title: "Once you join the streets you will have to do it": sexual practices of street children and youth in Uasin Gishu County, Kenya.
abstract: BACKGROUND
  Adolescents 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  In 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.
  
  
  CONCLUSIONS
  These 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.
authors.affiliation: Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya. lonnie.embleton@gmail.com.|University of Toronto, Institute of Medical Sciences, Faculty of Medicine, Toronto, ON, Canada. lonnie.embleton@gmail.com.
authors.forename: Lonnie
authors.initials: L
authors.lastname: Embleton
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), 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: Department of Behavioral Sciences, Moi University, College of Health Sciences, Eldoret, Kenya. vnaanyu@gmail.com.
authors.forename: Violet
authors.initials: V
authors.lastname: Naanyu
authors.affiliation: Warren Alpert Medical School, Brown University, 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: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. dayuku_2000@yahoo.com.|Department of Behavioral Sciences, Moi University, College of Health Sciences, Eldoret, Kenya. dayuku_2000@yahoo.com.
authors.forename: David
authors.initials: D
authors.lastname: Ayuku
authors.affiliation: Moi University, College of Health Sciences, School of Medicine, Eldoret, Kenya. paula.braitstein@utoronto.ca.|Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. paula.braitstein@utoronto.ca.|Indiana University, Fairbanks School of Public Health, Indianapolis, IN, USA. paula.braitstein@utoronto.ca.|University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada. paula.braitstein@utoronto.ca.|Regenstrief Institute, Inc, Indianapolis, IN, USA. paula.braitstein@utoronto.ca.
authors.forename: Paula
authors.initials: P
authors.lastname: Braitstein
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D001294:Attitude to Health; D002648:Child; D005260:Female; D017144:Focus Groups; D018453:Homeless Youth / Q000523:psychology* / Q000706:statistics & numerical data; D006716:Homosexuality / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D036301:Qualitative Research; D011902:Rape / Q000523:psychology / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000523:psychology* / Q000706:statistics & numerical data; D012747:Sexual Partners; D009626:Terminology as Topic; D035862:Vulnerable Populations / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult