Journal of Adolescent Health 60 (2017) S29eS34
www.jahonline.org
Original article
Paying for Sex by Young Men Who Live on the Streets in Dhaka City:
Compounded Sexual Risk in a Vulnerable Migrant Community
Tracy L. McClair, M.S.P.H. a, *, Tarik Hossain, M.P.S. b, Nargis Sultana, M.P.S. b,
Brady Burnett-Zieman, M.P.H. c, Eileen A. Yam, Ph.D. c, Sharif Hossain, M.B.B.S. b,
Reena Yasmin, M.B.B.S. d, Najmus Sadiq, M.P.H. e, Michele R. Decker, Sc.D., M.P.H. a, and
Saifuddin Ahmed, M.B.B.S., Ph.D. a
a
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Population Council, Dhaka, Bangladesh
c
Population Council, Washington, D.C.
d
Marie Stopes Bangladesh, Dhaka, Bangladesh
e
Link Up Bangladesh, Dhaka, Bangladesh
b
Article history: Received April 14, 2016; Accepted September 28, 2016
Keywords: Pavement dwellers; Transactional sex; Bangladesh; Adolescent; Male; STI; HIV
A B S T R A C T
Purpose: 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 15e24, 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 ¼ 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 infectionerelated symptoms in the last six months (adjusted odds ratio ¼ 1.76, 95%
confidence interval [CI] ¼ 1.17e2.64) and engaging in unprotected last sex with a nonprimary
partner (adjusted odds ratio ¼ 2.19, CI ¼ 1.58e3.03).
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.
Ó 2016 Society for Adolescent Health and Medicine. All rights reserved.
IMPLICATIONS AND
CONTRIBUTION
Studies of transactional
sex among street youth
have often focused on
their practice of selling
sex. This study highlights
the high prevalence of
paying for sex among
young men who live on
the streets in Dhaka City
and its association with
sexual health risk behaviors and outcomes.
Conflicts of Interest: The authors report no potential, perceived, or real conflict of interest to disclose.
Disclaimer: Publication of this article was supported by the International HIV/AIDS Alliance, under the Link Up project funded by the Ministry of Foreign Affairs of the
government of the Netherlands. The opinions or views expressed in this supplement are those of the authors and do not necessarily represent the official position of
the funder.
* Address correspondence to: Tracy L. McClair, M.S.P.H., Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public
Health, 615 N. Wolfe Street, Baltimore, MD 21205.
E-mail address: [email protected] (T.L. McClair).
1054-139X/Ó 2016 Society for Adolescent Health and Medicine. All rights reserved.
http://dx.doi.org/10.1016/j.jadohealth.2016.09.024
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T.L. McClair et al. / Journal of Adolescent Health 60 (2017) S29eS34
Dhaka City, Bangladesh is a densely populated city with
nearly nine million people [1,2]. It has been recognized as one of
the fastest growing cities in the world [2]. Rural-to-urban
migration contributes to the city’s growth, as people from rural
areas seek greater economic opportunities in the city [3,4]. In
addition, natural disasters in coastal areas have forced people to
relocate elsewhere, often to Dhaka City [2]. Rapid urbanization
has led to an increase in the number of people living in informal
settlements and without permanent shelter [5].
Bangladesh has low HIV prevalence in the general population,
at less than .1% [6]. However, factors that could contribute to the
spread of HIV in Bangladesh include high population density,
poverty, and migration. International migration of people to and
from neighboring countries with higher HIV prevalence rates,
including India and Myanmar, also poses a potential risk [7].
Among those most at risk of HIV are people who inject drugs,
female sex workers, and men who have sex with men (MSM),
known as key population groups. Young people of age
10e24 years are also at an increased risk of HIV due to the unique
biopsychosocial changes that occur in this stage of life. This age
group accounts for nearly 40% of all new HIV infections worldwide [8]. Young people who live on the streets, colloquially
known as pavement dwellers in Bangladesh, warrant special
attention as they are particularly vulnerable to HIV and experience increased morbidity with regard to infectious disease,
mental health issues, and reproductive ill health [9e13].
In Dhaka City, there are approximately 20,000 people who
live on the streets and sleep in public spaces such as railway
stations, bus terminals, and ferry landings [14]. Life on the streets
of Dhaka is characterized by high levels of physical violence. A
prior study among street children in Dhaka City found a 72%
prevalence of experiencing physical violence on the streets [15].
