"An Emergency that Requires Risk Taking”
April 22, 2015
“The very progress we’ve made in HIV/AIDS over the last 20 years is at risk right now because of our lack of engagement with young women.” That was the stark message delivered by Ambassador Deborah Birx, the U.S. Global AIDS Coordinator, at a dynamic, high-level panel at CSIS on April 17, which also featured Ambassador Mark Dybul, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Geeta Rao Gupta, deputy executive director of UNICEF; and Judith Bruce, senior associate and policy analyst at the Population Council. Ambassador Dybul echoed the urgency of new initiatives working to address this population: “This opportunity is one we just can’t miss.”
At the event, CSIS released a new report, Addressing HIV Risk in Adolescent Girls and Young Women. The report examines how adolescent girls and young women have become a priority focus in the fight against global HIV/AIDS, the approaches that have proven effective, and the gaps and challenges that remain. In particular, the report highlights the new DREAMS Partnership, launched by PEPFAR in partnership with the Bill & Melinda Gates Foundation and the Nike Foundation, to significantly reduce new HIV infections in adolescent girls and young women. With $210 million and highly ambitious goals, the DREAMS (Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe) Partnership aims to address HIV risks for adolescent girls and young women in high-burden “hot spots” in 10 countries throughout eastern and southern Africa. The partnership’s goal is to reduce HIV incidence in this population by 25 percent in two years, and by 40 percent in three years. Whether these targets are attainable or simply aspirational remains to be seen, but they represent a determined effort to do things differently.
The panel discussed new ways to increase the empowerment, security, and agency of adolescent girls and young women, including looking at the impact of gender-based violence, cash transfers/incentives, education for girls, safe spaces for girls, and reproductive health/family planning. Although little research has evaluated the combined impact of putting all these interventions together, the panelists agreed that this is the moment to move forward in pursuit of a multisectoral approach. The panelists also expressed the hope that new funding would continue to emerge from multilateral institutions, government partners, and the private sector. These different funders can leverage each other’s investments.
As exciting and laudable as this new attention is, the challenges are daunting, especially given the imperative to show significant impact within a short timeframe. Herein lies the biggest vulnerability of DREAMS: success fundamentally rests on shifting political, social, and cultural norms, legal practices, and economic realities that are notoriously slow and difficult to change. We have long known that girls and young women have represented a glaring gap in the AIDS response, largely because their risks are linked to social and economic factors, and there is no biomedical “magic bullet.” Effective interventions must go beyond the health sector; new approaches are needed to address the structural drivers that directly and indirectly increase girls’ HIV risk, including poverty, gender inequality, sexual violence, and lack of education.
Effectively addressing these issues requires working across government ministries to develop a truly multisectoral approach, which all the panelists agreed was a significant challenge. Other immediate challenges include using sex- and age-disaggregated data to target programming to reach the most vulnerable girls, measuring impact and adjusting in real time what is not working, bringing in new resources, and building toward sustainable approaches. Ultimately, social norms and social protection policies will have to be transformed to catalyze social and economic change, thus allowing adolescent girls to stay in school and to practice HIV-preventive behaviors.
New approaches hold considerable promise: recent data on cash transfers or incentives, for example, have shown dramatic impact; Ambassador Dybul noted: “If you use resources to keep a girl in school, HIV rates in three trials dropped by 30 to 60 percent.” He emphasized: “An investment in health and HIV/AIDS can have a dramatic impact on all of the development goals.”
The panelists agreed that success will require presenting data in a different way to get ministries of finance to understand the impact and for all sectors to stop looking for “silver bullets.” They also noted that success will require the engagement of a wide range of actors, including civil society, the faith community, local governments and communities, and the private sector.
The recent initiatives on adolescents and HIV – notably the DREAMS Partnership and the United Nation’s All In – offer promising platforms for coordinated action. Despite the many challenges, Ambassador Birx reinforced the need for urgent action, calling the situation “an emergency that requires risk-taking.” She presented stark data from South Africa, showing that in parts of KwaZulu Natal, by the age of 24, a stunning 50 percent of young women are infected with HIV. “This should be mobilizing all of the resources with the same focus that we put on Ebola. This should be all of us coming together and saying ‘This is a crisis’…. Hopefully this is a call to action.”