As the sixty-first session of the Commission on the Status of Women gets underway at the United Nations Headquarters in New York from 13 to 24 March 2017, UNAIDS highlights the urgent need to respond to gender based violence and HIV.

Through her work as a journalist, Alejandra Oraa, CNN news anchor and UNAIDS Goodwill Ambassador for Latin America and the Caribbean, has reported on many stories about women and violence in the region. Shortly after thousands of people took to the streets in October 2016 to protest against widespread violence against women in the country, she undertook a joint UNAIDS and UN Women mission to Argentina to meet with not only survivors of violence but also the groups and organizations working with them.

“In the region we have made progress to respond to gender-based violence, but, unfortunately, there is still a long way to go. I hope that our voices and examples change a statistic that shames Latin America,” said Ms Oraa, who is also a spokesperson for UN Women’s Orange the World campaign to raise money to respond to violence against women.

Gender-based violence remains one of the key development challenges in the region. In 12 Latin American and Caribbean countries, between 17% and 53% of women interviewed reported having suffered physical or sexual violence by an intimate partner. In seven of the countries, more than one in four women reported such violence. Gender-based violence is not only a human rights violation, it also makes women and girls more vulnerable to HIV infection.

Ms Oraa’s first stop was in Merlo, in the greater Buenos Aires area, which has the highest HIV prevalence in Argentina. There, she learned about how UNAIDS and UN Women are supporting local projects that integrate programmes responding to violence against women, promote gender equality and expand access to HIV prevention services, all of which are inextricably linked.

Ms Oraa met with the local organization of people living with HIV, which helps to run a free and confidential HIV testing site during health fairs organized by the Municipality of Merlo in different parts of the town, making it easy for anyone to access an HIV test.

During the visit, Marcela Alsina, President of the network of people living with HIV (Red Bonaerense de Personas que Viven con VIH), together with other representatives of the organization, spoke to Ms Oraa about how stigma and discrimination are affecting the ability of women living with HIV to access employment and health services.

“Despite progress in the HIV response, there are still important gaps and inequalities that limit women living with HIV from having full access to employment, motherhood and comprehensive health services. When HIV becomes a priority, as it is happening in Merlo, we see that stigma and discrimination starts to decrease and the quality of life of people living with HIV starts to improve,” said Ms Alsina.

Ms Oraa visited the HIV testing centre of the Dr Pedro Chutro Maternal and Paediatric Hospital in Merlo. The centre, through a joint team with support from the Ministry of Social Development, civil society and the Women’s Commissioner Office, promotes the integration of HIV services with services to prevent violence against women. It also offers outreach activities and support groups for women and children affected by violence and HIV.

In Buenos Aires, Ms Oraa met with Fabiana Túñez, President of the National Council for Women, and Mabel Bianco, Director of FEIM, a nongovernmental organization supporting women’s and children’s rights. They talked to Ms Oraa about the importance of a joint and coordinated response to HIV and gender-based violence in Argentina to ensure that the country can end its AIDS epidemic by 2030.

Ms Oraa also spoke to internationally renowned Argentine singer Diego Torres, a spokesperson for the HeForShe campaign for gender equality, who talked passionately about the importance of involving men in stopping violence against women and gender equality in Argentina.

“We have to ensure that men and women enjoy equal opportunities in different aspects of life, for example in the labour market and in politics. This is what I believe in and stand for,” said Mr Torres. 

In 2015 in Africa, 310 000 new HIV infections occurred among adolescent girls and young women between the ages of 15 and 24 years—approximately 6000 new HIV infections per week. In eastern and southern Africa, of the 19 million people living with HIV, women account for more than half (59%), and in western and central Africa 58% of the 6.5 million people living with HIV are women.

These statistics, and an appropriate response to them, were discussed at the Africa Gender Breakfast meeting, held in the run-up to the 28th African Union Heads of State Summit. The meeting was hosted by the Ambassadors to Ethiopia of Australia, Canada and Sweden, as well as the United States of America mission to the African Union, and was attended by the UNAIDS Executive Director, Michel Sidibé, African gender ministers and representatives of civil society and the private sector. The purpose of the meeting was to galvanize the international development community into more urgent action for adolescent girls and young women.

