Background: In 2018, Georgia ranked fourth in the USA for the number of people living with HIV/AIDS (PLWHA) and first for rate of new HIV diagnoses. Structural barriers to HIV prevention and care include homelessness, inadequate access to healthcare, insufficient sexual health education, HIV criminalisation and incarceration. Objective: Georgia Equality created the Youth HIV Policy Advisors (YHPA) Programme in 2015 to increase the meaningful involvement of young PLWHA in health policy and leadership. Design, setting and method: The YHPA Programme trains young PLWHA in the structural and social determinants of HIV risk and imparts HIV policy advocacy knowledge and skills. The programme typically involves weekend training events held between June and December, the creation of a policy agenda, and facilitation of a culminating World AIDS Day event. We conducted a mixed-methods survey of 29 alumni (91%) to understand programme engagement, benefits and skills gained. Results: Quantitative results showed average gains of 1.4 in HIV-related skills and 2.4 in policy-related skills (6-point scales). Qualitative analysis revealed important increases in knowledge and skills, self-awareness, social capital, political connections and social support that equipped youth to become change agents. Conclusion: Policy advocacy and leadership programmes are a unique and important mechanism to promote the meaningful involvement of young PLWHA in critical decisions about the structural changes necessary to end the epidemic. YHPA alumni engagement in future integrated strategies to address HIV prevention and care is essential.