Gender based violence

In 2015 in Africa, 310 000 new HIV infections occurred among adolescent girls and young women between the ages of 15 and 24 years—approximately 6000 new HIV infections per week. In eastern and southern Africa, of the 19 million people living with HIV, women account for more than half (59%), and in western and central Africa 58% of the 6.5 million people living with HIV are women.

These statistics, and an appropriate response to them, were discussed at the Africa Gender Breakfast meeting, held in the run-up to the 28th African Union Heads of State Summit. The meeting was hosted by the Ambassadors to Ethiopia of Australia, Canada and Sweden, as well as the United States of America mission to the African Union, and was attended by the UNAIDS Executive Director, Michel Sidibé, African gender ministers and representatives of civil society and the private sector. The purpose of the meeting was to galvanize the international development community into more urgent action for adolescent girls and young women.

At the meeting, the Australian Minister of International Development and the Pacific, Concetta Fierravanti-Wells, launched a US$ 1 million partnership with the African Union Gender Directorate. Half of these funds will go towards establishing a gender observatory that will produce annual strategic information on the status of women in Africa.

The Canadian Ambassador to Ethiopia, Philip Baker, affirmed that Canada’s international programming will have a renewed focus on gender equality, informed by its recent election onto the Commission on the Status of Women.

The Namibia Planned Parenthood Association clinic in Windhoek is decorated with colourful murals, its walls brightly painted with red ribbons. It has the feel of a welcoming classroom or youth club rather than a medical site. And that’s the idea, because this facility offers sexual and reproductive health services, including HIV testing and counselling, to adolescents and young people aged up to 25 years old.  

The site is staffed by young peer-to-peer counsellors, such as 20-year-old Claudia Ndinundjene, who offers a friendly ear to the clinic’s users and advises them on what to expect from the testing process. She can also give them information on how to protect themselves from unintended pregnancy and HIV and other sexually transmitted infections.

“It’s important for young people to be advised by other young people,” says Ms Ndinunjene, “People need to be helped in a non-judgemental atmosphere that meets their needs—they shouldn’t be asked a lot of questions, but just get the help they need, and quickly.”

The clinic carries out about 200 rapid HIV tests a week. The results are back within 15 minutes. People who test negative are given condoms and advice on how to stay HIV-free. People who test positive are immediately referred to a neighbouring clinic to get access to antiretroviral medicine, which can keep them healthy.

One of the biggest challenges is to get young people to adhere to treatment, especially when long queues translate into long waits at other clinics, which may also be less oriented to the specific needs of young people. That’s why the Executive Director of the clinic, Bravo Linosi, would like to expand services.

“We would like to be able to offer treatment services to the young people who come here as well as HIV testing and counselling,” says Mr Linosi. “This would make a huge difference to young people’s lives, helping them remain healthy by staying on treatment and also helping Namibia to end the AIDS epidemic by 2030.”     

The commodities used at the clinic are provided by the government, while funding and other support comes from a range of partners, including UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

The clinic offers Wi-Fi, so that young people can carry on with their homework or simply stay in touch with their friends online while at the clinic. Mr Linosi has plans for pool nights or TV soccer nights to attract more young men to the clinic. In this way, he hopes that HIV testing can become a more routine part of young people’s lives, particularly young men, whose service uptake is currently poor.

The clinic still sees some older adults who have turned 25 but don’t want to go anywhere else, having been visiting the site for several years.

“People feel happy here and they keep coming back to the clinic because they feel safe—that’s why they don’t want to go anywhere else,” says Nelapewa Baumuller, a senior nurse at the clinic. 

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.”

Video

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 and adolescent girls are disproportionately affected by HIV—in 2015, 75% of new HIV infections in sub-Saharan Africa among adolescents were among adolescent girls aged 10–19 years. There is still an urgent need to promote prevention programmes for young women and adolescent girls, to realize the sexual and reproductive rights of young women and adolescent girls and to guarantee access to services.

Empowering young women and adolescent girls to claim their rights, creating an environment where they can live free from discrimination and violence, is critical. The risk of acquiring HIV tends to be associated with gender inequalities, such as gender-based violence, lack of access to secondary education, early or forced marriage and lack of choice about how and with whom to have sex.

Young women must be meaningfully involved in developing policies and programmes. The causes of inequality also need to be addressed and girls and boys, women and men need to be involved in challenging discrimination, promoting gender equality and preventing gender-based violence.

Investment in comprehensive HIV prevention programmes integrated with sexual and reproductive health and rights will reduce new HIV infections among young women and adolescent girls. But it will also contribute to good health, well-being and safety, not only for girls and women but also for their communities and beyond.

GENEVA, 11 October 2016—On this International Day of the Girl Child, UNAIDS strongly supports the call by the United Nations for better age- and sex-specific data that can be used to improve the health and well-being of girls aged 10–19 years old.

Discrimination and disadvantage have held back the potential of girls and women for centuries. This generation of girls—an estimated 1.1 billion globally in 2016, the largest in history—has the power to change the world, but only if they can advance their knowledge, agency and freedom to make their own life-defining choices and reach their full potential.

“Girls count! We need to know what counts for girls, to make sure that they start life HIV-free, stay HIV-free or remain AIDS-free,” said UNAIDS Executive Director, Michel Sidibé.

Globally in 2015:

• Around 120 million girls (aged 15–19 years old) worldwide had experienced rape or other forced sexual acts at some point in their lives.
• In high HIV prevalence areas, women exposed to intimate partner violence were 1.5 times more likely to acquire HIV, with child marriage a risk factor for intimate partner violence.
• Almost 1100 adolescent girls and young women (aged 15–24 years old) were newly infected with HIV every day.
• About 70% of adolescent girls and young women (aged 15–24 years old) did not have comprehensive and correct knowledge of HIV.
• HIV, human papillomavirus (HPV) and cervical cancer are strongly linked. Giving HPV vaccine to all girls aged 9 to 13, regardless of HIV status, will prevent cervical cancer in later life.

The bold targets of the 2016 Political Declaration on Ending AIDS that promote the empowerment of women and girls uphold rights and gender equality as central to achieving the Sustainable Development Goals. They provide our greatest opportunity to guaranteeing that this generation of girls reach their full potential. The collection and analysis of age- and sex-specific data enriched and informed by the experiences and voices of the world’s girls and young women will put them on the Fast-Track to ending AIDS.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.