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Literature about knowledge of HIV/AIDS showed that most of the children on the street had heard of AIDS (Anarfi, 1997; Gurung, 2004; Kruger & Richter, 2003;

Lockhart, 2002; Pakistan Voluntary Health and Nutrition Association

(PAVHNA), 2004; Southon & Gurung, 2006; Swart-Kruger & Richter, 1997;

Tadele, 2003; Wutoh et al., 2006). Anarfi (1997) illustrated that 93% of the respondents had heard of AIDS and that the level of HIV awareness was higher in males (96.7%) than females (87.8%) in Accra. On the other hand, Wutoh et al.

(2006) found that HIV transmission knowledge was higher in females (88%) than males (77%). CPCS (2007) found that about 38% of the street children in Nepal did not know about HIV/AIDS.

Studies have shown that the majority of the street children had heard of AIDS, and some knew the major modes of transmission, but that nearly half of the

respondents did not know about transmission (Anarfi, 1997; CPCS, 2007; Gurung, 2004; Kruger & Richter, 2003; Lockhart, 2002; Southon & Gurung, 2006; Swart-Kruger & Richter, 1997; Tadele, 2003; Wutoh et al., 2006).

Most street children knew that HIV was transmitted through sexual intercourse (Anarfi, 1997; Gurung, 2004; Lockhart, 2002; Pakistan Voluntary Health and

67 Nutrition Association (PAVHNA), 2004; Southon & Gurung, 2006; Tadele, 2003;

Wutoh et al., 2006). PAVHNA (2004) illustrated that the majority of street children (78.6%) said sexual intercourse was a main mode of HIV transmission.

The second most frequent response was sharing of a syringe (21.9%), and that was followed by blood transfusion and mother-to-child transmission. HIV

transmission knowledge was lower among street children in Accra (Anarfi, 1997), where half of the respondents were not able to report two modes of HIV

transmission and one quarter of respondents were not able to name any modes of HIV transmission. However, Anarfi stated that sexual intercourse, sharing of syringes, blood transfusion and mother-to-child transmission were the most common responses by street children regarding HIV transmission.

Wutoh et al. (2006) found that the majority of street children (80%) had correct knowledge of at least one mode of transmission, including unprotected sex, use of contaminated needles and razor blades. Statistical data showed that 45% of respondents reported unprotected sex, 25% reported unprotected sex as well as infected blades and 4% reported unprotected sex and needles. 6% of the

participants reported that personal items including infected blades could transmit HIV, and one fifth of the respondents reported having no knowledge of how it was transmitted (Wutoh et al., 2006). Similarly, unprotected sex, sharing of needles and blood exchange with an infected person were the common responses by street children of Nepal on the modes of transmission of HIV (Gurung, 2004; Southon &

Gurung, 2006). Tadele (2003) found that knowledge about HIV/AIDS was relatively low among street children, and responses were not uniform and were fragmented. Tadele said some participants were relatively well informed about at least one way in which HIV was transmitted, while some could not respond with anything more than that AIDS was a punishing disease.

In South Africa, Kruger & Richter (2003) and Swart-Kruger & Richter (1997) reported that most of the street boys had heard of AIDS as an incurable sexually transmitted disease, but that none of the street children had heard of HIV or the

68 methods of HIV transmission. Some street boys said that AIDS was transmitted through needles and intravenous drugs (Swart-Kruger & Richter, 1997) and through anal and homosexual sex (Kruger & Richter, 2003). A significant number of street children did not know that HIV and AIDS are the two different stages in the occurrence of AIDS (Kruger & Richter, 2003; Swart-Kruger & Richter, 1997;

Tadele, 2003).

Kruger & Richter (2003) suggested that there was a lack of knowledge about HIV infection and the latency period between HIV infection and AIDS. They seemed to presume that full-blown AIDS occurs virtually instantaneously, as with other diseases. Similarly, Swart-Kruger & Richter (1997) reported that street children had an inadequate concept of HIV infection, as none of the boys were able to specify that the media for transmission were sperm, vaginal fluids and blood.

Similarly, Tadele (2003) stated that street children assumed HIV and AIDS were two different diseases and used two different names for the same disease; it clearly appeared that street boys did not know the different aspects of HIV and AIDS.

