Young Women and Girls Are Infected With HIV At Disproportionately High Rates. How Has The World’s Largest Donor Government to HIV Responded?
This week the international community gathers for the International AIDS Conference in Durban, South Africa. We hope they won’t forget the 380,000¹ adolescent girls and young women infected with HIV globally each year. Girls and young women account for 71 percent of new HIV infections among adolescents in sub-Saharan Africa. Here in South Africa, over 17% of women aged 20–24 years old are infected. It is clear that we cannot achieve an AIDS-free generation if women and girls are left behind.
That’s why I was so heartened when the U.S. global AIDS program, PEPFAR, announced the DREAMS initiative and for the first time ever set a goal for preventing new HIV infections among adolescent girls and young women. Launched on World AIDS Day 2014, DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) is aimed at reducing the disproportionately high rates of HIV infection among young women and adolescent girls in 10 sub-Saharan African countries (Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe). The DREAMS approach includes a core package of evidence based, multi-sectoral interventions that address structural drivers increasing risk, such as poverty, gender inequality, sexual violence, and lack of education. Beyond the rhetoric, there is money behind reaching these goals – PEPFAR and its private sector partners the Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, ViiV and Gilead have now committed nearly half a billion dollars to reducing HIV infections among adolescent girls and young women in DREAMS districts. Taken together, the approach could dramatically reduce HIV infections among women and girls age 15–24 and warrants attention, replication and institutionalization at this critical time in the fight against HIV/AIDS. In a promising sign for scale up and sustainability, here in South Africa the government recently announced the adoption of a national campaign to transform the health of young women and girls in the country that closely aligns with DREAMS.
Around the world, young people are advocating for their own access to comprehensive information so that they can take control of their own sexualities and futures, and DREAMS has heeded their grassroots call by making evidence-based, medically accurate, and age-appropriate sex education and adolescent-friendly sexual and reproductive health services a core part of the DREAMS initiative. In Uganda, for example, Planned Parenthood Global partner Reproductive Health Uganda (RHU) recently launched a social media campaign and hosted a series of “tweet ups” and other in-person events to promote young people’s knowledge of and access to a range of contraceptive services. These events focused on the call for sex education in Ugandan schools and young people’s access to contraceptive methods, including emergency contraception, promoted via RHU’s hashtag “#Not2Late2.” The campaign generated more than one million social media impressions and culminated with an intergenerational dialogue at Makerere University that drew more than 700 attendees, including hundreds of male and female students as well as members of parliament from key committees on health, education, and adolescents — whom RHU’s youth leaders urged to implement and fully fund Uganda’s existing health policy. These are the brave young changemakers whose vision is represented by a DREAMS initiative focus on adolescent-friendly sexual and reproductive health services. Beyond education, DREAMS also represents an exciting new approach in part because it includes an increased focus on expanding access to youth-friendly sexual and reproductive health services.
PEPFAR has also made important progress on engaging civil society and non-traditional partners — which will be critical to reaching the young women and girls who have been left behind by programs to date and ensuring sustainable outcomes. The DREAMS Innovation Challenge Fund is bringing some exciting new partners and ideas to the urgent needs of women and girls. Of course more funding and capacity building for these groups is needed. Civil society also has a critical role to play in advocating for the removal of policies that stand in the way of young women and adolescent girls accessing the information and services they need to stay healthy. Laws requiring age of consent, barring sex education in schools, and restricting access to sexual and reproductive health services will have to change for DREAMS to deliver for the women and girls who need it most. The comprehensive, evidence based approach in DREAMS matches the need we’ve seen in our work for a holistic approach to health, especially when it comes to young people and especially young women and girls. The policy environment must support the full implementation of this approach and civil society’s voices and global health diplomacy can help achieve that.
While all marginalized communities continue to be impacted by the HIV/AIDS epidemic, Black women and women of color are disproportionately affected among women in the U.S., where I live. While rates of new infections are declining overall, the population still heaviest hit is among Black women: Nationally, Black women account for 62% of new cases of HIV among women, with an incidence rate of HIV 20 times higher than their white counterparts, according to the CDC. And HIV/AIDS-related illness is now the leading cause of death among Black women ages 25–34. Issues such as poverty, gender inequality, exclusion, discrimination, lack of education, and violence contribute to their risk. Planned Parenthood is working to address this as a leading educator and provider of HIV testing in the U.S. Through Planned Parenthood’s approximately 650 health centers, we provide nonjudgmental, comprehensive, high-quality reproductive health care services to women, men, and young people that are critical in fighting the epidemic including among Black women. I encourage other health care providers as well as policymakers and donors to pursue a data-driven approach to HIV prevention and elevated attention to the needs of Black women in particular in order to make progress on this global epidemic and ensure the health and rights of women and girls.
No matter their location, gender, race, sexual orientation, age, or HIV-status, every individual should have access to the care they need to control their body and their future. But we have yet to fully realize this principle as a reality. We know what works in the fight against HIV/AIDS and much of it is represented in the DREAMS approach. Now is the time to protect our progress, and double down on our efforts to end this epidemic for good. This involves focusing explicitly on the needs of women and girls, as DREAMS does, and on voices from the Global South. At a recent consultation held in advance of the Women Deliver conference, I heard overwhelmingly from colleagues across the Global South about their needs and values, including the need for U.S. leadership on a wide range of global sexual and reproductive health and rights issues. I hope the U.S. will continue to heed this call by institutionalizing the approach of DREAMS, engaging in global health diplomacy, supporting civil society engagement, and facilitating better access to family planning services within PEPFAR – and that other donor governments and partners will follow suit.
Latanya Mapp Frett is the Executive Director of Planned Parenthood Global.
¹UNAIDS estimates a range of 340,000–440,000 infections.
