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Adolescents and young adults (AYAs; ages 13–24) remain an underserved and disproportionately affected population within the United States (U.S.). HIV epidemic. Despite overall national declines in HIV incidence, youth continue to account for approximately one in five new infections, with persistent disparities among Black and Latino youth, other structurally vulnerable youth, and those living in the Southern U.S. These inequities reflect structural barriers and developmental mismatches between youth needs and adult-oriented HIV prevention and care systems. This commentary examines the evolving landscape of HIV among AYAs, highlighting persistent gaps in testing, linkage, retention, and viral suppression. Drawing on national surveillance data and a case example from Orange County, Florida, we illustrate how developmental vulnerability, stigma, and fragmented systems undermine engagement across the HIV care continuum. We highlight emerging opportunities, including long-acting injectable antiretroviral therapy and PrEP, digital health tools, and youth-focused case management, and emphasize the role of implementation science frameworks in adapting and sustaining these innovations. We argue that meaningful progress will require embedding youth voices in program design, addressing structural determinants of health through legal aid, and committing to sustained investment in youth-centered strategies. Reimagining the HIV response with adolescents and young adults at the center is essential to achieving progress toward national and global HIV targets.
Martínez et al. (Thu,) studied this question.