By Linda-Gail Bekker, President of the International AIDS Society
Societies that don’t work for girls and young women don’t work.
Every young person deserves a decent shot at a happy, healthy and productive future. And yet, we have seen first-hand that far too many girls grow up without this hope. But don’t take our word for it. Revealingly, when asked, both male and female adolescents from 33 countries surveyed said that they wanted greater gender equality.
The basis of those survey results is reflected in the fact that the most vulnerable girls are growing up in societies where economic and social inequalities are stark. Far too many girls grow up in severe poverty in communities where jobs are scarce. Violence, coercive sexual encounters, and child marriage are much too common. Economic pressures and cultural expectations often combine to force young girls to drop out of school. Vulnerabilities are especially pronounced among young girls who are social marginalized and stigmatized, including those who are sex workers, transgender or inject drugs.
The tragic reality is further mirrored in the HIV epidemic where there are 4,500 HIV infections every day across the world, and nearly one in four is among adolescent girls and young women aged 15-24. In South Africa alone, almost 2,000 adolescent girls and young women become infected with HIV every week. In the most heavily affected countries of sub-Saharan Africa, adolescent girls are several times more likely to acquire HIV than boys their own age.
Although adolescent girls and young women are more physiologically vulnerable to sexual transmission of HIV and some STIs than males their own age, their disproportionate risk of acquiring HIV is intrinsically related to their social and economic disadvantages. We will never be able to end AIDS if we do not address the social and structural factors that make adolescent girls and young women vulnerable to HIV infection.
In short, we must provide hope to a generation of girls in which hope is in short supply.
In settings where educational and economic opportunities are especially limited, the restricted options for girls inevitably invite economic dependence on older men. In low- and middle-income countries, one-third of girls are married before they are 18, with one in nine married before age 15. Every year, an estimated 15 million girls marry before they turn 18.
Early marriage has profound consequences for the health and well-being of adolescent girls and young women. Globally, young women aged 15-24 who have been married are the population at greatest risk of spousal or partner violence. Experience of sexual or interpersonal violence is closely linked with an increased risk of HIV infection, in part due to the fact that relationships between younger women and older men are frequently typified by low condom use.
There are alternatives to hopelessness. Education, for example, serves as a “social vaccine”-it enhances employment prospects and generates long-term improvements in women’s health outcomes. Increased educational attainment is associated with a reduced risk of HIV infection. Girls with higher educational attainment are less likely to marry before age 18 than those with less or no education. Multiple studies have found that cash transfer programmes for young girls help keep them in school and reduce sexual risk behaviours, especially having sex with an older man. However, these social protection schemes that are specifically designed for young girls have yet to be scaled up in most settings.
Education alone won’t be sufficient. We must combine increased investments in girls’ education with national economic and international trade policies that create jobs, especially in sub-Saharan Africa. As the world’s largest-ever generation of young people advances towards adulthood, this demographic bulge can either be a blessing or a curse – for societies at large and for the young people who will be most affected. Job creation can help replace despair with hope within this new generation of young people, but continuing on our current path will inevitably lead to rising rates of HIV, social unrest, and the loss of the extraordinary potential of countless millions of young people.
The Sustainable Development Goals (SDGs) offer a potential roadmap to reverse the historic neglect of young girls’ needs and to restore hope for a new generation. While SDG 5 specifically focuses on gender equality, the health and well-being of adolescent girls and young women are central across the Agenda for Sustainable Development. SDGs 1-4 and 8, for example, address many of the core vulnerabilities that adolescent girls and women face – poverty, hunger, limited healthcare access, inadequate access to quality education, and few opportunities for decent work and economic advancement.
HIV programmes that serve adolescent girls and young women can and should integrate efforts to expand educational and economic opportunities into their work, but the HIV community on its own cannot ensure gender equality and hope in the future for today’s young girls. Only if we make common cause with diverse advocates and constituencies can we address the factors that increase the vulnerability of adolescent girls and young women. This multi-disciplinary, multi-sectoral approach is the animating vision of SDG 17, which aims to realize the global partnership for sustainable development.
By working together for adolescent girls and young women, we will reap a “triple dividend”: healthier young people today, healthier adults in future years, and stronger parents of future generations that will grow up with hope and opportunities.
This World AIDS Day must be more than a day about one disease; it must be about how HIV is intrinsically woven across the global health agenda. We cannot address one problem without addressing the common threads throughout. Gender equality exemplifies this argument. We are committed to working across the HIV and broader global health communities to make this a key point of focus at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam, Netherlands, next July.
Young people know best their own needs and their own potential; now is the time to create the space for a new generation of leaders to thrive.