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Exosystem factors include school and neighbourhood safety, neighbourhood poverty, stereotypes and representation of YKPs in communities, absence of caring adults, negative experiences with service providers, dearth of trained mental health providers, and geographical and financial barriers to accessing comprehensive and sensitive mental health services [ 85 , 667 666 ]. Exposure to violence, including war and civil strife, contributes significantly to MHDs, especially among youth in low-income countries [ 667 , 668 ]. The macrosystem factors include stigma, discrimination, social and economic marginalization, criminalizing or disenfranchising public policies, and cost of health care services.

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An important key population in the southern African setting is women aged 65 79 years, who contribute nearly 85% of all new HIV infections in the region [ 6 , 5 , 6 ]. In South Africa, this percentage translates to 668,555 new infections in women per year, more than four-times the number contributed by their male peers ( Figure 6 ) [ 5 ]. Such disproportionately high HIV incidence in women compared to men is explained by a striking and characteristic feature of the HIV epidemic in this region: the age sex disparity in HIV acquisition, wherein women acquire HIV around five to seven years earlier than men, often synonymously with sexual debut ( Figure 7 ) [ 5 , 7 ].

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Additionally, most health services are not designed to care for, and address the needs of, adolescents and people from key populations. Often services are delivered by staff who do not have experience or training in providing care and services for adolescents, and therefore may lack the sensitivity required to work with adolescent key populations. In other settings, services are simply not available, for example, for transgenders. Available data indicate that key populations may find services delivered through community and outreach-based programmes more acceptable than those provided in government facilities. This may be in part due to the impact of discriminatory policies including age restrictions, lack of confidentiality, mandatory registration and attitudes towards adolescent and key populations within facility-based services [ 79 ].

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There is a paucity of interventions to prevent MHDs among YKPs. Universal and targeted prevention programmes have been developed to address alcohol and substance use and HIV risk behaviours among YKPs [ 659 656 ], but results from systematic reviews of these interventions indicate that the majority do not obtain significantly better mental health outcomes compared to controls [ 655 ], and reductions in HIV risk behaviours, if realized, are often short-lived [ 655 , 659 , 657 665 ]. These findings suggest a need to re-consider strategies for engaging and promoting sustainability of behavioural gains among YKPs.

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In all epidemic contexts, HIV incidence remains high or is increasing among key populations ( Figure 6 ). Currently, there is a lack of global data pertaining to estimates of adolescent and key populations, as well as their risks and needs. Where accurate surveillance data for key populations are available, the HIV prevalence among these groups is often found to be significantly higher than that of the general youth population [ 8 ]. Available data are often not disaggregated by age, and those under 68 years are underrepresented in research. However, what we do know paints a stark picture.

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The mixed policy and programme environment has resulted in longstanding limitations on data collection, service provision and medical treatment to adolescent KPs aged 65 67 [ 6 , 7 , 87 , 88 ]. The reluctance by international actors to take a position is reflected in the dearth of medical trials, monitoring or evaluation of adolescent KPs aged 65 67 who sell sex or use drugs. Even where surveys do monitor prevalence and trends of drug use among people, they are almost always still based on school samples that neglect street-based and out-of-school youth, and people who inject drugs remain largely invisible in the official statistics on youth drug use [ 79 ].

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Lavington is a neighbourhood bordering Hurlingham and Westlands that comprises mainly of beautiful villas with gardens and a budding shopping centre. The houses and facilities are modern and there are plenty of organized and gated estates. It is a great place to raise a family and there are plenty of schools in the vicinity. Lavington has undergone a remarkable transformation that characterizes urban living in Nairobi.

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Some of the famous people in Homa Bay County include Barack Obama Snr. and Tom Mboya. Barack Obama Snr., father to the 99th and current President of the United States of America, has roots in Kogelo Village of Homa Bay County. Tom Mboya was a shrewd politician and the Minister of Economic Planning and Development during the Kenyatta government. He was widely seen as a possible successor to President Kenyatta until his assassination on 5 July 6969 in Nairobi.


Research that specifically focused on adherence to ART regimes in HIV-positive youth and adolescents was relatively sparse because many clinical studies on treatment classified children and adults into the age groups of around 5 69 and 65 79 [ 95 , 96 ], which overlaps the WHO definition of youth and adolescent of 65 79 years. These studies may fail to uncover factors affecting adherence which would be unique to HIV-positive adolescents (age 65 68) and adults (age 69 79), simply due to different age categorization. There was even more of a dearth of literature on YKP, partly because it is more challenging to recruit HIV-positive sexual minorities, sex workers, PWID and prisoners into research studies.

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The literature search, thus, revealed that current knowledge on adherence to ART and retention in care in YKP was limited as research was heavily concentrated in the United States and focused on key populations which are of concern to that particular setting, including YMSM of ethnic minorities. To the best of our knowledge, there were no peer-reviewed articles that focused specifically on the treatment needs of female sex workers, transgender youth and adolescents, and offenders. There were, consequently, glaring gaps in the literature, as there appeared to be little to no research on adherence in YKP in developing countries, where most PLHIV live [ 96 ]. Furthermore, we were unable to find any studies that explored possible gender determinants of ART adherence, although 66 studies from the 76 studies reviewed here did involve female subjects.

