[KUSMS IRC] [2015

Kathmandu University
School Of Medical Sciences
Dhulikhel, Kavre

A Research Proposal On:

Prevalence of Risk Behavior towards HIV among the Street
Children of Kathmandu

Advisor: Submitted By:

Deekshya Sapkota Rojina Poudel
Lecturer Roll no: 27
KUSMS BNS 3rd yr.
3rd Batch
KUSMS

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Contents:
Title…………………………………………………………………………………3
Objectives…………………………………………………………………………..3
Summary …………………………………………………………………………..3
Introduction………………………………………………………………………..4-5
Statement of problem………………………………………………………………6-7
Conceptual framework…………………………………………………………….8
Operational definition……………………………………………………………..9-10
Literature review…………………………………………………………………..10-18
Rationale of the Study …………………………………………………………….19
Research question…………………………………………………………………20
Research hypothesis………………………………………………………………20
Research design and methodology………………………………………………..20
Study variables……………………………………………………………………..20
Study site and its justification……………………………………………………..20-21
Population …………………………………………………………………………21
Sampling method………………………………………………………………….21
Sample size………………………………………………………………………...21
Selection criteria……………………………………………………………………21
Data collection………………………..……………………………………………22
Limitation of the study…………………………………………………………….22
Pre-testing the Data Collection Tools………………………………………………22
Plan for data analysis……………………………………………………………….22
Data Analysis………………………………………..……………………………..22
Expected Outcome of the Research…………………..……………………………23
Plan for Dissemination of Research Result………..……………………………….23
Ethical consideration……………………………….………………………………23
Work plan…………………………………………….…………………………….23
Budget plan…………………………………………….…………………………..24
Annexes
Questionnaire………………………………………………………….…………28-42

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Research Proposal Description Sheet

Title
Prevalence of Risk Behavior towards HIV Infection among the Street Children of
Kathmandu

Objectives
General objectives
* To assess the prevalence of HIV risk behaviors among the street children of
Kathmandu.

Specific objectives
* To find out knowledge regarding HIV infection among street children of
Kathmandu.
* To measure the distribution of behavioral risk factors among the street children of
Kathmandu
* To assess the association between socio-demographic factors and risk behaviors
among street children.

Summary
UNESCO defines street children as follows: “Street children are girls and boys for whom
the street has become their home and/or source of livelihood and who are inadequately
protected or supervised by responsible adults. They are temporarily, partially or totally
estranged from their families and society”.¹

Over the past few decades, the standard of living of many urban Nepalese has risen
beyond measure, even in the midst of political turmoil. But ironically, at the same time
many poor children are struggling for survival out in the streets, sleeping on makeshift
cardboard mattresses in main cities like Kathmandu, Pokhara, Dharan, Narayanghat,
Butwal, and Biratnagar.²

The risk of HIV infection among children and adolescents, especially those living on the
streets, may be especially high due to their marginalized social and economic situations,
as well as the existence of commercial sex and exchange sex (for food, shelter and other
needs), along with intravenous drug use and other high risk behaviors in this population.³

A cross-sectional method, quantitative study on ‘Prevalence of Risk Behavior towards

HIV Infection among the Street Children of Kathmandu’ will be done in selected areas of
Kathmandu, as having highest number of street children.

Study will be done on 83 samples for one month of period. Semi-structured questionnaire
will be used on the basis of the Behavioral Surveillance Survey and data will be collected
by interview technique.

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Pretesting will be done among the 10% of the sample population i.e. 8 in Kalanki and
Swayambu.

Introduction

“A child is anyone under the age of 18yrs” – CRC and Malaysia’s Child Act, 2001

UNESCO defines them as follows: “Street children are girls and boys for whom the street
has become their home and/or source of livelihood and who are inadequately protected or
supervised by responsible adults. They are temporarily, partially or totally estranged from
their families and society”.¹

Three categories of children can be found living on the streets:

 “Street” children, who are totally estranged from their families.
 Children “on the street”, who spend the majority of their day there before
returning to the family home at night-time.
 Children living on the street with their families, constituting a third emerging
category.¹

Low parental income, failure at school, family conflicts and parental negligence are a
number of reasons that lead to children living partially or permanently on the street.
Rather than living on the street, these children survive. On a daily basis, they are faced
with drugs, violence, gang rivalries and, in particular, the risks of HIV infection, linked in
particular to the fact that they are sexually precocious, exchange non-sterilised syringes,
lack information, etc.¹

"They work, living and sleeping in the streets, often lacking any contact with their
families. These children are at highest risk of murder, constant abuse and inhumane
treatment. They often resort to petty theft and prostitution for survival," reports
UNICEF. ²

Street children face difficulties in providing themselves with good sources of food, clean
drinking water, health care services, toilets and bath facilities, and adequate shelter. They
also suffer from absence of parental protection and security due to the missing connection
with their families. In addition, there is a lack of any kind of moral and emotional
support.⁴
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The risk of HIV infection among children and adolescents, especially those living on the
streets, may be especially high due to their marginalized social and economic situations,
as well as the existence of commercial sex and exchange sex (for food, shelter and other
needs), along with intravenous drug use and other high risk behaviors in this population.
The true prevalence of HIV and other sexually transmitted diseases among street children
in Nepal is virtually unknown, while information on behavioral risks in this population is
non-existent. Worldwide, IDU accounts for 30% of HIV infection.⁵

HIV/AIDS infection among street children continues to be a significant challenge despite

the progress that has been made in HIV/AIDS prevention and treatment at the national
level. As they pursue their livelihoods on the streets, street children embrace a street
culture that habitually influences sexual risky behaviors.⁶

The circumstances in which street children live and the challenges to which they are
subjected to, increase their vulnerability to HIV/AIDS and predispose the public to more
danger. This can be explained partly by the drives of economics of survival, little or
absence of information about the dangers of contracting HIV/AIDS and the risks
associated with it, inadequate health facilities attending to street children and inadequate
awareness programmes targeting the street children community.⁶

Moreover, the attitude of hopelessness about their lives encourages them to engage in
unprotected sex, while little information and low level of awareness limits street children
from adopting HIV/AIDS preventive measures.⁶

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Statement of problem
According to the World Health Organization (WHO), Exit Disclaimer there were
approximately 35 million people worldwide living with HIV/AIDS in 2013. Of these, 3.2
million were children (<15 years old).⁷

According to WHO, Exit Disclaimer an estimated 2.1 million individuals worldwide

became newly infected with HIV in 2013. This includes UNAIDS report shows that over
19 million of the 35 million people living with HIV today do not know that they have the
virus.⁷

Asia and the Pacific:

In Asia and The Pacific, nearly 350,000 people became newly infected in 2013,
bringing the total number of people living with HIV there to 4.8 million AIDS claimed an
estimated 250,000 lives in this region in 2013.⁸

The HIV/AIDS problem in Nepal is now more than a decade old. The first case of HIV
was reported in Nepal in 1988, and, in less than 15 years, approximately 61,000 adults
and children have become infected. HIV/AIDS infection rates are rapidly increasing due
to unawareness and lack of knowledge among vulnerable groups.⁹

Currently, four to six persons are getting HIV infection daily in Nepal while the number
of deaths caused by HIV/AIDS is 4800 in a year, according to a statics maintained by the
National AIDS and Venereal Disease Control Centre.¹⁰

The number of children surviving with HIV infection is 4,000 in Nepal, said Dr Naresh
Pratap KC, Director at the Centre, adding that the people taking drugs with syringe,
sexual workers, their customers, male homosexuals, those going abroad including India
for employment and their couple were at the high risk of HIV transmission and
infection.¹⁰

According to UN sources there are up to 150 million street children in the world today. ¹¹

Moreover, it is no longer a secret that street children statistics are just estimates, e.g.
Kenya: 250,000; Ethiopia: 150,000; Zimbabwe: 12,000; Bangladesh: 445,226; Nepal:
30,000; India: 11 million.¹

The risk of HIV infection among children and adolescents, especially those living on the
streets, may be especially high due to their marginalized social and economic situations,
as well as the existence of commercial sex and exchange sex (for food, shelter and other
needs), along with intravenous drug use and other high risk behaviors in this population.³

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Of the 251 street children and youth aged (11–24), 19 of them were positive for HIV,
yielding an overall prevalence of HIV infection of 7.6% in this sample. This is over 19
times higher than the estimated HIV prevalence of the general population of Nepal at
0.39%. This sample of street children and youth of Kathmandu has a nearly 20-fold
higher prevalence of HIV infection than the general population of Nepal (0.39%).
There are approximately 71,250 people living with HIV and AIDS in Nepal and the
estimated national HIV prevalence rate is 0.39%.⁵

Data taken in Jamaica reveals that street children interviewed engage in high-risk sexual
behaviour. This is evidenced in early initiation, transactional sex, multiple partners as
well as group sex, more commonly called 'battery'. There are also gaps in knowledge
levels related to HIV/AIDS as well as a worrying void of information on STDs, which
can significantly affect behaviour.¹²

In Nepal, Nearly half have been street children sexually abused while up to 30% are HIV
positive and 40% are drug-users, according to UNICEF.³

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Conceptual framework

Sociodemographic data:
-Age
-Sex Behavior
-Education -Drug use
-Occupation *alcohol
-Duration of stay *glue sniffing
*smoking
-Relation-ship status
-Condom use

Family background:
-History of abuse by the
family member
-conflict within the family

Risk behavior towards

HIV

Fig: Conceptual Framework for risk bahaviours towards HIV infection among Street
Children of Kathmandu

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Operational definition
Risk Behaviors for HIV: – any behavior that puts an individual or individuals at increased
risk of having HIV or transmitting HIV to another individual, with at least presence of
one behavior such as having multiple sex partners without using condoms consistently;
sharing used non‐sterile needles, syringes or other devices in last 1 month period .

