It has been 25 years since the groundbreaking International Conference on Population and Development, held in Cairo, Egypt, in 1994. Since then, significant progress has been made in the area of sexual and reproductive health and the rights of young women and adolescent girls. Voluntary access to modern contraception has increased by 25% since 1994, and the quality of sexual health and HIV services has also vastly improved.

So why are around 7000 young women and girls still becoming infected with HIV every week? And why, in sub-Saharan Africa, are girls aged 15–19 years three times as likely to become infected with HIV than boys the same age?

“We cannot wait another 25 years. We need to push for accountability to make sufficient progress in addressing the current government deficit to deliver on the sexual and reproductive health and rights commitments for women and girls,” said Gogontlejang Phaladi, from the Pillar of Hope Project in Botswana.

Her comments set the tone at an event organized by the Global HIV Prevention Coalition, during the Women Deliver conference in Vancouver, Canada. The event, co-convened by UNAIDS and the United Nations Population Fund (UNFPA) and held on 3 June, put the spotlight on why young women and adolescent girls are being left behind and why they continue to bear the brunt of poor sexual and reproductive health and HIV.

“We are facing an HIV prevention crisis,” said Shannon Hader, UNAIDS Deputy Executive Director, Programme. “While the target was to reduce new HIV infections among adolescent girls and young women to fewer than 100 000, an estimated 340 000 became newly infected with HIV in 2017. We have a huge task ahead of us.”

Speakers at the event discussed the critical importance of engaging young people as leaders of change. “We need to call out policy-makers, traditional and religious leaders, even parents,” said Monica Geingos, First Lady of Namibia. “We must never tell you what to say. Generations before, you were shamed and silenced. Never lower your voices.” She also added that the lack of progress for women and girls is being fuelled by gender discrimination, violence and denial of fundamental freedoms.

UNFPA’s Regional Director for Eastern and Southern Africa, Julitta Onabanjo, also stressed that more needs to be done. “I see a dynamic young women warrior generation here to take the agenda forward—so that by 2030 every young person can fulfil their best potential and nothing is going to hold them back,” she said, while noting that the recommendations of the event should be fed into a summit being held in Nairobi, Kenya, later in 2019.

A major issue preventing young women and girls from accessing HIV services is the requirement by many countries that young people have to be over the age of 18 before they can access health services, including sexual and reproductive health and HIV services, without parental consent. UNAIDS estimates that 78 countries have some form of restrictive laws or policies that prevent young people from accessing sexual health services without the consent of their parents.

As part of efforts to remove these barriers to young people accessing timely and effective HIV prevention, testing and care, during the youth-led Generation Now: Our Health, Our Rights preconference meeting on 2 June, UNAIDS committed to tackle parental consent laws, and their implementation, in five countries in eastern and southern Africa—Lesotho, Malawi, Namibia, Uganda and Zambia. This includes working with young people to ensure that youth are driving change and co-creating the quality services they want and need to have bright and healthy futures.

To advance progress, the participants agreed that investing in community organizations will be critical, as will taking small projects that work to the national level. Nyasha Sithole, from the Athena Network said, “People are watering the leaves, but not the roots. We need to move away from paper and pen to implementation on the ground.”

UNAIDS is a co-convener of the Global HIV Prevention Coalition, which works with countries with a high incidence of HIV to accelerate access to combination HIV prevention services. The coalition seeks to ensure accountability for delivering HIV prevention services at scale in order to achieve the targets of the 2016 United Nations Political Declaration on Ending AIDS, including a 75% reduction in HIV infections towards fewer than 500 000 new infections by 2020. The work of the coalition includes a particular focus on young women and their male partners.