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a Degree of desirability is indicated with a maximum of 3 "+" signs. Degree of undesirability is indicated with a maximum of 3 "-" signs. b All interventions need to overcome stigmatization of the target group and the illegality of the behaviours in order to be successful a Degree of desirability is indicated with a maximum of 3 "+" signs. Degree of undesirability is indicated with a maximum of 3 "-" signs. b All interventions need to overcome stigmatization of the target group and the illegality of the behaviours in order to be successful that 90% of injecting drug users were younger than 20 years, and 65% of young people living on the street who were also injecting drugs were HIV positive (16).

Not only do young people make up a significant proportion of injecting drug users, but as this study from Irkutsk indicates they may also be particularly vulnerable. In Bangladesh, sex workers who are younger than 25 were almost twice as likely to report having been beaten or raped when compared with their older peers (17); in Myanmar national surveillance reports show that sex workers and injecting drug users who are younger than 25 have a higher prevalence of infection with HIV than other age groups (18). A cross-sectional study from India found a significantly higher prevalence of HIV infection among female sex workers who were younger than 20 compared with the prevalence among older age groups (P = 0.002, odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.3-4.4) (19). A high prevalence of HIV among young women was also reported from a cohort of female sex workers in the United Republic of Tanzania that reviewed HIV prevalence among women aged 16-39 years: 46% of those who were younger than 20 were HIV positive; 72% of women aged 20-24 were HIV positive; and 68% of those aged 25 years or older were HIV positive (20).

Not only do the data indicate that young people represent a significant proportion of the population most at risk of becoming infected, and that they may be particularly vulnerable, but there is also some evidence that their needs differ from older people in at-risk groups.

For example, Tawil (21) cited a Moroccan programme targeting men who have sex with men. This programme's baseline survey found that only 28% of males aged 15-24 years reported using condoms regularly, while 57% of those aged 25 years or older reported using condoms regularly. Similarly, a Bolivian study conducted among female sex workers reported an increased risk of gonorrhoea, trichomoniasis and genital ulcer among those aged 24 years or younger, without indicating behavioural reasons for this disparity (22). A study that compared drug users who were younger than 26 with older drug users found significant differences in risk-taking behaviours between the two groups (23). Although younger drug users were less likely to inject their drugs compared with older drug users, the age at which users started taking drugs had dropped significantly among the younger drug users (16.2 years for younger users versus 17.9 years for older users, P < 0.001), and younger users were also less likely to be aware of their HIV status (41.8% for younger users versus 64.9% for older users, P < 0.001).

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