Street child: A street child has been defined as one who is 8 years and above - 18 years of
age, and who has been on the streets for at least a period of three months.

Rag picker: Collecting scrap materials such as metals and plastics for the purpose of
selling them back to local collection centers.

Human Immuno Deficiency virus: A retrovirus that impairs and destroys the function of
Immune system cells, such as T-cells and macrophages, and ultimately results in AIDS.

Occupation: An activity that serves as one's regular source of livelihood such as

ragpicking, begging, selling goods, doing odd jobs etc.

Knowledge: It refers to relevant information and awareness regarding HIV such as its
method of transmission, diagnostic measures and preventive measures .
The score of the knowledge will be classified as :
1. 100%- very high
2. 80%-99%-High
3. 60%-79%-Moderate
4. <60%- Low

Sex/Sexual Intercourse: Are both employed to refer to vaginal or anal penetrative sex.

Non-regular partner: refers to a sex partner who is not the wife/husband or

girlfriend/boyfriend of the respondent.

Regular partner: refers to the sex partners who are husband/wife.

Glue sniffing: refers someone who breathes in the dangerous gases produced by some
types of glue in order to feel excited.

Unprotected sexual intercourse: an act of sexual intercourse performed without the use of
a condom, thus involving the risk of sexually transmitted diseases such as HIV.

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Injection drug: A drug that is injected using a syringe and that is not used for
medical purposes or for treatment of an illness.

Commercial sex partner: Anybody to whom one gives money to for sex.

Literature review:
A cross-sectional descriptive study was done to assess the ‘Knowledge and attitude of
HIV/AIDS and sexual behavior among street teenagers in Kathmandu Valley’.
Altogether 90 street teenagers were interviewed by using non-probability snowballing
sampling method. Two focus group discussions and interview technique were
administered.
The study found that teenagers have heard about AIDS and nearly sixty percent (57.8%)
had good level of knowledge. However, significant number of respondents had
misconception that one could contract HIV through mosquito bites and kissing. A
significant number of teenagers (43%) had experienced risky sexual behavior according
to the definition used in this study. Mean age of first sexual contact was 13.13 years.
Most of the respondents inconsistently used the condom (79.1%). An overwhelming
majority (70%) of the teenagers had multiple sexual partners. Both quantitative as well as
qualitative findings confirmed existence of homosexual relationship, though minimal in
number.¹³

Quantitative and qualitative data was acquired in ‘A Study on Knowledge, Attitudes,

Practices and Beliefs in the Context of HIV/AIDS among Out-of-School Street-Based
Children in Kathmandu and Pokhara’ among 513 Street children based on Behavioral
Surveillance Survey indicators. The survey systematically identified risk factors relevant
to the design of programme interventions and to provide a baseline to monitor the impact
of interventions over time. A series of Focus Group Discussions provided the opportunity
the target population for in-depth understanding of factors leading to risk-taking
behaviour. The study reveals inconsistencies within the knowledge, attitudes, practices,
and beliefs of street-based children in the context of HIV/AIDS. Although respondents
had basic knowledge regarding HIV/AIDS, practical knowledge on the basic facts of
transmission and prevention is more limited and unclear. A total of 6.5% and 7.4% of
boys and girls respectively reported ever injecting drugs, whereas 31.8% and 21.6% of
boys and girls respectively are sexually active.⁹

A study on ‘Psychosocial Predictors of HIV/AIDS Risk Behaviors in Nepalese Street

Youth’ by Alison Homer shows Sixty-four percent of sexually active respondents had
ever had a known HIV positive, injecting drug using, or commercial sex partner, 56%
had ever had anal sex, survival sex, forced sex, or sex while intoxicated, and 78% had
had at least one of any of these. Only 30% and 13% reported consistent condom use with

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commercial and non-regular partners, respectively. Twenty-three percent of youth had

ever injected drugs, and of these, 65% had shared needles.¹⁴

‘A study of the prevalence and risk factors leading to HIV infection among a sample of
street children and youth of Kathmandu’ was conducted based on the purposive sampling
of ten streets in Kathmandu, Nepal. A total of 251 street children (aged 11–16 years) and
youth (aged 17–24 years) were enrolled, with informed consent, from November, 2008
through June, 2009. Case status was determined by serological assessment of HIV status;
data on risk factors were obtained using structured survey interviews.
Among the 251 children and youth, found an overall HIV prevalence of 7.6%. The
strongest behavioural risk factor to emerge from this study was intravenous drug use;
30% of the male subjects were injecting drug users and 20% of those were HIV positive.
Furthermore, frequency of drug injection was a highly significant predictor with a
dose–response relationship; males reporting occasional injection drug use were nearly 9
times more likely to be HIV positive than never users, while weekly drug injectors had
over 46 times the risk of non-users, controlling for exposure to group sex, the only other
significant risk factor in the multivariate model.
This sample of street children and youth of Kathmandu has a nearly 20-fold higher
prevalence of HIV infection than the general population of Nepal (0.39%). The children
and youth engage in number of high risk behaviours, including intravenous drug use,
putting them at significant risk of contracting HIV and other sexually transmitted
infections.⁵

A cross-sectional descriptive study on ‘Exchange sex and risk of HIV among street
children in Nepal’ conducted from September 2009 to February 2010. A total of 150
street children aged 5 to 18 years were interviewed face to face using a semi-structured
questionnaire and snowball sampling strategy.
Above sixty Percentages (61.3%) of street children reported having exchanged sex. The
reasons for participation in exchange sex included entertainment (82%), drugs (42.4%),
money (41.3%) and food and shelter (15.2%). Within the group of children who reported
involvement in exchanging sex, 67.4% exchanged sex when using drugs, 79.3%
participated in anal sex and 20.7% in oral sex. The following factors were significantly
associated with increased exchange sex: age of the children, age when first leaving home,
living in groups, alcohol and drug us. Exchange sex was 3.9 times higher in alcohol users
and 4.4 times higher in drugs users compared to non users. Condom use during sexual
intercourse was rare (5.4%).¹⁵

A cross-sectional survey ‘Substance use and risky sexual behaviours among street
connected children and youth in Accra, Ghana’ with a convenient sample of 227 (122
male and 105 female) street connected children and youth was conducted in 2012. Using
self-report measures, the relationship between substance use and risky sexual behaviours
was examined using logistic regression.

