Photo credit: Jessica Scranton/FHI 360

Adolescent girls and young women continue to be at unacceptably high risk for HIV infection. UNAIDS estimates that 7,500 girls and young women, 10 to 24 years of age, become infected with HIV every week, with the highest rates in southern and eastern Africa. Girls and young women account for 71 percent of new HIV infections among adolescents in sub-Saharan Africa, highlighting the gender disparity in this age group. Despite active prevention efforts, recent clinical trials in southern Africa have measured new HIV infection rates of 4 to 6 percent per year among young women. It is imperative that we implement aggressive measures to decrease new HIV infections among girls and young women.

Our current HIV prevention package of HIV testing, behavioral risk reduction, management of sexually transmitted infections and condom use is inadequate because young women often lack the ability to control their risk. The evidence is clear that the source of HIV infection for most girls and young women in southern Africa is older men. For young women, a complex mix of economic dependency, limited educational opportunity, gender inequality, unequal power dynamics and social norms leads to a lack of choice of how and with whom to have sex.

Bold measures that use the science to improve lives are key to #EndHIV4Her. What are programs that will help to curb new HIV infections among girls and young women?

• The DREAMS initiative, an ambitious partnership to help girls develop intoDetermined, Resilient, Empowered, AIDS-free, Mentored and Safe women will work to address these issues with the required urgency.
• We need to learn how to best employ pre-exposure prophylaxis (PrEP) for young women, especially those who are not aware of their HIV infection risk. We now have improved HIV prevention methods, including oral PrEP with antiretroviral drugs that can prevent HIV infection if taken regularly. Demonstration projects will explore how best to reach young women most at risk and support adherence to a regimen of a daily oral PrEP pill.
• Comprehensive sexual and reproductive health measures are needed to allow girls and young women to control their fertility and prevent unwanted pregnancies. Why? Because biomedical HIV interventions alone are unlikely to be successful.
• We also need to continue to address the complicated factors that lead to risk for young women and work to minimize the risks as fast as we can. Integrated approaches that address economic strengthening, educational opportunity, unhealthy social norms, and optimal behavioral and biomedical HIV prevention methods, including PrEP, are needed to prevent HIV infection among girls and young women. Staying in school longer is associated with decreased HIV risk, and economic empowerment is linked to continued education. In the developing world, girls all too often drop out of school when they begin menstruating because they don’t have adequate means or facilities to manage menstruation. Hence, menstrual hygiene management programs can be a key contributor to girls staying in school.

The momentum to protect girls and women from HIV and achieve an AIDS-free generation is picking up speed. The International AIDS Conference returns to Durban, South Africa, in July 2016, for the first time since 2000. The AIDS effort has been transformed during these 16 years, but there is still much to be done, especially for girls and young women. AIDS 2016 offers an opportunity to re-energize our HIV prevention efforts and bring together the holistic, integrated approaches that are most likely to lead to reduced HIV infections for those most vulnerable, especially girls and young women.

Dr. Timothy Mastro is Director of Global Health, Population & Nutrition at FHI 360, Durham, North Carolina, USA. He is also Adjunct Professor of Epidemiology in the Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Dr. Mastro oversees FHI 360’s health, population and nutrition research and program science conducted in the United States and through FHI 360’s offices in 50 countries around the world. Follow Dr. Mastro on Twitter: www.twitter.com/DrTimMastro