Dr. Paula Braitstein, Associate Professor at the Dalla Lana School of Public Health, Awarded 2017 CIHR-IPPH Trailblazer Award

SIMRIT KHABRA

The Trailblazer Award recognizes outstanding contributions made by researchers in the field of population health intervention research, according to the website. Residing in North-Western Kenya, Dr. Braitstein received the CIHR-IPPH Trailblazer Award for her research and service to street youth in Eldoret, Kenya. An accomplished epidemiologist, Dr. Braitstein has worked in Kenya for over 10 years, addressing the needs to the large population of street children through the implementation of programs like Peer Navigators. Nominated by the University of Toronto’s Dalla Lana School of Public Health for the award, Dr. Braitstein is a recipient of the Applied Public Health Chair with the CIHR. Dr. Braitstein’s work focuses on the causes of child homelessness and the conditions of violence and abuse. Her work relates to key policy issues rooted in the perception and treatment of this vulnerable population, and incorporates public health practices.

“We found that almost half of all street children are dying of HIV. Half. And nearly two thirds of the girls”, said Dr. Braitstein in a recent interview. She mentions her latest work, highlighting the stark statistics: over 1,900 youth are known to be [living] on the streets in Eldoret [and], on average, 3 die per month. Building a foundation for her research with this vulnerable population, Dr. Braitstein finds that researchers “didn’t know how to talk to young people about sex, and the role that sex plays in their lives”. In fact, she is hesitant to use the word sex to describe what street youth experience due to the high prevalence of sexual violence among girls especially. Recalling the stories that compelled her to pursue this avenue of research, Dr. Braitstein tells of forced sexual encounters between municipal guards and girls in exchange for protection, asking herself “what do the girls call that? Do they call it exchange sex? Do they call it forced sex? Do they even call it sex, or is it something that they just have to do?”. Through her 10 years of research and service, Dr. Braitstein has tackled issues surrounding sexual violence, exposing links between the social and political treatment of street children and the prevalence of HIV within the population.

Dr. Braitstein describes HIV research as the “thin edge of the wedge”, emphasizing the often-overlooked influence of social policy on population health. To facilitate evidence-informed policy, Dr. Braitstein advocates for the betterment of social services, rooted in securing food and shelter. She takes time to carefully explain the drivers of youth homelessness, challenging the criminal portrayal of street youth by local officials. “Part of the problem is the stigma they face”, said Dr. Braitstein. Per her research, the major drivers pushing children to the streets are extreme poverty, family conflict, and child abuse. Identifying the need for implemented harm reduction practices, Dr. Braitstein calls for an end to the “county-sanctioned violence” that further compromises the safety of street children. Recalling a poster distributed by the county children’s office which read “Do not give a future to street children”, Dr. Braitstein considers this portrayal of the vulnerable population as a “flagrant abuse of human rights”. Street children take much of the blame when it comes to their homelessness and HIV. “Every girl and every boy who is under 18, is getting [HIV] by sexual means. It constitutes statutory rape. We as a society are failing to help them” says Dr. Braitstein. Her research and advocacy work indicate the stigmatization worsens conditions for street youth, as at times some clinicians are reluctant to work with them.

Dr. Braitstein and her team implemented the Peer Navigator program to address the lack of services available to street youth. Two former street youth with mixed HIV status, one male and one female, are hired and sent into the community to provide information and counselling to street children, linking them to treatment. Consistent with her earlier assumptions, Dr. Braitstein finds that even with medication and testing, street youth face obstacles towards medical recovery. Without food and shelter, the children were unable to effectively complete their treatment. Dr. Braitstein also identifies the repatriation process, which involves placing youth back with their abusive guardians and family members, as retraumatizing and redundant. Moving away from the treatment of street youth as juvenile delinquents is an integral step in reducing HIV risk factors. The social stigma street youth face often reduces their access to meaningful treatment. According to Dr. Braitstein, her research can inform the work of others in sub-Saharan Africa.

Dr. Braitstein illustrates critical intersections between county politics, policy, and HIV. Through her research, Dr. Braitstein’s work offers comprehensive insight on an underserved and overlooked population. Her work makes important connections between population health and social assumptions that affect treatment. For a comprehensive list of Dr. Braitstein’s work, accomplishments, and affiliations, please visit her website.

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