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Substance use was relatively high as 12% and 16.2% reported daily use of alcohol and
marijuana respectively. There were age and sex differences in substance use among the
sample. As compared to males, more females had smoked cigarettes, used alcohol and
marijuana. While alcohol use decrease with age, marijuana use on the other hand
increases with age. Results from multivariate analysis revealed that having ever drunk
alcohol and alcohol use in the past one month were independently associated with all the
four indices of risky sexual behaviour (ever had sex, non-condom use, multiple sexual
partners and survival sex). Both marijuana use and smoking of cigarettes were associated
with having ever had sex, multiple sexual partners and survival sex. Other drug use was
independently associated with non-condom use.¹⁶

A cross-sectional behavioural survey on ‘Street-based adolescents at high risk of HIV in

Ukraine’ was conducted of 805 adolescents (aged 10–19 years) in the cities of Kiev,
Donetsk, Dnepropetrovsk and Nikolaev. Using location-based network and convenience
sampling, 200 adolescents were reached in each site and were administered a
standardised questionnaire on drug use, sexual behaviour, condom use, HIV knowledge,
access to prevention services, experience of violence and contact with state institutions
and police.
Considerable levels of HIV risk behaviour were found, including injecting drug use
among 15.5% of the sample. Almost three-quarters of adolescents had experienced sexual
debut, most before the age of 15 years. Male-to-male sexual behaviour was reported by
just under 10% of boys. Condom use was low although varied by partner type. There
were high rates of forced sex, and 75.5% of respondents reported police harassment.
Street-based adolescents in Ukraine are at significant risk of contracting HIV due to
involvement in injecting drug use and unprotected sex in personal and commercial
exchanges, including male-to-male sex. This group initiates risk behaviours at early ages,
and does not appear to have good access to prevention and other health services.¹⁷

A cross sectional study with a quantitative approach on ‘Exploration of knowledge,

attitudes and behaviours of street children on the prevention of HIV and AIDS in the
Huye district, Rwanda’ was carried out in two street children centres in the Huye district.
Non probability convenience sampling was used and 83 participants between the ages of
10 and 18 years old were invited to participate. These comprised of 43 females (51.8%)
and 40 males (48.2%).
The findings indicated that the knowledge level of the participants was moderate at
71.7%. However, they still had misconceptions regarding HIV and AIDS as 16.9% of the
participants said that there is a vaccine for HIV and AIDS and that it is curable. While
78.3% of the participants knew that HIV could be transmitted by body fluids, only 45.8%
and 49.4% knew that it could be transmitted by oral sex and anal sex respectively. The
current study revealed that 36.1% of the participants were currently sexually active and
53.7% had not used a condom during their last sexual intercourse. A total of 21.7% of the

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participants had been given money; drugs or place to sleep in exchange for sex and
20.7% declared that they had unwillingly been forced to have sex.
It is evident that although street children have a moderate knowledge level about HIV and
AIDS, they still have certain misconceptions and are exposed to HIV and AIDS due to
their risky behaviours.¹⁸

A cross-sectional study on ‘Comprehensive knowledge, attitude and practice of street

adults towards human immunodeficiency virus/acquired immune deficiency syndrome
(HIV/AIDS)’ was conducted on 325 street adults at two cities using a pretested
questionnaire. Comprehensive knowledge on HIV/AIDS was assessed using five
questions, attitude was measured using the Likert scale and practice by condom use and
number of sex partners in the last one year. Majority (96.9%) had ever heard about
HIV/AIDS. Only 31.4% had comprehensive knowledge, 23.7% favorable attitude and
27.7% used condom in their recent sexual intercourse. Almost a third (30.4%) had more
than one sex partner in the last one year. The level of comprehensive knowledge, attitude
and practice were low among street adults especially among those who cannot read and
write. ¹⁹

A study on ‘Prevalence and Correlates of HIV-Risk Behaviors among Homeless Adults

in a Southern Cityaims’ was done. A cross-sectional, interviewer-administered survey
was conducted with a convenience-based sample (N=116) of homeless adults. Sex
without a condom, sex while on drugs or drunk, and sex with an unknown person
emerged as the three most prevalent HIV-risk behaviors. Sex while drunk or high on
drugs was also assessed as a significant predictor for sex without a condom and sex with
an unknown person. Multivariate logistic regressions revealed that mental health status,
duration of homelessness, incarceration history, and sex while drunk or high on drugs
were significant predictors of HIV-risk behaviors. Consideration of these important
correlates in designing HIV prevention programs for this vulnerable sub-group of adults
is warranted.²⁰

A study on ‘Glue Sniffing & Other Risky Practices Among Street Children In Urban
Bangladesh’ aimed at assessing the nature of drug use and other risky practices among
street children aged 11 to 19 years in Dhaka and Chittagong, the two major metropolises
of Bangladesh.
Inhalation of glue and use of other substances like cannabis and pharmaceuticals,
smoking and chewing tobacco, were found to be prevalent among these children. They
were also found to be sexually active early and most of them were engaged in
unprotected sex, most girls selling sex, and most boys reporting low condom use. This
study shows an association between glue sniffing, injecting drug use and other risky
sexual practices, which amplifies the risk for HIV among these children.²¹

A study on ‘HIV knowledge and sexual risk behavior among street adolescents in
rehabilitation centres in Kinshasa; DRC: gender differences’, with a random sampling of

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200 street children (10-25 years of age) were selected from 17 rehabilitation centres in
Kinshasa, and a structured questionnaire was administered to all participants in their
respective centres. High knowledge, knowledge or awareness of condom was defined
when a participant gave more than 67% of correct responses.
The knowledge level of respondents was high. 54.3% of males and 45.7% of girls have
heard about HIV), and few participants cited unprotected sex as mode of transmission
(42.9% for males and 57.1% for females). A high number of children reported a previous
sexual experience. Satisfying a natural bodily need was the main reason for having sex.
However, the use of condoms is still low in both genders (26.2 versus 59.3%). Neither
gender reported a reason why they are not using a condom.²²

A community based cross sectional study on ‘High prevalence of HIV/AIDS risky sexual
behaviors among street youth in gondar town: a community based cross sectional study’
was conducted on 467 street youth living in Gondar town. A pre tested and structured
questionnaire via interview was used to collect data.
A total of 288 (61.7%) respondents had sexual intercourse in their life time. Among these
264 (91.7%) had more than one lifetime sexual partners. In addition, 80.5% of them used
condom inconsistently in the last 12 months. Khat chewing was found to be predictor of
having multiple sexual partners. Rural former residence and longer duration of stay on
the street are also identified as predictors of inconsistent condom use.
High prevalence of HIV/AIDS risky sexual behaviors were observed among street youth
in Gondar town. Interventions aimed at reducing sexual risky behaviors among street
youth should focus on reducing the duration of stay on the street and chat chewing.²³

A study on ‘HIV infection and sexual risk behaviour among youth who have experienced
orphanhood: systematic review and meta-analysis’ using systematic review methodology,
identified 10 studies reporting data from 12 countries comparing orphaned and non-
orphaned youth on HIV-related risk indicators, including HIV serostatus, other sexually
transmitted infections, pregnancy and sexual behaviours and then meta-analyzed data
from six studies reporting prevalence data on the association between orphan status and
HIV serostatus, and qualitatively summarized data from all studies on behavioural risk
factors for HIV among orphaned youth.
Meta-analysis of HIV testing data from 19,140 participants indicated significantly greater
HIV seroprevalence among orphaned (10.8%) compared with non-orphaned youth
(5.9%). Trends across studies showed evidence for greater sexual risk behaviour in
orphaned youth.
Studies on HIV risk in orphaned populations, which mostly include samples from sub-
Saharan Africa, show nearly two-fold greater odds of HIV infection among orphaned
youth and higher levels of sexual risk behaviour than among their non-orphaned peers.²⁴

A study on ‘Knowledge of HIV, sexual behavior and correlates of risky sex among street
children in Kinshasa, Democratic Republic of Congo’ shows most participants (85.8%,)
were sexually experienced and 55.8% had their first sexual intercourse when they were

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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, females tended to be more
involved with multiple sexual partners. Condoms were used less at the fist sexual
encounter (20.2%) 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 and having had the first sexual intercourse while living on the
streets were protective of risky sexual behaviour, while a history of drug use, and being
aged 20 to 24 years increased the likelihood of displaying risky sexual behaviour. In
females, not knowing where to get a condom, having started sexual activity when living
on the streets and not having an income-generating activity were protective of risky
sexual behaviour.²⁵

The Ethnographic participatory, qualitative study on ‘Vulnerability of Bangladeshi street-

children to HIV/AIDS: a qualitative study’ was conducted during 2010-2011namong
street children in Dhaka. Data collected in three phases: a)social mapping (n=493),
b)participatory group discussions (n=119), and c) individual interviews (n= 36).
Results showed that street children were engaged in behavior that entails risk of exposure
to HIV/AIDS. They possessed poor knowledge of the transmission of disease and of the
benefits of using condoms; most of them reported never using condom. The experience of
selling sex for money and a variety of sexual activities, like anal, vaginal and oral sex,
were commonly reported. The children children also reported that they were regular users
of one or more type of drugs, including those taken by injection.²⁶

