According to the World Health Organization, about one third of women worldwide have experienced violence. In some regions, women who have experienced physical or sexual intimate partner violence are 1.5 times more likely to acquire HIV than women who have not experienced such violence. Among marginalized populations, such as sex workers or transgender women, a high prevalence of violence is linked with higher rates of HIV infection.

In the Middle East and North Africa (MENA) region, UNAIDS estimates that around 220 000 people are living with HIV. New infections were up by 12% between 2010 and 2017 and AIDS-related deaths increased by 11% over the same period. The stigma and discrimination associated with HIV as well as high levels of gender-based violence are preventing several countries from making progress against the epidemic. Gender-based violence in the region is strongly associated with harmful gender norms and stereotypes.

In 2018, the LEARN MENA project was launched to provide women with a platform to share experiences and explore the linkages between gender-based violence and HIV in the region. Underpinning the project is the Action Linking Initiatives in Violence against Women and HIV Everywhere (ALIV(H)E) framework, a research project that collates evidence on what works to prevent violence and builds women’s awareness to understand and address linkages between violence against women and HIV.

Through community dialogues led by MENA-Rosa, a regional network of women living with or affected by HIV, women are strengthening their own understanding of the root causes of violence and the links with HIV. The dialogues have highlighted the fact that gender inequality is at the centre of violence against women and an increased risk of HIV infection. For example, through the dialogues it was revealed that some women had never been to school. Many had experienced early or forced marriage. Many women acquire HIV from sexual violence, including within their own marriage.

“Violence is everywhere. Over time, and as you get older, you get to see it as normal,” said an Algerian woman participating in one of the dialogues. 

The participants described multiple forms of violence across different settings, including in health-care settings, which impede their access to health care, including to HIV prevention and treatment services.

So far, the project has been implemented in seven countries―Algeria, Egypt, Jordan, Lebanon, Morocco, Sudan and Tunisia.

Findings from the project are helping women living with and affected by HIV to advocate for an improved response to the epidemic in the region and for measures to reduce the impact of violence against women. The dialogues have amplified the voices of marginalized women living with and affected by HIV, encouraging decision-makers and partners to build strengthened national community responses. UNAIDS is supporting countries to implement the recommendations and action plans developed from the project.

“MENA-Rosa leaders have learned through this painful process that violence against us should be denounced and not brushed under the carpet,” said Rita Wahab, Regional Coordinator of MENA-Rosa. “Empowerment will help women in all their diversity to know and understand their rights. Our advocates will move forward to expose the links between violence against women and HIV. Gender equality starts at home, grows in society and blossoms in the legal environment.”

LEARN MENA is implemented by UNAIDS, Frontline AIDS and MENA-Rosa, with funding support from USAID. Additional technical support is provided by the Salamander Trust, the lead author of the ALIV(H)E framework.

Rise clubs are helping adolescent girls and young women start conversations about HIV and sexual and reproductive health and rights.

Khayelitsha is one of South Africa’s largest townships, situated in the Cape Flats in Cape Town, South Africa.

As is the case in many other communities in South Africa, women and girls in the semi-informal settlement deal with gender inequality on a daily basis, which puts them at higher risk of HIV infection.

Gender inequality is a barrier for adolescent girls and young women to access HIV and sexual and reproductive health services and comprehensive sexuality education. It also places girls at higher risk of gender-based violence.

“There is a lot of crime. The community is not on the girls’ side. The community believes that women must submit to men. Sometimes it is hard for us to speak out,” said a young woman who is a member of the Rise club in Khayelitsha.

“We belittle ourselves to fit in the box that the community puts us in. Girls get raped, kidnapped … there is a lot of violence. “You can do this, you can’t do that”, you are told what to do,” she says.

For most girls, it is difficult to talk to parents, teachers or family members about sex, sexuality and sexual and reproductive health and rights. Young women and adolescent girls face stigma and discrimination, such as being shamed for being sexually active, from nurses in health-care settings when they seek sexual and reproductive health services. While many countries in eastern and southern Africa have signed the Ministerial Commitment on Comprehensive Sexuality Education and Sexual and Reproductive Health Services for Adolescents and Young People in Eastern and Southern Africa and have some sort of policy on comprehensive sexuality education, implementation is still uneven. 

Young women are at higher risk of HIV and other sexually transmitted infections than their male peers or older women.

In eastern and southern Africa, a quarter of the 800 000 new HIV infections in 2017 were among adolescent girls and young women between the ages of 15 and 24 years. Of the 2.17 million adolescents and young people aged 15–24 years in eastern and southern Africa living with HIV, 1.5 million are adolescent girls and young women.