Studies have revealed a lot of misconceptions among street children regarding HIV transmission. Street children perceived that particular groups such as homosexuals or prostitutes could transmit HIV (Dube, 1997; Kruger & Richter, 2003; Lockhart, 2002; Swart-Kruger & Richter, 1997; Tadele, 2003). Kruger &

Richter (2003) reported that street boys considered men and women could get AIDS from other men and women, and the majority of street children stated that they could get AIDS from adults, while more than half of the street children believed AIDS was transmitted from other children, and some believed children could not get AIDS at all. Lockhart (2002) reported that street boys felt

homosexual activities were not real sex, so homosexual activities did not transmit HIV, and also girl friends and acquaintances were not a risk for HIV transmission;

yet they strongly believed that females transmitted HIV, that prostitutes were a risk for transmission of HIV, and perceived that street girls were prostitutes. On

69 the other hand, Tadele (2003) stated that street children believed prostitutes were a safer group than schoolgirls, home girls or ordinary girls, since prostitutes

consistently forced their clients to use condoms.

Further misconceptions were also revealed: 8.7 % said HIV was transmitted through unhygienic conditions (Pakistan Voluntary Health and Nutrition

Association (PAVHNA), 2004), and others blamed mosquitoes and kissing (Dube, 1997; Gurung, 2004). Gurung (2004) illustrated that 60% of the street children thought it could be transmitted through mosquitoes, and 26.7% of the street children said that HIV could be transmitted by kissing. Other methods named included: using utensils (Dube, 1997); sharing food and cigarettes or drinking from the same glass (Anarfi, 1997; Dube, 1997; Swart-Kruger & Richter, 1997;

Tadele, 2003); sharing a toilet, clothes or a room (Anarfi, 1997; Swart-Kruger &

Richter, 1997); eating bad or rotten food; using a dirty toilet; flies or dirt; living in a dirty environment (Anarfi, 1997; Swart-Kruger & Richter, 1997); talking with someone with AIDS (Anarfi, 1997), or breathing in the same air (Kruger &

Richter, 2003; Swart-Kruger & Richter, 1997). In addition, Swart-Kruger &

Richter (1997) stated that street children in South Africa believed AIDS to be transmitted through saliva and skin, and from prisoners, soldiers and monkeys.

Further perceptions of street children regarding individuals at risk of contracting AIDS were those who do not sleep at home every day, criminals and lower class people (Swart-Kruger & Richter, 1997). Also, Tadele (2003) in Ethiopia reported that some thought HIV could be contracted by eating a chicken that had

swallowed a condom used by an HIV infected person. Furthermore, the study found that some believed one could get the virus from food, if an HIV infected person had accidentally cut a finger and the blood had spilled onto the food.

Street children associated AIDS with bodily appearance, in that they believed a healthy looking person would not have AIDS, and people could not get AIDS from a healthy looking person (Southon & Gurung, 2006; Swart-Kruger &

Richter, 1997; Tadele, 2003). Southon & Gurung (2006) found that major

70 misconceptions existed in street children in Nepal. Many boys believed that people could not get HIV/AIDS during first time sex. Similarly, CPCS (2007) reported that 44% of the respondents believed HIV/AIDS could be contracted by sleeping with an infected person, and 25% of them believed they could be infected by speaking with an HIV infected person.

Street children in South Africa expressed the belief that people who had AIDS would get thinner and become weak, and would have pimples or sores, shrunken eyes, dry lips, loss of hair, bleeding and paralysis (Kruger & Richter, 2003; Swart-Kruger & Richter, 1997). Tadele (2003) found that street children referred to symptoms such as weight loss, sparse or balding hair, coughing and lesions on the lips.

Information on STIs was very limited due to the limitations of the literature review. Anarfi (1997), in a study in Accra, found that more than 59% of street children did not respond with any knowledge about STIs: 68.4 % of female street children and 52% of male street children had no awareness of STIs (Anarfi, 1997).

Tadele (2003) in Ethiopia further reported that street boys had no real knowledge regarding STIs. Only one street boy could name any STIs such as gonorrhoea.

Also, street children were found to have misconceptions about STIs. They believed that STIs were the result of poor vaginal hygiene and developed in women who did not wash their vagina properly. Some street children thought that STIs could not be transmitted from a man to a woman because an STI infected man could not perform sex (Tadele, 2003).