$+PPA is the implementing partner of "ave the $hildren "!eden and has conducted trainings, consultancies, and research for &' $,*, "ave the $hildren &-, .roupe /eveloppemente, and the .overnment of Pakistan. t is affiliated !ith ,$PA0 nternational (,nd $hild Prostitution and 0rafficking) and "P$A' ( nternational "ociety for Prevention against $hild Abuse and 'eglect).

$#A$+PPA !orks for the better care of children against physical, se1ual, and emotional abuse. ts main target groups are children !orking in brick kilns of 2atapur (3ahore), children in hospitals, children in schools, and children living on the street. t is currently focusing on the training of teachers, doctors, and other service providers to detect, report, manage, and rehabilitate cases of child abuse. t also !orks closely !ith other '.4s in 3ahore for their capacity building on child protection issues. 4ther groups of children that $#A$+PPA has !orked !ith in the past include $hildren in conflict !ith the la!, $hild laborers, Abandoned children, 0ruck !orkers, "treet children, "e1ually e1ploited

girls5boys, #efugee children, 6otel !orkers, 0rash pickers, 7orkshop boys, #una!ay children, "pecial children, 8assage !orkers, $hildren involved in substance abuse, $hildren vulnerable to 6 95A /" and "0 s, and $hildren in alternate care institutes.

$#A$+PPA has collaborated !ith another '.4 (.odh) for the healthcare of nomad children. /etailed *ocus .roup /iscussions and secondary data indicates the follo!ing main findings:

&npublished reports of data collected from secondary sources confirm the presence of about ;<,)00 nomad families in the city of 3ahore and its surroundings.

Anonymity and loneliness as a community have definitely affected the permissiveness level of the nomads, as they do not feel bound by the social controls normally influencing a person or family. 0he nomads feel that they are a stigmati=ed group, as they are perceived as a threat by the local population. 0herefore, opportunities for earning a livelihood are further reduced due to this pre>udice in an already indigent !orld. n such a situation, the vulnerability factors for indulging in risky behaviors for economic gains are further increased.

Apart from begging and laboring, the most commonly adopted means of earning a living include cane+making, singing and dancing, !orking as acrobats, making mud toys, snake+charming, !orking as ?uacks, bangle+selling, garbage collecting,

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"0 : "e1ually 0ransmitted nfection 0he terms gypsy and nomad are interchangeable in this document @ #esearch conducted by Godh, an '.4 e1clusively !orking on gypsy communities in 3ahore

and !orking as behrupia (imposters). 0here is a large number of children involved in these activities, as it is customary for all family members to !ork. 0here is no kno!ledge about 6 95A /" or the conse?uences of unsafe abortions and unsanitary births. $ontraception is out of the ?uestion, primarily because of a lack of a!areness. Although medical services are available to neighboring communities, the nomads are reluctant to use these facilities because of economic and social constraints. 'o government authority supports these nomads as they are not considered as citi=ens of one particular geographic area. /rug abuse is an everyday reality in this community. 0hey use opium, hashish, heroin, alcohol, and intravenous drugs. "peaking about vulnerability to $ommercial "e1ual ,1ploitation of $hildren ($",$), the children said that it !as ?uite common for people to attempt sodomy !ith the boys !ho participate in public performances, especially !hen these children are dressed up like girls. B7e are usually 15+A0 boys, so !e try and save our companions from the lust of other people, but that is not al!ays possibleC. 6epatitis 2 and $, along !ith 6 95A /" are transmitted through se1ual contact. 0he incidence of hepatitis 2 and $ is on the rise, !ith almost 10D of the population carrying the virus in its blood. 6epatitis 2 vaccination is an effective method of prevention against this disease. 0he public campaigns against hepatitis 2 have already raised a!areness in the communities but its cost is a hindering factor in !ide coverage. Providing hepatitis 2 vaccination to these vulnerable children !ill be an effective method for gaining their confidence and !ill also serve as a community a!areness mechanism !here they can be made a!are about prevention of other "0 s, including hepatitis $ and 6 95A /".

