Judith Bruce
Miriam Temin
Kelly Hallman
Publication Date
March 1, 2012

"Despite the increasingly lopsided ratio between female and male infections in young populations, policymakers have persistently failed to engage directly with girls, too often submerging girls' needs within generalized health sector activities, male-focused and male-dominated community-based activities, and generic 'youth' prevention initiatives, all of which widely miss the mark."

From the United States Agency for International Development (USAID)'s AIDSTAR-One (AIDS Support and Technical Assistance Resources, Sector 1, Task Order 1), this document examines evidence-based approaches for protecting the large and vulnerable populations of adolescent girls who remain at risk of HIV around the world. The first section of the report explores "how girls got left behind" despite decades of investment in HIV prevention. Some recommended protection measures have assumed relative equality between girls and women and their sexual partners, presuming, for example, that girls and women possess: the ability to avoid pregnancy or choose abstinence: the agency to select a safe partner: and the power to use condoms consistently. Furthermore, "[g]irls' attendance at youth programs can be stigmatizing, even dangerous, and there is rarely a female mentor available to whom they can relate."

To address these types of inequities, the report urges advocates to articulate a positive vision that realigns both allocation of resources and measurement of results. Recommendations include:

  • Use available data to identify geographic concentrations of girls at exceptional risk - For example, specific indicators, largely drawing on census and Demographic and Health Survey data for 50 countries, are available for guidance on which girls are at risk and where they are located.
  • Create dedicated social spaces for girls as a strategy for changing girls' self-concepts and transforming the circumstances that put them at risk of acquiring HIV - These spaces - which can be established at existing community facilities like schools (after hours) and community centres - can serve as gathering places for vulnerable girls and young women. They can meet peers, consult with mentors, and acquire skills to help them head off or mitigate crises (e.g., threats of marriage, leaving school, or forced sex).
  • Reframe current investments to respond to girls' needs and engage their talents - Various examples are provided in the report; to cite one: "In Ethiopia, ...Biruh Tesfa ('Bright Future') offers girls regular meetings with female peers and mentors, basic financial literacy, valid identification cards, and a wellness checkup. A recent evaluation showed significant benefits for participants: girls involved in the project were more likely to have accurate knowledge about HIV, were more likely to know where to go for voluntary counseling and testing, were more likely to want to get tested for HIV, and were twice as likely to have social support and safety nets as girls in a control site..."

The report stresses that community-based platforms that provide safe spaces for girls are a core programme strategy that allows girls to develop key skills, safety strategies, and assets needed to prevent and mitigate the risk of HIV. These safe spaces provide:

  • a reliably available space apart from home and formal schooling;
  • friends: a dense network of non-family peers;
  • mentors and role models to learn from and intercede on girls' behalf;
  • experience in being part of a team: cooperating and leading;
  • skills and knowledge to access services and exercise health, social, and economic rights;
  • age-graded financial literacy and savings;
  • documentation for health, work, and citizenship;
  • self-protection plans;
  • specific knowledge of community resources to manage and mitigate crises (forced marriage, pregnancy, rape, violence); and
  • participation and activity with peers to develop agency and voice.

Email from Anna Lisi to The Communication Initiative on April 4 2012.