Women and girls

Women are disproportionality affected by HIV, particularly in sub-Saharan Africa. However, in some countries the imbalance is severe.

According to data collected in the Demographic and Health Surveys 2009–2017—a programme that collects and disseminates data on health and populations in developing countries—in the past decade HIV prevalence has been up to three times higher among 20–29-year-old women than men in some of the countries with the highest HIV burden in western and central Africa: Cameroon, Côte d’Ivoire and Ghana (see graph below). 

Data for 20–29-year-olds show the importance of HIV transmission through sex. Since men tend to start having sex at an older age than women, data for people who are 20–29 years old better cover both sexually active women and sexually active men. It is clear that women in the region are not being reached with the range of HIV prevention options they need to stop them becoming infected with HIV through sex.

With the ongoing drive in western and central Africa to match the progress made against HIV in eastern and southern Africa, there is a vital need for awareness of the disproportionate impact that the HIV epidemic has had, and continues to have, on women in the region. 

While Botswana has made excellent progress in achieving the UNAIDS 90–90–90 treatment targets, evidence shows it has experienced a 4% increase in new HIV infections from 2010 to 2017, from 13 000 to 14 000. This is against the backdrop of a massive 30% decrease in new HIV infections across the eastern and southern African region.

Adolescent girls and young women are particularly at risk of HIV infection, as well as unintended pregnancy and sexual and gender-based violence. In 2017 there were 1 500 new HIV infections among adolescent girls between the ages of 10 and 19 years, compared to fewer than 500 new infections among adolescent boys the same age.

As a result, Neo Masisi, the First Lady of Botswana, uses her voice to advocate for better health outcomes for adolescent girls and young women. In an effort to drive high-impact, age-appropriate and gender-sensitive interventions, she holds dialogues with adolescent girls and young women about their experiences.

On 9 December 2018, she hosted a post-World AIDS Day event attended by 100 adolescent girls and young women, to bring to light to issues they face on a daily basis—unintended pregnancy, gender-based violence, access to sexual and reproductive health rights and how these intersect with HIV. “I am concerned about how young people have not known a life without HIV and hence they are more vulnerable to social ills,” said Mrs Masisi.

During the dialogue, Richard Matlhare, a representative from the National AIDS Coordinating Agency, emphasised that “the five-year Botswana National Strategic Framework on HIV/AIDS provides a paradigm shift, which is a sector-specific strategy explicitly focusing on adolescent girls and young women and their male partners.”

Participants at the dialogue also previewed the Pan-African movie Faces, directed by Joseph Adesunloye and starring South African actress, Terry Pheto, who plays the character of Aisha, a woman who has to deal with HIV infection and gender-based violence.

Ms Pheto, who attended the dialogue, spoke about her role as an actress and influencer and how she aims “not simply to entertain, but also educate, adolescent girls and young women and men on HIV and gender-based violence.” She added that projects such as these are “very close to my home and heart.”

Cervical cancer—an illness that can be prevented by vaccination against the human papillomavirus (HPV) and that is curable if detected and treated early—is developed by more than 500 000 women each year, half of whom die of the disease. If cervical cancer prevention, screening and treatment efforts are not urgently scaled up, it is projected that this number could double by 2035.

Cervical cancer is an AIDS-defining illness, since women living with HIV who become infected with HPV are more likely to develop pre-invasive lesions that can, if left untreated, quickly progress to invasive cancer—women living with HIV are four to five times more likely to develop invasive cervical cancer. HPV infection has been found to significantly increase the risk of HIV transmission for both men and women.

Thanks to HIV treatment, many more women living with HIV are living long and healthy lives, but it is imperative that women living with HIV do not succumb to other illnesses, including cervical cancer. “It makes no sense to save a woman’s life from AIDS, only to let her die from treatable or preventable cancer,” President George W. Bush, whose George W. Bush Institute is leading efforts to end AIDS and cervical cancer, said in October 2015.

