Prevalence and Correlates of HIV Infection among Street Boys in Kisumu, Kenya

Despite their perceived vulnerability to HIV, East African street youth have been neglected in HIV prevention research. We examined HIV seroprevalence and correlates of HIV infection in a sample of male street youth in Kisumu, Kenya.We enrolled a street-recruited sample of 13-21 year old street youth. Participants completed a survey followed by voluntary HIV counseling and testing. Survey items included demographics, homelessness history, survival activities, sexual behavior and substance use. We examined the relationship between predictor variables, markers of coercion and marginalization and HIV.The sample included 296 males. Survival activities included garbage picking (55%), helping market vendors (55%), begging (17%), and working as porters (46%) or domestic workers (4%). Forty-nine percent of participants reported at least weekly use of alcohol and 32% marijuana. Forty-six percent of participants reported lifetime inhalation of glue and 8% fuel. Seventy-nine percent of participants reported lifetime vaginal sex, 6% reported lifetime insertive anal sex and 8% reported lifetime receptive anal sex. Twelve (4.1%; 95% CI: 2.3-7.0) participants tested positive for HIV. Of those, all had been on the street for at least one year and all had engaged in vaginal sex. Occupations placing youth at particular risk of coercion by adults, including helping market vendors (prevalence ratio (PR) = 8.8; 95% CI: 1.2-67.5) and working as domestic workers (PR = 4.6; 95% CI: 1.1-19.0), were associated with HIV infection. Both insertive anal sex (PR = 10.2; 95% CI: 3.6-29.4) and receptive anal sex (PR = 3.9; 95% CI: 1.1-13.4) were associated with HIV infection. Drug use, begging, and garbage picking were not associated with HIV infection.Although HIV prevalence in our sample of street youth is comparable to that of similarly-aged male youth in Nyanza Province, our findings highlight behavioral factors associated with HIV infection that offer opportunities for targeted prevention among street youth in East Africa

Reported sexual behavior and substance use stratified by length of time on the street.

<p>*Does not sum to total due to missing responses from “time on the street”,</p><p>**of those reporting vaginal sex,</p><p>^† of those reporting insertive anal sex,</p><p>^‡ of those reporting receptive anal sex,</p><p>^{<b>^</b>} of those reporting both insertive and receptive anal sex,</p><p>^{<b>^^</b>} of those reporting vaginal sex and insertive and receptive anal sex.</p><p>Reported sexual behavior and substance use stratified by length of time on the street.</p

Socio-demographic characteristics of the sample population stratified by length of time on the street.

<p>*Does not sum to total due to missing responses from “time on the street”.</p><p>**Participants could choose more than one option.</p><p>Socio-demographic characteristics of the sample population stratified by length of time on the street.</p

HIV Prevalence among Male SCY in Kisumu, Kenya.

<p>HIV Prevalence among Male SCY in Kisumu, Kenya.</p

Risk Behavior Correlates of HIV Infection.

<p>*Not estimated due to zero cells</p><p>Risk Behavior Correlates of HIV Infection.</p

Socio-demographic Correlates of HIV Infection.

<p>* Not estimated due to zero cell.</p><p>Socio-demographic Correlates of HIV Infection.</p

Correlation of Vulnerability to Coercion and of Marginalization with HIV Infection and HIV Risk Behaviors.

<p>Does not add up to N = 296 because participants could choose more than one answer</p><p>*Not estimated due to zero cell.</p><p>^† Fisher’s Exact Test</p><p>Correlation of Vulnerability to Coercion and of Marginalization with HIV Infection and HIV Risk Behaviors.</p