Knowledge of HIV, sexual behavior and correlates of risky sex among street children in Kinshasa, Democratic Republic of Congo.

CONTEXT Homeless children are at risk of getting many diseases, including sexually transmitted infections (STI). The number of street children is on the rise in the Democratic Republic of Congo (DRC), while very little is known about their health problems. OBJECTIVES To determine knowledge of HIV (transmission and prevention means), sexual activity, exposure to HIV-prevention services, and to identify correlates of risky sexual behaviour (not having used a condom at first or last sexual encounter and/or having multiple sexual partners over a 12-month period) among street children in Kinshasa. RESULTS At the time of the survey, most participants (85.8%, 95% CI = 83.5-88.1) were sexually experienced and 55.8% had their first sexual intercourse when they were already living on the streets. The median age at first sexual activity was 14.3 years for males and 13.5 years for females. Compared to males (median number of sexual partners = 1), females tended to be more involved with multiple sexual partners (median = 12). Condoms were used less at the fist sexual encounter (20.2%; 95% CI = 17.3-23.1) and the pattern of condom use depended on the type of sexual partners (61.1% at last sexual encounter with a paid/paying partner and 23.1% at last sexual encounter with a non-paid/non-paying partner). In males, sleeping in a NGO-provided night shelter (OR = 0.47; 95% CI = 0.27-0.79), and having had the first sexual intercourse while living on the streets (OR = 0.55; 95% CI = 0.35-0.88) were protective of risky sexual behaviour, while a history of drug use (OR = 3.00; 95% CI = 1.46-6.18), and being aged 20 to 24 years (OR = 1.59; 95% 1.00-2.55) increased the likelihood of displaying risky sexual behaviour. In females, not knowing where to get a condom (OR = 0.04; 95% CI = 0.005-0.29), having started sexual activity when living on the streets (OR = 0.10; 95% CI = 0.01-0.73) and not having an income-generating activity (OR = 0.09; 95% CI = 0.01-0.44) were protective of risky sexual behaviour. CONCLUSION Street children need to be regarded as a high-risk group for acquiring HIV. The potential benefit of providing homeless youth with night-shelters should be explored more since this could be an opportunity to integrate risk-reduction programmes that take into account all problematic behaviors such as risky sexual behaviour and drug use.