Today, there are nearly 37 million people in the world who are HIV-positive and an estimated 35 million who have already succumbed to the pandemic. While World AIDS Day is an opportunity for us to reflect on how far we have come in turning a death sentence into a treatable chronic illness, it also forces us to examine the promises still left unfulfilled, especially those we made to adolescents and young women.
In 1994, with the global HIV crisis escalating, the reproductive health community issued a call for greater access to HIV prevention, care and treatment services and integration with family planning programs. Even at a time when HIV treatment options were limited, the 1994 International Conference on Population and Development (ICPD) in Cairo highlighted the particular vulnerability of adolescents and young women to both HIV and unintended pregnancy, identified the need for specific interventions for them, and called for them to be more involved in the design of such programs. There was recognition that the two issues—HIV and reproductive health—were inextricably intertwined and required joint interventions, particularly for adolescent girls and young women.
Dual Threats to the Lives of Young Women
However, both the family planning and HIV movements have failed to fulfill their promises to the young women of the world; This failure lies with actors from all sectors, including governments. As of 2017, there were 214 million women of reproductive age in developing regions who wanted to avoid pregnancy but were not using a modern contraceptive method, including 20 million adolescents. Addressing the unmet need for modern contraception among adolescents would avert six million unintended pregnancies a year and prevent the premature deaths of 6,000 adolescents annually.
At the same time, in some regions of the world, adolescent girls acquire nearly 80% of new HIV infections among their age-group, with an estimated 460 adolescent girls infected with HIV every day around the world. Globally, more than one-third of all HIV-positive women are not receiving treatment for the disease, which is why AIDS-related illnesses are still the leading cause of death among women of reproductive age globally. These statistics are alarming and underscore the fact that the dual deadly threats facing young women—HIV and unintended pregnancy—have not fully abated in the last 25 years.
New Voices and New Approaches
The theme for World AIDS Day 2019 is "Communities Make the Difference," a sentiment that echoes the ICPD statement about the need to engage adolescents in the design and implementation of programs that support them. To make this vision a reality, the global community must get serious about addressing the unique health needs of adolescent girls and young women, use all tools available, and fully involve those communities in developing solutions.
Innovations in biomedical and behavioral science must be coupled with a person-centered approach and respect for the rights of adolescents to make their own choices. Funding and oversight for HIV, sexually transmitted infections and family planning programs must be integrated, as must training for health care providers and others who engage with young people. Social media must be used to help address the massive gaps in sexual and reproductive health knowledge among youth, but such campaigns must also be led by them.
The United States remains a leader in the fight against HIV but has struggled to achieve epidemic control, in part due to a commitment to regressive, ineffectual policies such as the promotion of abstinence-only sex education. While the sustained, bipartisan support from Congress for global HIV efforts is commendable, the public health potential of U.S. taxpayer resources is being squandered on programs that disproportionately harm adolescents. These damaging activities must be replaced by evidence-based, youth-driven, holistic interventions that address the realities facing today’s young people.
The risks facing adolescent girls and young women are myriad and can only be managed by a world ready to acknowledge its past shortcomings and collaborate with a new generation of leaders. The challenges and opportunities of adolescence are exceptional, but each person deserves to live that time free from the specter of disease and unwanted pregnancy, and to prepare to thrive in the world.