Women and girls

A global coalition of more than 80 youth organizations working on HIV (the PACT), and Youth Voices Count (YVC) launched a poll to get a sense of what young people know about sexual reproductive health.

More than half of the 270,000 young people aged 10-24 from 21 countries who responded to the U-Report poll (54% of boys and young men, and 58% of girls and young women) sought HIV and other services at a health centre or clinic in the previous three months.  About 36% of young people aged 10-24 who did not seek services reported feeling uncomfortable visiting a health centre or clinic, and more than 28% of young people (both sexes) said they felt scared to seek services.

The poll with support from UNAIDS, UNICEF and UNFPA was complemented by an in-depth survey and interviews led by YVC, which showed that approximately 15% of those who accessed any sexual health services in the past 6 months experienced refusal or mistreatment because of their age, sexual orientation, gender identity or HIV status. And of those who felt mistreated because of their age, 55% identified as gay, bisexual, and 25% identified themselves as living with HIV. Further, 32% of young gay, bisexual men and other young men who have sex with men, and 50% of young transgender people, felt that they had been discriminated against because of their gender identity or sexual orientation. Finally,16% of young people who identified themselves as living with HIV said they had been mistreated because of their HIV status.

Although healthcare settings should be safe spaces for those receiving care, this is not the case. Policies and attitudes remain barriers to youth-friendly HIV and sexual and reproductive health services. Indeed, 37% of respondents who reported having visited a clinic were not willing to recommend doing so to their peers.

This year’s theme for International Youth Day is Safe Spaces for Youth, highlighting the need of young people for safe spaces to come together, hang out, and participate in decision making processes as well as freely express themselves. This includes in healthcare settings, which should be places of safety and refuge, free from stigma, maltreatment, and violence.

Every day, approximately 1600 young people are infected with HIV, while one young person dies of AIDS-related illnesses every 10 minutes. Young women aged 15-24 are particularly affected. In sub-Saharan Africa, young women are twice as likely to be infected with HIV as their male counterparts. And young key populations (including gay men and other men who have sex with men, bisexual people, transgender people, young sex workers and young people who inject drugs) are at a high risk of HIV around the world due to rights violations, discrimination, exclusion, criminalization and violence. Of the young people living with HIV globally, most do not know their status.

Download more slides like this from 2018 Global AIDS Update Miles to Go 

Sitting on center stage, clutching a microphone, Chinmay Modi along with a dozen young people answered questions about HIV during an all-youth panel session at the Amsterdam 2018 AIDS conference.

The 25-year-old born with HIV described his struggle accessing services. "In India, sex is a big taboo. A 16-year-old cannot buy condoms for example and parents need to give consent to be tested for HIV." He said educating children and parents is key. His greatest desire involves pushing for specific youth-focused services.

Dany Stolbunov from Ukraine echoed that sentiment, saying "Nothing for us, without us." He said that in his region stigma and discrimination kept people from even accessing services. He bemoaned the fact that young people in Ukraine have limited information and are not seen as a priority.  

HIV FACTS

In 2017, there were approximately 250 000 new HIV infections and 38 000 AIDS-related deaths among adolescents and 1.8 million adolescents living with HIV globally.

Adolescent girls in sub-Saharan Africa are disproportionately affected by new HIV infections, making up 56% of new HIV infections among adolescents globally.

HIV is a leading cause of death among adolescents (10-19 years).

"We are ready to fight for our rights," he added, explaining that young people have a voice and want to use it.

Bruna Martinez strongly believes that broad sexual education discussing gender, health issues and pleasure would not only limit stigma, it would also make teenagers fear HIV less.

"HIV should not be in a vacuum," she said. "We are a generation that can discuss sex and that's a great thing; so give us the tools that tip things in our favor."

All agreed that teenagers and young people have the most at stake in ending the HIV epidemic. Their demand is clear: go beyond scholarships by empowering us.

Melodi Tamarzians, the Dutch youth ambassador for sexual and reproductive health and rights, said, "Do not tick the youth box by giving us a token position." In her view, to enable young people, adults need to invest in them and give them advisory roles.

