Adolescents and young people who fit within key populations face some of the greatest barriers to HIV care, but are frequently overlooked. We review the recent literature on these young, vulnerable populations including HIV risk factors, barriers to care and strategies for engagement.
Common risk factors include age, risky sexual practices, poor education and high levels of alcohol and drug abuse. Barriers to care include limited data, criminalization and high levels of stigma. Strategies to increase engagement include incorporating adolescents into biological and behavioral surveys and the use of social media. Digital innovations for HIV prevention and testing show promise, and pre-exposure prophylaxis (PrEP) may be acceptable. At a policy level, decriminalizing same-sex activity and commercial sex work are priorities. Differentiated models of care including HIV self-testing, after-hour services, community-based delivery and multi-month dispensing of antiretroviral therapy (ART), should be combined into holistic care.
There has been limited success in reaching these key adolescent populations largely due to criminalization and stigma. Accurate, generalizable data are needed to inform the development of innovative strategies for holistic care.