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Using information to reduce HIV incidence among adolescent girls in Mozambique

Palladium is gathering evidence on this demographic hit by the epidemic and how to best reach girls with information and services.

Photo credit: David Stanley

AIDS is the leading cause of death for adolescent girls in Eastern and Southern Africa where as many as 5,000 new infections occur every week. Girls and young women are disproportionately affected by HIV compared to their male counterparts, accounting for 74 percent of new infections among adolescents in sub-Saharan Africa.

Although we are seeing declines in HIV prevalence in many countries, the inequities of the epidemic are as deep-rooted as ever, and continue to exacerbate gender inequalities and threaten our future generations. The U.S. Global AIDS Coordinator and Representative for Global Health Diplomacy, Ambassador Deborah L. Birx, M.D., is quoted as saying: “The very progress we’ve made in HIV/AIDS over the last 20 years is at risk because of our lack of engagement with adolescent girls and young women.”

In terms of global commitments to support our girls, we are witnessing a new era. “DREAMS,” a partnership between the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, Gilead Sciences, and ViiV Healthcare, is committed to achieving a 40 percent reduction in new HIV/AIDS infections among adolescent girls and young women in 10 countries by the end of 2017. Mozambique is one of these countries.

In Mozambique, HIV prevalence among adolescent girls and young women aged 15-24 years is estimated to be nearly 10 percent – three times higher than the rate among males in the same age group. One third of women report experiencing gender-based violence – nearly 20% of adolescent girls report that their first sexual experience is forced. Further, Mozambique has one of the highest rates of child marriage in the world. Fourteen percent of girls are married by age 15, and 48 percent are married by age 18. Notwithstanding other human rights implications, early marriage exacerbates HIV and brings challenges to prevention efforts by introducing gatekeepers - people who impact girls’ health decisions - and reducing girls’ choices.

The commitment to doing better – in Mozambique and beyond – requires information. Information on which demographic groups of girls are hardest hit by the epidemic, how to best reach girls with information and services, and importantly, information on how our efforts at mitigating the impact of the epidemic are stacking up against our targets. Palladium is working in Mozambique to capture this information, in support of the global agenda.

We are working on two studies that specifically focus on reducing the HIV burden among adolescent girls. In one, we are working with girls to unpack their sexual relationships – how they choose partners, the power differentials and girls’ risk of acquiring HIV in different types of partnerships. Recognizing that not all adolescent girls are the same, we’ve segmented the population by in-school/out-of-school status, pregnancy status, and age-group. This information is critical to tailoring prevention messages for adolescent girls, and in defining the types of men that pose a transmission risk to girls, and reaching those men with prevention and care services.

In another study, we are asking adolescent girls and boys about the importance of staying in school, their views of marriage, and the opportunities available to them to become full productive citizens. We are finding out what they know and think about HIV and soliciting their input on how we can better reach young people with HIV prevention services. As part of this study, we recently completed a survey of approximately 2000 youth aged 12-17 years across the country to draw out their attitudes and beliefs on education, livelihoods and HIV and family planning, as well as their most trusted sources of information on sensitive issues. We will compile and integrate this information into adolescent-focused HIV prevention programming as well as use it to draw the attention of government and donor communities to a prevention agenda for youth.

The road to change is complicated. We need information to make sure we are headed in the right direction, with as few detours as possible. Palladium is committed to being part of the solution, raising the bar for results and the visibility of adolescent girls in HIV programming.