AIDS 2018 prided itself on giving a greater space to young people in Amsterdam. Youth and junior investigators made up more than one-third of the submissions presented at the conference, according to the conference organizer, the International AIDS Society (IAS.) In addition, young people got the most scholarships than at any other conference. And the Global Village (a free admission space by the conference area) featured the largest space conceived of and run by young people. It included a snack area, a mini-indoor football field, a safe-space theater area and youth-led activities, and booths such as a radio recording area, a youth against AIDS t-shirt stand and even an exhibit about the vagina.

Ms Martinez volunteered and then worked with the Amsterdam Youth Force that mobilized and organized other young people to make the youth space their own. "At this conference, we showed everybody that we could deliver," she said.

She hopes that this meaningful youth presence will carry over. "It's important that we are not being catered to but rather that we are recognized," she said, her AIDS 2018 lanyard laden with pins and stickers. She sees her recent stint with the Youth Force as a way to change things. "There are still so many young people getting infected with HIV and dying. It means we are failing and the system is not working," Ms Martinez said. In her view, HIV policy has to also come from the ground upwards. She emphasized peer-to-peer education and valuing local knowledge. Standing in front of a huge 'Let's face HIV together' she said, "We speak the language of the young people and we know what we are living, so acknowledge us fully."

Worldwide every year, 12 million girls under the age of 18 years are married—that's equivalent to 23 girls every minute. Married too soon. Their personal growth, health and fundamental rights and freedoms denied. Gender inequalities and gender-based violence force thousands of girls into marriage and motherhood. Girls with no education are three times as likely to marry by the age of 18 years as those with a secondary or higher education. And girls who marry before they are 15 years old are 50% more likely to face physical or sexual violence from a partner.

Child marriage often means that girls find it difficult to negotiate safer sex with their husbands, who are commonly older and more sexually experienced, making the girls especially vulnerable to HIV and other sexually transmitted infections.

UNAIDS’ latest report, Miles to go, highlights the reality that adolescent girls and young women aged 15–24 years, particularly those from sub-Saharan Africa, are being left behind. Every week, more than 6600 adolescent girls and young women become newly infected with HIV, with sub-Saharan African women and girls bearing the brunt, accounting for one in four HIV infections in 2017 despite being just 10% of the population.

Girls Not Brides, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Ministry of Foreign Affairs of the Netherlands and UNAIDS hosted a panel discussion on the issue of child marriage at the International AIDS Conference in Amsterdam, Netherlands, bringing together panellists from across regions, sectors and generations. Monica Geingos, the First Lady of Namibia, was a special guest speaker.

When girls and women are empowered with rights and given equitable access to education, enabled to participate fully in the labour force and equitably represented in government and decision-making bodies, the benefits far outreach improving the lives of the individual woman. Their families, communities and countries thrive. Yet, more than 150 million girls will become child brides by 2030.

The panellists highlighted the need to tackle the underlining determinants behind both HIV and child marriage. They emphasized the need for a comprehensive multisectoral and resourced approach. Gender inequality and harmful social norms have to be challenged. The solutions, they said, include keeping girls in school, providing health services that serve young people’s needs and mobilizing families and communities, including men and boys.

A meeting at the 2018 International AIDS Conference, being held from 23 to 27 July in Amsterdam, Netherlands, has showcased how Kenya is responding to the challenges and opportunities on the way towards validation of the elimination of mother-to-child transmission of HIV in a high-burden context. 

Building on the Start Free Stay Free AIDS Free framework, specific attention is being given in Kenya to ensuring access to treatment for children and adolescents living with HIV, while addressing inequities, particularly among adolescent girls and young women.

The participants heard about the role of high-level champions—including community leaders, parents, religious leaders and other relevant stakeholders—highlighting the need for action at all levels, based on robust programmatic data.

Kenya has made significant progress in preventing new HIV infections among children, which fell from an estimated 13 000 in 2010 to 8000 in 2017. This has been possible through programmes such as the mentor mother initiative, which supports and cares for women living with HIV, the mother–baby pair approach, which synchronizes appointments for the mother and the child at the health facility, and audits of every child exposed to HIV in order to identify barriers in accessing health facilities.

