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Guest Commentary: HIV and Adolescent Girls and Young Women

The Population Council is conducting the world’s largest body of research on ways to improve the lives of adolescent girls in the developing world. For more than 25 years, the Council has developed and evaluated innovative programs and systems to increase access to quality reproductive health and HIV services and reduce the vulnerabilities that can increase girls’ lifetime risk for HIV and AIDS. Council research shows that if we can reach girls early, keep them safe and in school, and give them critical skills and information and a say in their own lives, they will be on the path to a safer, healthier adulthood. 

A new global commitment to address the various factors that increase girls’ risk for HIV infection and help keep them safe from HIV was announced in 2014. We asked Janet Fleischman of CSIS to comment on what she thinks of this heightened response and what’s needed to keep adolescent girls HIV free.

New Action to Address HIV Risk in Adolescent Girls and Young Women

By Janet Fleischman, CSIS Global Health Policy Center

The data are stark and incontrovertible: In eastern and southern Africa, 7,000 girls and young women aged 15–24 are infected with HIV every week. A global convergence is finally emerging around the urgency of going beyond biomedical interventions to address the social and economic factors driving HIV risk for this population. Unprecedented high-level attention is highlighting this crisis – in July 2015 in Addis Ababa, President Obama emphasized the need “to keep teenage girls safe and AIDS free,” and in September the U.S. announced significant additional resources for this effort. Yet addressing HIV risk in adolescent girls and young women remains a fundamental challenge for controlling the AIDS epidemic.

On World AIDS Day 2014, a new initiative was launched by the President’s Emergency Plan for AIDS Relief (PEPFAR), in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation (now spun off to Girl Effect). With an accumulated $500 million in resources and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden “hot spots” in 10 countries in southern and eastern Africa. To accomplish this, DREAMS aims to identify where these girls and young women are being infected, what is putting them at risk, and how to target programs accordingly. The partnership’s goal is to reduce incidence in high-burden areas by 25 percent by the end of 2016, and by 40 percent by the end of 2017. Whether these targets are attainable or simply aspirational remains to be seen, but they represent a determined effort to do things differently.

As exciting and laudable as this new attention is, the challenges are daunting, especially given the imperative to show significant impact within a short timeline. Herein lies the biggest vulnerability of DREAMS—success fundamentally rests on shifting entrenched political, social, and cultural norms, legal practices, and economic realities, as well as ensuring that implementing partners develop new program approaches to reach this population. We have long known that girls and young women have represented a glaring gap in the AIDS response; new approaches are needed to address the structural drivers that directly and indirectly increase girls’ HIV risk, including poverty, gender inequality, sexual violence, and lack of education. Preventing HIV in adolescent girls and young women in high-prevalence settings means empowering them with social protection and safe spaces, education and economic skills, and access to family planning and reproductive health.

In a time of increasingly limited global resources for HIV/AIDS and partisan gridlock in Washington, it is all the more notable that PEPFAR is now making adolescent girls and young women such a high priority. Ambassador Deborah Birx, the U.S. Global AIDS Coordinator, speaks passionately about the need for urgent action, calling the situation “an emergency that requires risk-taking.” At a CSIS event on April 17, she presented stark data from South Africa, showing that in parts of KwaZulu Natal, by the age of 24, a shocking 50 percent of young women are infected with HIV. As Ambassador Birx put it: “This should be mobilizing all of the resources with the same focus that we put on Ebola. This should be all of us coming together and saying ‘This is a crisis’…. Hopefully this is a call to action.”

If DREAMS is to gain traction, it will require strong host-country commitment at all levels of government and civil society as well as a dynamic political strategy. This means U.S. ambassadors and U.S. country teams for DREAMS have to be fully on board and be willing to work in new ways, including new partners who understand and can reach adolescent girls and young women at risk.

This is a critical moment to transform a growing global interest in women and girls in a range of sectors into effective HIV programing, and to highlight the results at the July 2016 International AIDS Conference in Durban, South Africa. As the U.S. National Security Advisor, Ambassador Susan Rice, declared in September 2015: “No greater action is needed right now than empowering adolescent girls and young women to defeat HIV/AIDS.”

Janet Fleischman is a senior associate at the CSIS Global Health Policy Center. This entry is drawn from the April 2015 CSIS report, “Addressing HIV Risk in Adolescent Girls and Young Women,” by Janet Fleischman and Katherine Peck and from Janet Fleischman’s blog, “An Emergency that Requires Risk Taking."