At the meeting, the Australian Minister of International Development and the Pacific, Concetta Fierravanti-Wells, launched a US$ 1 million partnership with the African Union Gender Directorate. Half of these funds will go towards establishing a gender observatory that will produce annual strategic information on the status of women in Africa.

The Canadian Ambassador to Ethiopia, Philip Baker, affirmed that Canada’s international programming will have a renewed focus on gender equality, informed by its recent election onto the Commission on the Status of Women.

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The Namibia Planned Parenthood Association clinic in Windhoek is decorated with colourful murals, its walls brightly painted with red ribbons. It has the feel of a welcoming classroom or youth club rather than a medical site. And that’s the idea, because this facility offers sexual and reproductive health services, including HIV testing and counselling, to adolescents and young people aged up to 25 years old.  

The site is staffed by young peer-to-peer counsellors, such as 20-year-old Claudia Ndinundjene, who offers a friendly ear to the clinic’s users and advises them on what to expect from the testing process. She can also give them information on how to protect themselves from unintended pregnancy and HIV and other sexually transmitted infections.

“It’s important for young people to be advised by other young people,” says Ms Ndinunjene, “People need to be helped in a non-judgemental atmosphere that meets their needs—they shouldn’t be asked a lot of questions, but just get the help they need, and quickly.”

The clinic carries out about 200 rapid HIV tests a week. The results are back within 15 minutes. People who test negative are given condoms and advice on how to stay HIV-free. People who test positive are immediately referred to a neighbouring clinic to get access to antiretroviral medicine, which can keep them healthy.

One of the biggest challenges is to get young people to adhere to treatment, especially when long queues translate into long waits at other clinics, which may also be less oriented to the specific needs of young people. That’s why the Executive Director of the clinic, Bravo Linosi, would like to expand services.

“We would like to be able to offer treatment services to the young people who come here as well as HIV testing and counselling,” says Mr Linosi. “This would make a huge difference to young people’s lives, helping them remain healthy by staying on treatment and also helping Namibia to end the AIDS epidemic by 2030.”     

The commodities used at the clinic are provided by the government, while funding and other support comes from a range of partners, including UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

The clinic offers Wi-Fi, so that young people can carry on with their homework or simply stay in touch with their friends online while at the clinic. Mr Linosi has plans for pool nights or TV soccer nights to attract more young men to the clinic. In this way, he hopes that HIV testing can become a more routine part of young people’s lives, particularly young men, whose service uptake is currently poor.

The clinic still sees some older adults who have turned 25 but don’t want to go anywhere else, having been visiting the site for several years.

“People feel happy here and they keep coming back to the clinic because they feel safe—that’s why they don’t want to go anywhere else,” says Nelapewa Baumuller, a senior nurse at the clinic. 

Since 2010, the annual global number of new HIV infections among adults (15 years and older) has remained static, at an estimated 1.9 million. Members of key populations, including sex workers, people who inject drugs, transgender people, prisoners and gay men and other men who have sex with men, and their sexual partners accounted for 45% of all new HIV infections in 2015.

In some countries and regions, infection rates among key populations are extremely high—HIV prevalence among sex workers varies between 50% and 70% in several countries in southern Africa. One study from Zimbabwe found HIV prevalence rates of 27% for male inmates, 39% for female inmates and 60% for sex workers, with 9.6% of these getting newly infected between 2009-2014. New infections among gay men and other men who have sex with men have been increasing in all regions in recent years. Across countries, key populations are between 10 and 50 times in greater risk of HIV infection compared to other adults.  

Criminalization and stigmatization of same-sex relationships, sex work and drug possession and use, and discrimination, including in the health sector, are preventing key populations from accessing HIV prevention services. Effective government support and community-based and implemented HIV prevention and treatment programmes that provide tailored services for each group are currently too few and too small to result in a significant reduction in new infections.

In order to achieve the target of reducing new HIV infections among key populations by 75% by 2020, a large-scale increase of programmes and the creation of an enabling social and legal environment are needed.

We must reduce new HIV infections among key populations

The global number of new HIV infections among adults has remained static, at an estimated 1.9 million, since 2010, threatening further progress towards the end of the AIDS epidemic.