‘HIV/AIDS Risk Behaviours among Injecting Drug Users: Addressing Development

of Risk Behaviour Knowledge and Patterns of Risk Behaviour Practices in Context
of Demographic Characteristics’ is a cross sectional study, patients admitted for treatment
and rehabilitation from injecting drug abuse, were interviewed and statistical testing was
conducted using SPSS 10.1 to identify critical factors of risk behaviour practices.
149 male injecting drug users were included in the present study; females were excluded
due to insignificant representation. Patients were interviewed on a self-developed
structured questionnaire for demographic and psychosocial characteristics and another
structured questionnaire was used to obtain level of risk behaviour knowledge and
frequency of risk behaviour practices.
Present study investigated HIV/AIDS risk behaviour practices in injecting drug users.
Result shows that only two sources of knowledge Television and Print Media
significantly influenced acquisition of risk behaviour Knowledge. Among demographic
characteristics, of IDUs and their access to sources of knowledge, only socioeconomic
status and education are associated with access to sources of knowledge. Sexual risk
behaviour was predicted by marital status and Living status. Patients living alone showed
higher levels of risk behaviour practices than patients living with parents and patients
living with family. In addition, high frequency of injections predicted higher
levels of risk behaviour practices.²⁷

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‘Short risk behaviour knowledge index for HIV average risk population of sexual active
age in Munich, Germany’ is proposed and implemented for an HIV average risk
population in Munich.Knowledge levels about HIV/AIDS risk behaviour was assessed in
a group of people (n=210) in sexually active age range of 18–49 years which was at an
average risk of contracting HIV. Four questions about HIV transmission by unprotected
vaginal, anal, or oral sexual intercourse, and by needle sharing, and two questions about
HIV prevention by condom use, and the single use of needles and syringes were chosen
from ten others for making a four level risk behaviour knowledge index internally
consistent according to Cronbach’s alpha.
Results shows there is no association with sex and marital status, but depended (p<0.05)
on age, education and social status. General population of Munich in a sexually active
age group of 40–49 years, or those without further education or the unemployed, had a
significantly lower knowledge of HIV risk behaviour.²⁸

An ethnographic study was done on ‘High Risk Behaviours, STIs and Street Children in
Jamaica’, findings represent data collected via unstructured interviews and participant
observation from 26 street children and 9 adults who work in related fields in Downtown
Kingston, Ligueanea and Montego Bay, Jamaica. Data reveals that street children
interviewed engage in high-risk sexual behaviour. This is evidenced in early initiation,
transactional sex, multiple partners as well as group sex, more commonly called 'battery'.
There are also gaps in knowledge levels related to HIV/AIDS as well as a worrying void
of information on STDs, which can significantly affect behaviour.¹²

A study on ‘Canadian street youth: correlates of sexual risk-taking activity’, was to

develop a national perspective on the sexual activity of street youth in Canada and to
determine the correlates of risky sexual behavior according to street youth's link to the
street. Five categories of street youth (sex industry workers, heavy drug and/or alcohol
users, young offenders, homeless and unemployed) ages 15 to 20 years were recruited in
1988 from 10 Canadian urban centers to participate in a 45-minute structured interview
focusing on knowledge and attitudes regarding sexually transmitted diseases
(STD)/human immunodeficiency virus, current sexual practices, sexual and STD history,
demographic background, alcohol/drug use and relationship with parents and peers. Data
from the survey were also compared with findings from more than 15,000 non-street
youth adolescents surveyed in the same year with the use of parallel questionnaires. Of
712 street youth surveyed (391 males, mean age 17.3 years; 321 females, mean age 16.8
years), the majority were sexually active (95% males, 93% females) and 22% reported at
least one previous STD (16% males, 30% females). The lowest STD rates were in
unemployed males (5%) and the highest (68%) in female sex industry workers.
STD/human immunodeficiency virus high risk behaviors were frequent with 47% of
males and 41% of females having had at least 10 different partners, 73% of males and
75% of females inconsistently using condoms and 22% of males and 24% of females
participating in anal intercourse. Even among sex industry workers more than 40% used
condoms inconsistently.²⁹

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A qualitative study on ‘Street children's vulnerability to HIV and sexually transmitted

infections in Malawian cities’ was conducted by employed In-depth interviews with
street children in the two main cities of Malawi. A total of 23 street children were
interviewed.
The study strongly suggests that street children could be vulnerable to HIV and other
sexually transmitted infections. This is due to various factors which include low
knowledge levels of STI and HIV, high risk sexual practices, lack of safer place to spend
their nights for both boys and girls rendering them vulnerable to sexual abuses and the
use of sex as a tool to secure protection and to be accepted especially for the newcomers
on the street. ³⁰

The survey was conducted on ‘Street Life and Drug Risk Behaviors Associated with
Exchanging Sex Among Male Street Children in Lahore, Pakistan’ from August 2003 to
March 2004 among 565 registrants, ages 5–19, and 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.
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, reporting ever having used drugs and having
heard of HIV/AIDS after adjusting for demographic and street life variables.
Results shows 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.³¹

A study on ‘Children in the Streets of Brazil: Drug Use, Crime, Violence, and HIV Risks’
of 5 – 18 yrs reported the widespread use of inhalants, marijuana and cocaine, and
Valium among street children. Also common is the use of coca paste and Rohypnol. Risk
of exposure to HIV is rapidly becoming an area of concern because of the large number
of street youths engaging in unprotected sexual acts, both renumerated and
nonrenumerated. Moreover, Brazil's street children are targets of fear. Because of their
drug use, predatory crimes, and general unacceptability on urban thoroughfares, they are
frequently the targets of local vigilante groups, drug gangs, and police “death squads.”
Although there have been many proposals and programs for addressing the problems of
Brazilian street youth, it would appear that only minimal headway has been achieved.³²

A study on ‘AIDS-Risk among Street Children and Youth: Implications for Intervention’
with the co-operation of staff and volunteers from non-governmental programmes in nine
South African cities, focus group discussions were held with 141 street children and
youth, 79 of whom were enrolled in shelter programmes while 62 were still living

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independently on the streets. The group discussions focused on knowledge about

transmission and prevention, attitudes towards AIDS and people with AIDS, and sexual
and other behaviours related to AIDS risk. Both quantitative and qualitative information
on the topics covered was extracted from the transcriptions of the discussions. The results
indicated that, on a superficial level, South African street youth possessed relatively good
knowledge about transmission and prevention. However, a more critical analysis showed
that knowledge is obscured by moral imputations. In addition, street youth disclosed
extremely negative attitudes to condoms and to people with AIDS. Accounts of sexual
behaviour confirmed that street children and youth engage in a number of high-risk
behaviours.³³

A study on ‘Homelessness and unstable housing associated with an increased risk of HIV
and STI transmission among street-involved youth’ shows the factors associated with
number of sex partners using quasi-Poisson regression and consistent condom use using
logistic regression among participants enrolled in the At Risk Youth Study (ARYS).
Among 529 participants, 253 (47.8%) reported multiple partners while only 127 (24.0%)
reported consistent condom use in the past 6 months. Homelessness was inversely
associated with consistent condom use (adjusted odds ratio [aOR]=0.47, p=0.008), while
unstable housing was positively associated with greater numbers of sex partners. ³⁴

A qualitative study done on ‘Risks and Vulnerability to HIV, STIs and AIDS Among
Street Children in Nepal: Public Health Approach’ in 2013 with two methods of data
collection from children and young people in the street; these were observation and in-
depth interviews. The study revealed that children leave home due to parental
mistreatment; they engage in risky sexual behaviour living in the street, they have little or
no understanding of HIV, AIDS and STIs or of the respective relationship between these,
and they have negative attitudes towards HIV/ STIs treatment and people affected by
HIV/AIDS. Four domains of HIV/STIs and AIDS risks and vulnerability of street
children were identified: parental mistreatment (causing vulnerability to exposure and
thus the likelihood of acquiring HIV and STIs); high risk-taking sexual behaviour
(creating vulnerability to infection); lack of knowledge regarding HIV, AIDS and STIs
(vulnerability to re-infection); negative attitudes towards HIV/STIs treatment and people
affected by HIV/AIDS (resulting in denial, failure to seek treatment and contributing to
the perpetuation of the problem); and the effects of living in the street (increasing
vulnerability to progression from HIV to AIDS). ³⁵

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Rationale and significance of the study

Children aged below 16yrs constitute 41% of Nepal’s population. There are around 5000
street children all over Nepal. It is estimated that the number of street children is approx.
1200-1500 in Kathmandu only.³
According to CWIN (Center for child workers in Nepal) every year more than 500
children to streets of Kathmandu from districts of Nepal like Nuwakot, Sindhpalchowk,
Kavre, Dhading, Makwanpur and Dolakha.¹
Street children are at risk to infection because of the characteristics of street life.
Vulnerability to sexual abuse, unprotected sex, early sexual initiation, and injecting drug
use are all factors which place children at risk for HIV and other STIs. Street culture
encourages and reinforces risk-taking behaviour.⁹
Children on the street engage in different risky activities associated with health risks.
Independent tests of street children in Nepal, conducted by CWIN (Child Workers in
Nepal Concerned Centre) in 2002, reported that 25 out of 80 (31%) of respondents were
HIV positive. A 19 similar study reported a higher proportion, and stated that 16 (50%)
out of 32 children were HIV positive.³⁶
In a study of Kathmandu done in 2011, among 251 street children and youth, they have
20-fold higher prevalence of HIV infection than the general population of Nepal
(0.39%).⁵

Young people are particularly vulnerable to STDs because most know little about STDs,
even if they are sexually active; even when they know about STDs, young adults use
condoms inconsistently; the earlier people become sexually active, the more likely they
are to change sexual partners and thus face a greater risk of exposure to STDs.³⁶

The children and youth engage in number of high risk behaviors, including intravenous
drug use, putting them at significant risk of contracting HIV and other sexually
transmitted infections. Therefore, this sort of study should be carried out time-time to
explore the causes and consequences of vulnerability to HIV/STI and AIDS in street
children.³⁶

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Research questions
What is the prevalence of risk behaviors towards HIV among street children of
Kathmandu?