The leadership of Margaret Kenyatta, the First Lady of Kenya, and her Beyond Zero Campaign have been instrumental in raising awareness on the importance of services to promote the health of mothers and children, including HIV prevention.

The participants heard, however, that more needs to be done to ensure that progress is equal across the country. Progress has been threatened by recent challenges, such as a health workers strike, which has affected antenatal care and testing coverage, and reduced community support, which has affected demand creation for HIV services.

The participants decided that there was an urgent need to scale up HIV programmes. This would be complemented by innovations in tracking the targets for paediatric and adolescent HIV and accounting for every mother and child. Furthermore, the resilience of the health system needs to be strengthened.

The meeting, held on 24 July, was jointly organized by the Ministry of Health of Kenya, UNAIDS and the Elizabeth Glaser Pediatric AIDS Foundation.

New HIV infections are rising in around 50 countries, AIDS-related deaths are not falling fast enough and flat resources are threatening success. Half of all new HIV infections are among key populations and their partners, who are still not getting the services they need

PARIS/GENEVA, 18 July 2018—UNAIDS is issuing countries with a stark wake-up call. In a new report, launched today in Paris, France, at an event co-hosted with Coalition PLUS, UNAIDS warns that the global response to HIV is at a precarious point. At the halfway point to the 2020 targets, the report, Miles to go—closing gaps, breaking barriers, righting injustices, warns that the pace of progress is not matching global ambition. It calls for immediate action to put the world on course to reach critical 2020 targets.

“We are sounding the alarm,” said Michel Sidibé, Executive Director of UNAIDS. “Entire regions are falling behind, the huge gains we made for children are not being sustained, women are still most affected, resources are still not matching political commitments and key populations continue to be ignored. All these elements are halting progress and urgently need to be addressed head-on.”

HIV prevention crisis

Global new HIV infections have declined by just 18% in the past seven years, from 2.2 million in 2010 to 1.8 million in 2017. Although this is nearly half the number of new infections compared to the peak in 1996 (3.4 million), the decline is not quick enough to reach the target of fewer than 500 000 by 2020.

The reduction in new HIV infections has been strongest in the region most affected by HIV, eastern and southern Africa, where new HIV infections have been reduced by 30% since 2010. However, new HIV infections are rising in around 50 countries. In eastern Europe and central Asia the annual number of new HIV infections has doubled, and new HIV infections have increased by more than a quarter in the Middle East and North Africa over the past 20 years.

Treatment scale-up should not be taken for granted

Due to the impact of antiretroviral therapy roll-out, the number of AIDS-related deaths is the lowest this century (940 000), having dropped below 1 million for the first time in 2016. Yet, the current pace of decline is not fast enough to reach the 2020 target of fewer than 500 000 AIDS-related deaths.

In just one year, an additional 2.3 million people were newly accessing treatment. This is the largest annual increase to date, bringing the total number of people on treatment to 21.7 million. Almost 60% of the 36.9 million people living with HIV were on treatment in 2017, an important achievement, but to reach the 30 million target there needs to be an annual increase of 2.8 million people, and there are indications that the rate of scale-up is slowing down.

West and central Africa lagging behind

Just 26% of children and 41% of adults living with HIV had access to treatment in western and central Africa in 2017, compared to 59% of children and 66% of adults in eastern and southern Africa. Since 2010, AIDS-related deaths have fallen by 24% in western and central Africa, compared to a 42% decline in eastern and southern Africa.

Nigeria has more than half (51%) of the HIV burden in the region and there has been little progress in reducing new HIV infections in recent years. New HIV infections declined by only 5% (9000) in seven years (from 179 000 to 170 000) and only one in three people living with HIV is on treatment (33%), although HIV treatment coverage has increased from just 24% two years ago.

Progress for children has slowed

The report shows that the gains made for children are not being sustained. New HIV infections among children have declined by only 8% in the past two years, only half (52%) of all children living with HIV are getting treatment and 110 000 children died of AIDS-related illnesses in 2017. Although 80% of pregnant women living with HIV had access to antiretroviral medicines to prevent transmission of HIV to their child in 2017, an unacceptable 180 000 children acquired HIV during birth or breastfeeding—far away from the target of fewer than 40 000 by the end of 2018.

