There is a strong evidence base that the stigma,
discrimination and criminalization affecting adolescent key populations (KPs)
aged 10–17 is intensified due to domestic and international legal constructs
that rely on law-enforcement-based interventions dependent upon arrest,
pre-trial detention, incarceration and compulsory “rehabilitation” in
institutional placement. While there exists evidence and rights-based technical
guidelines for interventions among older cohorts, these guidelines have not yet
been embraced by international public health actors for fear that international
law applies different standards to adolescents aged 10–17 who engage in
behaviours such as selling sex or injecting drugs.
As a matter of international human rights, health, juvenile
justice and child protection law, interventions among adolescent KPs aged 10–17
must not involve arrest, prosecution or detention of any kind. It is imperative
that interventions not rely on law enforcement, but instead low-threshold,
voluntary services, shelter and support, utilizing peer-based outreach as much
as possible. These services must be mobile and accessible, and permit
alternatives to parental consent for the provision of life-saving support,
including HIV testing, treatment and care, needle and syringe programmes,
opioid substitution therapy, safe abortions, antiretroviral therapy and
gender-affirming care and hormone treatment for transgender adolescents. To
ensure enrolment in services, international guidance indicates that informed
consent and confidentiality must be ensured, including by waiver of parental
consent requirements. To remove the disincentive to health practitioners and
researchers to engaging with adolescent KPs aged 10–17 government agencies and
ethical review boards are advised to exempt or grant waivers for mandatory
reporting. In the event that, in violation of international law and guidance, authorities
seek to involuntarily place adolescent KPs in institutions, they are entitled
to judicial process. Legal guidelines also provide that these adolescents have
influence over their placement, access to legal counsel to challenge the
conditions of their detention and regular visitation from peers, friends and
family, and that all facilities be subject to frequent and periodic review by
independent agencies, including community-based groups led by KPs.
Controlling international law specifies that protective
interventions among KPs aged 10–17 must not only include low-threshold,
voluntary services but also “protect” adolescent KPs from the harms attendant
to law-enforcement-based interventions. Going forward, health practitioners
must honour the right to health by adjusting programmes according to principles
of minimum intervention, due process and proportionality, and duly limit
juvenile justice and child protection involvement as a measure of last resort,
if any.
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