The Impact of HIV on Adolescent Girls & Young Women

World AIDS Day celebrates its 30th anniversary this year with the theme of ‘Know Your Status’.

Great progress has been made since the first World AIDS Day in 1988 – 3 in 4 people living with HIV today know their status.

However, the work is not yet done – especially for women. Women account for more than half of the people living with HIV worldwide. In particular, adolescent girls (10-19 years) and young women (15-24 years) are significantly affected by HIV and have high prevalence rates.

In Eastern and Southern Africa, women make up 26% of new HIV infections despite making up only 10% of the population. Statistically, young women will acquire HIV five to seven years earlier than their male counterparts.

Why are women and girls at high risk of infection?

HIV disproportionately affects young women and girls because of their unequal social, cultural and economic status in society. These challenges include gender based violence, laws and policies that undermine women, and harmful cultural and traditional practices that reinforce stigma and the dynamic of male dominance.

Here some other reasons why gender inequality leaves women vulnerable to HIV:

  1. Lack of access to healthcare services – women encounter barriers to health services on individual, interpersonal, community and societal levels.
  2. Lack of access to education – studies show that educated girls and women are more likely to make safer decisions regarding sexual and reproductive health and have lower risk of partner violence.
  3. Poverty – an existing and overarching factor that increases the impact of HIV.
  4. Gender-based violence & intimate partner violence – these types of violence prevent young women from protecting themselves from HIV.
  5. ‘Blesser/Sugar Daddy’ culture and transactional sex – sex with older men for monetary or material benefits, exposes young women and girls to low condom use, unsafe sexual practices and increased rates of STIs.
  6. Child marriage – girls who marry as children are likely to be abused by their husbands and forced into sexual practices.
  7. Biological factors – adolescent girls are susceptible to higher rates of genital inflammation, which may increase the risk of HIV infection through vaginal intercourse.

Importance of HIV testing

HIV testing in young women and girls is essential. Many receive access to treatment and care services after testing. Some important determinants of testing are:

  • Going through antenatal care
  • Being married
  • Having primary and secondary education

We need to aim for more young women and girls to being tested so that they know their status, and can access adequate care and treatment services. HIV testing is necessary for expanding on treatment and ensuring that people with HIV have healthy, productive lives.

Addressing the Impact

To address the impact of HIV on young women and girls we need to have approaches and interventions that incorporate the diverse perspectives of women and girls. This is needed on all platforms from campaigning and policy-making to program design. As the World Health Organization recommends, a woman-centred approach that includes women as participants is required, so that our needs, rights and preferences are considered.

Better strategies are needed across all health system to improve accessibility, acceptability, affordability, uptake, equitable coverage, quality, effectiveness and efficiency of services, particularly for adolescent girls worldwide.

Young People Living with HIV/AIDS: the Y+ Summit

“People who work hard to fight HIV stigma inspire me, so I also want to join the fight. Stigma and discrimination are real but I’m able to cope because of peer support, counselors and doctors. I take my medication without thinking about it and I have undergone many trainings. I feel empowered.” – Robinah Babirye (22, 3rd year student at Kyambogo University)

HIV is a boogie man we have been taught to hate and fear. This is the reason that young people who are infected with this virus can feel like they have been handed a death sentence. It raises many difficult questions for them, like who will love them and how they will find happiness post HIV infection?

There is a cyclical relationship between stigma and HIV: people who experience stigma and discrimination are marginalised and made more vulnerable to HIV, while those living with HIV are more vulnerable to stigma and discrimination.

One of the ways we engage young people is through summits at which we can hold deep discussions about what these young people are facing. The HIV epidemic is one of the biggest challenges young people face today – over 500 girls are infected every week in Uganda.

The Y+ Summit, organised by the Uganda Network of Young People Living with HIV/AIDS (UNYPA), took place from 18-20 March 2018. The Y+ Summit is an innovative, youth-centered approach that aims to put young people at the forefront of fighting the HIV/AIDS epidemic. It provides young people living with HIV/AIDS with information on how to empower themselves economically, as well on how to live life post HIV/AIDS infection to the fullest.

