"How Can You Touch This Child? What Kind of Woman Are You? Provider Perspectives on Stigma, Victimization and Violence Among Native and Ethnic Minority Street-Connected Youth in Tbilisi, Georgia

Background and Purpose: Street-connected youth, that is, young people aged 10-19 years old who spend most of their time living and/or working on the street, experience high rates of social and economic exclusion. As a result, street-connected youth are vulnerable to experiencing a range of negative health and social problems, including violence, trafficking, poor mental health, and HIV/AIDS. In the Republic of Georgia, street-connected youth are a new phenomenon, with studies estimating that 2,500 youth live and/or work on the street. Although organizations have developed to serve street-connected youth, little research has examined provider perspectives on the social, health and economic needs of street-connected youth. As a result, relatively little is known about the service provision context, and the extent to which providers believe they are addressing the complex needs of street-connected youth. The present paper helps to address this gap by interviewing providers who serve street-connected youth in the capital city of Tbilisi, Georgia, which is home to almost 1,000 street-connected youth.

Methods: Trained interviewers conducted individual semi-structured interviews with 22 key informants (68% female; 32% male) from governmental institutions and social service organizations (n=6 social workers, n=5 psychologists, n=5 peer educators, n=4 managers and n=2 mobile health officers). Informants were asked to discuss their perspectives in three areas: (1) the social network characteristics of street-connected youth, (2) youth’s involvement in substance use and sexual behaviors related to HIV/AIDS, and (3) the social contexts of youth engagement and service delivery. Interviews were conducted in Georgian and a written transcript was produced for each interview. Three independent coders conducted a content analysis of the data in Dedoose using a theoretically-grounded codebook and open coding. Forwards-backwards translation methods were used to translate informant quotes into English to ensure linguistic and cultural equivalence.

Results: Service providers reported that street-connected youth experience high rates of stigma, victimization and violence at multiple social-ecological levels. Common types of victimization included parental abuse, youth bullying, police and street-based harassment and violence, and economic and sexual trafficking. Stigma, exclusion and violence were perceived to be highest among ethnic minority youth, many of whom are undocumented. Providers reported that stigma directly impacts their work and described negative public reactions to their outreach efforts. At the same time, some providers endorsed stigmatizing beliefs by stating a preference for serving native Georgian youth and attributing individual and cultural deficits to Kurdish-Azeri youth.

Conclusions and implications: Findings indicated that stigma towards street-connected youth, in general, and Kurdish-Azeri youth, in particular, negatively affected service engagement and provision. Results indicated that stigma at multiple levels, including provider stigma, prevented organizations from developing trusting and long-term relationships with street-connected youth, especially those vulnerable to violence and victimization. While targeted campaigns and relief efforts have been developed to increase public awareness on the plight of street-connected youth, study findings suggest that focused stigma reduction campaigns are needed. In addition, there is a specific need to improve the social and service contexts for ethnic minority Kurdish-Azeri youth, who experience higher levels stigma and victimization.