Around 180 young women and adolescent girls from Malawi, Kenya and Uganda have led a pilot project that aims to strengthen the leadership of young women and adolescent girls in the AIDS response. Called Empowerment + Engagement = Equality, the programme aims to build stronger leadership among young women and adolescent girls to engage in national assessments initiated by the All In to #EndAdolescentAIDS platform. The programme addresses issues of gender inequality that heighten adolescent girls’ vulnerability to HIV infection and provides safe spaces where experiences can be shared. 

The initiative, designed and implemented by UN Women and the International Planned Parenthood Federation, mobilized more than 1000 young advocates, including young women living with HIV, to voice their concerns at the local, regional and national levels. As well as sharing knowledge among themselves, the participants engaged in face-to-face and online meetings with parents, teachers, religious leaders and other community stakeholders to discuss how to change harmful gender norms and inequalities that increase the risk of HIV infection.

The First Lady of Malawi, Gertrude Mutharik, participated in one of the discussions and committed her support to challenging the issues that increase the risk of HIV infection among young women, including gender-based violence. The young leaders have continued to advocate at the highest levels, taking part in debates at the International AIDS Conference in Durban, South Africa, in July 2016.   

“Some of the most fulfilling work I have done as part of this project is to support other girls like me to feel empowered and in control of their lives,” said Divina Kemunto, from Kenya, “I shared my personal experience and encouraged girls living with HIV to believe that they too can walk with their heads held high and a smile on their face.”

Preventing new HIV infections among adolescent girls and young women in sub-Saharan Africa is crucial if the world is to end the AIDS epidemic by 2030—in 2015, 75% of new HIV infections in sub-Saharan Africa among adolescents were among adolescent girls aged 10–19 years. Preventing infections means empowering young women and girls to stay in school so they have better economic prospects, ensuring that they have the knowledge, information and tools to avoid unintended pregnancy and sexually transmitted infections and making sure they know what to do when faced with sexual violence.

Laws and policies that discriminate against women and girls must be dismantled and their sexual and reproductive health and rights must be fully respected.

Rushell Gray unflinchingly shares the story of her journey to the edge and back. She was infected with HIV after being abused at the age of nine, but her eight-year-old daughter is HIV-free. “It has been difficult. As a young girl in the community everybody turned a blind eye and blamed me,” she said. “Nobody said this man needs to go to jail. At one point I gave up because the stress was too high,” she recounts.

A petite young woman, Ms Gray is confident and articulate. She credits the Jamaican nongovernmental organization Eve for Life and its transformative programme for her turnaround. Through a combination of counselling, personal development and life-skills education, she has become one of the powerhouse peer educators of Mentor Moms.

The Mentor Moms programme deploys young, empowered women who are affected by HIV and young mothers to help others along the journey. They answer questions and offer reassurance, accompany adolescent girls to their clinic visits and they reinforce guidance on taking medicines, avoiding breastfeeding and keeping clinic appointments.

Ms Gray clarifies that the issues her mentees face are not just about HIV. “They do not have resources, they are not safe in their houses, they are afraid a partner or their family might throw them out. They might have two children or more,” she said. A 2012 survey by the Jamaica National HIV/STI Programme found that one in every five adolescent girls in Jamaica aged 15–19 years reported having experienced sexual violence.

Eve for Life Executive Director and co-founder Patricia Watson noted that many girls are being left behind. “A recent study showed that among girls in state care, 30% have sexually transmitted infections, 41% attempted suicide and 35% have been forced to have sex. Also, children infected with HIV at birth are growing older and becoming sexually active, some without having been informed about their status,” she said.

For the organization, responding to HIV among adolescent girls is about far more than promoting sex messages. It is fundamentally about social protection and addressing the structural and social issues that increase girls’ vulnerability.

For the past two years, Eve for Life has spearheaded the Nuh Guh Deh! (Don’t Go There) national campaign to end sex with girls.

“The overarching goal is to contribute to reducing sexual abuse of girls in Jamaica,” Ms Watson said.

The campaign seeks to mobilize Jamaicans to report acts of sexual violence while increasing awareness about the long-term effects of abuse and the links to HIV. Survivor stories highlight the serious issues they face. The approach maximizes participation and ownership from adolescent girls and young women who have survived sexual abuse.

The Nuh Guh Deh song by the Jamaica dub poetry group No-Maddz aims to reduce social acceptance of predatory relationships between older men and girls.

#WhatWomenWant is a virtual space that amplifies the voices of young women, allowing them to share expertise and life experiences, explore solutions and build strengthened networks across gender-related issues, sectors and movements.

Inspired by the impact of the virtual activism surrounding the 2016 Commission on the Status of Women, the Athena Network and its partners, including UNAIDS, used the momentum to build a platform where women could mobilize around the United Nations General Assembly High-Level Meeting on Ending AIDS. From May to July 2016, a social media campaign reached 13 million Twitter accounts and organized five Twitter conversations that engaged 120 000 people. The aim was to hear what women want and to identify specific actions needed to change the lives of women and girls.

The initiative continues to engage an expanding network of primarily women-led organizations working to advance gender equality, with a special focus on areas where health and rights meet.

#WhatWomenWant aims to:

• Focus attention on the urgent need to address women’s rights and gender-related disparities within and beyond the HIV response.
• Act as a catalyst for joined-up action where gender equality, human rights, sexual and reproductive health issues, gender-based violence and the HIV response intersect.
• Put women in charge of defining their own agendas.
• Harness the experience of women to create advocacy tools to advance their own solutions wherever they are.
• Identify opportunities for women to engage stakeholders and to be meaningfully involved in the decision-making processes that most affect their lives.

#WhatWomenWant continues to strengthen links across movements to end child marriage, stop sexual violence, ensure safe and legal abortion rights and advance comprehensive sexuality education.

“At a time when funding for women's rights has been on the decline, the #WhatWomenWant online campaign provides a space for young feminists to contribute to and influence global policy discussions on the HIV response,” says Catherine Nyamburra, a young activist from Kenya. “It provides a space to amplify young feminist voices through various channels of participation and for feminist thought leadership in the response to HIV.”

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United States Global AIDS Ambassador, Deborah Birx, explains why young women are more vulnerable to becoming infected with HIV. 1000 young women are being infected every day = 7000 a week globally.

It is estimated that worldwide only three in 10 adolescent girls and young women between the ages of 15 and 24 years have comprehensive and correct knowledge about HIV.

With inadequate knowledge, young people are ill-equipped to make healthy and safe decisions about their sexual health. However, knowledge, while a crucial foundation, is not in itself sufficient to change behaviour and reduce the risk of HIV infection. Knowledge needs to be combined with the right skills and attitudes, which can be taught and developed through high-quality comprehensive sexuality education (CSE).

CSE not only plays an important role in preventing negative sexual and reproductive health outcomes, but also offers a platform to discuss gender issues and human rights and to promote respectful, non-violent relationships. However, gender-responsive and life-skills-based HIV and sexuality education is only covered in the national curriculum by 15% of the 78 countries analysed in the Global education monitoring report, recently launched by the United Nations Educational, Scientific and Cultural Organization.

When CSE programmes focus on gender and power relations, they are much more likely to show positive effects in reducing sexually transmitted infections and unintended pregnancies than programmes ignoring gender and power.

Such a gender-responsive CSE programme have been implemented in Zambia, which is a signatory to the 2013 Ministerial Commitment on comprehensive sexuality education and sexual and reproductive health services for adolescents and young people in eastern and southern Africa.

The curriculum in Zambia focuses on puberty, HIV prevention, gender equality, sexual and reproductive health, relationships and human rights. The overall goal is for adolescents and young people in Zambia to enjoy better sexual and reproductive health and have better health outcomes overall.

Zambia currently has the largest population of young people in its history, with 52.5% aged below 18 years. During their school years, teachers and sexual health specialists have an ideal opportunity to reach students with correct and appropriate health education information. The onset of adolescence brings not only physical change but also vulnerabilities to human rights abuses, particularly in the areas of sexuality, marriage and childbearing.

Harriet Lilanda, aged 13, a student at Twalumba Primary School in Lusaka, Zambia, thinks that the new sexuality education curriculum is important for young people. “Talking openly about sexuality was not an easy thing, as boys would think I am a loose girl. Parents at home were also closed up on us; now I think the knowledge which we are receiving in class will help me,” she said.

Both teachers and students in Zambia welcomed the introduction of CSE in schools and appreciate its contribution to the attitudes of young people.

“I saw the need to get more involved in teaching comprehensive sexuality education because of the way our society hides information on sexuality,” says Agather Shindende, a teacher at Kabulonga Primary School. “I remember growing up and being told that if you sit next to a boy at school you would conceive. I don’t want the current generation to go through what we went through.”

Schools have the potential to contribute to healthy individual behaviour as well as improved social norms around equality and non-violence, but this cannot be realized if, at the same time, they are places of gender inequality and violence. Access to a safe learning environment must be combined with education about gender equality, non-violent behaviour and sexual and reproductive health for everybody.  

“Among the topics that I have learnt, gender stands out as the most interesting one,” says Harriet Lilanda. “I like gender because it teaches us to be equal. Boys and girls can do the same things—mathematics, science, home economics and technical drawing. I have learnt that we must respect each other and that household chores have to be done by girls and boys.”

Gender practices, norms and values influence sexuality, reproduction and relationships: unequal gender relations make it difficult for women and girls to make choices about sex, as well as increasing their vulnerability to violence, early marriage and adverse sexual and reproductive health outcomes.

Ms Shindende appreciates the benefits of CSE and feels that results are slowly being noticed. “The attitude and behaviour among learners regarding gender norms is slowly changing for the better, especially among boys,” she says. “Previously, boys never wanted to take subjects like home economics because they considered it as a subject for girls only, but today, out of 45 learners, 20 are boys and they willingly chose home economics as one of their optional subjects. Therefore, you can see that teaching comprehensive sexuality education from an early age can open up the minds of our young people. We also have many girls taking art and design courses, including technical drawing, which were exclusively for boys.”

When young women and adolescent girls have access to comprehensive age-appropriate sexuality education before becoming sexually active, they are more likely to make informed decisions about their sexuality and approach relationships with more self-confidence. CSE is also known to increase young girls’ condom use, increase voluntary HIV testing among young women and reduce adolescent pregnancy, especially when linked with non-school-based youth-friendly health services provided in a stigma-free environment.

Watch UNESCO video — Being a Young Person: Comprehensive Sexuality Education

Young women aged 15–24 years are at particularly high risk of HIV infection, accounting for 20% of new HIV infections among adults globally in 2015, despite accounting for just 11% of the adult population. In sub-Saharan Africa, young women accounted for 25% of new HIV infections among adults and women accounted for 56% of new HIV infections among adults. Gender inequalities, including gender-based violence, exacerbate women’s and girls’ physiological vulnerability to HIV and block their access to HIV services. Young people are denied the information and the freedom to make free and informed decisions about their sexual health, with most lacking the knowledge required to protect themselves from HIV. The impact of these barriers is strongest in high-prevalence settings, predominantly in eastern and southern Africa.

Youth activists from around the world call for comprehensive sexuality education and better HIV, sexual and reproductive health and rights services tailored to the needs of adolescents and young people. The activists came together at the ACT!2015 Global Youth Summit, 19 to 21 October 2016 in New Delhi, India from Algeria, Bulgaria, India, Jamaica, Kenya, Mexico, Nigeria, Philippines, South Africa, Uganda, Zambia and Zimbabwe.

Adolescents aged 10-19 years and young people aged 15-24 are among the groups most affected by HIV globally. However, they continue to face tremendous barriers to access services that are youth-friendly and targeted to meet their needs.

Anupriya Patel, Minister of State, Ministry of Health and Family Welfare, India opened the summit stressing the need to ensure meaningful engagement of young people in decision-making processes, especially concerning young people’s health. She committed to engage Indian youth in the national HIV response and achievement of the SDGs. Janine Kuriger, Director, Cooperation in India, Swiss Agency for Development and Cooperation highlighted now was the time to act and ensure that we achieve the youth-related SDGs.

Summit participants agreed that they need to document the challenges youth face in accessing HIV, sexual and reproductive health and rights services. This evidence can be used to develop national youth advocacy campaigns and establish greater accountability frameworks for national governments. National youth alliances can use the frameworks to monitor country progress towards the youth targets and commitments established in the 2016 United Nations Political Declaration on Ending AIDS and the Sustainable Development Goals (SDGs).

At the meeting, organized by UNAIDS, the International Planned Parenthood Federation, and The Dove Foundation—an ACT!2015 national partner in India—each country delegation produced a national plan outlining how young people will gather evidence, use it for advocacy at all levels, and to evaluate national progress towards ending AIDS among youth by 2030.

In South Africa the youth alliance plans to make youth and adolescent health service standards accessible and acceptable to young people in three provinces. In Bulgaria, youth networks will ensure that the comprehensive sexuality education law that was recently approved is being implemented at the local level, and that pending quality gaps are addressed. “We will identify those gaps, advocate for the government to strengthen the law, and push for its full implementation,” said Dina Tomas, ACT!2015 national youth alliance member, Bulgaria.