Hypothesis
H₀=There will be no association between the selected socio-demographic variables and
the risk behavior towards HIV among the Street children of Kathmandu.

Variables
Independent variables:
o Age
o Sex
o Education level
o Drug use
Alcohol
Glue sniffing
Smoking
o Duration of stay in streets
o Occupation
o Relation-ship status
o Condom use
o Family background

Dependent variable
o Risky behavior related to HIV
o Unprotected sexual intercourse
o IV drug use

Research design and method

Using a descriptive, cross-sectional method, quantitative data will be taken among the
street children of Kathmandu. A pre tested and semi-structured questionnaire via
interview will be used to collect data.

Study site and its justification

Study site: study will be performed in Pashupati area, ratnapark and thamel area.
Justification of its site: Kathmandu, the capital of Nepal, is among those cities like
Bombay, Manila, Rio de Janaiero, Mexico City, Bangkok, Nairobi, where the problem of
street children is very high due to the rapid growth of urbanization and many other

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problems, such as economic breakdown, social distortion, natural disasters and increasing
family disintegration.¹ As street children are commonly seen in these areas and it is
feasible for researcher.
According to CWIN (Center for child workers in Nepal) every year more than 500
children to streets of Kathmandu from districts of Nepal like Nuwakot, Sindhpalchowk,
Kavre, Dhading, Makwanpur and Dolakha.¹

Population
Target population: street children of Kathmandu
Study population: street children of ratnapark, Pashupati area and Thamel area

Sampling method
In my study, it will be based on Non-probability purposive sampling.

Sample Size
The sample size has been calculated by using the following formula:
n= (Z² X PQ) ÷ L2, where
Z = (z value at 95% confidence interval i.e. 1.96)
P= estimated proportion in the population
Q= 1-P (complement of prevalence)
L= maximum allowable error (20%)

Risk behaviour among street children (54.8% of Pokhara boys who were
sexually active reported having been engaged in high risk sex)⁹
55% i.e. =0.55
Q=1-0.55=0.45
L=20% of prevalence=20% *0.55=0.11
Here, sample size (n)=Z²*p(1-P)/L²
=1.96²*0.56*0.44/0.112²
=78.6
Therefore, Sample size (n)=78.6+7.8=86

Selection criteria
Inclusion criteria: street children aged between 8-18yrs of age who has been on streets at
least 3 mths.
Exclusion criteria:
street children:-A child who refused to get involve in data collection or who are violent.

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Data collection

 Procedure of data collection

 Semi-Structured and structured questionnaire will be prepared.
 Explanation about the purpose of study will be given to the study population.
 Questionnaires will be according to behavioural surveillance survey, and HIV risk
taking behavioural scale.
 Data collection will be done with the help of field workers.
 Interview technique will be used to identify the risk behaviours towards HIV
infection.

Tools
Questionnaire will be according to Behavioural Surveillance Survey which include:
 Socio-demographic characteristics
 Risk behaviour towards HIV infection
 Knowledge of HIV infection

Limitation of the study

As my study is on sensitive population (street children) with a sensitive issue(HIV) so
non-probability sampling technique will be effective.

Pre-testing the Data Collection Tools

Pre-testing of the instrument will be done on 8 street children of Kalanki and Sayambu,
Kathmandu who meets the inclusion criteria.
Questionnaires will be modified according to the results of pre-testing after analysis of
data.

Plan for data analysis

Statistical procedures
* Data will be analyzed by using descriptive statistical method like: Percentage,
Frequency, Mean, and Standard Deviation.
* Chi square test will be used to test the association between the risk behaviours
towards HIV and socio demographic variables.

Data Analysis
* SPSS (Statistical Package for Social Sciences) will be used for descriptive as well
as inferential statistics.

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Expected Outcome of the Research

* The null hypothesis may be rejected and research hypothesis will be accepted.
* The risk behaviour of street children may vary according to the selected
demographic variables.

Plan for Dissemination of Research Result

 Research advisor
 Library
 CWIN organization

Ethical consideration
 Confidentiality and anonymity will be maintained.
 Informed consent will be taken.

Work plan

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Budget plan
S.N. ITEMS AMOUNT

1. Internet service Rs.1000

2. Printing Rs.3500

3. Photo copies Rs.1500

4. Research presentation Rs.1000

5. Others (phone calls, travelling, stationary) Rs.500

6. For organization Rs. 1000

  Total amount: Rs.8500

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Annexes
Refrences:
1. 'Street Children And HIV & AIDS Methodological Guide For Facilitators'.
(2006)
2. Thapaliya, B., 'The Pathetic Reality Of Street Children In Nepal'. 2005. Web. 28
June 2015.
3. Rai, J. 'CWIN Nepal - Substance Use Among Street Children In Nepal'.
Cwin.org.np. Web. 28 June 2015.
4. Ibrahim, A. 'Characteristics Of Street Children'. E-International Relations, 2012.
Web. 28 June 2015
5. Karmacharya, Dibesh et al. 'A Study Of The Prevalence And Risk Factors
Leading To HIV Infection Among A Sample Of Street Children And Youth Of
Kathmandu'. AIDS Research and Therapy 9.1 (2012)
6. Oino, P. Benard S. 'The Danger Of HIV/AIDS Prevalence Among Street
Children On The Public In Kenya: Experiences From Eldoret Municipality'.
International Journal of Science and Research (IJSR), 2.3 (2013): 159-164.
7. Aids.gov, 'Global Statistics', 2014. Web. 29 June 2015.

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8. Amfar.org, 'Amfar: Statistics, Worldwide, The Foundation For AIDS Research,

HIV / AIDS Research', 2014. Web. 28 June 2015.
9. UNESCO, 'A Study On Knowledge, Attitudes, Practices And Beliefs In The
Context Of HIV/AIDS Among Out-Of-School Street-Based Children In
Kathmandu And Pokhara'. (2006)
10. Google.com.np,. 'Number Of HIV Infected People Not Declining In Nepal 2013
See More At: Http://Www.Myrepublica.Com/Portal/Index.Php?
Action=News_Details&News_Id=65345#Sthash.10Dp2ulf.Dpuf'. N.p., 2013.
11. Rai, J. 'CWIN Nepal - Street Children In Nepal'. Cwin.org.np.
12. MARTIN A. 'High Risk Behaviours, Stis And Street Children In Jamaica'
13. Gurung, G.. 'Knowledge And Attitude On HIV/ AIDS And Sexual Behaviour Of
Street Teenagers In Kathmandu Valley'. Journal of Nepal Health Research
Council 2.2 (2004)
14. Homer, A. 'Psychosocial Predictors Of HIV/AIDS Risk Behaviors In Nepalese
Street Youth'. (2008)
15. Tandan, M, and Poudel I.S. 'Exchange Sex And Risk Of HIV Among Street
Children In Nepal'. (2010)
16. Oppong A, Kwaku, A. Meyer-W, et.al. 'Substance Use And Risky Sexual
Behaviours Among Street Connected Children And Youth In Accra, Ghana'.
Subst Abuse Treat Prev Policy 9.1 (2014)
17. Busza, J. R. et al. 'Street-Based Adolescents At High Risk Of HIV In Ukraine'.
Journal of Epidemiology & Community Health 65.12 (2010): 1166-1170.
18. Mthembu, S. 'Exploration Of Knowledge, Attitudes And Behaviours Of Street
Children On The Prevention Of HIV And AIDS In The Huye District, Rwanda.'.
East Afr J Public Health 9.2 (2012): 74-9.
19. Megabiaw, B, Taddesse A. et.al 'Comprehensive Knowledge, Attitude and
Practice of Street Adults towards Human Immunodeficiency Virus/Acquired
Immune Deficiency Syndrome (HIV/AIDS) In Northwest Ethiopia'. (2013): 181-
187
20. Morrell, Kristen R., and Shelby County. 'Prevalence And Correlates Of HIV-Risk
Behaviors Among Homeless Adults In A Southern City'. Journal of Health
Disparities Research and Practice 7.1 (2014): 84-96
21. Mahmud, I. Karar Z.A et.al. 'Glue Sniffing & Other Risky Practices among Street
Children In Urban Bangladesh'
22. Mudingayi, A, P Lutala, and B Mupenda. 'HIV Knowledge And Sexual Risk
Behavior Among Street Adolescents In Rehabilitation Centres In Kinshasa; DRC:
Gender Differences'. Pan Afr Med Jrnl 10.0 (2011)
23. Tadesse, Negash et al. 'High Prevalence Of HIV/AIDS Risky Sexual Behaviors
Among Street Youth In Gondar Town: A Community Based Cross Sectional
Study'. BMC Research Notes 6.1 (2013): 234
24. Operario, Don et al. 'HIV Infection And Sexual Risk Behaviour Among Youth
Who Have Experienced Orphanhood: Systematic Review And Meta-Analysis'.
Journal of the International AIDS Society 14.1 (2011)

