For young women, inequality is deadly

If you are not a young women aged 15-24, there is much to celebrate on World AIDS Day. UNAIDS’ global update  indicates strides made in understanding and response to the medical implications of HIV and growing de-stigmatization. The record 18.2 million people on anti-retroviral therapy are able to live long and healthy lives. But in many countries, this is a disastrous time to be a millennial woman. Although only 11 per cent of the global population, these young women account for 20 per cent of new infections. They are the Agenda 2030 generation, but in some areas of the world, they are a group that is being left far behind.

UNAIDS data from seven longitudinal studies across Eastern and Southern Africa show that young women of 15-19 years accounted for three quarters (74 per cent) of new infections in eastern Africa and nearly all of the new infections (91 per cent) in Southern Africa. Globally, in 2015, every week some 7,500 young women aged 15–24 years acquired HIV.

Where there is poverty, social dynamics that give men strong dominance, low rates of education for girls and high rates of violence against them, frequent forced sex, and insufficient access to health services, this toxic combination has fostered alarming, disproportionately high rates of new infections among women in an age group that should be the flourishing hope for the future.

Reaching the 2020 target for prevention of HIV infections in young people will require a 74 per cent reduction in new infections among young women between 2015 and 2020. Achieving this will take rigorous efforts and increased investment in prevention. Central to these efforts is the recognition of the role that gender inequality plays in almost every aspect of the risk factors affecting young women.  For example, one of the epidemic drivers for this age group is older adult men infecting younger women who lack the ability or knowledge to negotiate safer sex.

Strong, enforced commitments and actions to advance women’s rights are critical for achieving gender equality and reducing the impact of HIV on young women.

Ensuring education for adolescents and young women is a key entry point to address inequality, and gain the potential for economic independence and greater autonomy. Women with post-primary education are five times more likely than illiterate women to be educated on the topic of HIV and AIDS, and this has a large protective effect against HIV risk. We also know that sexuality and HIV education programmes which address issues of masculinity and femininity, gender inequality in society, unequal power in relationships, and young women’s empowerment, are likely to result in lower rates of sexually transmitted infections.

We have immediate and urgent work to do to reduce biases and repeal discriminatory laws that stigmatize HIV and perpetuate harmful gender roles. This work will benefit everyone. As well as scaling up efforts to address power in relationships, and increasing knowledge and information, women need access to preventive care such as pre-exposure prophylaxis (PrEP), sexual and reproductive health care, and targeted testing strategies. Governments, civil society, women’s organizations, and human rights organizations are already working hard to build strong pillars of prevention. We must focus our attention on the young women who are not being reached by those efforts, for whom inequality is deadly.

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