Young Women Empowered Against HIV: Violence, Education, Institutions

Thursday, June 7, 2018
Mishi Mohammed, a phlebotomist, holds a blood sample from a woman to test for HIV at the Mater Hospital in Kenya, September 10, 2015. REUTERS/Thomas Mukoya
Mark P. Lagon

Chief Policy Officer, Friends of the Global Fight Against AIDS, Tuberculosis and Malaria

Olive Mumba

Executive Director, Eastern Africa National Networks of AIDS Service Organizations

Meighan Stone

Senior Fellow, Women and Foreign Policy Program, Council on Foreign Relations

Girls and women make up more than half of the 36.7 million people living with HIV globally. Research shows that gender inequalities, including gender-based violence, exacerbate girls’ and women’s vulnerability to HIV and lack of access to HIV services. According to UNAIDS, women who have experienced violence are up to three times more likely to be infected with HIV than those who have not. But when adolescent girls are empowered through secondary education, they are less vulnerable to HIV. Experts Mark P. Lagon and Olive Mumba discuss how the U.S. Congress, Donald J. Trump administration, and global institutions can invest in high value partnerships with local leaders to empower girls and help end the AIDS epidemic. 




STONE: (In progress)—with us today. I tried to get around and say hello to everyone because I am a new fellow here. My name is Meighan Stone. I am a senior fellow in the Women and Foreign Policy Program. And I just joined the team a couple of months ago and previously was the president of the Malala Fund. So I worked for the last several years with Malala Yousafzai and all of her work focused on girls’ education. So I am thrilled to be part of the girls’ and women’s focus programming here.

And thank you for voting with your feet by continuing to come to discussions that focus on girls and women because it helps us have even more ambitious programming. So we’re really grateful that you are here today.

So our mission at the Women and Foreign Policy Program is to analyze how elevating the status of women and girls around the world advances U.S. foreign policy objectives.

So to that end, today our conversation is on the record. And so I want to encourage anyone in the room who would like to tweet or post on social media about our conversation, we are on the record today.

And feel free to tag us. Our handle on Twitter is @CFR_WFP. Or if it’s just easier for you, you can use a hashtag, which is just #CFRWomen.

And so I want to encourage you, if Olive says something inspiring and if Mark drives you to action as you leave here on policy, don’t be afraid to put that on social. We’d love to retweet you or to engage with you there. So looking forward to that.

We’re going to have our conversation with our speakers today for about 30 minutes and then open it up to questions. We really want to hear from all of you when we go to questions.

I think most of you know CFR style is to put your placard up like this and that’ll help me know that you have something to share and to call on you so you can be part of the discussion in that way. So why don’t we get started.

Today, we are really focusing on how local and global actors can work together to empower girls through education and reduce their vulnerability to both gender-based violence and HIV/AIDS.

So we know we’ve made incredible progress. We were just talking amongst ourselves about how far we’ve come and how far we still have to go. So, you know, many of us know that since 2010 HIV infections among adults, they’ve fallen by 11 percent and that AIDS-related deaths have fallen by 48 percent since the peak in 2005. And I know that’s due to the efforts of many people in this room, so thank you to everyone that’s been part of working on this issue for so long.

We also know that there’s so much work that we still have to be done and that every day when we look at adolescent girls, there’s about a thousand adolescent girls and young women who are infected each day. And we all know that number is far too high.

So we know that adolescent girls’ vulnerability to infection not only undermines women’s empowerment in their own agency and lives, but also hinders an overall nation’s development efforts and economic progress. So this is an issue of specific girls and women that we want to stand with and also of national interest when it comes to economies and international development success in achieving SDGs.

So we’re really thrilled and honored to welcome two experts today to share with us, Olive Mumba and Ambassador Mark Lagon.

So we’re especially privileged to have Olive with us. She’s traveled from Tanzania where she serves as the executive director of the Eastern Africa National Networks of AIDS Service Organizations. And so she’s been working at this for over two decades as a leader in civil society efforts to reduce the spread of HIV. And today she’s going to share what I believe is really an invaluable perspective about how we can truly support local leadership on this issue and what international institutions and policymakers can do to make that work, have the most impact.

We’re also joined by Ambassador Mark Lagon who we’re welcoming back to CFR. He is a former senior adjunct fellow here. He is currently the chief policy officer at the Friends of the Global Fight Against AIDS, TB, and Malaria.

And I want to shout out he’s brought his two incredible interns, Sarah (sp) and John (sp), to join us today, and so we’re thrilled to have young-women leaders here at CFR as well.

Previously, Mark served as the deputy assistant secretary at the State Department’s Bureau of International Organization Affairs. He served as the executive director and CEO of Polaris as well—more incredible work—and the president of the Freedom House.

And we’re just so thrilled to have you both with us today. So why don’t we start our discussion.

We know, Olive, we were just talking before when we were meeting about how you’ve literally just come on a train from New York where you were part of high-level discussions at the U.N., you know. And you were there to bring your perspective as a leader in Tanzania. You know, in your work there, what is your mission at your organization and what have you seen in your work over the last two decades about this issue of bringing together a focus on adolescent girls, preventing gender-based violence, looking at education as a tool to combating the spread of HIV and AIDS? What have you learned in your experience, and what are you committed to right now in your work every day?

MUMBA: OK. Thank you very much, Meighan.

First of all, I also just want to say thank you for having me here. It’s a pleasure, you know, knowing that there are people who are also helping us who are working at the community level, but that we also have very good will up here in Washington, D.C. Yeah.

I come—I’m a Malawian, but I’ve lived and worked in Tanzania for the past 20 years. And my organization, EANNASO, is really involved in I can say three things: First of all is policy and policy advocacy, making sure that policies that are being developed really reflect the needs from the community. But also, secondly, is providing in terms of technical support to communities and civil society.

When I talk about communities, I mean in the various forms. This can be communities of women and girls, adolescent girls and young women. It can be communities of key population sex workers, people who use drugs, and, you know, other communities as well. But today, I’m going to specifically talk about adolescent girls and young women. So when I say communities, that is what I’m going to mean.

