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.

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

HIV: I am Positive

When it comes to HIV, I am positive. I am positive because I refuse to be any other way.

I am positive because too many people are negative about a disease that is neither deserved nor disgraceful, but circumstantial.

I am positive because 35.3 million people, almost half of whom are women, are living with a disease that has no cure. Of these women, 76 percent live in Sub-Saharan Africa and often become infected because of gender-based sexual or physical violence. I am positive because I cannot imagine looking at another woman negatively after she has had her rights completely stripped away through a violent act, only to discover she now also has an incurable disease.

I am positive because I believe positivity, action, and support create the best environment for sustainable change.

I am positive because when a woman in Sub-Saharan Africa is diagnosed with HIV, she needs an environment that encourages sustainable change, so she can access proper care, antiretroviral therapy (ARTs), and emotional and economic support.

Unfortunately, not all share my positivity.

There are millions of women who still lack access to ARTs, proper healthcare, and education about HIV. This is a serious problem. It’s also a serious problem that women and girls around the world experience physical and sexual violence at astounding rates, increasing their likelihoods of contracting HIV.

But what seems worst of all, is the fact that so many millions of women have to experience the diagnosis of a terminal illness, and are treated as less than human as a result. The negativity and stigma around HIV, is absolutely unnecessary.

The World Health Organization uses the definition of stigma as “an attribute that is deeply discrediting, which results in the reduction of a person to a discounted one”. Due to lack of education and awareness, people fear casual transmission of HIV, and often negatively judge those who have contracted it.

HIV studies in Ethiopia, India, Mozambique, Tanzania, and Zambia, have all found women experience more HIV stigma than men because of underlying socioeconomic gender inequalities. According to the World Health Organization,

“In Tanzania, almost two-thirds of women with HIV reported stigma, compared with less than half of men.”

HIV positive women also reported increased physical violence by an intimate partner after their diagnosis.

It will take years of education, awareness campaigns, and enhanced resources targeted to specific countries in Sub-Saharan Africa to change underlying gender stereotypes and socioeconomic inequalities that have helped create these stigmas around HIV positive women. Today, on World AIDS Day, I urge you to seek change in positivity.

I urge you to educate yourself on the facts surrounding HIV, and become aware of the unnecessary circumstances millions of people face beyond the physical illness of the disease. The People Living with HIV Stigma Index says it perfectly:

“It is not a moral disease, it is a viral disease.”

I urge you to be positive, compassionate, and open about HIV and those whose lives are forever altered by its stigma. Positivity creates an environment for positive change. When it comes to HIV stigma, we need positive change.

In the famous words of poet Maya Angelou I urge you to remember,

“People will forget what you said. People will forget what you did. But people will never forget how you made them feel.”

Gender Violence and AIDS: The Effect on Women

Right now is a busy time in awareness raising. We are currently in the middle of the ‘16 Days of Activism Against Gender Violence’ (which kicked off on November 25th, the International Day for the Elimination of Violence Against Women) and, as you may have seen, December 1st was the 24th World AIDS Day. Ending gender violence and the fight to stop the spread and find a cure for HIV and AIDS have been hot topics on the international health and development scene for awhile now; and the awareness raising only continues to grow as strides are being made to address the problems. But, since these two issues are at the forefront of our minds right now, let’s take a look at how they’re related and what we can do to help end both.

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HIV and AIDS affects women in unique ways: women are biologically more susceptible to contracting HIV; pregnant mothers can transmit the virus to their children during pregnancy, birth, or breastfeeding if ARVs (antiretroviral drugs) aren’t used to prevent transmission; women as victims of gender based violence are at higher risk of contracting HIV; gender power imbalances can affect a woman’s ability to negotiate condom use; and in some parts of the world dangerous, misguided superstitions persist that can threaten women and girls, such as the belief that having sex with a virgin will cure a man of HIV and AIDS (this is a small percentage of how girls become infected, but that does not take away from the fact that this does happen and this is how young girls have contracted HIV). Consider these stats:

  • HIV/ AIDS is the leading cause of death for women of reproductive age (15-49 years) worldwide,
  • Worldwide women are over half of all people living with HIV/ AIDS,
  • Young women (15-24 years) have twice the prevalence rate of HIV as young men[1],
  • In 2009, roughly 1,000 babies were infected with HIV every day during pregnancy, birth or breastfeeding,
  • Only an estimated 53% of pregnant women living with HIV in the developing world  in 2009 received ARVs (antiretroviral drugs) to prevent them from transmitting HIV to their babies[2].

