Thousands of children and adults living rough on the streets of Burundi's capital, Bujumbura, face a daily struggle to eat and find a warm corner to sleep in; many blot out the reality of their situation by turning to sex and drugs.
Innocent Bagayuwitonze, now 26, has been living on the streets for 12 years. He told IRIN/PlusNews that he used the pittance he earned as a casual labourer to pay local sex workers for their services. Unable to muster the same fee as other men, he only gets lucky when the girls have had a particularly bad night.
"We [homeless men and boys] offer them 1,000 francs [US$1]," he said. "We negotiate with them when they do not get the rich men they want."
Bagayuwitonze and other homeless people regularly get drunk or high on drugs in the evenings, and rarely use condoms, putting them at higher risk of contracting HIV. "When I negotiate for sex and the girl accepts, I don't remember to use a condom," he said.
Sexual violence is also prevalent, as people living on the streets of Bujumbura are vulnerable to sexual attacks and often have nowhere to turn.
Newcomers to the streets usually seek protection from older, more experienced boys, which often entails entering into a sexual relationship with one's protector.
Olivier Ndimubandi, 12, told IRIN/PlusNews about his humiliating rape by his protector, in the presence of other boys on the street. The attack left him injured, but he said he did not trust the non-governmental organisations (NGOs) that have offered him support, and had received no medical care.
A spate of violent rapes in the capital in 2005 was blamed on street dwellers, prompting the government to round up all street children and house them in a local rehabilitation centre, but a few months later they were back on the streets.
At Marthe Robin medical centre in Bujumbura, set up by Oeuvre Humanitaire pour la protection et le dévelopement de l'enfance en difficulté, a non-governmental organisation that cares for the city's homeless, Dr Cyrille Ntahompagaze admitted that the lethal combination of drugs, alcohol and sex made the over 5,000 street dwellers in the capital more vulnerable to HIV.
"We get about 80 street children coming for medical care per month, and in June alone we had three cases of sexually transmittable diseases, an indication that they have unprotected sex," he said, adding that it was difficult to follow up his patients, given their nomadic lifestyle.
Although some organisations have made an effort to educate the people living on the streets about HIV, many were apathetic. "They seem indeed to care little about their protection and [are] totally misinformed about the services available free of charge," said Didier Habonimana, another young man living on the streets, but who seemed to be better informed.
Bagayuwitonze, for instance, was unaware that health services could be accessed without payment. "If a street boy gets infected he dies rapidly because he cannot get drugs." He said he knew of six street boys who had died from AIDS-related illnesses.
Government programmes in Burundi, which has an HIV prevalence of about three percent, offer free HIV testing and counselling and free antiretroviral medication.