“One child becoming infected with HIV or one child dying of AIDS is one too many,” said Mr Sidibé. “Ending the AIDS epidemic is not a foregone conclusion and the world needs to heed this wake-up call and kick-start an acceleration plan to reach the targets.”

Key populations account for almost half of all new HIV infections worldwide

The report also shows that key populations are not being considered enough in HIV programming. Key populations and their sexual partners account for 47% of new HIV infections worldwide and 97% of new HIV infections in eastern Europe and central Asia, where one third of new HIV infections are among people who inject drugs.

“The right to health for all is non-negotiable,” said Mr Sidibé. “Sex workers, gay men and other men who have sex with men, prisoners, migrants, refugees and transgender people are more affected by HIV but are still being left out from HIV programmes. More investments are needed in reaching these key populations.”

Half of all sex workers in Eswatini, Lesotho, Malawi, South Africa and Zimbabwe are living with HIV. The risk of acquiring HIV is 13 times higher for female sex workers, 27 times higher among men who have sex with men, 23 times higher among people who inject drugs and 12 times higher for transgender women.

“Communities are echoing UNAIDS’ call,” said Vincent Pelletier, positive leader and Executive Director of Coalition PLUS. “We need universal access to adapted prevention services, and protection from discrimination. We call upon world leaders to match commitments with funding, in both donor and implementing countries.”

Stigma and discrimination persists

Discrimination by health-care workers, law enforcement, teachers, employers, parents, religious leaders and community members is preventing young people, people living with HIV and key populations from accessing HIV prevention, treatment and other sexual and reproductive health services.

Across 19 countries, one in five people living with HIV responding to surveys reported being denied health care and one in five people living with HIV avoided visiting a health facility for fear of stigma or discrimination related to their HIV status. In five of 13 countries with available data, more than 40% of people said they think that children living with HIV should not be able to attend school with children who are HIV-negative.

New agenda needed to stop violence against women

In 2017, around 58% of all new HIV infections among adults more than 15 years old were among women and 6600 young women between the ages of 15 and 24 years became infected with HIV every week. Increased vulnerability to HIV has been linked to violence. More than one in three women worldwide have experienced physical or sexual violence, often at the hands of their intimate partners.

“Inequality, a lack of empowerment and violence against women are human rights violations and are continuing to fuel new HIV infections,” said Mr Sidibé. “We must not let up in our efforts to address and root out harassment, abuse and violence, whether at home, in the community or in the workplace.”

90–90–90 can and must be achieved

There has been progress towards the 90–90–90 targets. Three quarters (75%) of all people living with HIV now know their HIV status; of the people who know their status, 79% were accessing treatment in 2017, and of the people accessing treatment, 81% had supressed viral loads.

Six countries, Botswana, Cambodia, Denmark, Eswatini, Namibia and the Netherlands, have already reached the 90–90–90 targets and seven more countries are on track. The largest gap is in the first 90; in western and central Africa, for example, only 48% of people living with HIV know their status.

A big year for the response to tuberculosis

There have been gains in treating and diagnosing HIV among people with tuberculosis (TB)—around nine out of 10 people with TB who are diagnosed with HIV are on treatment. However, TB is still the biggest killer of people living with HIV and three out of five people starting HIV treatment are not screened, tested or treated for TB. The United Nations High-Level Meeting on Tuberculosis in September 2018 is an opportunity to bolster momentum around reaching the TB/HIV targets.

The cost of inaction

Around US$ 20.6 billion was available for the AIDS response in 2017—a rise of 8% since 2016 and 80% of the 2020 target set by the United Nations General Assembly. However, there were no significant new commitments and as a result the one-year rise in resources is unlikely to continue. Achieving the 2020 targets will only be possible if investments from both donor and domestic sources increase.

Ways forward

From townships in southern Africa to remote villages in the Amazon to mega-cities in Asia, the dozens of innovations contained within the pages of the report show that collaboration between health systems and individual communities can successfully reduce stigma and discrimination and deliver services to the vast majority of the people who need them the most.