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25. Kayembe, PK et al. 'Knowledge Of Hiv, Sexua Behagior And Correlates Of

Risky Sex Among Street Children In Kinshasa, Democratic Republic Of Congo'.
East African Journal of Public Health 5.3 (2009)
26. Uddin, Md et al. 'Vulnerability Of Bangladeshi Street-Children To HIV/AIDS: A
Qualitative Study'. BMC Public Health 14.1 (2014): 1151.
27. MAQSOOD, N, J.A. MALIK, and M.R BHATTI. 'HIV/AIDS Risk Behaviours
Among Injecting Drug Users: Addressing Development Of Risk Behaviour
Knowledge And Patterns Of Risk Behaviour Practices In Context Of
Demographic Characteristics'.
28. Kuznetsov, A, Michael W, et.al. 'Short Risk Behaviour Knowledge Index For
HIV Average Risk Population Of Sexual Active Age In Munich, Germany'. Cent
Eur J Public Health 19.2 (2011): 79-83
29. MacDonald NE, et.al 'Canadian Street Youth: Correlates Of Sexual Risk-Taking
Activity.'. (1994)
30. Mandalazi, p. 'Street Children's Vulnerability To HIV And Sexually Transmitted
Infections In Malawian Cities.'. (2013)
31. Towe, Vivian L. et al. 'Street Life And Drug Risk Behaviors Associated With
Exchanging Sex Among Male Street Children In Lahore, Pakistan'. Journal of
Adolescent Health 44.3 (2009): 222-228.
32. Inciardi, James A., and Hilary L. Surratt. 'Children In The Streets Of Brazil: Drug
Use, Crime, Violence, And HIV Risks'. Subst Use Misuse 33.7 (1998): 1461-
1480.
33. Richter, L. M., and J. Swart-Kruger. 'AIDS-Risk Among Street Children And
Youth: Implications For Intervention'. South African Journal of Psychology 25.1
(1995): 31-38. Web.
34. Marshall, Brandon D.L. et al. 'Homelessness And Unstable Housing Associated
With An Increased Risk Of HIV And STI Transmission Among Street-Involved
Youth'. Health & Place 15.3 (2009): 783-790.
35. Karki, Sangeeta (2013) Risks and Vulnerability to HIV, STIs and AIDS Among
Street Children in Nepal
36. Anarfi, J k. 'Vulnerability To Sexually Transmitted Disease: Street Children In
Accra'. 7 (1997): 281-306.
37. Amon, J, Tim B, and Jan H. 'Family Health Impact Behavioural Surveillance
Survey'. (2000)

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Informed Consent Form / Ethical Issues:

Namaste, I am Rojina Poudel, student of BNS 3rd year. For the partial fulfillment
of our curriculum, I am conducting a research study on “prevalence of risk
behaviours towards HIV among the street children of Kathmandu”. I would be
very grateful if you could spare some time for the interview purpose with me.
Taking part in this study is entirely voluntary and without compulsion. I would
like to assure you that your participation in this study will be kept confidential.
Serial number will be written instead of participants’ name to ensure the
anonymity.
You will have no direct benefit from the participation however this process will
help to identify the causes and risk behaviour of HIV that could be useful for the
concern institution working in this field.

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Once I start filling out this form, you are supposed to be agreed to give
information about the issues below. You are also giving us consent to use this
information for our purpose.
You may at anytime stop giving response on my queries without any reasons.
The survey will take about 15-20 minutes to complete.
Now May I ask you to start the Interview? If you are agree please say yes,
otherwise no.
 If you have any questions, complains or concerns related to this research you can
tell me:
Rojina poudel
Kathmandu University School of Medical Sciences (KUSMS)

Date :……………

KATHMANDU UNIVERSITY SCHOOL OF MEDICAL SCIENCES

DHULIKHEL, KAVRE

Questionaire
Section A: Sociodemographic data:

S.N Questions Categories Coding Remarks

1. Current age (completed
years)
2. Sex Male 1
Female 2
3. Do you know how to read? Yes 1
No 2
3.1 Do you know how to Yes 1
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write? No 2
3.1.1 If yes, Have you ever Yes 1
attended school? No 2
3.1.2 What is the highest level of
school you completed?
4. To which ethnic group do Brahmin 1
you belong? chhetri 2
Newar 3
Tamang 4
Rai 5
Others(specify) 6
5. How long have you been in
street? (in months/yrs)
6. During these days, with With friends 1
whom do you live? With family 2
Organization 3
In street 4
Others 5
(specify) 6

7. Are you engaged in any Yes 1

type of work? No 2
7.1 If yes, specify. Ragpickers 1
Multiple answer question Porters 2
Labour 3
Begging 4
Others(specify) 5
8. What is your relationship Single 1
status? Married 2
Having 3
boyfriend or
girlfriend
9. Do you smoke? Yes 1
No 2
9.1 If yes, how often? Everyday 1
Sometimes 2
Rarely 3
10. Do you drink alcohol? Yes 1
No 2

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10.1 If yes, how often? Everyday 1

Sometimes 2
Rarely 3

Section B: Causes for being on the street:

11. Why did you come to live -conflict within 1

in the streets? family 2
-peer pressure 3
- 4
-Others (specify)
5

11.1 If there was a family History of abuse 1

problem, can you tell me Abandoned by 2
the actual reason behind their families
that? Family 3
(Multiple answer disintegration
question) Step parents 4
Parental death 5
Others (specify) 6

Section C: Risk behavior for HIV

12. Do you know about sexual Yes 1

intercourse? No 2
13. Have you ever had sexual Yes 1
intercourse? No 2
If you never had sexual intercourse, skip the questions and go to Q. no.17
14.1 If yes, At what age did you 1st Age in years: 1
have sexual intercourse? Don’t know 2
14.2 Have you exchanged sex for Yes 1
food, shelter, drugs, or No 2
money?

15 Who is your sexual partner? Male 1

Female 2
Both 3
16. For men: Yes 1
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Have you ever had any male No 2

sexual partners?

17 Have you ever heard about Yes 1

male or female condom? No 2
18. Have you ever used a Yes 1
condom? No 2
If No, skip the questions and go to Q. no 27
19.1 If yes, Do you know any Yes 1
place from which you can No 2
obtain condoms?

