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.
The street children and youth are commonly referred to as “Khate” in Nepali, and they are known to roam around in particular areas of the city, where they engage in begging and loitering. A previous study estimated the national population of street children in Nepal at about 5000; of these, 500–600 are thought to reside in Kathmandu. There has been no official census carried out on the population of street children in Kathmandu for the last decade.
There are approximately 71,250 people living with HIV and AIDS in Nepal and the estimated national HIV prevalence rate is 0.39%. The risk of HIV infection among children and adolescents, especially those living on the streets, may be especially high due to their marginalized social and economic situations, as well as the existence of commercial sex and exchange sex (for food, shelter and other needs), along with intravenous drug use and other high risk behaviors in this population. However, there has been no official study carried out to ascertain the actual prevalence of HIV infection in this population.
The National HIV & AIDS Strategy (2006–2011) developed by the National Center for AIDS and STI Control, Government of Nepal, defines Intravenous Drug Users (IDUs), Men having sex with Men (MSM), Male Sex Workers (MSWs), Female Sex Workers (FSWs), Migrants, and Spouses of Prison inmates as the Most At-Risk Populations (MARPs) for developing HIV/AIDS. Similarly, young adults, uniformed service men and women, street children, and trafficked girls are categorized as At Risk Populations (ARPs) as per the government of Nepal, National HIV/AIDS Strategy (2006–2011). The street children and youth of Nepal may be vulnerable to sexual abuse and exploitation, such as pedophilia. The probability of these children and youth becoming involved in commercial sex and injecting drug use is high, which may increase their risk of HIV infection.
The true prevalence of HIV and other sexually transmitted diseases among street children in Nepal is virtually unknown, while information on behavioral risks in this population is non-existent. Worldwide, IDU accounts for 30% of HIV infection. Because many of the street children and youth engage in intravenous drug use[8, 9], transmission of HIV in this population is expected to be high. Unprotected sex, usually as exchange sex, is known to be common among street children worldwide and may also be the case for street children and youth of Kathmandu. Furthermore, there are certain other behavioral risk factors (BRFs) which are suspected to play a role in HIV transmission among street children and youth. These include group sex, sex with male and female sex workers, anal sex, alcohol use/abuse, and glue sniffing, all of which may play a role in a street child becoming exposed to and potentially infected with HIV. This study was designed to assess HIV prevalence in a sample of street children and youth from Kathmandu, as well as the BRFs associated with HIV infection in this population.