“Once you join the streets you will have to do it”: sexual practices of street children and youth in Uasin Gishu County, Kenya

Reproductive Health

Paula Braitstein²  David Ayuku³  Susanna Winston⁴  Violet Naanyu³  Allan Kamanda⁵  Juddy Wachira⁶  Lonnie Embleton¹ 

[1] University of Toronto, Institute of Medical Sciences, Faculty of Medicine, Toronto, ON, Canada;Regenstrief Institute, Inc, Indianapolis, IN, USA;Department of Behavioral Sciences, Moi University, College of Health Sciences, Eldoret, Kenya;Rhode Island Hospital/Hasbro Children’s Hospital, Providence, RI, USA;Moi Teaching and Referral Hospital, Eldoret, Kenya;Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

关键词: Human rights;    Abuse;    Sexual violence;    Sexual behaviour;    HIV;    Sex;    Street youth;    Street children;   

Others  :  1233690
DOI  :  10.1186/s12978-015-0090-z

 received in 2014-09-13, accepted in 2015-10-23,  发布年份 2015

【 摘 要 】

Background

Adolescents living in HIV endemic settings face unique sexual health risks, and in the context of abject poverty, orphanhood, social marginalization, and discrimination, adolescents may be particularly at-risk of horizontal HIV transmission. Street-connected children and youth are a particularly vulnerable and marginalized population and therefore may be a key population at-risk.

Methods

We sought to describe the sexual behaviours of street-connected children and youth in order to comprehend their sexual practices and elucidate circumstances that put them at increased risk of contracting HIV utilizing qualitative methods from a sample of street-connected children and youth in Eldoret, Kenya. We recruited participants aged 11–24 years who had lived on the street for ≥ 3 months to participate in 25 in-depth interviews and 5 focus group discussions stratified by age and sex.

Results

In total we interviewed 65 street-connected children and youth; 69 % were male with a median age of 18 years (IQR: 14–20.5 years). Participants identified both acceptable and unacceptable sexual acts that occur on the streets between males and females, between males, and between females. We grouped reasons for having sex into four categories based on common themes: pleasure, procreation, transactional, and forced. Transactional sex and multiple concurrent partnerships were frequently described by participants. Rape was endemic to street life for girls.

Conclusion

These findings have important policy and programming implications, specifically for the government of Kenya’s adolescent reproductive health policy, and highlight the need to target out-of-school youth. There is an urgent need for social protection to reduce transactional sex and interventions addressing the epidemic of sexual and gender-based violence.