So EANNASO, we’ve been working for the last—since 2002. Can I say that’s around 13, 14 years? And what we have been seeing is that for effective policies and effective programs, we need involvement of adolescent girls and young women, and this has not been there in the past. And it’s also because of the political, economic, and social/cultural environment where as Africans we’ve seen that most of the times women and girls never would have a voice. And because they would not have been given space to know, to relate, to talk about the things that matter most about their lives, then they would not be given space to really talk about what are the key issues.

And if you know that, like, in most of East and Southern Africa, HIV is amongst—60 percent is amongst adolescent girls and young women. So it is very, very key that we also make sure that they are engaged, they are involved, and even in terms from the planning up to the implementation and monitoring of the activities that are happening. Yeah.

So the organization I work with, EANNASO, is also part of the can I say committee rights agenda program within the Global Fund. And we have what is called the Anglophone Africa Platform which mainly talks about engaging communities, strengthening their ability to participate, and also inform policies and programs. Yeah. So that’s what I can say for the time being, yeah.

STONE: Busy days. Busy days.

So, Mark, I’d love to shift to you to hear from you just from, you know, all of your deep policy experience. You know, we know that girls who experience gender-based violence are up to three times more likely to be infected with HIV. So could you speak, too, from a policy perspective and just, you know, looking at how these different issues intersect between gender-based violence, education, and HIV and AIDS, how they come together?

LAGON: And it’s really a pleasure to be here. And thank you for inviting me. And I’m happy to be an adjunct to the opportunity to listen to all on the front line.

You know, if you’re thinking about women and girls’ empowerment, before you ever get to the idea of economic opportunity, you need to think about debilitating pandemic disease. So in and of itself, there needs to be a focus on this for female empowerment.

But if you are to actually imagine epidemiological control of HIV—like a report from my organization “At the Tipping Point” looks at, and there are copies outside—you have to grapple with this demographic of young women and adolescent girls, especially with a growing, huge youth bulge in Sub-Saharan Africa and other parts of the global south.

So if you think about that, you have to, I think, focus on the driver of gender-based violence and the deterrent or preventive dimension of education. There is some good evidence that’s really, you know, coming together that, you know, really shows what we know in our gut: That those who are experiencing gender-based violence have a higher risk of contracting HIV and those who have contracted HIV have a higher risk of facing iterated gender-based violence.

And some of this is about what you might call by the all-too-gentle euphemism “involuntarily sexual debut” in Africa. But so much of the issue is young females not having the ability to negotiate their sexual life, whether it’s if they have sex, whether they’re going to have protected sex, whether they feel empowered or stigmatized in seeking HIV testing and treatment.

I mean, you see really, you know, some governments that have gotten their arms around this, like Rwanda where sort of they’ve created these, you know, blended efforts. I got to see in Kigali on a trip about a year ago of blending law enforcement, you know, gender rights, counseling, and health as crucial.

On the education side, there’s kind of a very strong correlation of education with not—with reduced rates of HIV infection. And I think it will be interesting over time to look, learning what element of education is most important. But, you know, The Lancet has documented this in Botswana where, you know, there’s an 8 percentage drop in the risk of HIV infection with each year in school and particularly among young females. With each additional year of secondary school education, you know, a reduction in the risk of HIV infection by 12 percent.

And so across the board on education, that is really a crucial element. And it needs to focus on women and their knowing about the risks, equipping them to be economically empowered so that they can negotiate their situations in sexual relations, and special measures for those who are not in school, those who are vulnerable, so that they—you’re not, you know, you’re not getting the easy-to-reach.

And then, ultimately, education must address males. There needs to be change of norms and education systems are crucial for changing the minds of the boys.

STONE: That’s critical.

You know, I know we didn’t discuss this before, but I wondered just as you were talking and I can’t help but notice when we say, you know, terms like “involuntary sexual debut” and we know what we’re really talking about, which is rape—it’s OK to use that word, sexual assault—you know, has the #MeToo movement, have you seen any sign of that in your work, Olive, with some of the young women or with women’s groups that you’re working? Has that reached Tanzania in terms of being something that women are talking about?

Because I know we’ve been seeing more and more in our work here at the Women and Foreign Policy Program that it has been having an impact globally. And we’re hearing reports. I even talked to an activist in Pakistan this week who told me that #MeToo is having a really big impact right now for girls and women and advocating around these issues, whether it’s education, HIV/AIDS, and women’s rights in particular

Have you seen—

MUMBA: Yeah.

STONE: How has that been happening?

MUMBA: Yeah. Yeah. There are groups now that are coming up and talking more about issues around women. And also, looking at, you know, in terms of the traditional cultural aspects, the ones that are harmful, and how can we change that status quo.

And also, when it comes to education, we’ve seen the change where, in the past, if a young girl gets pregnant, she would not be allowed to go back to school. But right now, we’ve seen that now they are able to go back to school.

Also, in terms of, like, inheritance, you know, when maybe if your husband dies and then—yeah, the property that he leaves behind, right now we are even seeing that there are organizations and corporations that are supporting to make sure that we get—you know, that the widows get their inheritance back.

But also, we’ve seen a quiet shift, a big—a big shift in terms of—I think, Mark, you talked about it—engaging men. Because there’s been that fight to say, OK, why are we only stressing on women and girls and we’re leaving out the boys and the young men? So there’s also been that element of engaging men with the effort—with the efforts of trying to make sure that women are also in the forefront, so it’s not seen like it’s just a women’s agenda, but it’s a community’s agenda. Yeah.

And there’s been increase in terms of dialogue at all levels down, which is at the grass roots in the villages. You see that women now are able to talk more about their issues and also come up with solutions and, you know, suggestions on this is what we would want. Yeah.

And the good thing is, like, we have what are called gatekeepers at the community level. These are chiefs, these are traditional leaders. These can be religious leaders. They’re also coming up and saying, OK, let’s involve women more, and also let’s listen to the women. So, yes, there is a lot of that force, yeah.

STONE: Yeah. I know that work can be so important in helping girls go to school and stay in school, especially through secondary school where we see a lot of this protective, effective education.

Why don’t—why don’t we talk a little bit about what works, like, what is working? You know, I think, you know, right now as we’re looking at the policymaking landscape and the budget landscape, the United States especially, you know, it’s important to see, like, what do we really need to lean into that’s showing real results in terms of impact?

