Core reasons why young women and adolescent girls are vulnerable to HIV

Every hour, around 34 young African women are newly infected with HIV. The reasons for relatively high rates of infection and low scale-up ofservices for young women in Africa are complex and interwoven.

 Changing the course of the epidemic requires addressing the root causes and understanding the core

conditions that exacerbate vulnerability. Seven core conditions stand out:

• inadequate access to good-quality sexual and reproductive health information, commodities and services, in some measure due to age of consent to access services;
• „ low personal agency, meaning women are unable to make choices and take action on matters of their own health and well-being;
• „ harmful gender norms, including child, early and forced marriage, resulting in early pregnancy;
• „ transactional and unprotected age-disparate sex, often as a result of poverty, lack of opportunity or lack of material goods;
• „lack of access to secondary education and comprehensive age-appropriate sexuality education;
• „ intimate partner violence, which impacts on risk and health-seeking behaviour;

„Violence in conflict and post-conflict settings.

Individually or in combination, these factors severely inhibit the ability of young women and adolescent girls to protect themselves from HIV, violence and unintended or unwanted pregnancy. Gender inequality and lack of women’s empowerment or agency are key themes that cut across these drivers.

Women’s agency or empowerment is the ability to make choices and to transform them into desired actions and outcomes. Across all countries and cultures there are differences between men’s and women’s ability to make these choices. Women’s empowerment influences their ability to build their human capital. Greater control over household resources by women leads to more investment in children’s human capital, shaping the opportunities for the next generation . In sub-Saharan African countries, more than half of married adolescent girls and young women do not have the final say regarding their own health care and play a low decision-making role in the household .

Poverty is another overarching factor. Poverty can push girls into age-disparate relationships, a driver of HIV risk for young women and adolescent girls. For example, in South Africa, 34% of sexually active adolescent girls report being in a relationship with a man at least five years their senior. Such relationships expose young woman and girls to unsafe sexual behaviours, low condom use and increased risk of sexually transmitted infections . The risk of trafficking and sexual exploitation is also higher for young women and adolescent girls living in poverty . Poverty also increases the risk of child marriage, and girls in the poorest economic quintile are 2.5 times more likely to be married as children compared with girls in the richest quintile . In 2010, 67 million women aged 20–24 years had been married as girls, of which one-fifth were in Africa .

 In May 2014, after numerous national and regional commitments to address child marriage (including the 2005 Maputo Protocol, Article 6c), the African Union Commission initiated a 2-year campaign, starting in 10 African countries , to accelerate the end of child marriage on the continent by increasing awareness, influencing policy, advocating for the implementation of laws and ensuring accountability. Eliminating child marriage will decrease African girls’ greater risk of experiencing domestic violence, premature pregnancies and related complications, and sexually transmitted diseases, including HIV. There are promising solutions, but the solutions today are not the solutions of yesterday. Fast-tracking the response is about being flexible and taking account of the rapid transition taking place in Africa today, looking at the new risks but also at the new opportunities.