PAYING FOR SEX AND ASSOCIATED RISKS AMONG YOUNG MALE PAVEMENT DWELLERS IN DHAKA CITY, BANGLADESH T McClair1, T Hossain2, N Sultana2, B Zieman2, E Yam2, S Hossain2, R Yasmin3, N Sadiq4, and Link Up Project 1Johns Hopkins Bloomberg School of Public Health; 2Population Council; 3Marie Stopes International Bangladesh; 4Link Up Bangladesh

Background Dhaka City, Bangladesh Pavement dwellers Densely populated Rural-to-urban migration Natural disasters in coastal areas Pavement dwellers Railway stations, bus terminals, ferry landings Unmet needs TARIK HOSSAIN/POPULATION COUNCIL *most densely populated city in the world *people who live on the streets in Bangladesh are colloquially known as pavement dwellers *estimated 20,000- 40,000 pavement dwellers in Dhaka City *shelter, employment, food, education, health *street youth are a particularly vulnerable group- living on the streets is associated with many negative health and sexual health outcomes. *a recent lancet editorial highlighted that we do not know a lot about the sexual health status and needs of adolescent boys. This study sought to shed light on the sexual health needs of this highly marginalized population.

Objectives Describe demographic and sexual risk characteristics Examine sexual risk factors associated with paying for sex What are the demographic and sexual risk characteristics of young male pavement dwellers? What are the sexual risk factors of paying for sex?

Methods Interviewer-administered survey January 2015–March 2015 N = 447; male pavement dwellers ages 15-24 years 7 pavement dweller hotspots TARIK HOSSAIN/POPULATION COUNCIL Randomization schemes Cluster-based sampling 7 pavement dweller “hotspots”

Results Participant characteristics N=447 % Age   15-19 70 20-24 30 Marital status Single 92 Married/cohabiting 8 Highest education None 45 Primary and above 55 Ever had sex 72 Paid for sex in last 12 mos. (n = 321) 80 Had STI symptoms in last 6 mos. (n = 321) 79 Unprotected last sex with non-primary partner (n = 321) 52 Ever tested for HIV (n = 321) 3

Adjusted odds ratios (95% confidence intervals) Correlates of engaging in unprotected last sex with a non-primary partner (n = 321) Adjusted odds ratios (95% confidence intervals) Marital status   Not married/cohabiting Ref. Married/cohabiting 0.27 (0.15-0.50)*** Paid for sex in last 12 months 2.19 (1.58-3.03)*** Controlling for age, education level, monthly income, time at current residence and early sexual debut *** p<0.001 *Controlling for age, education level, monthly income, time at current residence and early sexual debut

Correlates of having recent STI symptoms (n = 321)   Adjusted odds ratios (95% confidence intervals) Monthly income ≤5,000 takas Ref. 5,001-10,000 takas 0.46 (0.28-0.75)** >10,000 takas 0.37 (0.20-0.68)** Early sexual debut 1.84 (1.02-3.31)* Paid for sex in last 12 months 1.76 (1.17-2.64)** *Controlling for age, education level, marital status, and time at current residence Controlling for age, education level, marital status, and time at current residence * P<0.05 ** p <0.01

Conclusion Young male pavement dwellers are at high risk of HIV and other STIs. Those who paid for sex engaged in riskier sexual behaviors and had a higher prevalence of STIs. STI prevention resources as well as safer sex education are warranted. This study raises further questions about with whom, where, and why participants are paying for sex. STI prevention and treatment resources including HIV as well as safe sex education are warranted.

Rate of paying for sex in other populations: