While the intention of age of consent laws for medical services is often to protect children, in practice such laws do the opposite, by discouraging adolescents from accessing the services they need to stay healthy.

Age of consent laws for medical services require people aged younger than 18 years to obtain permission from a parent or guardian before accessing sexual and reproductive health services, HIV testing and treatment, pre-exposure prophylaxis and other health services. They particularly affect adolescent girls, whose sexuality tends to be stigmatized and who bear the physical and social burdens of unwanted pregnancies.

In 2017, 78 of 110 reporting countries stated that they required parental consent for a child under 18 years to access HIV testing, and 61 of 109 reporting countries required parental consent for HIV treatment. In addition, 68 of 108 reporting countries required parental consent to access sexual and reproductive health services.

Comprehensive sexuality education plays a central role in preparing adolescents and young people for a safe, productive and fulfilling life, and it is an important component of an HIV prevention package for young people. It provides opportunities to learn and acquire complete, accurate, evidence-informed and age-appropriate knowledge on sexuality and sexual and reproductive health issues.

Comprehensive sexuality education―defined as a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality―have been shown to contribute to delayed initiation of sexual intercourse, decreased frequency of sexual intercourse, decreased number of sexual partners, reduced risk taking, increased use of condoms and increased use of contraception among young people.

Despite the importance of comprehensive sexuality education, however, access to it is far from universal.

The earlier that a baby who has been born with HIV is diagnosed and starts treatment, the better the outcome.

To diagnose children younger than 18 months of age with HIV requires virological testing, which detects the virus or its components. Serological testing―which tests for HIV antigen and/or antibody generated as part of the immune response to infection―is used for children older than 18 months and adults. Serological testing cannot be used for infants, since it can’t differentiate between HIV antibody produced by the mother and then passed to her baby during the pregnancy, with the baby remaining uninfected, and HIV antibody produced by an HIV-infected baby.

Virological testing is not consistently available in most low- and middle-income countries, however, and when it is available it is often expensive and time-consuming, involving several clinic visits for mothers and infants, the transport of samples to centralized laboratories and potential delays in the return of results.

Globally, only half of infants who are exposed to HIV during pregnancy are tested before eight weeks of age. Since mortality among untreated infants is highest in the first three months of life, prompt diagnosis and linkage to treatment are crucial.

While the incidence of HIV infection globally for all ages declined by 22% between 2011 and 2017, HIV infections among people who inject drugs appear to be rising. HIV incidence—the number of new HIV infections among a susceptible population during a certain time—among people who inject drugs rose from an estimated 1.2% in 2011 to 1.4% in 2017.

There is compelling and comprehensive evidence that harm reduction—including opioid substitution therapy and needle–syringe programmes—prevents HIV infections among people who inject drugs. However, criminalization of drug use and possession for personal use and the widespread stigma, discrimination and violence faced by people who use drugs hampers access to health and harm reduction services.

In its new report, Health, rights and drugs: harm reduction, decriminalization and zero discrimination for people who use drugs, UNAIDS has outlined a set of recommendations for countries to adopt for a public health and human rights response to drug use.