Substance use and risky sexual behaviours among street adolescents and youths

Prof. (Dr.) Dharmakanta Kumbhakar

(The writer can be reached at drkdharmakanta@yahoo.com)

The phenomenon of street children and youths is global. Streets throughout the world are home to millions of children and youth. Circumstances on the street render older children (adolescents) and youths vulnerable to various kinds of physical and mental health problems and drug dependency. Their lifestyles are characterized by a high rate of sex trade and substance abuse, which places them at high risk for sexually transmitted infections, including HIV infection. The non-medical use of intoxicating chemical substances in order to achieve alterations in psychological functioning has been termed substance abuse. The linkage between substance use vulnerability and acquiring HIV/AIDS is well established. Injecting drugs carries a high risk of HIV infection, as well as many other diseases, because of the sharing contaminated needles.

Street adolescents and youths begin the habit of using substances for many reasons. The most common reasons are essentially peer pressure, the need to survive, and to experience pleasure or satisfy one’s own curiosity. The nature of continuous exposure to the street and its associated lifestyles makes them vulnerable to the use of psychoactive substances. They are at risk of a number of different dangers daily, as they work and live alone without adequate food, shelter, education, affection, and social security. As a positive coping mechanism to deal with the stress of their lives, their adverse circumstances, and to survive on the streets, the majority of them choose maladaptive strategies such as drinking alcohol and using drugs. They turn to psychoactive substances as a way to escape from the grim reality that they face in life, to bolster their courage and strength to cope with the everyday challenges of life on the street due to frustration concerning living on the street and to cope with cold, hunger, and fear. They don’t have access to recreational facilities and often venture into activities available to them on the street, such as drug abuse and drinking.

The type and prevalence rate of substances used by street adolescents and youths vary globally according to context and geographical location. In a comprehensive review, it was reported that street adolescents and youths in high-income countries usually use injecting drugs and other substances that are not commonly used by street adolescents and youths from low- and middle-income countries. A study among street adolescents and youths in Egypt indicated that 62 percent of the participants reported substance use, with the highest substance use being alcohol consumption (35 percent), with only 3 percent indicating injection drug use. Similarly, it was found that 82 percent of street adolescents and youths in the Democratic Republic of the Congo used marijuana, 63.5 percent used alcohol, and 3.8 percent used cocaine. A similar pattern of substance use was also reported among street adolescents and youths in Kenya, where lifetime and current substance use were 74 percent and 83 percent, respectively.

Substance use among street adolescents and youths has been found to be influenced by factors such as gender, age, duration of homelessness, and social networks (e.g., peer influence). Research has indicated that more males than females are substance abusers. Nowadays, there is an increase in the number of female street adolescents and youths who abuse substances. It may be attributed to this fact that female adolescents and youths with sexual abuse histories do abuse drugs on the street. Further, evidence shows that although differences in the choice of substances exist, the prevalence of substance use disorders is similar among males and females. Another factor that influences substance use is age. In a study of drug use among street adolescents and youths, it was found that younger participants (less than 21 years) were more likely to be engaged in excessive drinking of alcoholic beverages, while older participants (21 years and older) were more likely to be involved in heroin, crack, and injecting drug use. The number of years lived on the street influences substance use. Similarly, they reported from their cross-national study that the length of homelessness was associated with higher rates of substance misuse and psychiatric disorders. Social estrangement, which occurs when street adolescents and youths who move to the street become deeply rooted in street life with time, may explain youth susceptibility to engaging in high-risk behaviours, including substance use.

Substance use is viewed as a risk factor for other health-damaging behaviours, particularly risky sexual behaviour. Substance use increases the likelihood that individuals will engage in risky sexual behaviours, for example, non-condom use and multiple sexual partner patterns, which put them at risk of sexually transmitted infections and HIV/AIDS. Among street adolescents and youths in the Democratic Republic of the Congo, a constellation of health compromising behaviours were reported where a history of drug use was linked to engagement in sexual risk behaviour. Substance use with increased age may be associated with an increased risk of involvement in risky sexual behaviours. However, it is unclear whether street adolescents and youths engaged in risky sexual behaviour because they were under the influence of substance use or whether they engage in risky sexual behaviours as a means to support substance use or some “third factor” such as the social environment (e.g., peer influence and social networks) that facilitated risky sex or both behaviours. It is, however, known that substance use interferes with rational behaviours, which could make individuals more vulnerable to unsafe behaviours. 

A study conducted among 280 street adolescents and youths in Ethiopia indicated that 77 percent of the sample, who indicated they were sexually active at the time of the study, did not use condoms during their last sexual activity. The sexual behaviour trends of street adolescents and youths show that not only are street adolescents and youths not protected sexually, but that they also have multiple sexual partners. The same study further revealed that 62 percent of their sample was sexually active, and 97 percent of the sexually active had multiple sexual partners. The same study further showed that 80.5 percent of the street adolescents and youths used condoms inconsistently, and the length of stay on the street was also associated with inconsistent condom use. Reasons for non-condom use among street adolescents and youths include not being able to buy condoms, drug use, and negligence, as well as the belief that it decreases pleasure and difficulty using it in the “heat of the moment.”.

A study reveals that most street adolescents and youths engage in exchanged sex for food, money, and even a place to sleep, with females more likely to engage in such behaviours than males. Findings also show the vulnerability of female street adolescents and youths to exchange sex for money and/or protection in a male-dominated street life. A recent study in Ghana described that insecurity on the street and the avoidance of forced sex compelled females to seek protection from older boys by forming sexual relationships with them. Power dynamics and females’ inability to generate income through other forms of work have also been seen as contributing factors that “push” female street adolescents and youth to engage in survival sex. A study conducted among street adolescents and youths in Egypt found that 25 percent of the girls had sold sex to males, while a study in Tanzania reported that those aged between the ages of 11 and 17 engaged in commercial sex.

NGOs and international organisations should provide psychosocial services to street adolescents and youths to have access to clinical psychologists and other mental health professionals who can assess, support, and treat the varied health problems such as substance use and risky sexual behaviours that have been shown to be associated with homelessness. This could be done in collaboration with the government. NGOs and international organisations should target early entrants to the street before they become familiarised with the street sub-culture, which is characterised by violence, substance abuse, and sexually risky behaviours. Harm reduction interventions (e.g., harm reduction programmes that would address the needs of this population by ensuring that they use condoms correctly and consistently when engaging in sexual intercourse, especially for those who have multiple sexual partners) are needed to prevent street adolescents and youths from engaging in substance use and risky sexual behaviours. Such programmes should pay special attention to females, younger adolescents, and youths who are highly susceptible to the adverse conditions on the street. This initiative could use previously successful street adolescents and youths to act as peer educators, as peer-to-peer contact has proven to be one of the most effective approaches to reaching most-at-risk young people.

Evidence indicates that homeless adolescents and youths are growing in major cities and towns in Assam as well. We often come across them walking on the streets, sitting in isolated places, or lying on the street in a state of altered sensorium due to severe drug intoxication. Studies are needed using stronger statistical models to explore the multiple pathways between substance use and risky sexual behaviours among street adolescents and youths in Assam. NGOs and the government should come forward to curb this problem and save millions of vulnerable lives. The main responsibility to curb this problem and assist these abusers should be given to some NGOs, which should be backed financially by the government. The volunteers of the NGOs must help these street adolescents and youths understand the dangers of intoxicating substances for health-damaging behaviours, particularly risky sexual behaviour, so that they have a better chance of turning their lives around.