Innovation and Commitment Needed to Turn Back the HIV Epidemic Among Girls

Director of CDC’s Division of HIV & TB* Shannon Hader on 2015 International Day of the Girl

A version of this blog was posted on AIDS.gov and CDC’s ‘Our Global Voices’ blog.

 

Every year, an astonishing 380,000 adolescent girls and young women are infected with HIV. That’s more than 1,000 every day. These numbers are worth noting any day, but it’s especially relevant today as we recognize International Day of the Girl.

Consider sub-Saharan Africa, where one in four new HIV infections occurs among young women and girls. In the hardest hit countries, girls account for more than 80 percent of all new HIV infections among adolescents. AIDS is the leading cause of death for girls aged 15-19 in eastern and southern Africa.

Many countries with the highest HIV prevalence are also experiencing a massive increase in their youth population. This so-called “youth bulge” of people under 30 increases the absolute number of young people at risk for HIV. So much so that, even if we continue to reduce HIV incidence at the pace we are currently doing, the absolute number of young people susceptible to and possibly infected by HIV is estimated to increase dramatically in the next five years. Given these demographic trends, we have to work hard just to keep up with the epidemic, and even harder to get ahead of it.

If we are to turn the tide on HIV globally, we must act now to confront the HIV crisis among young women and girls. And, although we have a number of tools, the reality is that it won’t be easy. There is no magic bullet – no easy answer.

Here at CDC’s Division of Global HIV & TB, we know that the root causes that give rise to this disproportionate burden of HIV among young women and girls are complex – poverty, access to education, violence and other gender inequities. Our approach must be equally layered. It will also require us to be creative, vigilant and tireless.

To that end, we are working in a number of ways to make an impact.

 
Creating a supporting, empowering environment 

Because every girl is part of a larger community, we are reaching out to families and communities to build skills and support that protect against HIV. In CDC’s Families Matter! program, for example, we work with 9-12 year old girls and their families in Kenya, Tanzania, Cote d’Ivoire, South Africa, Zambia, Mozambique, and Zimbabwe to give them knowledge, skills, comfort and confidence to have open parent-child discussions. To date, the program has reached more than 450,000 families in 10 years.

Similarly, our Project AIM program in Botswana and South Africa pairs adult women with young at-risk girls as part of a powerful mentorship relationship. Using role play and small group activities, these partnerships help girls focus on their future goals, which, in turn, helps them make better decision about their health.

 

 

Addressing gender-based violence

According to data released in CDC’s June 2015 Morbidity and Mortality Weekly Report (MMWR), one in four girls in seven countries studied experience some form of childhood sexual violence by the time they are 18. Experiencing violence is associated with a range of negative outcomes including increased risk for sexual exploitation, unwanted pregnancy, and HIV.

As part of a global public-private partnership called Together for Girls and under the leadership of country governments, we are taking aim at the dual epidemics of violence and HIV, by implementing the Violence Against Children Surveys (VACS) in 14 countries with high HIV burden – to get a clear picture of the severity of the problem and to inform targeted solutions. And through the THRIVES program, we are helping develop tailored strategies to help countries and communities prevent violence against children through parental training, household economic strengthening and other country-specific strategies.

Expanding access to treatment for HIV-positive girls and young women

Reaching girls and young women living with HIV with life-saving care and treatment is another critical piece of the puzzle. In countries, across the globe, CDC is working hard to scale up access to ART for young HIV-positive women – including pregnant girls living with HIV. Adolescents and young adults worldwide experience challenges remaining in and fully benefitting from care. By tailoring materials and interventions to the unique needs of young women, we aim to improve their engagement in care and adherence to treatment.

We’re also spearheading peer-to-peer teen clubs in places like Malawi and Zimbabwe that help provide HIV-positive girls with the emotional and psychological support they need in addition to medical treatment. These groups offer teenage girls a safe space to discuss their concerns — and even have fun — with others who are sharing a similar experience.

 

Helping men control HIV can also help young women

Reaching men with treatment and prevention must also be part of the solution.

Adult men (25- 50 years old) can be among the hardest to reach and retain in HIV services. Among those on HIV treatment in sub-Saharan Africa, only 36 percent are men —in part because many of our traditional access points for HIV diagnosis and care have included antenatal care and women-focused services. Yet if HIV-positive men aren’t able to learn their status, access care and suppress their viral load, they lose out on treatment benefits. Benefits that include living longer, healthier lives, and significantly reducing transmission of HIV to partners who may include young women.

We are redoubling our efforts to ensure HIV-positive men know their status, are linked to treatment, and virologically suppressed. CDC efforts include partner testing programs at antenatal care clinics, programs with mining companies, and mobile testing targeting venues where men congregate. The new WHO ‘test and start’ guidelines, that support HIV treatment at all CD4 counts, may reduce missed opportunities to engage men by providing a tangible benefit – treatment — to accessing care as soon as possible.

For young HIV-negative men, we encourage voluntary male medical circumcision – a proven prevention intervention — to help them stay HIV-free. As of September 2014, as an implementing partner of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), CDC supported 3.2 million (or approximately half) of a total of 6.5 million circumcisions in 14 sub-Saharan African countries. By helping young men and young women control HIV infection, we can help realize the promise of an AIDS-free generation.

 

Partnering through PEPFAR to reach young women and girls

As a key partner of PEPFAR, CDC is also one of the lead agencies working to implement two powerful HIV initiatives aimed at reaching children, adolescents, and young women – the Accelerating Children’s HIV/AIDS Treatment program and the DREAMS initiative.

Through the Accelerating Children’s HIV/AIDS Treatment (ACT) initiative, we will support PEPFAR’s goal to enable 300,000 more children to receive life-saving ART across priority countries in sub-Saharan Africa. Likewise through the DREAMS initiative, a multi-pronged approach to help adolescent girls and young women live Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe lives, PEPFAR and its implementing agencies aim to drive down HIV infections among girls ages 15-24 in high-burden geographic areas. During the 2015 UN General Assembly, the Obama administration announced that PEPFAR is now investing nearly half a billion dollars to support an AIDS-free future for adolescent girls and young women. This includes strategically aligning $300 million in additional prevention investments in support of the DREAMS partnership and related efforts.

These programs are critical and they will make a difference.

But the data – and the young women we encounter around the world – tell us clearly that we must do more. As we mark the International Day of the Girl, we must recommit ourselves to reversing the HIV epidemic among girls, so they can grow up to lead a generation free of AIDS.

To learn more about CDC efforts to fight HIV among young women and girls around the world, visit our global HIV website at www.cdc.gov/globalaids.