Young people are a key population, which means that the social, political and economic trends of communities are directly attached to them. If young people are healthy, informed and empowered, their communities stand to benefit and develop. Poor health makes young people, and therefore wider society, less productive. Uganda is also a particularly young nation, with young people making up more than 70% of the total population.

Last month’s Y+ Summit was all-inclusive, keeping over 200 participants engaged over three days. From bold and fearless panel talks to extensive focus group discussions, positive living was made understandable to all. Many topics were discussed, including taking medication consistently, new trends in treatment, curbing new infections and discordance. There were even explanations of HIV and the law in Uganda, which the reigning Miss Y+ Gloria Nawanyaga explained in terms of the 90-90-90 strategy:

“Any intentional infection of another with HIV is criminal and punishable by law. This is in no way meant to marginalise anyone living with HIV, but it is a way for us to live positively and a guide for deterring any new infections,” she said.

Participants at the Y+ Summit. Photo credit: Uganda Network of Young People Living with HIV

The Summit attracted speakers from religious, cultural, legal and entertainment sectors, who each talked about positive living in their spheres. For us, the most memorable was Canon Gideon Mugisha, a clergy who has lived positively for 17 years. He was keen to remind the attendees of the coexistence between religion and medication: “We all know that God helps those that help themselves. If you find that you are positive, you need to pray for God’s protection but you also need to take your medication. Personally, I pray to God like there is no medicine, and I take my medication like there is no God.” 

Another panelist was Wilson Bugembe, a musician and pastor who shared his story of living with HIV positive siblings even when he himself was negative. Other speakers included Dr Karusa Kiragu, the UNAIDS Uganda Country Director and Hon Florence Nakiwala Kiyingi, the Ugandan Minister for Youth and Children’s Affairs.

Rio Babirye, a Communications Officer with UNYPA, told us that she was happy that the summit had promised more creativity to redefine the lives of those living positively in Uganda:

“This year’s turn up was greater than last year’s and it was a more productive summit. It is our dream to end stigma and discrimination against HIV, and we shall keep refreshing our young minds to come up with ideas to do so,” she said.

What’s the ‘Global Gag Rule’ & What Does it Mean for Women?

Two days after the Women’s March, the new president of the Unites States signed an executive order reinstating the Mexico City Policy, popularly known as the “Global Gag Rule”. The moment was captured in an emblematic photo: Donald Trump – surrounded by men – signing an order that so significantly affects the lives of women around the world, in what many described on social media as a picture of patriarchy.

But what exactly is this controversial policy, and what are its implications for women, girls and beyond around the world?

1) The policy’s origins

This policy is a U.S. government foreign policy. It was not originally created by Trump, simply reinstated by him. It was created by the Reagan administration in 1984 and first announced at the International Conference on Population and Development, which took place in Mexico City (hence the name “Mexico City Policy”). Since then, the policy has been in effect during every Republican president’s term, but not in effect during Democrat presidencies (with the exception of a temporary imposition of the policy during Clinton’s presidency as shown in the table below). 

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Photo Credit: http://kff.org/global-health-policy/fact-sheet/mexico-city-policy-explainer/

2) What it says 

The original text of the policy states that “the United States will no longer contribute to […] nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations.”

When this policy is in effect, international NGOs that receive U.S. government funding are prohibited from performing, promoting, or providing information on “abortion as a method of family planning”.

The policy does provide an exception: performing, promoting, or providing information on abortion in the cases where the pregnancy poses a risk to the woman’s life, or where the pregnancy is a result of rape or incest is not prohibited. But according to CHANGE (Center for Health and Gender Equity), it is unclear if these exceptions have actually been observed and if services were offered in those cases.

3) Its implications

Many NGOs that will be affected by this policy have been speaking up about its implications on the work they do and the services they provide. 138 organizations have joined Planned Parenthood in a joint statement opposing the policy.

