Voices from the Field features contributions from scholars and practitioners highlighting new research, thinking, and approaches to development challenges. This post is authored by Lanice C. Williams, advocacy and partnership manager, and Mark P. Lagon, chief policy officer, at Friends of the Global Fight Against AIDS, Tuberculosis and Malaria.
Globally, adolescent girls and young women continue to bear a heavy burden in the HIV/AIDS epidemic. In 2019, an estimated 19.1 million girls and women globally are living with HIV, making up more than half of the 36.9 million people living with HIV. Adolescent girls and young women are still disproportionally affected by HIV. Every week, around 6,200 young women aged 15-24 are infected with HIV worldwide. In sub-Saharan Africa, four in five new infections among adolescents aged 15-19 years are in girls.
Gender inequality and societal norms of appropriate behavior affect women’s health, put women and girls at higher risk of HIV, and create barriers to HIV treatment and care, which in turn impacts their ability to access economic opportunities. Supporting barrier-free access to treatment can empower communities and help strengthen the ability of women living with HIV to work and continue their education.
Effective HIV treatment and prevention programs must integrate strategies which take into account the multiple factors that influence young women’s opportunities and decisions. The Global Fund to Fight AIDS, Tuberculosis and Malaria has a range of strategies and interventions to address women and girls’ access to health care, sexual and general education, and job opportunities, which all help to mitigate the risk of violence. Through the Global Fund’s distinctive emphasis on local ownership of programs, grant recipient countries tailor interventions to meet the needs of local communities. For example, the Global Fund encourages local ownership of programs through its Country Coordinating Mechanisms (CCMs). At the country level, more than 40 percent of decision-makers on the grant committees are women.
In ten countries, the Global Fund supports livelihood and economic empowerment interventions to young women. Many of these interventions focus on vocational training, entrepreneurship training, small business loans, and savings groups. In particular, village saving loans can enable women living in poverty to increase their financial skills, gain access to and control over resources, and generate economic opportunities and income. Women are placed in informal groups of 20-30 where they make weekly saving deposits into a group fund. Members of the group gain access to small loans, which would not be available to them through other means. These tools provide young women with vocational training and life skills for achieving financial independence, in turn reducing their vulnerability to HIV.
Similarly, in South Africa, the Global Fund is working with young women to offer life skills coaching, support services, and financial education for young women who are out of school through girls’ empowerment groups, also known as RISE Young Women Clubs. The groups provide a safe space for young women to discuss challenges they face daily, from applying to schools or jobs to pregnancy prevention and avoiding unhealthy relationships. Participants also receive counseling and testing for HIV, as well as education on how to protect themselves from contracting the disease.
These Global Fund programs work closely with the President’s Emergency Plan for AIDS Relief (PEPFAR), and its DREAMS program (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe women). DREAMS includes non-biomedical interventions against HIV, like supporting girls to start and stay in school, which are designed to increase the prevention of HIV. We have had the privilege of working with women like Martha Clara Nakato, who has participated in gender empowerment programs from both the Global Fund and PEPFAR. As a DREAMS Mentor, Martha is helping young HIV-positive women in Uganda improve their self-esteem and self-sufficiency.
Global health programs must ensure that they are not only fighting diseases but also addressing health inequities and reducing gender inequality, which serve as barriers to women’s economic independence. Additionally, health programs must integrate innovative strategies that address every life stage for women and integrate livelihood and economic empowerment approaches.
Of course, the causal relationship between female economic empowerment and effective HIV response is not only in one direction. The latter advances the former too. For instance, if sick with or dying of AIDS, young women will not be able to take advantage of the three E’s of education, employment, and entrepreneurship. As the book, Human Dignity and the Future of Global Institutions highlights, successfully enlarging human agency and flourishing requires a holistic view. Development policies must address all aspects of women and girl’s well-being and health as it relates to their economic independence and empowerment.