As one of the most marginalized populations in Dhaka City,
people who live on the streets experience critical unmet needs in
all aspects of life including shelter, employment, education, food,
and health care [16].
Globally, young people who live on the streets engage in high
levels of sexual behaviors associated with an increased risk of HIV
and sexually transmitted infections (STIs) [13]. Early sexual debut
[9], injection and other drug use [9,17], multiple partnerships
[9,18], low rates of condom use [9,18,19], and transactional sex (the
exchange of sex for money, goods, or services) [19e23]
are commonplace among young people who live on the streets.
Transactional sex among these young people is of particular
concern because of its elevated association with STI and
HIV transmission [24,25]. Moreover, a recent systematic review
found that men who engage in transactional sex have a 20-fold
higher risk of HIV compared to the general population of men [26].
Much of the research on transactional sex focuses on those
who receive money, goods, or services for sex, particularly female
sex workers and MSM. However, men who pay for sex are a
population with sexual health needs that must be addressed as
well. In one study, male clients of sex workers were 10 times
more likely to have an STI than those who were not clients [27].
The present study was prompted by several gaps in the
literature. Discussions about adolescent sexual and reproductive
health (SRH) have largely focused on girls while neglecting the
needs of boys. Recently, however, there has been growing
recognition of the importance of addressing boys’ unmet SRH
needs [28]. Boys have a different risk profile compared with girls
and they are essential to the long-term sustainability of
improved adolescent SRH [28]. In addition, to our knowledge, no
prior study has investigated the sexual risks of street youth who
pay for sex, particularly in a developing country context. Therefore, the aims of this study were: (1) to determine the prevalence
of giving money, goods, or services for sex by young men who
live on the streets in Dhaka City, Bangladesh and (2) to investigate the relationship between paying for sex and sexual risk
behaviors and outcomes in this population.
Methods
This study was conducted as part of the Link Up project, a
global consortium that consists of service provision, advocacy,
and research aimed at improving the sexual and reproductive
health and rights of young key populations and other young
people affected by HIV in Africa and Asia. In Bangladesh, to inform
Link Up programming in Dhaka Cityeincluding mobile clinics and
on-site face-to-face HIV/SRH educational chatsewe conducted a
mixed-methods exploratory study focused on the HIV and sexual
health needs of young men living in the streets. This article presents findings from the quantitative component of this study.
Before administering the quantitative survey, interviewers
obtained informed consent from all study participants. Participants aged 18 years and older provided oral informed consent
directly. Written consent was not required due to low education
levels among young people living on the streets. Any young
person between the age of 15 and 17 years who did not live with
a parent or guardian was considered an emancipated minor and
was directly asked for informed consent. For those respondents
aged 15e17 years who lived with a parent or guardian,
interviewers obtained consent from the parent or guardian as
well as assent from the young person.
Trained interviewers then administered a quantitative survey
to collect data on the HIV and sexual health needs of young men
who live on the streets ages 15 to 24 in Dhaka City. The
interviewer-administered survey included questions about their
knowledge, behaviors, needs, and service utilization related to
HIV and sexual health. All participants were offered 100 Takas
($1.27, conversion rate on August 1, 2016) to cover the amount of
money they could have earned through work during the time it
took to participate in the survey. Participants were offered
referrals for free psychosocial and medical services at Marie
Stopes Bangladesh satellite clinics that were operating in each
hotspot under the Link Up project.
Ethical approval for this study was granted by the Population
Council Institutional Review Board (New York) and the
Bangladesh Medical Research Council (Dhaka).
