Background: Throughout the developing world, children living on urban streets is a byproduct of economic deprivation. In Lahore, Pakistan, there are an estimated 5,000-7,000 street children. Purpose: The study examined HIV risk behaviors and factors associated with exchanging sex among male street children in Lahore, Pakistan. Methods: The survey was conducted from August 2003 to March 2004 among 565 registrants, ages 5-19, of Project Smile, a program that aimed to enhance the lives of street children in Lahore. We analyzed the frequency of and correlates of recent (past 3 months) sex exchange for money, drugs, or goods. Multivariate log-binomial regression was used to evaluate the independent effect of covariates on exchange sex. Results: Approximately 40% of participants reported having exchanged sex during the past 3 months. In multivariate analysis, the factors associated with exchanging sex were living on the street for longer than 48 months (Prevalence Ratio [PR]=1.36, 95% Confidence Interval [CI]: 0.99-1.85), reporting ever having used drugs (PR=1.87, 1.10-3.16), cutting one's self (PR=1.66, 95% CI: 1.26-2.19), and having heard of HIV/AIDS (PR=1.36, 95% CI: 1.03-1.80) after adjusting for demographic and street life variables. Conclusions: We found high rates of sex exchange among a sample of street children in Lahore, Pakistan. The finding that children who have heard about HIV/AIDS are more likely to exchange sex suggests that children at HIV risk talk about HIV, but accuracy of their conversations is unclear. Street children in Pakistan are in great need of HIV education and safe alternatives for generating income. © 2009 Society for Adolescent Medicine.
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