Nine out of 10 women who die from cervical cancer live in low- and middle-income countries. Given that the burden of HIV is primarily felt in low- and middle-income countries, and particularly by adolescent girls and young women, responding to both cervical cancer and HIV together in those countries is vital. Unfortunately, however, most low- and middle-income countries with a high prevalence of HIV have limited programmes for cervical cancer prevention and control.

There is a growing awareness of the need to maximize synergies between the AIDS response and efforts to prevent, diagnose and treat cervical cancer through HPV vaccination, education, screening and treatment. Likewise, existing HIV programmes can play a strategic role in expanding cervical cancer prevention services.

Reducing deaths from cervical cancer requires a wide-ranging approach that includes the following:

• Health education, including age-appropriate comprehensive sexuality education.
• HPV vaccination for adolescent girls.
• Screening all women at risk of developing cervical cancer. Screening programmes should include HIV counselling, testing and treatment, as well as other sexual and reproductive health services and treatment of precancerous cervical lesions and invasive and advanced cervical cancer.
• Ensuring access to palliative care, when needed.

“All women living with HIV need access to information on HPV and should be offered cervical cancer screening and treatment if necessary,” said Michel Sidibé, Executive Director of UNAIDS.

In May 2018, the United States President’s Emergency Plan for AIDS Relief, the George W. Bush Institute and UNAIDS launched a joint effort through a US$ 30 million partnership to accelerate efforts in eight sub-Saharan African countries to ensure that women and girls living with HIV are a priority in national cervical cancer prevention and control programmes.

“Thanks to the generosity of the American people, the United States President’s Emergency Plan for AIDS Relief has saved the lives of millions of HIV-positive women around the world,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy, at the launch of the partnership in May 2018. “We must ensure these same women—mothers, daughters, aunts and grandmothers—who are living with HIV and thriving do not succumb to cervical cancer.”

Faith-based organizations have long played a critical role in the response to tuberculosis (TB). Many faith-based health service providers have implemented effective TB/HIV responses modelled on decades of work on TB. Today, faith-based organizations are delivering effective, high-quality TB/HIV services that complement national public health programmes in the countries most affected by TB and HIV.

Successful TB/HIV responses address both the biomedical and the social determinants that underpin these illnesses, such as poverty, inequality, situations of conflict and crisis, compromised human rights and criminalization. Children and adolescents are particularly vulnerable to infection and the impact of TB/HIV on their families. Because they have positions of trust at the heart of communities, faith-based organizations can provide services and support that extend beyond the reach of many public sector health systems.

To provide an opportunity to strengthen relationships and forge new partnerships, on 27 September the World Council of Churches–Ecumenical Advocacy Alliance, in collaboration with UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the United Nations Interagency Task Force on Religion and Development, hosted an interfaith prayer breakfast on the sidelines of the 73rd Session of the United Nations General Assembly in New York, United States of America. Keynote speakers and table discussions focused on the outcomes of the United Nations High-Level Meeting on Tuberculosis, which took place on 26 September, and examined how the longstanding experience of faith-based organizations in responding to TB/HIV can support the new declarations agreed by Member States during the historic high-level meeting.

The participants included faith leaders and health service providers from different religious traditions. Survivors of multidrug-resistant TB brought a powerful sense of urgency and reality to the discussion. The participants renewed their call to national governments to not only maintain, but increase, support in order to end AIDS and TB as public health threats by 2030.

Action-based partnership to support women and girls announced by health and political leaders at a high-level event at the 73rd Session of the United Nations General Assembly

GENEVA, 24 September 2018—UNAIDS, the Chair of the H6 partnership (six United Nations bodies working on health-related issues), and the African Union have pledged to enhance their collaboration to eliminate sexual and gender-based violence, prevent HIV and protect women’s health and rights in humanitarian settings.