And we’ve seen some real wins and some real achievements on impact from global institutions, regional institutions, you know, of course, PEPFAR, the Global Fund, UNAIDS

You know, Mark, do you want to start with some thoughts on this? Like, where have we seen these programs really work in terms of empowering adolescent girls?

LAGON: Well, I look forward to dialogue with Olive.


LAGON: And I won’t presume to talk so much about the on-the-ground, you know, things that you see in civil society in the countries you’ve worked in. So why don’t I concentrate a bit on the—

STONE: Perfect.

LAGON: —on the international programs. You know, the DREAMS program of PEPFAR is very promising. You know, and you sort of go down the map of the DREAMS countries of Uganda, Kenya, Tanzania, Zambia, Malawi, Mozambique, Zimbabwe, Swaziland, and Lesotho, South Africa, these are places where there’s beginning to be evidence that interventions that are not biomedical, but that are social can help empower girls and gird, you know, defenses, as it were, against HIV. We need to look a little more deeply into the data and see whether it’s correlation, whether it’s real causation, but it’s promising.

And I think the Global Fund, you know, which is my job to study and speak to in my current role, its best role is as a multiplier so that the United States is not singly this big funder, you know, of a huge transformational program as with PEPFAR. And so just as the Global Fund gets other countries to share the burden with the United States and there’s an alignment—like on, you know, the U.S. has decided on malaria that it will only work in the same countries in the president’s malaria initiative as the Global Fund so that there’s a reinforcing rather than redundant effort.

And so, too, the Global Fund has formed the HIV Epidemic Response initiative, which, of course, spells HER. And it works closely with HER Voice Fund that Olive is quite involved in in her regions of Africa, but on prevention programs, on sexuality education, educating women in economic rights and their financial literacy, trying to grapple with some of these issues of GBV as well. And I think that’s promising.

And in particular, it’s promising because the purpose of the HER initiative is to get the private sector to kick in and, better yet, to be involved in a substantive way in kind. So, you know, I think that Ambassador Birx has the view that this is something that is reinforcing, not redundant, that it extends the reach of the United States, like a number of ways that the Global Fund does.

STONE: Olive, would you share from what’s working that you’re seeing in communities? I know we talked about DREAMS quite a bit in our own conversations. But what does the DREAMS program look like in communities and what are you seeing that’s working that you would like to see the international community to invest in?

MUMBA: OK. I think Mark has already talked about, you know, the countries where DREAMS is operating. But one thing I would like to say is they, like, this year and last year, when countries were developing their COPs, their country operating plans, we’ve seen more engagement of communities and especially the adolescent girls and young women in the formation of the program itself.

And at first, you know, that’s something that we can talk about because in the past there was not known that participation. So this time, yeah, that’s—

STONE: How does that look when you are doing consultation? Like, what does it mean now to meaningfully include adolescent girls that you’re seeing that’s working in the consultative process where they weren’t being included before?

MUMBA: At country level, they will have consultation meetings before having the country plan. So you’ll find that civil society are sitting together and especially addressing girls and young women, would sit together, come up with what they see as their priorities, and then also then take them to now the country stakeholders’ meeting and then make sure that they have been included.

But then also, you find that during the country operating plans, there are the regional meetings. And again, civil society are involved, and this is the first time. Because I think, in the last two years, we’ve seen this really, really change, and that has a lot of addressing girls and young women, actually putting in their issues in the country plans.

But also, when it comes to operationalization at community level, because they have been involved in the planning, it also becomes quite, you know—they own the programs and the implementation of the activities.

What is more interesting also is that implementers are now also coming from the communities, meaning that they involve, like, adolescent girls and young women in all forms, not specifically from the general community, but also other communities. I don’t know when I say “other communities” whether you understand. That will mean maybe adolescent girls and young women who come from the sex workers’ community, those who come from, like, the very marginalized, like orphans. So you find they also are part of, you know, all that, what is happening. Yeah. Yeah.

STONE: That’s good. It’s heartening to hear that things are changing and that we’re actually starting to build more programs around the actual needs of the community and having, you know, God forbid, the community themselves be at the table crafting these programs with us. So it’s good to hear that you’re seeing real traction.

You know, Mark, I wanted to ask you just about the budget process specifically. We know that President Trump put in his budget request—which we all, most of us, know in the room is nonbinding, and even when you have the same party on the Hill and in the White House, is not really considered binding either—but we know that there were some significant cuts in the FY ’19 budget proposal. So we saw an 11 percent cut to PEPFAR and a pretty steep cut, 31 percent potentially, to the Global Fund.

And, you know, I know a lot of us who talk about these issues saw in the last budget cycle that champions on both sides of the aisle on the Hill saw the budget request and then, you know, maintained U.S. support of a variety of international development priorities for the most recent budget.

You know, as you’re looking, going back to this process again, you know, what would be the impact of this level of cut? Who do you see as the most promising champions on both sides of the aisle?

You know, in our nonpartisan, bipartisan spirit here at CFR, who do you see as partners in this? You know, what is the call to action around looking at the impact of these programs and how important it is to fund them?

LAGON: Thank you for asking a tough question and an important one. I mean, the good news is that Congress has stayed steady in the last few years at flat funding for fighting HIV. The bad news is that it’s been only supporting flat funding. But this is in the face of proposed cuts from OMB and President Trump.

You know, if you—if you were to make the cuts that President Trump proposed, for instance of 31 percent to the Global Fund—which I don’t expect, I expect, you know—and I’ll turn to who those champions are who won’t, you know, have it happen—but, you know, there are 400-and-you-know-55 thousand people who wouldn’t be put on to antiretroviral treatment. There would be, you know, 18,000 less who would get the key drugs they need on TB.

And then if you really kind of widen the aperture and you think about it, there might be, you know, by a conservative estimate, 9 (billion dollars), $9.4 billion of lost economic gains by those lives of people who no longer can thrive.

You know, the champions are on both sides of the aisle and in both chambers. You know, they range from Senator Lindsey Graham and Senator Boozman who are very seized with this issue on the Republican side, long-time stalwarts on the Democratic side like Nita Lowey and Barbara Lee.

