Tackling HIV in women and girls

Globally, HIV/AIDS is the leading cause of death among women of reproductive age and in some parts of the world, young women are twice as likely to be infected as young men.[1] There are around 380,000 new HIV infections in young women (aged 15-24 years) each year.2

Gender inequality, a lack of education and access to information, gender violence and stigma are amongst those factors cited as why women are more vulnerable to infection.[2]

These can result in in women and girls:

• having less knowledge about how HIV is transmitted and how it can be prevented;
• being unable to access effective prevention and treatment services; and
• having less power to control their exposure to infection.

Sustainable development goals

On World AIDS Day, the World Health Organisation (WHO) reported that there had been progress in tackling the spread of HIV. It highlighted a fall in new infections by 35% and AIDs related deaths by 24% since 2000.[3] The United Nations Millennium Development Goal to halt and reverse the HIV epidemic[4] was reached prior to the 2015 target.[5] However, it emphasised that more work needs to be done to reach the new targets within the Sustainable development goals.

At the UN General Assembly in September 2015, a new set of Sustainable Development Goals and Milestones was agreed. This included a call to end the AIDs epidemic by 2030. The first milestones towards this goal are to reduce the number of new infections by 75% and double the number of people on antiretroviral treatment by 2020.

Alongside the Sustainable development Goals, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has developed a new Strategy, UNAIDS 2016–2021 Strategy which highlights the need to achieve gender equality and eliminate gender violence, alongside advancing the rights of women- including improved access to healthcare and education.

In response to a Parliamentary Question on Government steps to tackle HIV/AIDS in November 2015, the Minister for International Development reported that the UK are firmly committed to the Sustainable Development Goals and already working towards this:

1. The UK remains firmly committed to the Sustainable Development Goals agreed in New York in September, including the target to end the AIDS epidemic by 2030. We are already working towards this goal not only through our substantial support to the Global Fund to fight AIDS, TB and Malaria, but also through our work with UNITAID and the Clinton Health Access Initiative to make testing and treatment more accessible and affordable.
2. We will continue to concentrate on the critical gaps in reducing new infections, particularly among women and girls and key affected populations while continuing to address the barriers that limit access to treatment. These include strengthening health systems and tackling the broader structural drivers of the HIV epidemic such as stigma and discrimination, and gender inequality.[6]

On International Women’s Day 2016 (8 March), UNAIDS called for a reaffirmed commitment to women’s human rights. It said that closing the gender gap was an important part of the Sustainable Development Goals and was crucial to ending the AIDs epidemic by 2030. It reported that although progress has been made in this area, the speed of change is slow and many challenges remained:

1. Every day, more than 40 000 girls are married before their 18th birthday, complications linked to pregnancy and childbirth remain the second leading cause of death among adolescent girls aged 15 to 19 and it is estimated that around 120 million girls worldwide have experienced rape or other forced sexual acts at some point in their lives.
2. The vulnerabilities and risks associated with HIV are closely linked to the gender inequalities woven into the political, economic and social fabric of our societies. AIDS-related illnesses are the leading cause of death globally among women of reproductive age. In 2014, there were around 220 000 new HIV infections worldwide among adolescents aged 10 to 19, with adolescent girls accounting for 62% of new infections among this age group. In sub-Saharan Africa, adolescent girls aged 10 to 19 make up 72% of total new HIV infections among this age group. Gender-based violence and a lack of control over decisions affecting their own lives increase the risk of HIV infection among women and girls.
3. One week before the sixtieth session of the Commission on the Status of Women and three months ahead of the United Nations General Assembly High-Level Meeting on Ending AIDS, the world must recognize the undeniable link between achieving social justice and creating the foundations for an end to the AIDS epidemic. No one must be left behind.
4. The UNAIDS Fast-Track approach to ending the AIDS epidemic has a set of time-bound targets, including reducing the number of people newly infected with HIV from 2 million in 2014 to fewer than 500 000 in 2020, reducing the number of people dying from AIDS-related illnesses from 1.2 million in 2014 to fewer than 500 000 in 2020 and eliminating HIV-related discrimination. These targets will not be reached without much stronger progress on ensuring that women’s human rights are respected so they are free to take informed decisions about their health and well-being.[7]