Data collection
Informed by a literature review and with input from key
informants with experience working in these communities, 32
“hot spots” where many young men who live on the streets sleep
and work were identified. Estimates of the population of young
men who slept and worked within a 2 km radius of each spot
were collected from three key informants; we averaged these
three estimates to calculate each hot spot’s population. Of the 32
hot spots, the 7 sites with the largest number of young men were
selected as study sites. The number of participants to be interviewed at each study site was calculated using the probability
proportional to size technique. The sampling interval for each
T.L. McClair et al. / Journal of Adolescent Health 60 (2017) S29eS34
S31
Table 1
Sociodemographic characteristics of young men who live on the streets who ever had sex by paid for sex status (N ¼ 321)
Sociodemographic characteristics
Total participants who
ever had sex, N ¼ 321
Did not pay for sex in
last 12 months, (n ¼ 63)
% (N)
% (n)
Sold sex in last 12 months
Age
15e19
20e24
Education level
No education
Primary education and above
Marital status
Not married/cohabiting
Married/cohabiting
Currently working for pay
Monthly income
5,000 Takas
5,001e10,000 Takas
>10,000 Takas
Residence
Kamalapur Railway Station
Karwan Bazar
Gulistan
Sadarghat Launch Station
Azimpur
Airport Railway Station
High Court Mazar
Time at current residence
<1 year
1 year
15.0 (48)
3.2 (2)
17.8 (46)
63.2 (203)
36.8 (118)
68.3 (43)
31.7 (20)
62.0 (160)
38.0 (98)
47.0 (151)
52.3 (170)
54.0 (34)
46.0 (29)
45.3 (117)
54.7 (141)
89.4 (287)
10.6 (34)
98.4 (316)
79.4 (50)
20.6 (13)
96.8 (61)
91.9 (237)
8.1 (21)
98.8 (255)
29.0 (93)
60.4 (194)
10.6 (34)
28.6 (18)
58.7 (37)
12.7 (8)
29.1 (75)
60.9 (157)
10.0 (26)
17.5
19.9
19.9
15.9
5.3
15.9
6.5
15.9
19.1
23.8
23.8
1.6
9.5
6.3
17.8
20.2
19.0
14.0
6.2
17.4
5.4
a
Did pay for sex in last
12 months, (n ¼ 258)
p valuea
% (n)
.026
.420
.323
.034
.191
.592
<.001
(56)
(64)
(64)
(64)
(17)
(51)
(18)
(10)
(12)
(15)
(15)
(1)
(6)
(4)
(46)
(52)
(49)
(36)
(16)
(45)
(14)
.423
19.0 (61)
81.0 (260)
23.8 (15)
76.2 (48)
17.8 (46)
82.2 (212)
Second-order Rao-Scott chi-square.
study site varied from 2.5 to 8 according to the total number of
young men. A minimum of 16 interviews were conducted at each
study site. Randomization schemes were followed to identify
participants. A common randomization method used was spinning a bottle and then interviewing the person closest to the
bottle, followed by an interview of every nth person in a counterclockwise direction.
Statistical analysis
We sought to interview 432 young men who live on the
streets, aged 15 to 24 years, from January 2015 to March 2015.
This sample size was calculated to estimate indicators of interest
with 95% confidence and an absolute margin of error of 5%,
assuming 75% prevalence, with a design effect of 1.5 to account
for unknown intracluster correlation.
All analyses were limited to those who ever had sex (N ¼ 321,
defined as penetrative oral, vaginal, or anal sex). We calculated
frequencies of sociodemographic characteristics, including age
(15e19 and 20e24 years), education level (no formal education,
primary education, and above), marital status (not married/
cohabiting, married/cohabiting), job status (not currently working for pay, currently working for pay), monthly income (5,000
Takas [$64 USD, conversion rate on August 1, 2016],
5,001e10,000 Takas [$64e127 USD], >10,000 Takas [$127 USD]),
hot spot location, and time at current residence (less than 1 year,
1 year, or more). We calculated frequencies of those who had
paid for sex (defined as giving money, goods, or services in
exchange for sex in the last 12 months) and those who had sold
sex (defined as selling sex for money, goods, or services in the
last 12 months). We used second-order Rao-Scott chi-square
tests to examine the relationship between sociodemographic
characteristics and paying for sex, accounting for intracluster
correlation within sites.
We also calculated frequencies of sexual risk behaviors
including early sexual debut (before age 15), ever had an HIV test,
unprotected last sex with a nonprimary partner, sexual abuse at
current work/residence, and physical abuse at current work/
residence. We examined the prevalence of experiencing one or
more symptoms consistent with STIs in the last 6 months using a
checklist of reported STI symptoms including lower abdominal
pain, burning pain during urination, pus filled in genital area,
genital sores, swelling in groin area, itching in groin area, pain
during intercourse, or genital warts. This is similar to standard
methods for asking about STIs when participants may not know
the names for STIs and/or may not have been tested.