The crucial thing we need to do is to have a new generation of legislators and champions who were not there at the sort of birth, you know, present at the creation of PEPFAR, and kind of get those left-right-face, secular, business, civil society coalitions going.

And I think it is quite possible. And in fact, it’s one of the reasons why I came to the job I’m in, is that I think even in this particular environment, which is caustic and difficult, that’s possible. The question is, you know, can we also get executive branch support for that?

STONE: I want to shift to our last question. So just in a few moments, we’re going to open it up, so this is your moment to think about what you want to share with the group. And again, when we open it up, if you want to put up your placard, that’s how I know that you have something to share with us.

So I want to go to Olive. You know, we have come such a long way, you know, in this fight. From 2005 to 2016, the number of people who died of AIDS has gone from 2 million to 1 million, so 1 million too many, but much progress has been made.

You know, as you’re looking to the future and going forward and thinking about how global and local actors need to work together, really work together, not just in talking points, you know, or in statements of intent, but in actual work in country, what do you think that local leaders need most from policymakers to be successful to truly say that we can end AIDS in our lifetime? What do you need as a local leader that a room like this that engages on policy could think about bringing and fighting for alongside you?

MUMBA: Thank you so much, Meighan.

Before I answer, I just wanted to talk about one other program that I think has really worked well and that will also touch upon, you know, the question that you just asked, and that is the Global Fund for AIDS, tuberculosis, and malaria.

In most countries, for us to reach the progress, it’s because of the Global Fund and the funding that comes, you know. Because we know, like, most of the funds come from America, and it has made a significant change, not only to HIV, but also TB and also malaria. But also, we’ve seen the increase—in terms of the process that the Global Fund follows, is it’s a stakeholders’, you know, consultation, coming up with the actual plan that needs to be done.

So we’ve seen in terms of, like where the DREAM countries, you know, which are 10, there’s been the 13 countries, the catalytic funding, where the Global Fund has said, OK, if you invest in the catalytic funding specifically for addressing girls and young women of such an amount, we will double that amount. So this has actually made countries want to invest more in adolescent girls and young women.

And then also, I think, Mark talked about it, about the HER initiative, where now we have what is called the HER Voice Fund. These are the same 13 catalytic countries, where now my organization, EANNASO, is providing small grants to adolescent girls and young women and ensuring that they can, you know, be part of processes, not—if they have any logistical issues, they’re able to utilize that funding to be part of it, but also in terms of information. Because sometimes, lack of engagement is because of lack of information. Yeah. So they can try to come up with information packages that suit the age group as well. And this cuts across up to youth and including young men.

Now, coming back to what is it that we need or—yeah, there’s a difference between need and want. Yeah? (Laughter.)

STONE: You can answer both. We’ll take your answers on need and want.

MUMBA: OK, thank you. So the first is, in terms of information, I think information is power. It helps you to make the right informed decisions. And once you have information, you are able to translate it into knowledge. And that is what addressing girls and young women need, for girls to be able to know that I need—I have a right to choose when to, you know, to start having sex, they need that. They also need to be given that information. They need to have the comprehensive sexual education information, but also the access to health services. So information is power. And I think that is something that requires us to—we need to continue working on it.

The other is technical support. Technical support can be in the form of expertise. It can be in the form of even funding, yeah, such that when there’s a need for an activity to happen, there is the required, you know, technical expertise around that. Yeah.

And when we talk about funding, especially for policymakers, in our countries, we are also trying, as civil society, we are trying to push for domestic resource mobilization, such that we don’t—you know, it’s not seen, like, it’s only the extent of funding that is coming in, but we also are pushing for the 15 percent Abuja declaration, which our presidents and our countries signed on to.

And we understand that, you know, inasmuch as we are being supported, but our countries are the ones who are a hundred percent responsible for their citizens. So our governments need to ensure that they’re putting in resources.

And the other thing that we are also requiring is we are also requesting is, yeah, we are seeing the decrease in investments specifically for HIV. And it may not be fatigue as such, but it may also be that we have seen that the emergency situation is not—it’s not as emergent, you know, as an emergency situation as it was. Yeah. But we need the continued global support in terms of the funding, but the continued rallying behind, yeah, this.

STONE: So you don’t want a sense of success to create a sense of complacency and lose ground.

MUMBA: Exactly.

STONE: Yeah, that’s a good message. That’s a good message.

Mark, from, you know, from your policy perspective, what do you feel is this role that the international community needs to play in backing local civil society organizations and leaders when it comes to this intersection of gender-based violence, education, and adolescent girls, and HIV and AIDS?

LAGON: Well, I’m biased because I’ve had a career focused on civil society. So it will not, you know, surprise you that I’ll focus on that. But if you’re thinking about females who can thrive, then you need to grapple with these issues. If you’re thinking about epidemiological control and if you’re thinking about this thing that everyone talks about in the international community and especially in Washington, transition, graduation from international assistance, you have to think about civil society. You cannot only think about the capacity of governments.

Civil society, very simply, whether it’s more broadly on HIV, but particularly this role of young women and adolescent girls, is the advocate. It’s the set of voices that are attached to eyes, that are seeing the affected communities from their own, you know, in their own shoes. They are the watchdogs. I mean, they are in fact a source of data to see whether governments are delivering.

They’re implementers. They’re the ones who reach for any one of these affected populations that Olive spoke of, but for young women and adolescent girls, those who reach them. They’re the ones who will implement GBV and GBV prevention programs and on education.

And so in a situation in which there is a squeeze on civil society around the world under autocratic governments and under, ostensibly, democratic governments, which makes the context even harder, I think the international community and American policy needs to think about putting its thumb on the scale for civil society. And that means looking at those policy instruments that do it.

UNAIDS is famous and rightly so for its data and its establishing targets. But it’s also really good about integrating civil society. And I think it’s worth thinking about also the leavening role of the Global Fund, that at its governance level and on the ground insists on a role of secular and faith-based civil society.

STONE: Thank you for sharing that perspective.

I want to now open it up to everyone else’s questions, thoughts, perspectives, and so if you want to go ahead and put up your placard. If I call on you, please do identify yourself, let us know who you are and what organization you’re from so that we can really appreciate the work that you’re bringing to the table today. And so we want to open it up to questions.

