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

Abstract

BackgroundAdolescents 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.MethodsWe 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.ResultsIn 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.ConclusionThese 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.

Eating sweets without the wrapper: perceptions of HIV and sexually transmitted infections among street youth in western Kenya

“…Girls on the street face unique sexual health challenges due to their need to engage in survival sex, their initiation rites, and the sexual and gender-based violence they sustain (Wachira et al 2015; Embleton et al under review). A novel finding in this study concerned the use of female condoms by girls.…”

“…Street boys sometimes seek sex for pleasure, power, and dominance in the street social hierarchy (Wachira et al 2015; Embleton et al under review). For girls, on the other hand, engaging in sex is a primary means of survival.…”

“…Street-connected young people in sub-Saharan African are often sexually active and tend to have an early sexual debut (Kayembe et al 2008; Wutoh et al 2006; Tadesse et al 2013; Mudingayi, Lutala, and Mupenda 2011; Anarfi 1997; Winston et al 2015). Research has revealed a variety of circumstances that place street-involved young people at high risk for contracting STIs including, sexual and gender-based violence, sexual street-initiation rites, transactional and survival sex, multiple concurrent partnerships, and inconsistent condom use (Kudrati, Plummer, and Yousif 2008; Lockhart 2002; Kayembe et al 2008; Winston et al 2015; Anarfi 1997; Wachira et al 2015; Embleton et al under review) Street-connected young people are also at risk of contracting STIs (Winston et al 2015; Kayembe et al 2008; Kaime-Atterhög et al 2007; Mandalazi, Banda, and Umar 2013). In Eldoret Kenya, Winston et al (2015) found street-connected youth had a high prevalence of STIs, with 28% of participants testing positive for at least one STI.…”

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

“…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). 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). SCY are socially and economically marginalized, earning less than 100 Kenyan Shillings (Ksh) (* 1.00 USD) per day, with young men earning significantly more than young women (Sorber et al 2014).…”