We conducted bivariate analyses using second-order RaoScott chi-square tests to determine the strength of the relationship between paying for sex and sexual risk behaviors and
outcomes. We then used multivariate logistic regression analyses
to examine the relationship between paying for sex, controlling
for sociodemographic characteristics, and early sexual debut, and
the sexual risk behaviors/outcomes that were significant in
bivariate analyses. We included early sexual debut as a covariate
in our multivariate model because of its documented association
with HIV risk and transactional sex in the literature.
In addition, we looked at whether selling sex was a driver of
the outcomes in the multivariate models. We examined how
many participants who sold sex in the last 12 months also paid
for sex in the last 12 months. We then created a single variable
with four levels (those who did not pay for or sell sex, those who
only sold sex, those who only paid for sex, and those who both
paid for and sold sex), and ran the multivariate models with this
variable. We then calculated linear combinations of estimators to
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T.L. McClair et al. / Journal of Adolescent Health 60 (2017) S29eS34
Table 2
Sexual risk behaviors and outcomes among young men who live on the streets who ever had sex by paid for sex status (N ¼ 321)
Sexual risk behaviors and outcomes
Early sexual debut
Ever had an HIV test
Unprotected last sex with nonprimary partner
Had one or more STI symptoms in last 6 months
Sexual abuse at current work/residence
Physical abuse at current work/residence
a
Total participants
who ever had sex
Did not pay for sex
in last 12 months
Paid for sex in
last 12 months
(N ¼ 321)
(n ¼ 63)
(n ¼ 258)
% (N)
% (n)
% (n)
61.4
3.1
51.7
78.5
14.3
83.5
50.8
3.2
33.3
68.3
9.5
76.2
64.0
3.1
56.2
81.0
15.5
85.3
(197)
(10)
(166)
(252)
(46)
(268)
(32)
(2)
(21)
(43)
(6)
(48)
(165)
(8)
(145)
(209)
(40)
(220)
p valuea
.097
.982
.005
.016
.143
.030
Second-order Rao-Scott chi-square.
compare those who only paid for sex and those who both paid for
and sold sex.
Robust standard errors were used to account for potential
intracluster correlation within study areas. The Hosmer-Lemeshow
goodness-of-fit test was used to determine model fit. We assessed
collinearity using the variance inflation factor. No individuals were
dropped from the analysis. All statistical analyses were performed
using Stata (version 13.1, StataCorp, College Station, TX).
Results
Across the seven study sites throughout Dhaka City, we
interviewed 447 participants. Among those, 72% reported that
they ever had sex (N ¼ 321). Table 1 displays sociodemographic
characteristics among young men who live on the streets who
ever had sex. Median age of participants was 18 years, 47% had no
formal education, 98.4% were currently working for pay, and 81%
had been living at their current place of residence for one year or
more. Median monthly income was 6,000 Takas (US $77). Eighty
percent of participants gave money, goods, or services in
exchange for sex in the last 12 months. Fifteen percent sold sex
for money, goods, or services in the last 12 months. Selling sex in
the last 12 months, marital status, and residence were significantly associated with paying for sex in the last 12 months.
Frequencies and bivariate tests of sexual risk behaviors and
outcomes among those who had ever had sex (N ¼ 321) are
displayed in Table 2, comparing those who paid for sex in the last
12 months with those who had not. Only 10 (3.1%) had ever had
an HIV test. Nearly, 80% had one or more self-reported STI
symptoms in the last 6 months. More than half (51.7%) engaged
in unprotected last sex with a nonprimary partner. In bivariate
analysis, unprotected last sex with a nonprimary partner, STI
symptoms, and physical abuse were significantly more common
among those who had paid for sex in the last 12 months
compared with those who did not.
Table 3 presents results from multivariate logistic regression
analysis examining the relationship between paying for sex in
the last 12 months and experiencing symptoms consistent with
STIs in the last 6 months. Those who paid for sex in the last
12 months had greater odds of having recent STI symptoms
(adjusted odds ratio [AOR]: 1.76; 95% confidence interval
[CI]: 1.17e2.64). Early sexual debut also was a significant
correlate (AOR: 1.84; 95% CI: 1.02e3.31). Higher income was
associated with decreased odds of having STI symptoms
(5,001e10,000 Takas compared with 5,000 Takas, AOR: .46;
95% CI: .86e.75; >10,000 Takas compared with 5,000 Takas,
AOR: .37; 95% CI: .20e.68).
