title: Paying for Sex by Young Men Who Live on the Streets in Dhaka City: Compounded Sexual Risk in a Vulnerable Migrant Community.
abstract: OBJECTIVE
  Dhaka City is home to thousands of migrants from Bangladesh's rural areas who often live in the streets. Prior studies examine street youth's practice of selling sex as a survival mechanism. We assess their less-studied practice of paying for sex and its association with sexual risk behaviors and outcomes.
  
  
  METHODS
  As part of the global Link Up project, trained interviewers recruited 447 young men who live on the streets, ages 15-24, from seven Dhaka City "hotspots" to participate in a survey about sexual health. Among those who ever had sex, we examined frequencies and conducted bivariate analyses of sociodemographic characteristics by paying for sex status. We then conducted bivariate and multivariate logistic regression analyses of paying for sex in the last 12 months and sexual health behaviors and outcomes.
  
  
  RESULTS
  Median participant age was 18 years. Among those who ever had sex (N = 321), 80% reported paying for sex in the last 12 months and 15% reported selling sex in the last 12 months. In multivariate analyses, those who paid for sex had significantly increased odds of reporting sexually transmitted infection-related symptoms in the last six months (adjusted odds ratio = 1.76, 95% confidence interval [CI] = 1.17-2.64) and engaging in unprotected last sex with a nonprimary partner (adjusted odds ratio = 2.19, CI = 1.58-3.03).
  
  
  CONCLUSIONS
  The adverse factors associated with paying for sex among young men who live on the streets in Dhaka City highlight the need for programs to educate on HIV/sexually transmitted infection prevention and promote condom use, STI screening/treatment, and HIV testing in this population.
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: tmcclair@gmail.com.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: McClair
authors.affiliation: Population Council, Dhaka, Bangladesh.
authors.forename: Tarik
authors.initials: T
authors.lastname: Hossain
authors.affiliation: Population Council, Dhaka, Bangladesh.
authors.forename: Nargis
authors.initials: N
authors.lastname: Sultana
authors.affiliation: Population Council, Washington, D.C.
authors.forename: Brady
authors.initials: B
authors.lastname: Burnett-Zieman
authors.affiliation: Population Council, Washington, D.C.
authors.forename: Eileen A
authors.initials: EA
authors.lastname: Yam
authors.affiliation: Population Council, Dhaka, Bangladesh.
authors.forename: Sharif
authors.initials: S
authors.lastname: Hossain
authors.affiliation: Marie Stopes Bangladesh, Dhaka, Bangladesh.
authors.forename: Reena
authors.initials: R
authors.lastname: Yasmin
authors.affiliation: Link Up Bangladesh, Dhaka, Bangladesh.
authors.forename: Najmus
authors.initials: N
authors.lastname: Sadiq
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Decker
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Saifuddin
authors.initials: S
authors.lastname: Ahmed
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000517:prevention & control; D018453:Homeless Youth / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D011477:Sex Work / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000706:statistics & numerical data; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D035862:Vulnerable Populations; D055815:Young Adult
keywords: Adolescent; Bangladesh; HIV; Male; Pavement dwellers; STI; Transactional sex