Providing comprehensive health services for young key populations: needs, barriers and gaps.
BACKGROUND
Adolescence is a time of physical, emotional and social transitions that have implications for health. In addition to being at high risk for HIV, young key populations (YKP) may experience other health problems attributable to high-risk behaviour or their developmental stage, or a combination of both.


METHODS
We reviewed the needs, barriers and gaps for other non-HIV health services for YKP. We searched PubMed and Google Scholar for articles that provided specific age-related data on sexual and reproductive health; mental health; violence; and substance use problems for adolescent, youth or young sex workers, men who have sex with men, transgender people, and people who inject drugs.


RESULTS
YKP experience more unprotected sex, sexually transmitted infections including HIV, unintended pregnancy, violence, mental health disorders and substance use compared to older members of key populations and youth among the general population. YKP experience significant barriers to accessing care; coverage of services is low, largely because of stigma and discrimination experienced at both the health system and policy levels.


CONCLUSIONS
YKP require comprehensive, integrated services that respond to their specific developmental needs, including health, educational and social services within the context of a human rights-based approach. The recent WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations are an important first step for a more comprehensive approach to HIV programming for YKP, but there are limited data on the effective delivery of combined interventions for YKP. Significant investments in research and implementation will be required to ensure adequate provision and coverage of services for YKP. In addition, greater commitments to harm reduction and rights-based approaches are needed to address structural barriers to access to care.
Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; sdelany@wrhi.ac.za.
Sinead
S
Delany-Moretlwe
CeSHHAR Zimbabwe, Harare, Zimbabwe;|Department of Infection and Population Health, University College London, London, United Kingdom.
Frances M
FM
Cowan
Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Joanna
J
Busza
Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
Carolyn
C
Bolton-Moore
Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Karen
K
Kelley
Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Lee
L
Fairlie
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006266:Health Education; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008603:Mental Health; D060728:Reproductive Health; D012944:Social Support; D047568:Unsafe Sex; D055815:Young Adult
MSM; adolescent; injecting drug use; integrated services; risk; sex workers; youth