While the Global Fund has had considerable success in providing services to women and children and in reducing infections in those groups, the rate of infection among adolescent girls and young women remains shockingly high. The Global Fund is committed to turning this around. This was one of the central messages in the Report of the Executive Director which Mark Dybul presented to the Board at its meeting on 16-17 November.
The Global Fund invests 55-60% of its resources in programs that reach women and children, Dybul said. Between 2005 and 2014, there was a 58% decline in AIDS-related deaths among women 15 years and older in 13 high-burden African countries, thanks to the rapid expansion of access to antiretroviral therapy. A study in 11 high-burden African countries showed that the rate of new HIV infections is going downwards equally for both men and women – at 22% and 23% respectively.
Yet, HIV is still the leading cause of death for women of reproductive age worldwide, Dybul said. In the hardest-hit countries, girls account for more than 80% of all new HIV infections among adolescents; 7,000 adolescent girls and young women aged 15-24 are infected with HIV every week. “The fuel to this epidemic fire is gender inequality, gender-based violence and basic discrimination,” Dybul said. “We should admit that, collectively, we have failed adolescent girls and young women.”
Dybul said that the Global Fund has committed with its partners to support countries to reduce HIV by 40% percent among adolescent girls and young women in areas where rates are high. “Investing in programs that increase access to critical HIV prevention and treatment services is not enough; we also support programs that seek to change environmental and social factors that put women and girls at increased risk,” he said.
Dybul outlined several initiatives the Fund and its partners are supporting. The Global Fund has just published an article entitled Focus on Women and Girls which covers some of the same ground. Below, we describe some of the initiatives.
Linking education and health. “Keeping girls is schools is tremendously effective in preventing HIV and promoting gender equality,” Dybul said. In South Africa, Kenya, Swaziland and Zambia, the Global Fund is supporting efforts to link education and health, from high-level political level engagement to country dialogues with many sectors and partners at the table.
In South Africa, the Global Fund is investing in programs that provide a comprehensive package of health, education and support services for young women and girls, both in and out of schools, in priority districts. Through a $63 million grant that will start shortly, the Fund will support innovative approaches that include combination prevention interventions for vulnerable young women who attend vocational education colleges, as well as programs with a family-centered approach, and programs for caregivers, and for young boys.
In Swaziland, the Fund is investing in initiatives aimed at keeping girls in school and providing them with information that allows them to make well-informed decisions that can reduce unintended pregnancies and diseases like HIV. With the World Bank, the Fund is supporting conditional cash transfers for girls, which allow young women to delay sexual activity or to use protection.
Addressing gender-based violence. In South Africa, where 20-25% of HIV infection among girls and women is attributed to violence, the Global Fund is the largest external funder of gender-based violence programs as a part of the national HIV response. In 2013 and 2014, these programs supported tens of thousands of women with psycho-social and legal services. These efforts will be further expanded in a new grant.
In Papua New Guinea, where girls and women suffer extremely high rates of violence, clinical and psychosocial services for survivors of sexual violence are being integrated into HIV programming.
In the Democratic Republic of Congo and Nigeria, new TB/HIV grants engage with women-led community organizations to address gender-based violence. An HIV program in Botswana provides legal aid services and support to women and girls who are survivors of gender-based violence.
Community engagement and preventing child brides. As part of the community response to HIV in Mozambique, under the leadership of Graça Machel, the civil society organization Fundação para o Desenvolvimento da Comunidade supports vulnerable groups, including young adolescent girls 10-14. They get information about HIV prevention and are trained in negotiation. Early marriage is common in Mozambique, with a high percentage of girls married before their 20th birthday. The Global Fund believes that it is important to provide information and start empowering girls at an early age, not only to reduce vulnerability to HIV infection, but also to give them better opportunities in life.
Gender advocates. Since 2013, the Global Fund has worked with UNAIDS to develop a gender assessment tool for HIV and to support more than 41 countries undertaking gender assessment to inform the development of the national strategic plans and concept notes. In 2014, the Global Fund supported the Stop TB Partnership in the development and piloting of a complementary TB component in the UNAIDS gender assessment tool to make it possible to do joint TB/HIV gender assessments.
With the support of Germany’s BACKUP Initiative, women’s organizations and gender advocates in South Africa, Malawi and Uganda are more actively engaging in country dialogues and concept note development. In Uganda, they were able to successfully advocate for a gender technical working group which provided technical advice throughout concept note development. In South Africa, women’s sector representatives helped integrate gender into the concept note, which now has more than $50 million for HIV prevention programs targeting adolescent girls and young women.
The Global Fund believes that these and other similar initiatives indicate that there is a mounting body of evidence on what needs to be done.
The Report of the Executive Director, Board Document GF-B34-02, should be available shortly at www.theglobalfund.org/en/board/meetings/34. The article on Focus on Women and Girls can be downloaded here.