Bring back our girls from HIV & AIDS

A young woman in South Africa is four times more likely to be HIV positive than her male counterpart – our young women and girls are disappearing to HIV in huge numbers. Globally, girls between 15 and 19 account for two out of three new HIV infections but in sub-Saharan Africa, the figure is nearly eight out of ten. According to UNAIDS and UNICEF, more than 800 girls in this age group are infected with HIV every week in South Africa [1]. Women and girls are also much more likely to be caring for those infected and affected by HIV [2], limiting their education, work and life opportunities.

Harmful attitudes, gender inequality and social norms create HIV risk factors for young women such as early sexual debut and early and unwanted pregnancy. In a LoveLife study in 2005, 15.5% of 15 to 19-year-olds reported having been pregnant and 66% said the pregnancies were unwanted [3].

Poverty and the heavy burden of domestic care on women and girls mean that girls are more likely to engage in transactional sex (sex in exchange for money, goods or favours) and inter-generational sex (sex with older men), both of which are well-documented HIV risk factors. Girls in families affected by AIDS are even more likely to engage in sex in exchange for money, school fees, transport or shelter. [4]

Sexual violence is one of the biggest drivers of HIV. Around 70% of reported cases at sexual violence centres are under 18 and the vast majority are female. There are very few treatment, care and support services tailored to the specific needs of young women and girls. Care and treatment for survivors of sexual violence can prevent HIV infection and reduce the impact of trauma (which, unless addressed, can lead to mental health problems and risky behaviour in the future) but negative attitudes of health and justice workers towards survivors of rape reduces  young women’s access to these vital services.

Limited survivor services tailored to the needs of young women and girls, make it doubly difficult for girls to access post-exposure prophylaxis (antiretroviral treatment given to survivors after being raped to prevent them contracting HIV), support, counselling and, ultimately, justice in the form of court appearances and convictions for perpetrators.

It is critical to reduce economic vulnerability by encouraging girls to stay in school, gain qualifications and access employment. Funding for community programmes focusing on reducing gender based violence and cash transfer programmes that provide girls with economic empowerment and autonomy is essential.

We call for ZERO for women and girls in the National Strategic Plan (2017 – 2021). We can bring back our girls from high rates of HIV infection if we come together and work towards eliminating gender inequality.

[1] Lake A and Sidibé M (2015), Ending the HIV/Aids epidemic requires a focus on adolescents.
[2] Akintola, O. (2009) Unpaid HIV/AIDS Care in Southern Africa: Forms, Context, and Implications.
[3] Pettifor et al (2005) Young people’s sexual health in South Africa.
[4] Cluver L. (2011), Children of the AIDS pandemic

Where is the ZERO for women and girls?

Women and girls carry the bulk of the HIV burden in South Africa where 6.4 million people are estimated to be living with HIV or AIDS. Women are both more at risk of infection and more likely to be caring for those affected.

While HIV incidence is declining overall, it has increased among women aged 15-49. HIV incidence is highest in young women aged 15-24 at 2.3%, making up a quarter of all new infections. Females have a significantly higher HIV prevalence (percentage of people living with HIV) than males, estimated at 36% among women aged 30-35, compared to 25.6% among men in the same age group.

Getting to zero new infections is the big global goal but we are very far from it, particularly for women. Our National Strategic Plan’s target is to reduce new infections by 50%, with no specific targets for women and girls.

More recently, UNAIDS launched its ambitious 90-90-90 strategy – 90% diagnosed, 90% on treatment, 90% virally suppressed – to end the AIDS epidemic by 2030 but it makes no mention of specific targets for women and does not recognise them as a key at-risk population.

With the focus now firmly on treatment as prevention, the effort to develop effective prevention methods that fit into the lives of women is slowing. More research and funding for research is critically needed in this area to give women more control over their sexual and reproductive health and reduce their risk of becoming infected.

Poor access to services for marginalised women – such as sex workers, rural women and lesbian, bisexual and transgender women – is still an issue. The sexual and reproductive health and rights of women and girls need to be understood and addressed. All the prevention tools in the world will mean nothing if they are not used. We need to create the demand for sexual and reproductive health services for all women, particularly marginalised women.

The reality is that we are very far from zero for women. Real and ambitious targets for women and girls will help us to get there. We call for ZERO for women and girls in the NSP (2017 – 2021).

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