I would like to start with our colleague Regan, actually who has joined us from UNAIDS, in the spirit of Mark’s comments just now about data and about all the important work that UNAIDS has done for so long on this issue.

So, Regan, I don’t know if you have any thoughts or something you want to put to the group as a question as well for us to discuss during the Q&A.

Q: Sure, thanks. Is this already on? It’s on. OK. First of all, thank you for having me here today. And as a woman living with HIV for more than 20 years, I’m just always so impressed with leaders like yourself and Mark. Thank you for all that you’re doing, and so many of you in this room.

It’s exciting that we’re talking that we’re talking about women and girls, obviously, at this moment. I just wanted to make two quick comments. Well, one comment and one question.

So at UNAIDS, you know, women and girls have always been central to the work that we do. And obviously, we’re not going to end this epidemic without dealing with women and girls with a thousand new infections a week and women and girls—it’s just imperative that this becomes a focus of acceleration for us.

You know, one of our goals, as you said, is to hold targets and put data out there. But the thing that we really want to do is mobilize governments and keep them accountable on these targets. So we have periodic meetings throughout time that elicit responses from governments and then also put forward political declarations.

So in 2011, we had a specific target for women, the first time that we had a specific target for women. And then in 2016, we had another specific target for women, which further evolved the language and the specificity of what we’re doing.

We bring the governments back together every year. Every five years, we have a large meeting and we put out a large report, but in between we have an annual meeting and we take a tally of where people are. So next week, we’re actually meeting in New York with the secretary-general and we’ll report back out on what the progress is.

And we’re seeing progress, which is good. I mean, we’re seeing it in a place like South Africa where South Africa is beginning to take the DREAMS program and scale up to a national level. We’re seeing movement in Malawi. I think we need to take a look at that progress and maybe highlight that. We highlight the absolute data, but showing specific progress against these targets and packaging that in a slightly different way.

But just back to the issue of empowerment of women and girls and HIV, I think when we invest, I mean, what is empowerment? To me, it’s telling someone that they’re worth it, that they have value, giving them the tools that they can then use to protect themselves.

I mean, I contracted HIV in a moment of vulnerability in my own life. I was not a young girl, I was in my mid-20s, but I was divorced. And I didn’t know the information. I was paranoid about HIV in the ’80s, didn’t think it could happen to me in the mid-’90s. I had never heard of anyone my age or my ‒ from my place in life having HIV. So I think that investing in women and giving them the specific tools to navigate their lifestyles and teaching women the negotiation skills that are specific to the context in which they live.

And I think just the very act of investing in them and telling them that they’re worth it is something that we need to sort of highlight more. And I think I guess I would turn to the group and say, how can we frame this work as more than just something that’s necessary from an epidemiological standpoint, but how is this building a different future for everybody? And how do we quantify those benefits?

Because I hear a lot, you know, when I do my work on Capitol Hill, well, how does this benefit Americans, how does this benefit the world at large, you know? So I think we just—so many smart people here, helping me think about those messages would be very helpful.

STONE: Thank you so much for sharing your perspective and that question, really important. I can see both Olive and Mark are ready with their answers.

I see—no, go, please.

LAGON: It’s not really a question, but I, of course, you know, deeply agree.

You know, there are very difficult issues on reproductive rights that are in our politics today. But there is a very strong consensus about women’s economic empowerment. And you see advocates on both sides of the aisle here. And so one way of thinking about this—and this would not be the bumper sticker, it would not be the talking point for Capitol Hill—but if you think about UNAIDS and you think about on-the-ground civil society organizations and the Global Fund and so on, the goal here for females is their agency, to be able to thrive.

And so what we want is to fund and support and reform agencies for agency, agencies for young women’s agency. That’s what it comes down to. And I think that’s what you’re talking about.

Q: I like that.

STONE: Olive, do you have any perspective on that from your day-to-day work?

MUMBA: Yeah. On my side in our country, we say when you educate a woman, you educate the whole community. And that, I think, is true, because once you give information to any woman, you find that it also—it does not only reflect within her household, but also reflects within the community that she lives, and, you know, the encouragement that she provides to other women, to other children, and even to the country as a whole. Because once you educate one person, it will—you know, it’s like a tree. And the tree, especially when you look at the roots, yeah, it spreads out. So it’s the same thing, that at times we may not be able to quantify specifically in numbers, but we can in terms of the quality. Yeah.

And I think that’s what, in most cases, we’ve been forgetting, that we want to look at numbers, but in terms of the quality, sometimes it’s a bit hard to really specify. But we’ve seen—we can see, you know, the change. And unfortunately, also, sometimes change takes time to see. Yeah.

STONE: And we all know this is a common challenge in foreign policy advocacy, especially around girls and women. There’s a human rights argument and the rights of girls and women. And then we also need to quantify. And it’s a sensitive balance between those two needs and we want to strongly defend both. We know there’s an intrinsic right and we also know that there are intrinsic measurable benefits and we need to be able to have both arguments.

I see Sarah (sp) has a question for us.

Q: Well, I’m just going to kind of build on Regan’s comment.

And I just want to say, I was at an event at the Wilson Center yesterday on ending preventable maternal mortality. And one of the speakers or participants who came in, she said, oh, I was in this other room and it was all men so I knew I was in the wrong event. So I just want to say I was really happy to be in the right event today and that a man is here talking about very important and tough issues.

So building on something that Olive said and, like, pushing you a little bit more, Ambassador, Olive said one of her strategies is to go to the chiefs and the elders and knock on the door and say how important this is. Granted, we live in tough political times. What is your advice to all of us to go to the chiefs and the elders in this community, in this new administration, and put the urgency on this? Because one thing I’m frustrated about is, under DREAMS, you know, a year ago, they’re talking about comprehensive sexual education, now we’re talking—I think the euphemism, and some is going to correct me if I’m wrong here, sexual risk reduction, which I think is abstinence. So that’s a big difference in the lives of girls in the community.

So what is your advice to us? How do we do that breakthrough that we have to do so that the elders and chiefs in our country—I’m speaking not as the U.N., as an American—what would you suggest to us that we do so that we come into this room and it’s a lot more men at the table?

