HIV and adolescents: focus on young key populations

Linda-Gail Bekker,Sybil Hosek

doi:10.7448/ias.18.2.20076

Abstract

Adolescents and young adults are at increased risk for HIV due to the many developmental, psychological, social, and structural transitions that converge in this period of the lifespan. In addition, adolescent deaths resulting from HIV continue to rise despite declines in other age groups. There are also young key populations (YKPs) that bear disproportionate burdens of HIV and are the most vulnerable, including young men who have sex with men (MSM), transgender youth, young people who inject drugs, and adolescent and young adult sex workers. As a society, we must do more to stop new HIV infections and untimely HIV-related deaths through both primary and secondary prevention and better management approaches. Using an interwoven prevention and treatment cascade approach, the starting point for all interventions must be HIV counselling and testing. Subsequent interventions for both HIV-negative and HIV-positive youth must be “adolescent-centred,” occur within the socio-ecological context of young people and take advantage of the innovations and technologies that youth have easily incorporated into their daily lives. In order to achieve the global goals of zero infections, zero discrimination and zero deaths, a sustained focus on HIV research, policy and advocacy for YKPs must occur.

Highlights

Young key populations, defined in this article as men who have sex with men, transgender persons, people who sell sex and people who inject drugs, are at high risk for human immunodeficiency virus (HIV)
It is estimated that 95% of new infections among adolescents in Asia are among key populations (PWID, men who have sex with men (MSM) and sex workers) [3] and that 70% of all individuals who inject drugs are under the age of 25 [4]
Challenges to HIV prevention among young key populations Young key populations are at increased risk of HIV infection compared to adults due to cognitive, contextual and structural factors that increase their vulnerability to peer pressure, manipulation and exploitation or abuse by older people [21]

Summary

Introduction

Young key populations, defined in this article as men who have sex with men, transgender persons, people who sell sex and people who inject drugs, are at high risk for HIV. Results and discussion: Combination prevention packages that include effective, acceptable and scalable behavioural, structural and biologic interventions are needed for all key populations to prevent new HIV infections. Conclusions: We put forth recommendations for future research and strategies to address the mental wellbeing of YKPs, including the need for integrated interventions that address the multiplicity of risk factors inherent in the multiple group membership, rather than single-focus interventions whilst addressing the unique needs or challenges of YKPs. At the epicentre of the HIV epidemic in southern Africa, adolescent girls and young women aged 15Á24 contribute a disproportionate Â30% of all new infections and seroconvert 5Á7 years earlier than their male peers. Going forward, health practitioners must honour the right to health by adjusting programmes according to principles of minimum intervention, due process and proportionality, and duly limit juvenile justice and child protection involvement as a measure of last resort, if any

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