Sexual and reproductive health issues facing young people with perinatal HIV infection

Young people with HIV from birth face unique sexual and reproductive health challenges. They are born into a multigeneration family living with HIV and must navigate adolescence with a stigmatizing sexually transmissible infection where personal disclosure has the potential to disclose the status of family members. The article highlights the need for tailored sexual and reproductive health education, emphasizing the importance of addressing HIV stigma, ensuring access to contraception, and providing support for the disclosure process. While rates of sexually transmitted infections are broadly comparable to their peers, higher rates of human papilloma virus infection and persistence highlight the importance of early prevention strategies, including vaccination and screening although gaps exist in the optimal vaccine schedule and age of screening onset. Rates of intimate partner violence and unplanned pregnancy in adolescence are high, with adverse maternal and neonatal outcomes, including higher rates of preterm birth and low birth weight infants when compared to aged-matched peers. Although vertical transmission rates are reassuringly low, maternal health outcomes are of growing concern, driven by prolonged HIV infection with the long-term complications that negatively impact on pregnancy including comorbidities such as hypertension, diabetes, and renal disease. Research gaps persist, particularly regarding fertility, contraception, pregnancy, and the outcomes for their HIV exposed uninfected infants. To thrive, this unique group of young people require inclusive, nonjudgemental, accessible, evidence-based interventions and services to support their sexual and reproductive health, integrated within holistic HIV care, tailored to their needs and voiced by them.