Our work has had impact in several key areas. First, we have identified a hotspot of HIV infection in SCY in this low-income population. It may be hard to believe given the pandemic of HIV in sub-Saharan Africa, but our cross-sectional study of the prevalence of HIV and other sexually transmitted infections conducted in 2014 (Winston et al. 2015), was the first study to actually measure HIV and other STI’s in this population in Africa. Combined with our research showing the number of SCY dying of untreated HIV infection, and the numbers living with HIV in Eldoret on the back doorstep of one of the world’s largest HIV care programs, we have been able to put this population on the map of key populations we need to be worrying about. The launch in November 2016 of the Moi Teaching and Referral Hospital Rafiki Center for Excellence in Adolescent Health is a testament to our success as it now houses not only our ongoing research with orphans and separated children and adolescents, but is also the adolescent HIV clinic of AMPATH where street children and youth can now more easily be seen.
Our systematic review and meta-analysis of the drivers of children to the street globally has clearly demonstrated that poverty, family dysfunction (including alcoholism), and child abuse are the three primary factors causing children to take to the streets, both in high-income and in low-income settings. As a result, the conversation has started about the population of SCY in Eldoret – not in terms of how they should be punished or criminalized, as if they are juvenile delinquents (still, today, what most people believe), but rather as children in urgent need of safety, protection and support.