Results from multivariate logistic regression analysis of the
association between paying for sex and unprotected last sex with a
nonprimary partner are displayed in Table 4. Controlling for sociodemographic variables and early sexual debut, paying for sex in
the last 12 months was significantly associated with a greater odds
of engaging in unprotected last sex with a nonprimary partner
(AOR: 2.19, 95% CI: 1.58e3.03). Those who were currently married/
cohabitating had reduced odds of engaging in unprotected last sex
with a nonprimary partner (AOR: .27; 95% CI: .15e.50). We also
examined physical abuse as an outcome in a multivariate model
with the same covariates in the prior multivariate models, and
paying for sex was not a significant predictor.
In addition, we found that among those who sold sex in
exchange for money, goods, or services (n ¼ 48), the majority had
also paid for sex in the last 12 months (n ¼ 46). We found no
significant differences in the outcomes between those who only
paid for sex and those who both paid for and sold sex, suggesting
that the far more prevalent behavior of paying for sex is driving
the association with the outcomes of STI symptoms and unprotected last sex with a nonprimary partner.
Discussion
While it is often presumed that young people who live on the
streets sell sex for survival needs, our study examined their
Table 3
Multivariate logistic regression analysis of correlates of having symptoms
consistent with STIs in the past 6 months (N ¼ 321)
Adjusted odds ratios
Age
15e19
20e24
Education level
No education
Primary education and above
Marital status
Not married/cohabiting
Married/cohabiting
Monthly income
5,000 Takas
5,001e10,000 Takas
>10,000 Takas
Time at current residence
<1 year
1 year
Early sexual debut
Paid for sex in last 12 months
*
p < .05.
p < .01.
**
Ref.
1.16 (.82e1.64)
Ref.
.98 (.63e1.53)
Ref.
.68 (.31e1.48)
Ref.
.46 (.28e.75)**
.37 (.20e.68)**
Ref.
1.10 (.43e2.77)
1.84 (1.02e3.31)*
1.76 (1.17e2.64)**
T.L. McClair et al. / Journal of Adolescent Health 60 (2017) S29eS34
Table 4
Multivariate logistic regression analysis of correlates of engaging in unprotected
last sex with a nonprimary partner (N ¼ 321)
Adjusted odds ratios
Age
15e19
20e24
Education level
No education
Primary education and above
Marital status
Not married/cohabiting
Married/cohabiting
Monthly income
5,000 Takas
5,001e10,000 Takas
>10,000 Takas
Time at current residence
<1 year
1 year
Early sexual debut
Paid for sex in last 12 months
***
Ref.
1.58 (.98e2.57)
Ref.
1.44 (.89e2.32)
Ref.
.27 (.15e.50)***
Ref.
1.00 (.63e1.60)
1.25 (.47e3.32)
Ref.
.70 (.38e1.27)
1.28 (.59e2.79)
2.19 (1.58e3.03)***
p < .001.
less-studied behavior of paying for sex. We found that most of
our sample of young men who live on the streets in Dhaka City
engaged in the practice of paying for sex in the last 12 months.
Moreover, those who paid for sex were more likely to report
symptoms consistent with STIs and less likely to use a condom at
their last sex with a nonprimary partner. It seems that paying for
sex by these young men depends on where pavement dwellers
sleep, the availability of sexual partners, the availability of likeminded friends, and to some degree, when money is available.
In this analysis, it is difficult to tease out the impact that income
has on young men’s likelihood of paying for sex because all
participants have relatively similar incomes and are of lower
socioeconomic status.
The prevalence of paying for sex in the last 12 months among
those who ever had sex in our sample (80%) is in vast contrast to
estimates of the percentage of men who had paid for sex in the
past 12 months in South Asia overall (3%e5%), and in Bangladesh
(10%) [7,29]. In addition, a study among truck drivers in Dhakaea
similarly vulnerable and highly mobile populationerevealed that
54% of men in this population had paid for sex in the past yearea
lower prevalence than what we found among young men who
live on the streets [30].