The implications go beyond abortion and women’s health. It could negatively impact serious health issues around the world, since many NGOs that provide services for issues such as Zika and HIV/AIDS would be affected. Melinda Gates has expressed her concern for the way this rule could be implemented by the Trump administration, saying it could affect clinics that provide lifesaving HIV/AIDS, malaria, and tuberculosis drugs. Beyond that, the policy could have negative impacts on humanitarian aid: after the Nepal earthquake in 2015, Marie Stopes International United States (which under the policy would be disqualified from receiving U.S. aid) was able to provide a variety of much needed women’s health services such as contraceptive implants and safe-deliver kits.

Governments have joined NGOs in expressing concerns about the policy. Several countries including Belgium, Canada and Sweden have joined in support of the Netherlands’s initiative to raise money “to help women access abortion services”, saying Trump’s ‘global gag rule’ would “cause a funding shortfall of $600 million over the next four years”.

The flaw of the policy is that, as with most policies and laws that attempt to stop abortions, it won’t stop abortions. It will instead mean that women will be more likely to access abortion through unsafe and unhealthy ways, risking their health and lives. A 2011 World Health Organization study found that, after President George W. Bush reenacted the policy in 2000, abortion rates increased significantly in sub-Saharan African countries.

At the moment, there’s uncertainty about the specific instructions government agencies and NGOs would have to follow. What is known is that comprehensive access to information about sexual and reproductive health is essential for women’s lives around the world, and that whatever measures are created to deter that will be – quite literally – putting lives at risk.

The policy means NGOs will struggle to keep providing lifesaving services, but it’s clear that they won’t stop doing their work. Sexual and reproductive rights may have struggled under this policy in the past, and will likely do so again. But they are still human rights, and they will be fought for.

10-Year-Old Girls are the Future of the World

According to the latest State of World Population by the United Nations Population Fund (UNFPA), girls at the decisive age of 10 are the future of the world. At this age, girls are moving away from the world of childhood towards the world of adolescence and adulthood. In this season of life, it’s essential that girls be presented with opportunities, encouraged to dream big, given tools to pursue those dreams, and have access to education and health care.

For many girls around the world, this phase of life is when they begin to face the reality of limited choices in life compared to boys and when they become more vulnerable to discrimination and gender violence. This reality needs to be changed, not only for the good of these girls, but also for the good of their societies and the world as a whole.

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Here are 4 reasons why investing in 10-year-old girls is good for the world:

1) Access to education is not only a human right, but it’s essential to helping girls achieve their full potential. The more years girls spend in school, the more opportunities they will have to get better jobs and earn higher wages. Several organizations and leaders, such as Michelle Obama, have recognized the positive and long-lasting impacts of providing girls a good education, not just for girls’ own lives, but for their families, communities, and even for the economy of their countries.

 2) Access to sexual and reproductive health allows girls to receive crucial information about their health and sexuality, as well as providing them with important health tools such as vaccinations for HPV. Investing in sexual education for girls is essential as many young women simply lack information about contraceptives, STIs and pregnancy. Information about these very important topics can empower girls to make conscious choices about their lives and bodies. HIV/AIDS is the leading cause of death among 10-19 year old girls, so investing on their health around this age means saving lives and preventing more infections in young girls. 

3) No child marriage means that girls can stay in school longer and pursue their life dreams and goals. It means that they can live healthier lives, be less likely to be infected with an STI, and can be free to be kids. It also means that they will have the choice to start their own families when and if they choose to. Child marriage is a human rights violation, therefore eradicating it means opening many doors of possibilities to girls which they wouldn’t have as child brides.

 4) Investing in young girls’ self-esteem helps to keep them encouraged to pursue sports, math, science, politics, or whatever they desire to pursue. The popular “Like a Girl” commercials by Always, have brought to attention how girls’ self-esteem tends to plummet significantly around puberty. Suicide has been found to be “the second-leading cause of death among adolescent girls”, which shows just how serious the issue of a girl’s self-esteem really is. Girls with high self-esteem will be more likely to pursue politics, to start a business, and to overcome the challenges they will inevitably face.

