LONDON, United Kingdom — The HIV epidemic colliding with the COVID-19 pandemic has revealed persistent economic and social disparities and insufficient investment in public health. After years of neglect, a global convergence is emerging around the urgency of going beyond biomedical interventions to address the social and economic factors driving HIV risk for adolescent girls and young women. Whether this new attention can catalyze reductions in HIV infections represents a fundamental challenge for controlling the AIDS epidemic.
Gender Disparity in HIV/AIDS
Young women represent a glaring gap in the HIV/AIDS response. Gender-based financial inequalities combined with social, cultural and political disparities contribute significantly to girls’ and young women’s vulnerability to HIV. Gender-based economic disparities play a major role in young women’s HIV susceptibility since having a low income is often associated with earlier sexual activity, decreased birth control and a higher likelihood of nonconsensual sex.
In sub-Saharan Africa, most of the programs that alleviate HIV’s negative effects focus on treatment options rather than prevention. As such, there are few programs that prevent young girls from engaging in risky behaviors that expose them to HIV. Many gender-based, violence-reduction efforts engage more often with people who have authority over girls than with the girls themselves. For example, noting that young women accounted for a large proportion of its violence victims, one nation recently implemented a set of ambitious programs and policies to prevent gender-based violence. However, the initiative recommended investing less than 5% of its overall funding on direct interaction with the female population and did not have distinct performance benchmarks for men and women.
While seeking to ensure that justice is served, programs often forget the importance of working alongside girls to offer direct assistance. As a result, most of the resources expended in these programs do not serve the intended purposes. Therefore, it is important that future prevention programs are more realistic. They need to focus on issues that affect the victimized population, especially adolescent girls.
Future Intervention Efforts
Future effective interventions must go beyond the health sector. Women need new approaches to address the structural drivers that directly and indirectly increase girls’ HIV risk. Additionally, it is crucial to build upon existing interventions, including improving access to HIV family planning services, creating safe spaces to discuss HIV and mobilizing communities to prevent violence against women.
Addressing the link between poverty and HIV is also important, as HIV infection in women is closely linked to their social and economic situations. Particularly, a lack of education and economic dependence on men impact these factors.
Building Sustainable Programs and Fostering Dialogue
Countries in sub-Saharan Africa should elaborate strategies and evaluations for country buy-in to build effective local programs. International initiatives aiming to develop economic empowerment programs for girls and young women, such as DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe), require buy-in from national or district leaders to have an impact. Host countries must also have a strong commitment and comprehensive political strategy to let these initiatives gain traction.
Groups, including different levels of government, civil societies, U.N. agencies, the private sector and trained healthcare workers, need to foster collaboration. Private sectors in sub-Saharan Africa need to devote more resources to alleviate the national health burden. Taking into consideration the need for reform of the private health sector, the government should advocate for a less confrontational approach to the private sector. It is crucial to seek opportunities to develop public and private partnerships in order to bridge the public-private divide.
Expanded public-private collaborations have the potential to leverage foreign investments in young women and fund a variety of projects. When projects allocate resources to maximize assistance for the population’s priorities, it is highly likely that the populations will benefit from the programs and potentially reduce HIV risk.
Making Cash Transfers Available
Cash transfers could assist in mitigating the immediate needs of lower-income families impacted by HIV. Women’s HIV infections are closely related to social and economic circumstances, especially their lack of education and economic reliance on men. Offering cash transfers is an effective method to address the link between poverty and HIV.
Unconditional cash transfers entail direct payments to families and individuals with no regulation of how the money should be spent. Conditional cash transfers include conditions designed to improve girls’ long-term financial security and increase their use of social services. The majority of conditional cash transfers require the girls to attend school. Education significantly delays marriage and childbearing, and educated girls receive higher incomes. In addition, education leads girls to gain decision-making power within relationships.
These cash transfer programs have proven effective in reducing HIV-related risk behaviors and HIV prevalence among adolescent girls. Positive changes occurred in the research and evaluation of large programs regarding structural piloting and ambassadors. Furthermore, a randomized control trial conducted in Malawi found that within 18 months, HIV pervasiveness was 64% lower in girls who remained in school than in girls in the control group. Shaping the underlying conditions ensures that cash transfers initiate change in girls’ HIV infection rate. Moreover, cash transfers improve self-protecting services like voluntary counseling and testing, which reduce HIV infection.
Conducting additional evaluations on existing cash transfer programs will get further clarity on its impacts on health and HIV transmission. These cash transfers can explain how wider social protection mechanisms positively or negatively influence HIV outcomes. However, such evaluations need not be confined to cash transfers. Microfinance, for example, should also be investigated and be compelled to help manage cash flow within the groups.
Creating Safe Spaces and Improving Access to Family Planning Services
A major factor contributing to social marginalization among teenage girls is the lack of safe communities and areas where they are supported and where their skills are developed. Therefore, Population Council launched three programs to address girls’ vulnerabilities related to HIV. Through these initiatives, teenage girls engage with their peers and have mentorship lessons about life skills and health.
At puberty, boys are more likely to have increased social networks than girls. One reason for this is that more girls marry before completing their education. In various countries, teenage marriage is often regarded as the beginning of sexual assault, especially in the case of girls who marry men that are 20 to 30 years older than them.
Additionally, the increase in social isolation among women and girls is primarily due to early marriages. Thus, safe spaces enable girls to gain social support and friendship. They also function as platforms to increase girls’ knowledge about their rights. HIV-related services can also be incorporated into family planning, which would help in preventing early pregnancies and HIV infection and reduce mother-to-child HIV transmission.
The spread of HIV/AIDS disproportionately impacts women, specifically in sub-Saharan Africa. Improving access to and quality of education for girls is vital to decrease their HIV risk. When girls are able to receive a proper education, they will advance their future job opportunities and raise their incomes. Moreover, staying in school instead of marrying at a young age will decrease the risk of gender-based violence. Programs that work to educate girls and offer HIV prevention help decrease the prevalence of HIV and empower women worldwide.
– Aining Liang