HIV prevalence in young people and children living on the streets, Kenya

Abstract

ObjectiveTo obtain an estimate of the size of, and human immunodeficiency (HIV) prevalence among, young people and children living on the streets of Eldoret, Kenya.MethodsWe counted young people and children using a point-in-time approach, ensuring we reached our target population by engaging relevant community leaders during the planning of the study. We acquired point-in-time count data over a period of 1 week between the hours of 08:00 and 23:00, from both a stationary site and by mobile teams. Participants provided demographic data and a fingerprint (to avoid double-counting) and were encouraged to speak with an HIV counsellor and undergo HIV testing. We used a logistic regression model to test for an association between age or sex and uptake of HIV testing and seropositivity.FindingsOf the 1419 eligible participants counted, 1049 (73.9%) were male with a median age of 18 years. Of the 1029 who spoke with a counsellor, 1004 individuals accepted HIV counselling and 947 agreed to undergo an HIV test. Combining those who were already aware of their HIV-positive status with those who were tested during our study resulted in an overall HIV seroprevalence of 4.1%. The seroprevalence was 2.7% (19/698) for males and 8.9% (23/259) for females. We observed an increase in seroprevalence with increasing age for both sexes, but of much greater magnitude for females.ConclusionBy counting young people and children living on the streets and offering them HIV counselling and testing, we could obtain population-based estimates of HIV prevalence.

Standardized mortality ratios between street-connected young people and the general age-equivalent population in an urban setting in Kenya from 2010 to 2015

“…PIT counts are a census-type approach to counting homeless individuals at a given time point. The methods are described in Braitstein et al 2019. In brief, after extensive community consultation, four teams were stationed at sites where SCY are known to gather.…”

“…A recent publication described a high number of deaths among street-connected young people (SCY) in an urban setting in Kenya, mostly from HIV and violence [1], and another described an HIV prevalence of 4.1% in the same population [2]. SCY, broadly defined as young people who live and work on the streets or for whom the streets are a central part of their identity, experience a high burden of morbidity related to infectious diseases, mental health, substance use, and sexual health [3].…”

Piloting an evidence-based intervention for HIV prevention among street youth in Eldoret, Kenya

“…In 2016, there were 1419 SCY under the age of 29 in Eldoret. Of those, 46% (n = 653) were aged 15 to 24 years (Braitstein et al 2019).…”

“…In Kenya, street-connected young people (SCY), for whom the streets play a central role in their everyday lives and social identities (Office of the United Nations High Commissioner for Human Rights 2017), engage in sexual practices that increase their exposure to HIV (Kaime- Atterhög et al 2007;Embleton et al 2015Embleton et al , 2016Wachira et al 2015Wachira et al , 2016. In Eldoret, Kenya, SCY have a STI and HIV prevalence that exceeds that of other young people in Kenya (Winston et al 2015;Shah et al 2018;Braitstein et al 2019). Street-connected young women aged 15-24 have an HIV prevalence almost four times higher than young women nationally (11% vs. 3.0%) (NASCOP 2014;Braitstein et al 2019) and frequently die due to AIDS (Embleton et al 2018).…”

“…In Eldoret, Kenya, SCY have a STI and HIV prevalence that exceeds that of other young people in Kenya (Winston et al 2015;Shah et al 2018;Braitstein et al 2019). Street-connected young women aged 15-24 have an HIV prevalence almost four times higher than young women nationally (11% vs. 3.0%) (NASCOP 2014;Braitstein et al 2019) and frequently die due to AIDS (Embleton et al 2018). Street-connected young women experience sexual and gender-based violence and are highly reliant on young men for security, economic, and material provisioning, and they are often perceived as 'unable to work' and/or rely on survival sex (Sorber et al 2014;Embleton et al 2015Embleton et al , 2016Wachira et al 2015;Winston et al 2015).…”