Approximately 2.2 million children under the age of 15 are living with HIV/AIDs worldwide of which 500,000 die every year (UNICEF, 2006). Within a decade of first detection, Nepal itself, switched from a low prevalence status country to become a state with a concentrated epidemic. 
This article attempts to look at how the situation of HIV is impacting children in Nepali, particularly street children. In order to gain a true understanding of the relationship between HIV and street children we need to unravel not only the issues surrounding the ‘HIV infected’ but also for those’ HIV affected’. UNICEF, UNAID and USAID (2006) together estimate 13,000 children in Nepal orphaned as a result of HIV and a further 111,000 children affected through HIV infected family members.
HIV therefore presents a double scenario of concern. At one end children are being driven into the labour market (and the streets) as a result of parents dying or becoming ill from HIV and at the other; children are exposed to a street subculture which endorses risk-taking behaviour, increasing the risks of abuse and the risks of contracting HIV. This behaviour which increases the likelihood of contracting HIV takes the form of early sexual initiation, injecting drug use (IDU), vulnerability to sexual abuse and unprotected sex.
Research by UNESCO, CWS and SathSath (2006) on 513 street children in Kathmandu and Pokhara found that overall 78.5% of boys who had participated had been involved in high risk sexual behaviour. Studies conducted by CWIN (2002) confirmed concerns when 50% of ‘high-risk’ street children were identified as HIV positive.
Substance use and sexual activity signify different things to different people. In order to reduce the risk of HIV infection, a better understanding of what these things mean to street children needs to be distilled. Participatory research, conducted and analysed by street children themselves, highlights the issue of social rejection. “Our biggest problem is the way society sees us, the way we are treated and scolded... We are not allowed into places and are thrown out of others (Southon and Dhakal, 2003).” Street children often turn to sex to fill the void of normal relationships because of this social rejection, often because they have lost or left their families. In this sense sex signifies ‘comfort’ and has often been described as play between friends (WHO, 2000).
This also leads to sex used as a form of ‘initiation’ for newcomers to a group and is conceived as a way of making the street child gain a sense of identity and belonging. It can often be forced on the victim and many street children see the incident as something unavoidable. If a street child does not conform to the group and its norms then sexual assault may be used as a form of ‘punishment’ (WHO, 2000).
For many street children sex is a form of ‘survival’ a means to secure basic needs, shelter and protection. It is seen as a way of forging relationships which provide welfare even though it is exploitative. Sometimes street children will use sex as a way of expressing physical ‘power’, often used to control younger and smaller street children and forcefully reinforce a hierarchy on the street.
It is all of these pressures which often lead street children to inject drugs and use sex as a form of escape. Research by UNESCO (2005) found that out of all the street boys who inject drugs 60% had shared needles, often weekly. The study into street children’s knowledge, attitudes, practices and beliefs found peer pressure as a strong determinant for risky behaviour. Over half of all the boys and 73% of all the girls in Kathmandu reported peer as the main reason for early sexual initiation before the age of 15 (Gurung and Southon, 2005). Of all asked only half would consistently use a condom during sexual encounters.
Although the majority of those involved in the study knew of HIV and some of the basic prevention methods, many believe that HIV/AIDS is a curable disease. They believed that a person could not become infected with HIV the first time they had sexual intercourse and 31.2% held that it was impossible for a healthy looking person to have HIV/AIDS. Less than 10% of all those who were interviewed could correctly dispel common misconceptions about HIV/AIDS (Gurung and Southon, 2005).
Whilst there is a lack of systematic HIV seroprevalence data with regards to street children in Nepal, it is clear that street children make up a highly vulnerable population group. They have had to endure this vulnerability from two 
fronts. They have migrated to the streets as a population HIV ‘affected’ and become dislocated from society as a result and they have often become HIV ‘infected’ after the social isolation, stress and pressures on the street led to negative coping mechanisms involving risk-taking behaviour. Raising awareness on HIV prevention on its own however is not enough. The role of society is crucial to obviate warped relationships and dangerous coping mechanisms from forming, to build stronger norms and a sense of self value. “A child with no self esteem does not think about tomorrow. A child with a devalued sense of his/her body won’t use a condom (Gurung and Southon, 2005).” Street children need healthy and positive relationships with society so that they can build their own identity and more positive images of themselves.
References
Child Workers in Nepal (CWIN) (2002) Alcohol, Tobacco and drugs experiences among Street Children in Nepal. URL: http://www.cwin.org.np/press_room/fact_sheets/fact_alcohol.htm [Accessed on: 12/03/2010.
Ennew, J. and Swart-Kruger, J. (2003) Introduction: Homes, Places and Spaces in the Construction of Street Children and Street Youth. In: Children, Youth and Environments. Vol. 13 (1).
Gilligan, B. and Rajbhandari, R. (2004) HIV/AIDs and Working Children in Nepal. Kathmandu, ILO-IPEC.
Gurung, H. And Southon, J. (2005) 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. Kathmandu, UNESCO.
Kharel, R. (2006) Street Children in Nepal Struggling with AIDS: Effective prevention must be targeted. URL: http://bit.ly/9MoPky [Accessed: 12/03/2010].
Sandhya, B. et al. (2000) Vulnerability of Street and Working Children to HIV/AIDs. URL: http://bit.ly/9Hd9Bh [Accessed on 12/03/2010].
Southon, J. and Dhakal, P. (2003) A Life Without Basic Service “Street Children Say.” Kathmandu, SathSath and Save the Children UK, Nepal.
UNESCO and P.A.U. Education (2006) Street Children and HIV&AIDS. Barcelona, P.A.U. Edcuation.
West, A. (2003) At the Margins Street Children in Asia and the Pacific. Asian Development Bank. URL: http://www.adb.org/Documents/Papers/Street_children__Asia_Pacific/SC_final.pdf [Accessed 12/03/2010].
World Health Organisation (2000) A Training Package on Substance Use, Sexual and Reproductive Health including HIV/AIDS and STDs. Geneva, WHO. A WHO report (2000) on child labour and HIV echoes the mounting concerns over the disproportionate burden of care placed on children (especially girls) to support ill parents and siblings. Increasingly children are dropping out of school as a result of family impoverishment caused by HIV, its social stigma and discrimination. This has resulted in rising numbers of Child Headed Households (CHH) and growing numbers of children migrating from their communities in order to earn an income and escape social discrimination (WHO, 2000).
