Date Published: August 28, 2012
Publisher: BioMed Central
Author(s): Dibesh Karmacharya, Dongmei Yu, Sameer Dixit, Rajesh Rajbhandari, Bhawana Subedi, Sonu Shrestha, Sulochana Manandhar, Susan L Santangelo.
The true prevalence of HIV and other sexually transmitted diseases among street children in Nepal is virtually unknown while information on related behavioural risk factors in this population is non-existent. The risk of HIV infection among street children and adolescents may be especially high due to their marginalized social and economic conditions. This study was conducted to determine the prevalence of HIV infection among a sample of street children and youth of Kathmandu and to identify risk factors associated with HIV infection in this group.
Among the 251 children and youth, we found an overall HIV prevalence of 7.6%. As the sample size of females was small (n = 13) and the behavioural risk factors are likely to be quite different for boys and girls, we conducted separate analyses by gender. As our small sample of females is unlikely to be representative and lacks power for statistical testing, our report focuses on the results for the males surveyed.The strongest behavioural risk factor to emerge from this study was intravenous drug use; 30% of the male subjects were injecting drug users and 20% of those were HIV positive. Furthermore, frequency of drug injection was a highly significant predictor with a dose–response relationship; males reporting occasional injection drug use were nearly 9 times more likely to be HIV positive than never users, while weekly drug injectors had over 46 times the risk of non-users, controlling for exposure to group sex, the only other significant risk factor in the multivariate model.
This sample of street children and youth of Kathmandu has a nearly 20-fold higher prevalence of HIV infection than the general population of Nepal (0.39%). The children and youth engage in number of high risk behaviours, including intravenous drug use, putting them at significant risk of contracting HIV and other sexually transmitted infections.
Nepal is a Low-Income Country, situated in South Asia, with a history of political and economic instability. Poverty and lack of education appear to be some of the factors that lead children and youth to leave their homes and come to the city centers in hopes of better living conditions. More often than not, however, such children are often forced to live on the street, which exposes them to many risks and dangers. Street children have been primarily grouped into three categories: children of the street, children on the street, and abandoned children
[1,2]. The first category encompasses children whose entire time is spent living on the streets, including eating and sleeping. These children may have minimal contact with family or relatives. The second category describes children who spend most of the time on the streets but spend time with their families at the end of the day. Abandoned children are those who have been left to live on the streets and have no contact with their family.
A total of 251 street children and youth aged 11–24 were surveyed; 19 of these subjects were positive for HIV, yielding an overall prevalence of HIV infection of 7.6% in this sample. This is over 19 times higher than the estimated HIV prevalence of the general population of Nepal at 0.39%
This study, the first of its kind in Nepal, was designed to a) assess the HIV status of a pilot sample of street children and youth of Kathmandu and b) identify risk factors associated with HIV infection among these children and youth. The serological tests revealed an HIV prevalence rate of nearly 8% among the sample of street children and youth surveyed. This is nearly 20 times greater than the estimated HIV prevalence of 0.39% for the general population of Nepal
. A similar study carried out in India reported a prevalence rate for HIV infection of 1% in street children of Kolkata
This sample of street children and youth of Kathmandu has a nearly 20-fold higher prevalence of HIV infection than the general population of Nepal (0.39%). The children and youth engage in a number of high risk behaviours, including intravenous drug use and sharing needles, putting them at a significant risk of contracting HIV and other sexually transmitted infections. Lack of formal education was a risk factor, albeit not the strongest one, highlighting the need for more education and prevention outreach in a population where formal education is not compulsory and illiteracy is even now, not uncommon.
AIDS: Acquired Immune Deficiency Syndrome; ARP: At Risk Population; BRF: Behavioural Risk Factors; ELISA: Enzyme Linked Immuno-Absorbent Assay; FGD: Focused Group Discussion; FSW: Female Sex Worker; HIV: Human Immunodeficiency Virus; IDU: Intravenous Drug Use; KABP: Knowledge Attitude, Behaviour and Practices; MARP: Most At Risk Population; MSW: Male Sex Worker; NHRC: Nepal Health Research Council; OR: Odds Ratio; STI: Sexually Transmitted Infection; WHO: World Health Organization.
The authors declare no conflicts of interest related to this study.
The overall study was designed by DK, SD, RR and BS with input from SLS. The field data collection was led by BS and supported by RR and SD. The lab work was done by SM under the supervision of SS. DY carried out all data analyses; DY and SLS interpreted results of statistical testing and made inferences. The manuscript was prepared by DK, SLS, DY and SD. All authors read and approved the final manuscript.