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This systematic review explores how informed assent and consent practices are reported, guided by the 2016 Council for International Organizations of Medical Sciences (CIOMS) guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was conducted of peer-reviewed studies from 2010 to 2023 involving MSM under 18 years, using PubMed, Embase, and Scopus databases. Key ethical components were extracted and synthesized thematically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 410 articles screened, 65 met inclusion criteria. All included studies reported informed consent, but only 20% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913) included informed assent. Most were conducted in high-income countries (64%), with no representation from low-income settings. Only 7% involved minors living with HIV. Quantitative methods were predominant (82%), and 20% used online platforms. Waivers of parental permission were reported in 27% of studies, while only 3% obtained parental permission. Four studies described tailored consent\/assent approaches, such as simplified language, comprehension checks, and involvement of minor advocates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This review highlights inconsistencies in how informed assent is addressed in HIV research involving MSM minors. Only one in five studies described ethically appropriate, youth-tailored processes. Limited use of waivers and adapted assent procedures points to ongoing gaps in aligning research with ethical standards. Future studies should adopt clearer, age-appropriate consent practices, ensure transparent reporting, and strengthen researcher training in ethics involving vulnerable minors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12910-026-01378-7","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T02:13:37Z","timestamp":1770084817000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Missing assent: a global systematic review of ethical practices in HIV research with men who have sex with men (MSM) under 18"],"prefix":"10.1186","volume":"27","author":[{"given":"Worawalan","family":"Waratworawan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T Charles","family":"Witzel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sin How","family":"Lim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas E.","family":"Guadamuz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"key":"1378_CR1","unstructured":"UNAIDS. 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