YOUTH-LED AND YOUTH-FRIENDLY SERVICES FOR PREVENTION, TESTING, AND TREATMENT OF HIV, AND SUPPORT SERVICES

Globally, HIV continues to disproportionately impact young people in all our diversity, yet we remain marginalised and relegated to the role of dependents in receipt of services rather than as autonomous actors. Time and time again, we have shown that we can innovate and lead HIV responses in our communities. The interventions we lead, and have led, must be recognised as vital contributions of national, regional, and global HIV responses. The strengthening of formal and informal youth networks and organisations around the world increases our capacity as partners and leaders.  

HIV prevention and treatment should not only include ARVs and condoms. New prevention interventions such as PEP and PrEP, comprehensive harm reduction services, adequate and accessible mental health services, community-based social support, and in- and out-of-school comprehensive sexuality education (CSE) all form a wider package of HIV prevention and treatment which should be made available to all young people, including key populations. All youth-friendly HIV services must be part of a greater package of universal health coverage, and special attention must be paid to young people living with HIV who are affected by TB. As a generation of digital natives, we ask that we be supported to lead in combatting disinformation online that threatens our health and wellbeing.  

As young people, we go through many changes and tackle many issues relating to our identities, health, bodies, social lives, and place in the world. Despite this, the loss to follow-up for HIV treatment among 15–24-year-olds living with HIV is almost twice as high as that of young adolescents (10-14 years) or adults (over 25 years). Urgent attention needs to be paid to adolescents in- and out-of-school living with HIV. Children living with HIV also require much more attention than is currently being paid to them, with only 53% accessing the medication they needed in 2019. We urge governments to quickly mobilise national campaigns to ensure children are tested for HIV, given treatment, and supported holistically as they grow and develop.  

RECOGNITION OF YOUNG PEOPLE IN ALL OUR DIVERSITY; INTERSECTIONALITY IN THE GLOBAL HIV
RESPONSE

The term ‘young people’ is often used to lump us all together and reduces us to a single entity with a single set of needs. As young people, we are not a homogeneous group but a diverse group with a unique set of requirements in the global HIV response. Young people who use drugs, young sex workers, young transgender people, gay, bisexual, and other young men who have sex with men, and young people in detention must all be recognised and engaged meaningfully in HIV responses. The different needs of young people who are in and out of school and the differences in rural and urban young people must all be recognised and engaged meaningfully in the HIV response.  

This is not to diminish the need for intersectionality; we often have many identities and experience many intersecting forms of oppression. Young people with disabilities and young indigenous peoples are often left out of the conversation on HIV and the same applies to young people living in fragile and humanitarian settings, but the need for engaging them is just as important as any other group; there is a critical need for engagement with young refugees and young internally displaced people, particularly as disasters increase due to inaction on climate change. Support and investment in youth-led HIV and SRHR responses are integral for young people living in fragile and humanitarian contexts.  

ETHICAL AND MEANINGFUL YOUTH ENGAGEMENT AND YOUTH-LED ACCOUNTABILITY IN THE GLOBAL
HIV RESPONSE

Since the last Political Declaration on HIV and AIDS in 2016, the progress that is needed to end AIDS has not been made. Governments have failed to meet many of the targets set on young people, and there are few avenues to hold them accountable. Community accountability of governments and decision-makers must be at the centre and built into any action based on the political declaration with commitments made during the upcoming High-Level Meeting and Political Declaration.

Not only should young people in all our diversity be involved in the planning and strategizing, but we must also be involved in the implementation and monitoring and evaluation of services. Young people must also be fairly compensated for our inputs and paid to lead HIV programming for true meaningful youth engagement and supported youth leadership.

REPEALING OF RESTRICTIVE AND PUNITIVE LAWS AND POLICIES, AND GUARANTEEING THE HUMAN RIGHTS OF ALL YOUNG PEOPLE

Young people demand the decriminalisation of drugs and sex work and the repeal of all laws that infringe on the rights of young LGBTQ+ people. Not only is it enough that restrictive, punitive, and discriminatory laws are repealed, laws protecting and upholding the human rights of young people in all our diversity must be implemented and enforced. Governments must protect the rights of adolescent girls and young women, young key populations and young people living with and affected by HIV. Anti-discrimination must be enacted and enforced. This includes recognising the impact that HIV and key population-related stigma have on young people's health and well-being and tackling these as a matter of national importance.  

Laws that act as barriers to accessing HIV testing, treatment, and prevention, such as the age of consent laws to access HIV testing, as well as laws limiting access to harm reduction services, must be repealed without delay. Any laws or policies restricting the provision of CSE must also be abolished.  

FUNDING  

Governments and donors must commit to sustainable and suitable funding for youth-led responses, without restrictive and burdensome application and reporting processes, and without the need for networks to be registered. Many youth-led organisations, directly and indirectly, work with large donors, including The Global Fund and the Robert Carr Fund, to access funding and other forms of technical assistance. Governments should acknowledge side-partnerships and establish mechanisms to guarantee financial and technical assistance. The impact that COVID-19 is having on young people living with and affected by HIV must be addressed and adequately funded with further funding commitments to youth-led responses from governments.  

HOLISITC APPROACHES TO ENDING AIDS, INCLUDING CLIMATE JUSTICE, SECURITY, EDUCATION, AND EMPLOYMENT  

As young people, we are living in a rapidly changing world that is becoming increasingly hostile to us. The climate crisis, an increase in disasters, attacks on comprehensive sexuality education, and lack of meaningful employment opportunities are meaning that often HIV is not our foremost priority. It is not enough for governments to focus on HIV testing, prevention, and treatment alone. As young people, we are telling you the following are needed for comprehensive, holistic HIV prevention and treatment adherence support:  

     guaranteed secondary education, including comprehensive sexuality education  

     meaningful and gainful employment and training opportunities  

     guaranteed shelter/housing  

     adequate, accessible, and acceptable specialised mental health services  

     comprehensive harm reduction services  

     climate justice  

     ending sexual and gender-based violence  

     access to sexual and reproductive health services and enjoyment of our sexual and reproductive health
     and rights

We are multifaceted individuals with multifaceted needs, and HIV testing, prevention, and treatment cannot be siloed; they must be part of a broader agenda for ensuring a sustainable and healthy future for young people in all our diversity. Governments can no longer afford to silo HIV and not tackle the wider poverty that directly impacts our lives.  In the context of the COVID-19 pandemic, as young people we are not wanting recovery, we are wanting radical change; the unequal global economy that led to the disastrous impact of COVID-19 must not be seen as something to aspire back to. As young people we know that the global community can do better than this.  

A radically substantive political declaration that deals with the multifaceted needs of young people in all their diversity is needed if we are to ever end AIDS as a public health threat. As young people, we have already stepped up to lead the response in our communities and globally. We are asking governments to provide the radical global agenda needed to allow us to reach these goals.