Young Key Populations

Young key populations (YKPs) are a hidden and vulnerable group of young people (age 10 – 24 years) within the community sectors that are characterised by vulnerability to the HIV epidemic, drug use, sexual exploitation and societal stigma.

The WHO lists the five key populations as:

men who have sex with men (MSM),
people in prisons and other closed settings,
people who inject drugs,
sex workers, and
transgender people.

Young key populations are reported to be at increased risk of HIV infection compared to the older people within the identified key populations, and experience age specific barriers to accessing health care or participate in health research.

There are specific barriers that young key populations are confronted with when accessing health care services and HIV health research studies. The Consolidated Guidelines on HIV prevention, diagnosis, treatment and care for key populations highlights how you are able to improve the experience and participation of young key populations in health research.

Developing targeted health services and research interventions requires specific implementation considerations for each of the young key populations.

Bekker identifies some of the HIV health considerations when working with young key populations:

Young MSM:

UNAIDS reports that in year 2020 the risk of acquiring HIV among the MSM populations was 25 times greater than any other vulnerable groups, and that 39% of new HIV infections among key populations are from the sub-Saharan Africa. To increase safer sexual behaviours and increase uptake of HIV counselling and testing among young MSM, WHO recommends that HIV health behavioural research looks into:

Targeting internet-based information.
Increasing social marketing strategies.
Targeting sex venue-based outreach.

It is important to remember that same sex relationships are illegal in some African countries and accessing this population group might further complicate research participation and accessing health programmes. Amnesty International UK mapped out the African countries that have favourable and hostile laws towards homosexuality.

Legal to have same-sex relationships	Illegal to have same-sex relationships
Benin, Burkina Faso, Cape Verde, Central African Republic, Chad, Congo-Brazzaville, Cote d’Ivoire, Democratic Republic of Congo, Djibouti, Equatorial Guinea, Gabon, Guinea-Bissau, Lesotho, Madagascar, Mali, Mozambique, Niger, Rwanda, South Africa	Algeria, Angola, Botswana, Burundi, Cameroon, Comoros, Egypt, Eritrea, Ethiopia, Gambia, Ghana, Guinea, Kenya, Liberia, Libya, Malawi, Mauritania, Mauritius, Morocco, Namibia, Nigeria, Sao Tome, Principe, Senegal, Seychelles, Sierra Leonne, Somalia, South Sudan, Swaziland, Tanzania, Togo, Tunisia, Uganda, Zambia, Zimbabwe

Youth who inject drugs:

The number of young adults injecting drugs like heroin in sub-Saharan Africa is increasing. This is a great concern for HIV health interventions because drug injecting increases the risk of exposure to HIV infection in a region that is highly burdened with HIV. Providing information and referral to adolescents about local services that support and provide safe injecting, overdose prevention and treatment within a harm reduction framework is important in addressing the risks associated with HIV exposure. Few countries have achieved sufficient coverage of harm reduction services as part of a comprehensive HIV package and strong advocacy remains needed.

Young sex workers:

WHO, UNFPA, UNAIDS, and the Global Network of Sex Work Projects have developed guidelines for the prevention and treatment of HIV for sex workers in low- and middle-income countries to better protect sex workers from HIV and other sexually transmitted infections (STIs).The objective of these guidelines is to provide technical recommendations on effective programmes for the prevention and treatment of HIV and other STIs among sex workers and their clients. Young female sex workers face other vulnerabilities like gender-based violence which further limits their ability to seek acceptable HIV health care services.

Transgender youth:

The greatest challenge in trying to create a safe environment for transgender youth to participate meaningfully in HIV and health research is that over and above being vulnerable to HIV and discrimination, they often face social, legal and economic exclusion, reduced access to healthcare services, and are at increased risk of violence and poor mental health.

Youth in prisons:

Data on health care services for the youth in prisons is very scant despite the international recognition of the increased exposure to HIV and TB infections in these confined spaces. Researchers and programmers interested in working with young people in prisons and other closed settings can follow the WHO guidelines on how to provide effective and acceptable comprehensive HIV and health services for their individual countries. The need to work with youth in prisons is exacerbated by the fact that in sub-Saharan Africa detainees have a higher HIV and TB prevalence than the general population. However, Telisinge (2016) identified some examples of promising practices of HIV and TB health interventions in some of the countries in sub-Saharan region:

Routine voluntary testing for HIV and screening for tuberculosis upon entry to South African and Zambian prisons.
Reforms to pre-trial detention in South Africa.
Integration of mental health services into a health package in selected Malawian prisons.
Task sharing to include detainees in care provision through peer-educator programmes in Rwanda, Zimbabwe, Zambia, and South Africa.

There remains a gap in the current services because they are targeting persons in prisons and closed settings as a homogenous group with no specific attention to the youth.

Overall, recommended behavioural interventions for young key populations include skills-based interactive and participatory approaches such as online, mobile health, peer and outreach programmes. Bekker (2015) recommends that at all times HIV prevention and treatment interventions must be adolescent centred and make use of technological inventions sensitive to the young people.

Special attention should be given to the country or countries in which you are doing your research as there are different social and legal frameworks for working with young key populations that will need to be applied and thus will have an impact on your research. There might be different legal and ethical considerations when working with pregnant young women in prison, or young people injecting drugs and are also in conflict with the law. In addition, in certain countries same sex relationships are illegal and these boundaries should be established prior to undertaking your research.

For example, what would be the considerations for designing an HIV prevention intervention for young female sex workers in a South African context where sex work is still criminalised. is provided by civil society organisations. Recommendations and guidance for working with young female sex workers are provided by civil society organisations. As such, examples of specific guidelines on working with key populations and best practice models for working with young key populations are provided.

Youth in prisons:

The benefits for increasing the involvement of young key populations in HIV and health research and services are numerous, and include:

Reducing the vulnerability of young key populations to HIV risk.
Improving young key populations’ visibility and meaningful participation in HIV and health research programmes
Improving evidence-based data that is specific to the health care needs of young key populations.

There are various opportunities for working with young key populations during HIV research and health interventions. For example:

Task sharing with key populations in prison to provide peer-education programmes in Rwanda, Zimbabwe, Zambia and South Africa.
To increase key population involvement and access to health care services, the Zimbabwean Ministry of Health & Child Care has developed a manual for healthcare providers. This training manual provides guidance on how to provide non-discriminatory health care services to key populations and can be adapted in other settings in the region.

You should check for country specific guidelines for working with key populations that may have an implication for working with young key populations.

BY YOLISWA NTSEPE (MA, PhD)
ADOLESCENT PROGRAMMES MANAGER

UPDATED NOV 22, 2023

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REFERENCES & ADDITIONAL RESOURCES:

Link for status of same sex relationships in Africa:
https://www.amnesty.org.uk/lgbti-lgbt-gay-human-rights-law-africa-uganda-kenya-nigeria-cameroon