World AIDS Day: Centering Adolescent Girls in the Journey towards HIV Epidemic Control

By: Betty Adera, Senior Technical Advisor HIV/AIDS and Health, Global Communities, Nairobi, Kenya 

The theme of this year’s World AIDS Day is “End Inequalities” and it is especially timely as the world continues grappling with COVID-19. Adolescent girls bear the greatest brunt of COVID-19-related inequalities. UNAIDS estimates that in sub-Saharan Africa, four in five new HIV infections are among 10 to 19-year-old girls. If adolescent girls are fully empowered and have the capacity to surmount the many challenges they face – in a supportive, enabling environment – then they have the potential to realize an AIDS-free future for themselves, and to influence their peers, families and communities to do the same. 

“DREAMS has been a source of information and inspiration and is helping we young ladies get through the pandemic,” a 19-year-old Botswana DREAMS participant said. Because adolescent girls and young women are disproportionately affected by HIV/AIDS in Africa, Global Communities builds the social assets of this population through the DREAMS initiative, which stands for Determined, Resilient, Empowered, AIDS-free, Mentored and Safe. With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID), Global Communities implements DREAMS to reduce the risk for HIV and violence among adolescent girls and young women. 

Inequality comes into sharp focus for adolescent girls who lack access to responsive sexual reproductive health services, COVID-19 vaccines, education, menstrual health information and products, mental health services, justice in the case of sexual and gender-based violence (SGBV) and safe home environments free from harmful cultural practices and stigma. Girls that were prenatally infected with HIV can experience self-stigma, mental health challenges and re-infection as they become sexually active. Experiencing SGBV trauma and poverty can cause significant setbacks in adolescents’ self-esteem and confidence to pursue their dreams.  

Global Communities uses evidence-based strategies in partnership with communities hardest hit by the HIV epidemic to enhance access to health and social services that are age-appropriate for adolescent girls. Every program is tailored to meet the developmental needs of young people so they can reach their full potential and remain HIV- and AIDS-free. Our PEPFAR-funded DREAMS Initiative in Botswana, Zambia, Rwanda and Kenya centers adolescent girls by promoting their education and school attendance.  

Global Communities encourages retention and engagement by:  

• providing access to community-based safe spaces for adolescent girls to receive social asset building resources; 
• working with mainstream health care providers to ensure access to responsive sexual and reproductive health services; 
• providing referrals for HIV testing antiretroviral treatments and pre-exposure prophylaxis; 
• enabling access to adolescent girl-controlled interventions to prevent HIV infection; 
• engaging with girls to guide policies and programming to enhance behaviors, biomedical and structural interventions; 
• ensuring social, mental and physical health needs of adolescent girls are considered; and 
• responding to their needs that are specific to the pandemic. 

As is practice at Global Communities to build on the successes of its own programs and make evidence-based adaptations to our approaches, the community-based safe spaces have been a signature approach through which information and services on protective assets are delivered to adolescent girls. To date, DREAMS programming in Kenya, Rwanda and Botswana has reached a combined 45,311 adolescent girls. These services include health, education, cognitive life skills, and economic and psychosocial support—all aimed at reducing risk and increasing opportunities for girls not just to survive, but to thrive.  

The ongoing COVID-19 pandemic has shone a light on how adolescent girls are disproportionately impacted by HIV and AIDS as a result of stigma and lack of education. We are committed to partnering with families and communities to resolve inequalities faced specifically by adolescent girls and creating an AIDS-free future now and for the next generation of girls.