Investing in 10-year-old girls means investing in the 17 Sustainable Development Goals, which include good health and well-being, quality education, and gender equality. In 2030, when these goals are hoped to be achieved, today’s 10-year-old girls will be in their mid-20s. The lives they’ll live then and what impact they’ll be able have in society depends on the opportunities they are given today. The main reason why investing in girls is so important is quite simple: when girls thrive, so does the rest of the world.

For more information, check out the UNFPA State of World Population 2016, and consider ways of investing in girls, such as donating to organizations like UNFPA and Girls’ Globe, and sharing information about the importance of investing in girls on social media.

Featured Image by: Jessica Lea/Department for International Development
Additional Image by: UNFPA/Matthias Mugisha

Decriminalization of Sex Work is a Human Rights Issue

Written by Preston Mitchum, Policy Research Analyst, Center for Health and Gender Equity (CHANGE)

Decriminalization is a social justice issue for women and girls around the world. Laws that criminalize trans-diverse populations, sexual minorities, drug users, and sex workers increase stigma and drive the HIV epidemic. Decriminalization serves as a vehicle to ensuring that the health and human rights of women and girls everywhere are upheld, honored, and protected. The sexual and reproductive health and rights (SRHR) of women and girls will not be achieved without decriminalization.

Evidence shows that criminalization of sex work, for example, results in more human rights abuses, impedes prevention of women and girls from actually being trafficked for the purposes of sex, and creates barriers to accessing health care and other services. It’s time to break these barriers.

In May, the Center for Health and Gender Equity (CHANGE) was proud to support Amnesty International’s new policy calling on governments to take specific actions in protecting the human rights of sex workers, including decriminalization of consensual sex work, the full engagement of sex workers in the development and implementation of laws and policies, ending discrimination, promoting gender equality, and ensuring sex workers can live a life free of coercion, harm, and policing. Amnesty International’s new adopted policy also underscores the negative impact that criminalization has on the health and safety of sex workers, and includes case studies from Argentina, Hong Kong, Papua New Guinea, and Norway. The policy makes clear that decriminalization is indeed a social justice issue.

As a woman’s rights organizations, CHANGE believes that human rights are universal, and apply to everyone – including sex workers. Ever since the establishment of the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, CHANGE has advocated for the health and rights of sex workers by opposing the government’s conflation of those who engage in commercial sex work with those who have been trafficked against their will. CHANGE was also in early opposition to the Anti-Prostitution Loyalty Oath (APLO) which prohibits PEPFAR’s foreign assistance delivery to any foreign non-governmental organization that does not have a policy explicitly opposing prostitution.

In March, CHANGE, American Jewish World Service, and Open Society Foundations hosted “End Criminalization to End AIDS” in Washington, D.C. to coordinate a public conversation about how criminal laws and policies drive the global AIDS epidemic. The panelists discussed the decriminalization of sex work, drug use, HIV, and being LGBTQ, and explored ways that criminal responses and stigma have universally fueled the AIDS epidemic. One general theme resonated: if human rights and social justice are not centered in these conversations, then decriminalization of people and associated behaviors will never be realized.

This month, the International AIDS Conference (IAC) will take place in Durban, South Africa. Out of the five articulated conference objectives, number three addresses key populations; specifically, IAC aims to reinvigorate the response to HIV and AIDS by “Promoting HIV responses that are supported by and tailored to the needs of at risk populations or people living with HIV, including women and girls, men who have sex with men, transgender people, sex workers, young people, and people who use drugs.”

At CHANGE, we agree that it is essential to put women – including sex workers – at the center of HIV prevention, treatment, and response. However, we can’t stop there. Civil society organizations, the advocacy community, and donor nations must advance the full spectrum of the health and right of sex workers, and to do that, we must work to decriminalize sex work.

