MELBOURNE, AUSTRALIA — While all youth face vulnerability to HIV, adolescent girls face unique challenges in reducing their risk of acquiring HIV due to gender inequalities, but much HIV programming lacks a specific focus on girls and young women. Many of the countries with the highest HIV prevalence are experiencing a massive “youth bulge” in population, so even with decreasing HIV prevalence, the absolute number of young people living with HIV or at risk of acquiring HIV is estimated to grow in the next five years. Young women are especially vulnerable to HIV and have HIV infection rates nearly twice as high as those for young men. At the end of 2012, approximately two-thirds of new HIV infections in adolescents aged 15–19 years were among girls. An AIDS-free generation is not possible without addressing the specific needs of adolescents—especially girls—that put them at risk for HIV acquisition.
A new paper, “What HIV programs work for adolescent girls?” by Karen Hardee (Population Council), Jill Gay (What Works Association), Melanie Croce-Galis (What Works Association), and Nana Ama Afari-Dwamena (former George Washington University student), reviews the vulnerabilities of girls; articulates the challenges of programming for girls; develops a framework for addressing the needs of girls; and reviews the evidence for successful programming for adolescent girls to highlight the need to focus on adolescent girls and young women as a critical priority in HIV prevention, treatment, and care.
This article is part of a series that presents a collection of reviews on adolescents examining current evidence and program experience to highlight how to improve HIV-specific outcomes. All articles can be found online in the new JAIDS supplement, Ending HIV and AIDS in Adolescents: Programmatic and Implementation Science Priorities, developed under the leadership of the United Nations Children’s Fund (UNICEF) and the United States National Institutes of Health (NIH), in collaboration with multiple technical leaders in the area of adolescent programming.
Based on 150 studies and evaluations from 2001 to June 2013, the evidence for HIV programming for adolescent girls falls under a range of interventions in three areas to address:
- the enabling environment: increase educational attainment for girls; promote gender-equitable norms, including working with men and boys; include a focus on adolescents in programs to reduce gender-based violence; strengthen legal norms to protect adolescent girls;
- the information and service needs of adolescent girls: provide age-appropriate, high-quality comprehensive sex education; increase knowledge about, access to, and demand for health and preventive information and services, including condoms and other contraceptives; expand harm reduction programs to include adolescent girls who inject drugs; and
- social support: promote caring relationships with adults, with an emphasis on parents and families; provide support for adolescent female orphans and vulnerable children.
Implications for the Future for HIV
“Today’s adolescents have never known a world without HIV, yet programming aimed at reducing their risk continues to lag behind the growing need. This analysis shows that there is evidence that could be used to guide programming to address the needs of adolescent girls and build their resilience,” says lead author Karen Hardee.
The paper also notes that serious gaps in programming continue to exist, including missed opportunities to understand the differential effects of programming for adolescents through age- and sex-disaggregation of data in evaluations. It is also clear that certain laws, such as those requiring parental consent for services or allowing child marriage, can be harmful. These and many other gaps in programming for adolescent girls must be addressed if we are to turn the tide of the increasingly feminine face of HIV.
Join the Conversation at the International AIDS Conference
UNICEF will host a conversation between young people, government leaders, researchers, and civil society about actions to scale up effective responses for HIV prevention, treatment, and care for adolescents at a cocktail reception in Foyer 1.4 on Sunday, 20 July 2014, 3:45 pm at the Melbourne Convention and Exhibition Centre (MCEC) Room 101–102. All are welcome to attend.
What Works for Women & Girls (www.whatworksforwomen.org) is supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR) and Open Society Foundations and is being carried out under the auspices of the USAID-supported Health Policy Project, Population Council, Public Health Institute, and What Works Association, Inc.
For more information about this article or the online resource www.whatworksforwomen.org please contact Melanie Croce-Galis, Executive Director, What Works Association, at firstname.lastname@example.org; Jill Gay, Chief Technical Officer, What Works Association, at email@example.com; or Karen Hardee, Senior Associate, Population Council, at firstname.lastname@example.org.
About the Population Council
The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees.
About What Works Association
What Works Association, Inc. is a non-profit organization dedicated to transforming the lives of women and girls by using evidence to improve policies and programs. Its primary resource—What Works for Women & Girls (www.whatworksforwomen.org)—is the most comprehensive review of interventions that have resulted in lower HIV incidence, prevalence, or programmatically constructive outcomes for women and girls. It is written in a style geared to provide those working on the frontlines with the rationale, potential interventions, and supporting evidence to make the most of limited resources.