Putting Adolescent Girls at the Center of HIV Prevention Efforts

This week, as the international community marked World AIDS Day, the United States announced additional resources for a new initiative aimed at preventing infection among adolescent girls. Although new HIV infections have fallen 38 percent since 2001, adolescent girls and young women remain disproportionately vulnerable to infection. Adolescent girls in Sub-Saharan Africa alone account for a quarter of new HIV infections globally.

Earlier this year, as part of the Sustainable Development Goals, the international community committed to ending the HIV epidemic by 2030. Governments and multilateral organizations are increasingly recognizing that stopping the spread of HIV requires specific attention to the needs of young women and girls. To do this, preventing infection among adolescent girls must be a centerpiece of HIV policy and programs.

The recently announced DREAMS Initiative — a partnership between the President’s Emergency Plan for AIDS Relief (PEPFAR), the Bill and Melinda Gates Foundation, and Girl Effect — could be a strong step in the right direction. The program currently includes 10 Sub-Saharan African countries which, taken together, account for nearly half of all new HIV infections among girls and young women. To complement the initiative, PEPFAR recently announced an ambitious new target: By the end of 2017, achieve a 40 percent reduction in HIV incidence among adolescent girls and young women (aged 15-24) within the highest burden geographic areas of 10 Sub-Saharan African countries.

DREAMS includes a core package of evidence-based approaches that not only target the health sector but also address driving factors such as education, poverty, and gender inequality. It commits to engaging not only with governments, but also with civil society and with adolescent girls themselves. Its evidence-based interventions are rooted in what we know works for adolescent girls and young women.

But the success of the program will depend on whether it can meet these commitments. It will be impossible to address the prevalence of HIV infection among girls and young women without addressing the underlying gender norms, power imbalances and structural drivers that undervalue them and leave them vulnerable to coerced sex, early sexual debut, and early marriage.

And HIV programs will not be successful unless they engage entire communities and ensure local buy-in and ownership. Adolescent girls themselves must be centrally involved in developing and implementing programs to ensure that they respond to their unique concerns and needs, and that they are empowered.

The DREAMS core package includes school-based HIV prevention, and it is critical that evidence-based comprehensive sexuality education be a part of this. Comprehensive sexuality education — which includes discussions of gender and rights in relationships — has been proven to be a critical component of successful programming. Population Council researcher Nicole Haberland recently published a study showing that sexuality and HIV education programs are more effective if they address gender and power in intimate relationships. DREAMS should build upon this research, and support comprehensive sexuality education that specifically addresses these dynamics.

Similarly, girls’ sexuality cannot be brushed aside — it must be part of the conversation.  Because HIV is most often acquired through sexual intercourse, the rights of adolescent girls and young women to control their sexuality cannot be deemed too controversial or too difficult to discuss. Programs must take into account the full range of girls’ and women’s sexual and reproductive health and rights.

These goals are achievable, but they will require significant vision and leadership from governments like the United States. The announcement of the DREAMS Initiative is an important start. Now, as implementation begins, the U.S. and others must make sure that programs address girls’ health and human rights in their entirety, including their right to control their bodies and sexuality.

Photo: Pierre Holtz/UNICEF

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