1. What is the evidence? Martin Choo Centre of Excellence for Research in AIDS (CERiA) University of Malaya, Kuala Lumpur The realities of young key populations © UNFPA Morocco - Youth participants-Rabat -Morocco 2012

2. Who are young key populations? Young people –10 – 24 years –One quarter of world’s population Key populations = groups at increased risk for HIV due to specific high risk behaviour, includes: –People who inject drugs –People who sell sex –Young men who have sex with men –Transgender people

3. Why young key populations matter? Vulnerabilities of youth –Adolescence increases pleasure seeking and risk- taking, peer pressures, wanting to adopt “adult” behaviours. Cascade of risk –Multiple overlapping risk factors, and where any risk behaviour often compounds further risk. Social marginalisation –Increased risk of social isolation for key populations.

4. Among most affected by HIV Over 5 million aged 10-24 living with HIV in 2013. Each day more than 2,400 young people become infected with HIV. 35% of new HIV infections worldwide are aged 15-24. Image available at http://youthrise.org/blog/youth-rise-and-rumah-cemara-6-months

5. Methodology (1) Review of literature on available epidemiological evidence guided by experts in the field. Global community consultations (2013): –UN Population Fund –Youth RISE – global youth-led harm reduction network –Youth Voices Count – policy brief on self-stigma among young MSM and transgender –Youth LEAD – Youth Leadership, Education, Advocacy and Development Project –HIV Young Leaders Fund

6. What are the realities for young people? Image available at http://youth-lead.org

7. Young people who inject drugs Injecting drugs in groups is common and sharing equipment more likely – young people often last in line to use injecting equipment. Drug use compounds rapid changes during adolescence, increasing risk for unprotected sex. Experimentation with drugs as part of adolescence can lead to dependence/addiction. Socially marginalized (including race and gender) young people more likely to inject drugs. Lack of resources and information on drugs can lead to exchanging sex for drugs. Criminalization, enforcement and incarceration of drug use disproportionately affect young people.

8. Young people who sell sex Economic necessity often drives selling sex. Poor negotiation of condom use is common. Seek protection from adults in exchange for sex. More prone to violence particularly from law enforcement. Criminalization of sex work disproportionately burdens youth – vulnerable to police action. Denied access to SRH/comprehensive services without parental guidance/consent – increases chances of poorly conducted self-administered abortions. No access to sex education and protection from HIV/STI especially among street-based youth often have

9. Young men who have sex with men Prone to violence and relationship dynamics mean inability to negotiate condom use. Homophobia/criminalization increases chances of social marginalization and isolation among youth – increases risk of suicide. Homophobic bullying more common at school than in other social venues. Misconception of risk from lack of information. Risk of drugs/alcohol use increases with need to fit in to social scene among adult MSM. Criminalization and social inhibitions further restricts access to services.

10. Young transgender people Normalizing gender identity is poor. Unprotected anal sex common among transgender women. Intersection of drug use with unprotected/selling sex. Criminalization/marginalization of sexual differences increases chances youth will be isolated – risk of homelessness, unemployment. Social marginalization keeps them from schools, and in accessing services (especially SRH). Selling sex to survive is an increasing reality for many. Sexual exploitation and violence are common – increased risk of police extortion.

11. Current gaps in research Implementation research –Insufficient data on what works and what doesn’t –Need more validation of programmes Qualitative research –Hearing the voices of young people –Case studies and community consultations. Consent restrictions for under 18s impede research. Results often not disaggregated by age even when young people have been included in studies.

12. Conclusions Social and structural conditions which usually compound HIV risk among key populations are even more acute among the young people, and place them disproportionately at risk for HIV. Due to their vulnerabilities young people are more likely to face a cascade of risk that further increases their vulnerability to other risks. Young people need dedicated services that cater specifically to their needs. More research is needed to augment existing data.

13. martin.ceria@um.edu.my Thank you! Image available at http://youth-lead.org