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Abstract
Whether transitioning out of a pediatric/adolescent care setting, or moving directly from the point of diagnosis into adult care, youth living with HIV are entering a system that is not set up to meet their needs. This can have an adverse impact on adherence to medication, treatment for opportunistic infections, and secondary transmission. The situation is further complicated for lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth with HIV who face a multitude of psychosocial and structural barriers due to their sexual orientation or gender identity. Engaging and retaining HIV positive LGBTQ youth in adult care is critical to their survival and to wider prevention efforts, yet many fail to initiate or remain in care. Health and social service providers play a pivotal role in overcoming these challenges. This paper provides a broad overview of the barriers to engaging and retaining HIV positive LGBTQ youth in adult care settings, with particular focus on youth that were infected via behavioral means. Key strategies for overcoming those challenges are then shared. Institutional and environmental solutions include addressing institutional stigma, strengthening the knowledge and capacity of health providers to work with this population, creating a youth friendly environment, and solving access issues. Patient-care oriented solutions include improving the patient-provider relationship, offering developmentally sensitive comprehensive services, and directly involving youth in the healthcare setting.