Of the 277 000 new HIV infections in South Africa in 2017, 77 000 were among adolescent girls and young women between the ages of 15 and 24 years, more than double that of their male counterparts (32 000).

Knowledge of HIV prevention ranges from a high of 64.5% in Rwanda to low of 20.37% in Comoros, with South Africa mid-range at 45.8%.

In some countries in the region, adolescent girls and young women are permitted by law to marry at a young age. Early marriages are associated with loss of bodily autonomy, lack of education owing to school drop-out, lack of economic independence and gender-based violence.

Transactional sex contributes to the gender disparity in HIV infection among young people in sub-Sahara Africa.

Evidence shows that transactional sex among adolescent girls and young women is associated with a number of sources of HIV risk, including abuse and violence, alcohol use, having multiple partners, lack of condom use and age-disparate sex.

Rise clubs

Rise is a club for adolescent girls and young women that seeks to build social cohesion, self-efficacy and resilience through allowing adolescent girls and young women (aged 15‒24 years) a space to support each other and undertake projects in the community that help prevent HIV, mitigate its impact and enable safer choices.

Rise helps meet the needs of adolescent girls and young women in terms of building self-confidence and encouraging them to speak out against social ills and helps them to make decisions about their lives.

The clubs were started in 2014 for young people in 15 high-burden districts in South Africa by the Soul City Institute for Social Justice.

“African parents do not talk to us about sex and we are embarrassed to talk to them. I couldn’t speak to my sister so I joined Rise and now I can sit with my girls. Some are older than me and they can give me advice.” —Cinga 

“My parents taught me that the only way to be knowledgeable is to ask questions. When I joined Rise, we’d ask questions for girls who can’t ask for themselves, making life easier for the girls.” —Okuhle

“I could not speak to anyone at home. And then I became the most talkative person. Rise has helped me deal with low self-esteem.” —Lisa

Adolescent girls and young women in eastern and southern Africa need laws, policies and programmes that meet their needs. These include tailored and focused programmes for sexual and reproductive health services and comprehensive sexuality education and on the prevention of unintended pregnancies, gender-based violence and HIV infection.

They must be informed by the principles of gender equality and human rights and should address other socioeconomic issues, such poverty and unemployment.

Having such policies and programmes will not only result in positive health outcomes but will give adolescent girls and young women the opportunity to live their lives with freedom and dignity.

“Without our voice, you are doing it for you, not for us”, said Winny Obure, a youth leader and women’s rights defender from Kenya, at the United Nations in New York, United States of America.

She was joined by other young women demanding the removal of barriers to their sexual and reproductive rights and for adolescent girls to be empowered. The event—Step It Up!—was a call to action for the most left behind adolescent girls and was convened by UNAIDS, the ATHENA Network, the Governments of Australia and Namibia, and UN Women, with 25 partners from the United Nations and civil society.

Adolescent girls and young women are still disproportionally affected by HIV. One million adolescent girls live with HIV globally and every week 7000 adolescent girls and young women become infected with HIV. Comprehensive sexuality education is so limited that levels of knowledge about HIV prevention among young people have remained flat over the past 20 years.

“We will not reach the Sustainable Development Goals if the voices and aspirations of adolescent girls are oppressed,” said Gunilla Carlsson, UNAIDS Deputy Executive Director, Management and Governance.“Where is the accountability for the millions of adolescent girls being left behind?”

All too often, adolescent girls remain invisible to decision-makers, especially if they belong to groups that are discriminated against, criminalized or stigmatized. As many of the participants pointed out, they are subjected to human rights violations, including violence and harmful practices, and denial of their sexual and reproductive health and rights.

“We need to move away from these meeting rooms and go to communities to talk to adolescent girls and young women. We need to address the uniqueness of specific groups of girls, of their specific needs .We have the solutions, it’s just a matter of including us in the discussion,” said Maximina Jokonya, a young woman from Zimbabwe.

“Teenage girls are often out of sight and out of mind and they are not where the power is, it’s still with men,” said Sharman Stone, Australia’s Ambassador for Women and Girls. She highlighted the barriers that girls face in the Pacific, where they are denied contraception and subjected to high levels of violence. She said that a key priority for Australia during humanitarian crises is to ensure access to sexual and reproductive health services.

