Comment from the field: young people 15–17 years old need PrEP access in Peru

Pre-exposure prophylaxis (PrEP) is a highly efficacious HIV prevention strategy. ¹ Despite freely available HIV care and the inclusion of PrEP in Peru’s national HIV prevention policy in June 2023,^2,3 HIV incidence remains alarmingly high among key populations. ² Prevalence is estimated at 0.5% in the general population but rises sharply to 10% among men who have sex with men and 31% among transgender women. ⁴ Yet, the national technical guidelines currently restricts PrEP access to individuals aged 18 and older. ³ This misses a key opportunity to reach young people under 18, particularly those with intersecting identities related to gender and sexuality, as well as those aged 15–17, which is a critical window for HIV prevention.

In the ImPrEP study conducted in Brazil, Mexico, and Peru, HIV prevalence at baseline among 18-year-olds was 13%, cumulative HIV incidence in this group was 4%. ⁵ Further, the incidence among sexual and gender minorities aged 18–24 in Brazil and Peru was 9.77% (95% CI 5.77–13.69%). ² In a study of transgender youth in Peru, HIV prevalence among those under 18 years old was 25%. ⁶ Yet, the Peruvian CDC does not provide separate data on 15–17-year-olds, reporting instead on the 15–19 age group. According to the Peruvian CDC in 2023, 10% of women and 8% of men diagnosed with HIV were between 15 and 19 years old. ³ These data obscure the risk across the arbitrary but legally significant age-18 is the threshold. Available evidence indicates an urgent and unmet need for PrEP access among young people under 18, especially among populations at increased vulnerability.

International sexual and reproductive health (SRH) guidelines affirm that individuals under 18 should receive services according to their needs, regardless of age. ⁷ Since 2017, Peruvian law has rescinded the parental requirement for adolescents seeking SRH services. ⁸ Yet in practice, providers often continue to require parental consent and presence, factors known to limit young people’s access to SRH.^9,10 In some cases, individual doctors could decide that youth asking for PrEP can receive it with the consent of an adult other than their parent (older sibling, aunt/uncle, etc.)—but this is entirely up to the discretion of the provider and is not contemplated by the existing guideline.

Legal and policy reforms must align with public health evidence and human rights frameworks to expand PrEP access for adolescents aged 15–17. This is only a first step, and effective HIV prevention for young people requiring tailored services, including and beyond biomedical access. Brazil’s PrEP 15–19 project is a landmark model that should be replicated, evidencing that with youth-friendly services, peer support, and no parental consent barriers, adolescents can successfully access and use PrEP. ¹¹ Peru must follow suit to ensure that young people, especially those at heightened risk, are no longer excluded from lifesaving HIV prevention.