Las perspectivas de género y de familia en la migración

The terms risk and vulnerability have been used differently in different contexts by different scholars (Millstein & Felsher, 2001) and can be conceptualized and measured in many ways. We can examine the individual’s risk and vulnerability by identifying those things that worry or concern the individual, as well as the anxiety that is generated by these concerns. We can also judge or identify whether people recognize the risks in a given situation or how someone accurately judges specific risk (Millstein & Felsher, 2001). Risk judgements may focus on situations (is having unprotected sex dangerous?) or on possible outcomes (what is the chance you will get HIV?) (Millstein & Felsher, 2001). Risk judgement reflects magnitude assessments of risks and focuses solely on an outcome. When assessments of risk do not involve magnitude estimates, this is termed as risk identification. Risk identification and judgement are the direct ways to tap

assessments of risk. When assessments focus on the degree of anxiety, or concern individuals have in particular situations, this is referred to as perceptions of vulnerability. Like the more cognitive aspects of risk perception vulnerability can be identified by the indication of the feeling of experiencing negative outcomes.

For example, an individual may have feelings of vulnerability to HIV. Other behavioural related risks, such as getting sick from drinking alcohol or acquiring a STI can also generate feelings of vulnerability (Millstein & Felsher, 2001). The literature reflects the difficulty in compare the concepts of risk and vulnerability across different studies. Rogers (1996) defined vulnerability as someone who is

47 susceptibility to health problems, harm or neglect. In this sense, the notion of vulnerability is interpreted as the danger, threat or harm to the person. Any individual experience of vulnerability creates stress and anxiety which affects physical, psychological and social functioning. Vulnerability is affected by personal factors as well as factors within environment.

Rogers (1996) states that degree of vulnerability varies as one individual may not perceive vulnerability (threat to harm or danger) in a specific situation, while another person may be acutely aware of feeling vulnerable in the same situation.

Perception of the degree of the vulnerability depends on the amount of control one feels over the situation (Rogers, 1996). Vulnerability is also situational and

depends on the person’s environment (Rogers, 1996). Children who live on the street face threats of illness or harm related to their situations in ways that might not be experienced by children living at home or in a different environment.

Therefore, children’s vulnerability to HIV starts in the street.

Risk factors that are responsible for vulnerability include both modifiable risk factors and non- modifiable risk factors. Age, gender and ethnicity are the factors that no one controls. However, Rogers (1996) suggests that poverty, low

education and level of social support are potent risk factors of vulnerability that are modifiable. Further, vulnerability also occurs due to non modifiable risk factors such as genetic predispositions to illness or poor coping skills; and modifiable risk factors that arise due to conditions occurring in the environment such as homelessness or abuse. Societal attitudes, unemployment, marital harmony and discord affect the functioning of the individual within the environment, and are risk factors for vulnerability. The modifiable factors of education, income, employment and the level of social support are the

environmental factors that influence health. Thus, the environment can have either detrimental effect on the person’s health or it can promote health (Rogers, 1996).

48 So, while risk and vulnerability are defined in many ways, the meaning behind these concepts is similar. For the purposes of this study we can understand that

‘risks are the external factors, which cause problems, harm or threats; while vulnerability is the probability or susceptibility of becoming infected with HIV/STIs and/or of developing AIDS’. This study has used the meaning of risks and vulnerability as used in the context of HIV/AIDS research in a report by (UNAIDS, 2008; WHO, 2008).

The report shows that risks include behavioural risk factors, social, cultural and, economic factors that may increase or decrease vulnerability to HIV. Other risks factors that increase vulnerability to HIV may be gender disparities, inheritance, or violence. The report also suggests that social discrimination and stigma are considered as one of the major socio-cultural determinants that increase

vulnerability to HIV WHO, (2008). The definition of risk and vulnerability that I adopt in this study is related specifically to HIV/AIDS and is in line with the definition proposed by UNAIDS (2008, p. 65):

“risk is defined as the probability or likelihood that a person may become infected with HIV. Certain behaviours create, increase, and perpetuate risk. Examples include unprotected sex with a partner whose HIV status is unknown, multiple sexual partnerships involving unprotected sex, and injecting drug use with contaminated needles and syringes. Vulnerability results from a range of factors outside the control of the individual that reduce the ability of individuals and communities to avoid HIV risk. These factors may include: (1) lack of knowledge and skills required to protect oneself and others; (2) factors pertaining to the quality and coverage of services (e.g.

inaccessibility of service due to distance, cost or other factors);

and (3) societal factors such as human rights violations, or social and cultural norms. These norms can include practices, beliefs and laws that stigmatize and disempower certain populations, limiting their ability to access or use HIV prevention, treatment, care, and support services and commodities. These factors, alone or in combination, may create or exacerbate individual and collective vulnerability to HIV.”

49 This definition of risk and vulnerability is widely used and has become a standard definition for both policy and practice in work on HIV/AIDS and is appropriate for this study.

The Literature - Street Children and HIV-AIDS and STIs

Since children ‘of’ the street and children ‘on’ the street are not mutually exclusively categories and both are at risk of, and vulnerable to, HIV/AIDS and STIs (Moon et al., 2001) literature on both groups of children has been reviewed.

The review is organised and presented under the main themes identified in the literature: reasons for being on the street; sexual behaviour, prostitution and drug abuse; knowledge regarding HIV/AIDS and STI transmission, prevention and treatment, and attitudes towards people living with HIV/AIDS. The intention was to review literature which was as current as possible and from developing

countries which may face similar socio-economic constraints to Nepal. These were the main criteria that guided the selection of the published literature (both quantitative and qualitative studies are included) while the key words used in the search were identified from the research aims.