Around 70% of adolescents living with HIV will have acquired it through vertical transmission and so will have been living with the virus since birth.18 Whilst programmes to prevent mother-to-child transmission (PMTCT) have been hugely successful in recent years, reducing new infections among adolescents is more difficult.19 There are many factors that put young people at an elevated risk of HIV.Adolescence and early adulthood is a critical period of development when significant physical and emotional changes occur.
It is estimated that 40% of female sex workers in North America, East and South Asia begin selling sex before the age of 18.38 In Bangladesh, many start before they reach 12-years-old,39 and in India, studies suggest that 17% of female sex workers began selling sex before the age of 15.40 A 2011 study from Ukraine found that 20% of female sex workers were aged 10-19.41 Research shows that adolescents under 18 who sell sex are highly vulnerable to HIV and other sexually transmitted infections (STIs), have higher levels of HIV and STIs than older sex workers, and have limited access to services such as HIV testing, prevention, and treatment.42 Young sex workers face many of the same barriers to HIV prevention as their older counterparts including the inability to negotiate condom use and legal barriers to HIV and sexual health services, which are amplified by their age.43 A study of female sex workers in three main urban areas of Mozambique (Maputo, Beira and Nampula) found that young women who sell sex (aged 15 to 17 years) were less likely to access available HIV testing and treatment services.44 Despite their vulnerabilities, young people who sell sex are severely under-represented in research on HIV and sex work.
Although secondary analysis from biological and behavioural surveys between 2011–2015 found HIV prevalence among young sex workers to be 28% in Cameroon, 42% in Rwanda, 15% Senegal, and 33% in Zimbabwe.45 Most studies of sex workers do not disaggregate programme outcomes by age, and no accurate global estimates exist of the number of young people engaged in selling sex.
Data on the prevalence of 10 to 17 year-olds who are sexually exploited is particularly weak.
In general, even fewer data are available on young men and young transgender people who sell sex than on young women who do so.46 Young transgender people’s immediate HIV risk is related primarily to sexual behaviour, especially unprotected anal sex.
An estimated 4.2% of men who have sex with men aged 25 and under are living with HIV, compared to 3.7% among all men who have sex with men.54 Young men who have sex with men are often more vulnerable to the effects of homophobia (manifested in discrimination, bullying, harassment, family disapproval, social isolation and violence), as well as criminalisation and self-stigmatisation.
This can have serious repercussions for their physical and mental health and their ability to access HIV testing, counselling and treatment.55 Use of drugs or alcohol and selling sex contribute to HIV risk and represent overlapping vulnerabilities that some young men who have sex with men share with other young key populations.56 Young MSM are often unable to respond effectively to homophobia because of their age – they have no income, no employment, and they are dependent on family for housing.If they get kicked out, and they often do, they end up on the street where they may be forced to trade sex for food, shelter or protection.57 Current methods of gathering and reporting data make it impossible to calculate a reliable global estimate of the number of young people who inject drugs.58 HIV prevalence among young people who inject drugs worldwide is estimated at 5.2%.59 However, it is much higher in certain countries.This means that, even if current progress is maintained, new HIV infections among young people are expected to increase.If progress stalls, the results could be devastating.This is particularly the case for younger adolescents because of the challenges in getting parental approval for their involvement in surveys and a lack of age-appropriate questions.