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Young Key Populations and the HIV response

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Mehrdad Pourzaki

on 15 January 2014

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Transcript of Young Key Populations and the HIV response

95% of new cases of HIV in young people are among certain key populations only
Young Key Populations and the HIV response
Their risks, needs, what works, and what doesn't in Asia and the Pacific
Young people from Key Populations (YKP) affected by and at high risk of exposure to HIV
Young men who have sex with men
Young transgender people
Young sex workers and their clients - young people engaged in commercial sex
Young people who inject drugs

As well as young migrants and young women

Always includes young people living with HIV
What do all YKP share?
Difficulty in accessing services
Legal, social, employment, education, health
Stigma and discrimination
Bullying in school
Apprehensive healthcare personnel
Abusive law enforcement agents
Lack of access to treatment, medical care and support
Lack of access to information tailored to their needs
Taboo nature of many of their activities - incorrectly-perceived notions
More than 42% of all new cases of HIV are among young people aged 15-24
Only 5% of new cases of HIV are among the average youth
550,000 people aged 15 to 24 live with HIV in Asia and the Pacific
More than 34 million young people living with HIV globally
Young People Who Inject Drugs
22x rates among general population

YPWID (capital city):
Pakistan 22.5
Indonesia 41.5
It's not all the same


The answer
For young people who do not use drugs:
Real information + proven education

For young people who already use drugs:
Harm reduction
Young MSM
Consenting adult sex between men remains illegal
19 out of 38 countries in Asia-Pacific
Ongoing stigma and discrimination
eg. homophobic bullying
Many young MSM may be unsure of their sexuality
try to hide; self-stigma; many questions
HIV prevalence rates are high (capital city):
4.1% in China, 3% in Viet Nam
12.6% in Myanmar
Risk group?
By epidemiology MSM have much higher HIV prevalence than general population

BUT a young MSM could also be in a committed relationship with a long-term partner
Risky behaviour
Lack of comprehensive knowledge on HIV and sexuality

Low consistent condom use

Multiple and anonymous partners

Risky sex under the influence - high ATS use
Young people engaged in commercial sex
All countries in Asia-Pacific criminalize some aspect of sex work except NZ

The involvement of children (< 18) in sex work contravenes UN conventions and international human rights law
BUT many start selling sex at a younger age (14-17)

Can be organized with intermediaries between sex workers and clients or sex workers can be self-employed
In different settings: brothels to private homes to roadside
Full-time or part-time
Money, gifts, benefits

Can be linked with criminal organizations in many places
Including human trafficking and drug cartels
NOT always the case, but often used against sex workers
The context
Sex work is a reality all across the world
"Ignorance is bliss"
Sex workers are not necessary a risk group
eg. Sweden
Sex workers must be empowered to protect themselves and their clients
positive messaging + empowerment
at the forefront of HIV prevention
Young transgender people
Transgender vs. transsexual
Very limited data
Many engage in sex work at some point
Widespread evidence of abuse + stigma
Early school drop-outs
Limited employment opportunities
Limited legal protection
Could have been at birth or acquired at a later stage

Questions about if, when and how to disclose their status, and how to safeguard their sexual and reproductive health

Many face stigma and discrimination
Including self-stigmatization

Ongoing prevention, care and treatment needs, including psychosocial support
What might effective programming look like?
Some common barriers to services
Negative image of the centre
Location + hours of operation
Cultural barriers
Economic barriers
Physical and administrative barriers
Provider-related issues
Good program design
Key populations involved
design and continuing feedback
Drop-ins okay, appointments arranged rapidly
No overcrowding and short waiting times
Affordable fees or none
All welcomed: men, transgender people
Unmarried clients welcomed
referrals and linkages
Many YKP not aware of services
Needs information dissemination, outreach and peers
YKP often have:
Poor health seeking behaviour, limited knowledge of SRH issues, Low self-esteem, and drug and alcohol use issues
Must make direct contact with YKP - peers or health professionals
Mobile clinical services or link to centre
Distribute commodities and information
Use of non-sterile injecting equipment
More difficulty in accessing clean needles than adults
Use drugs in groups; more needle sharing
May not identify as ‘drug users’
Subject to harsh penalties through ‘zero tolerance’ policies
"Support, Don't Punish"
SRH vulnerabilities
Low rates of consistent condom use
Multiple sexual partners
Higher rates of selling sex
Intoxication may increase risky sexual behaviour
Barriers in access to quality STI / antenatal care
Violence (intimate partners, police, clients)
Detention doesn't work
Usually share space with adults
violence, rape, new tricks
Lack of services
treatment, testing, mental, physical
Often military-style
harsh conditions, abuse, lack of human rights
Full transcript