【 授权许可】

   
2015 Embleton et al.

【 参考文献 】

• [1]UNAIDS: Thematic Segment: HIV, Adolescents and Youth. Geneva: UNAIDS; 2013. http://www.unaids.org/sites/default/files/en/media/unaids/contentassets/documents/pcb/2013/pcb33/agendaitems/20131121_Thematic-segment-HIV-%20youthadolescents%20.pdf. Accessed 23 October 2015.
• [2]WHO: HIV and Adolescents: Guidance for HIV Testing and Counselling and Care for Adolescents Living with HIV: Recommendations for a Public Health Approach and Considerations for Policy-Makers and Managers. Geneva; 2013. http://www.youngpeopleandhiv.org/files/HIV_Testing_guideline.pdf. Accessed 23 October 2015.
• [3]Kayembe PK, Mapatano MA, Fatuma AB, Nyandwe JK, Mayala GM, Kokolomami JI, Kibungu JP. Knowledge of HIV, sexual behavior and correlates of risky sex among street children in Kinshasa, Democratic Republic of Congo. East Afr J Public Heal. 2008; 5:186-92.
• [4]Wutoh AK, Kumoji EK, Xue Z, Campusano G, Wutoh RD, Ofosu JR. HIV knowledge and sexual risk behaviors of street children in Takoradi, Ghana. AIDS Behav. 2006; 10:209-15.
• [5]Tadesse N, Awoke Ayele T, Birhanu Mengesha Z, Addis Alene K. High prevalence of HIV/AIDS risky sexual behaviors among street youth in gondar town: a community based cross sectional study. BMC Res Notes. 2013; 6:234. BioMed Central Full Text
• [6]Winston SE, Chirchir AK, Muthoni LN, Ayuku D, Koech J, Nyandiko W, Carter JE, Braitstein P. Prevalence of Sexually Transmitted Infections Including HIV in Street Involved Adolescents in western Kenya. Sex Transm Infect. 2015; 91:305.
• [7]Mudingayi A, Lutala P, Mupenda B. HIV knowledge and sexual risk behavior among street adolescents in rehabilitation centres in Kinshasa; DRC: gender differences. Pan Afr Med J. 2011; 10:23.
• [8]Wachira J, Kamanda A, Embleton L, Naanyu V, Winston SE, Ayuku D, et al. Initiation to street life: a qualitative examination of the physical, social, and psychological practices in becoming an accepted member of the street youth community in Western Kenya. BMC Public Health. 2015;20.
• [9]Kudrati M, Plummer ML, Yousif ND. Children of the sug: a study of the daily lives of street children in Khartoum, Sudan, with intervention recommendations. Child Abus Negl. 2008; 32:439-48.
• [10]Embleton L, Wachira J, Kamanda A, Naanyu V, Ayuku D, Braitstein P. Eating sweets without the wrapper: perceptions of HIV and sexually transmitted infections among street youth in western Kenya. Cult Health Sex 2015, In Press.
• [11]Embleton L, Mwangi A, Vreeman R, Ayuku D, Braitstein P. The epidemiology of substance use among street children in resource-constrained settings: a systematic review and meta-analysis. Addiction. 2013; 108:1722-33.
• [12]CRA: Kenya County Fact Sheets: Uasin Gishu County. Nairobi: Commision on Revenue Allocation, Government of Kenya; 2011. http://siteresources.worldbank.org/INTAFRICA/Resources/257994-1335471959878/Kenya_County_Fact_Sheets_Dec2011.pdf. Accessed 23 October 2015.
• [13]Einterz RM, Kimaiyo S, Mengech HNK, Khwa-Otsyula BO, Esamai F, Quigley F, Mamlin JJ. Responding to the HIV pandemic: the power of an academic medical partnership. Acad Med. 2007; 82:812-8.
• [14]UN: Convention on the Rights of the Child. United Nations; 1990. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CRC.aspx. Accessed 23 October 2015.
• [15]NCAPD: Adolescent Reproductive Health and Development Policy: Plan of Action 2005-2015. Nairobi; 2005. http://www.policyproject.com/pubs/policyplan/KEN_ARH_POA%202005-15.pdf. Accessed 23 October 2015.
• [16]NCPD: Kenya Adolescent Reproductive Health and Development Policy: Implementation Assessment Report. Nairobi; 2013. http://www.prb.org/pdf13/kenya-policy-assessment-report.pdf. Accessed 23 October 2015.
• [17]Godia PM, Olenja JM, Hofman JJ, van den Broek N. Young people’s perception of sexual and reproductive health services in Kenya. BMC Health Serv Res. 2014; 14:172. BioMed Central Full Text
• [18]Godia PM, Olenja JM, Lavussa JA, Quinney D, Hofman JJ, van den Broek N. Sexual reproductive health service provision to young people in Kenya; health service providers’ experiences. BMC Health Serv Res. 2013; 13:476. BioMed Central Full Text
