By Kathryn Boulton, Legal Fellow
We cannot achieve an AIDS-free generation without young women and girls. Yet for far too long, research and programming devoted to HIV prevention and treatment have simply failed to include adolescent girls and young women. Today, girls and young women account for an alarmingly disproportionate number of new HIV infections globally, but the problem is especially pronounced in sub-Saharan Africa. In several countries within this region, more than 80% of adolescents newly infected with HIV are girls.
The Center for Health and Gender Equity (CHANGE) has recognized for some time the centrality of women-centered prevention efforts around HIV/AIDS. As an organization, CHANGE is thrilled that PEPFAR has zeroed in on the needs of girls through the DREAMS Partnership, a public-private partnership with the Bill and Melinda Gates Foundation and Girl Effect launched on World AIDS Day 2014.
DREAMS directs nearly half a billion dollars to the prevention of new HIV infections among girls and young women in ten sub-Saharan African countries: Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. Combined, these ten countries accounted for almost half of all new HIV infections that occurred among adolescent girls and young women globally in 2014. The DREAMS prevention goals are fittingly ambitious, considering the magnitude of the crisis facing is population.
DREAMS aims to achieve a 40% reduction in HIV incidence among girls and women 15-24 years old in the hardest hit areas of the ten DREAMS countries by the end of 2017. More broadly, the partnership will foster the development of girls and young women to be determined, resilient, empowered, AIDS-free, mentored and safe individuals with the ability to realize their full potential.
Adolescent girls and young women face a range of legal, economic, and social factors that directly and indirectly impact their risk of acquiring HIV, such as lack of education and social capital, gender-based violence, along with inadequate access to rights-based reproductive healthcare, family planning, and comprehensive sexuality education. And we know that traditional biomedical interventions are only one piece of the solution to HIV in girls and young women—our response must also promote gender equality and the fundamental rights of women and girls.
In a major departure from business as usual, DREAMS proposes a holistic package of multi-sectoral interventions intended to address these structural drivers of HIV risk. DREAMS is about more than advising girls to wait until marriage to have sex and throwing in a condom in case that approach fails to protect them from HIV (which it will). Through DREAMS, layered and complementary strategies target girls and young women, their families, male sexual partners, and broader communities in an effort to produce an empowering environment for girls that significantly and sustainably reduces their risk of acquiring HIV.
PEPFAR’s guidance to the country-based teams responsible for implementing DREAMS on the ground stresses the importance of civil society engagement and urges the inclusion of girls and young women on the DREAMS country advisory committees. CHANGE applauds these developments, as well as the recently announced PEPFAR targets, which reflect an ongoing commitment to the needs of adolescent girls and young women.
The success of DREAMS will depend on how effectively its implementation adopts an approach centered on girls and young women that fully ensures their health and rights. The extraordinary results hoped for in DREAMS demand an extraordinary effort— those carrying out DREAMS at the country level cannot ignore the lived experiences of individual girls and young women. This means acknowledging that girls and young women have sexual lives and need comprehensive sexuality education to make informed choices about their health and futures. It also means acknowledging that many girls and young women are mothers or are engaged in sex work and should have their unique needs recognized. Most vitally, it means transforming the lives of girls and young women, as well as the programs that serve them, by including them in every stage of program development, planning, monitoring and evaluation. Only when adolescent girls and young women are placed at the center will the DREAMS Partnership fully realize its potential.
Featured Image: CHANGE, AVAC, and ICW co-host a briefing with the State Department in Washington, D.C. in November on the U.S. government’s plan for HIV prevention programming for young women and adolescent girls. Photo Credit: John Nelson Photography