Methods: The present study conducted mixed-methods interviews with N=20 street-connected youth (50% female; M=13.95 years; SD=2.11) recruited from 10 social service centers in two cities. Youth were eligible if they were aged 10-19 and spent most of their time living or working on the street. Trained interviewers administered a close-ended survey on demographics, sexual behavior history and relationship behavior expectations for romantic and exchange-sex partners. Qualitative interviews explored youth’s attitudes, beliefs, and expectancies about romantic and exchange-sex relationships. Survey data was analyzed in SPSS 22. Gender differences in relationship expectations were calculated using Chi-square and Fisher’s exact-tests, with a Holm-modified Bonferroni to control for experimentwise-error rates and a Cramer’s phi (φc) to test the strength of significant associations. Qualitative data was audio-recorded, transcribed, and analyzed by three independent coders. All data was collected in Georgian and translated to English for linguistic and cultural equivalence.
Results: Forty-percent of youth had ever had sex and 15% reported exchange-sex. Among sexually active youth, condom use at last sex was low for oral (33.3%), vaginal (50%) and anal (20%) sex. There were no gender differences in relationship behavior expectations with a romantic partner. However, there were significant differences for exchange-sex partners. A higher proportion of boys than girls endorsed talking with (80% vs. 20%; p=.023; φc=.60) and saying I love you to (70% vs. 0%; p=.003; φc=.73) an exchange-sex partner, while a higher proportion of girls than boys endorsed using drugs (90% vs. 20%, p=.005; φc=.70) and having condomless vaginal sex (80% vs. 20%, p=.023; φc=.60) with an exchange-sex partner. Qualitative results contextualized these differences, with girls describing heightened states of vulnerability to sex, exchange-sex, and sexual violence, and little power in either romantic or exchange-sex relationships. Conversely, boys described a social environment where they had easy access to romantic and exchange-sex partners and expected to have greater power in these relationships.
Conclusions and implications: Findings point to clear gender differences in how street-connected youth view romantic and exchange-sex relationships, with girls having less social and economic power to refuse sex in either romantic or exchange-sex relationships. Programming to prevent HIV/AIDS among street-connected youth needs to develop gender-responsive content that addresses unequal power between boys and girls. This work should specifically target boys to foster attitudes and behaviors that promote joint-decision making in sexual relationships with female partners.