New HIV infections among gay men and other men who have sex with men are rising globally, and there has been no apparent reductions of new infections among sex workers, transgender people, people who use drugs or prisoners. Studies conducted in southern Africa have found HIV prevalence 10–20 times higher among sex workers than among adults in the general population, with rates of HIV infection reaching 50% of all sex workers tested, and HIV prevalence reaching 86% in one study in Zimbabwe. A synthesis of studies including more than 11 000 transgender people worldwide estimates HIV prevalence to be 19.1%.

Key populations remain among the most vulnerable to HIV. Analysis of the data available to UNAIDS suggests that more than 90% of new HIV infections in central Asia, Europe, North America, the Middle East and North Africa in 2014 were among people from key populations and their sexual partners, who accounted for 45% of new HIV infections worldwide in 2015.

Reinvigorating HIV prevention among key populations requires domestic and international investments to provide key populations with tools, such as condoms and lubricants, pre-exposure prophylaxis and sterile needles and syringes, and testing and treatment. However, the design and delivery of such HIV combination prevention services is often limited by a reluctance to invest in the health of key populations and to reach out to them.

In many countries, key populations are pushed to the fringes of society by stigma and the criminalization of same-sex relationships, drug use and sex work. Marginalization, including discrimination in the health sector, limits access to effective HIV services. There is an urgent need to ensure that key populations are fully included in AIDS responses and that services are made available to them.

Guidelines and tools have been developed for and with the participation of key populations in order to strengthen community empowerment and improve the delivery of combination prevention services by community-led civil society organizations, governments and development partners.

The available evidence shows that when services are made available within an environment free of stigma and discrimination and involving key population communities, new HIV infections have declined significantly. For example, street youth in St Petersburg had a 73% decrease in HIV seroprevalence from 2006 to 2012, primarily due to decreased initiation of injection drug use. This marked reduction in the HIV epidemic among street youth occurred after implementation of extensive support programs and socio-economic improvements.

The replication of such successes and the scale-up of combination prevention programmes in all cities and sites where key populations live and work, implemented by countries and community organization networks, will help prevention efforts get back on track to achieving the target of reducing new HIV infections by 75% by 2020.

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Around 180 young women and adolescent girls from Malawi, Kenya and Uganda have led a pilot project that aims to strengthen the leadership of young women and adolescent girls in the AIDS response. Called Empowerment + Engagement = Equality, the programme aims to build stronger leadership among young women and adolescent girls to engage in national assessments initiated by the All In to #EndAdolescentAIDS platform. The programme addresses issues of gender inequality that heighten adolescent girls’ vulnerability to HIV infection and provides safe spaces where experiences can be shared. 

The initiative, designed and implemented by UN Women and the International Planned Parenthood Federation, mobilized more than 1000 young advocates, including young women living with HIV, to voice their concerns at the local, regional and national levels. As well as sharing knowledge among themselves, the participants engaged in face-to-face and online meetings with parents, teachers, religious leaders and other community stakeholders to discuss how to change harmful gender norms and inequalities that increase the risk of HIV infection.

The First Lady of Malawi, Gertrude Mutharik, participated in one of the discussions and committed her support to challenging the issues that increase the risk of HIV infection among young women, including gender-based violence. The young leaders have continued to advocate at the highest levels, taking part in debates at the International AIDS Conference in Durban, South Africa, in July 2016.   

“Some of the most fulfilling work I have done as part of this project is to support other girls like me to feel empowered and in control of their lives,” said Divina Kemunto, from Kenya, “I shared my personal experience and encouraged girls living with HIV to believe that they too can walk with their heads held high and a smile on their face.”

Preventing new HIV infections among adolescent girls and young women in sub-Saharan Africa is crucial if the world is to end the AIDS epidemic by 2030—in 2015, 75% of new HIV infections in sub-Saharan Africa among adolescents were among adolescent girls aged 10–19 years. Preventing infections means empowering young women and girls to stay in school so they have better economic prospects, ensuring that they have the knowledge, information and tools to avoid unintended pregnancy and sexually transmitted infections and making sure they know what to do when faced with sexual violence.

Laws and policies that discriminate against women and girls must be dismantled and their sexual and reproductive health and rights must be fully respected.

