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BACKGROUND: Little is understood about the lives of street children in Khartoum, Sudan, particularly as relates to sexual health and risk behaviour. METHODS: 13 adult researchers and 11 child researchers interviewed more than 500 street children in qualitative interviews, and 2,200 street children in a quantitative survey. Participant observation, role-plays and drawing were also used. RESULTS: An estimated 6,000 children live on the streets full-time, 10% of whom are girls.
Children reported living on the streets because of "push" factors such as poverty, war, or abuse, and "pull" factors such as following friends or desiring drugs. 14% of girls and 1% of boys identified sexual abuse as their greatest challenge on the streets. However, qualitative research suggests that the majority of girls routinely experience rape, while many boys are occasionally raped. To protect themselves, girls may take boyfriends, while boys may become aggressive. Boys may engage in heterosexual or homosexual activities for pleasure, sometimes mistakenly believing male-to-male anal intercourse is safe from STDs. 17% of girls reported their main means of earning money was "taking risks" (mujazafa), or sex work. However, qualitative research suggests sex work may be the main source of income for girls, as they have few alternatives, are constantly approached, and it is a quick and lucrative way to earn money. Boys engage in sex work less, but are more likely to do so if they are addicted to glue. Misconceptions about HIV, AIDS and STDs abound, although many children reported having had symptoms that may relate to them. One-quarter of children reported inflamed genitalia, one-third reported skin infections, and one-half reported chest infections. CONCLUSIONS: There is an urgent need to provide children with sexual health education and protective measures while living on the streets. Efforts to assist them permanently off the streets must address the complex reasons why they are there.
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