National strategic frameworks or plans (NSPs) determine a country’s national response to HIV and AIDS, guiding allocation of funding, resources and human capacity and are now critical for Global Fund investments.

In the Asia-Pacific region, with low/concentrated epidemics, one would expect that NSPs would prioritize key populations at higher risk of HIV exposure, including men who have sex with men, transgender people, sex workers and their clients, people who inject drugs, and people living with HIV. This includes young key populations (under age 25), who are believed to represent around 95% of new infections among young people and who are experiencing growing epidemics in many countries in the region.

It aims to inform country-based reviews and progress reports of current NSPs, and the development of future plans with greater attention to these populations.

This review analyses attention to key populations, with a particular focus on younger cohorts, in 19 NSPs in the Asia-Pacific region. NSPs were coded by >40 sub-categories in areas of: NSP development and review, content and operationalization of the plan, and by key population/young key population. The analytical tool drew on: existing reviews of NSPs; guidance documents on comprehensive packages for key populations; and the UNAIDS HIV and AIDS Investment Framework.

While there is attention to KP in Asia-Pacific NSPs, young key populations are oft-invisible, whether in situation analyses, NSP development, or identified interventions.
• All NSPs included key populations in NSP development, with people living with HIV (n=12) being most common. 8 reported broad youth engagement (not YKP).
• 11 NSPs include strategic information on YKP (typically children/youth living with HIV), attention is rare to young men who have sex with men (n=4), young people who inject drugs (n=3), and young people selling sex (n=1).
• 6 NSPs specify future research on YKP.
• All NSPs include goals for key populations, and 3 NSPs for young people living with HIV; 9 NSPs had targets for young people living with HIV, 1 NSP had a target for young men who have sex with men.
• Basic programmes identified largely neglected young men who have sex with men and young transgender people, despite emerging epidemics. Only 3 NSPs referred to programmes for young people who injecting drugs, and 2 for young people selling sex.
• Enabling environment interventions for KP most commonly referred to people living with HIV (including young people living with HIV); only 3 refer to other YKP.
• Social/child protection most commonly discussed intervention (N=8, N=7, respectively) for HIV.
• No NSPs specified budgets for YKP.
Conclusions and recommendations
Countries need to take steps to connect the policy, political and financial processes to on-the-ground realities when revising or developing new NSPs. The report concludes with a number of recommendations including to address growing young key population epidemics through:
• Meaningful engagement in the development, review and operationalization of NSPs
• Strengthened strategic information to inform programming.
• Youth-friendly and -accessible prevention programmes which are tailored to YKP, where possible,
• Interventions to create an enabling environment and synergistic development activities to address broader protection issues and risks;
• Targets and allocated budgets.

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