These innovative approaches continue to drive the solutions needed to achieve the 2020 targets. When combination HIV prevention—including condoms and voluntary medical male circumcision—is pursued at scale, population-level declines in new HIV infections are achieved. Oral pre-exposure prophylaxis (PrEP) is having an impact, particularly among key populations. Offering HIV testing and counselling to family members and the sexual partners of people diagnosed with HIV has significantly improved testing access.

Eastern and southern Africa has seen significant domestic and international investments coupled with strong political commitment and community engagement and is showing significant progress in achieving the 2020 targets.

“For every challenge there is a solution,” said Mr Sidibé. “It is the responsibility of political leaders, national governments and the international community to make sufficient financial investments and establish the legal and policy environments needed to bring the work of innovators to the global scale. Doing so will create the momentum needed to reach the targets by 2020.”

In 2017, an estimated:

36.9 million [31.1 million–43.9 million] people globally were living with HIV

21.7 million [19.1 million–22.6 million] people were accessing treatment

1.8 million [1.4 million–2.4 million] people became newly infected with HIV

940 000 [670 000–1.3 million] people died from AIDS-related illnesses

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.

For decades, women’s rights leaders and civil society organizations have been actively working to advance gender equality. Civil society have also been critical partners to UNAIDS since its inception in 1996, UNAIDS being the only United Nations organization to include non-governmental organizations as active participants on its board.

The partnership between UNAIDS and civil society continues to be essential and on 18-19 June, UNAIDS and the ATHENA Network co-convened a meeting on addressing sexual harassment. The meeting provided a unique opportunity for dialogue with civil society on concerns and questions around sexual harassment and gender equality, as well as to provide valuable inputs on how to strengthen the work of UNAIDS in this area.

UNAIDS welcomed more than 30 women’s rights leaders and civil society advocates to share good practices, articulate concerns and discuss ways of moving forward to strengthen rights-based responses to sexual harassment and protect survivors and people who come forward to report incidents of harassment.

Participants expressed a wide range of perspectives on actions taken to date and demonstrated a shared commitment to work hand in hand with UNAIDS to ensure that sexual harassment both within and beyond UNAIDS is addressed and prevented.

They agreed that measures to transform organizational culture, ensure perpetrators are held to account and protecting survivors and whistle-blowers were central actions for UNAIDS to take. The importance of not only taking an inward approach but of also prioritizing efforts to  promote gender equality and diversity, and put an end to gender-based violence as part of UNAIDS work to end AIDS globally was emphasized.

UNAIDS Staff Association shared results from a recent UNAIDS staff survey which found that 4% of staff had experienced some kind of sexual harassment within the workplace, yet only one person said they that they had come forward to report the incident. UNAIDS leadership outlined new measures UNAIDS is putting in place, including a confidential 24-hour hotline, training and 360-degree evaluations, to stop harassment of any kind within UNAIDS, ensure that staff are supported in reporting incidents and that any incidents reported are addressed immediately. UNAIDS has also recently launched a Gender Action Plan 2018-2023, which includes a series of measures to strengthen organizational culture.

Active discussions took place with and between civil society representatives who brought their personal experiences, reflections and inputs to strengthen current efforts being undertaken by UNAIDS and other stakeholders. The meeting also provided an opportunity to hold discussions with other Geneva-based United Nations organizations working to eliminate sexual harassment in the workplace.

The meeting builds on a series of discussions taking place around the world on the issue of sexual harassment, including those led by UNAIDS. These have included a dialogue with civil society and women leaders at the Commission on the Status of Women in March 2018, a virtual Town Hall meeting in May 2018–which engaged over 40 civil society leaders, as well as individual meetings held with civil society by UNAIDS senior management in Kenya, South Africa and other parts of the world.

UNAIDS will continue to continue to engage with women’s rights leaders and activists to learn from their experiences and draw on their expertise to develop and implement policies to address harassment in the workplace and to tackle the broader issues of gender inequality, gender-based violence and discrimination as central to efforts to end AIDS.

