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Addressing the vulnerability of young women and girls to stop the HIV epidemic in southern Africa

Southern Africa is the global epicentre of the AIDS epidemic, with recent data highlighting the continuing urgency of ensuring sustained and effective prevention and protection efforts particularly addressing the vulnerability of young women and girls. Southern Africa comprises nine countries with the highest HIV prevalence in the world. Over 12% of all adults aged 15–49 years are infected with HIV in each of these countries. The broader sub-Saharan Africa region is experiencing a generalized epidemic, with HIV transmitted largely through heterosexual intercourse and with high levels of new infections being found among young people, notably young women. Globally, 45% of all new infections in 2007 occurred among young people aged 15–24 years. Almost two-thirds of all young people with HIV live in sub-Saharan Africa, where approximately 75% of all infections among young people aged 15–24 years are among young women. HIV prevention efforts to reach young people, and in particular young women and girls, in southern Africa have focused on some general programmatic areas: awareness raising; HIV education and information dissemination; reduction of socioeconomic vulnerability; service provision; and life skills development. Persistent high levels of HIV infection reflect the fact that HIV prevention responses are not adequately tailored to address the principal drivers or causes of new infections with the scale, targeting and intensity required for success. National responses are also hampered by variable and sometimes inconsistent leadership, lack of state accountability for prevention, weak institutional capacities for implementation, stigma, denial, and sensitivity to addressing the social and cultural determinants of new infections.

Responding to the evident need to understand these challenges and rise to them, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Reproductive Health and HIV Research Unit of the University of Witwatersrand in South Africa convened a technical meeting in June 2008 that brought together regional researchers, representatives of national AIDS councils, government departments and the Southern African Development Community, and members of the eastern and southern Africa United Nations Regional AIDS Team to reassess why young women and girls living in the HIV hyperendemic countries of southern Africa are so vulnerable to HIV infection. The background technical papers commissioned for the meeting were reviewed by global and regional peers in their respective subject areas. They have been collected here to form a cohesive summary of the evidence, the research gaps, and the actions required to turn the epidemic around for girls and young women in southern Africa. The papers address the current status of the epidemic in southern Africa: age-disparate and intergenerational sex; biological vulnerability; economic empowerment; education; gender-based violence; and knowledge, risk perceptions and behaviour.

There is no time to lose if HIV prevention is to make significant strides against the relentless HIV epidemic of southern Africa, which is mortgaging the future of hundreds of thousands of young women and girls. The articles included in this supplement are being transformed into hard-hitting issues briefs that will be used to influence policy makers and leaders across the region and at all levels through appropriate advocacy and communication. Nothing less than social transformation is needed now to turn this epidemic around. Every individual must see himself or herself as implicated in his or her personal and professional lives in either condoning the status quo or confronting it.

AIDS (Dec. 2008) Volume 22, Suppl 4
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  • Introduction: Addressing the vulnerability of young women and girls to stop the HIV epidemic in southern Africa
  • The epidemiology of HIV infection among young people aged 15_24 years in southern Africa
  • Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability
  • Vulnerability of women in southern Africa to infection with HIV: biological determinants and priority health sector interventions
  • Education and vulnerability: the role of schools in protecting young women and girls from HIV in southern Africa
  • Exploring the role of economic empowerment in HIV prevention
  • Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa
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