19.1.1 If yes, From where? Medical

Specify.. Organization
Others (apecify)
20. During the past 1mth, did Yes 1
you ever have unsafe sexual No 2
intercourse? Don’t know 3

21. If yes, with whom? Boy/girlfriend 1

Foreigner 2
Others(specify) 3
22. With what frequency did Every time 1
you use a condom with all Sometime 2
of your partners in the past Never 3
1 mth? Don’t know 4
23 What are the barriers of Not available 1
condom use? Too expensive 2
Partner objected 3
don’t like to use 4
hesitation to buy 5
others(specify)… 6
24. Have you ever reuse Yes 1
condom? No 2
25. One condom should be 1 time 1
used for how many sexual More than 1 time 2
act?
26. How many men/women No. of 1

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have you had sexual female/male

intercourse with during the partners in the
past 1 month? past 1 month- 2
Don’t know-
27. Do you know any forms of Yes 1
drugs? No 2
27.1 If yes, what sort of drugs do Marijuana 1
you know about? Dendrite 2
Charesh 3
Brown sugar 4
Others(specify) 5
27.2 Do you know any technique Smoking 1
for taking drugs? Inhalation 2
Ingestion 3
Injection 4
Others(specify) 5
28. Do you use any drugs? Yes 1
No 2
If no, skip the questions, and go to question no.28
28.1 What kind of drugs do you Marijuana 1
take? Dendrite 2
Charesh 3
Brown sugar 4
Others(specify) 5
28.2 How do you take those Smoking 1
drugs? Inhalation 2
Ingestion 3
Injection 4
Others(specify 5
29 How long have you been No. of months:
using illegal/non
medical/addictive drugs?
30. How long have you been No. of months
injecting drugs?
31. During the past one month 1 time 1
how often would you say you 2 time 2
inject drugs? 3 time 3
More than 3 4
32. Did you use needle or syringe Yes 1

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that had previously been No 2

used by someone else? Don’t know 3

32.1 If yes, when?

33. Have you ever had sex while Yes 1
you were drunk or after No 2
using drugs?

Section-D :Knowledge on HIV/AIDS

34. Have you ever heard of HIV Yes 1

or the disease called AIDS? No 2
35. Do you know the modes of Yes 1
transmission of HIV? No 2
35.1 If yes, specify? Unprotected 1
sexual intercourse
IV drug use 2
HIV infected blood 3
transfusion
Others 4
36. Can people protect the virus Yes 1
that causes AIDS themselves No 2
from HIV by using a condom Don’t know 3
correctly every time they
have sex?

37. Can a person get HIV by Yes 1

getting injections with a No 2
needle that was already Don’t know 3
used by someone else?
38. Do you think that a healthy- Yes 1
looking person can be No 2
infected with HIV, the virus Don’t know 3
that causes AIDS?
39. Have you ever had an HIV Yes 1
test? No 2
39.1 If no, why? Don’t like to test 1

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Not feel necessary 2

Don’t know place 3
for test
Fear of AIDS 4
Others apecify 5
40. Do you think that you are Yes 1
also vulnerable for HIV ? No 2
40.1 If yes, why?

Do you think there is something to add?

सहभागिको सहमती पत्र

मेरो नाम रोजिना पौडेल हो। म काठमाण्डौ विश्वविध्यालय अन्तर्गतको स्कु ल अफ मेडिकल
साईन्स काभ्रे धुलिखेलमा नर्सिङ्ग स्नातक तहमा अध्ययनरत विध्यार्थी हूँ । मैले मेरो अध्ययनको
एक भागका रुपमा काठमाडौँ उपत्यकाका सडक वाल वालिकाहरुमा HIV संक्रमणको खतरा हुने
खालका व्यवहारहरुका सम्बन्धमा अनुसन्धान गरी रहेको छु ।

मेरो यस अध्ययनको क्रममा मलाई तपाईको के ही समय उपलव्ध गराई दिनु भएमा म
अत्यन्त आभारी हुने थिएँ । यस प्रक्रियामा तपाईको सहभागिता तपाईको स्वतन्त्र इच्छा अनुसार
हुनेछ र यसमा कु नै किसिमको वाध्यता रहने छैन । तपाईले व्यक्त गर्नु भएका विचारहरुको
गोपनियता कायम राखिने कु राको म यहाँलाई विश्वास दिलाउन चाहान्छु । गोपनियता कायम राख्ने
प्रयोजनका लागि तपाईको नामको सट्टामा क्रमसंख्या उल्लेख गरिनेछ ।

यस सर्भेक्षणमा सहभागिताका लागि तपाईले कु नै किसिमको प्रत्यक्ष लाभ प्राप्त गर्नु हुने छैन
। तथापी यस सर्भेक्षणबाट सरोकारवाला संस्था वा व्यक्तिका लागि सडक वालवालिकाहरुमा हुने

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HIV/AIDS को कारण तथा खतरा जन्य व्यवहारका बारेमा जानकारी प्राप्त गर्न मद्दत मिल्ने मैले
अपेक्षा गरेकोछु । मैले तपाईलाई प्रश्न सोध्न शुरु गरे पछि तपाईले यो प्रक्रियामा सहभागि हुन र
यसक्रममा तपाईबाट व्यक्त भएका विचारहरुलाई अध्ययनको प्रयोजनका लागि प्रयोग गर्न तपाई
सहमत भएको ठान्नेछु । तपाईले कु नै पनि समयमा मैले सोधेका प्रश्नहरुको विना कारण उत्तर दिन
बन्द गर्न सक्नु हुनेछ । यो सर्भेक्षणमा समावेश भएका प्रश्नहरुको उत्तर दिन वढीमा ३० मिनटको
समय लाग्ने छ । यस सम्बन्धमा यहाँको कु नै जिज्ञासा भएमा सोध्न सक्नु हुन्छ ।

(कु नै जिज्ञासा भए )

(जिज्ञासा समाधानका लागि दिईएको उत्तर )

यस अन्तरवार्तालाई अगाडि बढाउन के तपाई मन्जुर हुनु हुन्छ ?

मन्जुर छु मन्जुर छैन

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काठमाण्डौ विश्वविध्यालय

स्कु ल अफ मेडिकल साईन्स

काभ्रे धुलिखेल

प्रश्नावली
नोटः प्रश्नको उत्तर दिंदा उपयुक्त स्थानमा √ चिन्ह प्रयोग गरिनेछ ।

खण्ड कः सामाजिक जनसंख्यिकीय तथ्याङ्क

क्र सं प्रश्न वर्गिकरण कोड नं कै फियत

१ पुरा भएको उमेर ? ..................

२ लिङ्ग ? पुरुष 1
महिला 2
3
३ तपाई लेखपढ गर्न सक्नु हुन्छ ? सक्छु 1
सक्दिन 2
३.१ यदि लेखपढ गर्न सक्नु हुन्छ भने थिएँ 1
तपाईले कु नै स्कु लमा अध्ययन गर्नु थिईन 2
भएको थियो ?
३.१. तपाईले कति कक्षासम्म पुरा गर्नु ..............
१ भएको छ ?
४. तपाई कु न जातीय सम्प्रादयमा पर्नु व्राम्हण 1
हुन्छ ? क्षेत्री 2
नेवार 3
तामाङ्ग/राई/गुरुङ्ग 4
दलित 5
मधेशी 6
अन्य खुलाउनु होस्
7

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५. कति समय देखि तपाई सडकमा रहँदै ...महिना/……वर्ष

वस्दै आउनु भएको छ ?
६. तपाई राती कहाँ वस्नु हुन्छ ? सडकमा 1
संस्थामा 2
घरमा 3
(एक भन्दा वढी उत्तर)
अन्य स्थानमा 4
७. तपाई अहिले कोसंग वस्दै आउनु एक्लै 1
भएको छ ? के टा /के टी साथी सग 2
श्रीमान /श्रीमती संग 3
(एक भन्दा वढी उत्तर) परिवार संग 4
८. तपाई अन्य कु नै प्रकारको काममा छ 1
पनि आवद्ध हुनु हुन्छ? छैन 2
८.१ अन्य काममा पनि संलग्न हुनु भएको प्लाष्टिक संकलन गर्ने 1
भए,सो काम के हो? सामान विक्रि गर्ने 2
भिख माग्ने 3
(एक भन्दा वढी उत्तर) भारी बोक्ने 4
अन्य 5
९. तपाई वैवाहिक अवस्था कस्तो छ ? एक्लो/अविवाहित 1
विवाहित 2
के टा/के टी साथी भएको 3
१०. तपाई धुम्रपान गर्नु हुन्छ ? गर्छु 1
गर्दिन 2
१०.१ यदि गर्नु हुन्छ भने कति मात्रामा गर्नु दिन दिनै /बारम्बार 1
हुन्छ ? दिनमा एक/दुई पटक 2
कहिले कहीं मात्र 3
११. तपाई मदिरा सेवन गर्नु हुन्छ ? गर्छु 1
गर्दिन 2
११.१ यदि गर्नु हुन्छ भने कति मात्रामा गर्नु दिन दिनै /बारम्बार 1
हुन्छ ? दिनमा एक/दुई पटक 2
कहिले कहीं मात्र

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खण्ड खः सडकमा आउनुको कारणहरु

१२. तपाई के कारण परेर सडकमा वस्दै -परिवारिक कारण 1

आउनु भएको हो ? -साथीसंगतीको कारण 2
-सुखी जीवनको खोजी 3
-अन्य खुलाउनु होस् 4
(एक भन्दा वढी उत्तर)
१२.१ पारिवारिक कारणले भए कस्तो -पारिवारिक यातनाको 1
पारिवारिक कारण हो ? कारणले
-टुहुरो भएर 2
-वावु आमाले छाडेकाले 3
(एक भन्दा वढी उत्तर) -परिवार विखण्डित भएर 4
-सौताने वावु आमाको 5
कारणले
-गरिवीको कारणले 6
-अन्य कारण भए 7
(खुलाउनु होस्)

खण्ड ग: HIV संक्रमणको खतरा वढाउने व्यवहारहरु

१३ तपाईलाई शारिरिक सम्बन्धको बारे छ 1

थाहा छ? छैन 2
१४. तपाईसंग शारिरिक सम्बन्धको कु नै छ 1
अनुभव छ ? छैन 2
यदि अनुभव छैन भन्ने उत्तर आएमा सिधै प्रश्न नं १५ मा जान सकिने छ ।
१४.१ अनुभव छ भने तपाईले पहिलो पटक वर्ष: 1
यौन सम्पर्क गर्दा तपाई कति वर्षको थाहा छैन 2
हुनु हुन्थ्यो ?
१४.२ तपाईले कहिलै खानाको लागि, राखेको छु 1
वस्नको लागि, लागु पदार्थको लागि राखेको छैन 2
वा पैसाको लागि शारिरिक सम्बन्ध
राख्नु भएको छ ?