LAGON: Well, I think you, you know, you can probably identify some figures that you will get nowhere with. And then you will have some champions who understand that there is a kind of a broader, holistic approach to women’s and girls’ empowerment. And I think we need to, you know, look at those who live in the world of conservatives and the culture of Republicanism. And, you know, I think there are more Lindsey Grahams out there than appear. And he may not have, you know, the views that you or some of us do or UNFPA, but finding those or minting those.

And I think I admire the idea that you don’t just wait for a future day, but reap gains where you can within some parameters that are tightening.

STONE: Olive, what is your perspective on this? Because you’re having these kinds of conversations in your community. And I heard Sarah (sp) say, what is your advice to us because we’re—how can you encourage us or what are your learnings from having those conversations with traditional cultural leaders? How do you bring somebody onside to agree that a girl should go to school or that you’re going to need to talk about these issues if you actually want to prevent HIV, that you’re going to need to address gender-based violence with both girls and boys and men to really make measurable change that we’re all seeking together? Like, what would have been your experiences in that or what would you counsel this group?

MUMBA: OK, thank you so much. In terms of—Mark had already talked about champions. It’s the same thing that we do. We identify who is on our side, know who is our ally, and we would give them information to say, OK, you know, if this doesn’t happen, these are the consequences, or if we do this, this will be what we will be able to gain. And once they get that information then they will be able to influence the others within that community.

But secondly is we also have ambassadors, you know, those that have—ambassadors will be, like, not Ambassador Mark. (Laughter.) But ambassadors in terms of, like, someone from the community who has done quite well and can influence in terms of, like, a mentor within the community where, like, for the women, would say, like, you share your experience, share your story of how you’ve been able to make the change. And then they, too, are also able to influence in terms of the other chiefs.

In Malawi, we had the traditional chiefs came up and signed a declaration to say that if any child, if any girl—because this was around child marriages—they said that if someone is pulled out of school without a proper reason, they have to sign and tell us why is it that this has happened. So this was an example of where, you know, they looked at one another, they gave each other, like, a peer support, but also, in terms of being accountable to one another. Yeah.

STONE: Yeah. I think that’s such a helpful story from your work as an expert and as somebody working. You know, it’s interesting that we hear that about working together with the traditional chiefs in such a new and productive way, but then we look at our own policymaking environment and feel like it’s impossible. But yet, when we do diplomatic work, it’s always seeking to bring together different sides, but then we look at our current environment and think it’s—that just can’t happen. And, of course, it can. And I hear in these questions and discussion that we need to recommit to that.

And I think for so many people here, especially colleagues at the ONE Campaign and other organizations, that we’re advocates. And, you know, part of PEPFAR originally in the Global Fund, it was very much an exercise in building coalitions across the aisle and finding shared values, even if there were other values that were very different, finding that middle space of that Venn diagram where we could agree and could come together. And that’s at the heart of the challenge for every policymaker.

I want to go to Elizabeth, if you want to share with us your question.

Q: Sure. Hi. Elizabeth Cafferty, U.N. Women.

So U.N. Women, this isn’t a priority area for us, but we do work on HIV in a number of countries. And one that was most interesting to me was Ukraine which is not the first that comes to mind. And most of our work there is women’s economic empowerment and women’s peace and security. But it’s something that the women’s groups had raised with us that this was an issue that they needed assistance on.

So that makes me wonder, and I think particularly maybe for Olive, working with young women, are there issues that they have raised, challenges that they have, or maybe ideas they had for solutions, that hadn’t occurred to you that you’ve been addressing because it came from the young women themselves?

MUMBA: Thank you. Yeah. Just to say that recently we just had a call with U.N. Women and that was around HER Voice Fund. And I can’t remember, but I think the lady who—(inaudible)—I think is based in New York, yeah. And she’s one who connected us to the 13 other U.N. Women offices within the 13 countries that we work with.

And, yeah, there is a—there is—one time we were having a conversation. Actually, it was a meeting within our Anglophone Africa Platform meeting. And one young lady, she’s from Kenya, that’s Lucy Wanjiku, and she mentioned, you know, like, sometimes—she’s someone living with HIV, sorry. But then she talked about, you know—she was expecting and then she wanted to give a solution to something. And the other—can I say the older women tried to tell her, no, please keep quiet, you know, this is not the way we’re supposed to handle. And then but she said I had to insist to say no, this is how I think this should be done. And at the end of the day, it really worked out well.

So, yes, at times know when we give a voice to young women and especially new ideas—and even, like, most of the things that some of us would do with—they may not—you know, they may do it better. So it’s always good to give them a platform to voice themselves. Yeah. Yeah.

STONE: Yeah. I know from our work at the Malala Fund, this was a question for us all the time, especially when we were looking at the SDG development around Malala’s focus, around girls’ education, secondary education, was, how do you meaningfully engage adolescent girls? So it’s not Youth Day at the U.N., which means the girls come to the same building, but actually don’t interact with anybody that makes decisions at the U.N. And so then our goal is not Youth Day, it is—it’s actually meaningful interaction between policymakers and young women.

I mean, just as a show of hands for those that are with us today, how many of you do work that touches adolescent girls in any—in any way in terms of issues that pertain to them? I’m seeing a lot of hands.

How many of you have any sort of active consultation process with adolescent girls? A smaller number of hands.

How many of you have an active consultation process that has a feedback loop to go back to them and say, do you feel like you were heard and do you think there was a meaningful impact? I see one hand. So, OK.

So our expert Olive has inspired us today to maybe take some of these learnings back to our organizations and how we think about crafting our work.

I want to go to our colleagues here. Do you want to introduce yourself?

Q: Hopefully it’s on. I’m Sanyukta Mathur, I’m with the Population Council. We are a research organization based in New York where we have offices around the world, including Washington, D.C.

I’m a social and behavioral scientist and I lead our DREAMS implementation science research portfolio, meaning we’re doing research around trying to answer the practical questions on how DREAMS is working, who is it reaching? So I’m really thrilled to be here at this event and recognize that it’s a really important topic to be talking about where, as you said very well, Meighan, we’re 30 years into the epidemic and we’ve made huge strides.