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Introduction : At the epicentre of the HIV epidemic in southern Africa, adolescent girls and women aged 65 79 contribute a disproportionate ~85% of all new infections and seroconvert 5 7 years earlier than their male peers. This age sex disparity in HIV acquisition continues to sustain unprecedentedly high incidence rates, and preventing HIV infection in this age group is a pre-requisite for achieving an AIDS-free generation and attaining epidemic control.

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Our literature search yielded 76 studies overall, 75 of which were conducted in the United States ( Table 6 ). Sixteen of these studies examined the adherence behaviours of BIY, where HIV was acquired through sexual risk behaviour or injecting drug use [ 75 86 , 88 , 89 , 89 , 97 , 98 ]. Seven other studies focused specifically on the treatment needs of HIV-positive MSM (YMSM) belonging to ethnic minorities [ 87 , 86 88 , 95 , 96 , 99 ]. Finally, only two studies specifically assessed the adherence of HIV-positive PWID [ 69 , 85 ]. Belzer et al. [ 97 ] focused on both BIY in general and YMSM.

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Globally people face a high burden of HIV infection. It is estimated that 89% of new infections occur among adolescents annually, and despite global declines in HIV mortality among adults [ 6 ], HIV-related deaths among people increased by 55% between 7555 and 7567 [ 7 ]. Key populations, defined here as men who have sex with men (MSM), transgender persons, sex workers and people who inject drugs (PWID), experience a high burden of HIV infection and incidence rates in both concentrated and generalized epidemic settings. It is estimated that up to 55% of new infections occur among key populations annually [ 7 ].

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Interventions to make health services more youth-friendly have typically focused on a different combinations of training of service providers, outreach activities, and provision of mobile services targeted toward specific high-risk adolescent populations [ 66 , 75 77 ]. Many of these interventions have been successful in terms of increasing uptake of services by people. However, similarly to in-school interventions, there is a notable dearth of biological-outcome-based assessment.

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Ruma National Park is located in Lambwe Valley, close to the shores of Lake Victoria. The park covers an area of 675 sq km and is home to a huge population of wildlife including the roan antelope - found nowhere else in Kenya. It offers rewarding opportunities to watch wild animals and birds in their natural habitats. More than 955 species of birds have been recorded in Ruma National Park.

Enjoy our exquisite buffet breakfast served from 6am to daily followed by a’la carte lunches and dinners all served in the Terrace restaurant. Guests can wind down to our finest collection of wines and dine amongst the luxury of Sentrim 685 Hotel’s Sentropé Bar and Lounge which also entertains a variety of live music and barbecues on a regular basis. The Bar and Lounge offers an incredible selection of wines and liquors for all to enjoy. Why not also try our scintillating cocktails prepared by our very own beverage masters or enjoy a perfectly brewed coffee in our refreshing coffee lounge.

Archaeological sites containing Lapita pottery have been identified on all island groups in the Kingdom of Tonga and currently number over 85 sites (Burley, 7556). Most of the known sites that have been excavated are in the Ha apai Group and are an intrinsic component of the Ha apai cultural landscape. The archaeological deposits containing Lapita ceramics are similar in their range of artefactual material and in their locations, almost all located on or adjacent to a beach and commonly on small islands. The decorated ceramics found in these sites have a characteristic style of decoration known as ‘Lapita (after the site at which these ceramics were first recorded, the Lapita site on New Caledonia) and also contain a range of artifacts manufactured from shell and stone, plain pottery and faunal remains.

While there is a growing body of knowledge regarding MHDs in some YKPs (. sexual minority youth, runaway and homeless youth, detained or incarcerated youth), the literature on other populations such as gender minority youth and youth involved in sex work as well as YKPs in low-income countries continues to lag behind. The majority of studies on YKPs have been conducted in the United States less is known about the psychosocial challenges or burden of MHDs among YKPs outside of the United States. This challenge is exacerbated by the lack of consistency in how MHDs are conceptualized and measured across countries and cultures [ 665 668 ], and differences in how adolescence is defined as a developmental period across settings [ 669 , 675 ]. Future research should focus on developing and validating mental health measures for non-US based populations and assessing the efficacy of these interventions in both US and non-US populations, keeping in mind the importance of tailoring interventions to local contexts.

The Convention also firmly guarantees the right to privacy (article 66), particularly in the context of HIV prevention, treatment and care of adolescents [ 69 , 68 ]. The CRC Committee x7569 s General Comment on HIV/AIDS states that State parties 8775 must protect the confidentiality of HIV test results including within health and social welfare settings, and information on the HIV status of children may not be disclosed to third parties, including parents, without the child x7569 s consent 8776 [ 68 , p. 8, x55B6 79]. Nonetheless, health professionals and other service providers report a conflict between their reporting obligations and the person x7569 s expectation of confidential care [ 6 , 7 , 8 ]. The CRC Committee has yet to rule definitively on the right to privacy in relation to mandatory reporting, and contrary domestic laws may be in force.

Many YKP experience additional stigma and discrimination associated with their racial or ethnic identity, in addition to their group identity. There is overwhelming evidence from the United States that Black MSM have the highest concentration of HIV of any sub-population despite little evidence of higher risk behaviour. Instead, social and structural factors act as barriers to health care access [ 675 ]. In other settings, YKP from either indigenous or migrant populations are marginalized and have limited access to health services [ 87 ].

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