World Health Organization (WHO)
"Programmes are frequently not designed to respond to the overlapping vulnerabilities of young people who inject drugs or the specific legal challenges and ethical concerns in working with children. These vulnerabilities require responses that may go beyond the harm-reduction programmes recognized as effective for adults."
This technical brief aims to catalyse and inform discussions about how best to provide services, programmes, and support for young people who sell sex. It offers an account of: current knowledge concerning the HIV risk and vulnerability of young people who inject drugs; the barriers and constraints they face to accessing appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build the strengths, competencies, and capacities of young people who inject drugs. They are among the key populations at higher risk of HIV that also include men who have sex with men (MSM), transgender people, and people sell sex. Young people who belong to one or more of these key populations - or who engage in activities associated with these populations - are made especially vulnerable to HIV by widespread criminalisation, discrimination, stigma, and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage - willingly or not - in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs.
In the area of HIV risk and vulnerability, the brief examines: sharing non-sterile injecting equipment; unprotected sex; changes during adolescence; social marginalisation and discrimination; racial and ethnic marginalisation; young women; and sexual exploitation/selling of sex. In the area of legal and policy constraints, the brief examines: criminalisation; police harassment and violence; legal minority status; and policy and research. In the area of service coverage and barriers to access, the brief examines: need for additional services for young people; lack of youth-friendly and youth-focused services and programmes; parent/guardian consent; stigma and discrimination by service providers; lack of integrated services and insufficient capacity; and poor access to HIV testing and treatment. Throughout, quotations by young people around the world who inject drugs are included. In addition, one section of the brief provides concrete examples in the form of text boxes illustrating promising programmes addressing the needs and rights of young people who inject drugs that are being implemented by governments, civil society organisations, and organisations of people who use drugs. Strategies examined focus on: reaching young people through a drop-in centre (Kimara Peer Educators and Health Promoters Trust Fund (Kimara Peers), United Republic of Tanzania); increasing the uptake of harm-reduction services through an incentives programme (STOP AIDS, Albania); building the capacity of local programmes (Youth RISE (Resource, Information, Support, Education), Asia-Pacific Region); disseminating information via multiple channels (Programa de Política de Drogas (Espolea, A.C), Mexico); and engagement of young key populations in responding to HIV and sexual and reproductive health issues (Fokus Muda, Indonesia).
The brief next outlines considerations for programmes and service delivery, stressing the importance of designing and delivering services in a way that takes into account the differing rights and needs of young people who inject drugs according to their age, specific behaviours, the complexities of their social and legal environment, and the epidemic setting. Sample suggestion: "Provide information and services through peer-based initiatives, which can also help young people find appropriate role models. Ensure appropriate training, support and mentoring to help young people who inject drugs advocate within their communities to support them in accessing services." Finally, there is a list of considerations for law and policy reform, research, and funding. Sample suggestion: "Examine current consent policies to consider removing age-related barriers and parent/guardian consent requirements that impede access to HIV and STI [sexually transmitted infection] testing, treatment and care....Address social norms around drug use through education with adolescents in schools, using evidence-based methods to build social skills and decision-making capacities, delivered by health professionals and peer[s]." An annex examines the United Nations Convention on the Rights of the Child (1989).
This technical brief is one in a series addressing 4 young key populations (see Related Summaries, below). It is intended for policymakers, donors, service planners, service providers, and community-led organisations. This series was led by the World Health Organization (WHO) under the guidance, support, and review of the Interagency Working Group on Key Populations with representations from: Asia Pacific Transgender Network; Global Network of Sex Work Projects; HIV Young Leaders Fund; International Labour Organization; International Network of People who use Drugs; Joint United Nations Programme on HIV/AIDS (UNAIDS); The Global Forum on MSM and HIV; United Nations Children's Fund (UNICEF); United Nations Development Programme (UNDP), United Nations Office on Drugs and Crime; United Nation Educational, Scientific and Cultural Organization (UNESCO); United Nations Populations Fund (UNFPA); United Nations Refugee Agency; World Bank; World Food Programme; and WHO.
UNDP website, January 23 2017. Image credit: © Lorena Ros for the Open Society Foundations