To End the HIV Epidemic, Focus on Sexual Violence Prevention
Voices from the Field features contributions from scholars and practitioners highlighting new research, thinking, and approaches to development challenges. This piece is authored by Gary M. Cohen, Founder and Board Chair, Together for Girls and Executive Vice President, Global Health, BD (Becton Dickinson and Co.), President, BD Foundation and Dr. Daniela Ligiero, Executive Director and CEO, Together for Girls.
Next week, some 15,000 participants from around the world will come together to discuss progress on responding to the HIV epidemic. The 22nd International AIDS Conference is an opportunity to reflect on how far we have come, but also to chart our way forward. This year is a particularly opportune moment for reflection as it also marks the 15th Anniversary of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
The last fifteen years have brought hope for ending the HIV epidemic—showing that with high levels of commitment and significant resources, it is possible to reverse the trajectory of an epidemic that once seemed unalterable. PEPFAR’s list of accomplishments include saving the lives of more than 13 million people with HIV treatment and enabling 2.2 million babies to be born HIV-free.
But in order to achieve the first HIV-free generation, we must focus our efforts on the most vulnerable populations. The data show that girls make up almost three quarters of new infections among adolescents in sub-Saharan Africa, with nearly 1,000 adolescent girls and young women infected with HIV every day. Adolescent girls and young women are up to eight times more likely to have HIV than their male counterparts. We know that sexual coercion, abuse and violence are major drivers of these infections. In fact, girls who experience sexual violence are up to three times more likely to be infected with HIV or other sexually transmitted diseases than those who do not. Preventing HIV among girls and young women demands a more ambitious, holistic and flexible approach—one that includes attention to sexual and gender-based violence.
Since 2009, the Together for Girls Partnership has been working with PEPFAR and other partners to ensure children and adolescents can grow up free from sexual violence—a critical component to enabling them to stay HIV-free. We believe that to effectively deal with this problem, we must first understand it—which is why our work is guided by data. The Violence Against Children Surveys (VACS), led by the Centers for Disease Control and Prevention (CDC) and national governments as part of the Together for Girls partnership with support from PEPFAR and other partners, have provided nationally representative data for more than 10% of the world’s young people (aged 13-24).
The results paint a disturbing picture.
In every country that has completed a VACS, we’ve found alarmingly high numbers of girls and young women being pressured, coerced or physically forced to have sex. Our data shows approximately one in three girls experience sexual violence before age 18, and one in four describe their first sexual intercourse as forced or coerced. The data shows that sexual violence happens everywhere: at home, at school, in communities, on the street. We have also found that girls are at risk for sexual violence throughout their lives—with adolescence being a particularly vulnerable time.
This is an egregious violation of human rights, with significant consequences for a variety of development outcomes—including HIV, unintended pregnancy, maternal complications and mental health issues.
The data from the Together for Girls partnership gives us key information that we didn’t previously have, and showcases just how crucial sexual violence prevention is in combatting the spread of HIV. The PEPFAR-led DREAMS initiative (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) —a groundbreaking public-private partnership working in ten African countries—has incorporated violence prevention and response as a critical component for HIV prevention among adolescent girls and young women. For the first time, we are seeing dramatic declines in new HIV diagnoses for adolescent girls. The latest data shows a 25-40 percent decline or greater in new HIV diagnoses among adolescent girls and young women in nearly two-thirds of the highest-HIV-burden communities implementing DREAMS. This offers hope that significant change is possible.
Through the power of partnership, we are closer than ever before to ending the HIV & AIDS epidemic. But we are at a crucial moment: there are currently 1.8 billion adolescents in the world, the largest cohort of young people in history. We cannot effectively prevent HIV among these young people unless we redouble our efforts to address violence prevention and response for adolescent girls. This is the moment to build on our successes, learn from our mistakes, and together, make the dream of an HIV-free generation a reality.