Government policy to tackle HIV in women and girls

In 2011, the Department for International Development (DFID) published a UK position paper on HIV in the developing world, ‘Towards Zero Infections’[8], with a particular focus on HIV-infected women and girls. DFID pledged to help reduce HIV infections by at least half a million among women in Africa by 2015. The paper outlines the following strategic priorities:

1. To significantly reduce HIV new infections, particularly for women, girls, children and key populations, through the scale up of evidence-based approaches, filling gaps in the evidence base for prevention and paying attention to underlying risk factors.
2. To scale up access to HIV and TB diagnosis, treatment care and support, including early infant diagnosis, within integrated services, focusing on sustainability so that treatment for all is achievable.
3. To significantly reduce stigma and discrimination by working for policy change for most at risk populations and to empower women and girls, including with sexual and reproductive health and rights.

A further aim of the position paper was to support the Global Fund so that 37,000 HIV-positive women could be treated.

A review, Towards Zero Infections - Two Years On (November 2013), reiterated a commitment to universal access to comprehensive prevention programmes, treatment, care and support, and noted that DFID was making progress against its expected results. It also pointed to changes in funding mechanisms, with DFID moving increasingly to work with global and regional mechanisms and partners. The review reported that DFID had achieved its aim of treating 37,000 HIV-positive women but progress at reducing new infections among women was slow. The review also states DFID’s continued commitment to treating and preventing HIV in women and girls:

1. DFID has committed to putting girls and women at the heart of its development assistance. As well as continuing a focus on women and girls in DFID’s bilateral HIV programmes, more work is required to capture, measure and maximise the HIV related benefits of DFID’s wider work with women and girls. Global progress on reducing new infections in women and girls remains a priority for DFID.

On 23 November 2015, the current Government published a new aid strategy for the UK, UK aid: tackling global challenges in the national interest. Underpinning the strategy is the principle that the UK’s development spending “will meet our moral obligation to the world’s poorest and also support our national interest”. While there is no explicit mention of AIDS/HIV in the strategy, tackling disease features prominently. For example the strategy highlights a new £1 billion commitment to global public health (the “Ross Fund”) which will fund work to tackle the most dangerous infectious diseases, as well as diseases of epidemic potential, neglected tropical diseases, and drug resistant infections.

A March 2016 Parliamentary question enquired about DFID spending on HIV and AIDs over the comprehensive spending review period. The Secretary of State for International development reported that the results of the bilateral aid review will be set out over the coming weeks but support for organisations such as the Global Fund will continue:

1. The hon. Gentleman will be aware that we plan to set out the results of our bilateral aid review over the coming weeks, but I can assure him that our support for multilateral mechanisms, such as the Global Fund, that do so much great work on tackling aid, will continue, and he will obviously be aware that HIV and AIDS particularly affect adolescent girls in a growing proportion, so it is important that we stay the course on this.[9]

[1] ‘Women’s health’, World Health Organisation, 2013

[2] UNAIDS, The Gap report, 2014

[3] WHO, World AIDS Day - 1 December 2015

[4] WHO, MDG 6: combat HIV/AIDS, malaria and other diseases, December 2014

[5] UNAIDS, UNAIDS announces that the goal of 15 million people on life-saving HIV treatment by 2015 has been met nine months ahead of schedule

[6] HC Written Question 14103: Developing Countries: HIV Infection, 5 November 2015

[7] UNAIDS, Respecting women’s human rights is key to creating a safer, fairer and healthier world, 8 March 2016

[8] ‘Towards Zero Infections’, DFID, 2011

[9] HC Deb 16 March 2016, c934