Children of female sex workers and drug users: a review of vulnerability, resilience and family-centred models of care.
BACKGROUND
Injection drug users and female sex workers are two of the populations most at risk for becoming infected with HIV in countries with concentrated epidemics. Many of the adults who fall into these categories are also parents, but little is known about the vulnerabilities faced by their children, their children's sources of resilience, or programmes providing services to these often fragile families. This review synthesizes evidence from disparate sources describing the vulnerabilities and resilience of the children of female sex workers and drug users, and documents some models of care that have been put in place to assist them.


METHODS
A large literature assessing the vulnerability and resilience of children of drug users and alcoholics in developed countries was found. Research on the situation of the children of sex workers is extremely limited. Children of drug users and sex workers can face unique risks, stigma and discrimination, but both child vulnerability and resilience are associated in the drug use literature with the physical and mental health of parents and family context. Family-centred interventions have been implemented in low- and middle-income contexts, but they tend to be small, piecemeal and struggling to meet demand; they are poorly documented, and most have not been formally evaluated. We present preliminary descriptive data from an organization working with pregnant and new mothers who are drug users in Ukraine and from an organization providing services to sex workers and their families in Zambia.


CONCLUSIONS
Because parents' drug use or sex work is often illegal and hidden, identifying their children can be difficult and may increase children's vulnerability and marginalization. Researchers and service providers, therefore, need to proceed with caution when attempting to reach these populations, but documentation and evaluation of current programmes should be prioritized.
Beard
Jennifer
J
Center for Global Health and Development, Boston University, 801 Massachusetts Avenue, Boston, Massachusetts, USA. jenbeard@bu.edu
Biemba
Godfrey
G
Brooks
Mohamad I
MI
Costello
Jill
J
Ommerborn
Mark
M
Bresnahan
Megan
M
Flynn
David
D
Simon
Jonathon L
JL
D000328:Adult; D002648:Child; D002669:Child Welfare; D005190:Family; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D011477:Sex Work; D019966:Substance-Related Disorders