The fact is that the decriminalization of sex work is a human rights issue and all women, sex workers included, are entitled to the full enforcement of those rights so they can live meaningful lives.

Cover Photo Credit: CHANGE, American Jewish World Service, and Open Society Foundations co-hosted a briefing in Washington, D.C. in March on how criminal laws and policies drive the global AIDS epidemic. Photo Credit: John Nelson Photography

An AIDS-Free Generation: Not Without Women

By Kathryn Boulton, Legal Fellow

We cannot achieve an AIDS-free generation without young women and girls. Yet for far too long, research and programming devoted to HIV prevention and treatment have simply failed to include adolescent girls and young women. Today, girls and young women account for an alarmingly disproportionate number of new HIV infections globally, but the problem is especially pronounced in sub-Saharan Africa. In several countries within this region, more than 80% of adolescents newly infected with HIV are girls.

The Center for Health and Gender Equity (CHANGE) has recognized for some time the centrality of women-centered prevention efforts around HIV/AIDS. As an organization, CHANGE is thrilled that PEPFAR has zeroed in on the needs of girls through the DREAMS Partnership, a public-private partnership with the Bill and Melinda Gates Foundation and Girl Effect launched on World AIDS Day 2014.

DREAMS directs nearly half a billion dollars to the prevention of new HIV infections among girls and young women in ten sub-Saharan African countries: Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. Combined, these ten countries accounted for almost half of all new HIV infections that occurred among adolescent girls and young women globally in 2014. The DREAMS prevention goals are fittingly ambitious, considering the magnitude of the crisis facing is population.

DREAMS aims to achieve a 40% reduction in HIV incidence among girls and women 15-24 years old in the hardest hit areas of the ten DREAMS countries by the end of 2017. More broadly, the partnership will foster the development of girls and young women to be determined, resilient, empowered, AIDS-free, mentored and safe individuals with the ability to realize their full potential.

Adolescent girls and young women face a range of legal, economic, and social factors that directly and indirectly impact their risk of acquiring HIV, such as lack of education and social capital, gender-based violence, along with inadequate access to rights-based reproductive healthcare, family planning, and comprehensive sexuality education. And we know that traditional biomedical interventions are only one piece of the solution to HIV in girls and young women—our response must also promote gender equality and the fundamental rights of women and girls.

In a major departure from business as usual, DREAMS proposes a holistic package of multi-sectoral interventions intended to address these structural drivers of HIV risk. DREAMS is about more than advising girls to wait until marriage to have sex and throwing in a condom in case that approach fails to protect them from HIV (which it will). Through DREAMS, layered and complementary strategies target girls and young women, their families, male sexual partners, and broader communities in an effort to produce an empowering environment for girls that significantly and sustainably reduces their risk of acquiring HIV.

PEPFAR’s guidance to the country-based teams responsible for implementing DREAMS on the ground stresses the importance of civil society engagement and urges the inclusion of girls and young women on the DREAMS country advisory committees. CHANGE applauds these developments, as well as the recently announced PEPFAR targets, which reflect an ongoing commitment to the needs of adolescent girls and young women.

The success of DREAMS will depend on how effectively its implementation adopts an approach centered on girls and young women that fully ensures their health and rights. The extraordinary results hoped for in DREAMS demand an extraordinary effort— those carrying out DREAMS at the country level cannot ignore the lived experiences of individual girls and young women. This means acknowledging that girls and young women have sexual lives and need comprehensive sexuality education to make informed choices about their health and futures. It also means acknowledging that many girls and young women are mothers or are engaged in sex work and should have their unique needs recognized. Most vitally, it means transforming the lives of girls and young women, as well as the programs that serve them, by including them in every stage of program development, planning, monitoring and evaluation. Only when adolescent girls and young women are placed at the center will the DREAMS Partnership fully realize its potential.

Featured Image: CHANGE, AVAC, and ICW co-host a briefing with the State Department in Washington, D.C. in November on the U.S. government’s plan for HIV prevention programming for young women and adolescent girls. Photo Credit: John Nelson Photography