And the focus on adolescent girls and young women in because there has been a group of people that has been left behind in some of the successes. And part of what the DREAMS or DREAMS-like programming that is now being taken on by Global Fund and other counterparts at the U.N. is really around understanding and reaching those that are the most vulnerable and understanding how to reach them and understanding that their risk is really multifaceted.

You know, so their—you know, schooling works really well. So the strategy of schooling is, how do you keep girls in school? And then for those that are out of school, how do you think about getting them back in school? And so that’s one of the things that we’re finding, is that the programs right now are doing really well in getting girls who have a lot of vulnerabilities, come from orphaned households, who are hungry, who come—who don’t—who have high-risk perceptions or high-risk behaviors, how do we do better to get the girls that are out of school? Can we provide them strategies or ways back into schooling or training that can reengage them in a meaningful way in their communities?

I also appreciated the comments around engaging men. Gender-based violence is a huge issue in these young women’s lives. We surveyed about 3,000 young women in Kenya and Zambia, 20 percent of them had experienced sexual violence or coercion in the last year. These are 20 percent who were willing to report that to us, so you can only imagine that this is the tip of the iceberg. And almost none of them had received any services or post-violence care.

So this is something that the DREAMS programs and partners are working actively toward. So I think the issue of addressing that topic and bringing men into the discussions, community-based programming becomes really important.

When you ask men—and one of the interesting pieces that we’re doing is talking to both adolescent girls and men—when you talk to men, many of them have experienced major trauma and violence in their own lives. And we find that this cycle repeats. So the men who have experienced violence, everything from being beaten themselves or experiencing, you know, seeing violence in their community go on to, you know, perpetuate that violence with their partners and risk behaviors.

So a lot of these issues are complex. I’m really glad to see so many people at this in this sort of forum because I think we need to talk about some of these complex issues to continue to invest towards this population and this topic.

STONE: Do you have a question for either of our speakers as well?

Q: I think it would be really helpful to hear from Olive a little more about how we can better engage in-country policymakers. That’s one of the things that the Population Council tries to do actively, is taking the evidence that is being generated so that they can feed it into programs and policies. So it would be—you know, that—I would love to hear you reflect a little more on that.

STONE: Olive, do you want to speak to that?

MUMBA: Yes. Just last—was it last week, two weeks ago, we were in Dodoma and Dodoma is the capital city of Tanzania and there was a parliamentary session happening. So we were working on TB, because what has brought me here is the TB high-level meeting preparations.

And during that time, we had realized that most policymakers actually don’t understand some of these issues that we talk about. And when it comes to, like, DREAMS, you know, like, the successes that are happening right now, I think there’s a delink because, yes, they live within that community, but they don’t have that information. So they even request it as, OK, TB, we see people with TB, and I think the same thing, that we talk about HIV, but we don’t understand what causes it and what can we do as policymakers.

And that is now the role of civil society, going and informing them. So similarly, when it comes to adolescent girls and young women, there was—there is a gap in understanding. You know, like, hearing from adolescent girls and young women themselves, you know, the issues that they are facing. And if policymakers are there, they would be surprised because they really don’t have that one-on-one, what I can say, experience. So that is one thing that I would like to say is providing dialogue space between the adolescent girls and young women and policymakers such that the issues can come directly to those who are making policies, and sharing experiences from projects and programs that are working so that they also encourage, you know, investing more in areas that support the change.

One other thing is, when it comes to, like, funding for adolescent girls and young women, our countries normally don’t look at that as priority. They would rather look at infrastructure or other things that, at the end of the day, when they look at their balance sheet, you know, the assets are better than the liability. And most of the things, like education, health, is not as priority. Yeah.

STONE: And I would agree. I mean, this is what we all talk about in terms of data. It’s, like, even the data’s not gender disaggregate, you know, not only in terms of impact or intervention, but also how money connects to that. And so we don’t even really know many times exactly what we can see because we don’t have the data available to us.

I know we have about six minutes left and I really want to honor everyone that has their placard up because we’re really grateful that you’re here to be part of this dialogue. So what I would suggest is we’re just going to go around the room. If you can share your name, your affiliation, and your question with some brevity so we can make sure we get to the four people that I see.

And then maybe if, Mark and Olive, you can respond to this last set of questions, that would be good.

So we’ll start with you, Janet.

Q: Thank you. My name is Janet Fleischman with the CSIS Global Health Policy Center. And thank you both for very—all of you, all three of you, for the interesting remarks.

Olive, I wanted to talk a little bit more about the challenges that you see. Many of us have been working on these issues for a long time. We know adolescent girls and young women have been left behind since the start of the epidemic. We’re excited to see DREAMS and HER and other efforts moving forward, and yet the multisectoral approach, the engaging governments—I mean, Tanzania is a place that’s had the VAC study. They’re supposed to have this governmentwide approach to violence against children. We’re seeing resistance to moving forward with the DREAMS program, communities that aren’t always as engaged as we would like, implementers that aren’t coordinated. There’s lots of challenges that we see from here.

But I wonder what you see as the key challenges that really could help move the dial on addressing the issues and the needs of adolescent girls and young women.

STONE: Fantastic. We’ll go to our second one, with Harry.

Q: Hi. This is Harry with American Jewish World Service.

Mark, I love what you said about moving from agencies to agency. I really liked that.

My question for Olive is, what do you see as the key legal and political barriers for adolescent girls and young women accessing not only—not only treatment services, but prevention services, to access their full range of rights?

And for Mark, how does the donor community—how is the donor community responding to resourcing and not only kind of the clinical and commodity work, but around the broader social environment by which young women do or do not access services related to HIV?

STONE: That’s a great question, we appreciate that.


Q: Katherine Marshall, Georgetown University.

Three things that I think we should take away from here and not lose sight of. One is Mark’s comment that we have to develop a new generation of advocates. I think that that has great importance. I think the civil society space issue in this—in connection with this issue is one that really is worth thinking about. And then the other is, just for people who have been dealing with this issue since the ’80s, having sort of fresh story with fresh generations is important.

But my main question is, where—we all know—I mean, everyone here at least, this is sort of a no-brainer, we should be focusing on gender equality and women’s rights, et cetera. Where is the opposition coming? I think you put your finger on it with the indifference, other priorities, this is really not very important, the sort of general attitudes. But looking more specifically, how are you dealing strategically with the religious communities?

