POLICY BRIEF STRENGTHENING PEPFAR FOR WOMEN AND GIRLS Globally, the HIV/AIDS infection is spreading most rapidly among young people between the ages of 15 and 24. Half of new infections worldwide, affecting 5,000 to 6,000 youth each day, occur in this age group.1 Women and girls now comprise 48 percent, or 17.7 million, of the nearly 40 million people living with HIV/AIDS. Especially vulnerable are young women and girls, who make up 75 percent of all new cases in sub-Saharan Africa, and a growing proportion of those infected in Asia, Eastern Europe and Latin America.2 Three-quarters of all women and girls with HIV and AIDS live in sub-Saharan Africa,3 many of them in the countries where the President’s Emergency Plan for AIDS Relief (PEPFAR)4 is working. In that region, young women and girls are at least three times more likely to be infected than their male cohorts.3
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PEPFAR is now in year four of a $15 billion, five-year initiative to combat HIV/AIDS through prevention, care and treatment in 15 focus countries.5 PEPFAR has made strides in addressing the vulnerabilities of young women and girls: sex-disaggregated data is being collected to ensure that PEPFAR programs equitably incorporate women and girls; the gender content of PEPFAR’s current programs is being assessed; and a Gender Working Group is advising on future strategies. PEPFAR’s second report to Congress identifies hundreds of program activities whose aim is to address “the special vulnerability of women to HIV/AIDS.”5 While the Global AIDS Coordinator has signaled his strong endorsement of these efforts, an evaluation released in 2006 by the General Accounting Office6 indicates that PEPFAR restrictions and policies hamper maximum effectiveness in reversing the pandemic’s toll on young women and girls. PEPFAR must place reducing the vulnerability of young women and girls at the top of its agenda. As plans for reauthorization of the Act4 are developed, the opportunity to scale up and fully fund empirically-based strategies that are responsive to the needs of young women and girls should not be lost.
Why and How is HIV/AIDS Disproportionately Affecting Girls and Women? A Greater Biological Susceptibility Physiologically, women and girls are at a disadvantage: male-to-female transmission of the virus is twice as likely as female-to-male.7 Tears and lesions, resulting from forced sexual encounters, increase the likelihood of HIV transmission, especially among younger women and girls.8
Gender-Based Violence Forced and coerced sexual encounters are all too commonplace.9 The first sexual experience for 20-25 percent of young women in villages of Zambia, Kenya and South Africa was found to involve physical force or coercion.10 The inability to avoid sex without protection, even in ongoing partnerships, is increasingly recognized as a primary factor in the rise in HIV infections among young women and girls. Violence and
threats of violence further prevent women from seeking information, counseling and testing, treatment and care. Throughout the world, lack of legal recourse and financial dependence leave women who are in abusive relationships with little power.
Poverty and Lack of Economic Rights Gender-based social and economic inequities underlie the young, poor and female face of HIV and AIDS. Poor girls are often unable to access education and, consequently, the opportunity to learn skills for productive employment. While educated girls are more likely to delay sexual debut and marriage, and are better informed about HIV prevention, girls comprise two-thirds of the 113 million school-aged children worldwide who are not in school.11