No woman left behind: Women and girls are integral to defeating HIV/AIDS
When describing key populations, defined by UNAIDS as “communities most likely to be living with HIV or those disproportionately affected by it when compared with the general population,”[1] often included are men who have sex with men, injecting drug users, sex workers and transgendered people.[2] One important set of constituents, however, is markedly absent from this list: young women and girls.
Thus far, despite their increased likelihood of contracting HIV and the structural and social inequalities felt by the population, women have not been explicitly included in the discussion under the header of key affected populations. Activists and lawmakers alike have heralded that the end of AIDS is within our reach and that key affected populations are vital to this end – including young women and girls from particular geographies in those discussions will be essential to achieving this goal.
In the 2014 UNAIDS Gap Report, 12 populations are highlighted as those left behind by HIV/AIDS services, policies and interventions. Among these 12 populations are two that include women and girls: adolescent girls and children, and pregnant women living with HIV. The necessity of including gender inequality in discussion of key affected populations is also addressed in the recent Compendium of Gender Equality and HIV Indicators, created through an international collaboration of multilateral and bilateral donors, civil society, NGOs, researchers and other experts.
Young women and adolescent girls account for a disproportionate number of new infections among young people. Globally, there are about 380,000 new infections among women ages 10-24 per year; this equals about 1,000 young women newly infected with HIV every day. Women account for more than half of adults living with HIV in the regions of sub-Saharan Africa (58 percent) and the Caribbean (53 percent), and also constitute a growing proportion of HIV infections in Asia – from 21 percent in 1990 to 38 percent in 2013.[3]
Addressing the incidence of HIV in young women is complicated by interrelated issues such as gender-based violence and gender inequality, which require structural, social and cultural reforms, in addition to epidemiological interventions.[4] Thus far, aid has focused on providing services centered on prevention, treatment and care. Though these are essential to ending the epidemic, services and programs that go above and beyond targeting the disease to focus on the person as an individual will be crucial to achieving an AIDS-free generation.`
Unique approaches to targeting the patient’s social and cultural issues are certainly being explored. In Malawi, where women and girls are twice as likely to be infected with HIV as men, the use of conditional cash transfers – providing money in return for fulfilling specific behavioral conditions – was studied and found to be successful. Operating under the theory that schooling can serve as a social vaccine for the spread of HIV, this program provided cash transfers to households with school-aged girls with the requirement that the girls attend school regularly.
The Global Fund to Fight AIDS, Tuberculosis and Malaria, the world’s largest public health financier, is committed to addressing the social, legal, cultural and biological issues that underpin gender inequality and contribute to poor health outcomes. The Global Fund is supporting half of all women receiving antiretroviral treatments for HIV/AIDS in Africa, and has invested in more than 10 percent of the total international funding for maternal and child health every year since 2005. In addition, in early 2014, the Global Fund launched a new Gender Equality Strategy Action Plan, increasing its focus on addressing inequalities and strengthening efforts to protect women and girls’ rights to health care.
Investment in the health of young women is crucial not only for stemming the HIV epidemic, but also because young women are powerful drivers for social change and crucial to the achievement of global health targets. [5] As the Global Fund’s Board Chair, Dr. Nafsiah Mboi, has said: “A society that does not cure and treat its women and young girls with love and care and with equality will never be a healthy society.”
Derrick is the president of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, an advocacy organization dedicated to sustaining and expanding U.S. support for the Global Fund. A global health thought leader with nearly two decades of policy and international development experience, Derrick serves on the board of the NGO alliance, InterAction, and previously served as a senior program officer at the Bill & Melinda Gates Foundation.
Continue this conversation at the 2014 AIDS Philanthropy Summit and join Derrick at the Friends-sponsored concurrent session “Unlocking progress in the AIDS epidemic: Investing for impact in key affected populations” from 3:15 – 4:15 pm on Monday 8 December.