ACT!2015 is a youth-led social action initiative supported by UNAIDS, IPPF and The PACT, financed by the Swiss Government, aimed at strengthening young people’s evidence gathering and data analysis skills to facilitate advocacy and accountability around policies that limit young people’s access to services. ACT!2015 national youth alliances are composed of 12-15 youth-led and youth-serving organizations and networks per country, which work together to advance young people’s access to HIV and sexual and reproductive health, human rights, participation and leadership in the HIV response.

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UNAIDS teamed up with Boiler Room—the world’s leading community of underground music fans—to promote ProTest HIV, a UNAIDS campaign that encourages young people to get tested for HIV.

A stellar line-up of artists, including Benjamin Bronfman, Joey Purps, Kindness, Grace Weber and Young Paris, performed live from Pioneer Works, a creative arts centre in New York, United States of America, in support of the campaign. During the live event, which was produced by DreamInc, long-time UNAIDS partner Housing Works was present to provide HIV testing, counselling and support.

To reach the end of the AIDS epidemic by 2030, a Fast-Track Target was set to greatly expand HIV testing and ensure that, by 2020, 90% of all people living with HIV will know their HIV status. Engaging new partners with a wide reach is paramount to making this target a reality.

ProTest HIV is a call to action to mobilize a new generation in the AIDS response. The initiative has been developed by young people from all over the world to promote HIV testing. 

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King Oyo Nyimba Kabamba Iguru Rukiidi IV of the Tooro Kingdom in Uganda expressed his commitment to ending the AIDS epidemic as a public health threat by 2030 as he accepted the role of Cultural Champion for HIV and AIDS among Young People in Eastern and Southern Africa on 8 September. At 24, King Oyo is the youngest reigning monarch in the world and has significant influence and respect among young people in the eastern and southern Africa region.

Speaking in Fort Portal, Uganda, in the presence of the UNAIDS Regional Director for Eastern and Southern Africa, Sheila Tlou, King Oyo highlighted the need to eliminate new HIV infections in the kingdom. He emphasized that this should not be the role of women alone and called on men to support their partners, especially with regard to the prevention of mother-to-child transmission of HIV.

Uganda has made much progress in its HIV response. Prevention of mother-to-child transmission of HIV coverage is over 95%, which has led to a reduction in the number of babies born with HIV from approximately 28 000 in 2011 to 3400 in 2015. New HIV infections have also dropped by more than half, from 162 294 in 2011 to 83 000 in 2015. While there have been many successes, new HIV infections remain high. Uganda registers an estimated 33 new HIV infections per day among young people between the ages of 15 and 24 years and comprehensive knowledge of HIV, as well as uptake of HIV prevention and treatment services among young people, remains low. Thus, King Oyo’s new role is critical to addressing HIV prevention among young people.

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UNAIDS and the Elizabeth Glaser Pediatric AIDS Foundation hosted a high-level Congressional briefing in the United States Senate to increase momentum around an ambitious Super-Fast-Track framework—Start Free, Stay Free, AIDS Free. The initiative, which was launched by UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partners in June 2016, outlines a set of time-bound targets to reach in order to stop new HIV infections among children, prevent new HIV infections among adolescents and young women and ensure access to antiretroviral treatment.

The Start Free, Stay Free, AIDS Free initiative builds on the progress made under the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan). The Global Plan made a major contribution to a 60% reduction in new HIV infections among children since 2009 in the 21 countries in sub-Saharan Africa most affected by the epidemic. Speakers highlighted the need to keep up the momentum, warning that complacency could reverse the important gains that have been made.

Michel Sidibé, Executive Director of UNAIDS, brought attention to the need to increase access to treatment for children. He said that despite the treatment scale-up for children, which has grown twofold in the past five years and resulted in a 44% reduction in AIDS-related deaths among children, one in two children living with HIV still does not have access. Without immediate access to treatment, about 50% of children infected at birth will die by age 2.

Senators Edward Markey and Benjamin Cardin, honorary co-hosts of the briefing, and Congressman James Himes referred to the commitment of the American people through PEPFAR, and the important results that have been achieved through the strong partnerships with the countries most affected by the epidemic. Monica Geingos, First Lady of Namibia, expressed appreciation for the support of PEPFAR and UNAIDS in Namibia, and emphasized the need for continued engagement to address challenges related to HIV prevention, inequality and harmful gender norms. Namibia is a leader in the response to HIV and one of six countries—together with Botswana, Mozambique, South Africa, Swaziland and Uganda—that have reached 90% or more of pregnant women living with HIV with life-saving antiretroviral medicines.

Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy, presented data illustrating dramatic recent achievements in stopping new HIV infections among children, and described evolving epidemic dynamics that demand new approaches so that the next phase of the response is successful in addressing the needs of the largest generation of young people the world has ever seen.

Director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, shared an overview of the science behind each pillar of Start Free, Stay Free, AIDS Free, showing that the world has the tools required to achieve the targets. Further innovations in treatment and prevention science hold the promise of accelerating the response by making commodities and services easier to access and use, and overall more effective.

Speaking in his capacity as a board member of the Elizabeth Glaser Pediatric AIDS Foundation, former Senator Christopher Dodd reflected on the bipartisan political commitment behind PEPFAR and the courage demonstrated by a number of elected officials at a time when AIDS was considered to be a difficult and controversial issue. He emphasized that this commitment must be constantly reinforced until the vision of an AIDS-free generation is achieved.

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National policies and practices continue to prevent young people (aged 10-24 years) from accessing the HIV, sexual and reproductive health and rights services that they need. On this International Youth Day, UNAIDS calls on national authorities, civil society organizations, youth activists and all stakeholders in the AIDS response to review and challenge national policies, such as those related to age of consent and spousal consent, which may cause young people to be left behind in the HIV response.

In 2015, about 1800 new HIV infections, and 150 AIDS-related deaths occurred every day among youth aged 15-24 years globally. Almost 4 million young people aged 15-24 are living with HIV, many of whom do not know their HIV status. Adolescents (10-19) are the only age group among whom AIDS-related deaths are increasing. Today, only 36% of young men and 30% of young women (ages 15-24) in sub-Saharan Africa have comprehensive and correct knowledge of how to prevent HIV infection.

Some countries continue to have age of consent policies that deter adolescents from accessing HIV testing and counselling services, without the consent of a parent or guardian. Spousal consent —the legal obligation for a woman or girl to ask permission from her husband to access a service— also hampers access to services for adolescent girls and young women. Adolescent girls and young women bear a disproportionate burden of new HIV infections among young people, 58% globally and 66% in sub-Saharan Africa in 2015. Twenty-seven countries require spousal consent for women to access any sexual and reproductive health service. Moreover, young key populations are frequently subjected to violence, stigma, discrimination and exclusion, and must be ensured a legal environment that respects, protects and promotes their human rights for any progress in the HIV response to be sustained.

UNDP supported a systematic desk review of age-of-consent laws and policies, as part of the All In partnership to engage, mobilize and support adolescents as leaders and agents of social change. The analysis, presented at the 2016 International AIDS Conference in Durban, South Africa recommends that: “at a minimum, countries should (i) specifically provide for age of consent laws that are non-contradictory and that reflect the evolving capacity, age and maturity of the adolescent; (ii) ensure that the age of consent applies to all adolescents, irrespective of sex, gender, sexual orientation or gender identity; and (iii) consider providing for an adolescent who has not reached the age set by law to provide consent based on an assessment of factors, such as the evolving capacity, age and maturity of the adolescent, the risk of HIV infection and the independence from or absence of parental or alternative care. For instance, the age of consent to HIV testing should not be higher than the age of consent to sex so that a sexually active adolescent should be able to consent to HIV testing. Furthermore, once an adolescent can consent to HIV testing, the adolescent should be able to independently consent to other HIV prevention, treatment and care services."

Building on this effort through the All In partnership, UNAIDS is supporting the development of an age of consent advocacy pack, for youth advocates, youth-led and youth serving organizations and networks vested in amending consent laws for the benefit of young people’s access to services. This advocacy pack is expected to be piloted in India and Zimbabwe in the following months.

Moreover, UNAIDS, in partnership with the International Planned Parenthood Federation (IPPF) and The PACT, are supporting youth alliances working on HIV and sexual and reproductive health and rights in Algeria, Bulgaria, India, Jamaica, Kenya, Mexico, Nigeria, Philippines, South Africa, Uganda, Zambia and Zimbabwe through the ACT!2015 youth-led social action initiative. ACT!2015 aims to strengthen young people’s evidence gathering and data analysis skills to facilitate advocacy and accountability around policies that limit young people’s access to services.

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