Sunday, September 4, 2016


Three central changes are taking place on the continent that have particular relevance for fast-tracking the end of AIDS among young women and girls.

Africa has a fast-growing economy
.Sub-Saharan Africa is among the world’s fastest-growing economic zones. In 2015 the gross domestic product (GDP) is expected to increase by 4.5%, and by 2020 the continent’s share of global GDP is predicted to rise to 4% compared with 1.4% in 2015 (22, 23). This economic growth can be a key engine for reducing poverty, particularly if fertility declines and yields a demographic dividend. This can be supported by generation of decent paid work and gender-responsive social protection and social services. The creation of decent work to ensure that women and their families have a route out of poverty is particularly important, as women are overrepresented in the informal labour market, including unpaid care work and low-paid employment.
The consequences of preventing women from participating in and contributing to the formal economy are far-reaching and adverse, and yet 61% of sub-Saharan African economies and 93% of economies in the Middle East and North Africa have restrictions on the jobs women can do (24).
Yet, when women participate in the economy, poverty decreases and GDP grows. An increase of only 1% in girls’ secondary education attendance adds 0.3% to a country’s GDP (25), a clear illustration of an early and smart investment that pays off. The health benefits of women’s and girls’ participation in a nation’s economy are huge, not only in terms of their own economic empowerment and health choices but also in terms of improving the health of their children and communities

Africa’s population is young and growing rapidly
Africa’s population is diverse and has an increasingly youthful population. Sourcing the power and potential of the region’s young people will provide enormous opportunity for growth.
Over 30% of the African population is aged 10–24 years. In 15 sub-Saharan African countries, half the population is under the age of 18 years (10). In some countries, fertility is barely declining while the number of women of childbearing age is rising significantly .
Africa made good progress in expanding facility-based deliveries from 40% coverage in 1990 to 53% in 2014, but the number of pregnant women needing antenatal care and delivery facilities doubled between 1990 and 2014, from 9 million to 18 million.Prevention of mother-to-child transmission services will need to increase significantly as the population of women of reproductive age is projected to increase by 65% by 2030, with the potential to outstrip services for young women and adolescent girls to prevent transmission of HIV to their children. If current population growth trends continue, then by 2030 almost one in four adolescent girls will live in sub-Saharan Africa, where the total number of adolescent mothers aged under 18 years is projected to rise from 10.1 million in 2010 to 16.4 million in 2030 (9). Africa’s young population presents challenges in terms of access to sexual and reproductive health and HIV information commodities and services; yet, this burgeoning youth population is also the region’s greatest asset. Reaching and engaging young women and adolescent girls, and empowering them to make their own health choices in safe and equitable environments, has the power to change the trajectory of the HIV epidemic

. Africa is urbanizing fast
Most African countries are undergoing rapid urbanization, calling for innovative solutions that adapt to these changes. Africa is projected to be 56% more urban by 2050. In terms of service outreach, 52% of people living with HIV in sub-Saharan Africa will be living in urban areas by 2020 – and 62% of urban people living with HIV will be living in slums (26). Increasing urbanization should improve proximity and access to services, but this is not always the case. Informal settlements or slums often do not have public services or have poor-quality private services. This context, combined with other aspects of urban poverty, such as exposure to violence, increases the HIV risk for young women and adolescent girls. The intersection of violence, insecurity and transactional sex means young women living in slums are 23% more likely than other urban young women to be living with HIV. They are also 3.4 times more likely than young men of the same age to be living with HIV. Urban poverty and location appear to have a bigger impact on the vulnerability to HIV of young women compared with men and older women (26). This rapidly changing environment calls for an AIDS response that accommodates change, including the integration of services for sexualand reproductive health and rights, gender-based violence and HIV, to address vulnerabilities and the specific needs of girls and young women in increasingly urbanized and crowded settings. In line with this, in 2014, UNAIDS launched the Fast-Track Cities initiative with world mayors to commit to fast-tracking the response in urban areas, demonstrating high level political commitment to address the HIV specific needs, that are arising out of a rapidly changing environment.

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