"To be effective, any health and development agenda needs to focus on the root causes of the gender gap, and the AIDS response is no different."
This report was produced to guide regional and global advocacy and inform political dialogue, particularly within discussions and planning being shaped as part of the African Union Agenda 2063 and the post-2015 sustainable development agenda, in order to consider actions needed to achieve the goal of ending the AIDS epidemic as a public health threat by 2030. The report centres on the understanding that this requires taking action to target the root causes of young women and girls' vulnerability, largely arising from harmful gender norms and inequality. As stated in the report, "Many cannot reduce their vulnerability to HIV because they are not permitted to make decisions on their own health care. They cannot reduce their vulnerability because they cannot choose at what age or who to marry, when to have sex, how to protect themselves or how many children to have."
The report first discusses the current progress, gaps, and impact of HIV among young women and adolescent girls in Africa, noting that young women and adolescent girls continue to be more highly affected and less likely to have access to prevention and treatment services, though there are examples of where progress can be made. "Providing access to comprehensive sexuality education, keeping girls in school and implementing social protection programmes such as cash transfer programmes have all proven effective in reducing new infections among young women and adolescent girls." However, there are still significant gaps. For example, "many young women who marry or enter into partnerships early do not have the knowledge or the personal agency that enables them to protect themselves from HIV, for example, they cannot negotiate when to have sex or to use condoms." Young women and girls are negatively affected by: harmful gender norms; inadequate access to good-quality sexual and reproductive health information, commodities, and services; lack of access to secondary education and comprehensive age-appropriate sexuality education; and intimate partner violence - all of which impacts on risk and health-seeking behaviour.
The report then goes on to discuss how to adapt, given the dynamic context of the African continent, and what needs to be considered in the response. For example, Africa's population is overwhelmingly young, and rapidly urbanising. This young population "presents challenges in terms of access to sexual and reproductive health and HIV information commodities and services; yet, this burgeoning youth population is also the region's greatest asset. Reaching and engaging young women and adolescent girls, and empowering them to make their own health choices in safe and equitable environments, has the power to change the trajectory of the HIV epidemic."
The final part of the report highlights how to leverage the commitments of African leaders to end the AIDS epidemic and transform the lives of young women and adolescent girls on the continent, offering five key recommendations:
- Women's agency, participation and leadership: By empowering women as political and social actors, institutions and policies can become more representative of diverse voices, including those young women and girls. This should include young women living with and affected by HIV being part of policy and decision-making bodies and ensuring women's participation in humanitarian situations.
- Strategies to reduce intimate partner violence and reduce vulnerability to HIV: "Strategies and action implemented at the community level to address intimate partner violence are critical to reducing young women's and adolescent girls' vulnerability to HIV." One example given is the Raising Voices SASA! kit, which was designed to inspire and guide community mobilisation to prevent violence against women and HIV. "Community activists spearheaded a wide range of activities in their own neighbourhoods designed to decrease the social acceptability of violence by influencing knowledge, attitudes, skills and behaviours on gender, power and violence."
- Scaling up social protection and cash transfers to reduce poverty and girls' vulnerability to HIV: According to the report, in the context of comprehensive social policies and programmes, "households affected by HIV are an appropriate target for cash transfer programmes that aim to alleviate poverty. Cash transfers can achieve multiple simultaneous outcomes, including declines in early marriage and teenage pregnancy."
- Strategies to keep girls in school and comprehensive sexuality education: Evidence shows that education contributes to a higher level of knowledge about HIV and sexual and reproductive health and rights, lowers exposure to gender-based violence, and increases women's and girls' chances of being financially secure and independent. As well, "when young women and adolescent girls have access to comprehensive age-appropriate sexuality education before becoming sexually active, they are more likely to make informed decisions about their sexuality and approach relationships with more self-confidence."
- Scaling up and integrating HIV with sexual and reproductive health services: "A massive scale-up of comprehensive and youth-friendly sexual and reproductive health and HIV services for young women and adolescent girls should be planned and rolled out, taking into consideration rapid population growth. " This would include condom programming designed to reach young people, removing barriers around reproductive health services such as parental and spousal consent, and ensuring access to youth-friendly sexual and reproductive health services.
The report concludes that "Fast-tracking the end of the AIDS epidemic by 2030 requires strong political leadership and commitment to stop new infections and deaths among young women and adolescent girls and eliminate mother to child transmission of HIV. This requires building on, and extending Africa's commitments on sexual and reproductive health and rights, expanding ministerial commitments on comprehensive sexuality education and stopping early marriage, adolescent pregnancy and expanding treatment service coverage."
UNAIDS website on February 1 2016.