The Minister of Gender Equality and Child Welfare of Namibia, Doreen Sioka, spoke about championing the rights of adolescent girls and young women, comprehensive sexuality education and integrated sexual and reproductive health and HIV services. She outlined major achievements in fulfilling international HIV targets. A new law in Namibia enshrines the right of all children to access critical services—at 14 years of age, children can now be tested for HIV without permission from their parents or guardians.

The young women at the event underscored their realities and restricted opportunities, as well as what works to improve their lives. Deneka Thomas, from Trinidad and Tobago, described how she uses art in schools to interact with lesbian, gay, bisexual and transgender young people and girls traumatized by bullying, rape and other forms of violence.

Raouf Kamel of AIDS Algérie spoke about the first-ever initiative in the Middle East and North Africa to hear the voices and experiences of especially marginalized groups of women. They had all experienced violence, pointing to adolescence as a crucial point in life when the risks to their health and safety, and of HIV infection, are especially marked.

The participants concluded that much more needs to be done to address the needs and rights of adolescent. Investing in inclusive, quality education, in HIV, sexual and reproductive health services and in mental health is key. Other important actions include preventing and responding to gender-based violence, promoting women’s rights, engaging boys and investing in youth organizations and community-based initiatives led by, and for, young women.

The event was held on 13 March on the margins of the sixty-third session of the Commission on the Status of Women.

Quotes

The second annual Global Health 50/50 report was launched on 7 March in Addis Ababa, Ethiopia. The report reviews progress made over the past 12 months by organizations active in the health sector to implement policies that promote gender equality, non-discrimination and inclusion in the workplace.

This year’s report, Equality works, reviews the gender-related policies and practices of almost 200 organizations. The sample includes organizations from 10 sectors, headquartered in 28 countries across the world that together employ an estimated 4.5 million people.

The report provides a comprehensive guide to how far global organizations active in health are taking steps to promote gender equality across four areas: commitment, evidence-informed policy content, equitable outcomes in power and pay and gender-responsive programming.

The Global Health 50/50 review identifies 14 organizations as very high scorers across these four areas, including UN Women, the United Nations Development Programme and the United Nations Population Fund. UNAIDS is included in a list of a further 17 organizations identified as high scorers.

However, the report stresses that even among good performers, there remains an urgent need for organizations to live up to and put into practice their stated policies on equality, non-discrimination and inclusion.

Ethiopia’s President, Sahle-Work Zewde, was the keynote speaker at the launch and spoke of the need to promote female leadership to implement policies and programmes that foster gender equality.

Ms Sahle-Work is Ethiopia’s first female head of state and currently the only female head of state across Africa. Ethiopia’s Prime Minister, Abiy Ahmed, has ensured gender parity among his cabinet ministers.

Speaking at the launch of the report, Michel Sidibé, UNAIDS Executive Director, said it was fitting that the event was taking place in Ethiopia and spoke of the importance of reaching gender equality as a matter of social justice.

“Women continue to be left behind and are more likely to face harassment and discrimination and slower career progression,” said Mr Sidibé, “It is an outrage that on average women today earn 20% less than men for no reason other than their gender. This must change.”

Mr Sidibé said UNAIDS had made progress on gender parity but acknowledged there was more to be done. He said that UNAIDS had increased the proportion of female country directors from 26% in 2013 to 48% today. He also pointed to the introduction of a single parental leave policy and the expansion of the UNAIDS Leadership Programme to all women in the organization as examples of its commitment to reaching gender equality.

Every day, 460 adolescent girls become infected with HIV and every week 350 adolescent girls die of AIDS-related illnesses

GENEVA, 8 March 2019—On International Women’s Day, UNAIDS is urging countries to step up and protect young women and adolescent girls from HIV.

AIDS-related illnesses remain the leading cause of death for women aged 15–49 years globally. In 2017, 66% of new HIV infections among 10–19-year-olds were among females globally—in eastern and southern Africa, 79% of new HIV infections among 10–19-year-olds were among females.

“There is a vicious cycle of gender inequities, gender-based violence and HIV infection in many parts of the world,” said Michel Sidibé, Executive Director of UNAIDS. “Oppression and power imbalances must be redressed and harmful masculinities addressed in order to ensure that women and girls have full control over their sexual health and rights.”

Much more needs to be done to reach young people with HIV prevention, treatment and care. Young women and adolescent girls are especially being left behind. Gender-based violence, sexual exploitation and drug use are among the many factors that can increase the vulnerability of young women and adolescent girls to HIV.