१५. तपाईको यौन साथी को हो? परुष 1

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महिला 2
दुवै 3
१६. तपाईले पुरुष वा महिलाले प्रयोग सुनेको छु 1
गर्ने कण्डमको बारेमा सुन्नु भएको छ सुनेको छैन 2
?
१७. तपाईले कहिल्यै कण्डमको प्रयोग छ 1
गर्नु भएको छ ? छैन 2
छैन भन्ने उत्तर आएमा सिधै प्रश्न नं १९ मा जानु होला
१७.१ प्रयोग गर्नु भएको छ भने तपाईलाई छ 1
कण्डम उपलव्ध हुने ठाउँ बारे थाहा छ छैन 2
?
१७.१.१ थाहा छ भने कहाँबाट ल्याउनु हुन्छ ? साथीहरुबाट 1
कु नै संस्थाबाट 2
अन्य ठाउँ बाट भए 3
खुलाउनु होस्
१७.२ के तपाई हरेक पटक यौन सम्पर्क गर्दा गर्छु 1
कण्डम प्रयोग गर्नु हुन्छ ? गर्दिन 2
१७.२.१ यदि कण्डम प्रयोग गर्नु हुन्न भने किन नपाएर 1
नगर्नु भएको हो ? महङ्गो भएर 2
साथिले नमाने 3
आवश्यक नठानेर 4
किन्न अप्ठारो मानेर 5
अन्य कु नै कारणले भए
6
खुलाउनु होस्
१७.२.२ तपाईले विगत एक महिना भित्र यौन गरेको छु 1
सम्पर्क गर्दा पहिला प्रयोग भएको गरेको छैन 2
कण्डम प्रयोग गर्नु भएको छ ?

१७.२.३ एउटा कण्डम कतिपटक प्रयोगगर्नु १ पटक 1

हुन्छ ? १ पटक भन्दा वढी 2

१८. तपाईले विगत एक महिनामा कति १ जनासंग 1

जनासंग यौन सम्पर्क गर्नु भएको छ ? २ जनासंग 2
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३ जनासंग 3
धैरै जनासंग भए 4
खुलाउनु होस्
१८.१ तपाईले विगत एक महिनामा कसैसंग छ 1
असुरक्षित यौन सम्पर्क गर्नु भएको छ ? छैन 2
१८.१.१ भए को संग ? साथिसंग 1
विदेशीसंग 2
अन्य खुलाउनु होस 3
१९. तपाईलाई नशा लाग्ने वा मात लाग्ने थाहा छ 1
लागु पदार्थ वा वस्तुका बारेमा थाहा छ थाहा छैन 2
?
यदिथाहाछैनभन्नेउत्तरआएमासिधैप्रश्ननं २२माजानसकिनेछ।।
२०. यदि तपाईलाई थाहा छ भने कस्ता गाँजा 1
कस्ता लागु पदार्थका बारेमा थाहा छ ? चरेश 2
व्राउन सुगर 3
(एक भन्दा वढी उत्तर) डेनडाईड 4
औषधीजन्य लागु पदार्थ 5
अन्य खुलाउनु होस्
२१. लागु पदार्थको प्रयोग कसरी कसरी चुरोटबाट/त्यस्तै तानेर 1
गरिन्छ ? सुँघेर 2
पिएर 3
(एक भन्दा वढी उत्तर) सुई लगाएर 4
अन्य माध्यमबाट भए 5
खुलाउनु होस्
२२. तपाई कहिल्यै नशा लाग्ने मत्याउने छ 1
झुम्म पार्ने वस्तुको प्रयोग गर्नु भएको छैन 2
छ?
छैन भन्ने उत्तर आएमा सिधै प्रश्न नं २७ मा जानु होला
२२.१ यदि प्रयोग गर्नु भएको छ भने कस्तो गाँजा 1
पदार्थ प्रयोग गर्नु भएको चरेश 2
छ? व्राउन सुगर 3
औषधीजन्य लागु पदार्थ 4

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(एक भन्दा वढी उत्तर) अन्य खुलाउनु होस् 5

२३. तपाईले लागु पदार्थको प्रयोग कसरी चुरोटबाट त्यस्तै तानेर 1
कसरी गर्नु भएको छ वताई दिनु हुन्छ सुँघेर 2
? पिएर 3
सुई लगाएर 4
(एक भन्दा वढी उत्तर) 5
अन्य माध्यमबाट
खुलाउनु होस्
२४. तपाईले लागु पदार्थको प्रयोग गर्न ...महिना/....वर्ष
थाल्नु भएको कति समय भयो ?
२५. तपाईले सुईको प्रयोग गरेर पनि लागु छ 1
पदार्थ ग्रहण गर्नु भएको छ ? छैन 2
२५.१ यदि छ भने विगत १ महिनामा कति १ पटक 1
पटक सुईको प्रयोग गर्नु भयो ? २ पटक 2
३ पटक 3
धेरै पटक 4
२५.२ तपाईले कहिल्यै लागु औषध लिनको छ 1
लागि अरुले प्रयोग गरेको सुई लगाउनु छैन 2
भएको छ ? थाहा छैन 3

२५.२.१ यदि छ भने अन्तिम पटक कहिले .........

प्रयोग गर्नु भएको थियो?
२६. तपाईले कहिल्यै लागु पदार्थ खाएको छ 1
वा लिएको वेलामा वा नसाको वेलामा छैन 2
यौन सम्पर्क गर्नु भएको छ ?

खण्ड घ:HIV/AIDS सम्बन्धी ज्ञान

२७. तपाईले कहिल्यै HIV वा AIDS रोगका सुनेको छु 1

बारेमा सुन्नु भएको छ ? सुनेको छैन 2
२८. HIV वा AIDS कसरी सर्छ तपाईलाई जानकारी छ 1
यस बारेमा के ही जानकारी छ ? जानकारी छैन 2
२८.१ यदि छ भने कसरी सर्छ ? असुरक्षित यौन सम्पर्क 1
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सुईको माध्यमबाट 2
रगत आदान प्रदानबाट 3
अन्य खुलाउनु होस् 4
२९. के तपाईलाई HIV वा AIDS को लाग्छ 1
जोखिममा छु भन्ने लाग्छ ? लाग्दैन 2
२९.१ यदि लाग्छ भने किन लाग्छ ? ..........

३०. तपाईले कहिल्यै HIV वा AIDS को छ 1

परीक्षण गराउनु भएको छ? छैन 2
३१.१ गराउनु भएको छैन भने किन नगराउनु मन नलागेर 1
भएको हो ? ठाउँ थाहा नभएर 2
पैसा तिर्नु पर्ने डर भएर 3
AIDS को डर लागेर 4
आवश्यक नठानेर 5
अन्य भए खुलाउनु होस्
6
३२. यौन सम्पर्क गर्दा कण्डम प्रयोग गरेमा थाहा छ 1
HIV वा AIDS बाट वच्न सकिन्छ भन्ने थाहा छैन 2
बारेमा के तपाईलाई थाहा छ ?
३३. अरुले प्रयोग गरेको सुई प्रयोग गरेमा थाहा छ 1
HIV वा AIDS लाग्न सक्छ भन्ने बारेमा थाहा छैन 2
के तपाईलाई थाहा छ ?
तपाईलाई मैले सोधेका विषयसंग सम्बन्धित अन्य कु नै विषयमा कु नै कु रा व्यक्त गर्न मन लागेको छ की? भए
खुलागउनु होसः

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