Clearly, there’s been a huge evolution in thinking within many religious communities since the start of the pandemic in the ’80s. But I know we work on family planning and the basic view is there is no sex outside marriage, can’t happen, a tremendous difficulty in dealing with adolescent sexuality. And this is true pretty much across. There are very few religious communities that are able to deal with that. What kind of strategy and dialogue is there for trying to deal with what in Africa is by far the largest civil society community or—I mean, it outstrips the NGO world by orders of magnitude. So how are we thinking and approaching that issue?

STONE: Great question.

And our last one, Chris?

And then we’ll have our speakers give us their responses.

Q: My name is Chris Farrar. I’m from Senator Boozman’s office. And I promise, I didn’t force the ambassador to name check my boss. (Laughter.)

So a couple of things that really struck home. One was the building new champions piece. One thing that is difficult for a principal like my boss is that you have constituency and you can’t spend—you can’t focus all your efforts on one issue, as much as you would like to, so it becomes difficult to kind of carry the water repeatedly. And so I think some members—like I think Mr. Yoho is a good example of someone who campaigned against these issues and was educated, is now—has now moved back to, according to him, I think education is a big issue.

So one, you know, for the ambassador, how are you kind of working to engage the policymakers in terms of educating them and their staff?

And the other thing, I was also going to ask kind of about the faith-based community. I’m Episcopalian. I’m a little biased, we have a pretty good track record on this stuff recently. But, you know, how are you identifying members of the faith-based community who are supportive of the efforts? And how do you engage them, especially on—(off mic)?

STONE: Great. So I heard a lot about current barriers and challenges to the work in country—Olive, especially for you—and trying to figure out where is this opposition coming from, where is the place for the donor community to engage on these issues and how to engage staff and the faith community writ large, in the donor community and also in the country as well?

So do you want to start, Olive? We’d love to hear from you.

MUMBA: Yeah. I think—thank you so much, Janet, for the question on what are the key challenges. And I think the very biggest challenge is learning from the past mistakes. Yeah. Because I think we don’t reflect quite a lot, so that’s around M&D, looking at documenting, evidence, and seeing what is working best.

In HIV, we always talk about know your epidemic, know your response. And that can’t happen if we don’t have the evidence and also stories, you know, where we can learn from. Yeah.

And the other thing is we need—I think also young, can I say, leaders, young adolescent girls, young women leaders, to be talking about their own issues. And I told Meighan when I was requested, I said I’m not the proper person, because last time when I talked about HER Voice, we had an audience of young women. And they were saying, but you, you’re not young. So we need to ensure that when we’re talking about young women issues that they are in the forefront and we don’t speak on their behalf, and provide them with, you know, the platform so that their voice is amplified.

The other thing is in terms of, I think we talked about policies, policies that are there have always not included, you know, the voice and the needs that are there from the young women’s, you know, can I say young women’s needs? So that is also the other aspect.

And prioritizing, I think that has not—we need to ensure that we’re prioritizing everything that we’re doing. We also make sure that we are prioritizing young women’s needs.

Harry, you talked about what are the legal barriers. I was going to talk about this. The two, you know—in most of our African countries, we will find that the age of marriage is much lower. You know, it can be between 16 to 18, then the legal age of—can I call it age of consent—which will be around 21. And there’s that, you know. There’s a need to balance these two ages.

Because one, you know, if someone wants to go access health services, then they require to, you know, have their parent’s consent. And therefore, that already acts as a barrier towards accessing comprehensive sexuality, you know, health services. And those are some of the issues.

Also, most of our countries are right now developing adolescent girls and young women strategies. So in the past, it’s not been there. So right now, what we’re also trying to do through HER Voice Fund is trying to encourage the young women to also be able to be part of these processes that are taking place. Yeah.

And there’s also a need for those legal assessments to be carried out so that we appropriately know how to respond to some of these issues.

In East Africa where I right now am developing what is called the sexual reproductive health bill, which is going to look at all these other areas, you know, in terms of the legal ages as well. Yeah.

I don’t know whether there’s any other question.

STONE: I think we’re going to close in two minutes. We’re a few minutes over.

So I don’t know if, Mark, if you want to bring us to a close with your response.

LAGON: I’ll be brief. And I’m just thankful that she had the first word as opposed to thinking that I have the last word. (Laughter.)

STONE: We appreciate that.

LAGON: Chris, you know, I think to simply answer about this question that some of you have raised about building new champions and so on, you know, I think any political leader or advocate outside should not concentrate on necessarily, you know, creating 10,000 champions, but a buddy system of a handful. And that, I think, really can matter when a, you know, a legislator like your boss, you know, sort of takes a few people from, you know, the Arkansas delegation or some other newer senators and says, you know, these things happened with PEPFAR a few years ago and you may have the general sense of it, but it’s been really impactful and it was, you know—Republicans were really onboard and so on.

We feel that mobilizing the faith-based community, youth, and business as advocates to try and engage political leaders is crucial. And that’s what we do.

On the faith front, Katherine, you asked, you know, a super-easy question about religious communities. But I do think, when we think about civil society and programmatic work out in the world, we have to think about working with, not despite the faith community and really as crucial implementers.

And, you know, the views you, you know, say that are held in that community are what they are. But I think it is deeply important, whether you’re the Global Fund or PEPFAR or other advocates, to do that.

And then finally, Harry, you know, you talk about, as much donor community support for social interventions as for commodities and biomedical interventions. And I just think we need to have data, but we also have to have a comfort level that the data is not going to be the same kind of data that you have with biomedical interventions.

And I just would say, if one is afraid that some constituencies would not be in favor of social interventions, just there might be a more robust consensus about, you know, engaging particularly when it comes to young women, you know, and civil society to enhance their voice. I think that is something that the gut instinct can go along with the data.

STONE: Well, very good. Thank you so much.

Again, we welcome your engagement on social media at #CFRWomen.

And I just want to invite you to thank our speakers, Mark and Olive, for joining us today. (Applause.)

Thank you so much. Have a wonderful rest of your afternoon.


This is an uncorrected transcript.

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