“The number of new HIV infections among adolescent girls and young women in sub-Saharan Africa remains exceptionally high. In 2015, 450 000 [380 000–530 000] new infections occurred among adolescent girls and young women aged 15 to 24 years, which translates into approximately 8,600 new infections per week.”
This programming guidance, produced by the Joint United Nations Programme on HIV/AIDS (UNAIDS), is designed to inform programmes that aim to reduce HIV infection among adolescent girls and young women in countries and locations where HIV incidence is high among adolescent girls and young women and where HIV is primarily spread through heterosexual transmission. This document is intended primarily for “policy-makers, planners, and implementers of HIV prevention programmes across multiple sectors, including organisations led by young people. It is also useful for experts in wider health and social sector programmes, including health workers and teaching staff, or any other professionals who can integrate dimensions of HIV prevention into their area of work.”
The guidance provides concepts and examples on how to: 1) understand the epidemic situation of adolescent girls and young women in the country context, 2) how to design effective responses, 3) how to deliver programmes for adolescent girls and young women, 3) how to address policy change and structural issues, and 4) how to measure and sustain programme impacts for adolescent girls. For all of these components, communication to bring about behaviour change and structural change plays a key role in HIV prevention outcomes, such as those related to knowledge, risk perception, social norms, skills, sexual behaviours, and HIV service demand.
A brief outline of each section follows:
Understanding geographical patterns and HIV risk among adolescent girls and young women - To understand the epidemic situation of adolescent girls and young women in the country context, it is important to understand which factors influence high HIV incidence among young women and which factors drive HIV acquisition and transmission by and to adolescent girls and young women. This helps identify what the underlying determinants of the epidemic are and to focus activities. The document highlights the importance of geographically mapping HIV infections to identify priority areas, as well as the importance of understanding who is most affected, e.g., which age group, unmarried young women or single young women, urban or rural, etc. It also explains the importance of understanding the behavioural factors (such as age disparate sex, multiple partnership, transactional sex, early sexual debut), biological factors, and structural factors (such as harmful social and gender norms, gender inequality, low secondary school attendance, and labour migration and spousal separation) that influence HIV infection in a specific country.
Effective HIV responses for adolescent girls and young women - This chapter offers guidance on the design of effective responses for adolescent girls and young women and how to define goals and a strategy. The document proposes a simple programmatic framework that builds on the UNAIDS investment framework and UNAIDS guidance on combination HIV prevention and human-rights-based approaches to HIV programming. It offers a detailed strategy mix for HIV prevention among adolescent girls and young women, proposing an option menu based on available evidence and programming experience that countries and districts can choose. This menu for HIV prevention activities includes the following: condom promotion; social and behaviour change communication programmes; school-based HIV preventions; pre-exposure prophylaxis; accelerated uptake of HIV testing services, antiretroviral therapy and voluntary medical male circumcision by men; community mobilisation; multimedia and new media; cash transfers/incentives; keeping girls in school; policy and legal change; integration with gender-based violence (GBV) prevention and sexual and reproductive health and rights (SRHR); and enhanced leadership. These are all meant to address either behavioural, structural, or biological factors influencing HIV infection in young women and girls and are described in more detail in the following chapters.
Delivering effective HIV prevention programmes for adolescent girls and young women - This section offers guidance on how to implement HIV activities at scale and overcome barriers. It looks in more detail at the implementation of a selection of activities outlined in the previous chapter - condom promotion; social and behaviour change communication programmes; school-based HIV preventions; pre-exposure prophylaxis; and accelerated uptake of HIV testing services, antiretroviral therapy, and voluntary medical male circumcision by men. The discussion of each of these activities offers a framework for implementation on each activity and highlights key issues to consider during implementation. For example, under social and behaviour change, the following are highlighted as issues to consider during implementation: 1) The most "successful models involved both males and females, as well as young people and adults, but they use tailor-made messages for the different groups; 2) Successful approaches followed structured programme models, which complemented the building of knowledge, risk perception and skills with approaches to change social and community norms; and 3) Successful programmes had strong community participation, well-defined curricula and gender-transformative approaches that addressed norms, gender roles and power imbalances."
Policy change and structural programmes - This chapter describes prevention activities, which are essential supportive programmes for HIV prevention, and looks at the importance of analysing gaps and bottlenecks of HIV prevention programmes for adolescent girls and young women. As explained in the document, “HIV transmission can be related to a range of structural factors that may impact the effectiveness of programmes. These factors can vary greatly between countries because of social, economic and cultural differences, as well as the stage of implementation of the country’s prevention response. In many cases, the actual bottlenecks may be practical implementation obstacles such as a supply chain gap for condoms or the lack of involvement of local leadership.” The chapter discusses in detail the following activities which form part of the menu options outlined in the document: community mobilisation; multimedia; cash transfers and social grants; keeping girls in school; integration of HIV, sexual and reproductive health services, and GBV programmes; and leadership and role models. For each of these, the document offers a framework for action, as well as examples such as the SASA! campaign and approach (or community mobilisation), the Shuga campaign and U-Report project in Zambia (for multimedia), and the SHARE (Safe Homes and Respect for Everyone) Project in Uganda (for integrating HIV and GBV).
Accountability for sustained national programmes and results - As stated in the document, “Achieving substantial HIV incidence reductions among adolescent girls and young women requires concerted efforts from a group of partners across different sectors. To ensure that all partners make the right commitments and are accountable for delivering on them, two core elements need to be in place: a clear national framework for delivery and a management mechanism to keep the framework and commitment alive by guiding and monitoring implementation.” The document offers guidance and examples on how this can be done.
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UNAIDS website on September 5 2016.