Introduction
While HIV index testing and partner notification (PN) services have the potential to reach adolescent girls and young women (AGYW) aged 15 to 24 and their sexual partners in need of HIV testing services, the potential social harms have not yet been studied. This commentary highlights the risks of this approach, including intimate partner violence (IPV), stigma and discrimination, and outlines an urgent research agenda to fully understand the potential harms of PN for AGYW, calling for the development of mitigation strategies.
Discussion
A substantial evidence base exists demonstrating the feasibility, acceptability and effectiveness of index testing and partner notification for adults aged 18 years and older in low‐ and middle‐income countries (LMICs), particularly for men, and for adults who are married/cohabiting and referring a current sexual partner. AGYW who are most vulnerable to HIV infection in LMICs do not reflect these demographics. Instead, they are often in age‐disparate partnerships, have limited negotiating power within relationships, experience high rates of violence and face economic challenges that necessitate transactional sex. PN services may be particularly difficult for adolescent girls under 18 who face restrictions on their decision making and are at increased risk of rape. Adolescent girls may also face coercion to notify partners due to unequal power dynamics in the provider–adolescent client relationship, as well as judgemental attitudes towards adolescent sexual activity among providers.
Conclusions
As index testing and PN with AGYW is already being rolled out in some LMICs, research is urgently needed to assess its feasibility and acceptability. Implementation science studies should assess the availability, accessibility, acceptability and quality of HIV PN services for AGYW. Qualitative studies and routine monitoring with age‐disaggregated data are critical to capture potential social harms, PN preferences and support needs for AGYW aged 15 to 17, 18 to 20 and 21 to 24. To mitigate potential harms, PN methods should prioritize confidentiality and avoidance of adverse outcomes. Healthcare providers should be trained to conduct routine enquiry for IPV and provide first‐line support. Support services for AGYW living with HIV and survivors of violence should be implemented alongside HIV PN.
The purpose of this article was to present the current state of evidence and experience of youth participation approaches in HIV and sexual and reproductive health decision-making, policies and programmes. By combining a literature review of evaluation evidence with in-depth interviews and a global survey targeting young people with the experience of participation, this study opens a new window into the support needs for meaningful youth participation globally. Limited available evidence indicates that youth participation has positive effects on programme, selfefficacy and empowerment outcomes for the young people engaged in policies and programmes. Young people who have participated in decisionmaking reflected on improvements in outreach and representation of young members of key affected populations, but also expressed concerns about tokenism, age-based hierarchies and access for younger adolescents, women and marginalized groups. Overall, evidence indicates a need for further investments in capacity building, training, inclusive participation spaces and research on meaningful youth participation.
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