Paediatric HIV Matters ONLINE ONLINE OPEN PEER-REVIEWD PEER-REVIEWD ONLINE A PEER-REVIEWD OPEN ACCESS OPEN HIV/AIDS JOURNAL HIV/AIDS JOURNAL CCESS ONLINEONLINE CCESS A OPEN OPEN PEER-REVIEWD ONLINE HIV/AIDS JOURNAL HIV/AIDS HIV/AIDS JOURNAL PEER-REVIEWD PEER-REVIEWD OPEN ACCESSONLINEPEER-REVIEWD A ONLINEPEER-REVIEWD CCESS HIV/AIDS JOURNALPEER-REVIEWD OPEN ACCESS CCESS A OPEN ONLINE ONLINE HIV/AIDS JOURNAL ONLINE PEER-REVIEWDHIV/AIDS JOURNALONLINEONLINE PEER-REVIEWDOPEN ACCESS PEER-REVIEWD ONLINE ONLINE OPEN ACCESSONLINE OPEN HIV/AIDS JOURNAL CCESS OPEN ACCESS HIV/AIDS JOURNAL PEER-REVIEWD PEER-REVIEWD PEER-REVIEWD HIV/AIDS JOURNAL PEER-REVIEWD A HIV/AIDS JOURNAL OPEN ACCESS PEER-REVIEWD PEER-REVIEWD PEER-REVIEWDONLINE HIV/AIDS JOURNAL HIV/AIDS JOURNAL OPEN ACCESS ONLINE ONLINEONLINE HIV/AIDS JOURNAL HIV/AIDS PEER-REVIEWD A PEER-REVIEWD ONLINE ONLINE HIV/AIDS JOURNAL CCESS HIV/AIDS JOURNALOPEN ONLINE PEER-REVIEWDONLINE PEER-REVIEWD HIV/AIDS JOURNAL OPEN PEER-REVIEWDJOURNAL HIV/AIDS HIV/AIDS JOURNAL HIV/AIDS JOURNAL CCESS ONLINE A A ONLINE OPEN ACCESS HIV/AIDS JOURNAL ONLINE HIV/AIDS JOURNAL CCESS PEER-REVIEWD OPEN ACCESS HIV/AIDS JOURNAL OPEN ACCESS ONLINE HIV/AIDS JOURNAL HIV/AIDS ONLINE OPEN OPEN ACCESS HIV/AIDS JOURNAL PEER-REVIEWD OPEN HIV/AIDS JOURNALPEER-REVIEWD PEER-REVIEWD OPEN ACCESS PEER-REVIEWD CCESS A OPEN PEER-REVIEWDONLINE PEER-REVIEWD PEER-REVIEWD HIV/AIDS JOURNALHIV HIV/AIDSand JOURNALadolescents:HIV/AIDS JOURNAL PEER-REVIEWD OPEN ACCESS CCESS PEER-REVIEWD A PEER-REVIEWD A focus on young key populations CCESS OPEN ACCESS Guest Editors: Linda-Gail Bekker and Sybil Hosek OPEN HIV/AIDS JOURNAL Volume 18, Supplement 1 Scan this QR code with your mobile device to view February 2015 the special issue online Acknowledgements CIPHER would like to give special thanks to Manoj Kurian and IAS President Chris Beyrer, as well as Charlie Baran and Alice Armstrong for their input on the concept for this special issue. We would also like to thank the editorial team of JIAS, in particular Marlène Bras and Susan Kippax, as well as the Guest Editors for their hard work and time, and for going beyond the call of duty to make this issue possible. Support The publication of this special issue was supported by the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), which is funded through an unrestricted grant from ViiV Healthcare’s Paediatric Innovation Seed Fund. HIV and adolescents: focus on young key populations Guest Editors: Linda-Gail Bekker and Sybil Hosek Contents Editorial: Building our youth for the future Linda-Gail Bekker, Leigh Johnson, Melissa Wallace and Sybil Hosek 1 Tailored combination prevention packages and PrEP for young key populations Audrey Pettifor, Nadia L Nguyen, Connie Celum, Frances M Cowan, Vivian Go and Lisa Hightow-Weidman 8 HIV testing and linkage to services for youth Ann E Kurth, Michelle A Lally, Augustine T Choko, Irene W Inwani and J Dennis Fortenberry 23 Providing comprehensive health services for young key populations: needs, barriers and gaps Sinead Delany-Moretlwe, Frances M Cowan, Joanna Busza, Carolyn Bolton-Moore, Karen Kelley and Lee Fairlie 29 Review: An urgent need for research on factors impacting adherence to and retention in care among HIV-positive youth and adolescents from key populations Priya Lall, Sin How Lim, Norliana Khairuddin and Adeeba Kamarulzaman 41 Mental health and support among young key populations: an ecological approach to understanding and intervention Massy Mutumba and Gary W Harper 54 Adolescent girls and young women: key populations for HIV epidemic control Rachael C Dellar, Sarah Dlamini and Quarraisha Abdool Karim 64 “We don’t need services. We have no problems”: exploring the experiences of young people who inject drugs in accessing harm reduction services Anita Krug, Mikaela Hildebrand and Nina Sun 71 “First, do no harm”: legal guidelines for health programmes affecting adolescents aged 10–17 who sell sex or inject drugs Brendan Conner 78 Young key populations and HIV: a special emphasis and consideration in the new WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations Rachel Baggaley, Alice Armstrong, Zoe