Rushell Gray unflinchingly shares the story of her journey to the edge and back. She was infected with HIV after being abused at the age of nine, but her eight-year-old daughter is HIV-free. “It has been difficult. As a young girl in the community everybody turned a blind eye and blamed me,” she said. “Nobody said this man needs to go to jail. At one point I gave up because the stress was too high,” she recounts.

A petite young woman, Ms Gray is confident and articulate. She credits the Jamaican nongovernmental organization Eve for Life and its transformative programme for her turnaround. Through a combination of counselling, personal development and life-skills education, she has become one of the powerhouse peer educators of Mentor Moms.

The Mentor Moms programme deploys young, empowered women who are affected by HIV and young mothers to help others along the journey. They answer questions and offer reassurance, accompany adolescent girls to their clinic visits and they reinforce guidance on taking medicines, avoiding breastfeeding and keeping clinic appointments.

Ms Gray clarifies that the issues her mentees face are not just about HIV. “They do not have resources, they are not safe in their houses, they are afraid a partner or their family might throw them out. They might have two children or more,” she said. A 2012 survey by the Jamaica National HIV/STI Programme found that one in every five adolescent girls in Jamaica aged 15–19 years reported having experienced sexual violence.

Eve for Life Executive Director and co-founder Patricia Watson noted that many girls are being left behind. “A recent study showed that among girls in state care, 30% have sexually transmitted infections, 41% attempted suicide and 35% have been forced to have sex. Also, children infected with HIV at birth are growing older and becoming sexually active, some without having been informed about their status,” she said.

For the organization, responding to HIV among adolescent girls is about far more than promoting sex messages. It is fundamentally about social protection and addressing the structural and social issues that increase girls’ vulnerability.

For the past two years, Eve for Life has spearheaded the Nuh Guh Deh! (Don’t Go There) national campaign to end sex with girls.

“The overarching goal is to contribute to reducing sexual abuse of girls in Jamaica,” Ms Watson said.

The campaign seeks to mobilize Jamaicans to report acts of sexual violence while increasing awareness about the long-term effects of abuse and the links to HIV. Survivor stories highlight the serious issues they face. The approach maximizes participation and ownership from adolescent girls and young women who have survived sexual abuse.

The Nuh Guh Deh song by the Jamaica dub poetry group No-Maddz aims to reduce social acceptance of predatory relationships between older men and girls.

#WhatWomenWant is a virtual space that amplifies the voices of young women, allowing them to share expertise and life experiences, explore solutions and build strengthened networks across gender-related issues, sectors and movements.

Inspired by the impact of the virtual activism surrounding the 2016 Commission on the Status of Women, the Athena Network and its partners, including UNAIDS, used the momentum to build a platform where women could mobilize around the United Nations General Assembly High-Level Meeting on Ending AIDS. From May to July 2016, a social media campaign reached 13 million Twitter accounts and organized five Twitter conversations that engaged 120 000 people. The aim was to hear what women want and to identify specific actions needed to change the lives of women and girls.

The initiative continues to engage an expanding network of primarily women-led organizations working to advance gender equality, with a special focus on areas where health and rights meet.

#WhatWomenWant aims to:

• Focus attention on the urgent need to address women’s rights and gender-related disparities within and beyond the HIV response.
• Act as a catalyst for joined-up action where gender equality, human rights, sexual and reproductive health issues, gender-based violence and the HIV response intersect.
• Put women in charge of defining their own agendas.
• Harness the experience of women to create advocacy tools to advance their own solutions wherever they are.
• Identify opportunities for women to engage stakeholders and to be meaningfully involved in the decision-making processes that most affect their lives.

#WhatWomenWant continues to strengthen links across movements to end child marriage, stop sexual violence, ensure safe and legal abortion rights and advance comprehensive sexuality education.

“At a time when funding for women's rights has been on the decline, the #WhatWomenWant online campaign provides a space for young feminists to contribute to and influence global policy discussions on the HIV response,” says Catherine Nyamburra, a young activist from Kenya. “It provides a space to amplify young feminist voices through various channels of participation and for feminist thought leadership in the response to HIV.”

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United States Global AIDS Ambassador, Deborah Birx, explains why young women are more vulnerable to becoming infected with HIV. 1000 young women are being infected every day = 7000 a week globally.