By Sarah Konopka
Sarah Konopka, MA, is Principal Technical Advisor for HIV & AIDS Management Sciences for Health’s (MSH) Global HIV & AIDS Program. Follow Sarah on Twitter @HIVExpert. This article originally appeared on MSH’s Global Health Impact blog.
There was an awkward silence and then soft giggling as the girls looked at each other. I had just finished talking about strategies for persuading sexual partners to use a condom. Laughter during these skills-building and girls empowerment sessions with 30+ secondary school students in Morogoro, Tanzania was not uncommon, particularly given the sometimes sensitive topics of discussion, but this time, the joke was lost on me.
I asked the student nearest to me, a confident teenager that I knew wouldn’t be too shy to respond, why everyone was laughing. She told me, “You speak about this as if we have a choice.” She wasn’t being sarcastic or combative, nor was she complaining – she was simply matter-of-fact about it, stating her truth.
This was 2006. As a Peace Corp volunteer, I met with this group of adolescent girls every two weeks to talk about reproductive health, HIV, laws, policies, and rights. These girls were vulnerable to HIV infection and unintended pregnancy. They frequently did not have power in their romantic and sexual relationships, and for many, their first experience of sex was not by choice. More than a decade later, I think about these young women, and of their immense potential, every day, and especially today, as we commemorate World AIDS Day and 16 Days of Activism against Gender-Based Violence.
Since then, so much has changed in the global HIV response. Antiretroviral therapy (ART) has been scaled up, and nearly 21 million people living with HIV are on treatment, up from just 685,000 in 2000. Effective biomedical prevention tools have allowed us to make important progress, including in preventing mother-to-child transmission of HIV. People who are at high risk for infection can now take action to avoid HIV exposure through interventions such as pre-exposure prophylaxis (PrEP), post-exposure prophylaxis, and voluntary medical male circumcision. Management Sciences for Health (MSH) has played an important role in this, supporting countries in expanding critical programs and adopting strategies to improve access to and quality of services.
But despite this progress, social and structural barriers remain and populations most affected by HIV still struggle to access the health and social services they need. AIDS remains a leading cause of death among women of reproductive age and young adolescents worldwide; in sub-Saharan Africa, girls and young women account for two-thirds of new HIV infections among young people.
The disproportionately high rates of infection among this group are directly linked to gender inequality, so when we talk about strategies to reach young women and girls with HIV prevention and treatment, we must also talk about gender-based violence.
Today, 15 million adolescent girls worldwide aged 15 to 19 years have experienced forced sexual intercourse or other forced sexual acts at some point in their life, and only 1% report seeking professional help, according to a recent study. Even more troubling is the fact that women and girls who have experienced violence are up to three times more likely to be infected with HIV.
So what can be done?
The rights of women and girls must remain high on the global agenda. The Sustainable Development Goals (SDGs) recognize gender equality as a fundamental human right and SDG 5 calls for an end to all violence against women and girls.
The U.S. Government, through PEPFAR – the largest bilateral funder of HIV services – is committed to meeting the needs of girls and women. For the first time in 2015, PEPFAR set specific targets for preventing new HIV infections among adolescent girls and young women, underscoring the U.S. Global Strategy to Empower Adolescent Girls. The ambitious DREAMS Partnership, which seeks to reduce HIV infections among adolescent girls and young women in 10 sub-Saharan African countries, has already reached over 1 million adolescent girls and young women. Strong political commitment is critical, and PEPFAR’s new strategy reaffirms support for DREAMS.
MSH is playing an important role in strengthening health systems and supporting the delivery of high quality, respectful health services that are gender-responsive and adapted to the specific needs of the populations we serve.
We’re proud to work with the Nigerian government, PEPFAR, USAID, and other partners to integrate gender-based violence screening and treatment into HIV services. We’ve done the same in Ethiopia, Uganda, and Malawi. In Angola, in partnership with UNDP and the Global Fund, and USAID and FHI360 through the LINKAGES program, we’re honored to work with communities of sex workers and members of the police to raise awareness of gender-based violence and build capacity for recognizing signs of abuse and reporting and treating cases. And in Mali, we’re committed to working with partners in government, civil society, and communities to prevent and respond to gender-based violence.
As UNAIDS rightly asserts in their report Right to Health, launched in advance of this year’s World AIDS Day, all people, including those living with and affected by HIV, have the right to quality health care for prevention and treatment, to make decisions about one’s own health, and to be treated with respect, dignity, and without discrimination.
Empowering adolescent girls and young women to realize these rights is a critical step in our efforts to address the rise of new infections. Our focus must also include other communities most affected by HIV—including sex workers, people who use drugs, and men who have sex with men—who also suffer from gender-based violence, discrimination, and unequal power dynamics.
We’ve achieved so much in the last decade in terms of expanding access to treatment and getting people living with HIV the care they deserve. But I think about those students in Morogoro, their experiences, and the reality for young women and girls around the world today, particularly in Sub-Saharan Africa. We need to do more. Women and girls have a right to choose what happens to their bodies. They have a right to make choices about their future. Investing in them and upholding their rights is the greatest tool we have in preventing new HIV infections. As we commemorate World AIDS Day, we must recommit to our shared goals of ensuring gender equality and ending violence against women and girls.