A new programme of work on this common agenda was announced at a special high-level event held in New York, United States of America, on the margins of the 73rd Session of the United Nations General Assembly.

“We are gathered here to coordinate our efforts among the African Union and the United Nations to plan and intervene so that people's rights are protected, HIV is prevented and the right to health is promoted,” said Faustin-Archange Touadéra, the President of the Central African Republic, who chaired the meeting.

The rise in the frequency and scale of humanitarian crises is having a devastating impact, particularly on women and children. In 2017, around 68 million people were forcibly displaced globally as a result of persecution, conflict or generalized violence—an increase of 2.9 million from 2016 and a new record high.

“We know that it is time to act. More than 2 billion people live in countries affected by fragility, violence and conflict—most are women and girls. This is unacceptable. We need political visibility and intensified international cooperation to eliminate gender-based violence and protect the health of women and children in humanitarian settings,” said Michel Sidibé, Executive Director of UNAIDS and H6 Chair.

UNAIDS will support the African Union in developing a joint African Union–United Nations plan of action. The plan will include developing training and awareness tools for uniformed personnel in peacekeeping operations and ensuring better reporting rates on sexual exploitation and violence against women and girls.

“The partnership between the United Nations and the African Union provides an opportunity to reinforce each other’s work and employ joint and comprehensive responses to the needs of vulnerable populations in crisis situations,” said Smail Chergui, African Union Commissioner for Peace and Security.

Protecting the health and rights of women and young people will be critical to mitigating fragility, conflict and disaster. It is estimated that 60% of all preventable maternal deaths occur in humanitarian and conflict settings, which equates to nearly 500 deaths each day.

“In South Sudan, 52% of our young sisters are married before their 18th birthday. I urge leaders not to remain loudly quiet. We call for the inclusion of women in political processes. It is our bodies, our lives and our futures at stake. We have the right to the highest attainable standard of health, whether in conflict or not,” said Riya William Yuyada, Executive Director, Crown the Woman, South Sudan.

There are currently too few successful programmes to prevent gender-based violence during conflict and against refugee populations. Studies have shown that violence against women and girls increases during periods of conflict, with rape and other forms of sexual violence often being a common practice of war.

“It’s not about silencing the guns, we must recognize that women and children have a right to life and a right to health and a right to peace. This is where we should put our energies and time to make sure women and girls are protected,” said Bience Gawanas, the United Nations Secretary-General’s Special Adviser on Africa.

The United Nations’ 2030 Agenda for Sustainable Development and the African Union’s Agenda 2063 have created an important political window. The new commitments provide a timely opportunity to enhance collaboration on human security and humanitarian health, in the context of the recently adopted Joint United Nations–African Union Framework for Enhanced Partnership in Peace and Security.

“We must not explain why we are partnering, but why we are not partnering to eliminate sexual and gender-based violence and protect the health and rights of women and children in humanitarian settings. If we care about addressing the root causes of deprivation and poverty and abuse, women and girls are the heart of the matter,” said Sigrid Kaag, Minister of Foreign Trade and Development Cooperation, Netherlands.

Among the commitments made by UNAIDS and the African Union is to work to ensure that there is adequate funding to strengthen coordinated programme implementation for the responses to sexual exploitation and abuse and HIV in humanitarian settings. This enhanced cooperation between the African Union and the United Nations will be paramount to ensuring sustainable people-centred peace, security and development.

For more information on the new partnership between UNAIDS and the African Union, go to unaids.org

ADDITIONAL QUOTES

Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy

It’s not just about the funds, it’s also about policies, laws and justice for girls and children, especially considering that 60% of the African continent is under 20 years old.

Elhadj As Sy, Secretary-General, International Federation of Red Cross and Red Crescent Societies

They need peace, they cry for peace, yearn for hope and try to retain the human dignity that they have lost along the way. It is the last piece of cloth, as we say in Africa, that is torn apart by gender- and sexual-based violence. Protection should not come as an afterthought.