Gender violence and HIV and AIDS are not mutually exclusive. You are never going to see the spread of HIV absent of any form of gender violence and you will never just see gender violence that doesn’t lead to the spread of HIV. The epidemic is too large and the two so deeply ingrained together. Unfortunately, the statistics on the gender based violence and HIV/ AIDS vary a lot, likely due to under-reporting  meaning that it can be hard to capture the true picture of the relationship between the two. However, the data we do have is concerning:

  • 6-47% of women worldwide report sexual assault by an intimate partner in their lifetime,
  • 7-48% of women and girls (10-24 years) report their first sexual encounter as being coerced[3],
  • Sexual abuse in childhood is closely associated with risky sexual behavior in adulthood, increasing lifetime risk of contracting HIV,
  • Fear of violence, even in a consensual relationship, can prevent a woman from refusing unwanted sex or insisting on condom use[4].

The takeaway is the same lesson we’re starting to hear repeated over and over: when women are disproportionately affected, the ramifications are felt by everyone. Children can become infected with HIV by their mothers before they are even born. Access to HIV testing and ARVs are crucial to preventing the spread of HIV to children, but unfortunately these options are not always available. Children with sick parents may have to drop out of school to care for said sick parents or their siblings, eliminating almost any chance for them to receive a full education and create a bright economic future for themselves. Children orphaned by the epidemic (because often both parents become infected and die) may have to rely on family members for care, a state system of care (if they live in a country with one), or face a possible future of poverty, homelessness and stigma. Think of all the lost potential productivity from sickness and death caused by HIV and AIDS, think of the lost potential of these children affected by it. It’s staggering to consider what is lost.

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There are so many organizations, large, medium and small, out there working to fight for the end of HIV and AIDS. UNAIDS, USAID, pretty much any UN department and programme, WHO, PAHO, et cetera. Practically any major health organization or any organization or nonprofit working on women’s health (unless specifically devoted to one health topic) deals in some way with the impact of HIV and AIDS on women because the problem is just that large and it is next to impossible to ignore it if one is focused on women’s health. Check out what is being doing in your area and see what your local health department, research institutes, hospitals and universities or local nonprofits are doing in your community to address HIV and AIDS, domestic and sexual violence, and women.

One last note: I know this is a blog devoted to women and girls, but let’s not forget that men are also affected by this epidemic and that they can also make an impact on reducing the spread of HIV, especially for women. Organizations like Sonke Gender Justice in South Africa are working to educate and empower men to practice safe sex, practice and promote gender equality, and prevent gender based violence all in the name of stopping the spread of HIV and AIDS. An epidemic like HIV and AIDS truly requires a multifaceted approach in which everyone is engaged in the fight.

Check out this video of Dr. Charlotte Watts, Research Director of STRIVE at the London School of Hygiene and Tropical Medicine, where she leads up studies on how social norms and inequalities drive HIV. Dr. Watts spoke at the World AIDS Day Commemoration at the Commonwealth Secretariat on 30 November 2012 about  the importance of engaging with youth and women to an effective HIV response.

The first featured image is courtesy of USAID.

The second featured image is courtesy of RNW.

Video courtesy of Commonwealthtube on Youtube.

[1] amfAR Statistics: Women and HIV/AIDS http://www.amfar.org/about_hiv_and_aids/facts_and_stats/statistics__women_and_hiv_aids/

[2] UNICEF: Preventing Mother-to-Child Transmission (PMTCT) of HIV http://www.unicef.org/aids/index_preventionyoung.html

[3] WHO and the Global Coalition of Women and AIDS: Intimate Partner Violence and AIDS http://www.who.int/hac/techguidance/pht/InfoBulletinIntimatePartnerViolenceFinal.pdf

[4] WHO: Violence against women and HIV/AIDS http://www.who.int/gender/violence/vawandhiv/en/