Serra Sippel
As we mark World Aids Day with a conservative US administration looming, it is vital that progress on HIV prevention in girls and young women is not undone
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| World Aids Day is commemorated in Castro Street, San Francisco, last year. US investment in HIV prevention had largely overlooked young women until recently. Photograph: Justin Sullivan/Getty Images |
Over the course of more than a decade, the US government spent in excess of $41bn (£33bn) on HIV prevention and treatment without investing in targeted prevention for adolescent girls and young women abroad.
Adolescent girls were instead lumped in with adult women in prevention programmes such as prevention of mother to child transmission, which was a critical intervention but did not address the unique health needs and risk factors for girls. In parts of Africa, 90% of new infections in adolescents occur in girls, so this left an enormous gap.
The US investment mainly supported life-saving antiretroviral treatment for 7.7 million men, women and children, as well as HIV testing and counselling for more than 14.2 million pregnant women (leading to 240,000 infants born HIV-free), and HIV testing and counselling for almost 58 million people.
But when it came to young adults, pressure from conservative religious organisations and policymakers prompted the US to spend $1.4bn on abstinence-only and fidelity-in-marriage programmes. These initiatives have had no impact whatsoever on reducing new HIV infections, regardless of where they have been implemented.
But in 2014, America turned a corner with the advent of a two-year programme for HIV prevention in adolescent girls and young women. The scheme prioritises social and educational tools in addition to biomedical interventions in 10 countries across sub-Saharan Africa. About $385m has been allocated for this programme through the Dreams partnership, a public-private collaboration with other aid organisations.
Through the partnership, girls have access to adolescent-friendly reproductive health services and information about consistent use of male and female condoms, pre-exposure prophylaxis, HIV testing and counselling, and other contraceptive choices. As sexual violence is a contributor to the spread of HIV among girls and women, there is also a focus on learning about violence prevention and post-violence care, including post-exposure prophylactics that can prevent HIV infection after rape.
The programme has put into use the Girl Roster, a new tool created by the Population Council to identify girls who are particularly at risk of HIV and hard to find, with prevention efforts focused accordingly. Dreams also provides girls and their families with access to financial literacy and savings education programmes.
Implemented by medical providers, community-based organisations and schools, the scheme promises real progress for girls. But while it could have far-reaching effects in combating HIV, it cannot survive on private backing alone.
Funding cuts to US foreign aid are not the only danger. The threatened reinstatement of the “global gag” rule – an executive order that restricts US foreign aid from supporting any organisation that provides abortion-related activities, even with non-US funds – could have potentially devastating consequences for the Dreams programme. If the policy is reinstated by the incoming Republican administration, funding could end for some of the most innovative and promising partners for adolescent girls, who need a variety of services to prevent HIV, including access to contraceptives and violence screening services. This only hurts the fight to combat HIV.
While Donald Trump may not yet have a governing record on the health and rights of women and girls, vice-president-elect Mike Pence’s record is long and vexing. Pence, the outgoing governor of Indiana and former Republican congressman who is heading up the Trump transition team, has an extensive record of championing policies that are hostile to women, science, and human rights.
Pence is a fierce proponent of abstinence-only education as part of domestic and foreign HIV funding. As a member of Congress, Pence supported legislation to reinstate the gag rule and, as a governor, he spearheaded the closure of Planned Parenthood clinics in his state. These clinics did not perform abortions but did provide testing for sexually transmitted diseases such as HIV. Under his administration, Indiana experienced the largest documented outbreak of HIV infections in two decades.
Other Trump hires seem similarly unpromising for women’s health policy. As governor of South Carolina, Nikki Haley, who has been named ambassador to the UN, rejected state-level matched funds through the Affordable Care Act that would have contributed to HIV treatment for low-income people. This despite South Carolina’s high rate of new HIV infections, which has had a devastating effect on African American women.
Just last week, Michele Sidibé, the UNAids executive director, called for action in helping to prevent HIV infections among girls and young women in Africa. He said that thousands are still infected each week, making the UN target of reducing new infections to fewer than 100,000 a year by 2020 way off course.
As we mark World Aids Day with a Trump-Pence administration looming, we must redouble our commitment to advancing the health and rights of women and girls. Advocates, donors and NGOs must work harder than ever to fight for continued investment in HIV prevention for adolescent girls and young women.
Moreover, we must be vigilant in our fight against policies that pull the rug out from under women and girls and threaten global public health outcomes.
The bottom line is that we can’t turn the tide on HIV without women and girls.
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