Michaëlle Jean, Secretary-General, Organisation internationale de la Francophonie

Violence, rape, assault against women and young girls and boys is worldwide and can be likened to a weapon of mass destruction. We are here to do more against all forms of discrimination and crimes committed against women.

Pramilla Patten, Special Representative of the United Nations Secretary-General on Sexual Violence in Conflict

Shame, stigma and the risk of reprisals and lack of access to services lead to chronic underreporting. By isolating victims and cutting them off from medical care and support, stigma facilitates the spread of HIV.

Armed conflict creates conditions that allow HIV to flourish, including through rape, sexual slavery, and trafficking and exploitation, in environments where the rule of law and public health services may have collapsed.

Bintou Keita, United Nations Assistant Secretary-General for Peacekeeping Operations

Female peacekeepers are now being deployed to facilitate dialogue as well as women protection advisers for a more comprehensive approach to peacekeeping. Peacekeepers are also the ones who provide civilian peace and security, men and women who are committed to provide the best peace they can.

Lorena Castillo de Varela, First Lady of Panama

Since I started this journey with UNAIDS and the United Nations, two powerful words have guided me: zero discrimination. The challenges faced by women and children—particularly in humanitarian settings—are fuelled by stigma and discrimination, creating obstacles that block access to vital health services, such as HIV testing and life-saving medicines. Zero discrimination should fill every space in the world.

Martine Moise, First Lady of Haiti

Haiti has known its fair share of natural catastrophes, from earthquakes to hurricanes, making women and girls particularly vulnerable. In Haiti, gender-based violence is also all too common. I support fully the fight against violence against women and gender-based violence. This is a fight that must involve all.

Laure-Marie Kitanu, Coordinator of the Network of Women Living with HIV, Democratic Republic of the Congo

We have cried out to the international community for help in regard to HIV testing and prevention and we implore you to maintain the priority of peace and stability so that we have a long-lasting solution. We commend this African Union and UNAIDS initiative.

Written contribution from Ashraf El Nour, Director, International Organization of Migration Office to the United Nations, New York

The International Organization of Migration calls upon African Union governments and partners to ensure the fulfilment of the right to health for migrants, regardless of their status, in order to enhance the resilience of populations living in vulnerable conditions. The failure to do so not only jeopardizes the public health safety of vulnerable groups, but also that of entire communities where they reside.

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 the second year in a row, UNAIDS has been recognized for meeting or exceeding all of the performance indicators of the United Nations System-Wide Action Plan on Gender Equality and the Empowerment of Women (UN-SWAP). UNAIDS was the first United Nations entity to achieve this and remains the only one to date.

In a letter sent by Phumzile Mlambo-Ngcuka, Executive Director of UN Women, to Michel Sidibé, Executive Director of UNAIDS, she congratulates UNAIDS for achieving gender parity at the professional and higher levels, as well as for having mainstreamed gender equality work objectives and learning objectives into its performance management tools.

Since the inception of UN-SWAP in 2012, UNAIDS has demonstrated continued progress and remains committed to continuing to improve its UN-SWAP scoring. In the UNAIDS Secretariat Gender Action Plan 2018–2023, launched in June of this year, the organization set a series of targets that will help to ensure that UNAIDS sustains and advances its commitment to gender equality and the empowerment of women in the workplace.

The targets include:

• Target 1: 50:50 gender parity across all staff levels and categories.
• Target 2: 100% of staff at all levels set a work and learning objective on gender.
• Target 3: 100% of eligible UNAIDS female staff to participate in the UNAIDS Women’s Leadership Programme and 100% of eligible UNAIDS staff to participate in the Mentoring Programme for Women.
• Target 4: 100% compliance with the UN-SWAP 2.0 framework.

UN-SWAP is a United Nations system-wide accountability framework designed to measure, monitor and drive progress towards a common set of standards for the achievement of gender equality and the empowerment of women.