Tailored combination prevention packages and PrEP for young key populations.
BACKGROUND
Young key populations, defined in this article as men who have sex with men, transgender persons, people who sell sex and people who inject drugs, are at particularly high risk for HIV. Due to the often marginalized and sometimes criminalized status of young people who identify as members of key populations, there is a need for HIV prevention packages that account for the unique and challenging circumstances they face. Pre-exposure prophylaxis (PrEP) is likely to become an important element of combination prevention for many young key populations.


OBJECTIVE
In this paper, we discuss important challenges to HIV prevention among young key populations, identify key components of a tailored combination prevention package for this population and examine the role of PrEP in these prevention packages.


METHODS
We conducted a comprehensive review of the evidence to date on prevention strategies, challenges to prevention and combination prevention packages for young key populations. We focused specifically on the role of PrEP in these prevention packages and on young people under the age of 24, and 18 in particular.


CONCLUSIONS
Combination prevention packages that include effective, acceptable and scalable behavioural, structural and biologic interventions are needed for all key populations to prevent new HIV infections. Interventions in these packages should meaningfully involve beneficiaries in the design and implementation of the intervention, and take into account the context in which the intervention is being delivered to thoughtfully address issues of stigma and discrimination. These interventions will likely be most effective if implemented in conjunction with strategies to facilitate an enabling environment, including increasing access to HIV testing and health services for PrEP and other prevention strategies, decriminalizing key populations' practices, increasing access to prevention and care, reducing stigma and discrimination, and fostering community empowerment. PrEP could offer a highly effective, time-limited primary prevention for young key populations if it is implemented in combination with other programs to increase access to health services and encourage the reliable use of PrEP while at risk of HIV exposure.


CONCLUSIONS
Reductions in HIV incidence will only be achieved through the implementation of combinations of interventions that include biomedical and behavioural interventions, as well as components that address social, economic and other structural factors that influence HIV prevention and transmission.
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; apettif@email.unc.edu.
Audrey
A
Pettifor
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Nadia L
NL
Nguyen
International Clinical Research Center, University of Washington, Seattle, WA, USA.
Connie
C
Celum
Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe.|Department of Infection and Population Health, University College London, London, United Kingdom.
Frances M
FM
Cowan
Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Vivian
V
Go
Department of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Lisa
L
Hightow-Weidman
D000293:Adolescent; D000328:Adult; D015658:HIV Infections / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D065129:Pre-Exposure Prophylaxis / Q000379:methods; D063106:Transgender Persons; D055815:Young Adult; D005260:Female
HIV; combination prevention; key populations; pre exposure prophylaxis