Adolescent girls and young women, HIV and gender equality
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Adolescent girls and young women are disproportionately affected by HIV.
UNAIDS Global AIDS Update 2018 reports that in sub-Saharan Africa, adolescent girls and young women (aged 15–24 years) accounted for one in four HIV infections in 2017 despite being just 10% of the population. Women represented 59% of new infections among adults (aged 15 and older) in the region.
In eastern and southern Africa, young women aged 15 to 24 years accounted for 26% of new HIV infections in 2016, despite making up just 10% of the population. Young women aged 15 to 24 years in western and central Africa and the Caribbean respectively accounted for 22% and 17% of new HIV infections in 2016.
WHO defines adolescents as people between 10 and 19 years of age. The United Nations considers “youth” as those people between 15–24 years and “young people” as people between 10–24 years.
Here, we focus on adolescent girls aged 15 to 19 years and young adult women aged 20 to 24 years, in line with UNAIDS guidance. However, specific programmes should also include actions for adolescent girls aged 10 to 14 years and young adult women aged 25 to 29 years.
Adolescent girls and young women may also belong to one or more key populations or engage in activities associated with these key populations. Punitive laws, discrimination and violence combined with the vulnerability of youth, power imbalances in relationships and possible alienation from families and friends means that young key populations face increased marginalization, hindering their ability to access HIV-related and other health services.
Factors that heighten the risk of HIV amongst AGYW include biological factors, as well as social, economic and cultural factors relating to gender inequality, harmful gender norms, gender-based violence and other human rights barriers experienced by AGYW.
Gender Inequality, harmful gender norms, gender-based violence and HIV
Gender inequality limits access to education, resources and services for AGYW, preventing AGYW from being able to make decisions about, control and access health care services.
A wide range of laws, customs and practices – for instance laws and norms allowing young girls to be married below the age of 18 years, laws that fail to criminalise the rape of a wife by her husband, laws and practices that prohibit women from owning or inheriting property or to having autonomous decision-making power within their relationships, and laws, policies and practices limiting adolescent girls’ independent and confidential access to sexual and reproductive health services - perpetuate gender inequality. These laws, policies and practices limit the ability of women and young girls to control their lives, including their ability to protect themselves from HIV and other sexual and reproductive health risks.
Increased vulnerability to HIV infection has also been linked to intimate partner violence, which is more common among younger women and women who are economically dependent on their male partners. Violence or the fear of violence can make it very difficult for women to insist on safer sex and to use and benefit from HIV and sexual and reproductive health services. Women living with HIV who experienced intimate partner violence were significantly less likely to start or adhere to antiretroviral therapy, and they had worse clinical outcomes than other HIV-positive women.