Efforts to end AIDS are undermined where the human rights of young women and adolescent girls—especially their sexual and reproductive health and rights—are not supported. Countries must therefore enact laws and policies that enable access to services, including health and social protection, by young women and adolescent girls, helping them to claim their right to health.

International law gives people, including young women and adolescent girls, the right to access services to protect their sexual and reproductive health. However, 45 countries worldwide still have laws that require people under the age of 18 years to obtain the consent of their parents in order to be tested for HIV.

Social protection, education—including comprehensive sexuality education—and HIV prevention services that are integrated with sexual and reproductive health services have been shown to improve the health of, and empower, young women and adolescent girls. A South African study showed that HIV prevalence among girls who had finished high school was about half that among girls who had not (8.6% versus 16.9%). Children who access universal primary education in Botswana, Malawi and Uganda have been shown to have similar outcomes.

Investing in education. Investing in HIV and other health services. Preventing and protecting women and girls from violence. Eradicating harmful practices such as early, forced and child marriage. Promoting women’s rights. Through these actions young women and adolescent girls can be protected from HIV and the world can build towards ending AIDS by 2030.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

When she was four years old, Selokela Molamodi’s teacher asked the class what they wanted to be when they grew up. While her classmates volunteered more conventional professions, such as nurses, doctors and lawyers, Ms Molamodi’s answer, given with a fiery determination, was, “I want to be Minister of Education.”

Her love for education, and her characteristic fieriness, has stood 19-year-old Ms Molamodi in good stead. Last year she graduated top of her class, having been head girl in both primary school and high school. Armed with an unshakeable self-confidence and her core principles of transparency, honesty and humility, Ms Molamodi has avoided the fate of many young South African women—HIV infection, unintended pregnancy and an abandoned high school education.

She says she has had to deal with the same harsh realities as other young women—financial difficulties, crime, violence, peer pressure, the temptation of “blessers” [older men] and drug and alcohol abuse. Staying in school kept her focused, she explained.

“There are still a lot of misconceptions about HIV among young people. Sex is not talked about openly. Young people are given knowledge about sexual and reproductive health, but they are not given knowledge on how to make a decision about sex,” she says.

In South Africa, 1500 young women and adolescent girls between the ages of 15 and 24 are infected with HIV every week. They accounted for 29% of all new HIV infections in the country in 2017. Research has shown that older men, generally five to eight years older, are mostly responsible for passing on HIV to younger women; once women reach their mid-twenties, they pass on the virus to men their own age.

“There is a perception among young women that we should have a high number of sexual partners when we are young because that is what it means to be free. Then, when we reach our mid-twenties we will leave that life behind and settle down. But girls don’t understand that they don’t have control over these sexual relationships, that their consent doesn’t count,” she says.

To start a dialogue about these and many other issues facing young women, Ms Molamodi started You for You while she was in her final year of school.

“I call it a movement, not an organization,” says Ms Molamodi. “It is about accepting and loving yourself for you. While we can exist as a community and a collective, we must first love ourselves as individuals,” she says.

Ms Molamodi, along with two friends who started the movement with her, have one-on-one mentoring sessions with other young women on issues such as self-esteem, body positivity, sexual and reproductive health and drug and alcohol abuse. She has also organized two events that focused on empowering young women as leaders “so we can rise as young women and stand up against discrimination, together.”

She looks at DREAMS—the initiative led by the United States President’s Emergency Plan for AIDS Relief—as the matriarch of a family of young women like her. In South Africa, DREAMS works closely with She Conquers, a government-led national campaign aimed at empowering young women and adolescent girls to take responsibility for their health.

“DREAMS/She Conquers has provided us with a space to have natural conversations about things that affect us as young women with other young women. It gives us a voice and brings enlightenment to us. For instance, most of the girls I know have tested for HIV, but none of them ever got to talk about it, until DREAMS/She Conquers came to our school,” she says.

“These are the kinds of initiatives that increase the effectiveness of what UNAIDS is trying to achieve,” says Ms Molamodi. “Yes, give girls access to discrimination-free HIV prevention and treatment services and family planning, but also ask for our feedback. Give us education and information and teach us that actions have consequences which are responsible for our progress or regress.”

She says she would like to see conversations about HIV prevention and sexual and reproductive health being brought together more often with those about careers, empowerment and entrepreneurship.

As for her ambition for You for You, “I want to help grow a continent of young women who are confident enough to speak out; who are able to stand up for each other and empower each other. If I have someone say, “I did not give up” then I know I had a purpose; that I was someone’s reason not to give up.”