• [19]Nada KH, el Suliman DA. Violence, abuse, alcohol and drug use, and sexual behaviors in street children of Greater Cairo and Alexandria, Egypt. AIDS. 2010; 24 Suppl 2:S39-44.
• [20]Towe VL, Hasan S, Zafar ST, Sherman SG. Street life and drug risk behaviors associated with exchanging sex among male street children in Lahore, Pakistan. J Adolesc Heal. 2009; 44:222-8.
• [21]Mandalazi P, Banda C, Umar E. Street children’s vulnerability to HIV and sexually transmitted infections in Malawian cities. Malawi Med J. 2013; 25:1-4.
• [22]Lockhart C. Kunyenga, “real sex”, and survival: assessing the risk of HIV infection among urban street boys in Tanzania. Med Anthr Q. 2002; 16:294-311.
• [23]Cluver L, Orkin M, Boyes M, Gardner F, Meinck F. Transactional sex amongst AIDS-orphaned and AIDS-affected adolescents predicted by abuse and extreme poverty. J Acquir Immune Defic Syndr JAIDS. 2011; 58:336-43.
• [24]Operario D, Underhill K, Chuong C, Cluver L. HIV infection and sexual risk behaviour among youth who have experienced orphanhood: systematic review and meta-analysis. J Int AIDS Soc. 2011; 14:25. BioMed Central Full Text
• [25]Steffenson AE, Pettifor AE, Seage GR, Rees HV, Cleary PD. Concurrent sexual partnerships and human immunodeficiency virus risk among South African youth. Sex Transm Dis. 2011; 38:459-66.
• [26]Rositch AF, Cherutich P, Brentlinger P, Kiarie JN, Nduati R, Farquhar C. HIV infection and sexual partnerships and behaviour among adolescent girls in Nairobi, Kenya. Int J STD AIDS. 2012; 23:468-74.
• [27]Knopf A, Agot K, Sidle J, Naanyu V, Morris M. This is the medicine:” A Kenyan community responds to a sexual concurrency reduction intervention. Soc Sci Med. 2014; 108:175-84.
• [28]Baird SJ, Garfein RS, McIntosh CT, Özler B. Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: A cluster randomised trial. Lancet. 2012; 379:1320-9.
• [29]de Walque D, Dow WH, Nathan R, Abdul R, Abilahi F, Gong E, Isdahl Z, Jamison J, Jullu B, Krishnan S, Majura A, Miguel E, Moncada J, Mtenga S, Mwanyangala MA, Packel L, Schachter J, Shirima K, Medlin CA. Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania. BMJ Open. 2012; 2:e000747.
• [30]National Council for Population and Development: Sexual and Gender Based Violence in Kenya: A Call For Action. Volume 26 . Nairobi: National Council for Population and Development; 2012. https://www.google.ca/url?sa = t&rct = j&q = &esrc = s&source = web&cd = 1&ved = 0CBwQFjAAahUKEwjEi6TLoNnIAhWEth4KHdvKB9w&url = http%3A%2 F%2Fncpd-ke.org%2Fncpdweb%2Fsites%2Fdefault%2Ffiles%2FPolicy%2520Brief%252026_%2520Sexual%2520and%2520Gender%2520Based%2520Violence%2520in%2520Kenya%2520A%2520Call%2520for%2520Action%2520%28June%25202012 %29.pdf&usg = AFQjCNHzhvG8dWAhIxQVdFviVdP92z0sdw&cad = rja. Accessed 23 October 2015.
• [31]Sexual and Gender-Based Violence in Africa: A Literature Review. Nairobi: Population Council; 2008. http://www.svri.org/sgbvreview.pdf. Accessed 23 October 2015.
• [32]de Carvalho FT, Neiva-Silva L, Ramos MC, Evans J, Koller SH, Piccinini CA, Page-Shafer K. Sexual and drug use risk behaviors among children and youth in street circumstances in Porto Alegre, Brazil. AIDS Behav. 2006; 10(4 Suppl):S57-66.
• [33]Raffaelli M, Campos R, Merritt AP, Siqueira E, Antunes CM, Parker R, Greco M, Greco D, Halsey N. Sexual practices and attitudes of street youth in Belo Horizonte, Brazil. Soc Sci Med. 1993; 37:661-70.
• [34]Woan J, Lin J, Auerswald C. The Health Status of Street Children and Youth in Low- and Middle-Income Countries: A Systematic Review of the Literature. J Adolesc Heal. 2013; 53:314-21.
• [35]Swart-Kruger J, Richter LM. AIDS-related knowledge, attitudes and behaviour among South African street youth: reflections on power, sexuality and the autonomous self. Soc Sci Med. 1997; 45:957-66.
• [36]Bal B, Mitra R, Mallick AH, Chakraborti S, Sarkar K. Nontobacco substance use, sexual abuse, HIV, and sexually transmitted infection among street children in Kolkata, India. Subst Use Misuse. 2010; 45:1668-82.
• [37]Marshall BDL, Wood E. Sex Work and Sex Exchange Among Street Children: An Urgent Need for a Global Response. J Adolesc Heal. 2009; 44:201-2.