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n vie! of the above, $#A$+PPA feels an urgent need to provide a!areness about 6 95A /" and "0 s to the community, especially the adolescent population of nomads. 2ecause of the vulnerability of the Pakistani population to 6epatitis 2, it is essential that an effective program be designed to protect this target group against the spread of "0 s, hepatitis 2, and 6 95A /". Objectives: 0o educate A00 vulnerable children on protection against preventable diseases through community seminars 0o vaccinate A00 vulnerable children against 6epatitis 2 0o advocate for a sustainable plan for e1tended coverage through soliciting the support of pharmaceutical companies Time Frame: < !eeks (1st August A005 E A(th August A005) An additional one !eek after a period of 1 month to give second dose An additional one !eek after a period of F months to give booster dose Activity Plan: 7eek 1: Pro>ect 4rientation:

0his !ould include visits to the offices of $#A$+PPA and .odh for capacity building on the issue. 9isits to pro>ect site for informal interaction !ith the community !ill also be undertaken during this !eek.

7eek A+5: $ommunity "eminars and 9accination $ampaign:

*our community cohorts of 50 adolescents each !ill be made for convenience. 4ne seminar per cohort, follo!ed by vaccination of the entire cohort !ill take place each !eek. n total, four community seminars !ill be held for A00 adolescent boys and girls of the nomad community. A community mobili=er !ill deliver a talk and ans!er any ?ueries that the adolescents have regarding 6 95A /", "0 s, and hepatitis 2. 0he discussions !ill be simple, easy to understand, and !ill include practical tips for prevention. A total of t!o hundred adolescent boys and girls of the nomad community !ill be given the first dose of hepatitis 2. 0hey !ill be given vaccination record cards and reminded to have their second dose after one month. 0he second and booster dose !ill be administered by $#A$+PPA. 6o!ever, for financial clarity, the vaccines !ill be purchased before the end of the pro>ect. 7eek F: 4ne to one meetings !ill be held !ith various pharmaceutical companies to try and convince them for financing $#A$+PPA for e1tended coverage of the pro>ect to make more adolescents immuni=ed against hepatitis 2.

Monitoring & Follow up: ,1ternal monitoring !ill be conducted by A/P !hile follo! up of the pro>ect !ould be by $#A$+PPA. f the pharmaceutical companies agree to further fund the pro>ect, $#A$+PPA !ill collaborate !ith '.4s like .odh to provide coverage to the target groups. Budget: 9accination cost (P-# A;0 1 ; doses 1 A00 adolescents) G /isposable syringes (P-# ) 1 ; doses 1 A00 adolescents) G 8ethylated alcohol s!abs (P-# 1 1 ; doses 1 A00 adolescents) G 9accination record cards (P-# 5 1 A00 adolescents) G 6onorarium to vaccinator (P-# 10 1 ; doses 1 A00 adolescents) G 2anners for community seminars (P-# 500 1 ; types of banners) G 6onorarium for $ommunity mobili=er (P-# 500 1 F seminars) G Total $onversion rate 1 &"H G F0P-# (#ounded to nearest 10). P-#1;),000 P-# P-# P-# P-# P-# P-# <,)00 F00 1,000 F,000 1,500 ;,000

#efreshment at community seminars (P-# A0 1 F seminars 1 100 persons) P-# 1A,000

PKR 166,900 US$ 2,782

Schedule: 1st Aug E Ith Aug: 8on: 0ue: 7ed+*ri: *ield 9isit 8aterial /evelopment "urvey /evelopmentJ $onsent *ormsJ /evelop record cardsJ registration

)th Aug E 1<th Aug: 8on+7ed: 0hurs+*ri: 50 person survey Kuestionnaire revised

15th Aug E A1st Aug: "eminar and first dose A00 $hildren