Sex workers, drug users, men who have sex with men and transgender people are at higher risk of HIV than the general population – a risk that is heightened if the person is young. WHO has produced specific guidance on how best to provide support and treatment for young people under 24 in these vulnerable groups, drawing heavily on young people’s own views.
“You have triple stigma if you are young, a sex worker and transgender,” said a young person in Asia. This was one of many comments gathered during a range of community consultations by WHO partner organizations* to learn about the barriers such young people face in accessing health services.
“In many countries, these young key populations are not even spoken about, much less provided for. But changes that happen in adolescence can add complications to already complicated lives,” says Alice Armstrong of WHO’s HIV Department, who coordinated this work. The consultations examined the experiences across the world of young men who have sex with men (MSM), young people who sell sex, those who inject drugs and those who are transgender.
The findings helped to shape WHO’s "Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations," as well as a series of discussion briefs developed with other UN agencies and community organization partners on how to provide services, programmes and support for these key groups.
Expelled, ashamed, abused
More than 5 million people overall aged 10 to 24 are living with HIV. Those aged 15 to 24 years were estimated in 2012 to account for 39% of all new infections worldwide in people over 15 years of age.
There is a dearth of reliable health data about young people but it is recognised that discrimination and stigma, violence and alienation from families and friends are factors that can lead them, willingly or not, to engage in behaviours, such as unprotected sex and the sharing of needles and syringes, that put them at risk of HIV and hepatitis B and C infections.
“I was expelled from school and abandoned by my own family when they found out I was taking some [non-injecting] drugs. So I thought, why not go all the way,” said a young Indonesian.
“Clients are too ashamed to purchase a condom and we are too scared to buy a condom,” a young male sex worker in Pakistan said.
Police respond with abuse when you try to report abuse by clients, a young sex worker in Kenya recounted, “telling us [we should instead] be selling potatoes in the market”.
Listen and learn
Legal barriers, such as age of consent to accessing health services, can also pose huge problems.
“It’s not helpful to tell a young person go away, we can’t give you a condom now, come back when you are 18,” says Dr Rachel Baggaley of WHO’s HIV Department. “For young men who have sex with men, for example, this is a period when they are often really at risk of HIV. If we can support them through this time to develop the knowledge and skills to protect themselves from HIV this could have an important impact.”
“We hope that these new guidelines and discussion briefings will serve as an exchange of information for groups working in all these areas, stimulate discussion and raise awareness of how these young people need more attention, in particular from health services,” says Ms Armstrong.
That includes listening to what young people themselves say. “Young people don’t want to be lectured at, yet we doctors love telling people what to do,” adds Dr Baggaley. “One group during the survey consultations drew a picture of their ideal health worker. It had huge ears – and a tiny mouth.”
* Partners included: United Nations Populations Fund, Youth Voices Count, HIV Young Leaders Fund and Youth Research Information Support Education (YouthRISE), Youth LEAD
