One of the crucial gaps in the current HIV response is that we are not reaching children and adolescents aged 10–17 years who sell sex, with life-saving prevention, treatment, protection, care, or support;by protection we refer to all child and social protection interventions that aim to protect rights and provide social and economic support. Under the Convention on the Rights of the Child (CRC)—the most widely ratified human rights treaty—and its Optional Protocol on the sale of children, child prostitution, and child pornography, adolescents younger than 18 years are
protected from all forms of sexual exploitation and entitled to the right to health. Children are defi ned by the CRC as all persons aged younger than 18 years.

Adolescents are defined by the UN as all persons aged 10–19 years. This Comment focuses on the HIV concerns of children and adolescents aged 10–17 years who are exploited in the sex industry through selling sex, and does not consider other forms of sexual exploitation. The term “sexually exploited children and adolescents aged 10–17 years who sell sex” describes the behaviour that renders this group at-risk of HIV and does not describe identity. Children younger than 18 years who sell sex, irrespective of the reason, are considered under international law to be sexually
exploited children.

There are no accurate global estimates of the number of sexually exploited children and adolescents aged 10–17 years, nor of the subset of those who sell sex.However, many studies show that substantial percentages of sex workers in many countries began selling sex aged younger than 18 years.

For example,in Ukraine, adolescent girls aged 10–19 years who sell sex comprise an estimated 20% of the female sex-worker population. Evidence also shows that this group is more vulnerable than older cohorts to health
harms—including sexually transmitted infections, HIV,and violence. For example, in Ukraine in2006,HIV prevalence among females aged 15–19 years selling sex exceeded 19%, compared to 1·4% in the general adult population. Also, in eight countries in eastern and southern Africa, median HIV prevalence g sex workers younger than 25 years is 11%.

Many factors specifi c to children and adolescents aged 10–17 years contribute to this vulnerability, including severe circumstances of initiation and involvement, such as physical force and lack of control over their situation and finances and an inability to negotiate condom use. Some studies show increased biological vulnerability to HIV in adolescent girls, which  is linked to weaker mucosal immunity of the adolescent female genital tract. Other reasons are systemic—these include legal and policy barriers to access to sexual and reproductive health and rights (SRHR) and other services; frequent contact with uniformed services such as police; and lack of confidential and adolescent-friendly HIV services.

Health interventions that target sex workers aged 18 years and older generally do not address the specific needs of this group because of law and policy barriers.The interventions that do target the group often focus exclusively on the immediate removal of the child from the sex trade, rather than the provision of necessary SRHR and HIV treatment, prevention, and care.
Responses to HIV in sexually exploited children or adolescents who sell sex