Empowering girls, ending HIV — a call to action on International Day of the Girl Child

On this International Day of the Girl Child, we are reminded of the urgent need to ensure the rights, health and future of adolescent girls, especially in the context of HIV.

In South Africa, HIV continues to disproportionately affect young girls and women, leaving them vulnerable due to the complex interplay of social, economic and gender-based factors.

UNAIDS data shows that every week an estimated 4,200 adolescent girls and young women aged 15 to 24 are newly infected with HIV globally, with three-quarters of these infections occurring in sub-Saharan Africa.

In South Africa alone, young women aged 15 to 24 account for a staggering 37% of new HIV infections despite making up just 10% of the population. This disproportionate impact highlights the vulnerability of girls and young women in the context of the HIV epidemic.

The reasons for this vulnerability are deeply rooted in gender and economic inequality. Girls face a higher risk of HIV infection due to intersecting factors such as poverty, gender-based violence (GBV) and limited access to education and healthcare. Addressing these drivers is essential if we are to turn the tide on new HIV infections and create a future where all girls can live healthy, empowered lives.

South Africa’s National Strategic Plan (NSP) for HIV, TB and STIs (2023-2028) is a critical framework that places gender equality at the forefront of the country’s response to the HIV epidemic.

The NSP recognises the unique challenges faced by adolescent girls and young women and includes dedicated strategies to reduce their vulnerability to HIV. The NSP also addresses the need to reduce stigma and discrimination, which remain significant barriers for many young women seeking HIV services.

However, at the core of the response to the HIV epidemic is the need to keep girls in school. Education is one of the most powerful tools we have in HIV prevention. Girls who stay in school are less likely to acquire HIV because they are more empowered to make informed decisions about their sexual and reproductive health.

In South Africa, where teenage pregnancy and school dropout rates among girls remain high, the link between education and HIV prevention cannot be overstated.

Girls who leave school are more vulnerable to early pregnancy, forced marriages and transactional relationships, all of which increase their risk of HIV infection. Ensuring that girls have access to quality education, particularly comprehensive sexuality education, is a vital part of reducing new infections.

The link between GBV and HIV is clear.

South Africa has one of the highest GBV rates globally, with many girls experiencing intimate partner violence and sexual assault. These traumatic experiences significantly increase their vulnerability to HIV infection.

Additionally, poverty plays a crucial role, as economic hardship can push girls into relationships with older men or transactional sex for survival, further increasing their HIV risk.

To break this cycle, we must invest in programmes that economically empower girls and young women. Providing girls with access to education, skills training and economic opportunities gives them the tools they need to build independent futures, reducing their vulnerability to HIV.

Despite being one of the groups most affected by HIV, adolescent girls and young women often face significant barriers to accessing HIV prevention, testing and treatment services. Fear of stigma, judgement and a lack of youth-friendly health services prevent many from seeking the care they need.

Many girls fear being labelled promiscuous or judged by healthcare providers, and as a result they avoid HIV testing or treatment. We must work to ensure that all health facilities are safe, welcoming and free of stigma, so that girls can access the life-saving services they need.

The Joint United Nations Programme on HIV/Aids (UNAIDS), along with our partners, is working to scale up access to a choice of HIV prevention tools such as pre-exposure prophylaxis (PrEP), a highly effective medication that can prevent HIV infection.

However, for PrEP – including oral PrEP, the PrEP ring and long-acting injectable PrEP – to be truly effective, we must ensure it is easily accessible to young women and that they have the information and support needed to use it consistently.  

We continue to advocate for the affordability of new technologies and injectables such as lenacapavir and Cab-LA, described as “game-changers” as prevention tools. 

Read more: Aids 2024 — exciting developments with the jabs promising to revolutionise HIV prevention

While our efforts to empower girls are essential, we cannot overlook the role that boys and men play in shaping gender dynamics and preventing HIV. Engaging men and boys in conversations about gender equality, consent and respect is critical to reducing both GBV and the spread of HIV.

Takuwani Riime, a government-led initiative, focuses on engaging men and boys in the fight against GBV and the spread of HIV, aiming to dismantle harmful gender norms which drive risky behaviours and perpetuate stigma.

By fostering positive masculinities and encouraging men to become protectors rather than perpetrators, Takuwani Riime and other similar men campaigns are integral to creating safer environments for girls and women.

The International Day of the Girl Child is a moment to reflect on our progress but also to recommit to the work that lies ahead. The fight to end Aids cannot be won without a gender-transformative response – one that puts the rights, health and empowerment of girls at the centre of all efforts.

Let us reaffirm our commitment to building a world where every girl is empowered to live a life free from HIV, GBV and inequality. The health, future and potential of millions of girls are at stake. Together, we can create a South Africa – and a world – where girls thrive. DM

Eva Kiwango is the UNAIDS Country Director for South Africa.