UNAIDS has taken a number of measures to reinforce its policy of zero-tolerance of sexual harassment. A five-point plan is being implemented to ensure that all forms of harassment and abuse of authority are identified early on, that measures taken are properly documented and that action follows due process and is swift and effective, with appropriate protection both for survivors and for whistle-blowers.

UNAIDS is also making it easier for people to report complaints in a secure and confidential way through an anonymous and confidential Integrity Hotline, which is open 24 hours a day, every day, and provides staff with an alternative way to report complaints.

In addition, UNAIDS has called for its Programme Coordinating Board Bureau to lead an Independent Expert Panel on harassment to provide policy recommendations on how UNAIDS can improve its response to harassment and identify areas where reform is needed. 

UNAIDS has recently launched its Gender Action Plan 2018-2023, to ensure gender equality in the workplace as a human right and critical to the performance and effectiveness of UNAIDS.

Lucy Wanjiku is a young mother living with HIV and team leader of Positive Young Women Voices from Kenya. She was just 19 years old when she found out that she was living with HIV, a devastating shock for her. “It was one thing to become an adolescent mother and another to be HIV-positive,” said Lucy. “I was discriminated against by the community, my family and even at the health facility. There is no real support structure available.”

Ms Wanjiku’s story is a familiar one in sub-Saharan Africa. Around 6900 adolescent girls and young women between the ages of 15 and 24 years become newly infected with HIV every week—5500 of whom live in sub-Saharan Africa.

Ms Wanjiku is now using her voice to help others and raise awareness around the challenges that young women face in Kenya on a daily basis. At an event organized by UNAIDS at the European Union Development Days (EDD) forum in Brussels, Belgium, Ms Wanjiku gave the audience an alarming insight into issues around gender-based violence, early marriage, intimate partner violence, transactional sex, low school attendance rates and lack of economic empowerment, which are all key risk factors for HIV that young women and girls face every day.

“Support groups work,” said Ms Wanjiku. “Community-based organizations can facilitate this smoothly when supported. We need to engage more adolescent girls and young women leaders at the decision-making tables to tailor what works for us so that it’s sustainable.”

The event, entitled Empowering Women and Girls—Reducing New HIV Infections, highlighted the importance of empowering young women and girls to stop new HIV infections. Held on 5 and 6 June, the EDD forum was attended by more than 6000 people from 140 countries, representing 1200 organizations from the development community.

“Considerable efforts need to be taken to reach the Fast-Track Target of reducing the number of new HIV infections among adolescent girls and young women to below 100 000 per year by 2020,” said Tim Martineau, UNAIDS Deputy Executive Director, Programme, a.i. “The HIV Prevention 2020 Road Map, launched by UNAIDS, the United Nations Population Fund and partners in 2017, will be critical to guiding efforts and I cannot stress enough the importance of also engaging men and boys for long-lasting change.”

The event was moderated by Ebony Johnson, a public health and gender strategist, and brought together a wealth of expertise and experience from youth activists, people living with HIV, civil society and international development representatives.

Highlighting the importance of access to information, Melodi Tamarzians, a youth ambassador on sexual and reproductive health and rights from the Netherlands, highlighted that only 34% of young people have accurate knowledge about HIV prevention and transmission. “I believe in the infinite power of young people to make a change for themselves and their communities,” she said. “And they need access to comprehensive sexuality education, which is not only a key for preventing violence but has far-reaching individual and societal benefits.”

Winnie Byanyima, the Executive Director of Oxfam International, addressed policy barriers and reminded the audience that in order to enhance agency among young women and girls, there needs to be space for young people, especially women and girls, to take part in decision-making processes. She added that investment needs to be secure in order to strengthen economic empowerment to enhance women’s health. “Young women affected by HIV can be afraid of accessing health care because of a lack of confidentiality, discrimination and cost. We need to invest in peer education and free access to health care to empower women to protect their health,” she said.

UNAIDS, together with a wide range of partners, including women living with HIV and women’s organizations, works towards meeting the needs of girls and women across all targets in the 2016 United Nations Political Declaration on Ending AIDS. UNAIDS works towards ensuring that women and girls everywhere have their rights fulfilled and are empowered to protect themselves against HIV and that all women and girls living with HIV have immediate access to treatment and care.