Our results have important implications for HIV and STI
programming among young men who live on the streets in
Dhaka City. There is clearly a need for HIV/STI prevention
education and STI screening and treatment, as well as targeted condom provision programs. In addition, a very small
percentage of our sample had ever had an HIV test. Because of
the prevalence of sexual risk behaviors among young men
who live on the streets and the low rates of HIV testing,
programs aimed at increasing access to HIV testing are
necessary.
Our analysis is based on a cross-sectional study, which limits
our ability to assess the temporal ordering of events with
certainty. However, our variables of interestdincluding paying
for sex in the last 12 months, STI-related symptoms in the last
6 months, and unprotected last sex with a nonprimary
partnerdare time bound in such a way that suggests that
participants experienced these events within close proximity of
(or simultaneously with) each other.
S33
Future research should aim to understand whom these young
men are paying for sex, such as whether they are male, female,
and/or hijra (transgender) and if they identify as sex workers. It is
possible that many of the young men in our study are MSM, but
we did not collect this information. Moreover, due to the sensitivity of the query, we did not ask participants to report whether
they engaged in insertive or receptive anal intercourse in the
quantitative data collection activity of this study, which also
impacts our understanding of their level of sexual risk. Furthermore, this study does not shed light on the motivation for
transactional sexdboth buying and sellingdby young men who
live on the streets. Prior studies have cited that young people
who live on the streets engage in transactional sex for pleasure,
procreation, money, goods, or it is forced [21,31,32].
A limitation of this analysis is that we did not collect data on
participants’ drug use behaviors. Prior studies of young people
who live on the streets have reported a high prevalence of drug
use [13]. It is important to consider that there is a growing
concentrated epidemic among people who inject drugs in Dhaka
City, among whom HIV prevalence is 7%dmuch higher than the
overall adult prevalence [7]. Furthermore, studies have shown an
association between drug use and risky sexual behaviors among
street children [11,20]. Women who use drugs in Dhaka City are
at a particularly high risk, as nearly two-thirds of women who
use drugs reported both selling sex and low levels of condom use
[7]. If young men who live on the streets buy sex from women
who use drugs, they may be at an elevated risk of HIV. Without
information on their drug use behaviors, we are likely missing an
important component of and perhaps a pathway to risky sexual
behaviors.
Future interventions in Dhaka City should incorporate strategies deemed highly effective for meeting SRH needs and
reducing risk of STI and HIV transmission among young people
who live on the streets. A program to reduce HIV transmission
among young people who live on the streets in Kampala, Uganda,
found that peer educators were effective at influencing street
youth to seek youth-friendly sexual health services at drop-in
centers set up by the program [33]. In addition, a program in
India set up “health camps” to provide STI testing and treatment
for children who live on the streets. The program also trained
child-health volunteers to provide health services to these
children [34].
Based on experience from prior interventions, peer educators
are effective in referring young men who live on the streets to
sexual health services located near where they live. For future
interventions targeting these young men who pay for sex, it
would be useful to develop a more in-depth understanding about
the settings and context by which they pay for sex to determine
how to best reach them with sexual health prevention and
treatment services.
In sum, most young men who live on the streets in Dhaka City
are paying for sex, a behavior that can be considered normative
among this population. Those who pay for sex are at an increased
risk of HIV and STIs, particularly if Bangladesh moves into further
stages of an HIV epidemic. This study adds to the literature of the
health status and needs of young men who live on the streets, an
immensely marginalized population in Dhaka City. Although
Bangladesh is currently a relatively low HIV epidemic setting,
macro-level risk factors including migration and poverty, the
prevalence of sexual risk behaviors among young men who live
on the streets, and the low rates of HIV testing in this population,
make it important to monitor the potential for a growing
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T.L. McClair et al. / Journal of Adolescent Health 60 (2017) S29eS34
epidemic and provide these young men with adequate sexual
health knowledge, treatment, and care.
Acknowledgments
The authors thank local implementing partner Nari Maitree
and data collectors for their support with study conceptualization and data collection activities. They are most grateful to the
young participants who generously contributed their time to
our study.
Funding Sources
This study was funded by the Dutch Ministry of Foreign
Affairs (SRHR Fund, Category A, Activity no. 24914) through a
subcontract from the International HIV/AIDS Alliance under the
Link Up project.
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