Dodd, Ed Ngoksin and Anita Krug 85 Volume 18, Supplement 1 February 2015 http://www.jiasociety.org/index.php/jias/issue/view/1472 Bekker L-G et al. Journal of the International AIDS Society 2015, 18(Suppl 1):20027 http://www.jiasociety.org/index.php/jias/article/view/20027 | http://dx.doi.org/10.7448/IAS.18.2.20027 Editorial Building our youth for the future Linda-Gail Bekker§,1,2, Leigh Johnson3, Melissa Wallace1,2 and Sybil Hosek4 §Corresponding author: Linda-Gail Bekker, The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. Tel: 27216506959. ([email protected]) 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. Keywords: young key populations; HIV; Prevention and treatment. Published 26 February 2015 Copyright: – 2015 Bekker L-G et al; licensee International AIDS Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 Unported (CC BY 3.0) License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Building our youth for the future There are approximately four million young people aged 15 to 24 living with HIV globally, and 29% of those are adolescents We cannot always build the future for our youth, aged 15 to 19 [4]. Between 2005 and 2012, the number of but we can build our youth for the future. AIDS-related deaths decreased by 30% for all ages except Franklin D. Roosevelt * among adolescents, who experienced a 50% increase in that The inaugural summary on the Global Youth Wellbeing Index same period. Similarly, two-thirds of new HIV infections in reports that a sobering 85% of youth (age 10 to 24) in the 2012 occurred among youth aged 15 to 24 [5]. HIV prevention 30 countries included report low levels of overall well-being and decreasing HIV-related deaths depend critically on reach- [1]. The overall well-being score, as defined by the index, is ing adolescents. composed of six domains shown in Table 1. Young people, adolescents and young adults, are at If these youth are representative of the one billion youth increased risk for HIV due in part to the multiple transitions alive in the world today, then we must ask ourselves where (i.e., biological, psychological) and developmental tasks (e.g., have we failed and what more we can do [2]. Young people establishing identity) in this period of the lifespan. Among are our future as well as the world’s greatest resource. youth, there are also key populations that bear dispropor- Overall, there were an estimated 1.3 million adolescent deaths tionate burdens of HIV and are the most vulnerable. These in 2012, most of them from causes that could have been young key populations (YKPs) include men who have sex with prevented or treated. Mortality is higher in boys than in men (MSM), transgender people, those who inject drugs and girls and in older adolescents (15 to 19 years) than in the sex workers, as well as youth who belong in multiple groups younger group (10 to 14 years). Whereas there are many (e.g., transgender youth who inject drugs) [6]. causes of mortality common to boys and girls, violence is a particular problem in boys and maternal causes in girls [2]. Young key population vulnerabilities Figure 1 shows the top 10 causes of death and disability- Young MSM adjusted life-years lost in adolescents worldwide. Among young MSM, HIV incidence has been shown to be very In contrast to reductions in other population groups, high across multiple countries, and global reports estimate estimates suggest that numbers of HIV deaths are rising an HIV prevalence of 4.2% for young gay men under the in the adolescent age group. This increase has occurred age of 25 [4,7]. In the United States, MSM account for predominantly in the African region, resulting in AIDS being most (72%) new HIV infections among youth aged 13 to 24, the leading cause of death among adolescents in Africa making them the only group that has shown a significant and the second leading cause for adolescents worldwide [3]. increase in estimated new infections. Among young MSM in 1 Bekker L-G et al. Journal of the International AIDS Society 2015, 18(Suppl 1):20027 http://www.jiasociety.org/index.php/jias/article/view/20027 | http://dx.doi.org/10.7448/IAS.18.2.20027 Table 1.