August 30, 2016

Girls in Danger: How Can We Ensure Girls Don’t Fall Through the Cracks in the HIV Epidemic

Written by Kirsty Sievwright, The International Center for Research on Women's (ICRW)

This post originally appeared on Medium here.

Imagine what it’s like to be a 15 year-old girl in 2016. What are your concerns at this age? For many of us, the immediate response might be something like “doing well in school” or “working up the courage to speak to your crush,” concerns that are fairly universal to the tumultuous experience of being an adolescent girl. But what about accessing sexual and reproductive health information? Being able to negotiate condom use without fear of violence? Fearing that you might get pregnant or contract the human immunodeficiency virus (HIV)? Unfortunately, these are concerns that far too many young women and girls around the world grapple with, especially when it comes to HIV.

Since the beginning of the HIV epidemic, women and girls have been uniquely at risk for contracting HIV and now, more than 30 years later, not enough has been done to meet their needs for prevention or treatment. As a result, in some regions of the world, young women and girls remain at greater risk of HIV infection than their male counterparts. Globally, 60 percent of all young people living with HIV (ages 15–24), are young women and 58 percent of new infections among all young people in 2015 were among young women.

Why do young women remain acutely at risk of HIV?

For a start simply because of biology; women have greater exposed surface area in their genital tracts compared to men, making them twice as likely as men to contract HIV during penile-vaginal intercourse. Adolescent girls and young women face an even higher risk, due to an increased risk of tearing and bleeding during intercourse.
Social factors — often the result of deeply ingrained gender inequality — further exacerbate girls’ vulnerability to HIV. A girl pulled out of school to help with the family business or to care for an ailing family member is more likely to contract HIV without the benefit of education and the empowerment that comes with it. A girl forced to marry at the young age of fifteen is more likely to experience intimate partner violence, which increases her risk of contracting sexually transmitted infections (STIs), including HIV. A young woman in poverty might engage in transactional sex to survive and in this position she has limited power to refuse sex or negotiate safe sex practices (like wearing a condom) to protect against HIV.

Furthermore, structural factors can put women at greater risk for contracting HIV. A girl at a school with a poor sexual and reproductive health (SRH) curriculum might not get the information she needs to protect herself from HIV. An adolescent girl who lacks access to youth friendly health centers that are welcoming and supportive might not access the sexual health information or routine screening that she needs.

While there is no silver bullet that protects girls from HIV, meeting girls’ needs and finding solutions that work for them, both to prevent contracting HIV and to treat those who are living with HIV, is possible.
We must give girls opportunities to stay in school longer so that they have greater financial prospects and decision-making ability. We must also ensure that sexual health curricula taught in schools are sufficient and are implemented appropriately, so that girls leave school with the knowledge they need to prevent STIs, including HIV, and unwanted pregnancy. We must revisit laws that perpetuate gender inequalities such as those that allow for early marriage. Amending these laws will help to further empower women to take control of their sexual and reproductive health. And lastly, we must expand access to HIV prevention and treatment services. Access to preventive options such as Pre-Exposure Prophalyaxis (PrEP), a daily pill that reduces risk of infection for those at high risk of contracting HIV, would give women and girls greater ability to protect themselves against HIV without having to negotiate its use with a partner.

The 21st International AIDS Society Conference came to a close last week. The importance of engaging youth — and in particular young women — in the fight against HIV was front and center among health professionals, researchers, policy makers, advocates, people living with HIV and young people. As we continue onward, we must double down on all fronts and ensure that HIV prevention, treatment and care reach young women. Only then will we be able to halt new HIV infections among the largest generation of young people ever and realize the end of AIDS.

This blog post was written by Kirsty Sievwright, research associate at the International Center for Research on Women.