"We don't need services. We have no problems": exploring the experiences of young people who inject drugs in accessing harm reduction services.

INTRODUCTION: Evidence suggests that people who inject drugs often begin their drug use and injecting practices in adolescence, yet there are limited data available on the HIV epidemic and the responses for this population. The comprehensive package of interventions for the prevention, treatment and care of HIV infection among people who inject drugs first laid out in 2009 (revised in 2012) by World Health Organization, United Nations Office of Drugs and Crime and Joint United Nations Programme on HIV/AIDS, does not consider the unique needs of adolescent and young people. In order to better understand the values and preferences of young people who inject drugs in accessing harm reduction services and support, we undertook a series of community consultations with young people with experience of injecting drugs during adolescence. METHODS: Community consultations (4-14 persons) were held in 14 countries. Participants were recruited using a combined criterion and maximum variation sampling strategy. Data were analyzed using collaborative qualitative data analysis. Frequency analysis of themes was conducted. RESULTS: Nineteen community consultations were organized with a total of 132 participants. All participants had experienced injecting drugs before the age of 18. They had the following age distribution: 18-20 (37%), 21-25 (48%) and 26-30 (15%). Of the participants, 73.5% were male while 25.7% were female, with one transgender participant. Barriers to accessing the comprehensive package included: lack of information and knowledge of services, age restrictions on services, belief that services were not needed, fear of law enforcement, fear of stigma, lack of concern, high cost, lack of outreach, lack of knowledge of HCV/TB and lack of youth friendly services. CONCLUSIONS: The consultations provide a rare insight into the lived experiences of adolescents who inject drugs and highlight the dissonance between their reality and current policy and programmatic approaches. Findings suggest that harm reduction and HIV policies and programmes should adapt the comprehensive package to reach young people and explore linkages to other sectors such as education and employment to ensure they are fully supported and protected. Continued participation of the community of young people who inject drugs can help ensure policy and programmes respond to the social exclusion and denial of rights and prevent HIV infection among adolescents who inject drugs.

CrowdOutAIDS: crowdsourcing youth perspectives for action.

To develop a strategy for how to better engage young people in decision-making processes on AIDS, UNAIDS launched the participatory online policy project CrowdOutAIDS in 2011. A total of 3,497 young people aged 15-29 from 79 countries signed up to nine online forums, and volunteers recruited through the online platform hosted 39 community-based offline forums with an additional 1,605 participants. This article describes the participatory approach of using social media and crowdsourcing solutions to integrate youth perspectives into strategy and policy processes. In these forums, youth consistently identified the need to change the way sex and relationships are dealt with through changing how sex is talked about, putting comprehensive sexuality education in place, and overcoming social and cultural taboos. The outcome document recommended three major priorities: dispel taboos surrounding sex and sexuality, eliminate stigma and discrimination against young people living with HIV, and remove social and legal barriers. Six strategic actions were also recommended: strengthen young people's skills for effective leadership, ensure full youth participation in the AIDS response, increase access to HIV-related information, strengthen strategic networks, increase UNAIDS's outreach to young people, and increase young people's access to financial support. Through leveraging social media and crowdsourcing, it is possible to integrate grassroots perspectives from across the globe into a new model of engagement and participation, which should be further explored for community empowerment and mobilization.