title: Initiation to street life: a qualitative examination of the physical, social, and psychological practices in becoming an accepted member of the street youth community in Western Kenya.
abstract: BACKGROUND
  The objective of this study was to describe the physical, social, and psychological initiation practices of street connected children and youths, in Eldoret, western Kenya.
  
  
  METHODS
  This qualitative study was conducted from August 2013 to February 2014. A total of 65 SCCY aged 11-24 years were purposively sampled from the three referral points: 1) A dedicated study clinic for vulnerable children and youth at Moi Teaching and Referral Hospital (MTRH); 2) Primary locations in which street children reside "bases/barracks"; 3) Street youth community-based organizations. In-depth interviews and focus group discussions were used to collect data. All data were audio recorded, transcribed, translated to English, and a content analysis performed.
  
  
  RESULTS
  The overall median age was 18 years (IQR 14-20.5 years) and 69.2% of participants were male. None had gone beyond primary level of education. The majority (81.5%) reported to be sexually active. The street community had well-defined structures and rules that were protective of members and ensured survival on the streets. To be fully accepted children had to go through an initiation ritual that had important gender differences. Common rituals between males and females included interrogation, smearing of black soot, and payment of tax. Ritual practices unique to boys were physical abuse, theft of personal possessions, volatile substance use, being forced to eat garbage, and sodomy among the physically weak. Rituals unique to girls were being forced to 'become a wife or sexual partner', rape, and gang rape. Physical and psychological abuse during initiation was normalized and there were no clear mechanisms of dealing with these forms of abuse.
  
  
  CONCLUSIONS
  There were important gender differences in the initiation practices of SCCY. Normalization of physical and psychological abuse during initiation contributes to the high health risks faced by these SCCY. Appropriate interventions need to be developed in collaboration with SCCY.
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, 30100, Eldoret, Kenya. wachirajuddy@gmail.com.
authors.forename: Juddy
authors.initials: J
authors.lastname: Wachira
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya. akamanda1@hotmail.com.
authors.forename: Allan
authors.initials: A
authors.lastname: Kamanda
authors.affiliation: University of Toronto, Dalla Lana School of Public Health, Ontario, Canada. lonnie.embleton@gmail.com.
authors.forename: Lonnie
authors.initials: L
authors.lastname: Embleton
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, 30100, Eldoret, Kenya. vnaanyu@gmail.com.|Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya. vnaanyu@gmail.com.
authors.forename: Violet
authors.initials: V
authors.lastname: Naanyu
authors.affiliation: Brown University, Warren Alpert Medical School, Providence, RI, USA. susanna.winston@gmail.com.|Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA. susanna.winston@gmail.com.
authors.forename: Susanna
authors.initials: S
authors.lastname: Winston
authors.affiliation: Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya. dayuku_2000@yahoo.com.
authors.forename: David
authors.initials: D
authors.lastname: Ayuku
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), P.O. Box 4606, 30100, Eldoret, Kenya. pbraitst@iu.edu.|Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya. pbraitst@iu.edu.|Department of Medicine, Indiana University, School of Medicine, Indianapolis, USA. pbraitst@iu.edu.|University of Toronto, Dalla Lana School of Public Health, Ontario, Canada. pbraitst@iu.edu.|Regenstrief Institute, Inc., Indianapolis, USA. pbraitst@iu.edu.
authors.forename: Paula
authors.initials: P
authors.lastname: Braitstein
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D018453:Homeless Youth / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D010379:Peer Group; D012929:Psychological Distance; D036301:Qualitative Research; D011902:Rape; D012111:Residence Characteristics; D012725:Sexual Behavior; D012747:Sexual Partners; D012931:Social Environment; D019966:Substance-Related Disorders; D055815:Young Adult