Girl power: rethinking the way we approach HIV/AIDS in girls and young women

Photo credit: PEPFAR.

Photo credit: PEPFAR

With over 1,000 new infections each day, young women and adolescent girls are the biggest risk group for HIV infection in the world. Nowhere is this risk greater than sub Saharan Africa, where girls account for 80% of all new infections among adolescents, and HIV/AIDS is the leading cause of death for girls and women age 15-49. Despite these stark numbers, policymakers in the HIV/AIDS community have historically neglected young women, often positioning them as an afterthought. What has resulted, in the words of Global Fund Executive Director Mark Dybul, is a “fundamental failure of adolescent girls and women.”

I recently attended two events on this issue—one hosted by amfAR and the other sponsored by the Center for Strategic and International Studies (CSIS). Admittedly, I was skeptical to attend, afraid to hear a clichéd recycling of phrases about needing to do better. Yet what I uncovered was a refreshingly honest discussion of the complicated nuances of HIV/AIDS in women and girls, as well as demand for more holistic solutions. Here are the five most important themes I heard at the events:

Power Structures

If we hope to eliminate HIV/AIDS in young girls and women, we must seek out new approaches that address the structural drivers that increase female HIV risk, including poverty, violence, a lack of education, and the gendered distribution of power in society. Secured by information access, technology, income, education, social capital, freedom from violence, and a voice, this power infiltrates all levels of society, from government to communities to families to personal relationships.

Too often, women’s access to power is compromised by their vulnerability to physical and sexual violence. Compared to older women, adolescent girls are at a much greater risk– studies in over 80 countries found that 30% of girls age 15-19 have experienced intimate partner violence (IPV), and 25% report that their first sexual experience was involuntary.

In order to lift women from cycles of violence and HIV/AIDS, it is crucial to empower them by fostering and harnessing their social, cognitive, and economic assets. At CSIS, Judith Bruce of the Population Council emphasized the need to provide girls and women with protective means to build upon these assets. Comprised of friends, a mentor, a safety plan, personal identification, a savings plan, and financial literacy, these “toolkits” will enable girls to develop skills, friendships, and social networks that will help protect them from violence and risk of disease.

Women as a Vital Resource

Investing in women in such a way will not only alleviate the risk of HIV/AIDS, but also contribute to broader development goals. As Mark Dybul shared at CSIS, 92% of every dollar invested in women is reinvested back into communities, in contrast to just 42% for men. Just last month, the value of investing in women was similarly stressed in ONE’s Poverty is Sexist: increasing the amount spent on key health interventions for women and children by just $5 per person per year, it reported, could yield a nine-fold return on investment.

Multisectoral Cooperation

At CSIS, U.S. Global AIDS Coordinator Debbie Birx offered an unsettling anecdote, in which an African Minister of Finance told her, “The Minister of Health never talks to me about HIV…is it still a problem?” In many parts of the world, this sort of miscommunication within governments is unfortunately the norm. In order to ensure improved outcomes for women, it will be critical for health ministries to collaborate and engage with other sectors, including finance, justice, women’s affairs, agriculture, and education. Fortifying the link between health and education will be particularly imperative to protect women, as better educated women are more likely to delay marriage, earn better incomes, and have greater decision-maker power in relationships.

Perhaps one of most illustrative examples of multisectoral cooperation in the global health space today is DREAMS, an initiative recently launched by the President’s Emergency Plan for AIDS Relief (PEPFAR) in partnership with the Bill and Melinda Gates Foundation and Nike. With over $200 million in funding, DREAMS aims to use education and increased economic opportunities to lift girls from the burdens of poverty and disease, with the ultimate goal of reducing HIV-incidence in high-burden areas by 40% in three years.

Increased Emphasis on the Science of HIV/AIDS

Better understanding the science of HIV/AIDS is also essential for designing better programs to keep girls healthy. At amfAR , the NIH’s Gina Brown revealed that the female anatomy makes women more susceptible to HIV infection than that of men, as semen can remain in the vagina for a prolonged period of time and the tissue of the vaginal lining contains certain types of cells that HIV can easily enter. For this reason, a female receptive partner’s risk of HIV is almost 13 times greater than that of an intrusive male partner. Likewise, amfAR VP Rowena Johnston explained how estrogen dramatically affects the way in which the HIV virus inhibits human DNA and can yield more serious side-effects to treatment.

A better understanding of the science of HIV/AIDS can help encourage the development of more targeted and innovative therapies for women and girls. At amfAR, Sharon Hillier of the University of Pittsburgh School of Medicine discussed some of these new options, such as pre-exposure prophylaxis (PrEP), vaginal rings, and gel products which have yielded an almost 40% reduction in infection in clinical trials.

Data & Numbers

The final, yet arguably most important, theme was the importance of data as an instrument of both motivation and evaluation for HIV/AIDS-related programs. As shared by Debbie Birx at CSIS, PEPFAR has begun using enhanced data tools to strategically target the geographic areas and populations most in need. Crowning herself a “data diva,” Birx lauded the recent launch of PEPFAR’s Dashboards, an online platform which enables everyone to view and utilize PEPFAR data, optimizing transparency, mutual accountability, and the actionable potential of information. It is only with such accessible data, speakers at both events agreed, that we will obtain the political impetus to invest in women’s health and the analytical capacity to track progress and prove that the investments we are making are worth it.

The girls and young women around the world affected by HIV/AIDS are undoubtedly worth it. Let’s now invest in the data, the scientific research, the multisectoral cooperation, the expanded opportunities, and the more equitable sociopolitical structures to prove it.